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Commonwealth of Massachusetts
Massachusetts
,�vstem Pumping Record
PU UNG RECORD
NOV 1 9 1997
CITY OF bALEM
HEALTH DEPT.
i
Date of Pumping: /o
Quantity Pumped: -7, gallons
Cesspool: No ❑ Yes
❑ Septic Tank: No ❑ Yes
;*stens Pumped by: ___/C�✓/'� ro/ SfiC�
Contents transferred to: ��� License
Date
Inspector �:.a