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HomeMy WebLinkAbout0016 JUNIPER ROAD - HAZMAT ll�su�� per- 5�o�eQ a�� - Sao c���e,rv, ► ��.- 1��Z. �1�`T� � - � . iII O i TOWN OF BARNSTABLE WvE fA G UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ASSESSORS MAP NO. p l 0 PARCEL NO. I '1 ADDRESS: J V Ni nr4b VILLAGE" <2-6'iA/7_Q::�2V! Li_L= 14AME _ �� y.1.�._._._.e CONTACT PERSON �p y i 7j C C}� �*i� PHONE NUMBER 11 �f7 7 �l 1-7i' ��� �'' 1 i LOCATION .OF TANKS_: . CAPACITY: .TYPE OF' FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION - - - - - - SYSTEIR V\( C fyVe 9) F PP�y �o COAL b J L_ o 4v&v DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. _ DATE OF FIRE DEPARTMENT PERMIT:.3 TESTING CERTIFICATION SUBMITTED: PASSEDDID NOT PASS PLEASE. PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. 8 QIGGS ® � G� a i t TOWN OF BARNSTABLE .- UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTR,AATION / MAP NO. PARCEL NO. ADDRESS OF TANK: 99 LUF-VIN AVE J UE VILLAGE: CEM7VRVl,l_t r_ Numbmr O!rw�t MAILING ADDRESS ( I F DIFFERENT FROM ABOVE) : P,Q.&Y U 0-_-tv`-�1RVII_LE 02 6�Z . OWNER NAME: fVl��� � f .�f'l1l PHONE: 362- 644 INSTALLATION DATE: Seiyr I786 BY: CAPL �7. PIEDl~f L � �o�/, Ih)f I NSTALLER ADDRESS: �7�" MAW �"�: , �?ST��2U1 LlE CERT.NO. *TANK LOCATION: F'f,)©N I OF ► OU E I\T- RICI1T (0KS0RIat TANK LOCATION WI7H RZO"KCT TO NUIl_DINO) CAPACITY 1000 GPI C TYPE OF TANK SM P3 AGE Z 4- YRS. FUEL/CHEMICAL OIL TESTING CERTIFICATION C J PASS [ ] FAIL DATE LEAK DETECTION C ] CHECK IF �N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES C�] NO DATE TO BE REMOVED �� FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE CONSERVATION C J CHECK IF N/A DATE r BOARD OF HEALTH TAG NO. C - ] DATE �1 C * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD