7 CEDAR AVENUE SYSTEM PUMPING RECORD 5-9-09 ; _ ___._ ace+anm�e
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Nichols Mat Primary Rome
7 cedar ave 7 cedar ave
Salem, MA, 01970 Salem, MA, 01970
(978)-335-2250 x (978)-335-2250 x
Nichols
Type: Emergent Routine
i
Cesspool: Nc Yes Septic Tank: No Yes®
Dote of Pumping: t--[-t/ Quantity Pumped: f000 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
S.E.S.D.
M see
Date: Pumper 5ignature: - Za'aL
Condition of System/Other Comments
n�" III
3ti0�9
v r.
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Dep Approved Form-12/07/95