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Home My WebLink About0001 ELM STREET - HAZMAT �� '1 yyl 4T)ni S I A- Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is.to Certify that Cape Cod Fuel I Elm St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------_ ------------ -------------- -----------------.-. .-------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------- ------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town ®f Barnstable t`f Barnstable Regulatory Services Department o, ;wicaC y • Public Health Division I BARNSTA13M 9�A KAM m 200 Main Street, Hyannis MA 02601 EEii77 � 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT r � NAME OF ESTABLISHMENT �p ADDRESS OF ESTABLISHMENT 7 • TELEPHONE NUMBER l SOLE OWNER: YES NO 4' " IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRE!�,;OF ALLY PARTNERS: r "C7 03- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.Ton ) STATE OF INCORPORATION 00015 C f FULL NAME AND HOME AD RESS.OF:. PRESIDENT TREASURER Lj CLERK S E OF APPLICANT • RESTRICTIONS: HOME ADDRESSCIJ HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC 1 MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow time for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please mail the required fee of$100. Please make the check payable to: Town • of Barnstable. The check must be mailed to the address listed above. Allow time for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division to Main Public Health Division Pale I QAHazmattHaz Mat Application2008.DOC f June 30, 2009 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come and clean up site Please let me know if you need any further information. I can be reached at 508-771- 0001. Sincerely, James . Shaughnessy President • ® CAPE COD FUEL EXPLANATION AMOUNT 10491 A DIVISION OF ZAKK CHURCHILL,INC. 58 WILLOW AVE. 53-13/110 M HYANNIS,MA 02601-5236 84600 PH.508-771-0001 0 z PAY OF AMOUNT Q �l do-d G �"h6b DOLLARS I CHECK DATE TO THE ORDER OF �DESCRIP ION NUMeeAAMOUNT CCU .� t oee,�e,�s Bank of America ' ACH R/T 011000138 nm 1120 10.49 Lum 1:0 1 LOGO L 381: 00q 20074 28 r 4 y? HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisholm BUSINESS: 775-1300 CHIEF Slowhe !E)eteetazd Save ,eived • EMERGENCY: 775-2323 DATE TO In accordance with 527CMR 9 .21 (1) [below] the following tank (s) ; U 1u 61.vr) 11-WI 0�u TONk Located at ; - SUN\ S\ 5 e.2.. 30 6jat,: Ave-, 321-D(93 Have been approved to be abandoned ° in place. The tank (s) have.been properly cleaned by ; and have been filled with an approved inert material of; S44g m( Y\-\�y Each step in2wi process has been inspected and was found to be in compliance th code For; Paul D. Chisholm ,Chief Hyannis Fire Department )y ' CC. r, f Town of Barnstable Board of Health `` 527CMR 9 . 21 (l) if the owner decides to abandon a tank which is either located under a building and. cannot be removed from'the ground without first removing the building or which is so located that it cajinot be removed from the ground without endangering the structural 'integrity of another tank, the owner shall. promptly notify the head of the local fire department of this condition. After verification that such condition so exists, the owner shall have all product removed from the tank, by hand pump if necessary, under the direction of the head of the fire department, and shall have the tank filled with a concrete slurry inix or any other inert material approved by the Marshal for this purpose. r S I RE �Street - 1 E _ ADDRESS OF PROPERTY BEING SURVEYED; Hyannis, MA 02601 Map 327 -/ PARCEL 063 ,. 06 OWNER : Town- of Barnstable PHONE:.__ 7 ADDRESS ; 367 Main Street - Hyannis, MA * . OCCUPANT: ' PHONE:_ ADDRESS PRESENT FLAMMABLE PERMITTED STORAGE AT PROPERTY; TANK PRODUCT LOCATION AGE CONSTRUCTION s I ZE (GAL) - FROM _ TANKS . REMOVED 01'1 THE PROPERTY, TANK PRODUCT LOCATION CONSTRUCTION DATE. , SIZE (GAL) REMOVED 1000 gal. # 2 fuel oil Underground Steel 12 FILLED IN PLACE WITH SLURRY MIX 1000 gal. 2 fuel oil ' Steel 1/95 * Not Witnessed No Hazard SPILLS / LEAKS AT THE PROPERTY; DATE: MATER I AL AP PROX. SIZE OF RELEASE None reported NF•3F1'1A T iGN PCICVIDEJ 8Y; (]ATE 6/16/98 "HYANNIS FIRE PREVENTION SUREA HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL RD.EXT HYANNIS, MA 02601 t HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisho'_m EWE BUSINESS: 775-1300 CHIEF Smohe Oeteetvzd Save ,elcoed EMERGENCY: 775-2323 PERMIT FOR; FOR REMOVAL AND TRANSPORTATION OF STORAGE TANKS FDID NUMBER : 01922 DATE OF APPLICATION Z/i PROPERTY OCCUPIED BY :�1 iJ of gAIRN STA6 (,C PHONE : LOCATION : Iz PROPERTY OWNER PHONE : TANKS TO BE REMOVED : ALL TANKS SHALL BY INERTED BY THE USE OF .DRY ICE AT 1.51bs per 100 gal. QUANITY SIZE (GALLONS) FORMER PRODUCT STORED cuv PROJECT SUPERVISOR PHONE COMPANY NAME Eiyyr A y — SA%2 ADDRESS : EXCAVATION COMPANY �Ah'� PHONE ADDRESS : DIG-SAFE NUMBER START DATE COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S) NAME : ,!�A n..- PHONE : ADDRESS : COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE : NAME PHONE : ADDRESS : D.E.Q. E. , LICENSE NUMBER: EXPIRES: i'� MANIFEST NUMBER: U COMPANY TRANSPORTING THE TANK(S) NAME: PHONE ADDRESS : THE TANKS SHALL BE TRANSPORTED TO YARD' NAME �i� ,._ SA(Vi �c PHONE 4 ADDRESS MASS . FIRE MARSHAL' S APPROVAL NUMBER r 6 G � DATE OF ISSUANCE / HYANNIS FIRE DEPARTMENT USE ONLY DATE OF EXPIRATION HAZARD FOUND - SEE LEAKPORT REMOVAL WITNESS NO HAZARD SIC,6ATURE OF APPLICANT SIGNATURE OF HYANNIS FA. OFFICIAL RECEIPT OF DISPOSAL OF �JNDERGROUND STEEL STORAGE TANK ` NAME AND ADDREi f - OF APPROVED TANK YARD APPROVED TANK YARD NO. i�,` Tank Yard Ledger 502 CMR 3.6 tuber: I certify under penalty of law I have personally examined the underground steel storage tank delivered to this "approved tank yard" by firm, corporation or partnership and accepted same in conformance with Massachusetts Fire Prevention Regulation 502 CMR 3.00 Provisions for Approving Underground Steel Storage Tank dismantling yards. A valid permit was issued by LOCAL Head of Fire Department FDIDM transport this tank to this yard.. Name and official title of approved tank yard owner or owners authorized representative: SIGNATURE TITLE DATE SIG= This signed receipt of disposal mist be returned to the-local head of the fire department FDTm —— pursuant to 502 CMR 3:00. (FACH TANK MUST HAVE A RQCEIPT OF DISPOSAL1 FORM F.P. 291 (rev. 9/88) (OVER) MASWt USETPS STATE FIRE MARSHALS OFFICE Tank Removed From (no. street) --------------- P_r�rLV-S-------------- (city or town) Fire DepartmentLA Permit # ------ � \----- (if applicable) f q ST.RE ADDRESS OF pROPERTY BEING SURVEYED; 1 Effm Street - Hyannis, MA 02601 Map 327 ./ PARCEL 063,. OWNER ToWn- of Barnstable 7 PHONE• • ADDRESS : 367 Main Street - Hyannis, MA • OCCUPANT: ' _PHONE:_ ADDRESS : PRESENT FLAMMABLE PERMITTED STORAGE AT PROPERTY; TANK PRODUCT LOCATION AGE , CONSTRUCTION S I ZE (GAI ) - -- TANKS REMOVED 'FROM THE PROPERTY; TANK PRODUCT LOCATION CONSTRUCTION DATE 5 i ZE (GAL) REMOVED 1000 gal. 2 fuel oil Underground Steel 12— FILLED IN PLACE WITH SLURRY MIX 1000 gal. 2 fuel oil ' Steel 1/95 * Not Witnessed No Hazard SPELLS / LEAKS AT THE PROPERTY; DATE: MATERIAL AP PROX. S i ZF OF RELEASt • None reported NF-3P1 5A T i CN PR1C V 1 DEO BY; DATE ; 6/16/98 "HYANNIS FIRE PREVENTION RUREA. HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL RD. EXT HYANNIS,MA 02601 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL(S) M B E DATA i MA Hazardous Waste (508)888-5478 DEPARTMENT Transport Lic.#329 Fax(5 IIDAD EXTENSION Pager(508)488-0621 1 SS. 02801 Paul I n9-9®93 ENVIRO-SAFE CORPORATION ENVIRONMENTAL CONTRACTORS rfd Save ,�'ived BUSINESS: 775-t3 •TANK REMOVAL SPECIALISTS• i EMERGENCY: 775-2323 f NICHOLAS P.CHRISTIANI P.O.Box 304 r FOR; Vice President Sagamore Beach,MA 02562 1RTATION OF STORAGE TANKS FDID NUMBER 01922 DATE OF APPLICATION PROPERTY OCCUPIED BY :�1 iJ v(-' gA2N STAG PHONE LOCATION : Iz PROPERTY OWNER PHONE TANKS TO BE REMOVED : ALL TANKS SHALL BY INERTED BY THE USE OF DRY ICE AT 1 .51bs per 100 gal. QUANITY SIZE (GALLONS) FORMER PRODUCT STORED PROJECT SUPERVISOR S r,gNl PHONE COMPANY NAME Eyvj A v — SA F2 ADDRESS . ' EXCAVATION COMPANY �Af�'L� PHONE : ADDRESS : DIG-SAFE. NUMBER : START DATE COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S) NAME )�A r.0 PHONE ADDRESS : COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE r NAME S/� _ PHONE �y S ADDRESS : D.E.Q.E. LICENSE NUMBER:- EXPIRES : MANIFEST NUMBER: i�0 (� lie,. COMPANY TRANSPORTING- THE TANKS) !' NAME: SA-jp Q P NE , ADDRESS : �,�►'S . THE TANKS SHALL BE TRANSPORTED TO � YARD' NAME :_ I l�1.�� SA (�h c- �,��'✓�p�4 9 PHONE ADDRESS : G O 1 MASS . FIRE MARSHAL ' S APPROVAL NU ; O DATE OF ISSUANCE / �1 1�9g NNIS FIRE DEPARTMENT. USE ONLY DATE OF EXPIRATION HAZARD FOUND - SEE LEA REMOVAL WITNE NO HAZARD, SI ATURE OF APPLICANT SIGNATURE OF .HYANNIS F OFFICIAL RECEIPT OF DISPOSAL. OF UNDERGROUND STEEL STORAGE TANK 1 NAME AND ADDRESSfdr OF APPROVED TANK YARD APPROVED TANK YARD NO. t Vro;; KA A!0,1"J.- Tank Yard .Ledger 502 CMR 3.(66 ber: + ! I certify under penalty.of law I have personally examined the underground steel storage tank delivered to this "approved tank yard" by firm, corporation or partnership and accepted same in conformance with Massachusetts Fire Prevention Regulation 502 CMR 3.00 Provisions for Approving Underground Steel Storage Tank dismantling yards. A valid permit was issued by LOCAL Head of Fire Department FDID Z this tank to this yard.. Q� o. transport Name and official title of approved tank yard owner or owners authorized representative: ! SIGNAZURE TITLE ME SIGW ! This signed receipt of disposal must be returned to the,local head of the fire department ! FDIID# _____ pursuant to 502 CMR 3:00. (EACH TALC MUST HAVE A REMM OF DISPOSAL) j FORM F.P. 291 (rev. 9/88) 10V R) MWSSACHUSLYZ STATE FIRE MARSHAL'S OFFICE r DIMENSIONS Tank Removed From Width Length ------- ---- (no. street) =- Tank I X - Tank 2 ----- X ----- (city or town) Tank 3 ----- X ----- Fire Department ------ - --- -`----- ._ Permit # Tank 4 ----- X ----- (if- applicable) I Tank 5 --- X ----- i s (feet) (feet) f FOAM F.P. 292 (rev. 9/90) . • •w � (u�p (1��JZIt)ItittilUYttif�' �� BBttr1�IHpff� . Department of Public Safety Division of. Fire Prevention and Regulation APPLICATION FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVE TANK YARD FDID# Permit # 9 n A , Date 1 19 S ty, Town or District C . 82 S . 40 M . G . L . DIG SAFE NUMBER Fee Paid: $ Oo �,�L -7 3_7 start date 11161 q5l In accordance with •the provisions of Chapter 148 , Sec. 38A, M.G. L. , 5.27 CMR 9. 00 application is hereby made by:JJ . Street Address & City or Town: / PP Signature of applicant: I C 9 Applicants name printed: �j1~ChU P,s C is I �✓d For permission to remove and transport one underground storage tank from. Owner own,' C. = 8AA V —4— )- t3(,�Street Address: C--L�V, S Firm transporting waste: _State Lic. #_ Hazardous waste manifest # E.P.A. # Approved tank yard: A Tank yard Address: Gux- kL-.e k-c rA(, S' C`1 ti—) Type of inert gas: k 0 1 e^) UL tank #: Tank capacity:_ P y I d w Substanceft stored: 61 L- Date of issue: 19 Date of expir A�FPRE Eli! A#�� 19 H opt M BAH» Signature/Title of Officer granting permit: RQ 1 �7 y r HYANNIS FIRE DEPARTMENT . 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 -RICHARD-R. FARRENKOPF S��/e �eteCtV'�d �7aUe �LUed BUSINESS: 775.1300 CHIEF fZ EMERGENCY: 775-2323 June 8, 1990 TO ,UNDERGROUND STORAGE TANK OWNERS t 'Fl { , - This Department is aware that ,you have 'an underground':tank ,at,.your:;property which is over twenti,"00 years old, s , According to Federal;'State and Town regulations, arrangements must be.made for the removVi al {of these tanks :-We suggest that prior toy emptying your present under.g _ound'tank you look into having a replacement tank installed' ! in the basem4nt or outside the premises, after which time you will have a;°-' N ; ! I period of two years to 1remove the=.underground tank_.,._ F. ;' We have been ormed by�,�som;. residents that. the :underground tanlc� at their: property has{) b///een ab -,. oned and is, not- in :.use These ,tanks shall be`'removed 4 k •1 as soon as pssible' ' ` 1. Please do nothe`sitater`� contact this Department if we can be of further : .:,ram_.pr •-•`' ,assistance or if, you would like a listing .of some of the underground:.-tank! removal companies1-7 \ Sincerely, '.,, RI C HARD R. FARRENKOPF, Chief Hyannis Fire Department RRF/dl IIJI Y r HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisholm e �q a BUSINESS: 775-1300 .S CHIEF nwhe �eteetou Sa e ,Cher EMERGENCY: 775-2323 DATE TO " In accordance with 527CMR 9 . 21 (1) [below] the following tank (s) ; Located at till S Have been approved to be abandoned in place . The tank (s) have ' been- properly cleaned by and have been filled with an approved inert material of;_ Ste- yy\�Y Each step in thep process has been inspected and was found to be in compliance wit th code For; Paul D. Chisholm Chief r "Hyannis Fire Department -� f, cc . •- � � � �J� Town of Barnstable Board of Healthf" .St N'R� 527CMR 9 . 21 (1) If the owner decides to abandon a tank which is either located under a building and. cannot be removed from the ground without first removing the building or which is so located that it cannot be removed from the ground without endangering the structural integrity of another tank, the owner shall promptly notify the head of the local fire department of this condition. After verification that such condition so exists, the owner shall have all product - removed from the tank, by hand pump if necessary, under the direction of the head of the fire department, and shall have the tank filled with a. concrete slurry inix or any other inert material approved by (lie Marshal for this purpose. IL __ K�E rq� Town of Barnstable BA a ..De artment of Public Works SS. ° P �pIE039.•`° 367 Main Street, Hyannis, MA 02601 Office 508-790-6300 Thomas J.Mullen Fax 508-790-6400 Superintendent December 1, 1994 Hyannis Fire Department 95 High School Road Hyannis, MA 02601 SUBJECT: Underground Storage Tank Former Police Station - Elm Street, Hyannis Dear Sir: am writing to request permission to abandon the subject underground storage tank in place. The tank is located in close proximity to the building and its_ appurtenances. I am concerned that the structural integrity of this relatively old building would be adversely affected if the tank were removed. The tank is under 1,000 gallons in capacity. The Town would propose to clean out the tank and fill it with concrete. We would investigate the soil around the tank to ensure that there is no contamination. Sincerely, Stephen Seymour, P.E. Project Engineer SS/dd HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisholm MXHX=XM1rA qX2MW=W BUSINESS: 775-1300 -CHIEF _ Smolhe Oetectow Save Zved EMERGENCY: 775-2323 PERMIT FOR; FOR REMOVAL AND TRANSPORTATION OF STORAGE TANKS ' . FDID NUMBER : 01922 DATE OF APPLICATION PROPERTY OCCUPIED BY :_7t94,,.J bF- ,3 A2,_)57t13 PHONE . LOCATION : _s30 EL_vn ST %?w,J( PROPERTY OWNER c9 ✓nth PHONE TANKS TO BE REMOVED ALL TANKS SHALL BY INERTED BY THE USE OF DRY ICE AT 1.5.1bs per 100 gal. QUANfTY SIZE GALLONS) FORMER PRODUCT STORED —t— oZ F'yE L- QO . PROJECT SUPERVISOR OILK. GH ✓L15 i�1 yj -)'I PHONE -S4�R' COMPANY NAME 6-jVtc_cD -- 5AFc CO2� ADDRESS : Po 3 b--t S-16 E A E7`a C 4 EXCAVATION COMPANY PHONE ADDRESS : DIG-SAFE NUMBER R44 Cony, too START DATE . t ja7 COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S) NAME PHONE : ADDRESS : COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE : NAME DJ V t 2 y -S✓l F G �srF' PHONE : ADDRESS :io3on S/aG K1 D.E.Q.E. LICENSE NUMBER: EXPIRES : MANIFEST NUMBER: WA COMPANY TRANSPORTING THE TANK(S) NAME: ?tll?J-)C-Z-- sAt✓vi Gc: PHONE ADDRESS: L...Yc).J t to M >� THE TANKS SHALL BE TRANSPORTED TO YARD NAME .S j9 l.L/✓a PHONE r ADDRESS /,.)✓a `! L iJ,c� r9 MASS . FIRE MARSHAL ' S APPROVAL NUMBER 4 DATE OF ISSUANCE 3 HYANNIS FIRE DEPARTMENT USE ONLY DATE OF EXPIRATION Q HAZARD FOUND - SEE LEAK REPORT REMOVAL WITNESSED - NO HAZARD SIG ATURE OF A PLICANT SIGNATURE OF HYANNIS F.D . OFFICIAL FORM FP- 292 (rev. 9/90) . I ttl�P C�lltitlitittttVpMlf�j �f �M�B�(rljliBPffB Department of Public Safety Division of Fire Prevention and Regulation APPLICATION FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD FDID# Permit # Date i9 City, Towri or Matrict 94600 C . 82 S . 4 0 R . G . L . DIG SAFE NUMBER Fee Paid: if s f 4g 6 o(- 100 start date t c 7 G In accordance with the provisions of Chapter 148 , Sec. 38A, M.G.L. , 527 CMR 9. 00 application is hereby made by: Street Address & City or Town: 4�0 L302n Z0 Signature of applicant: Applicants name printed: 2c-; c:; F o q Z S For permission to remove and transport one underground storage tank from. Owner: l3�qzo Street Address: -90 CC-v? ) .S,-T— Firm transporting waste: C-7)J✓r 20 - 5 M Fi�F State Lic. # 312 Hazardous waste manifest # ,ls/A E.P.A. # Approved tank yard: -TV2,� # 1, t I Tank yard Address: L Type of inert gas: i7'ICUC)v�L) UL tank #: Tank capacity: Sit? Substa" last stored: °his�, Date of issue: // 3 19 �� Date of exOI ,� fft, Signature/Title of Officer granting permit: T$ 4 n;._ F i ti z HYANNIS FIRE -;APPLICATION. FOR PERMIT' DISTRICT TO INSTALL'.-ALTER FUEL OIL BURNING EOUIPMENT To the Head of the Fire Department: _ Application is hereby made in accordance:with the,provisions of Chap 148,, G L j, and Regulations made under authority thereof by the undersigned for.permit to install-- alter, for the person or persons and at.the location named herein, certain equipment fore the keeping, storage`or use of fuel or other inflammable liquid.products used•for fuel. as described below. J-PNAME. ........_.._..�..�+�.+_!�1.._Q .......1 �- _.... ��1.JJ/ h C Y. ADDRESS ._............... 1_repe. � �'..:.� ........ Description— Name _ ............................_..._... ..........__.. ......_._......_..._. _,. ..:... Manufacture :................_...........::._..._........... ........ .......__........... .._... Burner: ' Type __:.....:. __.-Model. or Location ........... .... .... Mass Approved Storage Tank: Type .. . .. Capacity .:gals (or) Size Location .._.._vim!� ...... ..__.......... __' Amount of fuel required for testing.purpose...._............... gals; $. ;� _ This application is made with full knowledge'of the current requirements of the regulations governing such installation, which wilt be made in'compliance therewith Note: If this application'involves alterations-to existing equipment, describe fully on reverse side. .r> �T ...........___ f Signature oY Applicant AppT'Rec d B ._ Permit Issued _ Y -: - � Permit No Address t,,,��v�"/Y/Y S Certificate oY Competency No n PHYANNIS FIRE PREVENTION' t "'IS FIRE-RESCUE DEPARTMENT _ M HIGIISCHOOL RQAD,Ex� HYANNIS,MA 026!!r' l t , X i L t I