HomeMy WebLinkAbouttank removal 1994FORM FP.292
(rev. 9/90)
A 0l1r Oorrrnrrrrrrupulth nf. ffianaarlyuaills
APPUCATrcN FOR PERMIT, A}ID PERMIT, FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD
FDID#o,531 Permit f 9?- oa Date ?/aq q'l
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fn accordance with the provisions of Chapter 148, Sec. 38A, H.G.L.,
527 CMR 9.oo application ls hereby nade by:€.ttutn (-r
street Address & City or Town:B 3oV h*
Signature of appJ.lcant:
Applicants name printed:Nrc L. aln< ?Cl^nrS T tAA_tt
For permlsslon to ret[ove and transport one tinderground storage tank fron.
Owner:l.l. Coll"11o srreer Address: +L 9ftAD(oF D (^)
Firm transporting waste:'frY^State Lic. I 3>1
Approved tank yard t €/'L f v
5
DIG SAFE NUHBER
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start date
Tank yard Address;
Type of lnert gas:
)Co
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uL tank f:
AC //^-/
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{n Substance last stored , * )-
Date of expiration:g7
Signature/Tltle of offlcer granting permit:
sEr KEEP OR/G/NAL AS AppLtC/trtON AND TSSUE DUqL\CATE AS pERMtT alE
Department of Public Safety
Division of Fire Prevention and Regulation
c.82 S.(0 H.C.t.
Hazardous naste nanLfest {_ E.p.A.f--
t /t/91
Tank capacity:
Date of lssue:$t'1 uqv
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YARMOUTH FIRE DEPARTMENT
96 Main Street
SO. YARMOUTH, MA 02664
(508) 398-2212
Mtwe
R?U
Sept.13, L994
R - Larrton
G. Barabe
Health Dept.
MS
water Dept.
C. Stiefel
1.5 Atlantlc Ave., S.Y. - Tom Grew
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SIGNED:
,N,'Pe te ld.o, LtlInsp.A. Rais
! URGENT!
D soox as PossrBLE
D NO FEPLY NEEDEO
PBIORITY
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SIGNED:&AECYCLED PAPER
Cooietrtsr 4(P,6 Prc€oiB!.n€r. 10% Pci-Co@nror
SENDER: DETACH AND FILE FOB FOLLOW-UP
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