HomeMy WebLinkAbout0131 MAIN STREET (COTUIT) - Health (tQ,
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TOW1N/ OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: f.�1 � �/U �� (".. / MAP NO. 0 q PARCEL NO.
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OWNER NAME:' ` a, ��C MALL L 1�tl 169f V I LLAGE:
INSTALLATION DATE: '! BY: IAI
ADDRESS:DannC7�C ! ! l.CJ� 1dV CERT. NO.
r- t� TANK INFORMATION
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LOCATION OF TANK: p /,1yD r 0(), ' 1-Q 1..�- � OF c L as6f� I7
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CAPACITY TYPE ��") AGE FUEL/CHEMICAL t�L.% / � 0! L
TESTING CERTIFICATION C I PASS C ] FAIL DATE-rO
LEAK DETECTION C I CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES C NO DATE TO BE REMOVED C �JtJ
FIRE DEPT. PERMIT-0-ISSUED C 7 YESy CX NO DATE
CUNSERVATION CX] CHECK IF N/A DATE
BOARD OF HEALTH TAG
,, `NO. q C ]C ]C JC ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD