HomeMy WebLinkAboutSeptic Pump 6/23/20 YARMOUTH- DENNIS SEPTAGE TREATMENT FACILITY
GWOLA System Identification
Town Pumped Telephone#
Ae
No. Street �'j t r
Village
Owner's Name: C 5(4-5C"`
Mail Address:
(if different)
Use: Residence Business Name
Reason Pumped: Maintenances 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:
:CSC: �.
Pumped By
Licensed Pumper: i/( '( e
Truck License No.: �� Date:
Driver Name:
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#