HomeMy WebLinkAboutPanera Grease Trap - Septic Pumping Slip - 58 PETERS STREET 5/6/2026 Commonwealth of Massachusetts Town of NO*Andovtr
City/Town0f North Andover
System Pumping Record JUN 18 2026
Form 4
DEP has provided this form for use by local Boards of Health,Other forms may be used,but the if 4igpi be
of
substantially the same as that provided here.Before using this form,check with your local Board "Z
they use.The System Pumping Record must be submitted to the local Board of Health or other approving authorityr 29Ment
days from the pumping date in accordance with 310 CMR 15.351.
A. Facility Information
1. System Location:
58 Peters Street
Address
North Andover MA 01845
...............11-...........I.............
City/Town zip-C�. ..e.........................................
2. System Owner:
PR Restaurants LLC / Panera Bread IG Panera Bread #3410
Name
2150 Washington Street, Suite 125
........... ......................
Address(if diiierentfrom location)
Newton Lower Falls MA 02462
City/Town State Zip Code
7246013210
Telephone Number
B. Pumping Record
05/06/2026 100.0000
1. Date of Pumping .................................. 2. Quantity Pumped:
DateGallons
3. Component: F] Cesspool(s) F] septic Tank F]Tight Tank nX Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? Yes 1^1 No If yes, was it cleaned? Yes n No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 3 Bay Sink. 4 inches of grease on top. 8 inches of
water. 4 inches of bottom sludge. FOG 50%. 50 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. 0 bottles of drain master. BOH Logs Signed.
6. System Pumped By:
Nate Mckeithan
................ ................... ................... --------------.........................................
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlboro h, MA 01752
Company
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7. Location where contents were disposed:
Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343
..........-................ ...........
Nate Mckeithan 05/06/2026
...................... ..................................... .................................
Signature of Hauler Date
........................................... ............. --------........
Signature of Receiving Facility(or attach facility receipt) Date
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