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TOWN OF BARNSTABLE - 16DOEEkR660UND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. 3 Oq PARCEL NO.
ADDRESS OF TANK: " - VILLAGE:
Y �115
NIJTb�r
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME: Ake, 0�_ko91 - PHONE: 1)10_000,3
INSTALLATION DATE: !G J l 19% BY:E. Hoh-iick Hto� SeKicc -XhC►
INSTALLER ADDRESS: 0 EAayt-ick 'CERT.NO. 1952
*TANK LOCATION: ou-4 )4 tea&
(DC�Qf4I C TA K I�OQAT I N W I TH 1lQOPQCT TO mU I LD I NO/�
CAPACITY 2n 5_ TYPE OF TANK �; AGE YRS. FUEL/CHEMICAL -� �1G 01
TESTING CERTIFICATION C)(] PASS [ ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A\TYPE/BRAND I p ! p
ZONE OF CONTRIBUTION [ ] YES [� NO DATE TO BE REMOVED 04
FIRE DEPT. PERMIT ISSUED Cvl] YES C ] NO DATE
CONSERVATION [ ] CHECK IF N/AV' DATE
BOARD OF HEALTH TAG NO. C ] DATE
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
TOWN OF BARNSTABLE - UNDERGROUND FUEL` AND CHEMICAL STORAGE REGISTRATION
. MAP NO. J PARCEL NO. ( �
ADDRESS MF-TANK:: `") ) j A VILLAGE:
�"`^� Number Qtr��t
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER- NAME.e-w �C-c- .Aa PHONE: / llJ� 0003
INSTA L`ATION-DATE: SCA, MG- BY: E. Ho twic►1 see, c C,
INSTALLER ADDRESS: f(P)l Or e 04-al ' l f QV(4Ck -CERT.NO. 1 `S ' i
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*TANK LOCATION: tJ �St �toR
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F%I DC TjANK tLOOAT Z ON W S TH FRQOPQCT TO =Ud LLD S NO)
CAPACITY .L 57 TYPE OF TANK 04 .C'1 AGE YRS FUEL/CHEMICAL Qi�
TESTING CERTIFICATION C PASS C ] FAIL 'DATE
LEAK DETECTION C .].',CHECK . IF N/ATYPE/BRAND
9-1 4-1(
ZONE OF CONTRIBUTION, [ ] YES [ VNO. ' DATE TO BE REMOVEDC� "^`"
FIRE DEPT. PERMIT ISSUEyD . [ VJ'YES C ] NO -DATE
C ,�SERVATION [ ] CHECK IF N/A ti/ DATE
BOARD OF HEALTH TAG NO. C ] DATE
* PLEASE PROVIDE. A SKETCH SHOWING THE TANK LOGATION . ON THE BACK OF THIS CARD }.
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. '� PARCEL NO.
ADDRESS ''OF- TANK: U'� '("i er� si. VILLAGE: �r r l �5:S
1. _k Number Ytrw-t
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME: _f tC ��+I�. PHONE:
Ill 1� j
INSTALLATION-'DATE: )COt BY: ���
E. at'L's9& ����`�'�'� ��tU�C� •�"� `
� C rINSTALLER ADDRESS: ``jc CERT.NO. r 13
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*TANK LOCATION: r-COA
.P. r� TANK L_OQAT I ON W I TN IfGOPQCT TQ mLJ Z L_D 2 NO), +
CAPACITY �! 15 TYPE OF TANK CV1 AGE YRS. FUEL/CHEMICAL '1
TESTING CERTIFICATION" [\� PASS C ] FAIL DATE 1 fvt
.s
LEAK DETECTION C ] , CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES'a C Vj NO DATE TO BE REMOVED 0% Fr tl\ n
FIRE DEPT. PERMIT ISSUED• CVj�YES C ] NO DATE
Cb,NSERVATION [ ] CHECK IF'N/A V' DATE
HOAtD OF HEALTH TAG NO. [ ] DATE
* PLEASE PROVIDE A- S.KET.CH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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