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390 Pump Report 4-27-18 System Pumping Report Greg's Wastewater 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# POMALicense# Date of Pumping /2.,q/ D PL.)-'Zo1T h octv Address 390 NORTH FARMS ROAD Property Owner DANA PASQUALE Address 2 Home Phone 413-727-8677 Address 3 Bus Phone City FLORENCE Cell Phone State MA Zip Code 01062 Total Volume: ja) .__ Tank Size: 1000 GAL Concrete Good Tank Location BACK YARDMAP ON FILE Septic /Holding Tank i l Leach Tank Cesspool Grease Trap Date of Previous Pumping, If Known: 9 I 1 C I JL Waste Received at Licensed Facility: m 1� \ \.). QCf t t Licensed Facility Phone Number: -1T3- S 6Cr5 Town: �p-{� /� ,( A Misc Comments: Driver: Created 4/30/2018 at 3'10:49 PM Page 1 of 1