HomeMy WebLinkAboutChipotle Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 6/11/2026 Commonwealth of Massachusetts Town of North Andover
City/TownOf North Andover
JUL - '2 2026
System Pumping Record
Form 4
DEP has provided this form for use by local Boards of Health.Other forms may b 2q 6 substantially the same as that provided here.Before using this form,check with yHourl"a go r ==i t 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 Turnpike Road
Address
North Andover MA 01845
City/Town State i Code
2. System Owner:
Rubicon - OG - Chipotle #1425
Name
125 Half Mile Road, Suite 201
Address(if different from location)
Red Bank NJ 07701
cityif'-wri— State Zip Code
0000000000
Telephone Number
B. Pumping Record
1. Date of Pumping 06/11/2026 2. Quantity Pumped: 3000.0000
Date Gallons
3. Component: Cesspool(s) F-] septic Tank F-]Tight Tank Grease Trap
F� Other(describe):
4. Effluent Tee Filter present? F-]Yes No If yes,was it cleaned? F-1 Yes R No
1^1
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. 4 inches of grease on top. 3 inches of
bottom sludge. FOG 13%. 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:
NEMO Yard: 5-4- Knox-Trail, Acton, MA 01720
Michael Graham 06/11/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt) Date
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