HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 7/18/2022 Re'gieg
Commonwealth of Massachusetts 1 g �022
City/Town of North Andover
System Pumping Record of WRSH AN ENS
Form 4 �OHEALSN�EpA��M
M DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information must be
substantially the same as that provided here.Before using this form,check with your local Board of Health to determine the form
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authority within 14
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
93 Turnpike Road
Address
North Andover _ MA 01845
City/Town State Zip Code
2. System Owner:
Rubicon (PCS)
Name
125 Half Mile Road, Suite 201
Address(if different from location)
Red Bank NJ 07701
j City/Town State Zip Code
7322753434 x
Telephone Number
B. Pumping Record
1. Date of Pumping 06/09/2022 2. Quantity Pumped: 3000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank rY-j Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑Yes N] No If yes, was it cleaned? ❑Yeso No
5. Observed condition of component pumped:
Normal water 10 of 2i-n battom sludge 8in top solids Path }waffles are intact;
Main tine Ctear. No fittez ±3 present on the tanki L;ULIelLt tank is not designed to
e used with a i ter. Cover(s) secured. No 3rd party paperwork i e . Water leveT
normal baffles intact no filter present mainline clear moderate solids and sludge
pumped 3000 gallons of grease cover secured.
6. System Pumped By:
Geoffrey Howard
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780
06/09/2022
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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