HomeMy WebLinkAbouttank legal abandonment 1994FORM F.P. 292
(rev. 9/90)
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Departrnerrt of Public Safety
Divisiorr of Fire Preverrtion and Regulation
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*l.l{}IE APP{T€|YEO TA}IK YARI
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Clty, fbYr0 or Dlstrkt
Fee Paid "s 1)t'9-
Ila zardous waste nratrlf est
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DIG SAFE IIUI.II]E11
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In accordartce wlth the prov ls lorrs of Clrapt'.er l 4 B , sec. l BA, Il . c, L
527 CllR 9.00 appllcatlotr 1g lrereby rrr:rde l.ry:<t(L/ iJxl.
shart <laLe 1 ')- '.'t'J
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StreeL Address & Clty or 'l'ow :-.
Slgnature of appl lcallL:
Appllcants name 1;rlrrted !fit,e
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For permlsslotr to remove arrd trarrsporL orre utrdergrourrd sL.orage tarrk from.
owner z y'k 9*!e-street Atldress ,\r'/ €ttl?lr,( W"l'
Flrn transport- l rrg waste:->A"l7s ,i!{qa ziqarD
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St-ate
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Approved tank yardr t,t+
I'ank yard Address I
l'ype of lnert r.;asr
'I'ank capac l ty: ___
Date of lssue:
'-/2'4 '.,'....l,L t.anl( #r-'1
)____, sulJstarrce I ast stor-erl:
9___ llal-e of expJ ratlorr:l )/19
Slgnature/1'ltIe or- ufflcer granLlrrg perrnlt_:
I,FF KEEP ORIG/NAL AS APPLICATIOIV AND /SSUE DUPLICAT E AS PERMIT T
APruCATION FOII PETIMIT, ANO PERMT, FOII
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