HomeMy WebLinkAbout0154 EEL RIVER ROAD - Health (2) 6> 5- 0� 0�- 001 C�sT' -r- vILL�
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: IE I-- 1 I C PO MAP NO. PARCEL NO. F 10
OWNER NAME: A o, f I l L 1 1 �1R' ` VILLAGE: !� ' 'f t' r 1 /I � � �-
INSTALLATION DATE: BY: A �
ADDRESS: CERT. NO. t y i)-r
�} ],�.� 6 A TANK INFORMATION
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LOCATION OF TANK: E' z-t!- (0 .
CAPAC I TY 5 TYPE AGE 7 2 FUEL/CHEMICAL �✓ 1
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION CX7 CHECK IF N/A TYPE/BRAND.
ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES C/)(I NO DATE S (c E C!7 t7 U
GUNSERVAiION C 7 CHECK IF N/A DATE 1
BOARD OF HEALTH TAG NO. f:F"� 31 ]C ]C ] DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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