HomeMy WebLinkAboutSeptic Pumping Slip - Stop & Shop - 10/3/24 - Septic Pumping Slip - 757 TURNPIKE STREET 10/3/2024 Commonwealth nfMassachusetts
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System Pumping Record
Form 4
oEP 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 o[Health m determine the form
they use.The System Pumping Record must be submitted m the local Board o[Health or other approving authority within 14
days from the pumping date in accordance with a1DCwR1s.a51.
A. Facility Information
1. System Location:
757 Turnpike Street
Address
North Andover MA 0I845
Cityfrown
2. System Owner:
C&W Services/Stop & Shop
Name
117 Kendrick Street Suite 250
Address(if different from location)
Needham Heiahts MD O249y
uri//pw^ State Zip Code
2032381235
Telephone Number
B. Pumping Record
l0/03/2O34 500 000O
1. Date ofPumping 2. Quantity '
u�e � Gallons
3. Component F—� Cesspool(s) n Septic Tank F—|Tight Tank Grease Trap
| | [Dher(deecribe):
4� ��uent�e� F||barpne��nt? [—lYeop�� Nn |f yes, was itdeaned? [—1 Yes [—lNu
5. Observed condition nf component pumped:
Cover was accessed and properly secured. Bakery. 2 iooueo of grease on tog. 24
ioobea of water. 2 ioobea of bottom sludge. 50 gallons removed. Both baffles/tees
are intact. Gasket is in good condition. walla/bottom of trap in good oouuitiuo,
System is at proper working level. Left 8 bottles of drain master. seat, l iuobem
of grease on tog. 24 iuoben of water. 1 iooueo of bottom sludge. 50 gallons
G. System Pumped By:
ZG AnthonyTrabucco
mamm vomme License Number
Wind River Environmental, 46 IAzotte Drive, Suite I008 Marlb h, MA 0I752
Company
7. Location where contents were disposed:
Holbrook WD2 Yazd; 24 South Street, Holbrook, MA 02343
ZG Anthony Trabu000 10/03/2024
Signature mHauler Date
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