9 System Pumping Report 2010 ystem Pumping Report,aWastewater Removal
239 A Greenfield Road
South Deerfield.MA 01373
Phone 413-665-3989 Fax 413-665-7358
•*** This report will be sent to the BOARD OF HEALTH within 15 DAYS ******
Permit#6N%.3o09-ply MA License# Date of Pumping 01/ / (i 71/O
Property Owner ED JAZAB
Home Phone
Bus Phone
Cell Phone
Tank Size:
(413) 584-1439
(413)222-4910
1500 GAL 2 COMP.
Concrete
Good
Tank Location MAP ON BACK
Septic x Holding Tank
Address 9 SHEPERDS HOLLOW
Address 2
Address 3
City LEEDS
State MA
Zip Code 01053
Total Volume: AS-00
Leach Tank Cesspool
Grease Trap
Date of Previous Pumping, If Known: /j((.����� ,, �� �,,�� � ,�7
Waste Received at Licensed Facility: C.J �t-f2 772
Licensed Facility Phone Number: ¥a J a 70 0
Town: / / a R/II AP 1/4d1"-'
Misc Comments:
Driver:
Created 4/7/2010
at 913'.02 AM Page 1 of