HomeMy WebLinkAbout0075 HORNBEAM LANE - HAZMAT i
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INS�TALLER INFORMATION
ADDRESS: e)6,5—
r7 ) 1 MAP NO. PARCEL NO.
OWNER NAME: �� !X/ VILLAGE: #/
INSTALLATION DATE: / I BY:
ADDRESS: CERT. NO.
M ot,�q G e ! 7/ TANK INFORMATION
LOCATION OF TANK: tC
_,Alr6Q. OF 7 lnl) fit" 'X �-O �/ -r t �
CAPACITY�o TYPE 7 �L.. AGE _ FUEL/CHEMICAL4#t FtlCI- 0! L
TESTING CERTIFICATION C I PASS C I FAIL DATE
LEAK DETECTION Cx] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES Cam] NO DATE TO BE REMOVED [! I
FIRE DEPT. PERMIT ISSUED EXI YES C I NO DATE
CONSERVATION C I CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. 40& ]C ]C ]C 7 DATE-
PLEASE' PROVIDE:.A:!SKETCH SHOWING. THE TANK,.LOCATION ON THE .BACK OF THIS CARD .
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS e I
ASSESSORS MAP NO. . o�D J!j PARCEL NO.
ADDRESS! _75 HORN BEAM LANE VILLAGE: CENTERVILLE
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11AME _ GERALD E._ANDERSON
CONTACT PERSON `'SAS AS ABOVE PHONE NUMBER (617) 771-8549
LOCATION OF TANKS; • .;,` CAPACITY ; .TYPE.-OF FUEL.- AGE: TYPE: LEAK
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- ` HEMIC
__. _.;........_ .. -._..-...--.:.OR .0 AL' -- .•. DETECTION-. ..
-•.. . SYSTEM!
Center of .house frontage. 500 Gallons Fuel Oil 1979 Steel No
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DATE OF PURCHASE OF EACH: 1. 1979 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT PERMIT: 12-2 -79
TESTING CERTIFICATION SUBMITTED: _ PASSED DID NOT PASS
PLEASE PROVIDE A SKETCH SHOWING. THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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