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HomeMy WebLinkAbout0209 RALYN ROAD - Health (2) o� � (�o� a ©57- - C e9 emu/ TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OfW�VNlER AND INSTALLER INFORMATION nqADDRESS: Q 1« I MAP NO. PARCEL N,O. r i OWNER NAME: VILLAGE: / INSTALLATION DATE: BY: ADDRESS: CERT. NO. p fiuj`SEA"' *Rg-�5-0036 TANK INFORMATION LOCATION OF TANK: OIL AGE HN-FUEL/CHEMICALI�U F 6L,CAPACITY 1FJ� TYPE ,�l� TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION C�, ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES C NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES C ` NO DATE UUNSERVATION C ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. 1611 ]C ]C ]C ] DATE (3�✓ y 1 PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD 1 1 I 1 � I i s a I r r 1