System pumping record 3-8-12 0207029081 05101rnno
Commonwealth of Massachusetts Form 4--System Pumping Record LUG%
Massachusetts
System Pumping Record
iystem Owner System Location
Keznwood Country Club Kernwood Country Club
1 Kernwood St 1 lteznwood St
Salem, MA, 01970 Salem, MA, 01970
(978)-745-1210 x (978)-745.1289 x
( ba P7$5q,;a cell
Type: Emergent Routine ✓ Gceq,56
:CSspool: No Yes p*ieTank: No Yes
We of Pumping: )�_ Quantity Pumped:jab Gallons
System Pumped By: Wind River Environmental,LLC _Permit#:
:ontents Transferred to:
0
i
Contents Disposed at:
S.E.&D.
Date: Pumper Signature:
Condition of System/other Comments
...
P0/70 -igVd bab Aoeroved form-12/07/95
d3AI89NIP7 6980tSZB/6 TONT Ztw/IT/bel