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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTR`A�TION
MAP NO. a10- PARCEL N0: ! ( f?
ADDRESS OF TANK: /. �� Y�' i r ew f' `���r '-� VILLAGE: C�. -/V /r ✓
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MAILING ADDRESS ( IF DIFFERENT FROM ABOVE :) '
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OWNER NAME: //w- G h t C9- " P'HoN-tE -,77,5**- q P?7
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I NSTALL'ER ADDRESS: CERT.NO.
*TANK LOCATION: T i
(DC®CAIsNq AN LOCATION WIT MKSRKCT TO HUILDINO)
CAPACITY �7�°� TYPE OF TANK� AGE �'-t;H FUE
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TESTING CERTIFICATION [ ] PASS[ J FAIL tDATE
LEAK DETECTION ["'+/] CHECK IF N/A ' TYPE/BRANDr Iq _I
ZONE OF CONTRIBUTION [ ] YES [ 1. NO DATE TO BE REMOVED +
FIRE DEPT. PERMIT ISSUED [ J YES C NO DATE '" Apr
CONSERVATION IV] CHECK IF N/A DATE i %�
BOARD OF HEALTH TAG NO. [ ] DATE / A 1?, q A/
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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