HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 757 TURNPIKE STREET 8/5/2024 Commonwealth of Massachusetts
x City/Town of North Andover
System Pumping Record p�G�h ti
Form 4 0r
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:
757 Turnpike Street
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
C&W Services/Stop & Shop
Name
117 Kendrick Street, Suite 250
Address(if different from location)
Needham Heights MA 02494
City/Town State Zip Code
2032381235
Telephone Number
B. Pumping Record
1. Date of Pumping 07/11/2024 2. Quantity Pumped: 600.0000
Date Gallons
3. Component: ❑ Cesspool(s) Septic Tank Tight Tank a Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes 0 No If yes, was it cleaned? ❑Yes Lj No
5. Observed condition of component pumped:
[Deli 1 ] : . Plastic trap good. 6" H2O. 3" SOL. 3" GRS. Gasket OK. BOH logs signed.
Extra Services : . [Meat] : . Heavy rust. 15" H2O. 2" SOL. 2" GRS. No gasket. BOH
logs signed. Extra Services : . [Mop Sink] : . Heavy rust. 15" H2O. 3" SOL. 1" GRS.
No gasket. BOH logs signed. Extra Services : . [Meat] : . Heavy rust. 24" H2O. 2"
SOL. 1" GRS. No gasket. BOH logs signed. Extra Services [Seafood] : . Heavy
6. System Pumped By:
Marvin Collado
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
Marvin Collado 07/11/2024
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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