HomeMy WebLinkAboutGrease Pumping & Transportation - Septic Pumping Slip - 315 TURNPIKE STREET 3/13/2023 _ Commonwealth of Massachusetts W
City/Town of North Andover R 1 1023
System Pumping Record w4 of:MNOR�HANpOTER
Form 4 10 pEQARTMEN
,^ HEA�TN
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
Important:When
filling out forms 1. System Location:
on the computer, 315 Turnpike St
use only the tab
key to move your Address
cursor-do not North Andover MA
use the return
�1 City/Town Statekey. — -p Co
de
2. System Owner:
V� Merrimack College
Name
gun
Address(if different from location)
City/Town State Zip Code
Telephone Number
B. Pumping Record
02/22/2023 4,000.00
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: GreasePT (Grease Pumping and Transportation
❑ Other(describe):
4. Effluent Tee Filter present? ® Yes ❑ No If yes, was it cleaned? El Yes ❑ No
5. Observed condition of component pumped:
Good
6. System Pumped By:
Bob Brenton
Name Vehicle License Number
Waste Water Services, Inc. /Heritage Pumping
Company
7. Location where contents were disposed:
Cresent Farm
02/22/2023
Sign ture o H Date
Signature of Receiving Facility(or attach facility receipt) Date
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