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Septic Pump 4/22/20
YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY System Identification Town Pumped Telephone# rt No. Street ! I' �'� Village Owner's Name: i� // (1 /, /' 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: ,O('C) Comment: Pumped By Licensed Pumper: Truck License No.: Date: 7 2 2- ZG jG Driver Name: j Signature: Septage Received at Yarmouth - Dennis Approved by: Date: Received: Gallons Ticket#