HomeMy WebLinkAbout0092 LOCUST STREET - Health - � FR90 locust St
310-251 Hyannis
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION A/
MAP NO. �.� � PARCEL NO.
ADDRESS OF TANK: 1F �- C - -�� VILLAGE
Numb�r Ytr��t
'4
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : {{
OWNER NAME: % ' .. 'Jv:"� c:. c_' PHONE:
INSTALLATION DATE s' 1 ' 1 - 4: J BY: `
INSTALLER ADDRESS: -CERT.1-40.
*TANK LOCATION/:
/ (D C G Q Vt Z a G TANK L O Q A T Z ON W Z T H R¢O P Q C T T O m U Z L D Z N O)
CAPACITY ') TYPE OF TANK ` -' AGE YRS. FUEL/CHEMICAL cl
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ]. YES [ ] NO DATE TO BE REMOVED,i
FIRE DEPT. ' PERMIT ISSUED [ ]. YES [ ] NO DATE
\ 1
CONSERVATION [ ] CHECK IF N/A DATE -
BOARD OF HEALTH TAG NO. [ `' /_7 ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD