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Home My WebLink About0089 LEWIS BAY ROAD - HAZMATr gQ l.Qwis �a� {Cmac1, 1.��r�iS aa3 TOWN OF BARNSTAHLE UNDERGROUND FUEL AND CHEM ICAL STORAGE' REGISTRATION MAP NO. �3 � 7 PARCEL NO. ADDRESS OF TANK: �� `� �,1 ! VILLAGE: ��`I '� .-:a MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: i-�-t�,-3 `�" � C`C,C: g :` z c c � � PHONE: INSTALLATION DATE: ; t. BY: INSTALLER ADDRESS: CERT.NO. *TANK LOCATION: (DloOAlat TANK LOCATION WITH MKWPCCT TO WUILDINW) CAPACITY ��C��C h-TYPE OF TANK 7; #f AGE Wr YRS. FUEL/CHEMICAL TESTING CERTIFICATION C ] PASS C ] FAIL DATE, h LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND },/'} ZONE OF CONTRIBUTION [ ] YES C ! NO DATE TO BE REMOVEDt/ ' FIRE DEPT. PERMIT ISSUED [ ] YES C ] NO DATE CONSERVATION C 7 CHECK IF N/A DATE / BOARD OF HEALTH TAG NO. C � ] DATE / U PLEASE PROVIDE A SKETCH .SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD FIRE DEPT. I - F RE DE PT STATE S E USE CERTIFICATION 1C ONLY T F ATION L. Copy to be certified by local fire departrtle I.D.Number 3 nt � ZZ and: POSTED AT STORAGE FACILITY D to Re eived 4 1 G Fs°! rP �v�ntt�n Glen . 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'cty Act of 1968,or the Hazardous Liquid Pipeline Safety Act of 1979.of- May 8,1986,or that arebrought into useafter May 8,1986.The information requested wtuchisan intrastate pipeline facilitc 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'Nam or waste waicr collection s_\stems: The primary purpose of this notification program is to locate and evaluate under- 7.Ilow-through process tanks: ground tanks that store or hace stored petroleum or hazardous substances. It is 8•liquid trap%or associated gathering linesdirecth related tooilorgasproductionand expected that the information you pros'ide will be based on reasonably 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. mmcworking,drill,shaft,or tunnel)if the storage tank is situated upon Orabosc 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 apph to under- (a) in the case of an underground storage tank in use on Noscmber S. 1984.or ground storage tanks that contain regulated substances.phis includes any substance brought into use after that date,aria person who owns an underground storage tank defined as hazardous in section 101 (14) of the Comprehensi\e Em ironmental used for the storage,use,or dispensing of regulated substances,and Response.Compensation and L.iabilitc Act of 1980(CERCLA).with the exception of (b) in the case of any underground storage tank in use before Nmember 8. 1984. 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 immediately before includes Petroleum,e.g..crude oil 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 forms should be sent to the address stances."and(2)whose volume(including connected underground piping)is 10C('qr giscn at the top of this page. more beneath the ground.Some examples are underground tanks storing:Lgasoline. used oil,or diesel fuel,and 2.industrial sohents,pesticides.hcrbicides or f umigants. When To Notify? ].Owners ofoncicrground storage tanks in use ar that ha\c been taken out of Operation alter.lanuan I. 1974.but still in the round,must notify be What Tanks Are Excluded? Tanks remoscd from the ground are not subject to Mai 8. 1986.2 Owners who bring underground storage tanks into use after May 8. notification.Other tanks excluded from notification are: 1986,must notil\ scithin 30 days of bringing the tanks into use. 1.Iarm or residential tanks of L 100 gallons or less capaeity used forstorntg nuuur fuel for noncommercial Purposes: Penalties: Any owner who knowingly fails to notify or submits false information 2.tanks used fur storing heating oil for consumptke use on the premises v%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 3 photocopy the reverse side,and staple continuation sheets to this form. attached Owner Name s�()Corporation,Individual,Public Agency,or Other Entity) (If same as Section 1,mark box here®) Facility Name or Company Site Identifier,as applicable Street Address 106 Feel e21 S�` 69 t-�-ew nc( c l-et.,u l County Street Address or State Roa ,as applicable fLPoIL �3ar-�sfable City State. ZIP Code County 1 �X�S�bdl k n 0�1I C)� c4-a F) M n D7I6510 a Code Phone Number City( earest) State ZIP Code cc) Type of Owner (Mark all that apply®) Private or Indicate Mark box here if tank s ❑ Current ❑ State or Local Gov't '� Corporate ( ) P 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 • e • • '. Name(If same as Section I,mark box here ❑) Job Title Area Code Phone Number �a�1d Crook I�(alll�e al�c� Sv r-VI,5or- Goa-) ' I ❑ 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. Name and official title of owner or owner's authorized representative Si re Date Signed jo C/ aw/� r e 0M. ice,. • xa g. Form F.P. 290 Fart 3 Page I tt ll ll �� Owner,Name(from Section 1)_!vim O f t 1 C(� Location(from Section 11) Page No. 7 of Pages" F l Tani;Identification No.(e.g.,ABC-123),or Ta 'k No. Tank No. Tank No. Tank No. Tank No. Arbitrarily Assigned Sequential Number(e.g.,1,2,3...) I 1.Status of Tank (Mark all that apply®) Currently in Use Temporarily Out of Use 0 0 0 0 Permanently Out of Use Brought into Use after 5/8/86 �] 2.Estimated Age(Years) (Z 3.Estimated Total Capacity(Gallons) O'J 0 4.Material of Construction Steel D� 0 (� (Mark one®) Concrete Fiberglass Reinforced Plastic 0 0 Unknown 0 0 0 0 0 Other,Please Specify 5.Internal Protection Cathodic Protection 0 0 0 (Mark all that apply®) Interior Lining(e.g.,epoxy resins) 0 0 0 None 0 0 Unknown Other,Please Specify 6.Exter(Mark al Prothat apply Cathodic Protection (Mark all that apply®) Painted(e.g.,asphaltic) 0 0 0 0 Fiberglass Reinforced Plastic Coated 0 0 0 0 None Unknown u 0 0 0 0 Other,Please Specify 7.Piping Bare Steel 0 0 (Mark all that apply®) Galvanized Steel 0 Fiberglass Reinforced Plastic 0 0 0 0 Cathodically Protected Unknown 0 Other,Please Specify 8.Substance Currently or Last Stored a. Empty 0 0 in Greatest Quantity by Volume b. Petroleum (Mark all that apply®) Diesel 0 Kerosene 0 0 0 Gasoline(including alcohol blends) 0 0 0 Used Oil 0 0 Other,Please Specify c. Hazardous Substance 0 Please Indicate Name of Principal CERCLA Substance OR Chemical Abstract Service(CAS) No. Mark box®if tank stores a mixture of substances 0 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) O 0 O 0 O Page 2 I r TO T ,PAusar*wtis DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION APPLICATION FOR PERMIT TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY To: Head of Fire Department City or Town Date Application is hereby made for a permit to maintain an existing/new underground storage facility as required by 527CMR9.00: Permits. Location of property: Street address Owner of property: eik) -j e- haloII n cf�-es Full name of person, firm or corpora n Signature of owner or authorized representative:_ Fee:$ 1 O — (M.G.L.A. Chapt. 148 Sec. 10A) (Fire Department's Copy to be Filed with F.'P.290 part 2) Form F.P. 290 Part 4 Pr 1Z==n=,Pn1ffi of fiWo4mus 4 DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION rt) 02 P R M I T iz 19�� D to TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY In accordance with the provisions of 527CMR9.24 this permit to maintain an existing/new underground storage facility is granted to: Location of property: BQL4 j2d Street address Owner of property: Qcu Hoch co tehabl Full name of person, firm or corporation Restrictions: onderq roux d slc�rac�E? Fee Paid:$ 10 _ (M.G.L.A. Chapt. 148 Sec. 10A) Form F.P. 290 Part 4 This permit will expire cvn C' ��r� reireonGie.r� Date Signature 0Head of FUe Dept. or appointed designee (Owner' s Copy to be posted at the storage facility with F.P.290 Part 3) =,,