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HomeMy WebLinkAboutSeptic Pump 4/23/20 YARMOUTH - DENNIS SEPTAGE TREATMENT FACILITY System Identification Town Pumped Telephone# 1 No. Street ( Village Owner's Name: \) rl f`'� ? ` (a(',,° ) { Mail Address: (if different) 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: ./6'6 0 Comment: Pumped By Licensed Pumper: Truck License No.: Date: Le)70 Driver Name: Signature: Septage Received at Yarmouth - Dennis Approved by: Date: Received: Gallons Ticket#