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11 TRADERS WAY SYSTEM PUMPING RECORD 7-7-25Commonwealth 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 07/07/2025 1000.0000 Cover was accessed and properly secured. Grease Tank system serviced. Filter not present. Tank can be outfitted with filter - Sold Onsite. 1000 gallons removed. 1 inches of bottom sludge. 1 inches of grease on top. 15 inches of water. System is at proper working level. Both baffles/tees are intact. Main line is clear. Jonathon Colson NEMO Yard: 54 Knox Trail, Acton, MA 01720 07/07/2025 Salem Salem Jonathon Colson 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 21 Cedarcrest Avenue MA 01970 Tom Pyburn 21 Cedarcrest Avenue 01970Salem 9782574668 MA 07/08/2025 1000.0000 Cover was accessed and properly secured. Cesspool system serviced. Filter not present. Tank cannot be outfitted with filter. 1000 gallons removed. Moderate sludge on bottom of tank. Light top solids in tank. System is at proper working level. Main line is clear. Recommend adding Treatment. Please visit www.bookmyseptic.com to purchase online. Marcus Lark HaverHill Disposal Site: 40 S. Porter Street, Bradford, MA 01835 07/08/2025 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 07/03/2025 100.0000 Basement. 2 inches of grease on top. 12 inches of water. 2 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. BOH Logs Signed. Steven Dominguez 07/03/2025 Salem Salem 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 07/03/2025 100.0000 Basement. 2 inches of grease on top. 10 inches of water. 2 inches of bottom sludge. 30 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. Steven Dominguez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 07/03/2025 Salem Salem 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 07/03/2025 20.0000 3 Bay Sink. 4 inches of grease on top. 6 inches of water. 4 inches of bottom sludge. 30 gallons removed. Inlet baffle/tee is not intact - outlet baffle/tee is intact. Recommend inlet repair. Gasket is in bad condition - Recommend replacing gasket. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. BOH Logs Signed. Steven Dominguez 07/03/2025 Salem Salem 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 76 Lafayette Street MA 01970 JAA Services 10 Fort Eddy Road 03301Concord 6179918398 NH 07/03/2025 100.0000 3 Bay Sink. 6 inches of grease on top. 6 inches of water. 6 inches of bottom sludge. 50 gallons removed. Both baffle/tees are not intact. Recommend inlet/outlet repair. Gasket is in bad condition - Recommend replacing gasket. Grease trap needs 2 bolts replaced. Walls/bottom of trap are in need of repair. Recommend Trap Repair/Replace. System is at proper working level. Left 0 bottles of drain master. Recommend replacing the trap. Recommend Inside Grease Trap Steven Dominguez 07/03/2025 Salem Salem 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 144 Canal Street MA 01970 Starbucks 85 Wells Avenue, Suite 110 02459Newton Center 4133274959 MA 07/19/2025 100.0000 pumped 1 igt Marcus Spencer Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343 07/19/2025 Salem Salem Marcus Spencer 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 07/25/2025 100.0000 Back Room. 4 inches of grease on top. 8 inches of water. 4 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. BOH Logs Signed. Steven Dominguez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 07/25/2025 Salem Salem 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 07/17/2025 20.0000 3 Bay Sink. 4 inches of grease on top. 4 inches of water. 4 inches of bottom sludge. 25 gallons removed. Both baffles/tees are intact. Gasket is starting to tear - Recommend replacing gasket. Grease trap needs 1 bolt replaced. Walls/bottom of trap are in need of repair. Recommend Trap Repair/Replace. System is at proper working level. Left 0 bottles of drain master. BOH Logs Signed. Gabriel Mckinney-Dias Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 07/17/2025 Salem Salem 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 31 Bridge Street MA 01970 Dunkin Donuts - Fabios Donuts 241 Maple St 01949Middleton 9785781124 MA 07/03/2025 100.0000 3 Bay Sink. 2 inches of grease on top. 10 inches of water. 2 inches of bottom sludge. 30 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. Steven Dominguez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 07/03/2025 Salem Salem 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 197 Fort Avenue MA 01970 Eric's Kitchen 197 Fort Avenue 01970Salem 9788801880 MA 07/03/2025 100.0000 Kitchen. 6 inches of grease on top. 2 inches of water. 6 inches of bottom sludge. 30 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. Steven Dominguez 07/03/2025 Salem Salem 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 1 Kernwood Street MA 01970 Kernwood Country Club 1 Kernwood Street 01970Salem 9787451210 MA 07/18/2025 200.0000 BOH Logs Signed. Steven Dominguez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 07/18/2025 Salem Salem