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721 Pump Record 3-2020Commdnw6alth of MassachusWs City/Town of Sy$tqM.PjOpjq§.-FtO6ord.. Fonn'k DEP has provided this form for use by'local Boards of Hsaihi. 00* " may. be used, but the Inibrmaijori must be substantially to one as that provided here. Before tvft thle-fonn, chack with your iocai Board. of Health to determine the trm.they use. The System PumpkV Record mast be sub to the local Board of Heam or other approving autho.* within 14 days from the pumping date In acoordancewith MOCMR 16-351. A. Facility Information Important ut syidarn Location: Wien isno o ibims -an ft' GOMPUW, use o*fttsbw AMress to move your, ct.=" = do not ClIvrown Sbft Zip Code C I IPPAII cay/rmn ebb B. pumping Record �b'� z r% 96, A. Qate-of.Punips am QuW* Pum 'GaIMS 3, Type.Of- . system: ❑ 'C"POOKS) "�--qvftTank El Tight Tank El Grease Trap Fj other. (describe): 4.. Effluent Teo Fitter present? Ej Yes No If Yes, was it cleaned? 0 YesFIG 5. Cmdidon. of System- Ve*Ie Umm Number 7, Location where corftlW WGIS disposed: C ftneturs of ReOeMM fROM Vonn4AOM 0" Date Don &JMM PWPM Record' Paget Of I a