HomeMy WebLinkAbout0174 WIANNO AVENUE - Health (2) 1-7 (N i�W(3 hWla-
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
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ADDRESS: i'-t�I�- y'Q"!\n �A u+ °�C?t t MAP NO. t 1- 0 PARCErL'NO. I 'T
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OWNER NAME: . r zr c t r
INSTALLATION DATE: C.V t�i�,�f BY:
ADDRESS: '' CERT. "'NO.
TANK INFORMATION
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LOCATION OF TANK:i; ' `+� s A,n ae u k V ti ��`s T
CAPACITY # 00 Q.i,:iTYPE' �a AGE�� '.���5 FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FALL `•, DATE
LEAK DETECTION r
tv CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES, ] NO DATE TO BE REMOVED 1 �'
FIRE DEPT. PERMIT�'ISSUED C I -YES C 7 NO DATE
CUNSERVATION , C ] CHECK IF N/A DATE t
BOARD OF HEALTH TAG NO. I[ I[ 1 C ] DATE A�i JI IRZ It t A
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE` BACK,OF THIS CARD
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