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UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
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CONTACT PERSON �¢N@,� W /t92, ,�u'U PHONE NUMBER 6,62 73 4/ a (1,2JL 3Y.53
LOCATION OF TANKS:. CAPACITY: ..TYPE OF' FUEL. AGE: TYPE: LEAK
oORCHEMICA : - DETECTION�' �1., SYSTEM'
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DATE OF PURCHASE OF EACH: 1. 2. 3. q, 5.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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