HomeMy WebLinkAbout2884 FALMOUTH ROAD/RTE 28 - Health q o` $'�y lam✓-�)mow�� � ��-VlL.l-�.
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alwood (AKA 4632 Falmouth/Rte076 ,,
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UNDERGROUND/FURL AND CHEMICAL STORAGE,SYSTEMS
ASSESSORS MAP NO. >1 PARCEL N0:
ADDRESS: �0 "/ 7 /`� y Val VILLAGE
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CONTACT PERSON PHONE NUMBER
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK
OR CHEMICAL: 76 DETECTION
. 1 76 SYSTEM
DATE OF PURCHASE OF. EACH: 1. 2. 3.
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DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: � G�.cP�l�l_ PASSED DID NOT P S
PLEASE PROVIDE A SKETCH SHOWING THHE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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f - JUL 03 `91 15:47 CENT.0-T.FIRE DEFT. - F'. 'ice
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Department of Public Safety
Division of Fire .Prevention and 'Regulation
7
AMUCAT" M ' AND PERMT. FOR REMOVAL AND TRANSpOMATION TO APPROVED TANK YARD
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FDIp# _ permit # $10.00
Date JULY':-'3, 91
CENTEIZV2T,LE(TOCiTN, f BA NSTABLE)
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Fee Paid:S DXG SAFE IIUMBER
start date 3/ 1
In accordance with the provisions of Chapter 148, Sec. 38A, H.G-L ,
527 CMR 9. 00 application is hereby made by: LEW-MAc
Street Address & City or Town: BOX 55, OSTERVILLE, MA
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Applicants name printed:
For permission to remove and transport one underground storage tank from
Owners E.02KOwSKI
Street Address: 2884 FALMOUTH ROAp, OSTERVILLE, MA
Firm transporting wasterTJAII
-State LiC. #
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Hazardous waste manifest #
Approved tank yards MIT) CITY SCRAP # I2889
Tank yard Address! WESTPORT, MA
Type of inert gast UL tank #:
Tank capacity: 50Q CAI, substance last stored:
Date of issue: .DULY 3, date of exp rat J Y I7,
Signature/Title of Officer granting permit:
KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE
AS PERMIT --