HomeMy WebLinkAbout0019 THREE PONDS DRIVE - HAZMAT�19 -rh(te.. Pods vrove.� C��l�erUll��
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
,7 ` OWNER AND INSTALLER INFORMATION
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1 ADDRESS: Cl /h A7 ,F� o,��1�J J n' MAP NO.; .- PARCEL NO. /
OWNER NAME: ,_; . 1 Y�i, �- ! /` f. o ii VTL'LAGE e"Z�'E�=�!?"%M f i'v� �i c
INSTALLATION DATE: ``�i�l t�tii 17 BY:
ADDRESS:" } !M,�r <i/ �N,�/•�, Ci�,�/7 >'s / C r CERT. NO.
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TANK INFORMATION
LOCATION OF TANK: rig J.
CAPACITY /, o00 6V.1TYPE !i�t= AGE j FUEL/CHEMICAL
TESTING CERTIFICATION E I PASS E ] FAIL DATE
LEAK DETECTION qq CHECK IF N/A TYPE/BRAND lot
ZONE OF CONTRIBUTION E I YES E NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED E}�7 YES E ] NO DATE
CONSERVATION EX] CHEC//JK"`IF N/A DATE
BOARD OF HEALTH TAG NO IC JE ]E ] DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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hot 30 CENTERVILLE - OSTERVILLE FIRS~ DEPARTMENT �
PERMIT FOR STORAGE OF FUEL OIL /
In accordance with provisions of Chapter 148, G.L., and Regulations
made under authority thereof.
Name Suffolk• Realty., Name .R.., Gregoire
I ..
(owner or occupant) (Installer)
1 Three Ponds Dr.,, Address Phj, �y.'. ... a,....C. X1�R
Address .... ...-...............................
Burner Storage
j Make ...WAr j�......................................... Type of Tank •DY.allat.e l.............
I Manufacturer ....S.=e............................ Capacity ..275.... gals. (or) Size............
Model No. or Size Location ...B.499 Ult••••......................
Gu71 �VI s ss. Approval No. ..i 1�'........
PePmit issued ... � �.•�••••••••••••••• •••• John M, arri .gton,. Chie f
(Head' F 6epartmen
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(THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES)
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAME =� /�/'L)
ADDRESS 9 _71T 1 r )EE � Vi2 VILLAGE Ci-." T6"c V 14 Y-6
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAL
/1-':/ec/�/ � �r 17/u�Ji� 6,Y4
(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. 2. 3. 4.
DATE OF FIRE DEPARTMENT PERMIT: ��°`+3��
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS