HomeMy WebLinkAboutSeptic Pump 6/28/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped ,70 f% Telephone#
No. Street
Village
4
Owner's Name
�G' ( C () pQ�'
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance .., Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank Cesspool Converted Cesspool
Holding Tank Leach Facility Grease Trap
Porta-Potty Lift Station Other Wastewater Plant
Cover within 1 foot? Yes No Back Flow? Yes No
Gallons Pumped: Comment:
Hauler Information
Company:
Truck No.: Date:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: