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TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAME ''/iP• �I�LL��
ADDRESS �✓� �ZW.VILLAGE
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAL
04/A lyA) #Z
1--6<7
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(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT: G A �
TESTING CERTIFICATION SUBMITTED: V
PASSED DID NOT PASS
A P P R O V E D
Barnstaole Conservation Commission
-Z�a,-,A
Signed Date
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