HomeMy WebLinkAboutSeptic Pump 6/20/22 Yarmouth Septage Treatment Facility
, System dentification
Town Pumped //{'�0 Telephone#
`' !,� 1/0W \
No. Street � -
Village {
Owner's Name ' /' ' {'
Use: Residence Business Restaurant? Yes No
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Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - Facility Pumped
Septic Tank Cesspool Z 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: Comment:
Hauler Information
Dt. rouI.! s.o (71'
Company:
Truck No.: ate:
Driver Name. 63)
Driver's Signature: l f
Septage Received at Yarmouth
Weighmaster Initials:
Date:
Gallons Received: Ticket#:•
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