HomeMy WebLinkAbout0115 CAP'N CARLETON'S RD - Health (2) /�5Ca-p 'n Came-1o�s Rocee�
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
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ADDRESS: fTT.
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OWNER NAME: !- ;��� L / t l VILLAGE: Ty/ 7—
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INSTALLATION DATE: B - BY:
ADDRESS:
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' TANK I N?FORMATION i
LOCATION OF' TANK: O \!-D f-in ^of/A
CAPACITY TYPE S �' I AGE FUEL/CHEMICAL
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION C ]. CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES C NO DATE TO BE REMOVED
FIRE DEPT. PERMIT _ISSUED EY3 YES C ] 'NO DATE
UUNSERVAIION C ] CRE
IF N/A DATE
BOARD OF HEALTH TAG NO. ]C ]C ]C ] DATE K
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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