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tem Owner
Type: Emergency
Cesspool: W
Date of Pumping;
00,
Form 4 -- System Pumping Record
Commonwealth of Mossachusetss RECEIVF11-
Massachusetts JJ
System Pu!Wna Record' JUL - 9 2004
TOWN OF NORTH ANDOVER
I HEALTH DEPARTMENT
gystem Location
Routine
Yes
System Pumped By: Wind Piver, Enwromnental, UC
Contents transferred to:
Contents Disposed at:
Dais: Y Pumper
Condition of System/Other Comments
Dep Approved Form - 12/07/95
Septic tank: W 0Yes rVI
Qua" Pumped: 0 6allons
Permit #: