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0460 BEARSE'S WAY - HAZMAT
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NO. fj^ j D1lI 8 TF-370- TANK INF RAATION r l��l r iLO,CATION OF TANK: /r OR�r'�I w j ..t 0 f 4; �Iti c.N ' /d, f 0 04 � C. PACITY � t�' TYRE - AGE FUEL/CHEMICAL � I C //7TtlSTING CERTIFICATION Cy] PASS C ] FAIL DATE 'AK DETECTIOl C ] CHECK IF N/A TYPE/BRAND`'' ZONE OF CONTRIBUTION C I YES L(] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C)] YES C ] NO g DATE I:UNSERVATION C CHECK IF N/A DATE r 1 BOARD OF HEALTH TAG NO. C� ]C ]C, ]C. 11 DATE M . 1.5 C LEASE PROVIDE A'SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ED ©L �l t - � -'�LZ7[°iYGIWYC'C'� - I�1 2. Printers 9.vsatisfactory 3. . Auto Body Shops BOARD OF HEALTH4. Manufacturers r Q unsatisfactory- - (see"Orders") S. Retail Stores COMPANY f_ �'�i` '-�ti � -f o l "�} ' 6. Fuel Suppliers ADDRESS r �i1 f C'V_11_ r4 r Class: 7. Miscellaneous -V\ QUANT TIES AND STORAGE (IN=indocrs; OUT=outdoor MAJOR MATERIALS IN lots Drums AboveTanks Underground Tanks IN LIT IN JOUT INIOUT # & g2llonse Test Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL RECLAMATION REW,RKS: 1. Sanitary Sewage 2. Water Supply .�' �� !r. /t �. :.Town Sewer Public �f' „ ,,. ! . /9 OOn-site �0 Private v 4 3. Indoor Floor Drains: YES NO`< V Holding tank: MDC O Catch basin/Dry well OOn-site system 4. Outdoor Surface drains:YES,/\ NO O HoldinL� tank: MDC O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? flame of Hauler_ _I)estination -Waste Product- NO .. 3t IN A s1,4, �J fl 4/.-/) u ei [Person(s) Int.ervi-ewe w �" Inspector Tate'