HomeMy WebLinkAbout0070 WHITE OAK TRAIL - HAZMAT °?U 6Jh�4e Oo.�C -1'rrni I , Ca.�4e�i�U�,
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� OF BARNSTABLgE C�- UNDER'G/RO���F�E��A�D;, ��{F„�'y�CAL�T,��E REGISTRATION
IV Dl MMS ///� V'6 MAP NO. PARCEL
II(�/Ur (fr PARCEL N0.
ADDRESS OF TANK: � ���� i r k VILLAGE: <<
Number �tr��t i
MAILING ADDRESS ( I/F DIFFERENT FROM f ABOVE_). —
OWNER NAME: l� �71 i 1 �� t �/� `�J PHONE:
INSTALLATION DATE: �23 BY:
INSTALLER ADDRESS: M°tr"�1 J1J' err / ��, CERT.NO.
*TANK LOCATION: `�- ✓ w Izl,.° f,' 1- T
OWNCR I•K TANK LOCATION WITH' RZ=PKCT TO HU I LO I NO)
CAPAC I TY$ 6 '_7,TTYPE: OF TANK AGE /9-.. YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [, ] CHECX,kIF N/A TYPE/BRAND.
1
ZONE OF CONTRIBUTION, ry[ ] YES [ j NO DATE f TO BE REMOVED ��61
FIRE DEPT. PERMIT ISSUED [ ]'YES [ �] NO DATE
Z
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ , ]`-DATE
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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