32 Pump Report 2018 ., ' Commonwealth of Massachu
City/Town of -v d(4Tn
" System Punting Record -
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DEP has provided this form for use by local Boards of Hedlh.OtherTotn*nw be used,but the
information must be subemnhlly the erne as that provided here.Before using tiiefbmm,dredcwith your
local Board.of Health to determine the bin they use.The Syetem
41 from pumping m t delle submitted to
the local Bard of Health or other sppoving authority vain .
accordance with 310 CMR 15.351: ,
A. Facility Information -
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1. System Location. ' d
Melte on the
tonputer use
mea dire don
or-dnot (*flown Bab m CodeuetMreem _
mmY. 2 System Owner. -''.
C ,� LiU �' :/btU �9CEG �
Nfl3 V1-8-dna 3 12.0,
saae.elsenesestoe bpm)
atymaen 3- 5 7i- t3 . . •
B. Pumping Record
• . .1. Date:ofPumping P 1
l�' : 2. 4!amltq'Pumoed: . . � .
3 Type:of system:. • ID Cesepod(e) - ❑ Sept Tenk ❑ TIpSTook El Grease Trap
❑ Daher(deecdbey. : ,SF`W I ];4U1�CTBm2. TP MC
4. Effluent Tee Filter present? d Yes 2-1 Ifyes,via it clewed? .❑ Yes :446
5. Condition.of System: ..r
. G-0610 '
6.
., _
E V 'Sift wolk ., ydWelJarmre.mr _
. 7, Location where cordate were deposed: 4
.. Slyymce ofNaler. ... . . Dde
ameba ofPeaehlnp FaombOtis •- .
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