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Commonwealth of Massachusetts Farm 4--System Pumping Record 8-160 '
Massachusetts
System Pumping Record
System Owner System Location
Lewandowski Pau, Primary Avenue
1,5 arman Drive 15 'Wymar Avenue
Salem, MA, 31970 Salem, MLA., 01970
(973)-795-7656 x (978)-745-7656 x
Lewandowski Paul
Type: Emergen Routine
cesspool: No Yes Septic Tank: No Yes
Ezi
Date of Pumping: I r 1 (� quantity Pumped:��Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred fa
Contents Disposed at:
—
Date: Pumper Signature:
Condition of System/Other comments
Dep Approved Form-12/07/95
Commonwealth of Massachusetts Form a--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Lewandowski Paul Primary Avenue
It) Wyman Drive 16 Wyman Avenue
Salem, MA, 019'10 Salem, MA, 01970
(918)-745—'lbbb x (9"78)--795-7obo x
Lewandowski Paul
Type: Emergent Routine )
Cesspool: No Yes Septic Tank: No Yesl z
Date of Pumping: Quantity Pumped: �(i bo Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at: h
�SW c
Date: Pumper Signature:
Condition of System/Other Comments
S
t
RE IVSD
DEC 10 2001
CITY OF SALEM
1,39ABU OF HEALTH
Dep Approved Form- 12/07/95
l
FORM 4 - SYSTEM PUMPING RECORD
Qu
JUL 2 3 2002
Commonwealth of Massachusetts
Salem, Massachusetts CITY OF SALEM
BOARD OF HEALTH
System Pumping Record
System Owner: System Location:
Paul Lewandowski back yard
16 Wyman Drive
Salem, MA
Date of Pumping: June 8, 2002 Quantity Pumped: 500 gallons
Cesspool: No / /Yes /X/ Septic Tank: No /X/ Yes / /
System Pumped by: Service Pumping & Drain Co. , Inc. License # 5-01
Contents transferred to: SESD
Date: June 8, 2002 Pumper: M.W.
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by the Board of Health for regulatory purposes .
7
FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of MassachusettsRD
Salem, Massachusetts
DEC 5 2'�u0
CITY OF SALEM
HEALTH DEPT.
System Pumping Record
System Owner: System Location:
Paul Lewandowski rear yard
16 Wymon Ave.
Salem
Date of Pumping: November 1, 2000 Quantity Pumped: 500 gallons III,
Cesspool: No "Yes /X/ Septic Tank: No /X/ Yes / /
System Pumped by: Service Pumping & Drain Co. , Inc. License # 6-00
Contents transferred to: Salem Treatment Plant
Date: November 1, 2000 Pumper: M.F.
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by- the 'Board of--Health for regulatory Puler 6`s6s.
r
,
FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
Salem, Massachusetts
,M 0
CO
System Pumping Record � h
System Owner: System Location: '
Y
Paul Lewandowski back yard
16 Wyman Drive
Salem
Date of Pumping: September 19, 1998 Quantity Pumped: 1000 gallons
Cesspool: No F-1 Yes /X/ Septic Tank: No /X/ Yes
System Pumped by: Service Pumping 6 Drain Co., Inc. License #
Contents transferred to: Salem Treatment Plant
Date: September 19, 1998 Pumper: P.K.
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by the Board of Health for regulatory purposes.
FORM 4 - SYSTEM PUMPING RECORD
JUN 10 1996
CIT'OF SALS.M
HEALTH DEFT.
Commonwealth of Massachusetts
Salem, Massachusetts
System Pumping Record
System Owner System Location
Paul & Diane Lewandowski Rear
16 Wyman Drive
Salem
Date of Pumping: 05/11/96 Quantity Pumped: 1000 gallons
Cesspool: No F-1 Yes /X/ Septic Tank: No /X/ Yes / I
System Pumped by: Service Pumping & Drain Co. , Inc. License #
Contents transferred to: Salem Treatment Plant
Date: 05/11/96 Pumper: P.K.
Confidential Business Information
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IMPORTANT MESSAGE
FOR
DATE TIME O P.M.
OFWvm-ANriv
PHONE
AREA CODE NUMBER EXTENSION
U FAX 11
❑ MOB IL
AREA gqOE NUMBER TIME TO CALL
TELEPHONED PLEASE GALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE e i5 nc.. n
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SIGNED WND4, CLI nQ ' j 10
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