HomeMy WebLinkAbout0011 COVE LANE - Health MP17
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL (S)
Im ^ACC
DATA
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: MAP NO. PARCEL NO.
OWNER NAME: VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
TANK INFORMATION
LOCATION OF TANK:
CAPACITY TYPE AGE FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION C CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C I YES C I NO DATE
CUNSERVAiION EA CHECK IF N/A DATE f
BOARD OF HEALTH TAG NO. #H ` ]C ]C ]C ] DATE >
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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