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Fire DePartment retains originai ap pf it"titrt and issues duplicate as Permit'
Vr-r*r,,,aee/t/'
@ 17" armt./&a* fle'*'b't
icr storage iank removal and transPortatio! tg-"PqTu"d
ot fr,4.C.f-l Chapter 148, Section 38A, 527 CMR 9'00' app
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APPLICATION
tank disposal yard in accordance u/ith the prov'sions
lication is herebY made bY:
a
X
Tank Ovner Name (PIease Print)R ber i I'fl)rrA
3R USSC 11 ark uin0 A a2l 9
Address c4
Signature (il ep?lyin lat pe(
Other
--
Co. or lndividual
-ffi
tr lFcl certified I c LSP #Other
-
)
r a1iIiei
Tank Loca:icn C:/
Substance Last Stored +2
Tank Capacily (gallons)
Tank Dimensions (iiameler x Ienglh)
775
I
MV 5083 856 100
Firm lransponing v/aste@state Lic' #
E.P.A. iHazardous waste manifesl#
Approved iaok disPosal Yard
Type ol in€11 gas
James G.Grant Co. , T Tank Yard # OOF
Tank yard address
2
Permil#<t8 - o39FO|D*
-
Dig Sale Toll Free Tel. Number' 81o'322'1e41
Dig saie approval number
Si!nature / Tille ol Oiiicer granting permil
lier removal(s) send Form FP'290R signed by Local Fire DePt
oom t 310, 6oston, MA 02108'1618-
2 (re! sed S. !:)
to UST Fegulalory Compliance Unit, One Ashbudon Place'
and PERIVIIT F*' sa:;"
'
Company Name -fuiLa!.Fd FnLj-r'nman l- 2 1
Accressp.n F^y 272 d I hic r'-at--l{es+e++-Address --
Signature (il applying lor permit)
Ferxarks:
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