HomeMy WebLinkAbout0118 OLD STAGE ROAD - HAZMAT J
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: I�> _l1 .~ J� l� 1� MAP NO. f% 0P-ARCEL NO`3A/)
OWNER NAME: M Ail_.-f I&- VILLAGE: �kil':�- LI��t'. I 1 A �
INSTALLATION DATE: BY: 44f17�v �`°t= ! r
ADDRESS: ='i 4 CERT.i' NO JL I .S 1 4 t ( 1 l
! 1(Q '^►d ���� TANK INFORMATION
LOCATION OF TANK:
CAPACITY TYPE �1 C Ll AGE FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FAIL DATE \
LEAK DETECTION EX CHECK IF N/A TYRE/BRAND
ZONE OF CONTRIBUTION C I YES C/�] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C I YE///S��` C ] NO ' DATE
CONSERVATION C I CHECK IF N/A DATE
BOARD OF HEALTH TAG NO., ]C 1[ 3[ ] DATE l La
,.PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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