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Septic Pump 4/27/20
YARMOUTH - DENNIS SEPTAGE TREATMENT FACILITY / (vw System Identification Town Pumped ' 6((°'(( J Ad) (),,,,. __ Telephone# rfe77 No. Street Village Owner's Name: J L1 &I/ ����� Mail Address: (if different) Use: Residence 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— Ncr Gallons Pumped: Comment: Pumped By Licensed Pumper: 1 Truck License No.: Date: . / /' f, Driver Name: Signature: 1 Septage Received at Yarmouth - Dennis 1 IApproved by: Date: Received: Gallons Ticket#