HomeMy WebLinkAbout0765 OLD POST ROAD (CT & MM) - Health Pcw- had
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'' -TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGEz'REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: IlteS I� ` /U/ .MAP NO. PARCEL NO. V (�
OWNER NAME: }�j f AM t/ � �-���� �}� !� V I LLAGE: � � T G/
INSTALLATION DATE: -!� �47 " BY:
ADDRESS: I CERT. NO.`
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If r ` .. . �✓ l TANK INFORMATION
LOCATION OF TANK: r }�"�'D�`) �`�_�•�
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CAPACITY ^!G t TYPE ^� ' AGE / t!�f S FUEL/CHEM I CAL~4
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TESTING CERTIFICATI01,N. C ] PASS C ] FAIL DATE \ ;�
LEAK DETECTION EV GHECK IF N/A TYPE/BRAND` •:
ZONE OF CONTR I BUT I ON'', -'-C ] YES' ,` C NO DATE TO BEr REMOVED
FIRE DEPT. PERMIT ISSUED " Cam] YES C ] NO DATE
CUNSERVATION C� ]CHECK IF N/A DATE / ►
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BOARD OF .HEALTH TAG'' NO. H ]0 ]C ]C ]C 1.�3 DATE
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PLEASE'PROVIDE A SKETCH. SHOWING ,THE TANK L y CATION ON THE BACK OF THIS CARD
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