HomeMy WebLinkAbout0251 BAY LANE - HAZMAT 5i 13�� Lone,
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
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OWNER AND INSTALLER INFORMATION '
ADDRESS: �� -� Lan / Cvntervalle,l4la. MAP NO. w 16d PARCEL NO. 05?
OWNER NAME: Acnal . S. Hambly VILLAGE: 4 Centervil le.Ma.C261
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
i► ONC 0 775 TANK INFORMATION
LOCATION OF TANK: Side Yard
CAPACITY 540 TYPE ! AGE FUEL/CHEMICAL 01b
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION I CHECK IF N/A TYPE/BRAND WR
• ZONE-OF CONTRIBUTION C ] YES C�] NO DATE TO BE REMOVED t I dl
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FIRE DEPT. PERMIT ISSUED C I YES C NO DATE
CUNSERVAlION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C ]C ' ]C i]C ] DATE;:k
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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