HomeMy WebLinkAboutSeptic Pump 6/15/22 Yarmouth Septage Treatment Facility
System Identification
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Town Pumped %f,,''�u'L 4.7 Telep:hpne#
1
No. ` Street Li c { f '
Village Owner's Name -7 L 5 `i r f (r ovi M0OB
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: J rotit
Truck No.: 71 Date: �- /4.- 7
Driver Name: (1
Driver's Signature:
i n S g
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: