HomeMy WebLinkAboutSeptic Pump 7/11/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped a(�c- Tel h ne#
No. `(/ / Street J f ill*
Village \
?-(,1( (0(M"
Owner's Name
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank ( C 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: (000 Comment:
Hauler Information
Company:
/7/I
Truck No.: "' D ) 1!. 7z-
Driver Name: 7 �'
I
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: MI S Date: )40.
Gallons Received: /cC O Ticket#: -2-11Z7$2—