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Home My WebLink About0015 CRAIGVILLE BEACH ROAD - HAZMAT C 5 Cv-a�o�v�� 1��2, ��'1 'R:�oGi-�' ,,,\ ��2 � m�-� ,. i TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION 9A . `" OWNER AND INSTALLER INFORMATION 1 r) ADDRESS: 1' T r n,r.:r l,lFr 1`3r�r�/� r.� MAP NO. ..7C-,n PARCEL NO. OWNER NAME: ► r i N tits<.r' r=''- f•r . i! Y P r VILLAGE: a z.+ ' f-lVP iYx Pry w i INSTALLATION DATE: Jai 7 BY: r r2 - lly-t ox, n!j c. ADDRESS: `�` -r)e_,) r--;,:<ro, , CERT. NO. o I TANK INFORMATION 'j, LOCATION OF TANK: 1717C A17 «t: t' `V r616 4✓r CAPACITY TYRE?�e"n AGE FUEL/CHEMICAL TESTING CERTIFICAT ON C I PASS E ] FAIL DATE LEAK DETECTION E ]�CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION E ] YES I NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED E%/] YES E ] NO. DATE CUNSERVATION C ] CHECK F N/A DATE BOARD OF HEALTH TAG NO. 7E 'JE ]E ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD i � f .i �� S d�i�-� � �Ya�s�� t ��s f FIRE DEPT, FFIRE DEPT. STATE USE ONLY CERTIFICATION Copy to be certified by local fire depart ent .D.Numb er at and: POSTED AT STORAGE FAC I L I TY , Date Received -Fl I w 8" Notification is required by Federal law for all underground tanks that have been 4. pipeline facilities (including gathering lines) regulated under the "Natural Gas used to store regulated substances since January 1,1974,that are in the ground as of Pipeline Sal'ct\Act of 1968.or the Hazardous Liquid Pipeline Safety Act of 1979.or May 8,1986,or that are brought into use after May 8,1986.The information requested which is an intrastate pipeline Iacilitc regulated under State laws: is required by Section 9002 of the Resource Conservation and Recovery Act,(RCRA), 5.surface impoundments,pits,ponds,or lagoons: as amended. 6.storm'Hater or waste water collection ssstcros: The primary purpose ol'this notification program is to locate and evaluate under- 7•flow-through process tanks: ground tanks that store or have stored petroleum or ha%ardour substances. It is 8.liquid tiaps orassociated gathering linesdiiccd\related to oil orgas production and expected that the information you proside will be based on rcasonabh available gathering operations: records.or,in the absence of such records,your knowledge.belief'.or recollection. 9. storage tanks situated in an underground area (such as a basement. cellar. mineworking,drift,shaft,or tunnel)it the storage tank is situated upon or abuse the Who Must Notify? Section 9002 of RCRA. as amended, requires that. unless surface of the floor. exempted,owners of underground tanks that store regulated substances must notify designated State or local agencies of the existence of their tanks. Owner means— What Substances Are Covered? The notification requirements apply to under- (a) in the case of an underground storage tank in use on Nosember 8, 1984.or ground storage utnks that contain regulated substances.This includes anc substance brought into use after that date,an\ person who owns an underground storage tank defined as hazardous in section 101 (14) of the Co III prehenske Em ironmental used for the storage.use,or dispensing of regulated substances,and Response.Compensation and Liability Act of 1980(CERCLA).with the exception of (b) in the case of any underground storage tank in use before November 8, 1994. those substances regulated as hazardous waste under Subtitle C of RCRA. It also but no longer in use on that date.any person who owned such tank immediatel)before includes petroleum,e.g..crude oil or anc Fraction thereof which is liquid at standard the discontinuation of its use. conditions of temperature and pressure(60 degrees Fahrenheit and 14.7 pounds per What Tanks Are Included? Underground storage tank is defined as any one or square inch absolute). combination of tanks that(1)is used to contain an accumulation of"regulated sub- Where To Notify? Completed notilication forms should be sent to the address stances.-and(2)whose volume(including connected underground piping)is 10('(' or giscn at the top of this page. more beneath the ground.Some examples are underground tanks storing:1.gasoline, used oil,or diesel fuel,and 2.industrial sohents,pesticides,herbicides ur fumigants. When To Notify? 1.0wners of underground storage tanks in use or that ha\c been What Tanks Are Excluded? Tanks remosed from the ground are not subject to taken out of operation after.lanuan 1. 1974,but still in the ground,must notif\ bs Maro 8. 1986.2.Owncrs w hu bring underground storage tanks into use after May 8, notification.Other tanks excluded from notification are: 1986.must notilc within 30 dass of bringing the tanks into use. 1.farm or residential tanks of 1.100 gallons or less capacitc used lit storing muter I eel for noncommercial Purposes: Penalties: Any owner who knowingly fails to notify or submits false information 2.tanks used forstoring heating oil forcunsumpti\e we tin the premises w here stored: shall be subject to a civil penalty not to exceed $10,000 for each tank for which 3.septic tanks: notification is not given or for which false information is submitted. Please type or print in ink all items except"signature"in Section V'.This form must by completed for Indicate number of each location containing underground storage tanks.If more than 5 tanks are owned at this location, continuation sheets photocopy the reverse side,and staple continuation sheets to this form. attached Owner Name(Corporation,Individual,Public Agency,or Other Entity) (If same as Section 1,mark box here. ) —PE-f V—'� 'V� I QU 10 f'c t-f`�c� w TQ(-.1 I G f Facility Name or Company Site Identifier,as applicable Street Address Cc ty 1 1 Street Address or State Road,as applicable City State ZIP Code County &) IAA a*Gg` Area dode Phone Number City(nearest) State ZIP Code 50s - 1`irT 5 - 0(0 6,3 Type of Owner (Mark all that apply®) Private or Indicate Mark box here if❑ tank(s)Current ❑ State or Local Gov't Corporate number of are located on land within ❑ ❑ Former ❑ Federal Gov't ❑ Ownership tanks at this an Indian reservation or (GSA facility I.D.no. uncertain location on other Indian trust lands Name(If same as Section 1,mark box here ) Job Title Area Code Phone Number , Rini X ❑ Mark box here only if this is an amended or subsequent notification for this location. e I I certify under penalty of law that I have personally examined and am familiar with the information submitted in this and all attached documents,and that based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the submitted information is true,accurate,and complete. Name and official title of owner or owner's authorized representative S lure / f Date Signed h Form F.P. 290 Part 3 Paget s Uwner s iurt:2(from Section 1)_ Location(from Section II) Page No. of Pages Tank Identification No.(e.g.,ABC-123),or Tank No. Tank No. Tank No. Tank No. Tank No. Arbitrarily Assigned Sequential Number(e.g.,1,2,3...) 1.Status of Tank Currently in Use (Mark all that apply®) Temporarily Out of Use Permanently Out of Use Brought into Use after 5/8/86 0 2.Estimated Age(Years) 10 3.Estimated Total Capacity(Gallons) 7 4.Material of Construction Steel 0 0 (Mark one®) Concrete Fiberglass Reinforced Plastic 0 0 0 Unknown 0 0 0 0 0 Other,Please Specify 5.Internal Protection n Cathodic Protection (Mark all that apply m) 0 0 Interior Lining(e.g.,epoxy resins) 0 0 None Unknown 0 0 Other,Please Specify 6.External Protection Cathodic Protection (Mark all that apply®) Painted(e.g.,asphaltic) 0 0 0 Fiberglass Reinforced Plastic Coated 0 0 0 None 0 0 Unknown 0 Other,Please Specify 7.Piping Bare Steel 0 (Mark all that apply®) Galvanized Steel 0 0 Fiberglass Reinforced Plastic 0 0 Cathodically Protected 0 0 Unknown Other,Please Specify 8.Substance Currently or Last Stored a. Empty 0 0 O in Greatest Quantity by Volume b. Petroleum (Mark all that apply m) Diesel Kerosene 0 Gasoline(including alcohol blends) C�Used Oil Other,Please Specify 2• (1Q l oil c. Hazardous Substance 0 0 Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS) No. Mark box®if tank stores a mixture of substances d. Unknown 9.Additional Information(for tanks permanently taken out of service) a. Estimated date last used (mo/yr) b. Estimated quantity of substance remaining (gal.) c. Mark box®if tank was filled with inert material (e.g.,sand,concrete) 0 0 0 0 Page 2