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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
oa/2a/2ot4
permit Number: 101391
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 21 Bass River Rd /South Yarmouth, MA 02564
For permission to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operator: tank removal srvcs
Date lssued-Rejecled 0L / 2A / 20L4 By
Date of Expiration. 02/27/2oL4 Fee: $s0'00 $Paid
Cert. No.
(Signature of applicant)
Due
THEUOl
8ASS200015
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APPLICATION and PERMIT Fee
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of M.G.L. chapter 148, section 38A,527 cMR 9.00, application is hereby made by:
Address
Cily
X
(_
ztp
@Tank Owner Name (please print)US hn/)
Siqnatu€ (il appllng lor pemit)
Df lFCl- Certifi Other
+
Company Name
Signature (ii a ing for permit)
Address *,1
Co. or lndividu
Signature (if applying ior permit)
\ftt Le- rt
O' )t#
Tank Location
Tank Capacity (gallons)
Tank Dimensions (diameter x length)
Remarks:
Type ol lned Gas ,.I
Approved Tank Disp /'?14
LL
osaf YarO .r- , J 1
ranr yara aooress / )-Y S* ){-..- ) 31-
Firm Transporting Waste
Hazardous Waste lvanifest#
State Lic. #
E.P.A. #
n, ll
Permit#
Oig Sale Tdl F€e Tel. Numbe. -
Signature / Title oi Otficer granting permit
\\ol
Dig Safe approval number:
FDID#City or Town
Date of lssue Date of Expiration
Trenching Permit #
After removal(s) ("consumptive use'
MassDEP, Bureau of Waste Preven
*lnternational Fire Code Institute
fuel oil tanks d) send Form F 0 or Form FP-2908 signed by the local fire department to
'292 (revised rl0)
tion UST Program, PO Box 120-0'165,Boston, MA 02112-0165.
Make application to local fire department.
Fire department retains original application and issues duplicate as permit.
Remoual Contractor Contamination Assessment
Address
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Pnnl
D) lFCl' Certified D+ LSP #_ Other
Tank lntormation
Substance Last Stored
Disposal lnrormation
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Tank Yard #
Approvals
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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
or/28/20L4
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 21 Bass River Rd /South Yarmouth, MA 02664
For permissaon to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operator: tank removal srvcs
Date lssued-Rejecled 0L / 2A / 2OL4 By
Cert. No.
Date of Expiration: 02 / 2'l / 20L4 Fee: S50.00 $ paid
(sqnature ot applrcant)
Due
THEUOl
BASS2OOOl5
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PERMIT
City or Town: Yarmouth
ot/2a/2074
Permit Number (if applicable) 101391
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 'lO A this permit is granted
to: tank removal srvcs
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:2'l Bass River Rd /South Yarmouth, MA 02664
DIG SAFE NUMBER
Start Date:
ss0.00Fee Paid $
Signature of Official Granting Permit
is permit will expire on 0212712014
Title
This ermit ust be cons ic uousl osted upon the rem rses
permit Number: '101391
Date:
For permission to: Above Ground Tank Removal 527CMR 9.02