HomeMy WebLinkAboutSeptic Pump 8/8/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped Te phone#
No. { 1 / Street a
Village
Owner's Name
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic TankXCesspool 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 ''r,J;
Gallons Pumped: � d� Comment:
Hauler Information
Company: 3 0.01 ,J� `r
Truck No.: , a •
Driver Name:
f
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date: 15 7—
Gallons Received: Ticket#: Z h32'eZ