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APPLIGATION FOR PERMIT
City or Town:
Date:
Yarmouth
o9/L8/2oO8
permit Number: 100177
ln accordance with the provisions of M.G.L. Chapter '148, as provided in Section 1O A application is hereby made
by:
Address: 84 Camp St /South Yarmouth, MA 02664
For permission to: Tank Removal Chapter 148 sec 38A
Name of Competent Operator: tank removal services Cert. No
Date lssued-Re.iected 09 / fA / 20Oa
Date of Expiration . 09 / 22 / 2008
By
(Signature of apphcanl)
Fee: 520.00 $ paid Due
FAO RUELL
84CA01
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PERMIT
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City or Town:
Date:o9/r8/2Oo8
Permit Number (if applicable) 10 0 1 7 7
ln accordance with the provisions of M.G.L. Chapter 148, as provided in Section 10 A this permit is granted
to: tank removal services
For permission to: Tank Removal Chapter 148 sec 38A
Restrictions: Strict and complete compliance with all federal, state and local laws, rules, regulations and codes.
Notify YFD before and after work is complete.
At 84 Camp St /South Yarmouth, MA 02664
Yarmouth
DIG SAFE NUMBER
Start Date:
s20.00Fee Paid $
Signature of Official Granting Permit
This permit will expire on 0912212008
Tifle
This ermit must be cons icuousl osted upon the premises
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llake application to local Fir€ D€partment.
Fire Department retains original application and issues duplicate as Permit.
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APPLICATION and PERMIT Fee:Zo, od
for storago tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapler 148, Section 38A,527 CMR 9.0o, application is hereby made by:
Alter removal(s) send Form FP-290R signed by Local Fire Dept to UST
Room 1310, Boston, MA 0210&1618
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State z1pc4
l^eAl Cdl*r r=lTar* ot ner l.lame (please print)
Address
tr lFCl Certilied I LSP # _ Other
-
Co. or Individual
Siqnature (if applying tor permit)
Address
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I lFCl Certified Other _
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Signaturg (if applyiogior permil)
I sptz .Company Name
Address S
\L st e)
Tank Capacrty (gallons)
Tank Oimensions (diameter x length)
Bemarks
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IOWN OT BARNSIABTE' SOUD T{ASTT
Tank yard #
Tank yard address
Fim trprtins Yvaste
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Approved tank disposal yard
Type of inerl gas
State Lic. #
Hazardous waste manitest#
2
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City or Toryn FDlOit-
Oig Safe Toll Free Tel. Number - 8OG322-48'14
Permit#
/
Date of expirationDale ol issue
Signalurs / T'itl€ of Otficer granting Permit
Dig safe approval numb€r:
FP-292 (r6visod 9,€6)
Regulatory Compliance Unit, One Ashburton Place,
A.
Tank Owner
ContaminationRemoval Contractor
Tank lnformation
Substance Last Stored
Tank Location
Disposal lnformation
Approvals