HomeMy WebLinkAbout0031 WHITE'S LANE - Health ...�,-.
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION t
I�OA DRESS: 31 MAP NO. -7 PARCEL NO.
OWNER NAME: VILLAGE: Cy of u 1 1`
INSTALLATION DATE: 01116 f 7.3 BY: a ' 1
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DRESS: �� o" ( i+ CERT. NO.
09� eP-7 TANK INFORMATION
LOCATION OF TANK: 5`0
CAPACITY L 0 TYPE - '� AGE 1_ FUEL/CHEMICAL
TESTING CERTIFICATION C ] PASS C I FAIL DATE
LEAK DETECTION 6e'3 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C 7 YES 01 NO DATE'' T.O BE REMOVED
FIRE DEPT. PERMIT ISSUED Cam"] YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ %E ]C ]C ]C ] DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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