HomeMy WebLinkAboutChipotle Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 2/6/2026 Town ul North kndover
Commonwealth of Massachusetts
City/Town Of North Andover MAR 16 2026
System Pumping Record
Form 4 Health Depuis�jnent
DEP has provided this form for use by local Boards of Health.Other forms may be used,but the information
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
1. System Location:
93�rnpike_ Road
Address
North Andover MA 01845
City/Town State Zip Code
2. System Owner:
Rubicon - OG - Chipotle #1425
Name
125 Half Mile Road, Suite 201
Address(if different from location)
Red Bank NJ 07701
City/Town State Zip Code
7322753434
Telephone Number
B. Pumping Record
1. Date of Pumping 02/06/2026 2. Quantity Pumped: 3000.0000
Date Gallons
3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? Yes No If yes, was it cleaned? R Yes E] No
R
5. Observed condition of component pumped:
Cover was accessed and properly secured. Main line is clear. Both baffles/tees are intact.
System is at proper working level. 48 inches of water. 2 inches of grease on top. 4 inches of
bottom sludge. FOG 11%. 3000 gallons removed. Filter not present. Tank cannot be outfitted
with filter. Grease Tank system serviced.
6. System Pumped By:
Michael Graham
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
MEMO Yard: 54 Knox Trail, Acton, MA 01720
Michael Graham 02/06/2026
Signature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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