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HomeMy WebLinkAbout0441 SHOOTFLYING HILL RD - HAZMAT �K{( Shoc��-�ly�n� �11 Qoac6 Cep�.erv�1�-- I TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATrI�ON 1 ADDRESS: yl Nc; I L R D MAP NO. !" � � PARCEL NO. OWNER NAME: M,/I p I L_yN M . 1/ VILLAGE: C,=-)y'7~F R V I L L F t INSTALLATION DATE: "' BY: ADDRESS: 7 CERT. NO. v -�A > q I^! f ^ TANK i INFORMATION J ' - +r {/-=t.="rp 1 , _ !,,>• v�,?): C__ t.J c'M..^r7'f d/' •:;i I�+v, r j.•6"�t�� �*"J F'� C:rKt v'F^�l�, /�1!'—�1.��1{14!«.: LOCATION OF TANK: Z3/jc/,( t✓ I t� ! 5 "�" c� , ' /V f CAPACITY /©00, 4L. TYPE I AGE T 10 FUEL/CHEM I CAL C/ L TESTING CERTIFICATION C ] PASS C ] FAIL DATE LEAK DETECTION ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C ] ~YES � ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C ] YES 113 NO DATE UUNSERVATION Ce:l] CHECK l F N/A DATE i ( VJIL BOARD OF HEALTH TAG NO. ]E ]C ]C ]C ] DATEJAV I�> C VAV PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACOF THIS CARD b i 1 o P� 14 1