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No. 12134
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INITIATIVE CONTENT10%9
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SF1-01290
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TOWN OF BARNSTABLE vlo UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS 1� ((//�� rr C,3-
ASSESSORS MAP N`0. PARCEL NO. Lc Ol 6..
ADDRESS; 0s:Q.0 �0Pru pAy VILLAGE O
9
NAME Y1 EN.111 T!-}.. ... N
CONTACT PERSON CAP L F, fLi e 09LL j-S W SQL PHONE NUMBER 3
LOCATION OF TANKS: CAPACITY: ..TYPE OF- FUEL. AGE: TYPE: LEAK
OR CHEMICALS DETECTION
I PJ G^i?Ui-i rib (sAL � Z `'SO+- 5JC4-L SYSTEM
DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
• TASK U3iLL- S9 2EP"C.ID
$EASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
TANK.,
CENTERVILLE-OSTERVILLE-MARSTONS MILLS
FIRE DISTRICT
1875 ROUTE 28
• CENTERVILLE.MA. 02632
(508) 790-2380\FAX# (60$) 790-2385
OIL/HAZARDOUS MATERIAL RELEASE FORM
F.A : TaA
LOCATION:
ADDRESS OF RELEASE: 220 fingm RAY ROAD
09TF`RVTT,T_F- VA ngKSs;
DATE OF RELEASE: mmmnum
PRODUCT RELEASED: cecnT.Tn
ESTIMATED QUANTITY: ;lmmn N
CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: NOTIFIED PROPER AGMTES
i
NOTIFICATIONS:
FIRE DEPARTMENT:YES jb� NO t } DATE: R/1 ti/45. TIME: 121 S
NATIONAL RESPONSE CENTER: YES( ) NO V DATE: TIME:
DEPT, OF ENVIRONMENTAL PROTECTION: YES t } NO V DATE: TIME:
• OIL SPILL COORDINATOR: YES( ) NO V� DATE: TIME:
TOWN BOARD OF HEALTH: YES( ) NO jj DATE: TIME:
TOWN HARBORMASTER: YES( ) NO i lix DATE: TIME:
OTHER AGENCIES:
COMMENTS: RRUCE MACAT.T.T', ON TT.GCATTON AT STATION 1 O REPORT LEAK FOUND
IN 1If1 GAT.j.ON GARQj.ThTTAMREdQ= FROM ABOVE ADDRESS MR
HIACAT_T_TS,IMMIC OWNFR OF SWEET-TN TANK COMP NY_
DOMA MORANDl- TOWN TRFA1.33 D PT- ON T.00AT_TON ASRER. EG T.FAK
TN 'A MT. OTT. MARK AT RAMP. T.00ATTON_ SHE SITSEECTED
GAS WAS LEAUNG. SO TAT_�R> WAS RENQVED IN PRESENCE
OF HEALTH AGENT_ Mkt. MAC&IISTER ASKED IF F.D. WOULD LIKE TO
VIEW TANK_ T S'J'ATF�T I FELT CO"QRTABLE TH,ElT DONNA MW EXPERTISE
�IN TANK R&WAI. PROGEDIJRE&&
HAVE ROLE IN BOTTOM OF TANK.
DONNA T OPER/ '�
N F TIONS.
REPORT FILED BY: • 1 jr DATE: $/16I94
WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK C6PY-BOARD OF HEALTH
C.O.M.M. FORM 58
CENTERVILLE-OSTERVI LLE-MARSTONS MILLS
FIRE DISTRICT
1-875 ROUTE 28
• CENTERVILLEAA. 02632
(508) 790-2380\FAx# (508) 790-2386
OIL/HAZARDOUS MATERIAL RELEASE FORM
y
F.A ' : FA-619
LOCATION:
ADDRESS OF RELEASE: no NnRTR RAV RnAn
nqTFRVTT.T.F_ MA MARS
DATE OF RELEASE: T > n
PRODUCT RELEASED: si-2 m»* AYT
ESTIMATED QUANTITY:
CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: MAnF PRnPF'R NnTTFTf_ATTnNC
NOTIFICATIONS:
FIRE DEPARTMENT:YES NO( ) DATE: a/1 r,/QS TIME: nal 1
NATIONAL RESPONSE CENTER: YES( ) NO ki DATE: TIME:
YEPT. OF ENVIRONMENTAL PROTECTION: YES( ) NO(,V,, DATE: TIME:._
• OIL SPILL COORDINATOR: YES ( ) NO(Xi DATE: TIME:
TOWN BOARD OF HEALTH: YES ( ) NO§j DATE: R116.192; TIME: nQ1>
TOWN HARBORMASTER: YES ( ) NO U DATE:___P___._ TIME:
OTHER AGENCIES:
COMMENTS: ON, T.nVAT7rnN (IF JjgT RF.MAVAT, RV CxinRFT.TNF TANK rnMrANv zAn
r_Am nN I? Fm.r_ nTT_ TAKK 1-rmm--n Tn RAVF PRnnTV`T nnx gnTTnM nl?
TANY CRAM APPVARC To RA wamoI? AT TpTC TTMF
TMM RFAT.TR nFPARTMFUT unTTwTFn
REPORT FILED BY: �� %�•�-�` r) DATE: A['6/Q%
WHITE COPY-FIRE DEPARTMENT YELLOW/COPY-D.E.P. PINK COPY-BOARD OF HEALTH
C,O.M.M, FORM * 58