HomeMy WebLinkAbout0379 PARKER ROAD - HAZMAT 1 �5 022- ps�e�v�.QQ�.
6 Eisenhower Dr
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TOWN OF BARNSTA•BLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: + -pc4- MAP NO. P PARCEL NO.
! E i P L VILLAGE: 1 r
OWNER NAME: s + '�i ( ,� ,�
INSTALLATION DATE: BY
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ADDRESS: a f2 l" CERT. NO.
r TANK INFORMATION
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LOCATION ;.OF TANK: k 1A Ao t-In 4 �A10 AA /I A A 4�11AA
4 CAPACITY l (^, TYPE r {,
1..�. AGE FUEL;/CHEMICAL :�£�t'�� J&
.. TESTING CERT,I F I„G T.I ON •E ] PASS C ];, FA IL d 'DATE
LEAK DETECTION C+/] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES'. C ] NO
DATE TO SBE 'REMOVED
FIRE DEPT. PERMIT ISSUED C ]; YESF C �] NQ; t DATE
CUNSERVAT I ON C ] CHECK I F ;N/A DATE
BOARD OF HEALTH TAG ] , ]C . ]C ] DATE; ) �C
PLEASE PROVIDE A SKETCH SHOWING. THE, TANK LOCATION" ON,, THE BACK.:OF THIS CARD""