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HomeMy WebLinkAbouttank removal 2021Crr,rr r*rrlt / fl7tu frrt/b &rfrhj,,-f ,l J* &,**, - W "l fl* N"l" Ji*'tll",roA"l F.A. Bo* 1025, Nrl" P*"1,, $l*u, mA 01115 APPLICATION FOR PERMIT City or Town: Yarmouth Date:o2/22/2021 permit Number: 102750 ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A application is hereby made by: Address: 39 BREEZY POINT ROAD /South Yarmouth, MA 02664 For permission to: Above Ground Tank Removal 527CMR 1.12,8,2 Name of Competent Operator: Date lssued-Rejected 02 / 22 / 2O2L By Date of Expiration Micheal Podiozski/Tank Removal Services Cert. 6l0nature of applicanlf Due 398R01 Fee: Sso.00 $ paid -pi '- X&.99llcdoo b locl ffr ocdunra n . oo.r-.ltt iirrt -ofigr,* rprcoon rno tlrua duDuctb .3 F mlL gf.V""rr"rrr.rrrr*/dr/Q/{d;l'be q{,-"t*tr/&* &*r,a* - Wr- "/d' &"b €';* a'//a'dla/ PP LIGATION and PERMIT Fee: for stael tank r€tnoval and tsansFrtadon lo apprDwd f,ank disposd Yad in accodanco wift thg povisbns of M.G.L ChaPbr 1€, Sacrbn 38, 527 CMR 1.0o Soclio.r 1.12.S.i10, aPPlicakm b heobY nEde by: lnbm.lbrd FItr Co(b lll3dtlb FE2gl (R.YE IXO1O i S3 tll R Tsnk Osner Name (Plsase P(hl) Address Co. d lndridrd iE D |FcP cartifiad sLsPr- olh8' -- SlgnsuxB (if sPCYhg tor Fnit) AddrBss F4a Otlar - Company AddrBss Taok DlInrnCdE (dbfll*t r ladh) Rrnarta: Sub6tancg L8s{ 3q 1 Tlttk Localidt T6nk Ctpadty Typa ol lned GaG #s r(Fim Transpqtng Wssto P\F--H OE;FS,J srrts Lic" EP.A fHazadous wssts Manit€st# F,Yard #Apprcvsd Tank DirPGd Yad Mdress P6rmitDlg Sefe approval nrmben s lra rc E- r1 rarl - cq-aaaa Oty or Tovin Dsle d lEstr Disl)osal lnfonn ation Approvals Tank Owner Contam ination Assessmentrc Tank lnformation 6<1-. SignaMo / Tite d Ofrc.r grading FDD* Psn*g