HomeMy WebLinkAbout0000 OST.-W.BARN. RD - Health CENTERVILLE-OSTERVILLE-MARSTONS MILLS "
FIRE DISTRICT
1875 ROUTE 28 M0 r
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CENTERVILLE, MA 02632
(508) 790-23801FAXv(508) 790-2385
OIL/HAZARDOUS MATERIAL RELEASE FORM
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LOCATION:
ADDRESS OF, RELEASE: .. ...,,-�. _Ft
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DATE OF RELEASE: n 11 r
PRODUCT RELEASED:
ESTIMATED QUANTITY: y-! - e_ .. i. AJS
CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: - a,-,.,L s!
NOTIFICATIONS:
FIRE DEPARTMENT: YES( �/ NO( ) DATE: 0311 TIME. 431 Z-
NATIONAL RESPONSE CENTER YES(ri'NO( ) DATE; n-,Lr TIME: e z -.
DEPT. OF ENVIRONMENTAL PROTECTION YES( ) NO( ? f ATE: TIME:
OIL SPILL COORDINATOR: YES( ) NO( ) DATE: TIME:
• TOWN BOARD OF HEALTH: YES( ) NO( ) DATE:_TIME'
TOWN HARBORMASTER: YES( ) NO( ) DATE: TIME:
OTHER AGENCIES: Q
COMMENTS- ia_=r_" f ��� ,dr s' 1 4 4,1
REPORTED BY: �4.,,� DATE:
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