HomeMy WebLinkAbout0274 CARRIAGE ROAD - HAZMAT a� C, wr1 e v _I:
TOWN OF' BARNS,TABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. 6 7 / PARCEL NO.
ADDRESS OF TANK: ~I �"� C' AR P �G - V I LLAGE• C9 U( S T 7)f
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MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : - - 5 �Jjt �i'4�aK GSrz-�ejwlle-
OWNER NAME: f\bGew, k fil' n 41 1+711 PHONE:
INSTALLATION DATE: BY:
INSTALLER ADDRESS: -CERT.1-40.
*TANK LOCATION: ) -,4u rclzonl rlto jt l pou), A.4px 1" 1G pik4-t,
(D Q m C R I o m TANK LOCATION S T H R Q O P Q C T T O m U I L D I N O)
CAPACITY 6 U TYPE OF TANK ST4z'4- AGE / YRS. FUEL/CHEMICAL
TESTING CERTIFICATION C I PASS C I FAIL DATE,
LEAK DETECTION C I CHECK IF N/A TYPE/BRAND,
ZONE OF CONTRIBUTION C I YES C I NO DATE'',TO ,BE REMOVED
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FIRE DEPT. PERMIT ISSUED [ /I YES C I NO DATE
CONSERVATION C I CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. C ,cl,�- ] DATE '� .Z-71
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
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