HomeMy WebLinkAbout0070 CAILLOUET LANE - Health (2) �'� �°,•�xL.GouET LANE
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHfEMIfCAL STORAGE REGISTRATION
MAP NO. r + PARCEL NO.
ADDRESS OF TANK: r VILLAGE:
• Number � Otr��t ,,.�'-o
MAILING ADDRESS ( I F D I FFERENT FROM ABOVE)
OWNER NAME: I $fl) � �L^ PHONE:ic-
INSTALLATION DATE: � + 7
INSTALLER ADDRESS: " 1 j,F ZCERT.iJO.
*TANK LOCATION: �J�'1.2'i`�•� � � �.����t� �v�,���-- ��/ ��'�=�.tl��,.`�"�'��5� �..-
--d„�� acaow s a¢ TANK LOQA,T^�Z ON W S TH 1lQOPCCT TO aU I LD Z NO) i� ,,�
CAPACITY TtY11PE OF TANK AGE /•- Y_RS..__.FUEL/CHEM I CAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ]4CHECK IF N/A TYPE/BRAND t
ZONE OF CONTRIBUTION [ ] YES [ , ] NO DATE TO BE _REMOVED �s�J !
FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO DATE
CONSERVATION [ ] CHECK IF N/A 'DATE
BOARD OF HEALTH TAG N0. [ ..� =.]: DATE ./1 C� t
* PLEASE PROVIDE . SKETCH SHOWING THE TANKLOCATION.;, ..•„ ,. . , , _ E A G E ON THE HACK OF THIS CARD
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TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAME
ADDRESS 0 Ql. 1 L- L Q 6-t; — M v E VILLAGE
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
s
OR CHEMICAL
N 1� or - �.000 ��skL
L21
0
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(Give same information for any additio a1 tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING,CERTIFICATION SUBMITTED:
PASSED DID NOT PASS
FROM THE DESK OF.
R. B. Sellars
3/24/80
Town of Barnstable
Office of the Board of Health
397 Main Street
Hyannis;Ma:s-sachus-etts 02601
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The new fuel tank was installed by
Mr. Carl Riedell, a. plumbing contractor
from Osterville, Massachusetts and he
ca.n. and will provide any additional
information required by your department.
is
/r
Attachment