811 System Pumpning Record 2016 n9Ln04&144
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
06101/2112
Form 4--oystem Pumping Record.%
System Owner
Mass DOT
668 South Avenue
Weston, MA, 02493
(617)-973-7235 x Ann
Type: Emergen
Cesspool: No
Date of Pumping:
System Location
Pump Chamber - 811 North King Street
811 North King Street
Northampton, MA, 01060
(617)-973-7235 x
Mass DOT
Routine
yes Septic Tank: No Yes
System Pumped By: Wind River Environmental LAX
Contents Transferred to:
Quantity Pumped: 1 99 /' Gallons
Permit#: 5¢..ws (4M f)
Contents Disposed at:
Date:
'7 - (s-t%
Condition of System/Other Comments
Pumper Signature:
1..12
® ran mmwe.
Dep Approved Form-12/07/95
b3`L 3.