HomeMy WebLinkAbout0598 MAIN STREET (CENT.) - HAZMAT kAZ W AT
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATIO//N��
OWNER AND INSTALLER INFORMATION
ADDRESS: t t ' ` i ��. MAP NO. �`-0 1 rPARCEL NO. t. v
OWNER NAME: VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: / ^� Q CERT. NO.
/ f TANK INFORMATION
LOCATION OF TANK: A Or/
'CAPACITY b TYPE AGE �� FUEL/CHEMICAL ! rl,
'TESTING CERTIFICATION E ] PASS C ] FAIL DATE
LEAK DETECTION C�]� CHECK IF N/A TYPE/BRAND a '
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ZONE OF CONTRIBUTION C 7 YES NO DATE TO BE REMOVED J
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FIRE DEPT. PERMIT ISSUED . 1 ] YES C ] NO DATE
CUNSERVAiION C ]t CHECK IF N/A PPP r.1 DATE 1 I
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BOARD OF HEALTH. TAG NO. C` ."]C ],C y ]C ]C ] . DATE (J fJ 1! 1 I C-�
PLEASE PROVIDE A•SKETCH SHOWING THE TAWK LOCATION ON THE BACK OF THIS CARD
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