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-TOWN OF BARIVSTAZLE
UNDERGROUND FUEL AND CHEMICAL: STORAGE 'SYSTEMS
ASSESSORS MAP NO. PARCEL NO.
ADDRESS: m VILLAGE: Y,�/�//U��
NAME;._.
CONTACT PERSON PHONE NUMBER
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: LEAK
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DATE OF PURCHASE OF EACH: 1. �C 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT PERMIT:
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