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TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. R PARCEL NO. Dt�
ADDRESS OF TANK:�� ���'�'� A V a e L) J7 R . V I LLAGE: re -n�� �✓� �j�
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MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME:
1a� L A 1fh a ��u Y v& � �D o • . _ 77,'s� a�3
ct ��� ,
INSTALLATION DATE: LllfJ?2'BY:
T^IGTALLER ADDRESS: CERT.NO.
*TANK LOCATION: �/ ' 'lfw
(D66 RIUM TANK LOCATION WITH RKWPWCT TO WUILDINO)
CAPACITY ,. TYPE OF TANK AGE YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A �TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [i1] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [kf NO DATE
CONSERVATION [ ] CHECK IF N/A DATE q /�
BOARD OF HEALTH TAG NO. [ � � ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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TOWN OF BARNSTABLE — UNDERGROUND FUEL, AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO. Q c
r�
ADDRESS OF TANK: :1) R . VILLAGE: cp -nr� 'a� ✓s ���
MAILING ADDRESS ( IF' DIFFERENT FROM ABOVE) :
OWNER NAME: n l^ IA1" c, Ala'�a !?cF'F`'ION�E! Is Q�f - 7�.'��- 0 d c�
INSTALLATION DATE: ,./21—,lT a I Y
IINSTALLER ADDRESS: CERT.NO.
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*TANK LOCATION: Elan a Ali r�
(DLSCeR I it TANK LOCATION WITH RKM"KCT TO HU I t_D I Nm>
CAPACITY I TYPE OF TANK AGE YRS. FUEL/CHEMICAL
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES EM NO DATE TO BE REMOVED,
FIRE DEPT. PERMIT ISSUED C ] YES [k NO DATE
CONSERVATION [ ] CHECK IF N/A DATE f
BOARD OF HEALTH TAG NO. [ y ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. -2-1 PARCEL NO.
( ADDRESS OF TANK: / -1 �r +, ii VILLAGE: t
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) :
OWNER NAME: 1�. . 1 .A 1' + f 4 Al t)? �-► R,r4 H/? PHONE: • rf 4' - r' / '
INSTALLATION DATE: /k' ,, •iJZ"BY:
IINSTALLER ADDRESS: CERT.NO.
*TANK LOCATION: �
(0KWCRI=t TANK LOCATION W-ITN RZ=MKCT TO WUILDINO)
CAPACITY TYPE OF TANK I, AGE YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ ] YES [ i] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ ,�,. 4� ] DATE ° -r
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATI.ON ON THE BACK OF THIS CARD
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