278 Pump Report 5-25-18 f//U-Czil,a S�
-+ Commonwealth of Massachusetts
,. - r ., City/Town of \4_0440,,,i0"*. .
•t rn System .Puftrpin9 Record -
Form 4
'`, DEP has provided this fblm for use by load Boards of Health.Other time mey be used,but the
Information mut be subten0*the epgne method provided here.Before using thl form,deck with your
local Boardof Health to datrmine the hem.they we.TheSyetem Pumping Recgd must be etrbmhted to
the toad Board of Health cc otter approving authority wntdn 14 days from the pumping date '
sceardanco with 910 CMR 15.351. •
A. Facility Information
=r4out1. System Location: - t '
rams on the •
om4ter.tae
only eytett toy Mines
moor- mat ..
allose . . C1D'ttUea -W! ap Cods
•
wit
f'riT Q c () . “q
Aaangic ass9eem earn)
•
•
me.
7yeibef'
B. Pumping Record
• _1. `DQats.OfPunplrg \ n� ' \E- ?. CUM/Puroles . 1506 •
•
3, 1ype:of-system: P1 Caspaw(s) ❑ CTank ❑ 7IflTwt 0 Gramm Trap
ElOther(deeatbe): 1
. . 4. diluent Ta Rim ptssardy ❑ Ye . No •ifyes,'wasR deeded? .❑ Yes ANO/
5. -CandlIonof SyMem: 'r
.5. spm Pimtped By: _
• 7t ie: `SJIL &ok:M'2 .. Volts hods.Number
7: I.pC 0 ;wtlBfe cptffiyjd.vamp deposed: .
.. abty�reaftlaMe. .. oats
amen ofneWwy Faulk/ pyo
eoee4aeo came
Eopem Anew Reaped•es oil