HomeMy WebLinkAboutSeptic Pump 6/15/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumd Yq/tiCA'�/`1 /. lephone
No. ' Street DP
Village
Owner's Name
ma's t' ' (Cr AT
Use: Residence Business Restaurant? Yes No
Q
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank i 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: ,
fig
Truck No.: L Date:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: