16 Pumping Report 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#12)N9" Z L-03c3 MA License# Date of Pumping rJ / I / 14
Address 16 FOREST GLEN DRIVE
Property Owner VIOLA PRYMOWICZ Address 2
Home Phone 413-584-2036 Address 3
Bus Phone City FLORENCE
Cell Phone State MA Tip Code 01062
Total Volume: /WO
Tank Size: 1000 GAL
Concrete
Good
Tank Location Owner has
Septic1-9
H lding Tank 7 Leach Tank r i Cesspool 1 Grease Trap
Date of Previous Pumping, If Known: 1 i CC
P� 9� I
Waste Received at Licensed Facility: cV\n4a-C\) Cee-
Licensed Facility Phone Number: �-- -V 6�
Town: i\ f\4 rAl.-
Misc Comments:
Driver: Dh., Z
Created 5/1/2017 at 2:39:53 PM Page 1 of 1