HomeMy WebLinkAboutChipotle Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 4/7/2026 L\ Commonwealth of Massachusetts
City/TownOf North Andover
System Pumping Record
Form 4
kltqit�) DEP 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 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:
_j"u.r..np eke Road
Address
North Andover MA 01845
city ..................... -------
2. System Owner:
Rubicon - IG - Chipotle #1425
125 Half Mile Road, Suite 201
-Address-(if—different from location) ——-------------............
Red Bank NJ 07701
Cityrrown State Zip Code
0000000000
Telephone Number
B. Pumping Record
1. Date of Pumping 04/07/2026 —___ 2. Quantity Pumped: 100.9-0,00
Date Gallons
3. Component: F] Cesspool(s) F] Septic Tank n Tight Tank FAGrease Trap
Other(describe):
.................. ..........
4. Effluent Tee Filter present? n Yes FXj No If yes, was it cleaned? n Yes F1 No
5. Observed condition of component pumped:
Left 0 bottles of drain master. System is at proper working level. Walls/bottom of trap in
good condition. Gasket is in good condition. Both baffles/tees are intact. 50 gallons
removed. 6 inches of bottom sludge. 4 inches of water. 6 inches of grease on top. FOG 75%. 3
Bay Sink. Dc for preventive maintenance on pipes and floor drains recommended to have do pm
lines 2-3times a year to assure proper flow. Recommend Drain Cleaning. BOH Logs Signed.
6. System Pumped By:
Robbie Hall
Vw m License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
-----------
d6mpan" ..............
7. Location where contents were disposed.,
Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720
--.............. ................
Robbie Hall 04/07/2026
............................. ....... ........................Signature of Hauler Date
-1.1-1...................... .............................................. ........................
Signature of Receiving Facility(or attach facility receipt) Date
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