HomeMy WebLinkAboutSeptic Pump 8/24/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped Tele hone#
No►�� Street 0e -�
Village
Owner's Name
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank 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
Gallons Pumped: ?a " Comment:
Hauler Information
Company:
Truck No.: Date:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: