HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 12/22/2025 Co0OOlC]DVVealth of Massachusetts
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=~[�/ V �VVU °. North Andover
System Pumping Rec
ord
�Form4 u- ��
DEP has provided this form for use by local Boards ofHealth.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 o[Health or other approving authority within 14
days from the pumping date in accordance with 31VCMR15.351.
A. Facility Information
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1. System Location:
93 Turnpike Road
Address
North Andover MA 0I845
City[Town aL
2. System Owner:
Rubicon
Name
125 Half Mile Road Suite 20I
Address(if different from location)
d Bank NJ 07701
Cityrrown State Zip Code
7322753434
Telephone Number
B. Pumping
Record
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I2/22/2025 100.0000
1 Date��Pum Pumping 2 Clu�nt�v Pumped:` '' Date ' ^ ' Gallo nm
3. Component: [—] CeemVmo|(s) R Septic Tank F—]Tight Tank Grease Trap
| | Other(desoribe):
4. Effluent Tee Filter pnament? [—]YesyX-qNo |f yes,was itcleaned? F—1 Yes F—lNo
5. Observed condition of component pumped:
] Bay Sink. 7 inches of grease on top. 2 ioobeo of water. 7 inches of bottom
sludge. 50 gallons removed. Both baffles/tees are intact. Gasket is in good
condition. walla/bottom of trap in good condition. System is at proper working
level, Left O bottles of drain master. 16ioobea 50gallooa. BOB Logo Signed.
Recommend Drain Cleaning. Do for preventive maintenance on pipes and floor drains.
O. System Pumped By:
Robbie Hall
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite lUOO Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease - NEMU Yazd: 54 Knox Trail, Acton, MA 01720
Bobbie Hall 12/22/2025
Signature ofHauler Dmho
Signature of Receiving Facility(or attach facility receipt) Date
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