HomeMy WebLinkAboutCERT OF COMPLIANCE FUEL LINE 20259.&Q:q"7""rrrrr".r..t,br'o)%za..lrrz"a
527 CMR 1.00
Section 1 1.5.1.1 0.1 0.1
Form 1A
Certifi cate of Compliance
M.G.L. Chapter 14E, Section 38J
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Street Name & Number:
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Name of Property Owner:tr+26 4 -Dz(opeV
This certifies that a visual inspection of the fuel supply line(s) for the aboveground heating oil storage
tank was completed in accordance with M,G.L. Chepter 14t, Section 38J (d) for the residential property
identified abovg and the following equipment was observed:
/Y Each fuel supply/retum line is enclosed with a continuous non-metallic sleeve
tr Each fuel supdy/retum line is equipped with an oil safety valve
E Each fuel supply/refum line is not in direct contact with concrete, earth or any floor surface. No oil
safety valrie or continuous non-metallic sleeve is required.
E Bumer is located above the fud storage tank and the entire fuel line is connected to, aM above
the top of the tank. No oil safety valve or continuous non-metallic sleeve is required.
This visual inspection and certification of compliance was completed on:
Date:2
By: (Signature of Oil Bumer T
(Print Name of Oil Bumer Technician)J7Ff/€/6s4*acd
Certificate of Competency #:OZ8SZ6
Upon completion of Form lA, the property owner shall receive a copy ofthe form and
a copy shall also be submitted to the head of the local fire deparment or a designee.
This form can be pholocoPied or reProduced in riplicate.
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(Rev. 1 .26.201 5)
City or Town:
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