HomeMy WebLinkAbout0288 POND STREET - Health �� Pond S¢r.a� - t+g
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. ! PARCEL NO. Q /
! !' VILLAGE: 47.5.7s ✓'4�
ADDRESS OF TANK: •� _
Number r atr�ft! ,s
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE�)�: ':, < ��% �! /� �.sf/
OWNER NAME: cif ✓;lrG r /�� + ' "� PHONE: 1 �✓ t^ - Y---� �'r-�
r
INSTALLATION DATE: BY: 1 �
INSTALLER ADDRESS: 'CERT.i'J0.
/
*TANK LOCATION: /`'. / ✓� 1;. / cam! ." f ��is�-� r� .�� 1r°'c`'
c acOaR s aG TANK LOQAT=ON W S TH RQOPQCT TO aU S LD 2 NO)
CAPACITY ,-;;'-j_G.e�f-TYPE OF TANK AGE YRS. FUEL/CHEMICAL `��
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYP._E/BRAND-
ZONE OF CONTRIBUTION CV] YES { ] NO -DATE. TO BE REMOVED /
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CONSERVATION [ ] CHECK IF .N/A DATE
BOARD OF HEALTH _ TAG NO. C / G ` ] DATE F'
. PLEASE VIDE A SKETCH .SHOWING THE TANK LOCATION ON THE HACK OF THIS CARD
4 PRO ,
0
T,,,�
l.N
.y �o
���