HomeMy WebLinkAboutSeptic Pump 6/20/22 Yarmouth Septage Treatment Facility
System Identification
Town Pumped ((41 Telephone#
No. % I Street Up,to
Village
Owner's Name yC P C)
9
Use: Residence Business Restaurant? Yes No
Reason Pumped: Maintenance Overflow Blockage
Pumper's Observations - FacilityPumped
P
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: Comment:
Hauler Information-
svCompany: Z
C U(' ✓'
Truck No.: ate: '�` 7
Driver Name: ;,,' = /
Driver's Signature: /
Septage Received at Yarmouth
Weighmaster Initials: Date: 6/Z0/22—
Gallons Received: /0 00 Ticket#: 2112.)3 I