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KEEPING YOU ORGANIZED
No. 12134
2-153LGN
SUSTAINABLE ES MIN.RECYCLED
INITIATIVE CONTENT10%
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TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHiEMICAL STORAGE REGISTR/AAT/IION
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ADDRESS OF TANK: Q 1-\ VILLAGE:
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MAILING ADDRESS ( I F DIFFERENT FROM ABOVE) : 0
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INSTALLATION DATE: BY:
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CAPACITY TYPE OF TANK., AGE _jg YRS. FUEL/CHEM I,CAL 0 �-
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND >
ZONE OF CONTRIBUTION [ ] YES [ ]� NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES [ ] NO DATE
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CONSERVATION C ] CHECK IF N/A DATE 1 A
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