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APPLIGATION FOR PERMIT
P
Yarmouth
05/03/20r4
permit Number: 10'1489
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address:8 Bass River Pkwy ,South Yarmouth, MA 02664
For permission to Above Ground Tank Removal 527CMR 9.02
Tank Awav o:888{26-5765
Date lssued-ReJected 06 / 03 / 20L4 By
Date of Expiration: 09 / 03 / 2oL4 Fee: $50.00
Cert. No
(srgnature of applicant)
$ Paid
-
Due
THEUOI
8ASS200004
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PERMIT
City or Town: Yarmouth
Date:o6/03/20L4
Permit Number (if aPPlicable)1014 I 9
ln accordance with the provisions of M.G.L. Chapter 148, as provided in section 10 Athis permit is granted
to Tank Away p:888426-5765
For permission to Above Ground Tank Removal 527CMR 9'02
state and local laws, rules, regulations and codes'Restrictions: Strict
NotifY
At
and complete compliance with all federal,
YFD before and after work is complete'
I Bass River Pkwy /South Yarmouth' MA 02664
Fee Paid $
Signature of Official Granting Permit
This it will expire on 09/03/2014s50.00
DIG SAFE NUMBER
Start Date:
ermit must be consThis remtsesuon theicuous
4 Title
E,,.,.{fa
City or Town:
Date:
Name of Competent Operator:
rr,litir, iltt rr,liirir.iiiiir
IvlaKe aPpllcalton to local Flre uepartment.
Fire Department retains original aPPlication arid issues duPlicate as Permit'
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APPLICATION and PERMIT
lor slorage lank removal and transportation to approv6d tank disposal yard in accordance with the provisions
ol M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
A.'
Fee:
Atler removal(s) (tonsumptive Use'fuel oll tanks exempled)send Form FP.290R signed br Local Flre Dapt. to UST
Cornplianco Unll, Dopartment o[ Flre SeMces, P.O. Box 1025, Slate Road, Stow, MA 01775.
'lnt€rnational Fire Code lnslitute.
FP-292 (reused a/97)
print)
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SLlt Zba9
fv\l\i-/Tank OwneI Name
Address
Co.orlndividua! <
E lFCl' Certified O LSP f
-
Other
-
Address
Slgnature (if applying tor permlt)sisna'uc ((
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Other _;rcrF^"*
Company f{ame
Address sAinvs
nalTank Location )RS -q tufr ctl
StoredSubstance
Rernarks:
D
fa7eTsnk Capaq'ty (gallons)
Txttb XV 0Tank Dimonsions (diameler x leng[h)
M
A otL
Frm transporthg vrasls
A,t AO Sl{ulHazardous wast€ manllsstf
I
Approved tank disposal yard
-f,tans
Type o[ ios]t gas
E.P.A. #lo
Tank
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Lyerdaddress A),{ Lanf^<rq LA IL
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Qig SafE Toll Frae Tel. Number - 800-322-4844
Dale ol expiration'
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4
Permitfot.crA\
Signature / Title ot Of{icer grmling pemit
Dlg Eafg approval number:
C-ily or Town
Oate ol issue
Gonlamination Assessment
Disposal lnlormation
Approuals
ory
TankOwner
Removal Contractor
Tanklnfomation
Tank yard #
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