HomeMy WebLinkAboutSeptic Pump 6/20/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped Keq/4're Telephone#
No. Street Pee cc -e
Village
Owner's Name / GOO
Use: Residence G` Business Restaurant? Yes No
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank Q Cesspool Converted Cesspool
Holding Tank Leach Facility Grease Trap
Porta-Potty Lift Station Other Wastewater Plant
Cover within 1 foot? Yes No Back Flow? Yes No
(X)0
Gallons Pumped: Comment:
Hauler Information 1
Company: yrCY(117 ► (GZO,Z
Truck No.: Date:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: _ Date: 6/2C/2-Z
Gallons Received: )'d O Ticket#: 2'/2. I