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SEPTAGE HAULER - SERVICE PUMPING & DRAIN COKIMBERLEY'DRISCOLL MAYOR Permit # SH -17-1 Date of Print 1/27/2017 Permit Issued 1/27/2017 Permit Expires 12/31/2017 Permit Fee $945.00 Late Fee $0.00 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"' FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 health&salem.com License For: Granted To: Address: HAULER HEALTH PERMIT Location of Establishment: Restrictions: pllb)�Cil(C$1 h Prevent. Promote. Protect, LARRY RAMDIN, RS/REI-IS, CHO, CP -FNS HI:,ALTi I AGENT Septage Hauler Service Pumping Pumping & Drain Co. Inc. 5 Hallberg Park N Reading MA 01864 Notes: This permit is for 8 Mack Trucks: registration numbers: 82817 / 89043 / 89042 / 89041 / 89040 / 82820 / 82819 / 91201/94444 This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2017 , unless sooner revoked or suspended. Larry Ramdin, MPH, RENS, CHO Health Agent J CITY OF SALEM, MASSACHUSETTS lu BOARD OF HEALTH, ""PublicHeatth 120 WASFIINCiTON STREET, 4"ipiue � � ��® Prevent. Promote. Protect,- TEL. (978) 741-1800 FAX (978) 745-0343 KIMBERLEY DRISCOLL Iramdin@salem.com Df C© p J 2016 LARRY RAMDIN, RS/REHS, CHO, CP -FS MAYOR u � . y I ;F S"SEM HLALTH AGFi,NT �lAD OF H�LTh, APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES FEE: $105 Per Vehicle payable to the City of Salem No Cash Name of Applicant: Service PurnPln9 & Drain Co., Addrecc• Inc. Tel#: kO O -- --)o vl - 612- W— Name 1Z(o..J— Name of Company: b Hallberg Park North Reading, MA fil 864 Address: Tel#: Type Gross Weight 2�I D v a l b s Substance(s) Route of Tra (must be comp) Schedule of Year of Make: cM r L, r7i rf I HAVE READ THE BOARD OF HEALTH REGULATIONS, "RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE SUBSTANCES." I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I UNDERSTAND THEM; AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES. PURSUANT TO HGL C62C, S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW. 7", , / / - 31)- / >- to - i o2-- e 9 � Signature Date SS # or Federal ID # --------------------------------------------------------------------------------------------------------------------------------------- Permit # Check #� / Check Date V1I I Updated 1120/13 - Service Pumping & Drain Co. Inc. List of Vehicles V 1. Truck#18 2004 Mack 82817 2. Truck#19 2005 Mack 89043 3. Truck#20 2006 Mack 89042 4. Truck#21 2006 Mack 89041 5. Truck#22 2002 Mack 89040 6. Trailer #1 Arthur SM90930 1/7. Truck #8 2002 Mack 82819 �/ 8. Truck #27 1985 Mack 91201 KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/REHS, CHO, CP -FS HFALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OP HHALTH 120 WASHINGTON STREET, 4" FLOOR TEL. (978) 741-1800 FAX (978) 745-0343 Iramdm@( alem.wm 2011 APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES FEE: $105 Per Vehicle payable to the City of Salem No Cash Name of Applicant: adv Q c�C ��c n C o"mac. Address: S Hna\�es¢� Qom{ ti Reece�� r� o\S'te� Tel#: Name of Comnanv: TypeofVehicle Gross Weight �2 / G'oo Reg.# Year of Make: Substance(s) Hauled rkx� ha? orc�a_,s \'r q c os�c�a zl Route of (must be completed) Schedule of I HAVE READ THE BOARD OF HEALTH REGULATIONS, "RULES AND REGULATIONS FOR TRANSPORTUNG OFFENSIVE SUBSTANCES."! HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. 1 UNDERSTAND THEM; AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES. PURSUANT TO HGL C62C, S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT 1, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW, Signature Date Permit # Check #/ 711 Updated 5/23/11 SS # or Federal M # ------------- Dat ------ ---- -- Check -------- - -- f • Mnnnmus¢tts oeparsmm2orTramParsation `: �� Registry of'Motor Vehiiles. APPORTIONED REGISTRATION CAB CARD EFFECTIVE DATE: 01/18/2017 EXPIRATION DATE: 06/30/2017 MAILING INFORMATION SERVICE PUMPING AND DRAIN CO INC 5 HALLBERG PARK N READING, MA 01864-2611 - IRP REGISTRANT INFORMATION ACCT/FLEET/YEAR/S U PP: 23716-2-2016-1 LEGAL NAME: SERVICE PUMPING AND DRAIN CO INC DBA NAME: ADDRESS: 5HALLBERG PARK N READING, MA 01864-2611 - MOTOR CARRIER RESPONSIBLE FOR SAFETY- USDOT: 472074 NAME: SERVICE PUMPING & DRAIN CO INC ADDRESS: 5 HALLBERG PARK NORTH READING, MA 01864 PLATE: 94444 UNIT#: 38 VIN: 1M2AX07C6HM035108 PLATE TYPE: APN UNLADEN WEIGHT: 28000 VEHICLE TYPE: Truck MAKE: MACK FUEL: Diesel OWNER: SERVICE PUMPING AND DRAIN CO INC MODEL: GU713 COLOR: Blue INSURANCE COMPANY: CONTINENTAL WESTERN INSURANCE COMPANY YEAR: 2017 SEATS: NA SERVICE REPRESENTATIVE: Jur Weight r Wei ht JL1r Wei h Jui�"Wei''ht Jur Weight Weight AB 32658k GA 72000 ME 72000.NJ 72000 PE 32658k WA 72000 AL 72000 IA 72000 MI 72000 NL 32S8k QC 6+AXLE WI 72000 AR 72000 ,SID` 72�11g0 MN 00 NM 74' 0 RI 72000 WV 72000 AZ 72000 If 2000Ily( NS 3 658k SC 72000 WY 72000 Y hn K O t bT moM:W " BC 3265 k' IN •LOIasry o€ hA17�QS€,; NV =,20.0 SD 72000 CA 7200.0 K$ 72000 MT 72000 NY 72000 SK 32658k CO 7200.0 -KX�72000 NB 32658k OH 72000 TN 72000 CT 72000 LA 72000 N 20OU"n" OK 72000 TX 72000 DC 72000 MA 72000 ND 72000 ON 32658k UT 7200 DE 72000 MB 32658k NE 72000 OR 72000 VA 72000 FL 72000 MD 72000 NH 72000 PA 7200 , 1 VT7200 Issued under the authority of the Registrar of Motor Vehicles for the Massachusetts Department of Transportation. Registrar ORIGINAL MUST BE CARRIED IN VEHICLE AT ALL TIMES. VOID IF ALTERED. 25 Newport Ave Ext., 4th Floor Quincy, MA 02171 Tel: (857)368-8120 www.massrmv.com Control: 6000-9939-9630 ACC> o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD YYY ) 12/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FIAT/Cross Insurance 1100 Elm Street Manchester NH 03101 CONTACT Lynn Blanchard, CIC, CISR PHONE EXII, (603) 669-3218 AIC No: (603l 645-4331 E-MAIL SS: lblanchard@crossagency.com ADDRE INSURERS) AFFORDING COVERAGE NAIC t INSURERAAcadia Ins Co. 31325 INSURED 'Service Pumping 6 Drain Co., Inc. 5 Hallberg Park North Reading MA 01864 INSURER B:Continental Western Ins Cc 10804 INSURERc:Onion Insurance Company 25844 INSURER D:SCottsdale Ins CO 41297 INSURERS: 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16-17 All lines w/poll REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUSR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDNYYV LIMITS X COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMA ET REN 250,000 PREMISES Ea occurrence $ MED EXP (Any one person) IS 5,000 CPA5127323-12 12/31/2016 12/31/2017 PERSONAL B ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 PR POLICY F -1 LOC PRODUCTS-COMPIOP AGO $ 1,000,000 IS OTHER AUTOMOBILE LIABILITY MBIN INGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS $1T A5127324-12 12/31/2016 12/31/2017 BODILY INJURY (Peraccitlenq $ PROPERTY aocden DAMAGE $ X HIRED AUTOS X NON -OWNED PIP -Basic $ 8,000 X UMBRELLA LIAR X OCCUR EACH. OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 A EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ MA5127325-12 12/31/2016 12/31/2017 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? IN (Mandatory In NH) NIA WCA5127327-13 (3a.) M All officers included 12/24/2016 12/24/2017 PER 1 X I STATUTE ER E. L. EACH ACCIDENT $ 1,000,000 E. L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E DISEASE - POLICY LIMIT $ 1,000,000 D Pollution Liability WS0002661 12/31/2016 12/31/2017 Occurence. 1,000,000 Aggregate: 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Covering operations of the named insured during the policy term. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INS02512014011 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR INFORMATION ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y� s R Kittle, LPCS, CLCS/ ACORD 25 (2014/01) INS02512014011 ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Permit # SH -16-2 Date of Print 8/11/2016 Permit Issued 1/1/2016 Permit Expires 12/31/2016 Permit Fee $840.00 Late Fee $0.00 of , Tel. Fax. HAULER HEALTH PERMIT License For: Granted To: VdC415411I4-711 Location of Establishment: Restrictions: Septage Hauler Service Pumping & Drain Co. Inc. 5 Hallberg Park N Reading MA 01864 Notes: This permit is for 8 Mack Trucks: registration numbers: 82817 / 89043 / 89042 / 89041 / 89040 / 82820 / 82819 / 91201 This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2016, unless sooner revoked or suspended. Larry Ramdin, MPH, RENS, CHO Health Agent f ,:,,F,. .+ I - KIMBERLEY DRISCOLL MAYOR LARRY RAMDIN, RS/REHS, CHO, CP -FS HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4"` FLOOR TEL. (978) 741-1800 FAx (978) 745-0343 Iramding.salem.com ��.P 20.11 APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES / FEE: $105 Per Vehicle payable to the City of Salem No Cash Name of Applicant: Service Pumping & Drain 6e., Address: Inc. \ Tel#: I " O t) - ?rf t-(- 2.6-r Name of Company: 5 Hallberg Park Nodh lReading, MAUI 864 Type of Vehicle - S e 2 D.-AA-GiGI,- h s+% Gross Weight % Ooo I A- Year of Make: Substance(s) Route of Travel Se,—" /-n (must be Schedule of Travel a. S r t G, 1,1 / t of I HAVE READ THE BOARD OF HEALTH REGULATIONS, "RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE SUBSTANCES." I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I UNDERSTAND THEM; AGREE TO ABIDE BY THEM AND UNDERSTAN THAT FAILURE TO DO SO MAY RESULT IN REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES. PURSUANT TO HGL C62C, S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW. Date Permit # Check #- Updated 5/23/11 0 4 - a -D SS # or Federal ID # Check Date h� Service Pumping & Drain Co. Inc. List of Vehicles 1. Truck#18 2004 Mack 82817 2. Truck#19 2005 Mack 89043 3. Truck#20 2006 Mack, 89042 4. Truck#21 2006 Mack 89041 5. Truck#22 2002 Mack 89040 6. Truck #25 1993 Mack 82820 7. Truck #8 2002 Mack 82819 8. Truck #27 1985 Mack 91201 Permit # SH -15-2 Date of Print 3/18/2015 Permit Issued 1/1/2015 Permit Expires 12/31/2015 Permit Fee $945.00 Late Fee $0.00 City of Salem, Massachusetts Board of Health 120 Washington Street, 4th Floor, Salem, MA 01970 Tel. (978) 741-1800 Fax. (978) 745-0343 Iramdin@salem.com License For: Granted To: HAULER HEALTH PERMIT Septage Hauler IV Pab P-1- �ttuh Larry Ramdin, MPH, REHS, CHO Health Agent Service Pumping & Drain Co. Inc. Address: 5 Hallberg Park N Reading Location of Establishment: Restrictions: MA 01864 Notes: This permit is for 9 Mack Trucks: registration numbers: 89045 / 82817 / 89043 / 89042 / 89041 / 89040 182820 / 82819 / 91201 This permit or license is granted in conformity with the statues and ordinances relating thereto, and expires on 12/31/2015 , unless sooner revoked or suspended. ^ W)� 120 WASHINGTON STREET 4"FLOOR Prevent Promote. Pralect. CITY OI~ SALEM,M��SSACHUSI;'II'S BOARD OF HEALTH TEL. (978) 741-1800 FAx (978) 745- 43 KIMBERLEY DRISCOLL kamdin esalem.com MAYOR � LARRY RAMllIN, RS/RLHS, CI -IO, CP -1•S HEA1::1'H AGENT APPLICATION FOR A PERMIT TO TRANSPORT OFFENSIVE SUBSTANCES FEE: $105 Per Vehicle payable to the City of Salem No Cash Name of Applicant: Service Pumping 8• Drain Co., Address: go ff�. 5 Hallberg Park Tel#: 1 ' � r7 0 ' —)TN ' q Z%.(Name of Company:____N0fthjRe_adIT% 1,1,4 018,92, — Email Type of Vehicle ��av/�- Gross Weight7s--, 0 i] o / Route of Travel -D (must be Schedule of Travel GI's reg u / r ol o I HAVE READ THE BOARD OF HEALTH REGULATIONS; "RULES AND REGULATIONS FOR TRANSPORTIING OFFENSIVE SUBSTANCES." [HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REGULATIONS. I UNDERSTAND THEM; AGREE TO ABIDE BY THEM AND UN'JERSTAN THAT FAILURE TO DO SO MAY RESULT c/ veht�iti Year of Substance(s) IN REVOCATION OF MY PERMIT TO CARRY OFFENSIVE SUBSTANCES. PURSUANT TO HGL C62C, S49A I CERTIFY UNDER THE PENALITIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW. Signature Date SS # or Federal ID # ........................ . . ... - - --- - --- -- --- - - - - - --- -�- / --------------- Permit # Check #l_ Check Date' Updated 11 /20/13 � 1. 2. 3. 4. 5. 6. 7. 8. 9. Service Pumping & Drain Co. Inc. List of Vehicles Truck 49 1990 Mack 89045 Truck# 18 2004 Mack 828171" Truck#19 2005 Mack 89043 Truck#20 2006 Mack 89042 ✓ Truck#21 2006 Mack 89041 Truck#22 2002 Mack 89040' Truck #25 1993 Mack ` 82820 Truck #8 2002 Mack 82819 Truck #27 1985 Mack 91201 93 7)