HomeMy WebLinkAboutSeptic Pump 7/12/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped \�W/K 06/r ` Tele ho #
No. ✓` f Street
Village �, r
Owner's Name �nS l�l S condGS
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance-' Overflow Blockage
Pumper's Observations - Facility Pumped
9-
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: v' Comment:
Hauler Information
Company:
lY
Truck No.: te•
Driver Name:
Driver's Signature:
Septage Received at Yarmouth l
Weighmaster Initials: t Date: �/{/2J2)_"2
Gallons Received:
Ticket#: