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100 Pumping Report System Pumping Reporta 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#'WC) )Lfl MA License# Date of Pumping `6 I d I (AC'G\L Address 100 BLACK BIRCH TRAIL Property Owner ROCKY HILL CONDO ASSOC Address 2 Home Phone 413-923-4675 Address 3 Bus Phone City FLORENCE Cell Phone State MA Zip Code 01062 Total Volume: -C-') Tank Size: 5000 GAL INJECTOR PUMP-- Good Tank Location Septic PrHolding Tank Leach Tank Cesspool ri Grease Trap Date of Previous Pumping, If Known: -CZ JV I 1�*V'\/ Ic\ Waste Received at Licensed Facility: 'd 11U)1 P 1 \9±PD I Licensed Facility Phone Number: Lc1 Town: H CVS h lc\ \o-+Thn Misc Comments: Driver: A Created 8/14/2018 at 9:01:12 AM Page 1 of 1