HomeMy WebLinkAbout1118 BUMPS RIVER ROAD - HAZMAT Z - w4
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
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MAP NO. I219) PARCEL NO.
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ADDRESS OF TANK: r I�i f la, c f v`!=� .r r t VILLAGE:
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MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : -3�112 •
OWNER NAME: t/1 t A."")/,1, PHONE:
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INSTALLATION DATE: �_ 0 BY:
INSTALLER ADDRESS: -CERT.1-40. ['
*TANK LOCATION: f��'� V4 cC*�� r ` 9 � S 1 R b ti "�91c+-4-4 ,
(ommom I aG TANK t_oo^-o Z ON W S TH RQOPQCT TO mU I l-D Z NO) '
CAPACITY S-0 10 TYPE OF TANK - k, AGEj_�_YRS. FUEL/CHEMICAL r9c�,
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [� 7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES ; [ r] NO DATE TO- BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] , YES [ ] NO DATE
CONSERVATION [�`] CHECK IF N/A DATE J`
BOARD OF HEALTH TAG NO. [ ] DATE / �fl le
PLEASE PROVIDE A SKETCH SHOWING TWE TANK LOCATION ON THE BACK OF THIS CARD
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