HomeMy WebLinkAbout0400 POPONESSETT ROAD - Health boa Papo� ewe,-/� /1a�
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
S
ADDRESS: �� � ' ` - ' '" %� MAP NO. 0/1 PARCEL NO.
OWNER NAME: VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: E CERT. . NO �
' o - . .
TANK INFORMATION
LOCATION OF TANK:
CAPACITY TYPE AGE UEL/CHEMICAL '.
1
TESTING CERTIFICATION C ] PASS C ] FAIL ! DATE
LEAK DETECTION 43 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION�/II��''\\\\\ C 7 YES C I NO DATE TO BE REMOVED !J
3 - -
FIRE DEPT. PERMIT ISSUED EA3 YES C ] NO DATE
LUNSERVATION C ]CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. Eo ]C ]C ]C ] DATE .J l r U Co fl)/Tr
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
l
. �
d
�V
+ar