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HomeMy WebLinkAbout0610 MAIN STREET (CENT.) - HAZMAT �p7 _ © 13 Ce-%n+eyv � 11 � HAZMAT 1t TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION Ir p n!r (r\ OWNER AND INSTALLER INFORMATION ADDRESS: 6T, MAP NO. 107 i PARCEL NO. 01,3 OWNER I.M.E. RA NA NC1 m VILLAGE: CAA/T/W V L INSTALLATION DATE: t.( � " I � ( BY: ADDRESS: / 1{1hITl CERT. NO. I.. TANK INFORMATION ,t LOCATION OF TANK: L I list CAPACITY n TYPE AGE n+ FUEL/CHEMICAL -tF'l. 1C TESTING CERTIFICATION C I PASS C ] FAIL DATE i LEAK DETECTION C I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] YES ' �<3 NO DATE TO BE REMOVED ,>r FIRE DEPT. PERMIT ISSUED C�] YES C ] NO DATE A tt l= �� �a 1617 V CONSERVATION C I CHECK IFIN/A DATE / rj Q� BOARD OF HEALTH TAG NO.i� C "]C ]C ]C ] DATE —� PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD �, CAP cARAOr j 1 ?ANK. A I