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11 TRADERS WAY SYSTEM PUMPING RECORD 1-15-25Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 11 Traders Way MA 01970 Shaw's Supermarket 523 Spring Street 02333East Bridgewater 8028858450 MA 01/15/2025 1000.0000 Cover was accessed and properly secured. Grease Tank system serviced. Filter not present. Tank cannot be outfitted with filter. 1000 gallons removed. 2 inches of bottom sludge. 0 inches of grease on top. 30 inches of water. System is at proper working level. Both baffles/tees are intact. Main line is clear. Robert Herrick NEMO Yard: 54 Knox Trail, Acton, MA 01720 01/15/2025 Salem Salem Robert Herrick Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 4 Hilton Street, MA 01970 Debra Gauvreau 4 Hilton Street 01970Salem 9788150914 MA 01/15/2025 1000.0000 Cover was accessed and properly secured. Septic system serviced. Filter not present. Tank cannot be outfitted with filter. 1000 gallons removed. Light sludge on bottom of tank. Light top solids in tank. System is at proper working level. Main line is clear. Marcus Lark HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 01/15/2025 Salem Salem Marcus Lark Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 5 Cedarhill Road MA 01970 Cheryl and Richard Weldon 5 Cedarhill Road 01970Salem 9785784140 MA 01/24/2025 1000.0000 Cover was accessed and properly secured. Septic system serviced. Filter is present and was cleaned. 1000 gallons removed. Light sludge on bottom of tank. Heavy amount of top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. Marcus Lark NENO Yard: 163 Western Ave, Gloucester, MA 01930 01/24/2025 Salem Salem Marcus Lark Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 83 Washington Street MA 01970 The Juicery 40 State Street 01950Newburyport 6032341223 MA 01/15/2025 100.0000 3 Bay Sink. 2 inches of grease on top. 6 inches of water. 6 inches of bottom sludge. 40 gallons removed. Gasket is in good condition. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. Amauary Leon I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/15/2025 Salem Salem Amauary Leon I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 253 Essex Street MA 01970 Blackcraft Salem 253 Essex Street 01970Salem 7817031190 MA 01/09/2025 100.0000 Basement. 6 inches of grease on top. 2 inches of water. 6 inches of bottom sludge. 40 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. 14inches 40 gallons Trap is located in basement of address. Easiest access is use Burton square it`s a side street off of Essex st to access back of building for access for basement. Robbie Hall I Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 01/09/2025 Salem Salem Robbie Hall I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 7 Traders Way MA 01970 Londi's Famous Roast Beef 7 Traders Way, 01970Salem 9787411100 x MA 01/02/2025 100.0000 Kitchen. 3 inches of grease on top. 8 inches of water. 3 inches of bottom sludge. 40 gallons removed. Both baffles/tees are intact. Gasket is in good condition. Grease trap needs 1 bolt replaced. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. 14inches 40 gallons Trap needs new bolt currently does not have one. Recommend Plumbing. Trap needs new bolt currently does not have a bolt. BOH Logs Signed. Robbie Hall I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/02/2025 Salem Salem Robbie Hall I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 9 Bridge Street MA 01970 Bill & Bob's Restaurant 9 Bridge Street, 01970Salem 9787449835 x MA 01/02/2025 20.0000 3 Bay Sink. 3 inches of grease on top. 8 inches of water. 3 inches of bottom sludge. 40 gallons removed. Both baffles/tees are intact. Gasket is in bad condition - Recommend replacing gasket. Grease trap needs 1 bolt replaced. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. 14inches 40 gallons Current gasket does not exist in current bolt is missing.Also needs middle Robbie Hall I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/02/2025 Salem Salem Robbie Hall I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 7 Traders Way MA 01970 Londi's Famous Roast Beef 7 Traders Way, 01970Salem 9787411100 x MA 01/15/2025 100.0000 3 Bay Sink. 6 inches of grease on top. 6 inches of water. 6 inches of bottom sludge. 50 gallons removed. Gasket is in good condition. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. Amauary Leon I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/15/2025 Salem Salem Amauary Leon I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 9 Bridge Street MA 01970 Bill & Bob's Restaurant 9 Bridge Street, 01970Salem 9787449835 x MA 01/15/2025 20.0000 3 Bay Sink. 10 inches of grease on top. 2 inches of water. 2 inches of bottom sludge. 40 gallons removed. Gasket is in good condition. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. Amauary Leon I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/15/2025 Salem Salem Amauary Leon I Commonwealth of Massachusetts City/Town of System Pumping Record Form 4 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. t5form4.doc• 11/12 System Pumping Record • Page 1 of 1 A.Facility Information 1.System Location: Address City/Town State Zip Code 2. System Owner: Name Address (if different from location) City/Town State Zip Code Telephone Number B. Pumping Record 1. Date of Pumping Date 2. Quantity Pumped:Gallons 3. Component: Cesspool(s) Septic Tank Tight Tank Grease Trap Other (describe): 4. Effluent Tee Filter present? Yes No If yes, was it cleaned? Yes No 5. Observed condition of component pumped: 6. System Pumped By: Name Vehicle License Number Company 7. Location where contents were disposed: Signature of Hauler Date Signature of Receiving Facility (or attach facility receipt) Date Wind River Environmental, 46 Lizotte Drive, Suite 1000, Marlborough, MA 01752 Building 4, Suite 160 Shetland Park, 45 Congress St MA 01970 Gillian's Foods 45 Congress Street, building 4 Suite 160 01970Salem 3512016281 x MA 01/15/2025 200.0000 3 Bay Sink. 10 inches of grease on top. 2 inches of water. 2 inches of bottom sludge. 480 gallons removed. Gasket is in good condition. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. Amauary Leon I Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 01/15/2025 Salem Salem Amauary Leon I