HomeMy WebLinkAboutSeptic Pump 6/14/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped V Niv�' Telep%one#
•
No. 4treet 'r r
Village
Owner's Name r / (qc/c1L
Use: Residence Business Restaurant? Yes No
- i
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: cry( �� c_
J. ! 2 ?
Truck No.: D_ate: t
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date: 4 "'7-
Gallons Received: Ticket#: