HomeMy WebLinkAboutDunkin Donuts-Grease Trap - Septic Pumping Slip - 733 TURNPIKE STREET 1/14/2025 r�A�_' �� /��Mi� �_,���l7 ���
_ ~^�
CCJ000UoOVVea|th of Massachusetts
. ES
y�' Unf North Andover
_ ~ �Roc
���s*��� ������~�� ��������
~'� ~— Pumping�� Record
. _~ ��
� rK� 4 "uvxep
=
K�
osp has provided this form for use by local Boards'd Health.Om �vrfonnsmaybnumed.bu� ainh`nmaU ��a�n � e
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 yuummau to the local Board of Health o/other approving authority within 1*
days from the pumping date in accordance with 31uCwn1ean1.
A. Facility Information
1. System Location:
733 Turnpike Street
Address
North Andover M& 01845
City/Town
2. System Owner:
Caf a Maoa ement Company, LLC
Name
280 Merrimack Street
Address(if different from location)
Methuen MA 81844
Cityrrown State Zip Code
9786822382 x743
Telephone Number
B. Pumping Record
Ol/l4/2025 l00'O0OO
1 Date 2 Quantity� ou� ' � Gallons
3. Component: [—lCeeepoo|(e) [—] septic Tank [—|TightTank F\-"l Grease Trap
VNI
Other(describe):
4. Effluent Tee Filter present? F]Yes FX-1No K yes,was Kcleaned? F-]Yes RNo
5. Observed condition of component pump ed-
a Bar Sink. z inches of grease on top. zo inches of water. 1 inches of bottom
sludge. sn gallons removed. Both baffles/tees are intact. Gasket is in good
condition. Walls/bottom of trap in good condition. System is at proper working
level. Left o bottles of drain master. Bua Logs Signed.
S. System Pumped By:
IG Steven Dominguez
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, i I000 M lb b �& OI752
Company
7. Location where contents were disposed:
Water Solutions Group: 35 Mozzone Blvd Taunton, M* 02780
0l/I4/2025
§iQnamnom|Hauler oax,
Signature vf Receiving Facility(or attach facility receipt) Date
t5fonn4.doc-11/12 System Pumping Record^Page 1pf1