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35 HILLSIDE AVENUE SYSTEM PUMPING RECORD 5-20-25Commonwealth 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 35 hillside avenue MA 01970 Richard Devanna 35 hillside avenue 01970Salem 6174552294 MA 05/20/2025 1000.0000 Cover was accessed and properly secured. Septic system serviced. Filter not present. Tank cannot be outfitted with filter. 750 gallons removed. Light sludge on bottom of tank. Light top solids in tank. System is at proper working level. Both baffles/tees are intact. Main line is clear. Jonathon Colson Greater Lawrence Sanitary District : 240 Charles Street , North Andover, MA 01845 05/20/2025 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 7 Traders Way MA 01970 Londi's Famous Roast Beef 7 Traders Way, 01970Salem 9787411100 x MA 05/01/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 10 inches of water. 4 inches of bottom sludge. 20 gallons removed. No gasket is present. 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. Pumped one grease trap. BOH Logs Signed. Terrill Todman Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343 05/01/2025 Salem Salem Terrill Todman 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 05/01/2025 20.0000 3 Bay Sink. 4 inches of grease on top. 10 inches of water. 4 inches of bottom sludge. 20 gallons removed. No gasket is present. Walls/bottom of trap in good condition. System is at proper working level. Left 0 bottles of drain master. Pumped one grease trap. BOH Logs Signed. Terrill Todman Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343 05/01/2025 Salem Salem Terrill Todman 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 05/15/2025 100.0000 Basement. 2 inches of grease on top. 10 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. Raymond Saez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 05/15/2025 Salem Salem Raymond Saez 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 15 Bridge Street MA 01970 Ninety Nine Restaurant 14A Gill Street 01801Woburn 6172428999 MA 05/01/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 14 inches of water. 4 inches of bottom sludge. 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. Pumped one grease trap. BOH Logs Signed. Terrill Todman Holbrook WRE Yard: 24 South Street, Holbrook, MA 02343 05/01/2025 Salem Salem Terrill Todman 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 05/15/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 6 inches of water. 4 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. BOH Logs Signed. Raymond Saez Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 05/15/2025 Salem Salem Raymond Saez 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 05/15/2025 40.0000 3 Bay Sink. 4 inches of grease on top. 6 inches of water. 4 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. BOH Logs Signed. Raymond Saez Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 05/15/2025 Salem Salem Raymond Saez 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 05/15/2025 100.0000 3 Bay Sink. 3 inches of grease on top. 15 inches of water. 3 inches of bottom sludge. 25 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. Francisco Barros Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 05/15/2025 Salem Salem Francisco Barros 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 282 Derby Street MA 01970 All Souls Lounge 282 Derby Street 01970Salem 9783951517 MA 05/15/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 6 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. Raymond Saez Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 05/15/2025 Salem Salem Raymond Saez 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 282 Derby Street MA 01970 Sweet Boba 1032 Great Plain, 02492Needham 7818546253 x MA 05/15/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 4 inches of water. 4 inches of bottom sludge. 35 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. Raymond Saez Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 05/15/2025 Salem Salem Raymond Saez 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 05/01/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 14 inches of water. 4 inches of bottom sludge. 50 gallons removed. Gasket is in bad condition - 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. Heavy rust rotted walling. Recommend Inside Grease Trap Replacement. Pumped one grease trap. BOH Logs Signed. Terrill Todman Water Solutions Group: 35 Mozzone Blvd , Taunton, MA 02780 05/01/2025 Salem Salem Terrill Todman 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 05/15/2025 100.0000 3 Bay Sink. 4 inches of grease on top. 6 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. Raymond Saez Inside Grease - NEMO Yard: 54 Knox Trail, Acton, MA 01720 05/15/2025 Salem Salem Raymond Saez 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 05/21/2025 1500.0000 Cover was accessed and properly secured. Septic system serviced. Filter not present. Tank cannot be outfitted with filter. 1500 gallons removed. 3 inches of bottom sludge. 3 inches of grease on top. 25 inches of water. System is at proper working level. Both baffles/tees are intact. Main line is clear. Pumped 1500 gallons but this is at least 3000 gallon tank. Jaime Rivera NEMO Yard: 54 Knox Trail, Acton, MA 01720 05/21/2025 Salem Salem Jaime Rivera