HomeMy WebLinkAbout0024 PEN LANE - HAZMAT � = lg3-o2D
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'TOWN OF BARNSTABLE —UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. f �,' PARCEL NO.
ADDRESS OF TANK: IV /� fiV� VILLAGE: 4r33 it✓`/ � � I!< '�� �
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
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OWNER NAME: ��<_- +
l/�._/IL i r1U F"� 'ir ! PHONE: tl /7 n'37
INSTALLATION DATE: �, i t ' BY: I
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INSTALLER ADDRESS: -CERT.NO.
*TANK LOCATION: A/ F Al T y 1- l4oJ., t:E. - /o t„
�a c m ara s a a T A Nlt L O O A T I ON W I T H R Q O P Q C T T O m U 2 L D S NO)
CAPACITY IV U(+ TYPE OF TANK .- TL,- -- AGE / YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS C ] FAIL DATE
LEAK DETECTION C J CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES C J NO DATE
CONSERVATION [ J CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C 16 "r� ] DATE ` !
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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