136 System Pumping Record 2016 0252015726
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
1
03(27!2012
10%
Form 4-System Pumping Record
Owner
kamonwealth Dept. DCR Western Region
D Sox 1433
.ttsfield, !A, 01202
113)-339-5504 x
System Location
Conn River Greenfly State Park Tight Tank HQ
136 Damon Road
Northampton, HA, 01060
(413)-586-8706 x
DCR
Routine
.l: No Yes
Pumping:
Pupped By: Wind River Environmental,MC
s Transferred to:
N £ CZ
Septic Tank: No YesL
Quantity Pumped:al O12) - Gallons
Permit#:
is Disposed at:
Sguri4
6,- 1-1.G,
on of System/Other Comments
Pumper Signature:
4
7� f l-o
'rutted cn recycled papa
Dep Approved Farm-12/07/95