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FORM 4 - SYSTEM PUMPING RECORD
C 'TRRIER
SEPTIC & DRAIN SERVICE
107 FOREST STREET; MIDDLETON, MA 01949
(978) 774-2772
COMMONWEALTH OF MASSACHUSETTS
A/0 '41P ; , MASSACHUSETTS
SYSTEM PUMPING RECORD
SYSTEM OWNER: �c e (i ' C� SYSTEM LOCATION: Yo{
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DATE OF PUMPING: / QUANTITY PUMPED: JS��C> GALLONS
CESSPOOL: NO 0 YES SEPTIC TANK: NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: i's
DATE: S IIVSPECTOR: e�ed(9
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