HomeMy WebLinkAbout0078 PLEASANT STREET - HAZMAT ��' �1 �r�f I���nm�.�
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=A � TOWN Or BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS !
ASSESSORS MAP NO. C PARCEL NO.
ADDRESS: ` �' ra-no S'1' VILLAGE: p
NAME,-- 1��-�!�!s(.���i..��. �-� �:✓s r.u. �T�s'�_ �. -. L� a vC T : @Gold A Jr �d�7 � l�
CONTACT)PERSON PHONE NUMBER
LOCATION OF TANKS: CAPACITY: TYPE- OF- FUEL AGE: TYPE: LEAK
f OR CHEMICAL: DETECTION
SYSTEM'
DATE OF PURCHASE OF EACH: 1. 2. 3. 4. S.
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. EJ W bOD
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DEPARTMENT OF PUBLIC SAFETY--DIVISION OF FIRE PREVENTION
P Ev R ?A 1 cjol/
Date
Form F.P. 290 TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY
Part 4
In accordance with the provisions of 527CMR9.24 this permit to maintain an
existing/new underground storage facility is granted to:
Location of property:
Street adds ss
Owner of p rope rty•
Full name f person, firm or Corp tion
Restrictions: - A0?)
Fee Paid-3/ (M.G.L.A. Chapt. 148 Sec. 10A)
This permit will expire �'� ,Oe-19�� -. - c,
Date gnature of Head of Fire Dept. or appointed designee
(Owner's Copy to be posted at the storage facility. with F.P.290 Part 3)
1Z\ FIRE DEPT. STATE USE ONLY CERTIFICATION
Copy to be certified by local fire department I.D.N be
3and: POSTED AT STORAGE FACILITY a
Date,.,ecejvedi
_
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 Safety Act of 1968.or the Hazardous Liquid Pipeline Satcty Act of 1979.or
May 8,1986,or that are brodglit into use after Mav 8,1986.The information requested which is an intrastate pipeline facility regulated under State 15ws:
is required by Section9002'oflhe Resource Conservation and Recovery Act,(RCRA), 5.surface impoundments.pits.ponds,or lagoons:
as amended. 6.storm'water or waste Hater collection systems:
]'he primary purpose of this notification program is to locate and twaluate under- 7•llow-through process tanks:
ground tanks that store or hale stored petroleum or hazardous Substances. It is 8.liyuidtrapsorassocaatedgathcringline directlyrrtatedtooilorgasproductionxnd
expected that the information you provide will be based-on reasonable available gathering operations:
records.or.in the absence of such records.your knei\vledge,beficl,or recollection. 9• storage tanks Situated in an underground area (such as a basement. cello •
mineworking.drift.shaft,or tunnel)it the storage tank is situated upon"or above the
Who Must Notify? Section 9002 of RC RA. as amended- requires that. unless surface of the Iloor.
exempted.owners of underground tanks that store regulated substances must notily
designated State or local agencies of the existence of'their tanks. Owner means-- What Substances Are Covered? 1-he no'-fific9tion requirements apph to under-
(a) in the case of an underground storage tank in use on November 8. 1984.or ground storage tanks that contain regulated substances.This includes an\substance
brought into use after that date,any person who owns an underground storage tank defined as hazardous in section 101 (14)'of the Comprchensisc Environmental
used Gir the storage,use,or dispensing of regulated substances.and Response.Compensation and Liability Act(if"1980(CERCLA),with the exccotion of
(b) in the case of am underground storage tank in use before November 8. 1984, Ahose 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 immcdiateh bclorc includes petroleum.e.g..crude oil or an\fraction thereol which is liquid at standard
the discontinuation of its use conditions of temperature and pressure(60 degrees Fahrenheit and 14.7 pound,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 he sent to the address
stances."and(2)whose volume(including connected underground piping)is 10i"i or given at the top of this page.
more beneath the ground.Some examples are underground tanks storing:1.gasoline.
used oil.or diesel fuel.and 2.industrial solvents•pesticides.herbicides or fumigants. When To Notify? 1.0wners of underground storage tanks in use or that hale been
taken out o1 operaton after,Ianuarc 1. 1974.but still in the ground.must notily by
What Tanks Are Excluded. Tanks rernmed from the ground are not subject to Max 8, 1986.2.Owners who bring underground storage tanks into use after May 8.
notification.Other tanks exc,udcd from notification are: 1986.in 'notil\within 30 da_I:s olbringing the tanks into use.
1.fa rni or residential tanks of I..l00 gallons or less capacm used for storing motor I ucl
for noncommercial purposes: I Penalties: Any owner who knowingly fails to notify or submits false information
2.tanks used I`rstoring heating oil torconsumptivc use on the premises where 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 e.\ccpt"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
photocopy the reverse side,and staple continuation sheets to.this form. attached
Owner Name(Corporation,Individual,Public Agency,or Other Entity)
f/ (If same as Section 1,mark box here
X ❑)
Facility Name or Company Site Identifier,as applicable
Street Address Z.
��
l2l�� b' /
Co 7p r d f Z�Z,, Street Address O r d Roaeiapplic�'e
city State ZIP Codey Co
Area ode Phone Number +-� Cit earest) State ZIP Code
�/7 2.71 /7l2
Type of Owner (Mark all that apply®)
Private or Indicate Mark box here if..tank s
Current ate o oval Gov t ❑ Corporate ;`'number of are located on land within
Federa Ownershiptanks at this an Indian reservation or ❑
❑ Former ❑ (GSA facility I.D.no. ❑ uncertain location on other Indian trust lands
•
R
gNe.,(If,sa�me as Section I,mark box here ) Job Titl Area Code Phone Number
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MHz
❑ 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 gnature Date Signed
SOSS'✓ y •-" ��
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1 Form F.P. 290 Part 3 Paget
Owner Name(from Section I)_ Location(from Section 11) Page No. -of_:_Pages
Tank Identification No.(e.g.,ABC-123),or - Tank No. Tank No. Tank No. Tank No. Tank No.
Arbitrarily Assigned Sequential Number(e.g.,1,2,3...)
1.Status of Tank Currently in Use 0
(Mark all that apply®) Temporarily Out of Use
Permanently Out of Use 0
Brought into Use after 5/8/86 �� 0
2.Estimated Age(Years)
3.Estimated Total Capacity(Gallons) A00W
4.Material of Construction' Steel
(Mark one®) Concrete [� 0
Fiberglass Reinforced Plastic 0 0
Unknown
Other,Please Specify
5.Internal Protection
(Mark all that apply®) Cathodic Protection 0 0 0 0
Interior Lining(e.g.,epoxy resins) 0
None 0
Unknown, 0 0 0
r;
Other,Please Specify
6.External Protection Cathodic Protection 0 0
(fdark all that apply®).
Painted(e.g.,asphaltic) [W
Fiberglass Reinforced Plastic Coated 0 0
None [�
Unknown 0 0
Other,Please Specify .»
7.Piping Bare Steel 0 0 0
(Mark all that apply®) Galvanized Steel 0
Fiberglass Reinforced Plastic
Cathodically Protected 0 0 0
Unknown 0 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
Kerosene 0 0
Gasoline(including alcohol blends)
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 IN if tank stores a mixture of substances
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) 0 O
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SIGNATURE) 3i1{
ems'•:'. y.. �. �•+l Y t -� t §� .x '�y�t... � '" "�'` � ' 1
— — ———
— — — — r {OWNER. OCCUPANT OR�HOLDE
' x� •-- --- _�tOFFICIAL TiTLE� �" '� ,,�ADDRESSS __— —___ ,
,iNOTE: THIS CERTIFICATE ` OF : REGISTRATION -MUST :.BE SIGNED BYiTHE HOLDER - OF .THE
LICENSE . IF -SAID LICENSE ..WAS - GRANTEDPRIOR TO .JULY j, 'A 936 -OTHERWISE BY .
.THE : OWN ER 0R OCCUPANT OF T HE :L AND;aLICENSED.
TOWN OF ' BARNSTABLE
h 1 °y" `a F ,, e;.367 .MAIN'`STREET
HYANNISP.4MA; 02601 r 1
- - °�E�Iiig�Il4� �• ,� .
DATE: - ALQAL29_
THIS IS ,TO .CERTIFY THAT .. �, � 4 �e �? I�1S= 7 #� T _,_HAS, ICU .
i
" ACCORDANCE WITH THE PROVISIONS <OF CHAPTER '74$, .SECTION ;"13 OF- THE GENERAL ,
eLAWS,- FI�,�D.: WITH =.ME 'A �-CERT;I FICATE OF REGIS,TRATION .'SETTI'NG.,FORTH THAT i
,BAR-NSTAB N(IC�ST3�`_AUTHOR ITY IS ':THE HOLD ER ' OF ;THE LICENSE :-GRANTED ;:BY j
;F4$ THE `LAWFULIUSE OF 'THE . BUILDING(S) pflR STRUCTURE{S) SITUATED .
AT Z3_filE-BSa Nlk _ P A R C c L NUM8ER
'TDTAL ' CI I N`j GALLONS. '1j�Q r '' UNDERGROUND__
" ;'KIND 0��'"�IEL 70 BEY -STOfRED
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r 7SIGNATiJRE3
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NOTE. A +'CERTIFICATE OF;REGISTRATIO�{ tAiUST BE FILED 0N'l R1BEF0RE APRIL :3 0 T H
3,0F EACHi,YEAR. x ,
=�{THIS REGISTRATIDN iMUST BE CONSPICUOUSLYPOSTEDDiVtTHEaPRER�ISi:5.)
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