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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION ,
• 7 " /
71,
OWNERNAND INSTALLER INFORMATION � ' . h
ADDRESS: C-flla
% +71f MAP NO. PARCEL NO. I
OWNER NAME:1 \ ,i R t'k�, y k1 I & /i ,f' VILLAGE:
INSTALLATION DATE: �BY:
ADDRESS: CERT. NO
4
TANK INFORMATION
LOCATION OF TANK:
CAPACITY A%_1 -4 —TYPE .r AGE , > FUEL/CHEM I C'flL ("�
� , >-j\ � .--/ �(
TESTING CERTIFICATION-- t I PASS -C--'] -FAIL DATE
LEAK DETECTION C 7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C 7 YES C ] NO DATE TO BE REMOVED
FIRE. .DEPT. PERMIT ISSUED C ] YES C ] NO DATE
GUNSERVAiION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C ]C ]C ]C ]C ] DATE J/ ks PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CAR J,
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TOWN OF BARNSTABLE
y�f 1NE TD
OFFICE OF
.s�►na TAM BOARD OF HEALTH
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NABS. 367 MAIN STREET
t679. HYANNIS, MASS. 02601
1988
Dear Ar
Enclosed is brass valve tag #_�!Q_ . Please attach to
the fill pipe of your underground tank .
You must do the following as indicated.
- ,- Remove your tank . I have enclosed information for you
regarding tank removal .
---- Have your tank tested starting now . You must test
during the 10th , 13th, 15th, 17th and 19th year and
annually thereafter. Removal in the year I
have enclosed information regarding tank testing . In
order to have your tank tested you must first contact an
Company (see att-noltP.0) to.jinve a monitoring
well installed . Once the monitoring well has been .
installed you can then call 362-2511 , Ext. 334 and ask
for Charlotte Stiefel or George Heufelder at the
Barnstable County Health Department, to have your tank
tested via the Soil Vapor Analysis Test. Currently, the
test is done free of charge under the auspices of an EPA
grant.
_ Due to the unknown age of your tank we must presume it
is twenty (20) years of age. You must have it tested
every year and remove it by the year 1993 . To have it
tested please follow the procedure as . indicated above
from the ** (asterisk) on .
If you have any questions please feel free to call me at 775-
1120, Extension 183.
17, Thank you,
Don
na MioLi�
Health Inspector