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APPL!GATION FOR PERMIT
Date:oB/23/202r
permit Number: '102844
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 21 BENTBLUFF LANE /South Yarmouth, MA 02664
For permission to: Above Ground Tank Removal 527CMR 1.12.8.2
Name of Competent Operator: Keith Froleiks/Removal Pro LLC
Date lssued-Rejecled OA / 23 / 2O2L By
Cert. No.
Date of Expiration Fee: S50.00 $Paid
Crtnatureof applicantf
Due
City or Town: Yarmouth
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