680 N. Farms Road Pump Report /P-
Conimortwealth of, - "Massachusetts
City/Town of - :
System Pyniping-Record -
Porta 4 • ,
• .
• DEP has provided this tun for use bilocal Boards of Healrh.Other Tonna May be used,but the
information must be subelandally the sane aa that provided here.Before wing thlelomi,&ea with your
tonal Board of Health to determine the forrn they use.The.Syabam Pumping Recant must be submitted to
the kcal Board or Health or other approving authority within 14 days from the pumping date In -
accordance with 310 CMR 15.351. . . • •
A. Facility Inforniation
q ad 1. System LOCalIOnt
he
LEO
da key /aem
o net • Cftyrovm Stab Zip Cab •
-•
Owner.
}Vri Gik D tkLki Cy-
Sfltbo N FARMS kg
addrear(Vbfforera tom wallop)
cuentren - • °
Stab np Cods
- Ftaq,N Ck''T • t • ischone-NuTter
B. Pumping Record . •
71A4-09-`)1( iL93
. •Dated Pimping 13,01 nfi. Qttwatty Pumped:
3, Type:of system: Oessppoltai „0"--SeptIcTank 0 TwpitTank 0 Grease Trap
o -cempPrgilrflela4 INPE)-
Other(describe).
Ls°
4„ Effluent Tea Filter present? 0 VeSJa4 if yes,was It cleaned? 0 Yesp140
• 5. Condition of System:
4.
•
e• sys:ree*Frped By': •
7. •Location where contents Were disposed:
yarns license bather •_
Wanabtre afRearaVaw Fad*
tartar woe
System Pumping Record Page 1 or i