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TOWN Or BARNSTABLE VA c-s
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS'
A ASSESS MAP NO.. FRS I{� PARCEL N�.
ADDRESS: 'S VILLAGE �S�8.i� y i 1[,e „I
tdAME �(/r�Jr L i4_c'16 Q.y_/�� /1 j.�.'c_5 '" Q ,0a � /6 If!`l� �/AA 03
CONTACT PERSON PAL � �/�LQ( !�- PHONE NUMBER
LOCATION OF TANKS:. - CAPACITY: TYPE- OF' FUEL. AGE: TYPE: LEAK
p OR CHEMICAL:_ DETECTION
SYSTEM'
DATE OF PURCHASE OF EACH: 1 2. 3. 4. 5. _
DATE OF FIRE DEPARTMENT PERMIT: Ny
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
imou L
JN22454' Peter S
LOW No.
I90UNDARY EXAMINATION
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