104 System Pump Report 2020fta
Cammoinwdalthof'Ma OOUS t
City/Town of .. � I � p .
System <PgMpIlnrg.4tacor�.
Fot%4 .
DEP has provided this %m; for use by kxaFBoards of Health. OlherYohcis' mW be Lved, but the
Inibanadon must ba subethrftRy tate apme.as Vat provided here. B*m ting ttds•farm, diedc with your
local Board of Health to determine thstrm'.they ►ree. The:Systam Pumpim Reowd must be submifled tis
the local Boatti of tleaith or othsl aPPtnving authority within 14 days fiom the pumping date In . .
accordance with 310 CMR 15.551.
A. VIkOlttty InforrT Atlon'-
r
a,r
1. ' Syatam Location: •. ,.
� _.. 'ache.
cool M
d
Address •_
jorh6vo Yaw.
q�S0r4({G;rMt
1@Btile �Lrl
Sia caft .
a. Systemowner
4
r •
x
°Jddf+p'n•(�dll�"'rt toltiloraGan) - _.
,
civirown
B. Pumptnia Re+c60d
1. t>ate.of:Puinpir>g
— ^• 2. (Aust* 113wYrOed: Golan
Mobs
s(s) cTank' ❑ 'PgKTw* D GrsWeTMp
3... Type.'61sysbem: F7 •Cesppoi
C
1 \
o Ott (describe)'
+ ;
4. EMlueirt'Tea Fiiterpraserrt7 )] Yee No -..if ye®, week deari®d? -0 Yee td�i
5. Goncatiion.of System
Ell
6. "System Pumped By
VettlddUDOWN�anCer j
S
1:
p
7. Location where Contents W"".dtepoaed.
Date
Edna o(riea6lug f ed9lfr
m4.dar 08/08 .. �1='Pape,"irrt