HomeMy WebLinkAbout0155 CHASE STREET - Health 155 Chase Street Sewer Acct # 3781
Hyannis -
A = 307 - 164
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Make application to local Fire Department. PL '
Fire Department retains original:application and issues duplicate as Permit
Wommo~",&X X(.oeM LO
APPLICATION and PERMIT Fee s
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
Tank Owner Name(please print) a }�_ �; ���,��-P X
l � nue app4'�9 Pemu
Address 15 5 is )4C• SL S -
sraer CWY State Zip
Company Name _1 vn (-Z`fYt0L'0 SCai2 V(�, Co.or Individual PrW
Address f L Z 1 !) ,4 V e Address
Signature g for rmit) _ / f Signature(if applying for permit)
.0 IFCI'Certified Other -
_- - - 0lFCI'-Certified 0 LSP# Other
Tank Location �� 01 4A S e
stool Address city
Tank Capacity(gallons): 5�- �aa p Substance Last Stored l 01,
Tank Dimensions(diameter x l'en-gth)
Remarks:
DIE
Firm transporting waste 1-U'� 0 1 urn'7 State Lim# /
Hazardous waste manifest# E.P.A.#
7AG ��Z
3 �
Approved disposal ardf
PP tank P osaf Y � T l ank yard#�-O y i3�2i,S
Type of inert gas Tank yard address S
City or Town � �iJt��� FDID# Permit#
Date of issue / S/ 7.e 4fevof expiration J�
Dig safe approval number _ ..g. �- Dig Safe Toll Free Tel. Number-800-32 44
Signature/Title of Officer grantrng°perm►tf
After removal(s) ("Consumptive Use fuel oil tanks exempted)send Form FP-290R signed by Local Fire Department to Office of the
State Fire Marshal,UST Regulatory Compliance Unit,P.O_Box 1025, Stow,MA 0 5.
'International Fire Code Institute
:P-292(revised 4/97)
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Ba f rnstable
FmdMaplP�arcelK; 307164 I HealthrDe�ertm'entHeatt'hS stem '
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T nk Nbr Tag Nb✓ 0 Ie Instaif d Location r
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,�1"est Not�fication�D to � �' � Status � '�� ®ate
/,�'YT,KempvaI Notfication®ate1
Abandon r
"Removal " 05/08/2006
' ,. l/anamb °
Fuei!St pre d FO Fuel Storage Reaso H
�,, Capaety Gonstructao'n Lea�f]etectNon Cathodic Detection
StorageT nk Info 500 s
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AdditWria No leaks
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