5-21-10 nvnvannn
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Kernwood Country Club Kernwood Country Club
1 Kernwood St 1 Kernwood St
Salem, MA, 01970 Salem, MA, 01970
(978)-745-1210 x (978)-745-7289 x
John Eggleston
Type: Emergen Routine
Cesspool: No Yes -50"Tank: No YesE n
Date of Pumping: ,j Z� 6 L') Quantity Pumped: 25?lU Gallons
System Pumped By: Wind River Environmental,LLC Permit#: a
Contents Transferred to: _
Earth Source Inc.
1950 Broadway
Raynham, MA 02767 =3
Contents Disposed at:
Date: Pumper Signatur
Condition of System/Other Comments
® Noted onrecyclM a er Dep Approved Form- 12/07/95