HomeMy WebLinkAbout0190 GREAT MARSH ROAD - HAZMAT qv 6tr ems+ /YI h -R o 0-CG
TQWN OF BARNSTABLEa UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: ��� �,r�rt7 I ji Jc' MAP NO. fi.. 11) PARCEL NO.
OWNER NAME: POA 11711r - >fX/ tl. VILLAGE: ( PlfX.�
INSTALLATION DATE: / 7 xr BY:
ADDRESS: CERT. NO.
t/ TANK INFORMATION
LOCATION OF TANK: �r rycfir "i1
CAPACITY C; TYPE AGE t/ FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C ] FAIL DATE
Y
LEAK DETECTION E ] CHECK IF N/A TYPE/BRAND .
ZONE OF CONTRIBUTION C I YES C I NO DATE TO BE, REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
UUNSERVATION C I CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. / 7C 71 ]C ]C ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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i CENTERVILLE OSTERVILLE MARSTONS MILLS FIRE DISTRICT
UNDERGROUNP TAfjK REGISTRY PROGRAM
Owner of Property: si/d,� Date of Installation:
r
t.: Address: /'/�D �.- « �AL S 1-r'01
r�
Description: Installer: U17
Size: a D D Certification:
Location of Tank:
INSPECTION INFORMATION DATE COMPLETED BY
Site Inspection
Air Test on Tank—Above Ground
Air Test on Tank—Within Hole
Test on Piping
Cathodic Protection Test
4, Continuous Monitoring System-Type
Backfill Operations
Vent and Fill Pipes
Other:
-1
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t TESTING OF TANKS AND PIPING: EXISTING TANKS
;•9' 10th 19 15th y S 19th
13th �/ 3 17th 9 20th 2D O
21st 22nd Ua 23rd 03
•24th 4 25th S� 26th G
27th 28th o 29th o y
(30) Removal �o D
NEW TANKS:
i
15th 20th 22nd'
j 24th 26th 28th
(30) Removal
Remarks:
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