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9-26-11
. • .:enqMUlitMf/IAVy( Commonwealth of IS!Mas5achusetis Form 4--System Pumping Record�• � Massachusetts system'Pumping Record System Owner System Location st t'.,§L'C;'m'!:7C%(k N�:S:r1,'.ri I'.C:ti' �..1,u12 iCE?k;it4'336351 !.'..rr S7l".}.L✓ f�:1 d,IJ 5a.1.em , 1.171, ')l:i?q te,'pLl ..•r�sF,-1:%'a.i? � (r,,7yt..?�::- ';!"if9 s: Typo: Emerg?n _ Routine � cesspool: Nv Yes Date of Pumping: 19 r --(r Quantity Pumped: S�7 Gallons System pumped 6y+ Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at. S:E.S.A Date: Pumper Signature: O NSG ' Condition of System/Other Comments �7�C7c2LC y ® ttir,rea on recyc�eapaper Dep Approved Form-12/07/95 "" .