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HomeMy WebLinkAboutSeptic Pump 4/22/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY / System Identification Town Pumped I Telephone# No. Street ° (r Q kg 1..) Village Owner's Name: yl4) /! (Oda 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: Comment: Pumped By Licensed Pumper: }� / - 21 .. � Truck License No.: Date: tic.O Driver Name: _Y Signature: Septage Received at Yarmouth - Dennis Approved by: Date: Received: Gallons Ticket#