HomeMy WebLinkAboutSeptic Pump 7/11/22 Yarmouth Septage Treatment Facility
System identification
Town Pumped 6t'�C Te.ephooie#
No. Street 1/ ` �5 4 ( l�f�
Village
I
Owner's Name �lC t J t/( CdJf
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-000
Gallons Pumped: Comment:
Hauler Information
Com an k QU `"P (f
p Y .-/_ ZZ-
Truck No.: ate:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: `1 Date: 7i//22'
Gallons Received: '000 Ticket#: 2-42_7 32