HomeMy WebLinkAbout0088 BRIDGE STREET - Health �Ut�YL�
CEUTERVILLE-OSTERVMLE-MARST015S MWLS
FIRE DISTRICT
1875 ROUTE 28
CIERTERVILLE,MA 02632
(508) 790-2380 JIF AX O(505) 790-2385
OILMAZARDOUS MATERIAL RELEASE FORM
F.A.R 07-A-f35L)S
LOCATION:
ADDRESS OF RELEASE: RA RRTnr.F RTRFFT
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NOTIFICATIONS:
F IRE DEP ARTMENT: YES(n) NO( ) D ATE T/15/pT T IME: n
NATIONAL RESPONSE CENTER YES( ) NOV DATE: TIME:
DEPT.OF ENVIRONMENTAL PROTECTION YES( NO(o DATE TIME
.; OIL SPILL COORDINATOR: YES( ) Nam) D ATE TIME:
TOWN BOARD OF HEALTH: YES( NO( ) DATE• T,/ s/Q7 TIME: l ngs
TOWN HARBORMASTER: YES( ) NO(r4 DATE:-TIME:
OTHER AGENCIES
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REPORTED BY: L� �€ !�t 1.l ,.,� r"? DATE' T/I S/Qa
WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-LARD OF HEALTH
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