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Home My WebLink About0097 HARBOR BLUFFS ROAD - HAZMAT da4 u0j, Ir t �M , (n A'r • TOWN Or BARNSTABLE vAUNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS , , t�, A 6 ASSESSORS MAP NO. PARCEL NO. �� " r(fC 6. ADDRESS, Aw'8'1,2 ,�ld<6 A;�q VILLAGE' -lyo,(&1-5 NAME;._. CONTACT PERSON PHONE NUMBEI�7jr977d� LOCATION OF TANKS: CAPACITY:_ TYPE ,OF FUEL AG TYPE: LEAK OR CHEMICAL: > DETECTION r-lklA G I-IVV e p?4j&/ P �� I /< I•//�Ja C� SYSTEM 141 w�!� DATE OF PURCHASE OF. EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. .Fk�. �f��vtr /3lvfF .Q, J y�.t ��, OV2r6tt� C4 f �� c�1�F C�, Pttltf� u� �BSttrI�SP�S — — DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION PIS Date V Form F.P. 290 TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY Part 4 In accordance with the provisions of 527CMR9.24 this permit to maintain an existing/new underground storage facility is granted to: Location of property: 2z &A6e�2r /Fw. Street address Owner of property: T— Full name of person, firm or corporation 11" Restrictions: e ' oma /94 Fee Paid:$ D (M.G.L.A. Chapt. 148 Sec. 10A) This permit will expire 19 6s g-v Date i ature of Head of Fire Dept.or appoi ted designee (Owner's Copy to be posted at the storage facility with-- .P. 90 'Fart 3) ' _,(from Section 1) Location(from Section 11) � ~'N--_-----_ P-"-- 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 (Mark all that apply M) Currently in Use Temporarily Out of Use Permanently Out of Use Brought into Use after 5/8/86 2.Estimated Age(Years) 3.Estimated Total Capacity(Gallons) 4.Material of Construction Steel (Mark one M. Concrete Fiberglass Reinforced Plastic Unknown Other,Please Specify - "^Internal Protection Interior Lining(e.g.,epoxy resins) None Unknown EAD Other,Please Specify 7xlernal Protection Cathodic Protection ,-'Mark all that apply M) Painted(e.g.,asphaltic) Fiberglass Reinforced Plastic Coated None (Mark aft that apply IM) Cathodic Protection Other,Please Specify (11clark aft that apply 0) Bare Steel- --------- Galvanized Steel I V 'Reinforced Plastic L-� Fiberglass Cathodically Protected Unknown Other,Please Specify B.Substance Currently or Last Stored a. Empty in Greatest Quantity by Volume Kerosene Gasoline(including alcohol blends) Used Oil Other,Please Specify A J11 c. Hazardous Substance Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS)No. Mark box IN 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 13 if tank was filled with inert material ` ' Page t / �•;�, �¢�"��'��r4• �• l• • • • .,• ,�+�,��+�}+u.,w�s�CS�.?+� ,�Yt-fni�A�`b,,dw is�SY�n•.„}„ +Cc.i•::�� F � .;. yea "''''4K��'''�"��••• � .'w e. .."..----" .1.,...A_ fr }:. , � } r..Y wnX+•; Mj�.�� '[� 7;:f1 ` �� m FIRE DEPT, STATE USE ONLY ciIitr,uiI0K � � Copy to be certified by local fire departrlexlt I D Nu;beZ/ POSTED AT STORAGE FACILITY s. Dale Received r. Notification is required by Federal Iaw for all..underground tanks that have been 4. pipeline facilities (including gathering line) regulated under the Natural (ra•. used to store regulated substances since January 1..1974,that are in the ground as of Pipeline Safet) Act of 1968.or the Hazardous liquid Pipeline Safcn Act of 1979.,,, May 8,1986,or that are brought into use after May 8,1986.The information requested u hich is an intrastate pipeline facility regulated under State laNs: is required by Section 9002 of the Resource Conservation and Recovery Act,(RCRA), 5.surl Ice impuundnxnu.pits,pond,.or lagoons: gas amended. 6.storm'water or waste water collection systems: The primary purpose of this notification program is to locate and evaluate under- `—(,Clow-through process tanks: • ground tanks that store or hate stored petroleum or hazardous substances. It is �•liquid(rapsurassociatedgatheringlineditretlyrtlatrdtnoilorgasproductiunand expected that the information you provide will he based on reasonably available. gathering operations: 'r 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. Who Must Notify? Section 9002 of RCRA,as amended, requires that, unless mineworking.drift,shaft,or tunnel)if the storage tank is situated upon or above the exempted,ostnrrs of underground tanks that store regulated substances must notify surface of the floor. designated State or local agencies of the existence of their tanks.Owner means- What Substances Are Covered? The notification requirements appl% to under- (a) in the case of an.underground storage tank in use on 1\owniber 8. 1984.or ground storage tanks that contain regulated substances:This include am substance brought into use after that date,any person who o%%ns an underground storage tank defined as hazardous in section 101 (14) of the Comprchenske Fri%konmental used for the storage,use,or dispensing of regulated substances,and Response.Compensation and Liability Act of 1980(CERCLA).with theexception of (b) in the case of ant'underground storage tank in use before Nowmber-8, 1984. those substance regulated as hazardous Waste under Subtitle C of RCRA. It also but no longer in use on Chat date.am'person who owned such tank immediate4-.befure includes petroleum,e.g.,crude nil or any 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 notification firms should be sent to the address stances,"and(2)whose solume(including connected underground piping)is IOC!or given at the top of this page. more beneath the ground.Some examples are underground tanks storing:1-gasolme..._ used oil,or diesel fuel.and 2.industrial sohents.pesticide,herbicide or lumigants. When To Notify? I.OA nct:s of underground storage tanks in use or that hasc been What Tanks Are Excluded? Tanks,emoted from the ground are not subject to taken out of operation after.)anuart I. 1974.but still in the ground.must notil_%bs notification.Other tanks excluded from notification arc: MN X. 1986.2.0%ners tsbo bring underground storage tanks into use after May 9. 1.farm or residential tanks of 1.100 gallons or lescapac•ity used lixstoring motor furl 19M.mist notify within 30 days of bringing the tanks into use. for noncommercial purposes: Penalties: Any owner who knowingly fails-to notify or submits false information 1.tanks used tixstoring heating oil tixconsumptiye use on the premise v here stored: shall be subject to a civil penally not to exceed$10,000 for each tank for which 3.septic tanks: notification is not given or for which false information is submitted. .4'A sx Please type or print in ink all items except"signature"in Section V.This form must by completed for Indicate: 'mber 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 ' ; ,c 'D,�' +` m .• • z t -mid :^R.': • • • ''1.�, ti.. Y..}S Bid Owner Name(Corporation,Individual,Public.Agenn�cy,or Other Entity) (If same as Section 1;mark box here LLi�f'' G — (_-And ,, �^t'1 V A)ro Facility Name or Company-Site Identifier,as applicable .- Street Addres ` r V.41N STRP-e r` 9�' y4•-.t er .t61 ' A/, County M,L Street Address or State Road,as applicable City State ZIP Code County Area Cc a Pho a Number CfY(nearest) State ZIP Code /7 BVS—S11V �OAr 7as-8270 r Type of Owner (Mark all that apply(@) �( rival r Indicate ® Current' ❑ State or Local Gov't .OJ orate Mark box here if tank(s) 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 MEN v� s„ Name(If same as Section I,mark box here ❑) Job Title Area Code Phone Number `fA ❑ Mark box here only if this is an amended or subsequent notification for this location. 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. Lme icial title of owner or owner's authorized representative S� / Date Si ne ..�w:14- ;,�„ ,yd ' �. 'drat.�.� • • • Ts, •r��3,•V;.-:�+"1,%`�F�i'-'�' �� ' ''•�x'`EIt IWO; y, r �•- Form F.P. 290 Part 3 Page t