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HomeMy WebLinkAbout1500 MAIN STREET (COTUIT) - HAZMAT c TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION --. , ADDRESS: �`' - MAP NO. PARCEL NO. v OWNER .NAME: Ave" � ' � ��1�� VILLAGE• tom~�^ti r. ^� �,�, .t ' 1 Q INSTALLATION DATE: BY: r ADDRESS: CERT. NO. lod� 0 it �- ' - 6 � 'TANK INFORMATION i LOCATION OF TANK: A0AlQi V )Ve4/-re,y 1 CAPACITY,5-0 7 TYPE AGE FUEL/CHEMICAL TESTING CERTIFICATION C ] PASS C I FAIL DATE t. PF LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBJTION C ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES C 7 NO DATE CUNSERVATION C ] CHECK IF N/A DATE a BOARD OF HEALTH TAG NO. ]C ]C 3E 7 DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD r - T POO r TOWN rOF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION * OWNER AND INSTALLER INFORMATION `. ADDRESS: "` � w~ MAP NO. PARCEL NO. . '71 OWNER NAME: N11 E .SS �I VILLAGE,; 4,T wry �` 1 INSTALLATION DATE: Ag BY: PO ADDRESS: ' RERE T NO.'. ` ash try TANK\-I-NFORMATION , LOCATION OF TANK: I 1 t /©yS�- PSx,+�� t�' ^`1 ,d �t/ ,Ake IIJ J, CAPACITY lne© 6h4 TYPE Z;) AGE %i .l FUEL/CHEMICAL " 7141— 0 f TESTING CERTIFICATION C I PASS C I FAIL DATE LEAK DETECTION C I CHECK IF N/A TYPE/BRAND LL� ZONE OF CONTRIBUTION C I YES [Al NO DATE TO BE REMOVED 11 9 FIRE DEPT. PERMIT ISSUED C ] YES C 7 NO DATE CUNSERVATION C I CHECK IF N/A DATE BOARD OF HEALTH TAG NO. V 7C ]C 71 ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD I �G y 7 C4 T �r OORL