HomeMy WebLinkAbouttank removal 2000Address /?3
- r.q^e srrJ.redl,\rrr !v rveqr I lrg sEpe. r.r.vr.uFire Department retains original application and issues duplicate as permit.
€*, *n*r r r, * /t1, rV' e/y'/ot to cL, u.t e ltt
Z'
"7
o,, t r, r'r, t of QV^, c/o,r* rb "o - . r. ) r,, r, r/ olaz,, o .7/),
",
r, r r, lr r,
APPLICATION and PERMIT lree
for 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:
Tank Owner Name (please print)6;tli*X
Address PO Box 472 so. Denn i
,.L Lv 4"6'Z(',7 3
C,!t
, Co or lndividual
Address
Company Name Advanced Envi ro. Serv. TDC
I''la.
o2660Signaturelvirnit)
- lFCl Certified
Tank Dimensions (diameter x length)
Bemarks:
Olher
--
- lFCl Cediiied LSP;Othe r
B3 6;,/rz i't/)Tank Location
Tank Capacity (gallons)2zs cnv
SLrbstance Last Stored */ 1-
Contamination Assessment
Tank lnformation
Disposal lnformation
Approvals
Firm transporting wasleAdvanced Enviro. Serv.
Hazardous waste manilest#
Srare Lic. # MV50 8 38 561 OO
Approved lank disposal yard
EPA,f,
James Grant Co. f n(-. Tank yatd *ooF
Type ol inert gas Tank yard address tr{a l ..)l f St - Pa: rlrr
uA/'*,tf,"n/- 0 5'City or Town
Date ol issue
FDID4 ,35
Dig safe approval number:2aaz/6o *?qf gS ll Free Tel. Number - 800-322-4844Di
Permit#
Jt,/'t,r/*
e
Signature / Title ol Ollicer gianting permit 0
Aiter removal(s) send Form FP-2908 signed by Local Fire Dept. to UST Regulatory Compliance Unit, One Ashburtcn Place.
Eoom 1310, Boston, MA 02108-1618.
FP-282 (revised 9/96)
Signature (il applyinE lor permit)
h))L.
Tank Owner
.,Removal Contractor
Date ol expiralion