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1
DEPART|4EI.iT OF
P. 0. [0x 490
'1 titi(sELrRY , tl^
PUBLiC SAFETY , U.S.T
c1s76i1Al L TO :
STATE USE ONLY r rtl 0{t1.ctrll crltdiFIRE DEPT.
I O Num@,
I'iolificrlion is requied br fedcrsl lr$ ,.,r rllll,rderground l.nli\ rhrl h.!. be.n
usrd lo slore r.guhled $ubsrrncci rinc( Jr urr\ l. 197J. lh.t rr. in Ihr Bruund 11o[iuil 8.l086.orihri.rebrought i.n' u*.fr.r lh) t.19t6. l'hr inform. tion ,.qu.stcd
i! r.quir.d br S.dnrn !|002 ofrh. R6our(. ( orsr.r.li(,n rnd Re(or..1 rct.(R( RAl.
I hc trrn.,r\ purpo.. ,'r rh'. r,n,l,.rr,,',, f: L'!,.rr!r ,. r,' ldL.,r..,,,J .\ rlnrr. ondi],
!rNrnd 'rnt. thrt 'tofu or h.rr..r({r., ffr,{'l(i,rx,! hra,rJor. {rh.rxn(. h Fr\p.!r.d IhJI lh. rnlo,nur,,'r \ou prr\,J( s,lr b( h.,..(I i'r r..r\)nrhl\ Jrrrlijbl(r.corJ..,x.,nlhc.rh..n.rol .url,r.r,rrl. \.{rt,r,\r(J!. h(1,.1 o. r.(,'ll..rllnr
$ho llusl Notifri Sr.(rr':r e(X): !l R( R,\..'. rnrnd.d. rcqr,tr.\ lhal. unh\\c\. rprcd.,,q n.h ol und(rground rrnl. rhnl nor( ,.rulrr.J 'ub\rJn(lj\ n)un norr!\d{iln:lt.d Srll. or local nf.I(r(. (n rh. lr\6r.n(. ol Ihr,r li|nl\. Osn.r nr.nrN(r) rn lhL.a\. ol J. undcrtrourr.l .irrJ!( l.rril ,rr !!c orr \1,\cnrh(t Ii. 19N4. or
bn)uFhltnroutcnli.r thrldal(an\11!,\{1\h\to$n\rnu'rd.rfr(,undnota8.lutrl
ua.d l(,r lh! \lor!U(. u\.. Ltr drsl^-n.,,r! ol rlStlLIlcd \ub\rrndr\. and
(h, ri lh. c.r\' ,)l Jnl ulldcr!,orLnJ .rorIllj unl ,! u'e helor. \,'\cnrhcr t. 1914.
bul.r(r lonU., in u.c on Ihar drr.. an\ pcr\!f $ h os:r.d'Lrchlrnl!ornr(dri,r!l\h(lor.
rh. di$onllnrull()n ol rr. u\(
\thrl T.nls Ar. lnclud.d? I nJrrfr.Lrkj .l,,rnB( Irril i' d.lin.d r\ ro\ on( or
combrnrrtr)n ol r!nl' rhrr r lr h u..d ro (,'nh1n rD .,.(L, ul!llon nt hSulnr.d nrb-.rnncr'. .rnd(2Jqho.r\olunr.(rn.ludrl!(otrtr..r.J! d('!rdund p,pro!) i\ l0.i,tr
nror,L.hcrrcnrhth.S(xnd Som..\rnrpl(.ritund(!!,ouDdhnl\.rorin8: l.Ba(rLl^..
ur.dorl.o,dr(.!'lfu('1.and,.rndu.rnrl$l\(nr'.pr.r,.rtlc'-hcrh,(.\oiiunnSnnr\
Whrt Trnl5.{'r Etclud.d': LnI. r(rn{\.d lroDr rh( !round rrc nor.uht.(t ro
norrlr(:rr&,n Orhcr knl\ e\.lud(d lroh o,,l,lrcilr.,,r Jr!
l.larnr,rr r(.rdenr llanl.ol Ll(U$rll,{sor le*(i;1r.,ru,..dlor.iofin!nrtnorlu(l
lor nor).omm(rcial purpo'c':
l. tilnlr u.rd lor slofln8 hcarnt orl lor !nn\umpll\. Lr\( on rh( F..mN(\ trh(rlj \r(rrrd:
J.lrpric l:lnl\r
{. prpLlnc l"crl,nc. (rncludrn! !rth(i,,r8 i,n(.r :r!tl.,r.(l rnJr, th( \.rr1ril (;r\
llpchn( Sal(l\ A(rol l96l.o, rhr l .,lrrJ('u. l.!uiJl)!r(l nrS.,1.r\ \.t ,rl l9;q..,rqhich Nan inrra'tar( p,r-_linc lrolLr\ r(!uhr(,1 u,trlrr \rtrL( 1.,n,5..udlct inrpoundnrrnr. rr\ t,ri(l\ rr lJ!,n,,,'
6. \lornr \rrLr or uastL \rrcr (ollccr,)n'\.rcrn.
7- ll(\r-rh,ou8h pr(|..c\. r!ll1..t.hquidlIap.oill.\(xrrr.dE.!lh(rn!loi:'ilr(.rit,.l.rrrdr,',rlrtr!r.a,,11lrtl,DInd
!1lrhcnnl oIr.furnn\.
9. nrtrr$ tntrt. rrurrcd in:rn und(rfround Jr.r l.!(l r.., h!.rnr(,ll. r(1hrn)rnLsorl,rn8-dn,r.\halt.orlunn(llrl rh.\r1,rx!.rJ,rlhnrurr(dtrl)('n,'rnbo\.rh.
llhrt Substtn ai Ar. Cor...d? lhc llrjtrl .rr'r ,(rlr't( r(nr\.!npt\ to und(r-tr und .lorr!! hnl\ lhdt (ollta r r(BUhrLd.uh.r,n.r. ],,,. L Ju.\ J,r\ \uh\lnn((
d'jl,n(d d' hn/ard('u. in \(rx r l0l (l{) (, lh. (,.n,Fr(h{n.\(. ln,,r,nnrLIrJtl{L\F,,n\'.(i,nir^-nsrlron!odl'Jb,l'l\
^Lrii
lrhUt( I R( I \'s,rhrn((\L(pt'oL,t
rhos. \ubnano.\ r.Sularcil ai hn/.1rdou, \ ,rc und(r Subr,rle ( ,, R( R.\ lr l\ornclud(\ n{lr lijum...!.. crud( o'lor u1\ rr.rLr'..r rl:(,(,,1 qh,rt.r. ..qu,J rr 'rxtr,hrd(ond,l,('n\ ol lcmfl1'rururc anr, prc\\ur( rf'U J([r(. I {hrrnru,r rJ rr 'p,\ l(l\ prr
'quxr( in(h nb\ruk'r
t\ h.rr To Notit? (i)mplcrrd norri.llur l{',nr\ \h(\,lti i^-'.( r ro rh( addrc\,
8r\rr) al lhc top ol rhr\ pat!
$h.nTo\olifr?l.Oqn(^',tund.rEr.,L,nLl,r,,,.rirr.!nt.,,.(..rr.,rhJr(|\([rnl.r('utr'l olxl.drtrrn all(r JJ U!r\ l. l97.r. bur,l'Il ,n rrr !.,,,'r,r.,Iu.l n,,rr\ h\VJ\ I lel(6 l.Osn(r\tr}lohIIrunJ(rtrou|tl .r,,,.,1ir,,ni. nr. L{,tr(' UJ\ r.
19[6 nru\r rxrlil\ $Ihin.l0dr\\ot h n!,nB rh( rrnt,,Ir., u.(
P.n.hi6: An! osn.r lrho looEinsh fiils tu notif! or rubmits hls. informrtionlhrll b{ subi.'cl lo. ciril Fr.llr not to.x.ed t10.000 for.rch rrnt lor ehich
Dolificrrion ii nol gh.n or to. *hich Lls. informriion h sbmitt.d.
Plclsc t\ pe or prinl in ink a ll il.nr\ c\ccpt ".r{rjnl urc in Scclion V. This form must b} completed fol
erch localion contrining undeaBround rtomBe lanks. ll-nror a lhan 5 trnkr arc ou ned al lhis lo!.alion.
photocopr the rcrcrsc \id!-. ilnd \laFrl! continLr.rlron :'hccts lo (his Ii)rnl
lndicllc nunbcr ol
con!inLlittion \hccl\
attilchcd
Owner Name (Corporalioo. lndiv,dual Publ,c Agency o. Olher Enlily)J. ROBffit CArnictg / DORCI]ry E. C]riliol{
ciry centerville lif t"
Type ol Owner lu.t t. lhol apply8)
! crr'r"nt E Stare or LocatGov tI ro,.e,. tr ff3"rl?13fl,"r', o ""
t"""tff85"i'"1r,--ru, nd
ol9z?0"
o'"" Eff-77s!1T6d"0"'
co'nBarnstable
E3:n OwnershroLJ uncertarn'
vale orrporaie
(ll same as Section 1, marr box nere fl 1
Facility Name or Company Site ldentitier. as applrcabte
CA}rcO ENETGY CORP.
Streel SgteiHr. staB€oad. as appticable
c'ry(W'et) Yarnputh !fl" nlffi*
2
counlEarnstibre
tr
Name (ll same as Section l. mark box here E )
J. SCOTT CAI{I{OT{
Job Title
PRESIDETII
Area Code Phone Number
617-775-2800
!Mark box here only il this is an amended or subsequent notification ,or lhis localron
I certrty under penalty ol law lhat I have personally ex
documents. and lhat based on my inquiry of those indi
subanrlted inlormation rs true, accurate. and COmplete.
amined and am lamaliar with the informalion submitted in this and all attachedviduals immediately responsible forobta,ning the Inlormation. lbelreve that lhe
Name and olliaral trlle ol owner or o!,vner's aulhofi2ed reoresenlative 'l Llatc srcned>- 1 -B-
Notiftcaton lor Un terground Stofage Tanks
GEI{ERAL IiIFOR AIIOI{
r, ow[ERsHrP oFT nx(s)ll. LOCATTON OFTA r(S]
III. CONTACT PERSON AT TA K IOCAIION
rv, wPE oF NonFtcaTtoit
V. CEE[lFlCArlOI{ (R.!d lrtd dgn tll.r coord.llne S.cllon V1.)
!NSTNUCTIONS
lndicate
number ol
tanks at this
location
Mark box here il tanl(s)
are localecl on land wilhrn
an lndian reservalron or
on other lndran trust lands
n
Tank ldentilication No. (e.9.. ABC-123), or
Arbitrarily Assigned Sequenlial Number (e-9., 1,2,3...)
Tank No.
1
Tank No.Tank No.Tank No.
1. Status ol Tank
(Ma* a that applyB)Currently in Use
Temporarily Out ol Use
Permanently Out ol Use
Brought into Use alter 5,/8/86
:. Estimated Age (Years)
3. Eslimated Total Capacily (Gallons)500 500
m, Cathodic Protection
ldterior Lininq (e.9., epoxy resins)
None
Unknown
Other, Please Specify
5. lntemal Protection
(Mark a lhat apply
6' Erlemal-P-rolection cathodic protection(
'a,ta 'l,tap9lylfr) painted (e.g., asphartic)
FiberglassBeinforced Plastic Coated
None
Unknown
Olher, Please Specify
Bare Ste€l
Galvanized Steel
Fiberglass Reinrorced Plastic
Cathodically Protected
Unknown
Other, Please Specify
8. Substance qurentlyor lrsl Stored a. Emptyin Greatesl Ouanlity by volume
(Ma* a nn appty[,) b' Pelroleum
Kerosene
Gasollne (including alcohol blends)
used oil
Other, Please Specify
c. Hazardous Substance
Please lndicate Nameol Principal CEFICLA Substance
OR
Chemical Abstract Service (CAS) No.
Mark box E if tank stores a mixture of substances
d. Unknorvn
t--El
Gas
Owner Name (lrom Seclion l)J ROBRI @NI.IODI Location (liom Secllon ll)350 l4ain St. I{ Y Page No.
-
ol
-
PaEes
4. Malerial ol Conslruclion
(Ma* oneB)Sleel
Concrete
Fiberglass Reinlorced Plastic
Unknown
Other, Please Specily
Vl. OESCRImON OF UI{DEnGBOU D StOnaCe ralXS (ain pte.8torrtr/dtti * araMs,c{5/r,o,t.)
Tank No.
2
fY-l
T-l
fxt I Xt
rxt T--rt
7. Piping
(Ma* a rhal applytB)
+12 0i1
-xl
E E
9. Addillonal lnlormation (tor tanks permanenlly
laken out ol s€rvice)
a. Eslimated date last used (mo/yr)
b. Eslimated quantity ol substance remaining (gal.)
c. Mark box E if tank was f illed with inerl malenal
(e.9., sand, concrete)
STATE USE ONLY rtP:0ati.
2 Submit to:
LOCAL FIRE DEPARTIIENT
A
mrntuorLrnlilnlr..hrlr,rlunn.l)'lrht\rorJ!rlrnlNirurr.ilu0,,n(tr.!hltr'jrh.
llhrl Subshnc.. A.. Cor...d? lhc notrtirirn,n rcqurrrm.nl..rttl\ ro utrd.r-
Frr,und .r,,r I( runt\ rhnr (onlr'n !c!:ulirrcd \ub\lrnc(\ 'l hr. rn(lr.d(.,,r\ .Lh.r.'n(c
d(l'n(J J. hr/r'Lj,,o. in '((!hnr l{ll {l4l ol lhL (ompr(h(n',r. t :.:.'nrrrrr,trlR.\por{. ( Dnr,,( n.rr(nr:rnd l.rbrhr\ Acr ol l9l0(( [ R( l.A ). $,rh rh! (\r(0rr,,f ,n
rho\. \rb\hn!!\ rcfulrlcd r\ ha/,rdou. trir.t( und(r SublrllL ( ,n R( R \ lr Jin'
includu\ F rn!l.unr. . 8.. cnrdlr nrl or,rn) lra.l(nr rhtr(ol s hi(h A LLqr,J Jr .rrntirrJ
.ondnnnr(, lrnrr^_Blui: ! l pn..urlr lt{) dcgni.' I:rh.(oh(rr rU l.rI f,,r,od' |.r
'qulr. rnlh !h\,lurc)
$h.rt To lolir): ( oDpl.rd notrlrul,o,r l,rm. \honU lt .(nr L' thr itdd'(*
t,\cn nr rh( rr,f,,1 rhN pr8(
lnh.nTo\olit!? l.O$n.r\ol $tul.rgritundnorrltunl.rr!'(," ri'trr h.,1. hc(n
r.rlcn i)ut ,rt uErdrion nttt. Janurr\ l. l9?4. bur 'rrll ro th. !,oL,nJ D!.r E,'r,r\ b\
Ma\ x. l'lt6 2.O$n(r\$hob.rn!nnd(.rrrotlnd.r,jrir!!l nt.rnrdL^rJlr.rNt,r\ t.
l9li6. nru'r r\oril\ $ithin l0dii\. ol bnflIin! rhr unl',nlo Lr.!
P.nrlthr: An) orn.r rho Ino$inll! llib lo mlifr ()r rubmiis frls. iotormrtion
rMll b. rubirl lo r ciiil p.rullr not to.rc..d 310,000 for.rch ltnl fo. $hich
no ficrtion ii not gir.n or 10. whi.h l:b. inlonrrtior k .ltbmillcd.
\rho :tlust Ncri,r? S!!tn.n 9llrl nl R( R . il\ nixcndcd- (q irt. rhJI irnl(..
crcmnrcd. o" ner' oi r,ndijrg,ounil IJnA\ rh!r \ror': rt!ulrrctl \ub\rancL\ nru\r ntrlrl)
,J.,!;.rrd Slalc ot klrirl !|tljn(,(. ol rh(.\rl(nc( ol rhLir lanl. Osn(r m':rn\'
r.i ,r rhr r.r.c rr .rn rrnie,lr'-:n,1 'r,'",!. r.rnt ,n u\',rn \n\Lnri^-r F tax4. ,rr
b(rL,rh ntotl\cali.rlhtrldrlc-an\r,(r\rn$ho1!t\n.rnund(rgroundnoru!{lunl
u.(d j,'r rh. \k)rrgc. Lr\. or dr.rt.ns,n! ,!l rtUul.rltd \uh'rrnc$. rod
th, ,r rn( La.(i'l rn\ ur (,r,. . rrC J' r',ru r.rrt rr' ...( h(l,rr(' \.\lj,n'(r l. lqxr.
hur tr,, h,,i!.r ,n u\( r,n Ih:rr Jrt(. an\ F,.. r s r.,,,$ n(,, .r{h l]nl ,nrm(dhr(l\ h(lor(
rh. di.(r!nlrntHlion ol rl. u.,i
l,lhrl Trnli Ar. tncluded: i ,trl.trr.ur{l .rorr!. r,il r. d.rrncd n':rr:\ on..tr
Lornbrnirronol krnl\rhrlIIIr\u..llf!r'nrd,rrnr((!nrIhl,(,nol tc!uhtld !,|1.
'uncc'. :lnd (l) \\ ho\(' \ olum. r,n(iuJ n! cr,nn..r.d un(l.rBround IrPinr) F lU; or
nror( i^-ncarhrh.Br.ond Sornc.\!!:rPl.' rr( und(rsround ri!nt. 'Iorinr: ,. tanrlin(
u.cd oil. or dr.s.l luel. and l. rn,.,u.lr,rl *rl.tot.. F_.lr.LiJ$. hcrb,cld$ or lum'8rnl\.
$h|( Tinls Arr Ercluded? Iirnl. r(nx,\.d lrorlr rh. rtound !rt not.uhj(tr ro
n.r,r(.rlt,,n OIh(r rrnt\(\Llud(d,,,n''i.,l.l(.rr:, tr.,r(
l. turn) or r..id.nrialhn\\ (,1 llUlNrll,,n.nrl.s(;rtr(rr\!..dlornonnlnrtnt'rlu.l
lor no'rijonrm.'rcial puIpo....
:.r:rnl.Lr.cdlor\toiin8htntinSorllo.tor\tlmFlr\.u\'nlhtPrcnrr\t\shcr.\lor(d:
J. 'lrllr tan\':
l.
5.
6.
t.
\orific.rn,. i5 requir.d bt !.de.rl 1.. frtr tll undcrBi('und trnlr lh.l hrt. b.tn
u\tdlo(orrregul.l.d\ubrlrn(6\in.r.,anu.r!l.l9?llhilar.inthtgruund.\oftlrr t. lq&. "r rhrt ir. br'nrthl 'n,,, u\.,t|(r \1. r E. lerio I he inform.tion rt(tuc\rd
i\rc(turrdbtsrclx,n9{m2,'fth(R€\,rrrir('r\rrrrtitrrrndRt(.^trt{cr.{x(R'\r.
I li f, Lnur) purno.. ,,1 rh,. r,)l.r .rlr(t
!,1'und r.,rrr. rh.ir {or( ,'r hr'( .,.',.tj
(\r.((r(J rhrr lh. ,nl.rnlJrNri .,'Li I!t, 'i.coi(l.. or. rn lhc!h.(nLL ol \L(h r(artJ.
n'rtlnr lr(rIl(' l,n(h,d,n! !Jth(Ittl! hn..r r:r_r'l.rt.tl r'r\l(r r'. \
ri".,i'ne s.,rit' \(rdl lq\$.,r rh(HJ^rrd rr.l eL, tl I'n(:'n(\''r',. \.'
htr h ,..,,r 'nrJ.L'r( t,r\ l'n( lJ\,,ln\ r(!UI rc,i und(, \r,,r(i.,$.
\ou, rnoq l(dtr. h.ltI. o. rccollr(udo
,ir
' r h r,, lo.irc rnil .\ 1tr,r. undrr
r , .r h xrdo!. .ub'ri'n!(. lr r.
h. hJ.(d dn r.jl{loahh r\rrlxbl(
.u' lri! xnF,Unilntnr.. nir'. n(,nrj..,n lx!,','n':
\rnl1r *i!r(r or \i!\r( \rrr(r aoll(!ltrrn \\\l.nr\.
tl(N -rhroL,rh pri'ccs hrl.:
lrqord !rap.o' a \r(x !nl(d rilr hclnS lrn 'dir('(rl) rLklcd ro lor 8r.I,r({u(
.rorJt\ rrnt. \IU.'r.d , u11 und(rlr,,und rtl.l {\uih r. .' hJ.(:,(n
l'lcas.l\prorpnntininllllrrcnrrcrc'lpl"rr8n!lurc inScclrolr\ Thisform must b1 complelcd ffi I
each locrlion conlsining underground storgSc tlnks. lfmortlhan5lanlsareo\\ncdilllhl\locJlion. Iphoto(op\ tha re\ersc sidc. ilnd \tatltc c()ulrrltrittir)n shcels Io thi. li)rnl. I
lndrcntc numbcr ol
continualion shccl\
altached I
(lt same as Soclion l.markborhere E )
Facilily Name or Company Site ldentitier, as appircable
cl\I{co B{mor coRP.
Streel Address or State Road, as applicable
350 Main St.
ZIP Code
tr
County
Barnstable
Stale
IA
City (nearesl)
I{est Yar.nDuth
lndrcale
number ol
lanks at lhrs
localron
Mark box here il lank(s)
are located on land wilhrn
an lndian reservation or
on other lndian lrusl lands
OwnerName(Corporal,on. lnd,vrd!al Publ,cAgencv.orOlherEnlrlv,
J. ROBERT CAI[{CD{ ,/ DOBOIHY E. CE}iTON
Type ol Owner ( latk.llhstapplyA)
E curr"n, ! State or LocatGov't
l-l FederalGov'lLJ rormer U {Gsatac.r,ty tD no
Srreel Addressf343 Falrouth Rd.
C rly Centerville
to'n#atar"tubl-a
ZIP Code
02632
Slate
MA
Area Code
617
Phone Numtler
775-14A9
Privale orCorporate
O'.rnershipuncerlarn
Name lll same as Section I. mark box here
J. S@IT CATO{ON
Job Trtle
PRESIDN\TI
Area Code Phone Number
6t7-775-2800
tr
Mark box here only if lhis is an amended or subsequent notitacation lor thrs location
Dare Sroned) :q -82
I certrfy under penatty o, taw thal I have personally examrned and am lamiliar with the information submitted in this and all attached
docurn;nts. and that 6ased on my rnqurry ol thcse-individuals immediately responsible tor obtaining the inlormation. I believe that lhe
subrnitted intormation is true. accurate. and complete
Notifrcalion tor Undergrcgnd Storage Tanks t
GC'GRAL tiFM'TNOiI
trstnucTtot{s
III. COI{TACT PERSON AT IANX LOCATIO
u. rYPC OF r{OflFrCAlrOl{
v. CERTIRCATION (n..d .nd .lgri rft.? cdrPLtlne Srcllon Vl.l
FIRE DEPT.
lD Number
. ' , .lr. Locanor oE rA K(s)L WrGRsHri OFTANI((s)
2
E}
tr
)
tr
Owner Name (lrom Section l)J. ROBffiI CA}I}iCDI Location (trom Ssctlon ll)350 Main st., w.Y Fago No.
-
ol
-
Pager
Tank Identilication No. (e.9., ABC-123i, orArbitrarily Assigned Sequential Number (e.9., 1,2,3...)
Tank No.
1
Tank No.
2
Tank No.Tank No.
'1. Status ol Tank
(Mad< a lhat apply8)Currenlly in Use
Temporarily Out of Use
Permanently Out ol Use
Brought into Use after 5/8/86
2. Estimated Age (Years)
3. Estimated Total Capacily (Gallons)500 500
.. Material ol Construction
(Ma,* oneEl)Steel
Concrete
Fiberglass Reinlorced Plastic
Unknown
Other, Please Specily
E) Cathodic Protection
lnterior Lining (e.9., epoxy resins)
None
Unknown
Other, Please Specify
5. lntemal Protection(Mafta lhalappty
6' Erlemal Prolection cathodrc protection(Ma* ell g,o' applya) painted (e.9.. asphartrc)
Fiberglass Reinforced Plastic Coated
None
Unknown
Other, Please Specify
Bare Steel
Galvanized Steel
Fiberglass Reinlorced Plastic
Cathodically Protected
Unknown
Other, Please Specafy
7. Piping
(Mark all thal applyti)f xl
#2 0i1
t---.l
Gas
9. Additional lnlormalion (lor lanks permanently
laken out ot service)
a. Estimated date last used (molyr)
b. Estimated quantity of substance remaining (gal.)
c. [,1ark box o| it tank was f i ed with inert material
(e.9.. sand, concrete)
Vl. D€SCRIPnON OF UNDEnGnOUNO STORAGE TANXS (Corrrprolo lot fra&,anh,]a tbroa or-)
Tank No.
T*l
fl
t-Yl
I xl
Txl
8. Substance- C-urently-or -Lasl Stored a. Emplyin Grealesl Cluanllly by Volume
(Maft alt n:r,. epptyL) b' Pelroleum
Kerosene
Gasoline (including alcohol blends)
Us€d Oil
Other, Please Speciry
c. Hazerdous Subslance
Please lndicate Name ol Principal CEBCLA Substance
Chemical Abstract Service (CAS)oJo.
Nlark box El if tank stores a maxture ol substances
d. Unknown
r-B I
tr
E
r-I E
E
I P:ll
STATE USE ONLY Ra oatl.FIRE OEPT.lO Nlmber3Cop)' to be certified by loca1 fire deparunenand: POSTED AT STORAGE FACILITY
\orific.rn,n ir .tquir.d b! fed.rrl lr$ for .ll urd..Sround lrnks lhrl h.t. b..n
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ir..qui..d br s.crn,n 9002 oflh. R.vrur(. ( on*rririoo.nd R.co!.r! A.l.lR( RA).
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i\p.rrcd thilr rh. lnlornration \orr nro\rdr qrll i"- nr..d on,(iii,n!hl\ il\ril.rble
rcr,trd. ,,, rn Ih. xb'(nc. ol .uch r.cord'. \our kn(,$ldlir- bclicl. or r!(olllrclron
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rh. dr'(onrrnuilrrn ol rti u*'
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?. ll(N -thiourh proc!* trtrt'.
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rnclud!\ prrrol0unr. { I . crud. orl or.rn\ lri|ct$n lh(rurl $hr(h N irqud !r nJ.drrd
(ondrrron\ ol r.nrr^_rrrur. rrlij t,r.$ur( (t0 drgr.r. i!hr.nhrrI rnJ rt 7 n(uoJ- F-',.qua,L. inch nh\tluk ,
$h... To Sorifr? (i)lntlcrrd nolrl,'inrr lonn' 'ln,uld h{..r1r r,' rh( nddr(*
!i\Ln !l !h,j tr)p,,1 lhi\ nl!e
$'h.n To Notib? l.(x\Dcr','tun(i(!rotudnor.rStrnnl.,nu\{,'rrh.,rhI\(h(nrnI.r oul ('l op(r!rn)n irIfl hnLri,r\ I 197J. bul \lrllin lh( !r)trlll. nru.l n,n,,1 h\\1r\r l916 2.O$n(r.!hdh,,rrf nd.r!ro.rnd \l,,rufc trnl\ irl(, u\( Jri.r \lr\r
l9r. !r!.r troltl\ $ irhrn il, dJ\. ol h,,n!irS rhc lInl. rnro u.c.
l'rnrlri.r: Anr orn.r $ho lnoltintl! fcils to notirt or rubmils hls. informrlion
rhrll b. subi.ci lo. civil p.nrlrl nol !o.rced ll0.m0 for.rch tsnl for ehich
oorificsrion i! not Blr.n or for rhich f.ls. intormrtlon Isrubmilted.
4. prF_lin( lacr[1rlr. lrn(ludirrs f!lhcl)nS Inr.r rr! lrr.rl ! dLr
I',ar'liD( Saltt\ Act ol 1968. or rh( Hil/itrdou' Luu,d I',l1Lli,). srll
$h('h r' atr,nrl.lnr( p,tri,n( lJ.rl,ll r.Sulrr!.i und(r 5rrr. irs.
lllcr\. r\ p. or lnnt in ink all ircnrr \cept ":rgnalurc 'in S(clron \ This form musl b) complet.d for
each locetion conteining undergtound slorrSe lrnks. ll nrorc I hln 5 tankr urc o\ ned al thi:' localion.
photocopl thc rcrcrse sidc. and staple c.rntintration shcclr to thi: lornr.
lndicalc numt!'r ol
conlinualion !hect\
attachcd I
(lt same as Sectaon 'l, mark box nere ! i
Facilily Name or Company Sile ldentilier, as applacable
CAIrcO N{FNT;Y MRP.
Streel Address or State Road, as applacable
350 Main st.
2
Cily (nearesll Stale ZIP Code
D
County
Barnstable
Mark bo)( here il tank{s)
are located on land within
an lndian reservalaon or
on other lndian trusl iands
lndicate
number ol
tanks at lhis
location
Owner Name (Corporaljon. rndrvrc,uel. Public Agency. or Olher Enlrly)
J. ROBERT CAI{NON ,/ rpRC[Hy
Type ol Owner (Mr* ell lh.laP yB)
I cu,r"nt I State or LocalGov t
l-l Federal Gov lLJ Formel U (GsAtac,tity tD. no
Centerville
E. CAI]NCTJ
Slreet Address
1343 Falnrrth Rd.
Co\.rnty
Barnstable
ZIP Code
02632
State
I4,
Area Code Phone Number
6t7-775-).489
l-l Pflvate orLJ{ CorporateI I ()wnersnrolJ g66g1161n
)
Name (li same as Section l, mark box hereJ. SCUIII CANIION
Area Code Phone Number
6t7-'775-2800
Job TillePresidert!r
5:""b _ ?7)
I
rsonally examined and am familiar with the information submitted in this and all attached
I those individuals immediately responsible lor obtaining the inlormation. I belreve thal theI ceri,ty under penalty ol law that I have pe
oocLrments. and that based on my inqurry o
Nanre an I oilicral trtle ol owner or owner's aulhorized represonlative
submilled inrormation is true. accurate. and complete
tor Underground Stolage Tanks
GEIIERAL IXFOBUANOii
N
t]lslnucllo s
[. LOCATIOi{ OF TANX(S)r.ow EnsHtPoFTANx(s)
III. CONTACT PERSON AT TANK LOCATION
Y. CEBTIF|CAfIO]{ (Re!d.nd .lgn .llot conpl.Une Secllon Vl.)
Ctty
tv. TYPE OF t{OTtFtCATrOil
E Mark box here only il this is an amended or subsequent notrficataon lor this localaon.
Owner Name (riom Section l)J CANM)N Location (trom Seclion ll)160 l.{ain St. W Y
Tank No.I Tank No.
2
Tank No.Tank No.Tank ldentilication No. (e.9.. ABC-123), or
Arbitrarily Assigned Sequential Number (e.9., 1,2,3...)
Tank No.
Currently in Use
Temporarily Out of Use
Permanently Out of Use
Brought into Use after 5/8/86
2. Eslimated Age (Years)
3. Eslimaled Total Capacity (Gallons)5no qnn
4. Malerial ot Conslruction
(Mad( oneE)Steel
Concrete
Fiberglass Reinlorced Plastic
Unknown
Other. Please Specity
I
E) Cathodic Protection
lriterior Lining (e.9., epoxy resins)
None
Unknown
Other, Please Specily
5. lntemal Proleclion(ttarta ,hal apply
6. ErlesEl Protectlon cathodic protection('ta,* a'l uEt aPPlylfr) painted (e.9., asphartic)
Fiberglass Fleinlorced Plastic Coated
None
Unknown
Other, Please Specify
Bare Steel
Galvanized Steel
Fiberglass Beinforced Plastic
Cathodically Protected
Unknown
Other, Please Specafy
8. Substance_ C-unentlyor -Last Slored a. Emptyin Grratesl Ouantily by Volume
(Maft at, un applya) b' Petroleum
Kerosene
Gasoline (including alcohol blends)
Used Oil
Other, Please Specity
c. Hazardous Sub6tance
Please lndicate Name of Principal CERCLA Substance
Chemicat Abstract Service (CAS1ilo.
Mark box E if tank stores a mixture of subslances
d. Unknown
#2 0i1
t-----l
Gas
VI.oESCRIPTION OF U DEnGnOUNO STORAGETANKS (Comprdle lor each aank alflhlstof€l/,o,-)
9. Addilional lnrormalion (lor tanks permanently
laken out o, service)
a. Estimated date last used (mo/yr)
b. Estimated quantity ol substance remaining (gal )
c. Mark box E il tank was lilled with inert material
(e.9., sand. concrete)
Page No.
-ol -
Page3
1. Slalus of Tank
(Mark all that apply W)-xl
Txl
7. Piping
(Mark a that apply$)rxr r;r
-B-l
ff
m
4 Ohr gomnrnueult& sf fiursurhrrpttr
DEPARTMENT OF PUBLTC SAFETY-DIVISION OF FIRE PREVENTION
APPLICATION FOR PERMIT TO HAINTAIN AN EXISTING/NEW UNDERGROUND
STORAGE FACILITY
To: Head of Fire Department
19
Clty or Torn Drl.e
Application is hereby made for a pennit to maintain an existing/new
underground storage facility as required by 527CHR9.00: Permits.
Location of property:---------Gi;;E-
owner of property:
ull nanP p€rsoD,ii or
Signature of olrner or authorized representat!ve
Fee: $(M.G.L.A. Chapt. ,l48 Sec. 10A)
(Fire Department's Copy to be Filed with F.P.290 part 2)
Foni t. P. 290Part t
A..DEPARTMENT OF PUBLTC SAFETY-DIVISION OF FIRE PREVENTION
PERM IT 19
Date
TO MAINTAIN AN EXISTING/NEI.I UNDERGROUND STORAGE FACILITY
In accordance with the provisions of 527CMR9.24 this permit to maintain an
existing/new underground storage facility is granted to:
Location of orooertv:
owner of Drooertv:
Full llallle of peBon, flrfl oa corpo"tion
Restrictions:
Fee Paid:$
This permit will exPire
Date Signdture of tlead of Fire Dept. or appointed designee
(M.G.L.A. Chapt. 148 Sec. 10A)
l9Forir F.P
Part 4
290
s\
OIp Oournrttlrulth d Jflurrur[rurrs