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CURRIER
R FORM 4-SYSTEM PUMPING RECORD
SEPTIC & DRAIN SERVICE
1. VOREST STREET;MIDDLETON,MA 01949
(978)774-2772
COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS
I .
SYSTEM PUMPING RECORD
SYSTEM OWNER:
SYSTEM LOCATION:
-e�4 Kl3k � �Jo DP J .AuIA3e
"A `� ���
ac..• V\_
DATE OF. PUMP
TNG: QUANTITY PUMPED:
GALLONS
CESS' NOESEl
SEPTIC TANK: NO
0 YES Q-
' SYSTEM P[TMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENT'S TRANSFERRED'TO:_ 6_z � S�
s
DATElz:
S/a
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INSPECTOR:
MAY"'3 _