HomeMy WebLinkAbout0886 MAIN STREET (COTUIT) - Health (2) — — \ C'Qi-�cu-E— � -035-0�7 �
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
{�p OWNER AND INSTALLER INFORMATION
ADDRESS: MAP NO. OYX PARCEL NO '
OWNER NAME: �la/���s /! iq!-Zew ZA tf Z VILLAGE: ( ,)7-ly 1 T" `u
INSTALLATION DATE: /��� F BY: 141i.r-r 4t. //�AR T'AJrZ•
ADDRESS: .¢ I ` � CERT. NO.
T TANK INFORMATION
LOCATION OF TANK:
CAPAC I TY TYPE •. % L. AGE J FUEL/CHEM I CAL
TESTING CERTIFICATION E ] PASS E ] FAIL DATE
LEAK DETECTION E ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION E I YES E,�] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED ,Y] YES EYI NO DATE
CONSERVATION E ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO-3Q13 ]E ]E ]E ! ] DATE. i
PLEASE PROVIDE.,A SKETCH SHOWING THE TANK LOCATION ON THE BACK .OF THIS CARD '
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