HomeMy WebLinkAbout0077 CIRCUIT AVENUE - HAZMAT (2) `7�7 C'ircui'�- %ve-nue-
b54 Nyar,n �S
t
r
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: -77 CIKCuIT AVF-, MAP NO. PARCEL NO.0=-4
OWNER NAME: VILLAGE: 1fYfiIVAhs
INSTALLATION DATE: BY:. vt:VdwN
ADDRESS:
" CERT. NO.
(6/1)�a5,*_7,�NANK INFORMATION
t
LOCATION OF TANK: I-PoNT YAP-0 1V611 TO GA-9"F-
CAPACITY S'OD G TYPE STF-EL. AGE 2OYk-tt- FUEL/CHEMICAL AO,a FVCL QIL—
TESTING CERTIFICATION C I PASS C I FAIL DATE DTI
LEAK DETECTION C CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION C I YES C: NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C I YES C 7` NO DATE
GUNSERVATION CX] CHECK F N/A DATE
BOARD OF HEALTH TAG NO. C ]C ]C ]C ] DATE [� U
PLEASE PROVIDE A SKETCH SHOWING THE TANK"~LOCATION ON THE BACK OF THIS CARD
I
1
1
i
I
`j A
_ I
4
.P
r b�cc�o T /4 v c