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City or Town: Yarmouth
o9/t2/20L9
permit Number: 102511
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 34 ARLINGTON STREET /South Yarmouth, MA 02601
For permission to: Above Ground Tank Removal 527CMR 1.12.8.2
Name of Competent Operator: TANK REMOVAL SERVICES
Date lssued-Rejecled 09 /L2 / 2OL9 By
Cert. No.
Date of Expiration Fee: S50.00 $ paid
(5Enature ofapplican0
Due
6080
34ARLINGSTON ST
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PERMIT
Date:09/!2/2oLe
Permit Number (if applicable) t a z \1 '-
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: TANK REMOVAL SERVTCES
For permission to: Above Ground Tank Removal 527CMR 1.12.8.2
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 34 ARLINGTON STREET /South Yarmouth, MA 02664
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L.,I
DIG SAFE NUMBER
s50.00Fee Paid $
Signature of Official Granting Permit
This permit will expire on
Title
This permit must be conspicuously posted upon the premises
APPLIGATION FOR PERMIT
Date:
City or Town: Yarmouth
Start Date:
tlate rppllcstlon to loctl flrt deptrtmenl.
Flrc deplrtment rrt lns orlglnal ,ppllc.0on and b3uoa dupllc.te !r p.tmlt.
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r- APPLICATION and PERMIT Fee:
for steel storage tank removal and transportaoon to approved tank disposal yard in accordancs with the
provisions of M-G.L. Chapter'148. Seclion 38, 527 CMR 1.00 Soctbn 1.12.8.40. apdication is hereby made by:
Tank Owner Name (please prinl)t x
Address
Co pany
Addr€ss
Co. or IL Ah
Addass
-
SignaturE (it apdying for Frmit)Signah.,i6 (if spplying fo{ permn)
*trcfcertfied Otls *trcrc"nirred *LSP,Olier _
Tank Location tJ
Tank Capacity Last Storsd
Tank Dimeasions (diamoter x l€ng h)
R€ma*si
Firm Transpqting Wasto Lic. #2ss
Hazardous wasl€ l{animg /\EP.A '
Approved T8nk Oisposal Tank Yard *
Typa of lnerl Gas Tank Ya.d Add.Gssrffi
City o. Town
Date of lssua
FOtO#
-
Oat€ of E4iralbn
Dig Safo approval rtlmber: Ttrlldting Porrit _4 La td ti- Lt r{nrE - @anaa
Signature / Ti{o of Oficer granling
'lnbmatoid Filr Codc lnsttt 6
FF292 (Revi..d 12018)
3q. ^.-l , nt^(l tu S.l''*l 10'
Removal Conlractor Contamination Assessment
lnformation