HomeMy WebLinkAboutSeptic Pump 7/19/22 Yarmouth Septage Treatment Facility
i
System Identification
Town Pumped Ycal6 Telephone#
No. Street fv Atif/�' (�
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
/ 2OC)
Gallons Pumped: Comment:
Hauler Information
Company:
Truck No.: Date:
Driver Name:
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date: I LI c.
Gallons Received: Ticket#: 3 r I