HomeMy WebLinkAboutSeptic Pump 10/22/18 .Llfication r
Town Pumpeu Telephone#
No. aCii Street
Village
Owner's Name: ct/7
Mail Address:
(if different)
Use: Residence e' Business Name
Reason Pumped: Maintenance %/' Overflow Blockage
Pumper'sr' Observations
Facility Septic Tank v �' Cesspool Converted Cesspool
Pumped: Holding Tank__Leach Facility Grease Trap
Cover within 1 foot? Yes No Back Flow? Yes No
Gallons Pumped:-3'00 Comment:
Pumped By
Licensed Pumper: Be
Truck License No.: 23_5;4:71,(Dat
Driver Name: /GCl 4
Signature:
Septage Received at Yarmouth - Dennis
Approved by: ..01 Date: /O/'u
Received: ?2/ Gallons Ticket# �e04/5