HomeMy WebLinkAbout0309 BAY LANE - HAZMAT 3og 3H y L14uE
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TOWN OF BARNfSTAb'E - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: TO 9 ;&.=%t Ll f, lx Q MAP NO. PARCEL NO.
OWNER NAME: t �' aif " rIl� C'��c�t� 1'f�r/�! ,` . i VILLAGE:
INSTALLATION DATE.-/9_q'�-f;_/i �.Z BY: ��i�k aHw
ADDRESS: t CERT. NO..'.'
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F TANK INFORMATION
LOCATION OF TANK: zoo
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CAPAC I TY TYPE AGE-)6 Ys FUEL'/CHEM I CAL Xe )05a f' j C.✓d
TESTING CERTIFICATION E ] PASS C ] -FAIL DATE n 1
LEAK DETECTION � ] CHECK IF N/A_ TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES 1,3� NO DATEITO BE REMOVED
FIRE DEPT. PERMIT I SSUED C ] YES C -] NO DATE
CONSERVATION C ] CHECK IF N/A � - DATE
BOARD OF HEALTH TAG NO. I I ]G/ ]C ]C ] DATE 31 U U
PLEASE PROVIDE A SKETCH SHOWING' THEUTANK LOCATION ON THE BACK OF THI�S .CARD
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JUN 05 '91 0�,:1 3 '`ENT.OST.FIRE DEPT. P.Z 2
FORM F.P. 292
(rev. 9/90)
(Tilt CID1111=tt=10 of filits08 getts i
' Department of Public Safety
Division of Fire Prevention and Regulation
APPL.{CATION K% PERMITS AND PERMIT, FOR REMOVAL. AND TRANSPORTATION TO APPROVED TANK YARD
FDID# 01920 permit # bate June 4, 91
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Barnstable
CRY,Town or Mulct ✓�/ C . 8 2 3 . 4 0 M , G . t .
DIG SAFE NUMBER
Fee Paid-.4 1.0.00 d'l �l 91201614
f �! } start date June 4, 199
In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L. ,
527 CMR 9.,00 application is hereby made by:, Sh maline Tank
Street Address & City or Town: 87 Pond St eet, Osterville, MA
Signature of applicant: _
Applicants name printed:.
For permission to remove and transport one underground storage tank from,
owner: Archibald Williams Street Address: 309 Bay bane, Centervil.lf.
Firm transporting waste: Hitchcock Waste oil 14A-1.0
state Lie. # r
Flazardous-waste manifest # E.P.A. #`_
Approved tank yard: Abandonment �
Tank yard Address: N/�: ,
Type of inert gas: �._. UL tank/ #: - X
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Tank capacity: 1 000 Substance last ssftored: #2 Fuel oil
Date of issue: June 4, ig 91 Date of expiration: June 1-81 3S 91
Signature/Title of officer granting permit: .. _ �l✓,'.�' k
KEEP ORIGINAL AS APPLICATION AND ISSUE OUP "ti. LYE
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