HomeMy WebLinkAboutChipotle Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 6/24/2026 Commonwealth of Massachusetts Town of North Andover
City/Town of 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 be used,
substantially the same as that provided here.Before using this form,check with your local Boar ilTe, ow M a
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:
23 Turnpike Road
Address
North Andover MA 01845
City/Town Zip Code
2. System Owner:
Rubicon —_LG j le1425
Name
125 Half Mile Road, Suite 201
'Address-(iFdi rent from location)------
Red Bank NJ 07701
City/Town State Zip Code
0000000000
Telephone Number
B. Pumping Record
1. Date of Pumping 06/24/2026 2. Quantity Pumped: 100.0000
Date Gallons
3. Component: F] cesspool(s) R Septic Tank F]Tight Tank Grease Trap
F] Other(describe):
4. Effluent Tee Filter present? F-1 Yes No If yes, was it cleaned? R Yes ❑ No
5. Observed condition of component pumped:
Cover was accessed and properly secured. 3 Bay Sink. 6 inches of grease on top. 4 inches of
water. 4 inches of bottom sludge. FOG 71%. 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:
Tammy Marotta
Name Vehicle License Number
Wind- - River Environmental,- - - - - - --4-6 Lizotte Drive, Suite 1000, Marlborough, MA 01752
Company
7. Location where contents were disposed:
Inside Grease — NEMO Yard: 54 Knox Trail, Acton, MA 01720
Tammy Marotta 06/24/2026
Signature of Hauler Date
Signature of Receiving Facility(or attach facility receipt)
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