HomeMy WebLinkAbout0423 ELLIOTT ROAD - HAZMAT Cev,+ergs Ile
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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: L) •,h l 1=1 k MAP NO. 1 PARCEL NO. ?
OWNER NAME: 0 f VILLAGE: LL:• ra i
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
10 Nr t� - 7.1 0 ® TANK INFORMATION M1
LOCATION OF TANK: :-Z
CAPACITY -2... TYPE S AGE 1 `t: a FUEL/CHEM I CAC� k
TESTING CERTIFICATION E ] PASS E I FAIL DATE
LEAK DETECTION E)(I CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION E 7 YES EA NO DATE TO BE REMOVED Z10
FIRE DEPT. PERMIT ISSUED E I YES E ] NO DATE
UUNSERVAiION E ] CHECK IF N/A DATE tq l-`t
BOARD OF HEALTH TAG NO. ]E ]E ]E ] DATE // X
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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