HomeMy WebLinkAboutSeptic Pump 6/20/22 Yarmouth Septage Treatment Facility
System Identification
,�Town Pumped �I Teleph ne#
No. Street I
Village
r
Owner's Name 0 l\/ !'
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: /K, C) Comment:
Hauler Information
Company: 5 cr.x1 t'
Truck No.: Date: / 4` L -(—
Driver Name: j
f f�'
Driver's Signature:
Septage Received at Yarmouth
Weighmaster Initials: Date:
Gallons Received: Ticket#: 1101 1 i1