HomeMy WebLinkAbout0658 MAIN STREET (COTUIT) - Health ���' r'��.ir� ���n�—
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TOWN OF BARNSTABLE #'",=UNDERGROUND FUEL AND CHEMICAL. STORAGE REGISTRATION
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DOWNER AND INSTALLER INFORMATION 31&lqo
ADDRESS: b s lw), Jj xo no 1 MAP NO. PARCEL NO. D 3b
4i 7k v . ry 1
OWNER NAME: l Z� �S / 1� 8 ��� S-S VILLAGE: PAC D/
INSTALLATION DATE:'', /,o 7� BY: /��+ lP?,�1 f ,l f�tt S�� l�E ea r ,�J 6 a 1 rlt�t
1 M t-3 CERT. NO.
ADDRESS: �/" 1 S
�TANK INFORMATION"
LOCATION OF -TANK.- f /w
CAPACITY J/ 41,1TYPE F l'C6 0 AGE;i ! FULL/CHEMICAL II L
TESTING CERTIFICATION, C ] PASS _C 3-"- A`,T ATE
41
LEAK DETECTION E$l CH -ICK IF N/A TYPE/BRAND.'a
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ZONE OF CONTRIBUTION ] YES C ] NO DATE TO BE Ey I q"
FIRE DEPT. PERMIT ISSUED 1 a If-AS 4 ,Q!!el NO 4. DATE
CUNSERVA i ION C-'] jCHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C J C ]C ]C J DATE r �9 lL
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON TH� Bift OF THIS CARD
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