HomeMy WebLinkAbout0065 CEDAR STREET - HAZMAT s cusp 5' k--vw- 11 ����
TOWN OF BARNSTABLE — UNDER
G
ROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. '� PARCEL NO. �
ADDRESS OF TANK: ' C e d'19 S TReeT- VILLAGE: 0
Numbwr Y!rwiwt
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : G
OWNER NAME: PHONE: �
INSTALLATION DATE: BY:
INSTALLER ADDRESS: '?.
*TANK LOCATION:
(DGaCR��S a¢ TANK l_OQAT I ON W 2 TH R�m-wmacY TO aU S L-o x r"cm)
CAPACITY ? TYPE OF TANK �.. 1 AGE YRS.{ FUE%CHEM I CAL
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT. ISSUED [ ] YES [ ] NO DATE
CONSERVATION L [ ] CHECK IF N/A DATE ./ /ram} �
BOARD OF HEALTH TAG NO. [ 91-7-2 /] DATE l)/If.,. I
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD