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System Pumping Records (003) �� I i RECEIVED 10/06/2017 01:39PM 9787450343 Salem Health Dept 2017-10-06 09:40 TRCT-Newtown 2034260067 >> 9787450343 P 4/4 �L\ Commonwealth of Massachusetts kl,RtCity/Town of �-Oj System Pumping Record Form 4 DEP has provided this farm for uss by local Boards of Health.Other forms may be wood,but the Information must be substantially the same as that provided hers.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 15.361, A. Facility Information ImpaMnt when iliong*L4 form 1. System LV an the cornputar, use only the tab ..... ... key to move your _ ._ cursor•do not a MA Cl� �'Q Wn _ use the(alum key, Cltylfawn. . stats tlp0oda 2. System towner: Name ldtdresa(it Offore om I n) ct=�� �` .��°.. . . .r. � TOPMA4wUnrb B. Pumping R000rd 1, Date of Pumping _AP/0.3,f.J'1._.. .._ 2. QuantltyPumpad: 4a,...,,. Was 3, Component: D Cesspool(s) © Septic Tank 0 TiptltTank G?/GreaseTrap 0 Other(dascrlba). _�_ �.'.__, __. . ......�. 4. Effluent Tee Filter present? 0 Yes tom' o It yea,was It cleanodl? Cl Yes gra'�o S. Observed condition of component pumped: t 6, System Pump d By .^t M7n co�sor, Wind River Environmental CcmPam 1111. _ 7. Location where contents were disposed: 1111... ....... rlr _1111. �a�'�a°�1.1`'7 . ... ....... . ....... . . n�uire of solar oa 9tgnaturo atl�6dsivir�saralitY(ixr siw>xi tarrsiity mcstPE} data tsfcmta.doe,11112 system Pumping R9a7rd•Page 1 of t RECEIVED 01/27/2017 03:50PM 9787450343 Salem Health Dept 01/27/2017 15:43 9782814869 WINDRIVER PAGE 07/07 OtlnPJ2018 Commonwealth of Massachusetts Form 4--System Pumping Recorog% Massachusetts System,Pumping Record System Owner System Location i,Jcndv's ISE Famra OG—Wendy's 14862269 1t15F :011�h Ingram Mi.11 load 91 Lafayette 5trset �PrJ.ngffeld, MO, 65804 'Salem,. 1%1, 01910 (�_l7)-268—gf183 x (976)-70-954D Wendy's of Mi"csti Type: Emergen Routine �u Cesspool: No yes � q Tank: No Yes Date of Pumping: Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: slimContents Disposed at: Date: � ��� Pumper Signature: Condition of System/Other Comments Dep Approved Form-12/07/95 05/0812013 13:32 9782814869 WINDRIVER PAGE 03/07 ----------- commonwealth of Massachusetts Form 4•-System Pumping Record q260% Massachusetts System Pumping Record 5hystem Owner System Location Wendy's Restaurant 0G-%endy`s Ve62269 31 Nagog Park 91 Lafayette St suite 100 Acton, MA, 01720 Salem, MA, 01970 (978)-206-6122 x 6128 (978)-745-9545 x Manager Type: Emergen 1, Routine ve Cesspool: No ✓ yes ESeptic Tank: No Q yes Date of Pumping: 10- at-12 Quantity pumped: /&C-0 Gallons System Pumped By: Wind River Environmental LLC Permit contents Transferred to: Contents Disposed at: Date: Pumper Signature: —q---�—J Condition of System/Other Comments ���� Dep Approved Farm-12107/95 12/0512012 11:24 9782814869 WINDRIVER PAGE 03103 0207133032 p?�t{ Q02 Commonwealth of Massachusetts Form 4--System Pumping Record S.novL Massachusetts System Pumping Record System Owner System Location .horny°s 'lt� •tat]rartr i�Tetxdy's t'i2fi;?2fi3 31 Hayng Bark 91 Lafayette .5t a"�1iCe 104 i Acton, MA, 01720 Salem, MA, 01Q70 (9?flS--2o6-6122 x 5128 (978)...745-9545 x Man Iger 1 Type: Emergenc Routine Cesspool: No Yes 6"44c Tank: No YesEtl� — Date of Pumping: �, Quantity Pumped: 14 Wo &811ons System Pumped 8y: Wind River Environmental,LLC Permit 9 :ontents Transferred to: :ontents Disposed at: C1� r- , .ate: JS�'+ L�� Pumper Signature: LI onditiom of 5y4tem/Other Comments R�. mv,�to�m,,.aior Dep Approved Form-18/07!45 02/04/2015 07:37 9782814869 WINDRIVER PAGE 05/06 Commonwealth of Massachusetts Form 4--System Pumping Record 6.260% Massachusetts System Pumping Record System Owner System Location ik=Tv:�}:° Fc=s.•-:aaea.rt. OG-TRendy's #862269 . : 7. ?^. gcr; :';a;•ck 91 Lafayette Street Mz• ' 01720 Salem, M, 01970 ;::Tay-:;.^+Et-• :L22 1128 (978)-795-9545 x Manaaer Type: Emergen Routine Cesspool: No Yes Septic Tank: No F7� Yes= Date of Pumping: �,�, 3�j-//, Quantity Pumped: IbOU _ Gallans System Pumped 8y: Wind River Environmental,LLC Permit Pk: Contents Transferred to: Contents Disposed at: Date: /0 Pumper Pumper Signature: -- Condition of System/Other Comments ,5 VA= btl� ® erlm<ea.2�y�ka��. Dep Approved Form-12/07/95 IL_ 12/09/2013 11:21 9782414869 WINDRIt1ER PGCE 10f7.1 5.,. ¢r.- 15"Yd5'Yf}AdbiRit =. �' O'1't'f"i i72Cl02 ' Commonwealth of Massachusetts Form a--system Pumping RecorA% Massachusetts System Pumping Record System Owner \ System Location ndy's Restaurant OC-Wendy's #862264 31 Nagog Park 91 Lafayette St Suite 100 loon, MA, 01'720 Salem, MA, 01970 (978 -206-6122 x 6128 (978;-745-9545 x manager TYpe: Emergen Routine �J'cctSc„ Cesspool: Na Yes is TONo Yes Date of Pumping: D�.^� vJ fn Quantity Pumped: 100Q Gallons System Pumped BY: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: / 1 Date 1y ` 3 d ` 13 Pumper Signature: [ � �""u6G1ll Condition of System/Other Comments ,( i + R;mWonrcc>.ix�p�, Dep approved Form-12/07195 , s 03/05/2014 10:16 9782814869 WINDRIVER PAGE 04/05 Commonwealth of Massachusetts Form 4--System Pumping RecordO16 Massachusetts 5ystem Pumping Record System Owner System Locotian @endy's Reataurant OG-Wendy's "62269 31 Nagog Park 91 Lafayette St Suite 100 Acton, MA, 01720 Salem, MA, 01970 (973)-205-6122 x 6128 (978)-745-9595 x Manager Type Emergence Routine Cesspool: No rl Yes %c p Tank: No Yes'- - Date of Pumping: 2 - 3- quantity Pumped: /OCJC7 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Date: Pumper Signature: sl��"`--" Condition of System/Other Comments ® ?r'�iwvnrccrchNooPr Dep Approved Form-12/07/95 07/18/2013 11:42 9782814869 WINDRIVER PAGE 05/08 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Location 5 System Owner Y Wendy's Restaurant QCT-Aeady'o #862269 31 Nagog Ra4k 91 Lafayette St Suite ]-00 AC-On' MA, 01720 Salem, MA, 01970 (978)-2066-6122 x 6128 (978)-795-9545 x Managar Type: Emerges Routine Cawasz Cesspaa1: No Yes Tank: No Y� Date of Pumping: 3 Quantity Pumped:i.110A Gallons System Pumped By: wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S.E.S,D. MA. Dater Condition of/Sys/tem/Other Comments YNiC�✓ ® Prim:dovmUcledpaper Dep Approved Form-12/07/95 03/05/2013 12:36 9782814669 WINDRIVER PAGE 02/03 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wendy's P.eataurant 00-'Rendy's #86226669 31 Nagog Park 91 Lafayette St Suite 100 Anton, MA, 01720 Salem, MA, 01970 !d;J97,8)-206-6122 x 6128 (978)-745-9545 x Manager Type: Emergen Routine ll i Cesspool: No Yes �ank: No yes© Dote of Pumping: quantity Pumped: 'e2;t9 Gallons System Pumped By: Wind River Environmental,LLC Permit#; Contents Transferred to: Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments SJMA Dep Approved Form-12/07/95 - 02/1014428 001/2002 Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wor,lf':� Fe:.taurant Wendy s #862269 234 Litt'eton Roacl 91 Mfayette St Westford, MA, 01886 Sa.iom, MA, 01370 i8o(ro -443 7,'66 x (978)-745 .9545 x Ed McDavitt. Type: Emergent Routine Cesspool: No Yes No E--1 Yes Date of Pumping: Quantity Pumped: Z Oa 0 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: �5 Contents Disposed at: Date: ' G Pumper Signature: Condition of System/Other Comments RECEIVED FEB - 2 2007 CITY OF SF.LENI BOARD OF HEALTH Dep Approved Form-12/07/95 k -i 0207028364 02(MrA= Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wendy's Restaurant Wendy's #862269 31 Nagog Park 91 Lafayette St Suite 100 Acton, MA, 01720 Salem, MA, 01970 (978)-206-6122 x 6128 (978)-795-9595 x Manager Type: Emergent Routine Cesspool: No t:Kd YesTank: No F—I Yes® Date of Pumping: 01 —/—P Quantity Pumped: /D00 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: r"IXEIVED Contents Disposed at: OF SA'-tM H S,E.S.D. BOR qF Hi ALT Sa em, MA. Date: Pumper Signature: - �"p�+ •� Condition of System/Other Comments , L ,44 J ^ 'e ® PnnWdmmyclydpaM Dep Approved Farm-12/07/95 Wind River Environmental 577 Main Street, Suite 110 Hudson, MA 01749 November 7, 2011 Please find attached our disposal slips for the month of October. If you have any questions or concerns please contact me. Best regards, Jamie Coble Office Administrator 978-282-7315 163 Western Ave, Gloucester, Massachusetts 01930 ph 978-282-7315 fax 978-281-4869 e-mail Jceble@wrenvironmental.com a4w% Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts 5ystem Pumping Record System Owner System Location F VJ..'.a41 x':11-ir 'ti.�. T A:ay*-OH , ;'0: '31.2. '. h. Type: Emei`genc Rout,no Cesspool: No d Yes '&Tank: No yes Date of Pumping: J11 Quantity Pumped:/0 Or-) Gallons System Pumped By: -Wind River Environmental,LLC Permit#: Contents Transferred to: - Contents Disposed at: Dote! Pumper Signature: Condition of 5ystem/Other Comments p P pe Approved Form-12/07/95 - p ® x,, i.ntt,uarw� li . k i Commonwealth of Massachusetts Form 4--System Pumping Record 0% Massachusetts System Pumping Record System Owner System Location Wendy's Restaurant Wendy's #862269 234 Littleton Road 91 Lafayette St Westford, MA, 01886 Salem, MA, 01970 (800)-443-7266 x (978)-745-9545 x Ed MoDavitt Type: Emergent Routine ,(L-A 'e. Cesspool: No jp Yes -5epkic Tank: No = Yes® Date of Pumping: Quantity Pumped: /000 Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: RFs. Contents Disposed at: Date: Pumper Signature: Condition of System/Other Comments `f ® Pnutedonrc vdedpap r Dep Approved Form-12/07/95 1 NOV 0 w 2010 -;F K�H i- Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wendy's Restaurant Wendy's #862269 234 Littleton Road 91 Lafayette St Westford, MA, 0188n Salam, MA, 01970 (809)-443-7266 x (978) -745-9545 x Rd McDavitt Type: Emergent Routine ,�1ej G,few0, Cesspool: No Yes Ssptie Tank: No Yes ' Date of Pumping: �,i���p Quantity Pumped: /U�D Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: S.E.S.D. Salem, MA. Date: Pumper Signature: `�� < �!'"✓ Condition of System/Other Comments •,t ® Nntedon mcycled paNr Dep Approved Form-12/07/95 V Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wendy's Restaurant Wendy's #862269 234 Littleton Road 91 Lafayette St Westford, MA, 01886 Salem, MA, 01970 (800)-443-7266 x (978)-'745-9545 x Ed McDavitt Type: Emergent Routine CIIY4�rQ Cesspool: No Yes .S-�Tank: No Yes Date of Pumping: Quantity Pumped/aor� Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: � n w a MA. Date: Pumper Signature: Condition of System/Other Comments C,4,:n`Q ® fronted urecycled paper Dep Approved Form-12/07/95 ------ - --------- Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner System Location Wendy's Restaurant Wendy's #662269 234 Littieton Roacl 91 Lafayette 5t Wcsttord, MA, U1t+86 Saiom, WA, 01970 (BOUI-44,3--7269 r: �918)-745-9545 s Rd McDay.itt Type: Emergent Routine GrekYQ Cesspool: No Yes .irep}ic Tank: No Yes Date of Pumping: LQ —0-0! Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: Sae m, MA. `4 Date: Pumper Signature: // Ivo � Condition of System/Other Comments ® Printed on recycled papa. Dep Approved Form-12/07/95 I i I I NOV O 6 2009 l ....:r..X43 HEALTH Commonwealth of Massachusetts Form 4--System Pumping Record Massachusetts System Pumping Record System Owner ,System Location Wendy's ite.,5tdurant Werlay 9 #8b2G69 [S4 Ll.ttleton Road 91 Lafayette St We-tt4rtX, KA, ultldu Srdlem, MA, (11970 (dVu7-44{-7�bei x (H'ISi—'/45-4 r4S x Ea Hcbav tt Type: Emergent Routine (;reA,( Cesspool: No Yes Sep#ieTank: No Yes 1341 Date of Pumping: &--`/—p9 Quantity Pumped: /O� Gallons B System Pumped : Wind River Environmental,LLC Permit#: Y P Y Contents Transferred to: Contents Disposed at: Ssy` S.E.S.D. Salam, MA. Date: Pumper Signature: Condition of System/Other Comments , Dep Approved Form-12/07/95