600 Pump Record 4-2020is" on the
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Commonwealth of Massochuseft
City/Town of; I Q e j
syst®m .Puflri�cord
For% 4 .
DEP has provided this is rti for use by tical Boards of Health. tJlher: toittis ms J_ be used, but the
intorrndon must be subst nu*I the same as.. that p vMpd hem. Bob* u*V He fwn, do* with your
local Bwrd. of Heath to determine the tbrm.t wy use. The System P(snping Pacard mt*t- be,M&n Ad to
the loom Board of Haettir or oifW app vft &Moft Vftn 14 days from the pumPb V deb in
accordance wNh 310 CHAR 15.351.
1. sy*em Looadon:
AA.I.wwn i '
a.
IiIiAVAA ,
norm
. - , • � cone
ZUS
B. Pumping Record
Q C�Ca
. 1. ' D,ste:of Pumpfig Dare c�eAone
3, Type,at'aystiem: ElQ�ep ts). �1-e1' k [J`ran11ghtTW* E]OreaeeTr9
❑ Other (describe):
N Nes was It Cl"? ❑ Yes PrNo
4.. Et4luent Te,® FiBsr present? 2.4uar* Pumped
❑Yes . o Y
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