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46 Pump Report 5-9-18 • Commonwealth of Atlas: • City/Town of - 11/-tuilinKTITelk " System .Puniping kecord Forth 4. . . _ DEP has provided this form for use by local Boards of Heal t.OlderfoMp may.he used,but the Information must be eub0tandaiy the apse as that provided are.Mae uetng tlds:fbrm,chedcwith your local Board of Health to determine the form they tat The System Pumping Record must be submitted to the load Board of Health or other approving authority wain 14 days tom the pumping data In _ aceardanre wlhf 910 CMR 15.951. • A. Facility Information - a aut t. Syatam Laceton: .• : fame aethe ' computer, foe aie anyyatr hearth - anteyar weer*not Ah ueasem � � " - Ste Dom kW' • 2 System owner. OEB T ` Palm Cien mime I-1(p YF LL RFD G€ a 2n, )).,d'A amreeaaA aa+on) Clay/ram • B. Pumping Record l'L, .1. Date of Pimping l 0.10 ;�G 1 6 2- Quantity Purpau µesoRs 9, Typa'olsystem: P1 Cempool(s) —Sepucrenk El TIghtTanc ❑ Grease Trap . - ❑ Other.(describe): . 4. Effluent Tee Flfter present? ❑ Yes. Iryeq"wes a dearied7 .❑ Y 5. Candton of System: - (1-136C) tr.: 1:s `• 1tm &t _ ye .uaae.ra.rosr 7. Loc6tionwbere corderihhwee deposed: - . • sand..orileaar: .: oea Striatum of Rambling Faaib oar erOmMAoc.Dema - _ araraa Pumping Rad•Paw 1 01