HomeMy WebLinkAbout0340 SEAPUIT ROAD - Health vJWvc� �®a1�' ld � J
0
0
°
°
" n
Y "
N � '
e.
'
_ � f
-. .=r.., ,.�, �. .:.. . - . -�..—. . ....,....,�m..r.ti ._.-•...r-•�- , -mom-.
TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
i 41 t MAP NO. PARCEL NO.
lk r4
ADDRESS OF TANK: `9 VILLAGE:
Numbir rt Qtr�.�t
r i
MAILING ADDRESS ( IF DIFFERENT (FROM ABOVE) : s h"41: '
OWNER NAME: Y . .� -� �. r`�':�; � PHONE:,
INSTALLATION DATE: GL/VKNOWA) BY: Ow A.,*
INSTALLER ADDRESS: CERT.NO.
*TANK LOCATION: &7f7t OF 140 w6 r -1-0 61101( r j k' H-7 td S j 19L,
'DwOOMzna TANK LOOATION 1ITN PROMMCT TO MUI,LLDINO)
ST��L_ AGE' / YRS. FUEL/CHEMICAL `ZCAPACITY �S?b TYPE OF K C1
TESTING CERTIFICATION C ] PASS C ] FAIL' DATE
Y
LEAK DETECTION [ I CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [i-j YES [ I NO DATE TO BE REMOVED SIPf l` qI
r
FIRE DEPT. PERMIT ISSUED C I YES C ] NO DATE '
CONSERVATION ��[� ] 1 CHECK I:F!N/A DATE
BOARD OF HEALTH TAG NO. [ ,/0 ] DATE "`' .
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
g -
��� ,
Q
e
v
�1
� Z � /
J
• \�
��
_���
�� c'��a,
�1 V