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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