HomeMy WebLinkAbout0426 OLD POST ROAD (CT & MM) - Health Z{a�
Ako V l .+ G ik" l#sue. ;. r.r :�,.rf°iw o' t; •.,- _ *. ..
TOWN OF BARNSTABLE —UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: 0'o MAP NO. r PARCEL NO.�
OWNER NAME: (>: .�'1 VILLAGE: t
INSTALLATION DATE: = 'By:
A DRESS: `JC 7 z)6 t IST• r CERT. NO.
!V L% 0 c/ ( TANK I NFORMAT•fiON—M. .:-- ---_--
LOCATION OF TANK:
CAPACITY 0/2 75 TYPE — AGE FUEL/CH MICAL
*j�*
TESTING CERTIFICATION• C ] PASS C ] FAIL LATE
LEAK DETECTION CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C A YES C ] NO DATE (w1.11 aG 0
CUNSERVATION EX CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. 60 ]C ]C ]C ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
140,
/yJV
Tall
�t-