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UPC 12834
N®, 2-153LW aOoST•CONSJ�
HASTINGS, MN
TOWN OFBARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS OtlAs TTA
ASSESSORS MAP NO. //-$- PARCEL N0. O o f / <
tj8IIDRESS' ,` � S +�-Uy�c /fps VILLAGE �i9•�/�tJi �� �
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13 k
NAME, _
CONTACT PERSON 17 PHONE NUMBER: J'o 8 y Ze ?"'7 2_.
J'GCATION OF TANKS CAPACITY: .TYPE OF FUEL AGE: TYPE: LEAK
DETECTION
a 4 OR CHEMICAL:.
SYSTEM t
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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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PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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