10 BARNES CIRCLE - SYSTEM PUMPING RECORDS i
v RRI R FORM 4-SYSTEM PUM 16 RECORD
SEPTIC & DRAIN SERVICE
07 FOREST STREET; MIDDLETON,MA 01949
(978) 774-2772 _3 yy WlvED
f�l'UU��II
JUN j 0 2000
OF
COMMONWEALTH OF MASSACHUSETTS Ci i Y HEALTTH DEPT.
SALEM
l e �
S�1
MASSACHUSETTS
SYSTEMPUMPING RECORD
SYSTEM OWNER:
Z
'4Q(+x SYSTEM LOCATION:c
DATE OF PUMPING: � ���a
QUANTITY PUMPED: SO CJ GALLONS
CESSPOOL: NO Ej'YES SEPTIC TANK:
NO � YES �"-
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
�ONTENTS TRANSFERRED TO:
ATE:
INSPECTOR:
CT T TER FORM 4- SYSTEM PUMPING RECORD
SEPTIC & DRAIN SERVICE D (GEA U ED
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772 MdY I 0
CITY
HEALTH DSP 1,
COMMONWEALTH OF MASSACHUSETTS
, MASSACHUSETTS
SYSTEM PCIVIPIIi'G RECORD
FSYSTEMOWNEIR: TYSTEM LOCATION:
Dec
DATE OF PUMPING: Gl�
QUANTITY PUMPED: / GALLONS
CESSPOOL: NO a YES a SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC Q, DRAIN SERVICE
CONTENTS TRANSFERRED TO:
DATE:
INSPECTOR: