HomeMy WebLinkAbout0355 EEL RIVER ROAD - Health .335 �Z-L 1�I✓El2�otAJ �=
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: RD 0 MAP NO. PARCEL' NO. �-
OWNER NAME: f"'7�i �I� i � VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: o Q V0V _ ♦ CERT. NO.POr� �o` U 0 � v
ANK INFORMATION
LOCATION OF TANK: IVA
PI
CAPACITY l ^D0 TYPE AG /)Vtt/ FUEL/CHEMICAL 01-- 16l�
7 �
TESTING CERTIFICATION C I PASS C ] FAIL DATE
LEAK DETECTION CX7 _CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C I NO DATE TO BE REMOVED Al-
FIRE DEPT. PERMIT ISSUED C I YES CX NO DATE
CUNSERVATION C CHECK IF N/A / \ DATE
BOARD OF HEALTH TAG NO. 0 JC ]C ]C ] DATE �✓ lJ
LEASE PROVIDE A SKETCH S OWING THE TANK LOCATION ON THE BACK OF THIS CARD
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