HomeMy WebLinkAboutGrease Trap - Tripoli - Septic Pumping Slip - 542 TURNPIKE STREET 12/16/2025 Town of Not Andover
Commonwealth Of Massachusetts
City/Town of J 14riaotle'r DEC 17 2025
MOM PumipAining record4 Health epartment
DEP has provided this form for use by local Boards Of Health.Other fons 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 H681th to determine the form they use.The System pumping Record must be submitted to
the kxal Board Of Health Or Other rdance with 310 CMR 16.361.approving authority Within 14 days from the pumping date In
acco
A. Facility Information
Iffoatoft
MV an the Ow form 1. System Location:
compuw e 4
u***M ,Y the tab
key to move your
0jnW-do not I
use the ratum
own key. ZA
stow
Mov-� Zip Code
Wg4jj 2. System Owner
-2 Z-A
arne
Address
I of IVIR 1TVM 10muon)
State -7JP Coe
B. Pumping Record
11. Date of Pumping 2. Quantity Pumped: V—
3. Comport&* Gallons
El CassPOOKS) rl Septic Tank 13 Tight Tank (R/Grease Trap
n Other(describe):
4. Effluent Tee Filter present? C] yes 'No If Yes,was it cleaned? ❑ Yes a No
6- Observed OOr1dft1On Of Component pumped:
S. System Pumped By:
VeNde a Number
—
sainy
7. Location where contents were disposed:
Date
=Wmurc OT MMVftV Facilfty(or iG;RftcHftY�recelpo
tft"MAW 11/12
System PUmPkV Record•Page 1 of 1