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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
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ADDRESS: \fft-jKXf MAP NO. PARCEL NO. I
OWNER NAME: 1N N -C 'V I LLAGE: d
INSTALLATION DATE: ,VI - BY: ��• - �?t� - �� � � - V/
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ADDRESS: 1V1 l -:-� CERT. NO.
75 -! TANK INFORMATION
LOCATION OF TANK: �G
CAPACITY c�.O C� TYPE4k-FUE •CAEAI}CAL
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TESTING CERTIFICATION C ] PASS C ] FAIL DAT'
}' LEAK DETECTION C}�] CHECK IF N/A TYRE/BRAND _
' ZONE OF CONTRIBUTION C ] YES w �� ] NO �DATE, TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C � .YES C - ] NO DATE ''l`-y
CONSERVATION C ] CHECK '/I N/A DATE
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BOARD OF HEALTH TAG N0. ] ]C ]C ]C ] DATE
. PLEASE PROVIDE-A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD