HomeMy WebLinkAbout0271 WIANNO AVENUE - Health (2) a� a lu��na 9�v►u.�.
,-.TOWN OF=BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
} t J OWNER AND ,IINNSTALLER INFORMATION
9 J` ADDRESS:-`� 1,4/'-71 y + fi ►-0 �l € .{ t1 '_ MAP NO. F tI"`�� PARCEL NO.
OWNER NAME: VILLAGE: �t =;
INSTALLATION DATE: _ BY:
ADDRESS: CERT. NO.
TANK INFORMATION
LOCATION OF TANK:
CAPACITY t'/1#,r TYPE �U F Fo L' r)f'� ;''�c�L� AGE ,l��t�-�s FUEL/CHEMICAL
TESTING CERTIFICATION I I PASS C I FAIL DATE '
r
LEAK DETECTION C�7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES [)( -NO " DATE TO;BE REMOVED
�r v _- °
,,
FIRE DEPT. PERMIT ISSUED C ] YES C 7N0 fi7 DATE
LUNSERVATION C 7 CHEC IF N/A DATE /
BOARD OF HEALTH TAG NO.L ]C ]C ]C ] DATE (l .
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD