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TOWN OF BAR NSTABLE
UNDERGROUND FUEL AND CHEMICALV (✓V �� /STORAGE
ASSESSORS MAP NO. S PARCEL N0.
ADDRESS: �. "� VILLAGE: �7 y��✓V f
CONTACT.PERSON G e— PHONE NUMBER
LOCATION OF TANKS;. . CAPACITY: TYPE OF- FUEL. AGE: TYPE: LEAK
j >�o��,� OR CHEMICAL: �G1.5 DETECTION
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DATE OF PURCHASE OF EACH: 1. /#vt,l 4"'91 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.
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