HomeMy WebLinkAbout3625 MAIN ST./RTE 6A(BARN.) - Health (2) 3t,oa5 Main Sti�ad- I*zmqTT
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KEEPING YOU ORGANIZED
No. IM4
2-163M
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GErOrANSICrS1MM
t Town of Barnstable
m 0 Regulatory Services
Thomas F. Geiler, Director
Public Health Division
Thomas McKean,Director
2.00 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
To: HICKS,ROBERT J&ALLYSON J Date Tuesday,February 20,2007
2 GREYLAN AVE-#281
NANTUCKET MA 02554
RE: Underground Storage Tank at: ,
g g
3625 MAIN ST./RTE 6A(BARN.)
Map Parcel: 317042
O� Tank NO: 01
Tag NO: 00848
Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has
not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel
and chemical storage systems.
You are directed to remove this tank within sixty(60)days from the date of this notice.
After your tank is removed, ;please furnish this office evidence in the form of a permit from your local
Fire Department within ninety(90)days of the receipt of this notice.
You may request a hearing provided a written petition requesting same is received by the Board of
Health within ten(10) days after this order is served.
Per Order of the Board of Health
Thomas A.McKean,RS,CHO
Health Agent
oFtNWE
Town of Barnstable
' snaxsTnaIX ` Board of Health -
v� P.O. Box 534, Hyannis MA 02601
ArEO�A
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Ralph A.Murphy,M.D.
Sumner Kaufman,M.S.P.H.
To: HICKS,ROBERT J&ALLISON J Date Monday,March 05,2001
2 GREYLAN AVE SUITE 281
NANTUCKET " M 0255.4
RE: Underground Storage Tank at 3625 MAIN ST./RTE 6A(BARN.)
Map Parcel: 317042
Tank NO: 01
Tag NO: 00848
Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has
not been removed as required by section 03: subsection 2 of the Town of Barnstable Health Regulation
regarding fuel and chemical storage systems.
You are directed to remove this tank sixty(60)days from the date of this notice.
After your tank is removed, please furnish this office evidence in the form of a permit from your local
Fire Department within ninety(90)days of the receipt of this notice.
You may request a hearing provided a written petition requesting same is received by the Board of
Health within ten(10) days after this order is served.
Per Order of the Board of Health
Thomas A.McKean,RS,CHO
Health Agent
May • 11. 2uuy 1 : b2PM BAKN5IAB.LL tire dept No 1.14bb f' • Z
arvrWIN .r 2.7a.
��. (rev. 9/90)
BEHEIRM
. � u�hp tII�ittuictnwp�it� of "
Department of Public Safety
s Division of Fire Prevention and Re ation
APPLICATION FOB PERW, AND PERM, FOR REMOVAL AND TRANSPORTATION T ED TANK YARD
FDID# Mql Permit # Date 10 6
19 95
Cummiguid 6&wm e]
City, 70wn Or District C . 8 2 9 . 4 0 N . G . L .
C'�ref Jai DIG SAFE NUMBER
Fee Paid:S f� 4`3 ins 954301398
start date 10/26/95
In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L. ,
527 CMR 9. 00 application is hereby made by: ADVANCED ENVIRONMENTAL SERVICES
Street Address City or Town: P.O. BOX 472,j SOUTH DENNIS,i MA,
Signature of applicant:
Applicants name printed: WWA--C "
For permission to remove and transport one underground storage tank from.
Owner: Moore, Thcmas Street Address:.
3625 Rte.. 6A
Firm transporting waste: SAME State Lic. # MV5083856100
Hazardous waste manifest # E. P.A. #
Approved tank yard: JAMES G. GRANT CO. # 03501
Tank yard Address: RFADVILLE MA
Type of inert gas: `' UL tank #:
j
Tank capacity: �560 Substance last stored:•
Date of issue:— U I Z� 19 E---n. Date of e a n• 1 c1�
Signature/Title of Officer granting permit:
BEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT
4
�MaY . 12. 11JUS I : b M UAHWAULt tire dept NO44bb F . I
PO Box 94 Jqa Vd t1► b& ✓ iW
3249 Mein Street
Barnstable MA 02630
Phone:(508)362-3312 QA
Fax'(508)362-362-8444
------------------------
Cindy Martin From: Deputy Chief Richard P. Pfautz
Fax: 508-7905304 Pages: 3
Phones Date: 5/12/09
Rae: 3625 Main St Tank Removal
❑ Urgent ❑ For Review ❑Please Comment ❑Please Reply ❑Please Recycle
Thank you,
Deputy Chief Richard P.Pfautz
508 362 3312
�^ c+ t -
Barnstable
tKE r �� Town of Barnstable
BARNSTABLE, *�$ Regulatory Services Department
��fo hAA't A Public Health Division ZOO
200 Main Street, Hyannis MA 02601
Office:508-862-4644 Thomas F.Geiler,Director
Fax:508 790-6304 Thomas A.McKean,CHO
To: Date: April 1, 2009
William & Susan L. Laramee
33 Lake Street
S. Windsor, CT 06074
COPYRE. Underground Storage Tank at:
3625 Main Street
Barnstable, MA
Map Parcel: 317042
Tank NO: 1
Tag NO: 00848
Our records indicate that your underground fuel (or chemical) storage tank is over 30
years old, and has not been removed as required by section 326-3: subsection 2 of the
Town of Barnstable Code regarding fuel and chemical storage systems.
You are directed to remove this tank within sixty,(60) days from the date of this notice.
After your tank is removed, please furnish this office evidence in the form of a permit
from your local Fire Department within ninety.(90) days of the receipt of this notice.
You may request a hearing provided a written petition requesting same is received by the
Board of Health within ten (10) days after this order is served.
' Per Order of the Board of Health
App ii-Z3";L/V9 Thomas A. McKean, RS, CHO
ey'J ``"'" Health Agent
cp-
urngmai i�icsscayc-----
From! BILL LARAMEE [mailto:hoonut@hotmail.com] 1�15
Sent: Thursday, April 23, 2009 4:20 PM
To: Martin, Cynthia
Subject: 3625 Main Street, Barnstable, UST
Cynthia,
I am requesting a formal hearing regarding the Underground Storage Tank located at the above,
referenced address.
I purchased the property in December 2007 and occupied the property in May 2008.
No mention of the_existence of any UST was ever made by the former owner when the property
was purchased and the existence of this comes as a complete surprise to us.
When I received your letter I contacted the former owner and they were insistent that there was
no UST on the property. They pointed out that the house is now heated with natural gas which
was installed by them during the renovation of the house and before that the house was heated by
oil from a tank which is still located in the basement of the house, although not being used at'this
time.
During our discussions,you gave a rough description of the location of the.tank on.th.e drawing that
your offices has on file. If I.am correct in,understanding that location, without seeing the drawing,
it sounds as though the tank is located below a large porch that was erected on the side of the
house a few years ago.
I would assume that a building permit was issued for this porch as it was,erected during extensive
renovation of the house. I would also assume that the.building department would not issue a
building permit to place a permanent.structure directly over an,existing Underground Storage
Tank.
I am awaiting your mailing of the plot drawing with.the location of the UST so I can continue my
.- investigation of this.issue.
Please be assured that I am concerned about this situation and take this mattes seriously and
intend to resolve this in as expedient a manner as practical.. This will take some time on my part
4/28/2009
Message Page 2 of 2
as I live in Connecticut and work full time. As such I will do my best to follow.up on this, issue.
Thank you for your assistance with this.
Bill Laramee
Town of Barnstable
oFIHE r Regulatory Services
Thomas F. Geiler,Director
Public Health Division
BARNSTABLE, Thomas McKean,Director
9 MASS.
0o 039, ,�� 200 Main Street, Hyannis, MA 02601
ArFD MA't A
Phone: 508-862-4644
Email: healthna,town.bamstable.ma.us 0 p
Fax: 508-790-6304 rc f�a ,
Office Hours: M-F 8:00—4:30
May 12,2,009
Mr.and Mrs.William Laramee RE: Underground Storage Tank Removal
33 Lake Street Order,'3625 Main Street,Barnstable,MA_
South Windsor,CT 06074 Map Parcel 317042
Tank# 1,Tag#00848
Dear Mr. and Mrs.Laramee:
The Barnstable Public Health Division is in receipt of a copy of the tank removal Application and.Permit
issued by the Barnstable Fire Department demonstrating that the above referenced underground storage
tank was removed on or about October 26, 1995.
The Public Health Division appreciates your attention to this matter and has updated its data base to
reflect this fuel tank status change. Should you have any further questions please contact Cynthia Martin of
this office at 508-826-4645:
Thomas A.McKean,RS, CHO
Director of Public Health
.1as,• 12 . 2009 1 : 52PM BARNSTABLE fire dept No , 0466 P . 3
DIMENSIONS Tank Removed' From
Width Length --------------------
(no. street)
Tank I ----- X -- --
Tank 2 ----- X ----- (city or town)
Tank 3 ----- X ----.-
Fire Department
Tank 4 ----- X -----
Permit # ----- -=--------
(if app icable).
Tank 5 ----- X -----
(feet) (feet).
1
RECEIPT OF DISPOSAL OF U ''� � S EL STORAGE TANK
NAME AND ADDRESS J. I , tiAt� Co. INC
OF - 1 . 28 WQ(carr CT
APPROVED TANK YARD' HTADY11 t F AAA 02137
APPROVED TANK YARD NO.
Tank Yard Ledger 502 CMR 3..03 (9) Number: 02
I certify under malty of'law I have personally exanined the underground s /storage tank
delivered to this "approved tank yard" by fiun, 'corporation or partnership dP/9sti/-0
and 'accepted same in confo=ence with Massachusetts Fire Prevention
Regulation 502 CMR 3.00 Provisions for Approving Underground Steel Storage mantling yards.
A valid permit was issued ky. LOCAL Head of Fire Department FDID# to transport
this tank to this yard.
Name and fci title of app c yard or owners autMrized representative:
IC�IANRE Trr x DATE SIQffD
This si Aretie of disposal mist be returned to the local head.of the fire department
MM4 pursuant to S 2 CMR t 0 . FACH TAW MUST HAVE'A RV=IPr OF MUMALI
FORM F.P. 291 (rev. 9/B 91 (OVER) W.SSACMISE M STATE FIRE HUGHAL'S OFFICE
May, 12 , 2009 1 : 52PM BARNSTABLE fire dept No - 0466 P . 2
N - _ %-Vn9w1 / ..w 2.7a
E " (rev. 9/90) :
�hr (ffatnwttwrdt4 of AnnotirlMopffs
Department of Public Safety
Division of Fire Prevention and Re ation
APPLICATION FOii PERw, AND PERNYT, FOR REMOVAL AND TRANSPORTATION T ED TANK YARD
FDID# Mq1 Permit # Date_ 10/26 19 95
Cunmiquid Gta9��rls ��
City,frown or District c . s 2 s . 4 0 M . c i .
DIG SAFE NUMBER
Fee Paid:S 5 IN sr 954301398
start date 10/26/95
In accordance with the provisions of Chapter 148, Sec. 38A, M.G.L. ,
527 CMR 9. 00 application is hereby made by: ADVANCED ENVIRONMENTAL SERVICES
Street Address & City or Town: P.O. BOX 472,i SOUTH. DENNIS;i MA_
signature of applicant:
Applicants name printed: 2QjVE-vim-
For permission to remove and transport one underground storage tank from.
Owner: Moore, Street Address: 3625 Rte. 6A
Firm transporting waste: SAME State Lic. #MV5083856100
Hazardous waste manifest # E.P.A. #
Approved tank yard: JAMS G. GRANT CO. # 03501
RFADVILLE M&
Tank yard Address:
� r
Type of inert gas: `, UL tank #:
Tank capacity: Substance last stored:,,
Date of issue: 19C*2 Date of e a n:
Signature/Title of Officer granting permit:
V. V
KEEP ORIGINAL AS APPLICATION AND ISSUE DUPLICATE AS PERMIT
(f//J Niay:, 12 . 2009 1 : 52PM BARNSTABLE fire dept No • 0466 P . 1
t� IT
'r PO Box 94 J3a vd k&& ✓iw
3249 Main Street
BarnstPhone:(5 )3 02630 ��
Phone:(508)362-3312
Fax'(508)362-362-8444
To: Cindy Martin From: Deputy Chief Richard P. Pfauiz
Fax: 508-7906304 Pages: 3
Phona Date: 5/12/09
Re: 3625 Main St Tank Removal
❑Urgent ❑ For Review ❑Please Comment ❑Please Reply ❑Please Recycle
Thank you,
Deputy Chief Richard P. Pfautz
508 362 3312
w
r.�
w.r
Barnstable
Town of Barnstable
i 1
9BAWSTASM
Regulatory Services Department
A
Public Health Division 2007
200 Main Street, Hyannis MA 02601
Office:508-862-4644 _._. _ _ _ _ _ . .. . . .Thomas F.Geiler,Director
Fax:508-790-6304 _ Thomas A.McKean,CHO
To: Date- April 1, 2009
William & Susan L. Laramee.
33 Lake Street
S. Windsor, CT 06074
p
RE. Underground Storage Tank at.
3625 Main Street
Barnstable, MA
Map Parcel: 317042
Tank NO: 1.
Tag NO:.00848
Our records indicate that your underground fuel (or chemical) storage tank is over 30
years old, and has not been removed as required by section 326-3:.subsection 2 of the
Town of Barnstable Code regarding fuel and chemical storage systems.
You are directed to remove this tank within sixty(60) days from the date of this notice.
After your tank is removed, please furnish this office evidence in the form of a permit
from your local Fire Department within ninety.(90) days of the receipt of this notice.
You may request a hearing provided a written petition requesting same is received by the
Board of Health within ten (10) days after this order is.served.
Per Order of the Board of Health
Thomas A. McKean, RS, CHO
�'-z ` '",� Health Agent
y av�'�=�uI0T.
�2uv it-t A-�LtU
OL
�_ -o
04-Jan-06 Town of Barnstable " '✓ Page No: 1
_List of Storage Tanks
Below Ground Tanks Outside Zones of Contribution which are over 29 years old i'
As of: 1/5/2006
Fire Tank
District Owners Name/Address Map/Parcel Tank 'rag Tank Fuel Installed Age Loc ZOC
No. No, Permit Date g
BARNSTABLE,COUNTY OF r313007 02 01263 Y FO 1/1/1976 �30 B N
POLICE/TRAINING SCHOOL 0 f}0d ] p {/} 0 )v() D
POBOX397 ( SV� 9 4!' l�� i�� i171�o�1 �R�
tCIRRITO,
NSTABLE MA 02630
FRANCES E 259001001 01 00462 N FO 1/1/1976 30 / B N
EPHERDS WAY 1 1 p p� o
BARNSTABLE MA 02630 r' 7 1_~r•7�/0/D q
HICKS,ROBERT J&ALLYSON J 317042 01 00848 N FO 1/1/1970 36 B N PC) PPh6S.
2 GREYLAN AVE-#281 C� MAI,/Q &�Z aTC (�
`a (/ NANTUCKET MA 02554 lvl l ,�QS
B (0 MASS,COMMONWEALTH OF '236005B00 02 01111 P 1/1/1972 "34 B N
N Cape. Cd NA►a.�u,i,u;9-�CO l j ,o� �—/�A '�-bc�', ��2240 ROUTE 132 u WAY,
,
2Z40 k7- . 13�
HYANNIS MA 02601
BA VETORINO,MARGARET M `298011 01 00036 Y FO 1/1/1976 30 B N
P0 BOX 234 _ l �r � j7 11V/v Of/Ki15
�dDkC..i/t
BARNSTABLE MA 02630
CO APOG,VERA M 138008 01 00917 Y FO 10/1/1972 33 B N
%Z JOHN SKAPARS
2 TOWER DRIVE
DOVER MA 02030
CO APOG,VERA M 138008 02 00000 Y FO 1/1/1973 33 B N
%Z JOHN SKAPARS
2 TOWER DRIVE
DOVER MA 02030
CO BAGSHAW,ROBERT E JR 207014 01 00732 N D 1/l/1968 38 B
609 TREMONT ST#2
BOSTON MA 02118
CO BIRD,MARGERY W 162013 01 00313 Y FO 1/1/1974 32 B N
%BIRD,ANNA C
POBOX III
E WALPOLE MA 02032
6 .x
04-Jan-06 Town of Barnstable Page No: 2
List of Storage Tanks
Below Ground Tanks Outside Zones of Contribution which are over 29 years old
As of: 1/5/2006
Fire Tank
District Owners Name/Address Map/Parcel Tank Tag Tank Fuel Installed Age Loc ZOC
No. No, Permit Date g
CO BORG,NANCY J& 140159 01 00374 N D 1/1/1957 49 B N
BORG,LINDA A
P 0 BOX 113
OSTERVILLE MA 02655
CO CALLAHAN,RICHARD P&CYNT 072026 01 00209 N D 1/1/1971 35 B N
345 SEASPRAY AVE
PALM BEACH FL 33480
CO CANZANO,GAIL A 114018 01 00713 N D 1/1/1968 38 B N
483 EEL RIVER RD
OSTERVILLE MA 02655
CO CENTERVILLE/OST/MM FIRE DIS 118110 03 00424 Y D 4/1/1969 36 B N
1875 FALMOUTH RD
CENTERVILLE MA 02632
CO HOSTETTER,DANIEL C JR 228107 0 0 fo 1/1/1968 38 b
485 PINE ST
CENTERVILLE MA 02632
CO MELLON,RACHEL L 070010002 02 00230 Y P 1/1/1975 31 B N
P 0 BOX 151
UPPERVILLE VA 20185
CO MELLON,RACHEL L 070010002 03 00231 Y P 1/1/1975 31 B N
PO BOX 15t
UPPERVILLE VA 20185
CO MELLON,RACHEL L 070010002 01 00229 Y D 1/1/1975 31 B N
P O BOX 151
UPPERVILLE VA 20185
CO PARKER ROAD FAMILY LTD PRT 115025 01 00249 Y FO 1/1/1976 30 B N
1
979 SEAVIEW AVE
OSTERVILLE MA 02655
04-Jan-06 Town of Barnstable Page No: 3
List of Storage Tanks
Below Ground Tanks Outside Zones of Contribution which are over 29 years old
As of: 1/5/2006
Fire Tank
District Owners Name/Address Map/Parcel Tank Tag Tank Fuel Installed Age Loc ZOC
No. No, Permit Date g
CO RIEDELL,CARL S 140035 01 00067 Y D 1/l/1973 33 B N
SHARRON E RIEDELL
178 SCUDDER RD
OSTERVILLE MA 02655
CO SHAFFER,BENNETT A&SEMA L 124005 01 00478 N FO 1/1/1968 38 B N
24 CORCORAN ST
RANDOLPH MA 02368
CO WHITCOMB,STELLA PRZIREMBE 115031 01 0 fo 1/1/1969 38 b
%WHITCOMB,STELLA PRZIREM
131 CLIFF RD
WELLESLEY MA 02181
CT GOODMAN,ALLAN E&COLLETT 033014 01 00441 N D 1/1/1974 32 B N
4711 JAMESTOWN RD
BETHESDA MD 20816
HY AQUA-LEISURE INDUSTRIES INC 288213 01 00024 Y D 12/4/1974 31 B N
PO BOX 84
HYANNISPORT MA 02647
HY DUMONT,DAVID S TR 327063 01 00000 Y 1/1/1960 46 B
GREENWOOD STERLINE REAL T
67 WILLOW ST
HYANNIS MA 02601
HY DUMONT,DAVID S TR 327063 02 00000 Y FO 1/1/1970 36 B
GREENWOOD STERLINE REAL T
67 WILLOW ST
HYANNIS MA 02601
HY NEWMAN,MARY F 287006 01 0 fo 1/1/1968 38 b
IRVING AVE
HYANNISPORT MA 02647
HY OGLISHEN,JAMES S&DEBORAH 307227 01 00200 N D 1/1/1968 38 B N
123 MILLER ST
FRANKLIN MA 02038
04-Jan-06 Town of Barnstable Page No: 4
List of Storage Tanks
Below Ground Tanks Outside Zones of Contribution which are over 29 years old
As of: 1/5/2006
Fire Tank
District Owners Name/Address Map/Parcel Tank Tag Tank Fuel Installed Age Loc ZOC
No. Permit Date
HY PARTYLITE WORLDWIDE INC 327160 03 01010 N WX 1/1/1973 33 B
59 ARMSTRONG RD
PLYMOUTH MA 02360
HY PARTYLITE WORLDWIDE INC 327160 02 01009 N WX 1/1/1968 38 B
59 ARMSTRONG RD
PLYMOUTH MA 02360
HY SIMON,FREDERICK L 287028 01 00065 N D 1/1/1953 53 B N
23 AVONSIDE
AVON CT 06001
HY SOARES,RAYMOND 328062 01 01073 Y FO 1/l/1971 35 B N
141 SPRING ST
HYANNIS MA 02601
WB BARNSTABLE,TOWN OF(CEM) 156027 01 00000 N G 1/1/1927 79 B 'N
367 MAIN ST
HYANNIS MA 02601
WB CARDOZO,THERESA A 152013W00 01 00334 N FO 1/1/1973 33 B N
1504 LELAND DR
SUN CITY CENT FL 33573
WB POKRASS,EDWARD H&SARA C 132025 01 00996 N FO 1/1/1975 31 B N
PO BOX 495
W BARNSTABLE MA 02668
i
R
i�
RECEIPT OF DISPOSAL OF UNDERGROUND STEEL -STORAGE TANK
NAME AND ADDRESS n`,,..fZAN`.T C0.JNQ
1 OF 128 WOLCOTT S?
APPROVED TANK YARD p_efhuvil I E . 4 g2ap
APPROVED TANK YARD NO.
Tank Yard Ledger 502 CMR 3.03 (4).,Number.: ' �
I certify under penalty
It of law I have personally examined the unundergrounds storage tank
delivered to this "approved tank yard" by fian,'corporation or partnership
/ �U/4�/��
and accepted sane in oonfonnance with Massachusetts Fire Prevention
Steer Storage T rtling yards. , .
Regulation 502 CMR 3.00 Provisions for Approving Lh�r'4� t FDID transport
A valid permit was issued by LOCAL Head of Fire Department =lL
this tank to this yard.
or moaners autl�rized representative:
Nave and ici title of app =TrrLE
IGNAWRE I?ATE SIC3JF9
♦ISiis signed reoei of disposal must be returned to the local head of the fire Wit'
FqID# �z � pursuant to 502 CMR 3:00. (EACH TANK MUST HAVE A pZ E7pr
FORM F.P. 291 (rev. 9/88) (OVER) MASSAC�USETTS SMTE FIRE MARSHALS OFFICE
♦
DIMENSIONS Tank Removed From
-
Width Length
- � �--- �-- ---------- ------ ,
.
(no. street)
Tank 1 ----- X -= -- _� -� _ _ - 1✓ !� -
`� (city or town) 4
Tank 2 ----- X ----
Tank 3
----- X Fire Department
__
P --------
Permit #
X ----- (if app icable)
Tank. 5 ----- X- -
(feet)
(feet) ,, ,
4
a
FORM F.P. 292 4
(rev. 9/90)
1� (�gittntttiupttl# of ��ttrtp##
gAl
y
_ Department ®f Public SCifety
-
Division of Fire Prevention and Regulation
.APPLICATION FOR PERMIT, AND PERMIT, FOR REMOVAL AND TRANSPORTATiOfV TO APPROVED TANK YARD
�� ..
FDID# 1 q Permit # Date '10/2.6 19 95
Cummiquid .
City, Town or District C 8 2 S . 4 0 M . G L.
DIG SAFE NUMBER
Fee Paid: S �s � 51f 954301398 .
' start date 10/26/95 '
In accordance with. the provisions of Chapter 1-48, . Sec. 38A, M.G.L: ,
527 CMR 9. 00 application- is, hereby made by:' ADVANCED ENVIRONMENTAL SERVICES.
Street Address & City or Town: P. BOX 472,i SULJ—LH.. DEITNIS;i MA
Signature of applicant: / W
Applicants name printed: ce�Ul�l^ ��;� ,
F)r permission to remove and transport one underground storage tank from. "
Moore, Thomas '3625 Rte. 6A
Owner: Street Address:
Firm transporting waste: SAME State Lic. # MV5083856100
Hazardous waste manifest # tE. P.A. #
Approved . to-nk yard: JAMES G. GRANT CO., # 03501
READVILLE MA
Tank yard Address: ;
Type of inert gas U6✓t � UL tank #
Tank capacity: Substance last stored! 6
Date of issue: 19�` Date of a 'i 6a Ubn:
4 J
e'
Signature/Title of officer granting permit
V.
KEEP ORIGINAL AS APPLICATION, AND ISSUE DUPLICATE AS PERMIT.