503 Pump Report 4-19-18 . . o(g/U-sozU ,
Commonwealth of Massat:husetts
City/Town of W64:40.4.;$4, 7
rii SystemPull/ping Record
Fort'4
DEP hasprovWed this form for use by loom Boerda of Health.other forme mak be wed,but ire
Inlanlalal must be substantially the ease as that provided here.Before using Nater 1,check with your
local Board of Health b determine the tern use.TheSysOem Pupping Record mum be submitted b
the loom Board of Health a other approving authority wlttdn 14 days tom the pumping date In -
accordance vAt h 310 CMR 13.351.
A. Facility Information i _
? .
aLLo,d 1. System Location. - 4
fa to -
m
ee
p a ten,e/
moor-do not cawrwm alga $Code •
tette Mon ' ,.�.
ifs iwl b . • r N.Ar‘ . , ,.
�e" a3u51/ tgarN P, .
tijA sdne.nRdesetewe lonelier)
Oeylmeen - art: cats. .
he`- OS 777 ' .
B. Pum Ing Record
t. RasedPmprg 99autL- 1`1 tg-- f5ea
•
o.e =.x Quantity Pumped: won.
3,. Type:ofsystem: . RI Ceaepadiaj .-eptcTwik 0 TIghtTank o oreaeeTrap
cane Nt i- N1 Gird NFC',
0 Omer.(describe): ���///
. . 4. Effluent Tea Filter present? ❑ Yes.lp Ho Hyes� a d
wes aeri0ed? Yea�No
dti
- . 5. Conon.ofSyehe,m: /
GpGo—trAverd .
WYWsllosiesfa.aw
qSISI WD A • J
7. Loeetianwhere contents were disposed: 4.
sp -
atl+la.a otFledr. ... _ . • : pe
Signalers ofReoeMa Foca
eionMAoo 08/09 - Breen Pimpled Record•Peeet ori