HomeMy WebLinkAboutSeptic Pump 6/14/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped Telephone#
'7? r �- !
No. Street t
Village
Owner's Name 0_,Q J '
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: / `J C) Comment:
Hauler Information
Company:
l('-Z Z
Truck No.: D
:::
Name:
s Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date: h y
Gallons Received: Ticket#: /fa,