HomeMy WebLinkAbout0354 WHITE OAK TRAIL - HAZMAT i
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: 72- f i/ '' MAP NO. � '� �`�- PARCEL NO.
OWNER NAME:' VILLAGE:
INSTALLATION DATE: r3 i •.` BY:
ADDRESS: �`�'i C) ,'►. ,::1��tw.j CERT. NO.
P470 A^C a 1 ! TANK INFORMATI-ON
LOCATION OF TANK: / -t+ 3 --
CAPACITY 17 TYPE -j arc dt(Z.- AGE d` j;g FUEL/CHEMICAL /
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TESTING CERTIFICATION C ] PASS C I FAIL DATE
LEAK DETECTION C CHECK IF N/A • TYPE/BRAND � n
ZONE OF CONTRIBUTION C ] YES C NO DATE TO BE REMOVED dt / �
FIRE --DEPT.-PERMIT-ISSUED-----C]--YES___C_.-] ,NO ,-DATE
CUNSERVATI3N_______... _CY7_ CHECK IF N/A -DATE
BOARD OF HEALTH TAG NO. ✓ ]C I C ]C ] DATE
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PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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