HomeMy WebLinkAboutSeptic Pump 4/22/20 YARMOUTH - DENNIS SEPTAGE TREATMENT FACILITY
\6 a�_ System Identification
Town Pumped Telephone#
No. Street f t)°'«eti
Village
Owner's Name: .0 se" . I/
Mail Address:
(if different)
Use: Residence r' Business Name
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations
Facility Septic Tank Cesspool Converted Cesspool
Pumped: Holding Tank Leach Facility Grease Trap
Cover within 1 foot? Yes No Back Flow? Yes — No
Gallons Pumped: Comment:
Pumped By
DLicensed Pumper:
,F.xcta(�¢-` 5P IC
Truck License No.: l l— Dale: 4— o/O
Driver Name: )1 j
1 r% d
Signature:
Septage Received at Yarmouth - Dennis
Approved by: Date:
Received: Gallons Ticket#