HomeMy WebLinkAbout0809 MAIN STREET (COTUIT) - Health �r� fnatn ���—.
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: 111AW S+- MAP NO. PARCEL NO.
OWNER NAME: VILLAGE: 1
INSTALLATION DATE: PZ L/ BY: KC1
ADDRESS: CERT. NO.
TANK INFORMATION
LOCATION OF TANK: tt
CAPACITY �Zate'd TYPE T .. AGE qb-t FUEL/CHEMICAL
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION Ctf47 CHECK IF. N/A TYRE/BRAND
ZONE OF CONTRIBUTION C . ] YES C ] NO DATE TO BE REMOVED V11
FIRE DEPT. PERMIT ISSUED C ] YES C 0--NO DATE
CONSERVATION CV] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. j] ]C ]C ]C ] DATE f f I
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PLEASE PROVIDEhA SKETCH SHOWING THE •TANK LOCATION.; ON, THE_,BACK OF THIS .CARD ,
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