HomeMy WebLinkAbout0071 PLEASANT STREET - HAZMAT r7i PleaSan� Ut* n�
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TOWN"T�OF BARN�S1 TABLE IDEF�GRF l:rWD`FUEL AND CHEMICAL STORAGE REGISTRATION
` a. N 1� y NER AND INSTALLER INFORMATION
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ADDRESS: SA 1 v / S o MAP NO. PARCEL NO.
OWNER NAME: c--, r ! (,5k..1VILLAGE: Pv)9AJ1J1ls
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INSTALLATION DATE: BY:
ADDRESS:: `� CERT. NO.
PPON6 � / ?—A�37 TANK INFORMATION
3 LOCATION OF TANK:AT:�° " F,UEL/CHEM,-CAPACITY Ar
TYPEI CAL FV 6 L V�
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
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LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND r
ZONE OF CONTRIBUTION C ] YES C NO DATE' TO BE REMOVED
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FIRE DEPT. PERMIT ISSUED C ] YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE a
,BOARD OF HEALTH TAG NO. C ]C ]C ]C ] DATE q1z,
PLEASE PROVIDE A SKETCH SHOWING THE TANK, .LOCATION ON THE BACK OF THIS CARD