HomeMy WebLinkAboutSeptic Pump 6/15/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped g_v,I0t,4 Telepone#
No.2. Street Dr> J(
Village
1!
Owner's Name ` )p S' I{` ( (y/1(/d r
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.To Back Flow? Yes No
Gallons Pumped: f cy0 Comment:
V Hauler Information
Company: j j 1 y
Truck No.: Date: ' 2 2
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: 161,4 1