HomeMy WebLinkAbout0554 WIANNO AVENUE - Health (2) k3
- :;TOWN OF BARNSTABLE — UNDFERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: ri�� /6TiciN!� i/G'� MAP NO. � PARCEL NO. I
OWNER NAME: °• - G�.r� � a 1 . �: VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
TANK I NFORMAT I ON
LOCATION OF TANK:
CAPACITY )0 TYPE AGE S FUEL/CHEMICAL 4 t Las
TESTING CERTIFICATION C 7 PASS C ] . FAIL DATE
LEAK DETECTION 'C�] CHECK IF' N/A. TYPE/BRAND
ZONE OF CONTRIBUTION .0 7 YES C ] NO DATE TO BE REMOVEDi/'
FI.RE DEPT.. PERMIT ISSUED C` 3 YES . E ] NO DATE
CONSERVATION . 1) 3 CHECK IF N/A DATE s
BOARD OF HEALTH TAG NO.�C4C ]C ]C ]C 7 DATE
PLEASE PROVIDE,A ,SKETCH SHOWING .THE. TANK LOCATION ON THE BACK OF THIS CARD
G t
k ] ) � f,. y+ . x 3 i .}�i, i {� 1i a'l:. .Cr < y . r S'' yi e ✓t .j.Y.