SYSTEM PUMPING RECORD 6-16-14 08/06/2014 14:35 9782814869 WINDRIVER PAGE 12/14
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Commonwealth of Massachusetts Form 4--system Pumping Record.260%.
Massachusetts
System Pumping Record
System Owner System Location
liama:xe Grace Primary Bome
14 -edar View Street 14 Cedar View Street
Salem, MM, .01970 Salem,. M.7+, 01970
(978)-748-2295 x (978)--745-2295 x
Lamarre
Type: Emerge Routine
Cesspool: No Yes septic Tank: No Yes —
Date of Pumping: - Quantity Pumped: 27 _Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
S.E.&�D�y.A
Sakai
date: Pumper signature:
:ondition of system/Other Comments
`;kyenrtrydedpapv .Dep Approved Form-12/07/95