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HomeMy WebLinkAboutSeptic Pump 4/24/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY System Identification Town Pumped Telephone # No. Street ' /9/ 5 /7 1( Village Owner's Name: j-c' 1/ �� tde°r/o 5' Mail Address: (if different) Use: Residence Business Name 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 No Back Flow? Yes — No Gallons Pumped: Comment: Pumped By Licensed Pumper: r-^ zyl Truck License No.: Date: �� ` LuZO Driver Name: / Signature: Septage Received at Yarmouth - Dennis Approved by: Date: Received: Gallons Ticket#