HomeMy WebLinkAboutoil tank removal 2003lE -\
APPL
lor storage tank removat and transpool M.G.L. Chapler 148, Sedion 38A,
Tank Owner Name (please pnnt)
E;-^ 6 _ Make application to local Fire Department.tne uepadrnent, .ins originat "ppli";ti"; ;;;'i.*;;;L," as permir
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ICATION and pERMtT tr_$_-- _l
11lol.,.o-"f qlo"ed rank disposat yard rn accordance wrlh rhe provrsrons527 CMR 9.00, appticarion is hereby made by:
Address
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Address j)r-Ir*0
C,tt
Address
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OSr(rl applyi lor
! lFCl Ce(ilied
Tank Location
Tank Capacrty (gallons)
Tank Ormensrons (drameler x length)
Signalurc (r, applying lor pe,mit)
Other _; lFCl Cenrlied ii LSP #
\l)Ocat
Subslance Lasl Stored
Other
cr-Ne_
Frrm lransporlrng wasle \ \] oi\llr,c Stare L'c ,
Hazardous waste manilestl
Approved lank disposal yard \u\nor\tuCKrnO Tank yard ,
Type ol rnen gas _ Tank yard address
E er r -r\-\ $f-8ltg,s laa0
Crly or Town
Oale ol rssue
T-77" / 03
Or9 sale approval rlumber
S.gnalure / Trtle ol Olicer g.anling permil
Aller remova,(s) send Form FP.2gOR signed by
Room l3l O. Bosron. MA 02lOa-1618
V atlno"-lh FDID!Permrr, 07-a/3
Dale ol exprralron o/o
D,g Sale Toll Free Tel Number . AOA-322.4a44
Disposal lnformation
Tinklnformation
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Contamination Assessment
:92 l.e v,srd 9/96)
ocaI Fire Oepr. ro USr Be l.1lory Coinplrance U.rrt. Ooe Ashburton Ptace
F erna rk s:
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Co. or lndividualCompany Name
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