HomeMy WebLinkAboutSeptic Pump 4/24/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY
System Identification
Town Pumped Telephone#
No. Street G t a('-v
Village
Owner's Name: -7— f ' �t '4/M
Mail Address:
(if different)
(17
Use: Residence / Business Name
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations
Facility Septic Tank Cesspool Converted Cesspool
Pumped: Holding Tank Leach Facility Grease Trap
Cover within 1 foot? Yes No Back Flow? Yes — No
Gallons Pumped: X1 000 Comment:
Pumped By
cc
Licensed Pumper: -X1aJ ' �,.� ?
Truck License No.: Da : L
Driver Name:
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#