HomeMy WebLinkAbout0138 HINCKLEY CIRCLE - Health J'
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL :STC!R—AGE REGISTRATION
!3 if i 7F > f• OWNER AND INSTALLER INFORMATION
ADDRESS: ( 1,,i—r1 ' MAP NO. PARCEL NO. ,-
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OWNER NAME: VILLAGE:
INSTALLATION DATE: —z _I BY:
ADDRESS: , •� '7`// /" ( /d' � f-P CERT. NO: t`ca
TANK INFORMATION
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LOCATION OF TANK:
CAPACITY � TYPE p ./ AGE —�= — FUEL/CHEMICAL-- r
TESTING CERTIFICATION C ]' PASS C ] FAIL DATE
LEAK»DETECTION C .] CHECK IF N/A TYPE/BRAND t'
.ZONE OF CONTR I BUT I ONE . `YES. C ] NO DATE 0"Blz fREMOVED
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CONSERVATION C ] CHECK IF' N/A DATE
BOARD OF HEALTH TAG NO. �)C. ]C ]CYr. ]C ]. DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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JUL 03 '91 15:48 CENT.OST.FIRE DEPT. .8. 3
� aFORM P.P. 292
(rev. 9/90)
alit 0011int 1ill"PU10 of Admadriptottto
Department of Public Safety
Division of Fire Prevention and Regulation
Af*UGATION FQA PERMIT, AND PSWO FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD
FDID# Q1220 permit Date_ JULY 3, 91
CENTERVILLE(TOWN OF BARNSTABLE)
G ,t n or 01s»�� 7 31q/
y C . 82 S . 40 M . G . t .
E& t;>O e,7— DIG SAFE HUMSER
Fee paid:s / . bC�_
start, date 7/2/91
In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L. ,
527 CMR 9.00 application is hereby made by: ,' TANKS UNLIMITED
Street Address & City or n: PO BOX 178, 'N0. FALMOUTH, MA 02556
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Signature of applicants
Applicants name printed t
For permission to remove and transport one underground storage tank from.
Owners Street Address: 138 HINCKLEY CTRCLE, OSTER.VILLE,MA
Firm transporting waste: SAME State Li,c. # �
Hazardous waste manifest # E.p.A. #
Approved tank yards A.W.MARTINS
Tank yard Addpesst
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Type of inert gast co � UL tank #::
Tank capacity: 275 OAL. substance last stared: #2
r Date of isSue2 JULY 3 91 Date of expiration: JULY 17, 91
Signature/Title of Officer granting permit:'
KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS ,HERMIT
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