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TQKN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
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MAP NO. t - PARCEL NO.-A ty
ADDRESS OF TANK: �j l�XAM�YllIt) WA V VILLAGE: (207 u
Numbmr,
MAILING ADDRESS ( IF
(( IF p DIFFERENT FROM ABOVE) :
:
OWNER NAME: f ./ 1�IV�. "S A 0` rA YiV..,�. PHONE:
INSTALLATION DATE: I � BY:
INSTALLER ADDRESS: -CERT.NO.
*TANK LOCATION:
�717TYPE (DC¢Of9=�G�,,,TANIC LOOAT S ON W S TH Pf¢CP¢CT TO mIJ 217�S NO) � )
CAPACITY OF TANK AGE YRS. FUEL/CHEMICALa , L-�
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE .
CONSERVATION [ ] CHECK IF N/
A DATE J
BOARD OF HEALTH TAG N0. [ ] DATE 7 #^ "
PLEASE' PROVIDE . A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
TOWN OF BARNSTABLE ' I G !/I o
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
ASSESSORS MAP NO. PARCEL NO.
,WDRESS; UC k vt � vu Dcu VILLAGE' (°-8+tAi t
NAME;:.._. f r vv-r-i-S
CONTACT PERSON 5 PHONE NUMBER
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK
OR CHEMICAL: DETECTION
to r i. Silo, tsf k b U (�L-J �i 611 .h�aT�s, � SYSTEM.
DATE< OF PURCHASE OF. EACH: 1. (�j �__ 2. 3. 4. 5. p
DATE OF° FIRE DEPARTMENT PERMITS
TESTING CERTIFICATION, SUBMITTED: PASSED DID NOT PASS
PLEASE PROVIDE A`SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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THE. The Town of Barnstable
• Health Department
367 Main Street, Hyannis, MA 02601
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Office 508-790-6265 Thomas A. McKean
FAX 508-775-3344 Director of Public Health
October 1, 1992
Dear Mr. Fayne:
Enclosed is brass valve tag #1110. Please attach to the
fill pipe of your underground tank.
You must do the following as indicated:
---- Remove your tank. I have enclosed information for you
regarding tank removal.
XX Have your tank tested starting NOW. You must test
during the loth, 13th, 15th, 17th and 19th year and
annually thereafter. Removal in the year 1997 . I have
enclosed information regarding tank testing.. ** In ---
order to. have your tank tested you must first contact
an engineering company (see attached) to have a
monitoring well installed. Once the monitoring well
has been installed you can then cal 362-2511, extension
334 and ask for Charlotte Stiefel or George Heufelder
at the Barnstable County Health Department, to have
your tank tested via the Soil Vapor Analysis Test.
---- Due to the unknown age of your tank we must presume it
is twenty (20) years of age. You must have it tested
every year and remove it by the year DEC 1993. To have
it tested please follow the procedure as indicated
above from the ** (asterisk) on.
If you have any questions, please feel free to call me at
790-6265.
T k you.
n e e
Donna Miorandi
Health Inspector