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UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS' V � "
ASSESSORS MAP NO. PARCEL NO. ®
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CONTACT PERSON TV.o-m,, ,y, ®S C PHONE NUMBER ov
LOCATION OF TANKS; . CAPACITY: TYPE- OF' FUEL AGE: TYPE: LEAK
OR CHEMICAL, DETECTION
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DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
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