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80 Pump Report 12-13-17 System Pumping Reportr GegaWastewater 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 22*****"' Permit#®hp-JOe MA License# Date of Pumping)(1\/ 1 / C- 03/-)3 Address 80 DUNPHY DRIVE Property Owner ED ACUS Address 2 Home Phone 413-587-0975 Address 3 Bus Phone City FLORENCE Cell Phone State MA Zip Code 01062 Total Volume: 1 (' NCO Tank Size: 1200 GAL Concrete Good Tank Location MAP ON FILE Septic - I Holding Tank 7 Leach Tank L-iI Cesspool f Grease Trap fl Date of Previous Pumping, If Known: \a\s \ L/\ Waste Received at Licensed Facility: , I\U 119r Licensed Facility Phone Number: `� Town: '010�-\-(Act Misc Comments: Driver: Created 12/14/2017 at 10:27:57 AM Page 1 of 1