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Septic Pump 11/4/21
YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY aG/ 1,0 System Identification Town Pumped � Telephone# No. (0 Street j .Z ``��� 5' Village Owner's Name: Mail Address: (if different) Use: Residence Business Name Y Reason Pumped: Maintenance Overflow Blockage Pumper's Observations • Facility Septic Tank Cesspool Converted Cesspool Pumped: Holding Tank Leach Facility Grease Trap Cover within 1 foot? Yes k No Back Flow? Yes — No-k7 Gallons Pumped: <Ood Comment: Pumped By ter. Licensed Pumper: �..iC-DU� �P < Truck License No.: ( Date: Driver Name: t/ tCV:), Signature: Septage Received at Yarmouth - Dennis Approved by: Date: " _y - 2/ Received: Gallons Ticket# "55/�r?