HomeMy WebLinkAbout0614 BUMPS RIVER ROAD - Health ��F'�L.�
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A/ SMEA®
No.2153L BE
P UPC 12034
emaad.com • Made In USA
TOWN OF BARNSTABLE VA LU _94
-'- UNDERGROUND' FUEL-ANV CHEMICAL STORAGE SYSTEMS
ASSESSORS MAP NO. ! C PARCEL NO..
ADDRESS,' I �l .�/ t `5t VILLAGE ��! !- ► `'
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NAME APA AJ A
CONTACT PERSON (- A f®- $1 1 o4—` #4AfPHONE NUMBER `7
,.LOCATION OF' TANKS: CAP CITY: .TYPE OF FUEL AGE: TYPE:. _. LEAK
.. OR CHEMICAL DETECTION
( ) SYSTEM!
DATE OF PURCHASE OF. EACH: 1. to 3 2. 3. 4. 5.
DATE.`OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
PLEASE PROVIDE A SKETCSHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. ,,/
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