HomeMy WebLinkAbouttank removal 1995FORM F.P.292
(rev. 9/9o)
A,
APPTJCAI'IO}T FON PERMTT, AH) PERITT,FOR REMOVAL AND TRANSPOaTATION TO APPROVED trAl{(tYAFD
rDI D,o l3s i Pe rni. t tgs-617 Date
start date
2 ,t
y't 1t) t
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Clty, Town o. ot.t lct c.82 S.{0 X,6.t
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DIG SAFE NUHBER
Fee PaId:S ^J/A 1
In accordance wlth the provlsions of chapter 148, Sec. 384, H.G.L. r '-:'.-
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527 c!!R e.oo appllcatlon le hereby made hy:
P.O- b( 472,; S.rrth EtrDis, HA
signature of appl lcant:
appllcants narne prlnted:
-
fi,a+r,uf/Ffi*r,an.k-
For permlssion to renove and transport one underground storage tank fron.
ovnert /z,,r, '' 1t-trrz.',.'/ l-/street Address:l/)
Plrm transportlng saste:S,r
Hazardous waste manlfest fl_
State Lic. #xv5m3856lm
E,P.A.d
Approved tank yard:Jara G. Grant Oo.t 03501
Rsadville, HATank yard Address:
Type of lnert gas:
Tank capacl ty:
Date of lssue:
i)c,'
//,rlu
uL tank #:
Substance Iast stored:
(,/r !: 1
Lt.-9/*'/,1 1? f-/ t9 /:,
Slgnature/Tltle of Offlcer granting p
_ Date of expiration:
ermit: d.;.21
HF KEEP ORIGiNAL AS APPLiCATIOIJ AND
'SSUE
DU\L\CATE AS pERMtT !E
OIye Oournrnrrruraltll of fiurrudpmltr .. ,,, ,
Department of Public Safety :rii.,, ,
Division of Fire Prevention and Regulqtl-.941,
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AD\TA}@ EI{YIROII{ETXAL $TrICES ITC,
Street Address & clty or Town: