HomeMy WebLinkAbout0159 GREEN DUNES DRIVE - HAZMAT Green uv'N ,
013
i
i
I�
i
i
i
i
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
0 NJ f; • � 7 I � � '� ,�� OWNER AND INSTALLER INFORMATION /NO
ADDRESS: �� l" /1" �.t/�l riyvs 7.'�-/ �— a + -MAP NO. �� '� _.,PARCEL . o a- 1,
OWNER NAME: C-t '' .r .,, -`: {• VILLAGE: �1 'Uai . J
INSTALLATION DATE: ,�'�UI ,i 4,q D BY: u a n!
ADDRESS:4;? CERT. NO.
TANK INFORMATION
LOCATION OF TANK:! TL rwr,•t�° tdc w-nq G; F'
CAPACITY SOO VC TYPE AGE '$ o FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION C -iCHECK ~IF N/A ~TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES-� C)(] NO DATE TO J E REMOVED
FIRE DEPT. PERMIT ISSUED C 7 YES C I NO DATE
CONSERVATION ] CHECK 'IF N/A DATE k
BOARD OF HEALTH TA, NO C ]C ]i ]C ] DATE
PLEASE PROVIDE A SKETCH SHOWING.. THE TANK LOCATION ON THE BACK .OF. THIS CARD
Oi
�ti Ss
7
C P-tf#oi