HomeMy WebLinkAboutChipotle Grease Trap - Septic Pumping Slip - 93 TURNPIKE STREET 8/27/2026 Town of North Andover
Commonwealth of Massachusetts
City/Town of North Andover SEP 2 2026
System Pumping Record
Form 4 De partment
DEP has provided this form for use by local Boards of Health.Other forms may be used,PuRhIte hinformati n 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:
93 Turnpike Road
............
Address
North Andover MA 01845
dwfowr_........................... -------------------------------------- ------- ------------------
2. System Owner:
Rubicon - IG Chipotle #1425
125 Half Mile Road, Suite 201
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Address(if different from location)
Red Bank NJ 07701
-,-State..................... Zip Code
0000000000
Telephone Number
B. Pumping Record
1. Date of Pumping 08/2 7/2 02 2. Quantity Pumped: 100.0000
DateGallons
3. Component: F] cesspool(s) F] septic Tank F]Tight Tank Grease Trap
Other(describe):
4. Effluent Tee Filter present? R Yes � No If yes, was it cleaned? F]Yes Ej 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. 6 inches of bottom sludge. FOG 75%. 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:
Robbie Hall
Name Vehicle License Number
Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752
6cm—pany---'--- -----------...........
7. Location where contents were disposed:
Suncook Wastewater Treatment / Allenstown Sewer Commission: 35 Canal Street
Robbie Hall 08/27/2026
Signature of Hauler Date
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Signature of Receiving Facility(or attach facility receipt) Date
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