2013 SEPTIC HAULER-SERVICE PUMPING & DRAIN Commonwealth"of Massachusetts
City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Septic Haulers Permit
DATE PRINTED: 12/l7/2012
ESTABLISHMENT NAME: Service Pumping& Drain Co. Inc.
File Number:BHF4999-000003 5 Hallberg Park
N Reading MA 01864
LOCATED AT:
- SALEM, MA' 01970,
Permit Type_ Permit No. Permit Issued Permit Expires Fee Restrictions/-Notes
SEPTIC HAULER BHP-2012-0611 Jan -201-3} Dee 31;2013 $105.00 VEHICLE TYPE: 2004 Mack Reg#
N80742
Total Fees: $105.00
.PERMIT EXPIRES December 31,'2013
Board of Health
Page 1'
s
Commonwealth of MAssachusetts
t City of Salem
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,-MA 01970
SepticHaulers Permit
DATE PRINTED: 12/17/2012
ESTABLISHMENT NAME: Service Pumping&Drain Co. Inc.
File Number:BHF-1999-000003 5 Hallberg Park
N heading MA .01864
LOCATED AT:
SALEM, MA, 01970
Type Permit No. Permit Issued, Permit E iris- Fee Restrictions/Notes
Permit T XP
SEPTIC HAULER' BHP-2012-0672 Jan 1,2013: Dec 31,2013 $105.00 VEHICLE TYPE: 1Vlaek 2005 Reg#
_- N80743
Total Fees: $105.00
PERMIT EXPIRES Decembe-r3l, 2013
Board of Health
V
Page 1
}
Commonwealth of Massachusetts
City of Salem
iI Board of Health Kimbedey DdsCol(
Mayor
120 Washington Street,4th Floor
°SALEM,MA 61970
Septic Maulers Permit
DATE PRINTED: 12/17/2012
ESTABLISHMENT NAME: Service Pumping& Drain Co. Inc.
File Number:BHF-1999-000003 5 Hallberg Park
N Reading MA 01864
LOCATED`AT:
SALEM,MA 01970
Permit Type Permit No,. Permit Issued Permit Expires Fee Restrictions!Notes
SEPTIC HAULER 8HP-2012-0670 Jan 1,2013 Dee 31,2013 -' $105.00 VEHICLE TYPE: 200 Mack Reg#
N80744
Total Fees: $105.00
PERMIT EXPIRES _. December 31, 2013
Board of Health
Page 1
,ca
�p Commonwealth of Massachusetts
�s City of Salem,
Board of Health Kimberley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Septic Haulers Permit
DATE PRINTED, 12/17/2012
ESTABLISHMENT NAME: Service Pumping&Drain Co.Inc.
fileNumber:BHF-1999-000003 5 Hallberg Park
N Reading MA 01864
LOCATED AT:
SALEM, MA. 01970--
Permit Type Permit No. Permit Issued ;Permit_Expires e' Fee Restrictions/Notes
SEPTIC HAULER BHP-2012-06738 Jan 1 2013 Dec 31,2013 ` $105.00 L60587
Total Fees: '$105.00
PERMIT EXPIRES.; December 3112013 .
Board of Health
-Page-1
CITY OF SALEM, MASSACHUSIB ['$0 2012
CIS) BOARD OF HEALTH
CI ry
�F�ALEM
SIINTON STREET, Sto OF E Prevent.TtjUWCHalth
TEL. (978)741-1800 FAX(978) 745-0343
KIMBERLEY DRISCOLL lramdinGa salem.com
L;11tRY RAIvIDIN,RS/REIIti,C[-IO,CP-I-,�',
MAYOR HF;fal,�l r AG ENT
APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES
FEE: $105 Per Vehicle payable to the City of Salem No Cash
Name of Applicant: SERVICE
Address: Pumping&Drain Co.;Inc. Tel#: 0 0 `-?Ct(4
5 Hallberg Park
Name of Company:-_ _ North Reading_MA njS64_
Address: Tel#:
Type of Vehicleo) M0LLk-7 r vexL S,
Gross Weight_ -7 S'_p D 0 1 105
Year of Make: Go �� 2.6eys'. 2vc3tN,
Substance(s)Hauled 5 C'�} t, �L►��; __ c2 _ "tom c~7a_ C� c..3 _
Route of Travel _ �-e r y-\
(must be completed) ff
Schedule of Travel { S y- e G ,, t P Cd
I HAVE READ THE BOARD OF HEALTH REGULATIONS,"RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE
SUBSTANCES."I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I
UNDERSTAND THEM;AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN
REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES.
PURSUANT TO HGL C62C,S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT 1, TO MY BEST KNOWLEDGE AND
BELIEF,HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW.
lZ � kZ 04
Signature Date SS #or Federal ID#
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Permit# Check# Check Date
Updated 5/23/11