HomeMy WebLinkAbouttank removal 1994rev(
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Department of Public Safety
Division of Fire Prevention and Regutation
APPUCATIOI'I rch PERTITT, A}{) P€RITT, FOfl REA{OVAL AND TRANSPORTATION TO APPROVED IAI.I( YARD
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Permit I 1Ll- oS?Date
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Clty, Town o. Dlalrkt
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fn accordance with the provislons of chapter 14B, Sec. lBA, H.c.L.,
527 CHR 9.00 application is hereby made.!y:AD\AICED EN VIIiONHEITAL SERWCES Irc.
street Address & CIty or Town: P.O. Uox 472,. Sout} Eonis, l.l1\
slgnature of appl lcant:
AppJ. icants name printed :Artlu:r ltCorrmd(
For permlssion to remove and transport one und rground sLorage tank from.,9 O,anh"gl &,rao/e @Owner:fr
e
Street Add res s
Firm transportlng waste i_ .s,,e
Hazardous waste nanlfest {
State i,jc.l Hv5OB3ti56l0O
Ii.l,.A. I
Jares c- Q:ant Co.f 0350rApproved tank,:,yard:
Tank yard Address:RBadyi]-te, HA
1'ank capacity:Substance last scor.r,d ;5-
Date of issue: lt I t{ ,fl*
Signature/Tltle of offlcer granting permrt
.: '.+l
Type of lnert gas:
l)J G 5.A l.-!l tlUl.lAER
4
UL tank l:
t)ate of expiration: