HomeMy WebLinkAbout0145 SANTUIT ROAD - Health (2) o31-p9y Cofa��" '�
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'TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION „ " •-'
ADDRESS: U• \ra Yl t t 1 1 t"\C3 MAP ENO. ( PARCEL NO.
OWNER NAME: 1J C�.M.Ana n µ ., �l ►P! VILLAGE: CO-rl A ► I
INSTALLATION DATE: Cl— tD BY: Ate Ani\ c� m_t. l C1F c—
ADDRESS• 1` CERT. NO.
;rp( � rJ TANK INFORMATION
LOCATION OF TANK:
MO 5
CAPACITY SIG' TYPE rn AGE- FUEL/CHEMICAL A r�
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YTESTING CERTIFICATION E I PASS E 3=",FAIL DATE
LEAK DETECTION E I CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION- E 7 YES E I NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED E ] YES - , E I NO DATE
CONSERVATION . E I CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. E ]E. ]E ]C ] DATE
PLEASE-;PROVIDE A,,:,SKETCH SHOWING:. THE'JANK LOCATION ON :THE .BACK ,�OF- THiS CARD
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