The URL can be used to link to this page

Home My WebLink AboutWind River Environmental LLC (Fog)- 12/31/2020LICENSE NUMBER: ` BUSINESS NAME:L' \;zN-)) MAILADDRESS: TOWNSTATE: ZIP CODE: (v� NAME OF OWNERC;t�u(�;� BUSINESS TELEPHONE: l CELL: FAX: EMAIL: FED ID/SS NO: NUMBER OF RUCK(S): FEE PER TRUCK: Truck Registration numbe , Circle one: SeptagerFO Truck Registration number: Circle one: Septage Truck Registration number: Circle one: SeptageTruck Registration number: Circle one: SeptageTruck Registration number: Circle one: Septage .........................................................................................................................................v ....................... SEPTAGE PUMPERS: 310 CMR 15.505 Equipment: No person shall use equipment to remove or transport the contents of prives, cesspool, or septic tanks or other offensive substances unless such equipment has first been inspected and approved by the Board of Health. TRUCKS INSPECTIONS: DATE: WEDNESDAY NOVEMBER 13, 2019 TIME: 7:30AM-11:OOAM PLACE: FOXBOROUGH DPW PARKING LOT, 70 ELM STREET, FOXBORO PLEASE BE THERE, OR CALL THE FOLLOWING NUMBER (508) 261- 7366, IF YOU CAN NOT MAKE THIS DATE FOG PUMPERS: Town of Mansfield BOH Fats, Oils and Grease (FOG) Regulations Article 3, Section 9: As of January 1, 2019, all Septic/FOG Hauler trucks that service systems in the Town of Mansfield will be required to have a Septic/FOG Hauler Permit. Septic/FOG Haulers must provide a list of all FOG customers as part of the permit application. PLEASE NOTE: Onsite logs must be kept at all locations recording the % Combined Solids and Grease when pumping occurs for BOH records. I acknowledge that all pumper)s'will record the % Combined Solids and Grease on the onsite logs. All documents must be compl, Checks can be made payable Mansfield, MA 02048, ,. SIGNATURE: 9d and returned to the Health Department with the appropriate payment. of Mansfield. Mail to: Board of Health, Town of Mansfield, Six Park Row, DATE: TAX CERTIFICATION FORM I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. Signature4lndividual or Corrpora ame By: Corporate Officer (Mandatory, if Applicable) l — \-\ �� ----y L-i **Social Security No. (Voluntary) or Federal Identification Number *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. C:\Usem\sleite\Desktop\Scoa's Documents\Food Establishments- Temp\TAX CERTIFICATION FORM.doc De cowwnweauhOf A, All ACCI*n& 600 wash 1,ry •.. ea".I 1,1. 11" 1 t ti:. n, _:tea Cbak the appropriate bon Are You en employer?employees (fidl and/ 1. I a employer with or part-time).° and have no uft w 2.0 I ton o eoleprop�ristor or parm employees far me is any caPaeity' [No workers' comp. insurance required) 313 We are a corporation and its offrem have clteroised their right of ftemption per c.152, 11(4), and we bavc no employees. [No workers' comP by o r 4.[1 We are a nonprofit o workers' comp. ituroence re9• Phone #• Suu-" _ Buslowa Type (r'e9 5. ® Remit 6. ® Resmu<anUBadE ft Estabibbmwd 7. ® Office and/or Sales (me" reel esWe, auto, S. ® Non-profit 9. ® EatertdOment 10.0 Menufachubg 11.® Nealds can 1219 041er can_ tp = Sanifatien with no employees. [N mmPnreo�potior is reaulref such an ®poy appitomt that ehoda tll mart dro fll auf lee eecdon eetove �o ow �PtaY�. a WORM- O w"�' i•�_--- c®If coraermohas officerherowca"dtheaadveo, but dx orpWtegoo ehautd chwk boa 01• Below k tke poft tglorwradow, er tkot Lsprovfdfwg w®rkas' eo ¢dew Gesurar+cejor w� emp�J IMannwploy F=- Insurer's atyffi: ExpW2020 1000003291 uahon Dsu`.6L3 policy # or Self-ius• Lia # ® ahowlog the policy number and expiration date). Attach a espy Of the workers compensation policy declaration POP ( on of criminal penalties of a Failure to seem coverage as under Section 25A wall MdL c. 152 can lead frho ofa S ti fine up to S1,500.00 and/or one-year impria enP, as well as civil penalties in may bee Sforwarded to theOieo of d a �e the violator. a that a copy of this staterbent of up to $250.00 a day verificatioa _ _e.u- nr♦ fnr sl,ceengai verge _ _ _ __..�_s �e.....m le MeB awdC0ir6CL u 'town: 1 ➢� 4. Licensing Bard 5• Selectmans Mee 6DOR CERTIFICATE F LIA ILL INSURANCE 6/30/2020 9/13/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THEHOLPO CII5THI5 ED CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, By OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E THIS E CERTIFICATE O INSURANCE ANE ECERTIFICATEDO OHOLDER. CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOAIL REpRIf SUBROGATION IS WAIVED, subJect to the terms end conditions Of the policy, Certain policies may mqulro an endorvsment A tsiatBimel on IMPORTANT: H the eRrtifiate holder la an ADDITIONAL INSURED, Ohs potiey(isB) must haws ADDITIONAL INSURED provlslons or bB Bndsa® _. ___v_ .L.wte a. the certificate holder In IIBu o9 cosh endoreemen e . _--_ CA License #OF15767 AWL 777 S. Figueroa Street, 52nd fl. INSURER a APFORLXNGeovERAOE Los Angeles CA 90017 213.659.0065 INSURER A: StarrjIIdL7nn1 &LiabilitYCo* INSURER 0:Oei INSURED Wind River Environmental, LLC INSURERe: 1448815 46Lizotte Dr• INSURER o: Marlborough MA 01752 INSURERS: :OVERAGES WINRI01 CERTIFICIR7 POLICIES POLICIES OF INSTHIS INII URANCE LISTED BELOW HAVE BEEN RANGE LISTS OF ANY ISSUED TO CONTRACT THE OR OTHER DOCUMENT WITH RESPECT WHICH ALL THE TEPMS, ALL THIS IS TO CERTIFY THAT THE NOTWITHSTANDING ANY Nr, TERM OR CONDITION INSURANCE AFFORDED BY TVE D CLAIMS. CLAIMS. HEREIN IS SUBJECT INDICATED. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE LIMITS SHOWN MAY HAVE BEEN C DFOIES REDUCED SY PAID EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. POLICY NUMBER EACH OCCURRENCE S 2 O00 OOO OR 7YPALGNsuMNCE N 1000090612191 6/30/2019 b/30/2020 .e S300000 X COMMERCIAL GENERAL LIABILITY N E S 10000 A CWMS,MppE OCCUR MEDEIIPIM one RM E 1,000,000 PKERS M 1AADVINAIRY GENERALAGGREGATE S 4000000 PRODUCTS-COMP101 AGO S 4000000 GEML AGGREGATE LIMIT APPLIES PER: S PRO Q LOC POLICY N JECT S 2,000,0w OTHER: N N 1000196837191 ((MA� ) 6/30/2019 6/30/2 19 6/30@020 6130l2020 Et Wtlant BODILYINJURY(FafJA n) S J(J(}p(x1$ A AUTOMOBILE LIABILITY 1000198836191 (AO BODIIV NJURY(PRncWanl) S A X ANY AUTO SCHEDULED PROPERTY DAMAGE S j(�}[.).(�Xa�7viyX OWNED AUTOS ONLY ^uTGs NO0"WNEO S 71:XX7�x HIRED pUT05 ONLY AUTOS ONLY X: Coin /Coll D I$ VSTiOuS 6/30/2019 6/30/2020 EACH OCCURRENCE 14,000.00 UMBRELLA LIAB OCCUR N N See Anaehed AGGREGATE S B X EXCESS LUB CWMS•MAOE N• S DEO RETENTION COMPENSATION 1� ]000003291 6/30/2019 6/30/2020 X E.L.FACH ACCIDENT S 1,000,000 A WORKERS AND EMPLOYERWLIASILITY YIN E.L.OISEASE•EAEMPLOYEE S I000000 AM•PRO.AIEvMFIIR CLUD�ECVTIVE ®NIA ei NBEASE•POLICY UMR $100�® 147405OX Fvidence Of Insurance THE SHOULD AffEXPIRTONHOATE VTHEREOF, DESCRIBED NO ICE POLICIES WILEL BE CANCELLED R DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ACORD 26 (20f6103) Atjachment Code: D551077 Master ID: 1448815, Certificate ID: 14740892 $1,000,000 Occurrence $1,000,000 Aggregate $10,000 Retention $10,000 Deductible $5,000,000 Occurrence $5,000,000 Aggregate $10,000 Deductible $150,000 Maximum Occurrence $1,000 Deductible Deductible g . 4/3/2020 Union Fire Insurance Co Pitts, PA Aftachment Code: D552357 Master ID: 1448815, Certificate ID: 14740892 Exces,� s L�ab111tV $3,000,000 Occurrence / Aggregate Auto Carrier: Gemini Insurance Company policy # GVE100230101 Effective: 6/30/2019 — 6/30/2020 $5,000,000 Occurrence / Aggregate Auto $6,000,000 Occurrence / Aggregate General Liability Carrier: Evanston Insurance Company policy# MKLV5EUL301790 Effective: 6/30/2019 — 6/30/2020 $6,000,000 Occurrence / Aggregate Auto & General Liability Carrier: Aspen Specialty Insurance Company policy# CXOOD4Y19 Effective: 6/30/2019 — 6/30/2020 un y, r �. .aExcess January 14t12019 To whom R may concern: WSG (Water Solution Group) a Wind River Environmental LLC. Company. Located in Taunton MA at; 35 Mozzone Blvd. Taunton, MA 02780 plant contact phone number p: 508-860-9992 Water Solutions Group (WSG) located in Taunton MA will accept non -hazardous septic and grease trap waste loads from Wind River Environmental LLC. Branches in New England. Mi M , " Your Septic, Grease and Drain Service Expertst vi � 2�Is:ry o: P?m:nc «rehktesf, APPORTIONED REGISTRATION CAB CARD EFFECTIVE DATE: 07/01/2019 EXPIRATION DATE: 06/30/2020 MAILING INFORMATION WIND RIVER ENVIRONMENTAL LLC 46 LIZOTTE OR MARLBORUGH, MA 01752 vcuir, c iumouwr,nu - IRP REGISTRANT INFORMATION ACCT/FLEETNEAR/SUPP; 26050-1-2019-1 LEGAL NAME: WIND RIVER ENVIRONMENTAL LLC DBA NAME: ADDRESS: 46 LIZOTTE DR MARLBOROUGH, MA 01752 USDOT: 846857 NAME: WIND RIVER ENVIRONMENTAL LLC ADDRESS: 46 LIZOTTE DR MARLBORUGH, MA 01752 PLATE: 9354A UNIT#: 1906 VIN: 1M2AX04C8CM013916 PLATE TYPE: APN UNLADEN WEIGHT: 25000 VEHICLETYPE: Truck MAKE: MACK FUEL: Diesel OWNER: WINDRIVER ENVIRONMENTAL LLC MODEL: GU713 COLOR: Green INSURANCE COMPANY: STARR INDEMNITY & LIABILITY COMPANY YEAR: 2012 SEATS: NA SERVICE REPRESENTATIVE: Jig Weight JW Weight Jur Weight Jur Weiaht Jur Weight Jur Weight AB 29029k GA 64000 ME 64000 NJ 64000 PE 29029k WA 64000 AL 64000 IA 64000 MI 64000 NL 29029k OC 3 AXLE WI 64000 AR 64000 ID 64000 MN 64000 NM 64000 RI 64000 WV 64000 AZ 64000 IL 64000 MO 64000 NS 29029k SC 64000 WY 64000 BC 29029k IN 64000 MS 64000 NV 64000 SO 64000 CA 64000 KS 6400D MT 64000 NY 64000 SK 29029k CO 64000 KY 64000 NB 29029k OH 64000 TN 64000 `• "" CT 64000 LA 64000 NC 64000 OK 64000 TX 64000 `• "" DC 64000 MA 64000 NO 64000 ON 29029k UT 64000 *`*` DE 64000 MB 29029k NE 64000 OR 64000 VA 64000 `• `"`" FL 64000 MD 64000 NH 64000 PA 64000 VT 64000 •• "*• Issued under the authority of the Registrar of Motor Vehicles for the Control: 9001-2227-3479 Massachusetts Department of Transportation. e Registrar ORIGINAL MUST BE CARRIED IN VEHICLE AT ALL TIMES. VOID IF ALTERED. 25 Newport Ave Ext., 4lh Floor Quincy, MA 02171 Tel: (857) 368-8120 www.massrmv.com u".01 e Ik Rocktry o �7o2or Vehicles APPORTIONED REGISTRA 1TION CAB CARD EFFECTIVE DATE: 07/01/2019 EXPIRATION DATE: 06130/2020 MAILING INFORMATION WIND RIVER ENVIRONMENTAL LLC 46 LIZOTTE DR MARLBORUGH, MA 01752 - IRP REGISTRANT INFORMATION ACCT/FLEET/YEAR/SUPP: 26050-1-2019-1 LEGAL NAME: WIND RIVER ENVIRONMENTAL LLC DBA NAME: ADDRESS: 46 LIZOTTE DR MARLBOROUGH, MA 01752 USDOT: 846867 NAME: WIND RIVER ENVIRONMENTAL LLC ADDRESS: 46 LIZOTTE DR MARLBORUGH, MA 01752 "PLATE: 1• v, 9385A UNIT#: 1907 VIN: 1M2AX04C1CM013918 PLATE TYPE: APN UNLADEN WEIGHT: 26000 VEHICLE TYPE: Truck MAKE: MACK FUEL: Diesel OWNER: WINDRIVER ENVIRONMENTAL LLC MODEL: GU713 COLOR: Green INSURANCE COMPANY: STARR INDEMNITY & LIABILITY COMPANY YEAR: 2012 SEATS: NA SERVICE REPRESENTATIVE: ur Weight J_Ur Weight >lZ Weight JZ Weight Jur Weight Jur Weight AB 29029k GA 64000 ME 64000 NJ 64000 PE 29029k WA 64000 AL 64000 IA 64000 MI 64000 NL 29029k CIC 3 AXLE WI 64000 AR 64000 ID 64000 MN 64000 NM 64000 RI 64000 WV 64000 AZ 64000 IL 64000 MO, 64000 NS 29029k SC 64000 WY 64000 BC 29029k IN 64000 MS 64000 NV 64000 SD 64000 CA 64000 KS 64000 MT 64000 NY 64000 SK 29029k CO 64000 KY 64000 NB 29029k OH 64000 TN 64000 CT 64000 LA 64000 NC 64000 OK 64000 TX 64000 DC 64000 MA 64000 ND 64000 ON 29029k LIT 64000 DE 64000 MB 29029k NE 64000 OR 64000 VA 64000 FL 64000 MD 64000 NH 64000 PA 64000 VT 64000 Issued under the authority of the Registrar of Motor Vehicles for the Control: 9001-2227-3453 Massachusetts Department of Transportation. & e Registrar ORIGINAL MUST BE CARRIED IN VEHICLE AT ALL TIMES. VOID IF ALTERED. 25 Newport Ave Ext., 4th Floor Quincy, MA 02171 Tel: (867) 368-8120 vnvw.massrmv.o= 1-111 APPORTIONED REGISTRATION CAB CARD EFFECTIVE DATE: 07/01/2019 EXPIRATION DATE: 06/30/2020 MAILING INFORMATION RYDER TRUCK RENTAL INC 329 JEFFERSON RD ROCHESTER, NY 14623 UNIT: 355603 / LOC: 130$ CUSTOMER: WIND RIVER ENVIRONMENTAL LLC VEHICLE INFORMATION PLATE: 94298 PLATE TYPE: APN MAKE: MACK MODEL: GU713 YEAR: 2016 UNIT #: 355603 UNLADEN WEIGHT: 17000 FUEL: Diesel COLOR: Green SEATS: NA - IRP REGISTRANT INFORMATION ACCTIFLEET/YEARIS UPP: 28876-1-2019-0 LEGAL NAME: RYDER TRUCK RENTAL INC DBA NAME: ADDRESS: 285 WOOD ROAD BRAINTREE, MA 02184 - MU i UK CARRIER RESPONSIBLE FOR SAFETY USDOT: 846857 NAME: WIND RIVER ENVIRONMENTAL LLC ADDRESS: 46 LIZOTTE DR MARLSORUGH, MA 01752 VIN: VEHICLE TYPE: OWNER: INSURANCE COMPANY: SERVICE REPRESENTATIVE: 1M2AX04C3GM027292 Truck RYDER TRUCK RENTAL LT ARGONAUTINSURANCE Jur wgigm Jur Weicht Jur WWejaht Jur W eicht J--u ( Weight Jur Weight AB AL 29483k 65000 GA IA 65000 ME 65000 NJ 65000 PE 29483k WA 66000 AR 65000 ID 65000 65000 MI 65000 NL 29483k QC 3 AXLE WI 65000 AZ 65000 IL 65000 MN 65000 NM 65000 RI 65000 WV 65000 BC 29483k IN 65000 MO MS 65000 NS 29483k SC 65000 WY 65000 CA 65000 KS 65000 MT 65000 65000 NV 65000 SD 65000 CO 65000 KY 55000 NB 29483k NY OH 65000 SK 29483k CT 6500C LA 65000 NC 65000 OK 65000 65000 TN 650DO ** **** DC DE 65000 65000 MA 65000 ND 85000 ON 29483k TX UT 65000 650DO FL 65000 MB MD 29483k 65000 NE 65000 OR 65000 VA 650DO NH 65000 PA 65000 VT 650010 Issued under the at hority of the Registrar of Motor Vehicles for the Massachusetts Deep/ rtment of Transportation. Registrar BE CARRIED )N VEHICLE AT ALL TIMES. VOID IF ALTERED, 5 Newport Ave EXL, 4th Floor Qulncy, MA 02171 Tel: (857) 368-8120 W W W.Massrmv.com Control: 9001-2216-4253 I&T A, 4, F APPORTIONED REGISTRATION CAE CARD " EFFECTIVE DATE: 07/01/2019 EXPIRATION DATE: 06/30/2020 MAILING INFORMATIO14 RYDER TRUCK RENTAL INC 329JEFFERSON RD ROCHESTER, NY 14623 UNIT: 659894 y LOC: 1308 CUSTOMER: WIND RIVER ENVIRONMENTAL LLC — IRP REGISTRANT INFORMATION ACCT/FLEET/YEARISUPP: 28876-1.2019.0 LEGAL NAME: RYDER TRUCK RENTAL INC DBA NAME: ADDRESS: 286 WOOD ROAD BRAINTREE, MA 02184 USDOT: 846857 NAME: WIND RIVER ENVIRONMENTAL LLC ADDRESS: 46 LIZOTTE DR MARLBORUGH, MA 01762 PLATE: 93506 UNIT#: 059894 VIN: 1 M2AX04C9GM032500 PLATE TYPE: APN UNLADEN WEIGHT: 22000 VEHICLE TYPE: Truck MAKE: MACK FUEL: Diesel OWNER: RYDER TRUCK RENTAL LT MODEL: GU713 COLOR: Green INSURANCE COMPANY: NEW HAMPSHIRE INSURANCE COMPANY YEAR: 2016 SEATS: NA SERVICE REPRESENTATIVE: Jur Welch Jur Weiaht Jur Weiaht Jur Weight Jul Weight JyL Weight AS 29483k GA 65000 ME 65000 NJ 65000 PE 29483k WA 66000 AL 65000 IA 65000 MI 65000 NIL 29483k CC 5 AXLE WI 65000 AR 65000 ID 85000 MN 65000 NM 65000 RI 65000 WV 65000 AZ 65000 IL 65000 MO 65000 INS 29483k SC 65000 WY 65000 BC 29483k IN 65000 MS 65000 NV 65000 SD 65000 CA 65000 KS 65000 MT 65000 NY 65000 SK 29483k CO 65000 KY 65000 NB 29483k OH 65000 TN 65000 CT 65000 LA 65000 NC 65000 OK 65000 TX 65000 ** **** DC 6500D MA 65000 ND 65000 ON 29483k UT 65000 DE 6500D MB 29483k NE 65000 OR 65000 VA 65000 ** **** FL 6500D MD 65000 NH 65000 PA 65000 VT 65000 ** **** Issued under the authority of the Registrar[of Motor Vehicles for the Massachusetts�t T Department of Transportation. &' e Registrar MUST BE CARRIED IN VEHICLE AT ALL TIMES. VOID IF ALTERED. 25 Newport Ave Ext., 4th Floor Quincy, MA 02171 Tel: (857) 368-8120 wW W.massnnv.com Control. y 9001-2216-4266 APPORTIONED REGISTRATION CAB CARD W EFFECTIVE DATE: 07/01/2019 EXPIRATION DATE: 06/30/2020 MAILING INFORMATION RYDER TRUCK RENTAL INC 329 JEFFERSON RD ROCHESTER, NY 14623 UNIT: 679439 C y 5 "f LOC:1308 CUSTOMER: WIND RIVER ENVIRONMENTAL LLC - IRP REGISTRANT INFORMATION ACCT/FLE ET/YEAR/SUPP: 28876-1-2019-0 LEGAL NAME: RYDER TRUCK RENTAL INC DBA NAME: ADDRESS: 285 WOOD ROAD BRAINTREE, MA 02184 - MOTOR CARRIER RESPONSIBLE FOR SAFETY USDOT: 846857 NAME: WIND RIVER ENVIRONMENTAL LLC ADDRESS: 46 LIZOTTE DR MARLBORUGH, MA 01752 PLATE: 98081 UNITM 679439 VIN: 1 M2AXD4CXHM037139 PLATE TYPE: APN UNLADEN WEIGHT: 19000 VEHICLE TYPE: Truck MAKE: MACK FUEL: Diesel OWNER: RYDER TRUCK RENTAL LT MODEL: GU713 COLOR: Green INSURANCE COMPANY: NEW HAMPSHIRE INSURANCE COMPANY YEAR: 2017 SEATS: NA SERVICE REPRESENTATIVE: Lu_r Weioht >Jur Welaht A([ Welaht JJt Weight Jur Weight Jur Weight AB 29483k GA 65000 ME 65000 NJ 65000 PE 29483k WA 66000 AL 65000 IA 65000 MI 65000 NIL 29483k QC 3 AXLE WI 65000 AR 65000 ID 65000 MN 65000 NM 65000 RI 65000 WV 65000 AZ 65000 IL 65000 MO 65000 NS 29483k Sc 65000 WY 65000 BC 29483k IN 65000 MS 65000 NV 65000 SD 65000 CA 65000 KS 65000 MT 65000 NY 65000 SK 29483k CO 65000 KY 65000 NB 29483k OH 66000 TN 65000 CT 65000 LA 65000 NC 66000 OK 65000 TX 65000 DC 65000 MA 65000 NO 65000 ON 29483k UT 65000 DE 65000 MB 29483k NE 65000 OR 65000 VA 65000 FL 65000 MD 65000 NH 65000 PA 65000 VT 65000 (Issued under the authority of the Registrar of Motor Vehicles to� the Control: 9001-2216-4321 ff Massachusetts Department of Transportation. Registrar MUST BE CARRIED IN VEHICLE AT ALL TIMES. VOID IF ALTERED. 25 Newport Ave Ext., 4lh Floor Quincy, MA 02171 Tel: (857) 368-8120 www.massrmv,com Places we do FOG for Longhorn Dunkin Donuts B goods 99 Quans Fiesta Fridays Subway Burtons