795 System Pumping Record 2016 o,((//U-9049J
commonwealth of Massachusetts
.city/Town of - nl pig `,(??k
System .Punipifg:Record
Form
DEP has provided this iatn tor use bibeal Boards of Health. toiire may.be used,but the
.informagon muss be substareally the"erne aatha provided here.Before using yde-t n,dredcvdth you
to Board of Health to determine the tonn.trey tap The System Pal B Record mu t be suMnld®d to.
the lad Board of Health or other approving authority WPM 14 dayseam the prenpkg date In - . -
accordance with 310 CMR 15.951. _
A. Facility Information
System Location:
77frit
QG TR rt N RP/
*WSW afirtatoe lodool
a
Ala PrAP -G-Wz
B. Pumping Reci$
Date.afiPmnptrk9 Dab� .W
9, Typebssystem: CCesapoo!(si ❑ sepncilick D Tight Twit
81//3 ' ? 6 'MO
faruM.do •09/05
Elignattge Fatiny
1666
Gera.
❑ Grease-nap
Semen Pumping Reuse•Pegg,all