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0050 TOBEY WAY - HAZMAT
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CO PLEASE DETACH AT OSTERV I LLE, MA t�'2655 _ VERTICAL PERFORATION Al' 508-771-6655 OR 508-477-6655 RETURN ENTIRE PORTIOP w WITH YOUR REMITTANCE # SERVICE INVOICE *** 155182 NORMA HALL NORMA HALL 50 TOBEY WAY D I V: 10 i TYP: 1 WEST HYANNISPORT, MA t 267'2 AC:C:T# 34834L 8/07/13 34834L 8/07/13 � REF # 155182 1 .000 B4 FILTER & GASKET 11 . 18 � 1 .000 GARBER REPLACEMENT FILTER 15.92 CART 1 .000 MINI PUMP STRAINER RS939 7.56 1 .000 DELAVAN NOZZLE 12.28 1 .000 ENVIRONMENTAL FEE 1 .23 TOTAL PARTS 48. 17 PART TOT 48. 17 TOTAL LABOR �r 136.00 LABR TOT 136.00 SALES TAX 3.01 SLSTX 3.01 . . : TOTAL CHARGE FOR INVOII_E # 155182 >>> 187. 18 TTL CHRG 187. 18 SITE:NORMA HALL/71 TOBEY WAY/ . /WEST HYANNISPORT MA 02672 CALL DATE: 8/07/1;3 CALL REASONS: CLEAN AND TUNE—UP � WORK PERFORMED: ANNUAL TUNE—UP, REPLACED PARTES7 LISTED ABOVE: f= LU IL I° a THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) Im ^ACC DATA 527 CCMR�: BOOW OOF M?RYN1TU� � s ,.03: continued 4.03: continued A*H%. 227 CW440D�Fo°m I�t Certificate of Com fiance M G.L.c.148, 8 City or Town: City or Town: Street Name&Number: Street Name&Number: Name of Property Owner: Name of Property Owner: This certifies that a visual inspection of the fuel supply line(s)for the above roundea n oil�tikaLxA t�istadt>anatk�iStlri�f+t4Fb1 ; p �ib`f}#�bt9es� ��`i`a �io�`Inr i eng 8, 38J d1 for the rest en a ro er ten above,and the following equipment was observed: ❑ Each fuel supply line is enclosed with a continuous non-metallic sleeve ❑ Each fuel supply line is enclosed with a continuous non-metallic s�eeve ❑ Each fuel supply line is equipped with an oil safety valve ❑ Each fuel supply line is equipped with an oil safety valve This visual inspection and certification was completed on: This visual inspection and certification was completed on: Date: dr Date: - By: (Signature of Oil Burner Technician) By: (Signature of Oil Burner Technician) (Print Name of Oil Burner Technician) (Print Name of Oil Burner Technician) Certificate of Competency#: Certificate of Competency W: Upon completion of Form 1 A,the property owner shall receive a copy of the form and a copy shall also be stil�ittdrtpldleolo�BTofithell � a copy of the form and a copy shall also be submitted to the head of the local fire department or a designee. This �form can be photocopied or reproduced in triplicate. Form 1FCte c i�� eo� eVa�sachic;eAsg).W, tCouncil. Form IA reproduced in triplicate by the Massachusetts Oilheat Council. 4/16/10 527 CMR-46 4/16/10 527 CIAR-46 527 CMR: BOARD OF FIRE PREVENTION REGULATIONS 4.03: continued ✓tee �uu� � a�uddt� -'ba�mont 527 0Ma 4.00-Form IA Certificate of Compliance M.G.L.c.148,§38J City or Town: :.... Street Name&Number Name of Property Owner: !f I This certifies that a visual inspection of the fuel supply lines)for the aboveground heating oil storage tankwas completed in accordance with M.G.L.c.148,§W(d)for the residential property identified above,and the following equipment was observed: 91ma fuel supply line is enclosed with a continuous non-metallic sleeve O Each fuel supply line is equipped with an oil safety valve This visual inspection and certification was completed on: Date: .. By: (Signature of Oil Burner Technician) (Print Name of Oil Burner Technician) Certificate of Competency#: Upon completion of Form 1 A,the property owner shall receive a copy of the form and a copy shall also be submitted to the head of the local fire department or a designee. This form can be photocopied or reproduced in triplicate. Form IA reproduced in triplicate by the Massachusetts Oilheat Council. 4l100 527 CUR-46 f THE OIL PE 435 ROUTE 134• P.O. BOX 1401: M SOUTH DENNIS, MA:02660 , M 0 TOLL FREE,1 866-""070 ' } 1 22 TM 70 50845-200 - 0506-398 =�< a ` ' . a Z , •� O. Y FRA�l x 71 TosF WAY ,a.. J . . W 'W z W H1f ANN 18.PORT. .27516 $ v _2042 74►6-8758 TAB AL•S. DELIVERY Rim aairE a: -� z z W DATE PAID p O Q Q QRRDERED DOUARS ORDERED Fn l B 275 2. w L] z 12/03/201 9ACANCE c 1►539r85 pFfit USE � cl`o aQ PRICEIfiAL DISCCOuw Ovm.xxx c7 -Cg a a E _ s o 3.599 v /03/20 PAT© CC _ ACR099 FROM THIRD ST 12 OT120i2 ; OUTSIDE= 'TANK ON LEFT IPl;�pECT T.A�t w cn THE OIL PEDDLERm _ m 435 ROUTE 134 ® P.O. BOX 1401 SOUTH DENNIS, MA 02660 0 o t. o TOLL FREE 1-866-398®0070Irm a " , 508-398-0070 508-775-2001 508-896-5122 a z r d ' o z Lu � Y a z z 3 Q = m W X _ ... - 17 \r � z CC z LL U O CJ [L W ci t W W V U UU � 'O W ..f a! a a o w