HomeMy WebLinkAbout0037 LONGBOAT DRIVE - HAZMAT Iq 3 , 1 5"$ ����rv► L 1
7� YrFA T
s-
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER A(� C
AND INSTALLER INFORMATION
ADDRESS: tS� �Y MAP NO. PARCEL NO. 1�/
1kc" �� a
OWNER NAME: t -¢ � �t e�1\ c ' '�� . �` VNk0` VILLAGE:
INSTALLATION DATE: 0 _ BY: t t J���"'�'
ADDRESS: CERT. NO.
7 TANK INFORMATION
LOCATION OF TANK: =.-7/I I flotz!E
CAPACITY lO(/L/ TYPE S AGE / / FUEL/CHEMICAL
TESTING CERTIFICATION C 7 PASS C 7 FAIL DATE
LEAK DETECTION C�] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C 7 YES C 7 NO DATE TO BE REMOVED cVo
O � �
FIRE DEPT. PERMIT ISSUED CX7 YES C 7 NO DATE
CONSERVATION C7 CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. q JE 31 7 C 11 7 DATE
PLEASE PROVIDE :A SKETCH SHOWING THE.TANK. LOCATTON ON THE BACK OF THIS CARD `
�A
CENTERVILLE - CISTERVILLE FIRE DEPARTMENT
PERMIT FOR STORAGE OF FUEL OIL
In accordance with provisions of Chapter 148, 0.L., and Regulations
made under authority thereof.
Name ...Aav d...RefK)ty..................... Name .PGregoire............:.............
(owner or occupant) (Installer)
Address .37..LQnZb.Qatr.J)r..Q.9X1tAddress NY L=--1§..A.a....................
Burner Storage t
Make .....Beckett..... ....................... Type of Tank Steel... ` ....................
Manufacturer .AMe.............................. Capacity 10QQ... gals. (or) Size............
Model No. or Sizel!.............................. LocationqRq!Tground.......................
Type....IM............ Mass. Approval No. .....9..69.....
Permit issued ....... ....... .JAX.••FeX'
�L �... �.......:.. .......:.... . o .. .............
(H ad of r pa e
................................ By .��I(. . . . ... ............ . ...........
-K (THIS PERMIT MUST BE CONSFICUOUSLT POST, UPON TH PREMISES)
i