HomeMy WebLinkAbout0100 TERN LANE - Health 100 Tern Lane
Centerville
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SMEAD
No.2-153LOR
UPC 12534
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HL/2 7/2012M I 07:33 Ali C.0.M.M. Fire Dept FAX No, 508-7 60-238F P. 001 �)
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CENTERVILLE-OSTERVILLE-M�kRS` ONS MILLS FIDE DISTRICT
DEPARTMENT OF FIRE-RESCUE & EMERGENCY SERVICES
1875 Falmouth Road, ate. 28 Emergency Number:
Centerville, MA 02632-3117
Business: (508)790-2375 John M. Farrington
Facsimile: (508)790-2385 Fire Prevention/Administration Chiei of Department
Facsimile: (608)957-8239 Dispatch Center
FAX COMMUNICATION MESSAGE
DATE' 49
TC: PHONE: %- 41 b (AW
ATTN: y�
FROM: FPD
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WE ARE SENDING D ( + )PAGES, INCLUDING THIS COVER SHEET,
PLEASE CALL(508)790-2375 IF YOU DO NOT RECEIVE THE TOTAL NUMBER OF PAGES.
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transmission to us by mail or delivery at our address above. We sh211 cover the cost of return mail. Thank you!
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JUL/27/,9012/FR I 07:34 Alf C.0.M.M. Fire Dept FAX No. 508-760-23H P, 002
Make appjjoat c)rt to local Fire DeportmenlL
Vire Department retains orlginai application and lssut�-,dupiloate as Parmli.
(•'O�i'�'l�txt.G+�a'fell �� t ��7/ff,Ldb� �,.� � '
°' /�1-4�l�.(/K�/�C'fl✓�� k���r/A'RXC7E'i — `C:' GCIl t��A"icd'�/�X�L�.9'�i%!�{<�,/l�Hdl�ir,�
. PLICATE and PERMIT Fes: 25.Oo
for storage tank removal and transportation to approved tank disposal yard in a r nce with the provisions
of M.G.L.Chapter 1G.1 ,'Section 38A,527 CIVIR 9.00,apaficatian is hereby rn a by
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lank Owner Name(please print) JAMI R FARHADI x
WqO
Address 100 TERN-LANE CENTERVILLE2
straar p(Y Mara ZIP
Cornpapy Name TANKS A LOT _.. Co,or Individual
Prat
Ad s 11 CHOOL ST,JEY.FLRETT, MA ,Address
WCj
rmtt• SignatureIr Cl`C ie Other Ee her
n e
Tanki_ocaticn 100 TERN LANE _ CENTERVILLE- .
'4"r exy
Tonic Capacity(gallons) 2,000 Subst nco Last S ored 42 FUEL OIL
Tank Dimensions(diameter x length) 43 X 27 X 60
--- __EMPTY-
..---.._,.... - Remarks; - --- . .... . . . . -_..._.._
Tt d
Firm transporting waste TAN KS-A-LOT data l lc.#1 MAV00D019924
Hazardous waste manifest# F-P.A.1*.
Approved tank disposal yard GRANT'S Tank yard#f___007- - -.
Type of Inert gas.- Tank yard addroas HYDE PARK MA
Cltyor7own CENTERVILLE FDID#f 01920 pem,it# 004638 ^
Dais of issue JULY 26, 2012 Data of expiration JULY 28, 2012
Dig eafe approval numbers 2012-28076 Safe 1A Fr er 500-322.4 444
14
signature!Titre of Offlcer granting permit . f Vku Aj V1zWY_
After removai(s)("Gonsumptive use fuel oil ianks exampled)send Form FP-29OR signed b1r Local Pire Dept,to UST Regulatory
Compllar►j�s Unit,Department of Fire Servloes,P.C.6ax 1025,State goad,Stow,MA 01775.
'International Fire Code Institute
PP-292(r®visad 4/97)
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