HomeMy WebLinkAboutSeptic Pump 6/14/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped
Tell hone#
No. Street ()-045- ��I vci
Village
/, (7( r
ar
Owner's Name
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#: