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TOWN OF BARNSTABLE UNDERGROUND FU L/AND CHEMICAL STORAGE REGISTRATION
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f/UWNER AND INSTALLER INFORMATION
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ADDRESS:OWNER NAME: ,,i elf j Aeb/j /`u't .Q IC A S VILLAGE: ��i'l /eyo Ac'
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INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
TANK INFORMATION.
LOCATION OF TANK:
CAPACITY TYPE AGE FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS ` C I FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/,.BRAND
ZONE OF CONTRIBUTION C I YES C I NO DATE TO BE REMOVED
DEPT. PERMIT ISSUED C ] YES C ] NO DATE `
CONSERVATION C I CHECK IF N/A DATE
--4BOARD OF HEALTH TAG NO. [ ]C 7C ]C ]C ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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