HomeMy WebLinkAbout0113 BLANTYRE AVENUE - HAZMAT yre, Avg
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
` OWNER AND INSTALLER INFORMATION
ADDRESS: 1/ 3 //1� n1 ?�Y ti' �� MAP NO. PARCEL NO.--
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OWNER NAME: l>�id'S�!1 /7 Z_ VILLAGE:
INSTALLATION DATE: f�16 .i' BY:
"ADDRESS: CERT. NO.
TANK INFORMATION
LOCATION OF TANK: � -
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CAPAC I TY 5'; 7) TYPE l 0L'AJ,0 AGE c>26 Ik FUEL/CHEMICAL
TESTI-NG CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION Cam]'CHECK IF N/A TYPE/BRAND
_ ] NO; REDZONE OF-CONTRIBUTION"- -C ] -:-YES- �
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FIRE DEPT. PERMIT ISSUED Cd,,]'fYES C, ] NO DATE
UUNSERVA i ION C j,-C ECK IF N/A DATE
BOARD OF HEALTH TAG NO.613it . ]C ]C ]C ] DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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