HomeMy WebLinkAbout0173 OLD POST ROAD (CENT.) - HAZMAT Old pdj� &A
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: o P(,, Ro Cli evi-Poi-L.p /4A MAP NO. '' PARCEL NO. S
OWNER NAME: / ?r r4 a '�.A �r,A{ 1�I.� N �' t g -� VILLAGE: IV L L
t INSTALLATION DATE: -- ' v BY E „^'� F-► T4, t r7 k�'
ADDRESS:�( t' CERT. NO. '.
STANK iINFORMATION
LOCATICON OF TANK: 80 1 C.;
CAPACITY 5:66ntc TYPE T y Pr wyf) AGE FUEL/CHEMICAL ni,- -
TESTING CERTIFICATION C 7 PASS C I FAIL DATE ti'� r 4„oit:;.'�;� ? _, h���{vx0 , Cu J rtSt
LEAK DETECTION C 7 CHECK,'IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ]'<YES 0<� NO DATE TO BE REMOVED 9�
FIRE DEPT. PERMIT I SSUED--`�3 C'>Q YES 1' ] NO DATE
UUNSERVATION CXJ CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C `]C ]C ]C - ]C J DATE i n`'� s
PLEASE PROVIDE A SKETCH' SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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t `4 `R.:CENTERVILLE 6+ OOMVILLE;FIRE DEPARTMENT.
PERMIT FOR STOR OF FUEL OIL j
t �, f� In accordance with provisions of Chapter 148, C+ L.;r and Regulations
w; `. �+ f ,;t ' made under authority thereof:
Y Scudder & Taylor
` Name Fred„�Vialoney„�` � " Jose h ntr
" > Ip.Name P..... ........3t.............
(owner or,occupant)43F' tr<;�. et (Installer)
r + i Address 91d ..host-;Rq�d...,4 . Address Ose i�}..;S eet.............
. Cer�tervf,lle ,rs nnis
urner�� � orage
ca MakeL C F R " c � ,,4:Y Ype{of ,Tank Steel F�Ound
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Nationalr, Y+ # f 00. ..
�, * , ��Manufacturer ... eCapacity ..�.........:
Ca ., gals. (or) Size.............
_ round
Model No or Size G ` :. ;Location ,+Under.................++..........++..
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;¢ Type Gun-. } . .� Mass. A roval.No
is Permit-iv
Issued ;rA ? 7 ;: r �3"r+k.`�,"{;ohn 11. Fgrr nPti nr Chigf
t (Bead o F1 De ai ment
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x(�+ :� * �:��� ' •�� (THIS PERMIT MUST BE CONSPICUOUSLV IRosTE UPON THE PREM ES) j
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