256 Pump Report 5-16-18 1
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• +. Commonwealth of Massachusetts
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1.. ' y •, Cityrrown of. - ni �-a .:
r System P{ntip ttflecord.-
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. . _ DEP has provided tits form for use by IDS Boards of Health.Obit Yon NW.be ted but the
local Boar'da Health ally thettme they aSystem utts usRecord must check mIMedyto
the local Bcerd of Heetth or other appovtng authority within 14 days torn the pumping date N - ' .accordance web wl8r 910 CMR 16.961.
A. Facility Information '
=tot out t. gystem Location: - ' .•
ieme mer-
.e •
mmowyw.
Moor-dons Carrs . - stab m
7 .
256 ,S` L\l(3S7tiR 01),
Scldrialleireasnittfti
abarw0 / 7--
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v.O 7 a°9710;.2,
nu a.C`N C, raePha■rawer.
B. Pumping Record �
- A. Detss.oftmt
Ppbio : kv `\� � .,2. Q fly Pianped . 'r n u .
9.. -rYPamayetem: . Q Cesep_d(a) �aBeplIcTenk ❑ 11ptdTerrb 0 ereese.TreP
O Omer(de.ame>: •-el last7rntrr\tT- 0 i" IP6.)
•- . . 4.. E6uert Tee Flaer present? ❑ Yes es 0 fyes:was f domed?. 0 Ye�
_ 6. QmdlBon.d 9yetem:
G_-060 NI-RP.. (RP. V Jz`i TN°telt,
8. BYete(rrreed By • . •
Wats wan Nava .
;(Set L i„io�k, '
7: location where contents Were&dosed: ,. .
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araNeesofHrea'
a......f RemMC Fadi' .Osie
a tnN.tlec OW08 %sem A9paia Record•Pete 1 ort