HomeMy WebLinkAbout0120 EEL RIVER ROAD - Health ..n'
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TOWN OF BARNSTABLE — UNDERGROUNDFUEL AND CHEMICAL STORAGE REGISTRATION
!! OWNER AND INSTALLER INFORMATION
c A,7DRESS: r ^fJ QSa.liewl 1 \MAP NO. t f b PARCEL NO. Sr
OWNER NAME: I'`r i� PI i� , if'r / t' +f W �-� S VILLAGE: St�rJ l/P
INSTALLATION DATE: tln Y%d 1.1.,1% BY:
�._A�DRESS_ CERT. NO.
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— 1.,,,,!7/ TANK INFORMATION'
LOCATION } Y G-F_OF TANK:
CAPAC I TY!000 TYPE S L AGE a kK4 FUEL/CHEMICAL Z-
TESTING CERTIFICATION C ] PASS C ] FAIL DATE '
LEAK DETECTION CHECK IF N/A TYPE/BRAND
` + :ZONE ,OF',CONTR'IBUTION C--.71 YES,',.C„ ], NO ::_ .DATE TO _BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES Cf] NO DATE
{ UUNSERVAiION C 7 CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. J C ]C ]C -, ] DATE
PLEASE PROVIDE- A_ SKETCH:!,'SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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CENTERVILLE *" z V K+- OSTERVILLE FIRE DEPARTMENT
} Y r F PERMfT FOR STO
PAGE OF FUEL OIL z
+� In accordance with provisions of Chapter I48, G.L. and Re
w made under authorityRe"
thereof.
Name d
s..HOW3� '� � •*
(owner or occupant) '. Nome AwA,ltr!=•4�• 6IQ Y
'Address 120 Ee1.. ,� ' ' (Installer)
k _ dw Address QSI�PY ],g^• �4
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Manufacturer ..� �a*�.A..
Type of Tan k
wn, gw...... Capacity ...��QQ. gals. (or) Size..--' �.�
! Model No or Size .• 10 (• rY'
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Location UUdeX9r-Q1Md p.
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ass APP No
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issued :L.. ...........
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... �ep
ent
..................... ........... By
T (THIS PERMIT MUST SE CONSPIGUOU557 POSTED U ...........
•••• •.• •
N THE PREMISES)
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