HomeMy WebLinkAbouttank removal 1994FORM FP.292
(rev. 9/9o)
Department of Public Safety
Division of Fire Prevention and Regul
APPLlcAflot'l Fofl PERI,|IT, A-No PERMIT, Fon REMoVAL AND TRANSPoflTATIoN To APPRoVED
FDrDI_ . ot3g I Pernit fl ql -olE gvys Il/16
l,,l , Yarnouth
Clty, Town o. Oa.t kt c.82 s.(0 l{.6.t
Fee Pald: S 2O
fn accordance with the provlsions of Chapter 14g, Sec. 3gA, H.c.L.,
Street Address & Clty or Town:P.O. hx 472,i South EDnis, tG
DIG SAFE NUHBER
start da te ,b
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52 7 cl.tR 9 . 00 appl lcation ls hereby made. hy :ADTA}IM EN\'IROT*{EVTAL SRV:Ir'FS Irc.
Slgnature of appl lcant :
Appllcants name printed:Arttur
For permlssion to remove and transport one underground storage tank from.
owner: !?Y Street Address: 31 Arlington St.v-t'1oii,L!+^,
Firm transportlng waste: Srno
Hazardous waste manlfest {
.rares c. kant Co.
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State Lic. f 1fl508356100
E.P.A.#
o3501Approved tank yard:
Tank yard Address:ReaMl_1e, IC
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Type of Inert gas:Verltu,
Tank capac i ty:
lt lb 1f,4
substance last stored: + Z R)
Date of lssue:Date of expiration: Dl I l9
Slgnature/Title of offlcer granting permit:
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UL tank {:_2rs
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