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APPL!CATION FOR PERMIT
Yarmouth
09/23/20L0
permit Number: 100660
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section l0 A application is hereby made
by:
Address: 40 Briar Cr /South Yarmouth, MA 02664
For permission to: lnstall Oil Burning Equipment/tanks
Name of Competent Operator : Tank Removal Service
Date lssued-Rejecled 09 / 23 / 20L0 By
Date of Expiration: 70/22/2oLo Fee: 525 00 $ Paid
Cert. No
(Signature of applicant)
Due
THEUOl
BRIAOT
City or Town:
Date:
*t.\
Make appllcation to local Fire Department.
Fire Department retains original application and issues duplicate as Permit.
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APPLICATION and PERMIT Fee:
{or storage tank removal and transportation to approved tank disposal yard in accordance with the provrsions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
,r,oo oJlJ'/City or Town
Date ol issue
Dig sale approval number:
t /)
Dig Sate TolL Free Tel. Number - 800-322'4844
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a\,lu-,trE Ao.yDovvlAddress
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for permit)
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A
ed I a LSP*_ Other
Signature (i,
AddressAddress
9j9litsIgg "pptving
lor permit) t\yD tl|tlr )
I
Remarks:
Yr)Tank Location
Tank Capacity (gallons)f
Io7, Cta
?,Substance Last Stored g
Tank Oimensions (diameter x length)
E.P.A. *
I 1^/l I1,1
State Lic.*L) L
Hazardous waste manifest#Mtl.arFr.f .
u.Approved lank disposal yard xyaro* V-tLYC\E \lO, .
Firm transporting wa g.c,
Signature /'l'ille of Otficer 9
Date ol expiration
Permit#i/rlr- "-Mr
Tank Owner Name (please prin.
Removal Contractor Contamination Assessment
Olher _
Co. or lndividualCompany Name
Tank yard addressType of inert gas
Approvals