HomeMy WebLinkAboutBake N Joy Pumping Slip - Grease Trap Batter - 10-29-2024 - Septic Pumping Slip - 351 WILLOW STREET 10/29/2024 i
Commonwealth of Massachusetts
City/Town of No. Andover
System Pumping Record
�`� ~ Form 4
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,
use only the tab 351 Willow Street
key to move your Address
cursor-do not No. Andover MA 01845
use the return
key. City/Town State Zip Code
419=D
� 2. System Owner
Bake Joy.....
Name _
SAME
Address(if different from location)
city/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping 2, Quantity Pumped:
Date Gallons
3. Component: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ® Grease Trap
Batter
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ® No If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
Batter/Sludge All of this estimated
Information is non-binding, valid only at the time of pumpinc�Not responsible beyond the date above.
XSystte, mped By&<--._6. u V
Name Vehicle License Number
J&S Development Corp. d/b/a Stewart's Septic
Service
7. Location where contents were disposed:
XtewaReceivin Facility, So. Mill St., Bradford, MA01835 `_ . . See above ✓'
Signature of Hauler Date
See above
Signature of Receiving Facility(or attach facility receipt) Date
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