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- --TOWN OF' BARNSTABLE - UNDERGROUND FUEL A`i3 CHEMICAL STORAGE REGISTRATION
�j,7a ,�i yglll /`Qf�� MAP NO. : 7 xf PARCEL NO.
ADDRESS OF TANK: fZ-r t) T t7 Q A-7d)I LLAGE: fTYr1.`yfY1S
Num bmwr ®t r•it
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : sl-� e"
Al
OWNER NAME: -t A Cog ti)ex Reza '7"tf ,-o r- PHONE: ���' •"e�? � �f�! 2
INSTALLATION DATE: u L V / c�,1BY: 10 C- 1) L_ s
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I NSTALLER ADDRESS: k(-T) 74 0fZ e lf'4 4V".r4) CERT.NO.
*TANK LOCATION:
(0WWCRI=K TANK LOCATION WIT. RK.ICCT TO DUILDINm)
CAPACITY /0. 15h h TYPE OF TANK T7 G AGE YRS. FUEL/GHE-M I CA't (-
TESTING CERTIFICATION [ k-j'PASS C ] FAIL DATE 12-h if Ll
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND 4- IA14:- C c /�L -7Z" 77G►V
ZONE OF CONTRIBUTION 04 YES [ ] NO . DATE TO BE REMOVED VIA,
t'
FIRE DEPT. PERMIT ISSUED C 91-1YES C ] NO DATE
CONSERVATION Cy-,CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. ] DATE
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO. �f
ADDRESS OF TANK: ) .+? Q l u� tX /mil VILLAGE: I^
Numbwr r ®tr��t /
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : _5"fhl
OWNER NAME: 4-t A k'-_TiX_olt�y l !_zn4.-rV _L.Nc PHONE: _�i icy' _77 19',,2-
r
INSTALLATION DATE: TVI.V !RpZ HY: �fR fS�'/ ,•r .y
P � � r
I INSTALLER ADDRESS: �' Tit 2 , I CERT.NO.
*TANK LOCATION: f "Ti"�#Ct -� MAP'
(OKSCRInN TANK LOCATION WITH MMSPCCT TO BUILDING)
CAPACITY /� ./)�14 TYPE OF TANK _S7Z Z.- AGE R' YRS. FU}EL/CHEM-10AL A�/
TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE 1Zj
LEAK DETECTION [ ] CHECK IF N/A -TYPE/BRAND I. AA! /�_xA' f/ CAI
ZONE OF CONTRIBUTION [X] YES [ ] NO DATE TO BE REMOVED dli-
FIRE DEPT. PERMIT ISSUED [ tj YES [ ] NO DATE r1 /
i
CONSERVATION CA, CHECK IF N/A DATE
fff<
BOARD OF HEALTH TAG NO. [ ] DATE '
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
.,».,-,.-�' ,. �...•Y.,..h..•'!*.a.,a-•e..i......-GmM•.v�..i`w-..^inr -J7Gb.-+TM7y..Ykrr-rz.•}t..�^err-,.r...•.-•-"'x'�r-•r•"'G:;rYt`�3a6 r-r..,__,,,'ti,r.+,,,"..:+....,.: .:.,,,Tv'-'•.
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO. !I.�
2 3 U .� VA i0 `t_!-: !� VILLAGE:
ADDRESS OF TANK: ,C C!.
Number Qtr��t
MAILING ADDRESS ( IF��•^� .DIFFERENT FROM ABOVE) :
OWNER NAME: ?"t`���t a�l�: C Lry �i . . PHONE: • ( 19 Z-
p
INSTALLATION DATE: O` LBY: 1
INSTALLER ADDRESS: 6-4 c-rwkoyz.e 1�'1 t -CERT.NO.
*TANK LOCATION: 5 t rl(-TA c. Ff�y ") A r
DCDOf9 Z nC TANK 1_00AT I ON W 2 TH "wommCT TO mu S LD S NO)
CAPACITY TYPE OF TANK rIP-,L AGE YRS. FUrEL/CHEMICAL " +�
TESTING CERTIFICATION . [ v]---PASS [ ] FAIL DATE
LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ , ] YES C ] NO DATE TO BE REMOVED "
FIRE DEPT. PERMIT ISSUED P-01 YES . C ] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG •NO. C ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
TOWN OF BARNSTABLE -. UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION (�
MAP NO. PARCEL NO.
ADDRESS OF TANK: I�� /� .230 -T'II.4 Je 0!-14 i�d I VILLAGE: YY�A/r1f/
- fvumb�r� jQtr��! M
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : ,!//
OWNER NAME: -irq Ho=_wjf(-r 1�01CTV lor- PHONE: C i 7 0t L
INSTALLATION DATE: b/ 1-BY: kx4,-- C of 0 C~
r
INSTALLER ADDRESS: - -CERT. JO.
*TANK LOCATION: .50F A �Ctfe�D 1111,4
(owoon2oK TANK L00A72ON W21rH RGOPQoT To nu2L02NO)
CAPACITY }0)0)b TYPE OF TANK S?L" C AGE YRS. FUEL/CHEM-I-CAL � L
TESTING CERTIFICATION Cf,-]"' PASS C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND /field .
ZONE OF CONTRIBUTION [ ]YES [ ] NO DATE TO BE REMOVED X11A
FIRE DEPT. PERMIT ISSUED [4 YES C ] NO DATE
CONSERVATION [(,-]'CHECK IF N/A� DATE
BOARD OF HEALTH TAG NO. C AO q p ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD