HomeMy WebLinkAboutSeptic Pump 7/12/22 4 ", , ' i ti +._ r=aas —16 w •W,+. :•'s;.-: ,.
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Yarmouth Septage Treatment Facility
SKystem Identification lk
rtree
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t D C- �r
1 Village
(7)
Owner's Name
Q.s i / (o(1c7
Use: Residence L Business Restaurant? Yes No
{ Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank 2CessPool Converted Cesspool
Holding Tank Leach Facility Grease Trap
Porta-Potty Lift Station Other Wastewater Plant
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Cover within 1 foot? Yes ' No Back Flow? Yes No - 4.--
Gallons Pumped: ! ®O Comment:
Hauler Information
Company: i ,;.i(,,-;u �' f f; C
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Truck No.: •
7/ (2 - 2Z
Driver Name: f'
Driver's Signature:
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Septage Received at Yarmouth
Weighmaster Initials: 1 1 Date: 7/1 �.f u --
t Gallons Received: 1 Ticket#: 2
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