HomeMy WebLinkAbouttank removal 2012Lonurmuullt, { ftAdatlrum
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APPLICATION FOR PERMIT
City or Town:
Date:
Yarmouth
03/ o8/2072
permit Number: 100993
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made
by:
Address: 20 Braun Rd /South Yarmouth, MA 02664
For permission to: Above Ground Tank Removal 527CMR 9.02
Name of Competent Operator: Tank Away p: 617-561-1117
By
Date of Expiration: 04/oe/2oL2
(Sagnature of applicant)
Due
TH E UO,1
BRAUO2
Fee: 950. 00 $ paid
Cert. No.
Date lssued-Rejected 03 / OA / 2012
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APPLICATION and PERMIT Fee
for storage lank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L, Chapter|48, Section 3BA, SZZ CMR 9.00, application is hereby made by:
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n Irk VTank Owner Name (p
Addross
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tor
Al't l( At"A
s Av5
Company llame
Addrsss
Slgnatur€ (if
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Addiess
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O LSP f_ Olher _D lFCl' C6
Co. or lndividual
SlgnaturB (ll applying.ror pomlt)
f3n Au ru 40Tank Location
B6marks:
Tank Capadty (gallons)?7s
Tank Dlmenslons (diamster x lgng[h))7x LIL Tb O
,|
t/(,nt
r-asrsore'i'frd olL
Flrm lransporling wasls
AiL
,Q,
E.P.A. #
Type ol lnerl gas
Tank yard #elo 3,
LTank yard address ila 5 a
/vNMN S
/h
t7 ?q0 Bqohv
htAilL State Llc #
o 5/rHazardous wasto manlfest*
Approved tank disposat yerd
nL {a(
Dlg Sal Toll Frso Tel. Numbsr - 800-322.4844
Parmll*\r)()oq3Clty or
Signalur8 /Title of Offic€r granting permll
Date of expiralion
(]86l
Dato gl issuo
Dlg Bals approyal number:
Tank Inrormalion
Apprsuals
Atter romovd(r) (rconsumptiyg Uso" luol oil tanks exe mpled) ssnd Form FP..29OF Eigned by Local Fke Dept. to UST Rsgutatocomplianc6 Unlt, Doparlment o! Fire SoMces, p.O Box 1025, Stale Fload, Stow,MA 01775.ry
rvrd|\c dpprrr,d!u (u tuudr r-are r.repalullcrtt.
l Fire Department retains orjginal appligation and lssues duplicate as Permit. '\' ,-r, ^ ././V-r-""rr*"*//" /a/fr-r*"/"r"tr" F^X ,-rl (61 lA30
/Tank 0wner
Removal Conkaetor Contamination Assessment
Disposal lnformation
FDID*
'lnt6rnaliohal Fire Cod6 lns tde
P-29?{roylsod 97)