HomeMy WebLinkAboutSeptic Pump 7/25/22 Yarmouth Septage Treatment Facility
System dentification
Town Pumped /011/I ` , T^el phone#
No. i j' Street ( $ )1 �t
Village
j°(-010",
I-<Uk1i1
Owner's Name
Use: Residence Business Restaurant? Yes No
rr
1 '
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 ,k._...
Gallons Pumped: l0 V Comment:
I
Hauler Information
Company: (, of r
2 =Truck No.: Date-
‘
, )
Driver Name:Driver's Signature: a'
1
Septage Received at Yarmouth J
Weighmaster Initials: G.- %� 7,/o'C /t 4"
�` Date:
Gallons Received: .7 Ticket#: JJ 0 o