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TOWN OF BARNSTABLE - UtfERGROUND FJJEla AND CHEMICAL STORAGE REGISTRATION
AP NO. PARCEL NO.
ADDRESS OF TANK: -�. .. _ . VILLAGE:
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MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : So f t � �- � ^'1 �`'� C"� Im A
OWNER NAME: C G. C�T+Z P-R-KO:NEa:. '" ?
INSTALLATION DATE: po-Sv OIL-
INSTALLER ADDRESS: r` 'CERT.NO.
' �4 "® " ( '�Al STANK LOCATION: �
(DCCORZOC TANK LOQATaON WITYIyPfCCPCCT TO mu2LDINO)
CAPACITY '��DU TYPE OF TANK AGE `j YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [ ] PASS [ J FAIL DATE
LEAK DETECTION [�7 CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ J YES [)6], NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED C J YES C J NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ ] DATE
PLEASE. PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE ,BACK OF THIS CARD
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