HomeMy WebLinkAbouttank removal 1993FORM FJ'. 292
(rev.9/9O)
A.
APPUCATION FctR PERMT, Al{D PERMIT, FOE REMOVAL AND TRANSPORTATON TO APPROVED TANK YARD
FDIDil C)/ss
q l.f'\ O L.
Oty, Town oa U3lrtct
Pernrit n ?,\-b3 t Da te ,>/t le 9.j
c.82 S.(0 X.G.L
Fee Pald:S &0 o)
fn accordance with the provisions of chapter 148,Sec. 3 84, H.G.L.,
527 cHR 9.oo appllcation ls hereby made by : f uvi€Cr SerE ZdF
street Address & city or Torrn:bA 3(j.<. <
DIG SAFE NUMBER
9.ic a o+1aa
start date Oec 1 1c197
l-/
Slgnature of appl lcant:ffi
Applicants name prlnted:Qoaaz alu5
For perrnlsslon to renove and transport one underground storage tank frorn.
owner: e -T4ov4fis Street Address:l.l BPss. Ptt)6,2 PEIJ/
Firn transporting vastez 4,rAfn€ State Lic,#szg
Hazardous waste rnanifest #_ E.P.A,f_
Approved tank yard I 'ruen L SAOUAb1 i
L'iitJcLA Y LY4J m ATank yard Address i
Type of lnert gas:
Date of lssue:/ef " :393
UL tank ,3
Date of expiration:/J
r)t oo6)
Tank capacity:€oQ 6oc substance last stored: /
a1
Slgnature/Tltle of offlcer granting permit:
sEgr- KEEP ORiGINAL AS APPLTCATION AND
'SSUE
DUPLTCATE AS pERMtT TlE
Olr Oouururrurrrulth rf fisssurhrurtls
Department of Public SafetY
Division of Fire Prevention and Regulation
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