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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: ��Q" �G a'/�/ '1 . , Ti;n�14L4 MAP NO. I(5 6 PARCEL NO.0 i
OWNER NAME: ' L L !l `,A C�' ,5 - �L1 VILLAGE:
INSTALLATION DATE: BY:
ADDRESS: CERT. NO.
PA�� / ' .0rJn - ' TANK INFORMATION
LOCATION OF TANK:
CAPACITY /000 6AL-TYRE AGE r mFUEL/CHEMICAL
i TESTING CERTIFICATION E ] PASS E ] FAIL DATE
` LEAK DETECTION L�] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION E ] YES E NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED E\] YES E ] NO DATE
CUNSERVATION E J CHECK IF N/A DATE
BOARD OF HEALTH 'TAG{�NO. G ]E ]E ]E ] DATE (l✓
PLEASE PROVIDE A SKETCH S OWING THE TANK LOCATION ON THE BACK OF THIS CARD
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CENTERVILLE 0ST ILLS;FIRE DEPARTMENT::
"�t,r %' FPS ' . , ;: ;. a a , ;. n ' . ' •.. .. :, �. .'
PERMIT-:FOR-' STOI AGE .OF FUEL OIL '
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accordance.with provisions of Chapter 148; M L.,'and.Regulations 4,
njade underauthority thereof.
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Name .Zohn...T Mi c.GiJ.ld'XA NaIne . ... ,
F , (owner or-occupant) .4 t ''(I staller? TN
,. 700 Main' St. Cent Oster4.
ville z
t _ Address Address ,
Burner' ' , Storage
Make Beckett Type of Tank e: iSt
r Manufacturer :83illC; Caacl#y gpls:.(or) Size
�t Bndergroun,
h Model No: or Size ,� Location d,
' Type , .: Mass Approval No
John M. r
Farington }
6 Permit issued , . .............4.............................. f
(Head of Fire Department z
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..u. \.... ..lxi,. ,..�:. j
(THIS PERMIT.MUST BE CONSPICUOUSLY:POST UPON E�REMISES) ;
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04 BA��
sa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
Z SUPERIOR COURT HOUSE
BARNSTABLE, MASSACHUSETTS 02630
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PHONE:362-2511
VV�® ✓ EXt 330
LAO
V LAB 337
CLINIC 340
NAME William Hilmer DATE TESTED 9/8/88
TANK LOCATION 700 So. Main Street Centerville
TANK AGE unknown TAG #469 CAPACITY
1000
[\ .I a 771 -0g
Thank you very much for participating in our program to test
underground storage tanks (UST) by soil gas analysis. The free
test was offered under a grant the Barnstable County Health &
Environmental Department received from the Environmental
Protection Agency.
Because the use of soil vapor monitoring for UST system release
detection is very recent and only limited information and
experience exists with using vapor sensors in this manner, we can
not guarantee that your ta-:k has co leaked. However, our tests-
did not indicate and problem. You should also realize that a
"good" result from our test is no indication of how long the tank
will remain sound. If you ever decide to remove your tank, it
would help our work if you notified us so we could take a look at
it after excavation.
This method has been given an interim approval for 1988 by your
Board' of Health. Depending on results of research this year,
complete approval may be given, otherwise you may be required to
pressure test your tank to keep it in service after 1988. A copy
of this letter has been sent to your Board of Health and the
records reflect that your tank test indicated no problem.
If you have any questions, please contact Charlotte .Stiefel at
362-2511 extension 334.
NOTE: To prevent possible contamination of your monitoring well
with oil or other substances, we highly recommend
locking or covering the well .