HomeMy WebLinkAbout0281 GOSNOLD STREET - HAZMAT 4 Ann i S
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TOWN OF BARNSTABLE# — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS: Il 3 7 MAP NO. ' a k� PARCEL NO. f I
OWNER NAME: l � y '42n!r .fii 10-f 'A *!tt f,A;, VILLAGE: 1!*-/1C:r„ A 1P
INSTALLATION DATE: BY: t 1R.; /r trxe.at+
PA� 1 ..v�' "'� e �! —�� TANK INFORMATION
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LOCATION OF TANK: k 1,0 h 1 t h 1-6 ;
CAPAC I TY X_QA 0,./( TYPE J L, AGE �,i,FUEL/CHEM I CAL f V' O I L
TESTING CERT I F I CAT ON..-_C_..]..:,PASS C ] FAIL DATE
LEAK DETECTION C�]CHECK IF N/A TYRE/BRAND
ZONE OF CONTRIBUTION C ] YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
h CONSERVATION C ] CHECK IF N/A DATE ,
BOARD OF HEALTH TAG NO. C ]C ]C ]C ] DATE >
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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