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APPLICATION FOR PERMIT
City or Town: Yarmouth
Date:05/13/2015
permit Number: 101742
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
For permission to: Underground Tank Removal Chapter 148 sec 38A
Name of Competent Operator
Date lssued-Rejecled 05 / L3 / 20Ls By
Date of Expiration: o8/L3/2015 Fee: 100'00 $Paid
Cert. No
(Signature of applicant)
Due
Address: 17 Horse Wy /South Yarmouth, MA 02664
Mike Walker ph.: 508-737-2825
THEUOl
HORSO5
Make appllcation to local Flre DePartmenl
Fire Departmeni retains original application and issues cjuplicete as Permit.
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APPLICATION and PERM!T Fee:too.o
ior siorage tank remcyal a,'rd ti-anspofiation to aFprovad iank disposal yard in acDordanc? with ihe provisions
ol li4.G.L, Chapter .143, Saction 3EA, 527 Ct\4R 9.00, applicatiDn is hereby made by:
Tanli Owner l.jame {rbase prini)+r-L
Addisss tr\Sbn uE (it ap,r'yng lot P2@4)
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LT
Comoany l,lam
p ior
D IFCi' CeiiiiaC Other_
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otv Zit
co. or lndividual
Signature (ii applying ior pefir t)
E lFcl" caidfied tr L,SP # Othel
Address 2-'rl l,<rlll-
Sig;r
T3nk DimensioBs (diameter x lengih)
tl.4\
4tl,r/\D
tF z$r^j-Surstance Last Siored
Bemarks:
T, ank Capacily (gallons)
(a lbo5(zgt "*'^*'" _
I
Firm transportinE *.asle State Lic. +
Ha.:ardous Basle manliest#
fi<o c-}**St---+
ApproYed ta'rk
Type ol inerl g
ank yard
N,-.dYl*
Dig Sale To[ Free Tel. Number - 800-322-4M4
Pennii+\b\,ICI81^U,ffrrr{Qlt-,\
Daie of expirauon
Signalure /1itle of oflicer granting permlt
Dig saie approvai number
Cily or Town
Date olissue
.d&o@j''
Afler removai(s) ('ConsumPtive Use" iualojltanks exemPtsd) send Form FP'2908 sig
Comptiance r-inir, o+artmert of Fire Services, P o- Box 1025, Stste Boad, Stow' MA
'lnlernal.ional Fire Gode lnstitute
oed'by LooalFire Dbpt. to UST Eegulatory
01Tl5.
Tank Lciation
Tank yard address'
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E.P.A +
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APPLICATION FOR PERMIT
City or Town Yarmouth
Date 0s/73/2O!5
permit Number: 101742
Address: 17 Horse Wy /South Yarmouth, MA 02654
For permission to: Underground Tank Removal Chapter 148 sec 38A
Name of Competent Operator Mike Walker ph.: 508-737 -2825
Date lssued-Rejecled 05 / 13 / 20Ls By
Cert. No.
Fee: 100.00
(Signature of applicant)
DueS PaidDate of Expiration: 08/L3/20L5
THEUOl
HORSO5
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PERMIT
City or Town: Yarmouth
Date:05/t3/20Ls
Permit Number (if applicable) 1ai1 a2
For permission to: Underground Tank Removal Chapter 148 sec 38A
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes
Notify YFD before and after work is complete.
At 17 Horse Wy /South Yarmouth, MA 02664
DIG SAFE NUMBER
Start Date:
100.00Fee Paid $s permit will expire on 0811312015
Signature of Official Granting Permit
T
Title
This ermit must be cons icuousl posted upon the rem tses
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section'10 A application is hereby made
by:
ln accordance with the provisions of M.G.L. Chapter '148, as provided in Section 10 A this permlt is granted
to: Mike Walker ph.: 508-737-2825