292 Pump Report 5-29-18 1
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07i//Q-.D7)8,././
. -+, Commonwealth of Massachusetts
• w City/Town of ` b aft 4- �-Fz
_J System Purrrpiltg'Record - .
Form-4. _ -
•
DEP het provided this form for use by local Boards of Hearth.of errotme maybe used,but the
hdarmetlon must be atba6 ntMy the Gyne aathet provided hate.Before wing Cdsdam,dtedcwith your
local Board of Hearth to determine test=they use.The.Syatem pumping Record must be submitted to
the local%nerd of Health a other approving authority within 14 days trap the pumping date to - '
accordance with 310 CMR 16.961.
A. Facility Information
-Ittet out 1. -System Location: _ `?' ..R'
computer,use
t rI )v bry Adusee
awn
no not
t
UM Off
return aktir€011 Stile apCeea •
2 Ryetan Owner
C ' *Ve-dao s
Purnapsip., oco wISc i, PO
Me.aaasm.*+o"momoo
f ls • L//3-s 3.- y3 f
, cTeM,J.a)ieser'
B. Pumping Record
V11104,. 'DeeewPme�dre t2-ctcE 1500-
Dm. L.A. Quint/Pumped . aloe
. 3,. Type:osystem: • • • _mai • ' •.. Tank' •O light Tank ❑ adeese.Trap
p Other.(describe): -_ nista n 4is1 T-- G 1p '1 f L-
4.. Effluent tea Filter w _
aaent?� Yee.0 No nves,'wasadearied4 p'Ho .
. ' 5. Comdtlon.of System:
•
'OMonN . V QIP'
7. ethers cantina)were deposed:
131pM;a.ortielr� ... . . Db - I
Oman of fbmntng Fumy DYe
la!"M.Gav 08108
BPavn WyIP1e-aK6r4'Pepe 1 aft