HomeMy WebLinkAboutUnderground Storage Tank Permit - Permits - 1 MASSACHUSETTS AVENUE 9/13/2016 /.
Application for Standard Permit
FP-oo6(Rev. 1,1,2015) 4 Return completed application to: 1..6.. ,..1°•2 4a
Permit Number: DIG SAFE NUMBER.
City or Town: t°"N fd , .. r ,' t� t -'_f Start D to ��� ii a "
Date: I w
In accordance with the provisions of M.G.L. Chapt 448,as provided in Section application is hereby made
(Fullby
eo PersoWrnoCorporatior ft ..(PhoneNumber)
)c.of r; ..
(Address:Street or P.O.Bo ,City or Town,Zip Code)
for permission to(state aloofly purpose for which permit is requested) �� � � �(K
,.
Name of Competent Operator(if applicable) Cert. No.
Date Issued-rejected
(Signature of Applicant)
Date of expiration ----- fee Amount Paid$ - L!3
a))o)zt9vmwfz,� a o
FP•006
(Rev. 1.1,2015) PERMIT
City or Town: DIG SAFE NUMBER
Date:
Start Date:
Permit Number(if applicable):
In accordance with the provisions of M.G.L. Chapter 148,as provided in this permit is granted
to P4Tdd //E cfC>i
(Full Name of Person,Firm or Corp ration)
for e.S S /%Y�i �ar� c2 - v :, Ei.�/���1 G/�S i.A.a /-e oyv tirz/ tP.�•r`do.4� ia�J
Restrictions:
at — IS /?'7. zS�s',q 'Gr t/.f ,�`,�,1 f 1,/ —
(Street and#or Describe Location for Adequate Identification)
Fee Paid $ o v This permit will expire on
Signature of Official Granting Permit: Title
This permit must be conspicuously pasted upon the premises
Make application to local fire department.
Z4 Fire department retains original application and Issues duplicate as permit-
APPLICATION and PERMIT Fee:
for steel underground storage tank removal and transportation to approved tank disposal ya rd in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9,00, application is hereby made by:
X
Tank Owner Name(please print) L'', Signature(if app�ymg tar perm�,�
)
Address L 4t 4 v,;11 1 6'
Tank Own Street chy e Zip
Address
I EIMM • A
Company Name_..L0t-r-)fy-s'7—cL,,k_, Jr)c. Co.or Individual
Print print
Address Address
A SIceA, o- e - 7- Address
Print Print
Signature (if applying for permit) Signature(if applying for permit)
Z
E>I>IFCI*Certified Offier E3>IFCI*Certified Di>LSP# Other
Tank Information
Tank Location I t: 1, fe;' A[(' t'-I'A Af�! �1"A
'Y S I es t&
Tank Capacity(gallons)" Substance Last Stored A,L") -Q )e,
Tank Dimensions(diameter x length) CXX ('-)'61
J J
Remarks:
Firm Transporting Waste State Lic.# s ICQ a 0
Hazardous Waste Manifest# 16 0 0 0 0 9,2 q r A/ E.P.A.# I)MA000 15002-) (P
Approved Tank Disposal Yard i cA i e 0 A"6t 5 Tank Yard# 0/
Type of Inert Gas —Tank Yard Address S2 19eA-tf?_f_ 57'liee4t
City or Town FDID#
Permit#
Date of Issue_
Date of Expiration
Dig Safe approval number: (e, (D Trenching Permit#
Dig Sale Toll Free Tel.Number-800-322-4844
Signature/Title of Officer granting permit
After removal(s) ("consumptive use'fuel oil tanks exempted)send Form FP290 or Form FP-29OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention LIST Program, PO Box 120-0165, Boston, MA 02112-0165,
*International Fire Code Institute
FP-292(revised 3/10)
IG
Make application to local fire department.
Fire department retains original application and Issues duplicate as permit-
'9 Vlwl,,&n&a ol c 9-,;,)w, 6&v t c,?4
APPLICATION and PERMIT Fee: J-49
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
7,,y
Tank Owner dame(please print) L /11'C)R�) X
Signature(if applying for permit)
Address or 0 C,i)t,t se,
Street City d State Zip
0
Company Name 60rl-)ev-s-7 7-Li K, Jr)c. Co.or Individual
rr-1 I ss7 Print Print
Address _,I_ -e4�n kSfr�(, 0- 0&,j el Address
Print Print
Signature(if applying for permit) Signature(if applying for permit)
N>IFCI*Certified Other N�IFCI*Certified E+LSP# Other
Tank 7Location -I e, ...........
as Au cress
Tank Capacity e" 6, Substance Last Stored 11,1 ,A
Tank Dimensions(diameter x length) cv-) 'o-)d
Remarks:
Firm Transporting Waste_ 04,At/Cc 0 K State Lic. #— 3
J
Hazardous Waste ManifestR-1 -7a T 6 0 Q 0 2216 E.P.A.# MAP,000 50,2
Approved Tank Disposal Yard /)2in cA y e I/ 0 190, Tank Yard# 0
Type of Inert Gas —Tank Yard Address
City or Town FDID# Permit#
ity or Townes
Date of Issue Date of Expiration
Dig Safe approval number: r2L,,21(0 Trenching Permit#
Dig Sale Toll Free Tel.Number-WO-322-4844
Signature/Title of Officer granting permit
I
After removal(s) ("consumptive use"fuel oil tanks exempted) send Form FP290 or Form FP-29OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention LIST Program, PO Box 120-0165, Boston, MA 02112-0165.
`International Fire Code Institute
FP-292(revised 3110)
C
Make application to local fire department.
Fire department retains original application and Issues duplicate as permit-
Oyla"?,twwwt 0/C 9t'f* dye""VeC e4 0/&W, 6&&
APPLICATION and PERMIT I Fee: 1-0 j
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
lyeicl Va"i le�c
Tank Owner Name(please print)
t Signature(if app!,ylnglc)r permit)
A ess 2
d d Tank
Z '3' PLI" e""213
Street City State Zip
Company Namq_60rr1fy-�-7—a,)1-", Jnc. Co. or Individual-__
A7 Print Print
&i_iem Address
Address Al 7dd
Print Print
Signature(if applying for permit) Signature(if applying for permit)
E36 IFCI*Certified -O(Rer Di>IFCI*Certified �LSP# --Other
MM A 51 ro,=jj i Mi N
Tank Location b/I S w e,i c 4,1 %L,
5teetAMMS
Uny
Tank Capacity(galluris) (LIV)S,_ substance Last Stored )",if
Tank Dimensions(diameter x length) IAO
Remarks:
Firm Transporting Waste C. m m 'ra o K State Lie.# 3
Hazardous Waste Manifest# 10 62 0(2 0 9216 T 1J E.P.A.# /4 0 0 0 150 Iq
Approved Tank Disposal Yard in -,CA ie 0 A"4t Tank Yard#
Type of Inert Gas L d q Tank Yard Address IWI'le r e"tiel-e-H. 1p�d adl-,11
City or Town 11z1 e9p 412 FDID# Permit#--
Date of Issue Date of Expiration
City or Town
Date of Issue " '
e
M,
Dig Safe approval number: 2", Trenching Permit#
Dig Sale TO Free Tel.Number-800-322.4844
Signature/Title of Officer granting permiL��_� "A
After removal(s) ("consumptive use"fuel oil tanks oxemVed)send Form FP290 or Form FP-29OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention LIST Program, PC Box 1120-0165, Boston, MA 02112-0165.
*International Fire Code Institute
FP,292(revised 3/10,
tl
Make application to local fire department.
Fire department retains original application and Issues duplicate as permit- I
0/�e C%,V(c
APPLICATION and PERMIT [Fee
for steel underground storage tank removal and transportation to approved tank disposal ya rd in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
Mt ,
Tank Owner Name(please print)
I(c--
Signature(it applying[or permit)
Address ij L1 lz, I'L�
Street tlly State ZJP
0 1 T71 17 •
Company Name..ekryl 7—cz-,)K, jr)c. Go.or Individual
Print Print
Address 24 Atew &-d-ein S4r-.e,-.l o- e -c)^07Address
Print Print
Signature(if applying for permit) Signature(if applying for permit)
Dl>IFCI*Certified Other F,+lFCI*Certified E+LSP# Other
j. Tank Information
Tank Location AL
Stea ress Ully
Tank Capacity (gailons), LL) (""a 11() )":L— Substance Last Stored
"J ,9
Tank Dimensions(diameter x length)
'ILL-�,- (
Remarks:
Firm Transporting Waste State Lic.# 3
Hazardous Waste Manifest# 166 It 00 929`6 E.P.A.# M14AOO 0 L5 OR 5'
Approved Tank Disposal Yard 122in c-A I e // 0 JI^65 Tank Yard# 0/ 6
Type of Inert Gas d Tank Yard Address m4
OMCity or Town FDID# e,;�2 Permit V
Date
of Issue Date of Expiration
City
of Issue
Dig Safe approval number: c� Trenching Permit#
Dig Sale Tell Free Tel.Number-800-322,W4
Signature/Title of Officer granting permit
After removal(s) ("consumptive use"fuel oil tanks exem )send Form FP290 or Form FP-29OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention LIST Program, PO Box 120-0165, Boston, MA 02112-0165.
*International Fire Code Institute
FP-292(revised 3110)
Make application to local fire department.
Fire department retains original application and Issues duplicate as permit.
APPLICATION and PERMIT
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
a ce 7cT
X
Tank Owner Name(please print)
Sionatur.(if applying for permit)
Tank
I L A lQ14 e:,
Street CRY State ZIP
Removal ContracW 7 1 11 It Oil
Company Name Co.or Individual
Print Print
Address Aftw Print Print
Print
Signature(if applying for permit) Signature(if applying for permit)
E>1>IFCI*Certified Other Dl>IFCI*Certified D1>LSP# Other
Tank Information 1
Tank Location --sL
Steet Address
LFY-L—
Tank Capacity(gallons) Substance Last Stored i
Tank Dimensions(diameter x length),,9(" IX X,) 6 1. (V') clei-4
J
Remarks:
VI-T!=- Iggiium
Firm Transporting Waste 01,an,/Y) rcz n r State Lic.# 3
Hazardous Waste Manifest# &2 c2 o o o -r A/ E.P.A.# A AQ 0 0 5 0 R (P
Approved Tank Disposal Yard 1�')in �-cA �e 0 A"65 Tank Yard#
pproved Tank
Type of Inert Gas Tank Yard Address .2 Dg,4el- -5:b`eel C`Ue/-e-H Odl-'17
A
Cityy or Tow
ity or Town FDID# Permit#
it
1) to of Issue
Date of Issue Date of Expiration
Dig Safe approval number: b,C) Trenching Permit#
Dig Safe Toll Free Tel.Number-800-322-4844
Signature/Title of Officer granting permit,
After removal(s) ("consumptive use"fuel oil tanks exempted) send Form FP290 or arm FF` 211OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention LIST Program, PO Box 120-0165, Boston, MA 02112-0165.
*International Fire Code Institute
FP-292(revised 3/10)
Make application to local fire department.
Fire department retains original application and Issues duplicate as permit-
9(lwl,16,n&a 6A {i (9ewve,e6 — '%w olWw P%te, C_5�51/%/w Q&awdlwl
APPLICATION and PERMIT [Fee:
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
4 (7"q G tI
X.
r Tl�l L Owner f
Tank Owner Name(please print)
Signature(if appfying for permit)
Tank
sc( chus�,4-fs A
Ar,,eJcv4,( EA
Street kofly State 21P
Company Jr)c. Co.or Individual
Print ( Print
Address-24 klew &,Llem S41--et-1 0- -'�e J Address
Pnnt Print
Signature(if applying for permit) Signature(if applying for permit)
E>15,IFCI*Certified Other Y+IFCI*Certified �LSP#_ Other
Tank Location 2 ?
as 'esses.
W Uky
Tank Capacity(gallons) C)rX Y el)�z, Substance Last Stored
Tank Dimensions(diameter x length) v Occ) ail" i'l"t,
4 v
Remarks:
Disposal-Informa, tiow,!
Firm Transporting Waste— (1 0 M/Y) 'ra n K-,— State Lic.# 3 12ao
Hazardous Waste Manifest# 10 6 0 00 My 6 T A/ E.P.A.# /4/QO 0 0 5 0,2_
Approved Tank Disposal Yard Ai Cl �] i �/ 0 A'0 5 Tank Yard#
Type of Inert Gas (10 R Tank Yard Address &2_QLef_ -5-7L46?1. Inli adlelv
City or Town FDID#
Permit#
Date of Issue ..................I --- Date of Expiration
Dig Safe approval number: C Trenching Permit#
Dig Safe Toll Free Tel.Number-8D4-)22-4844
Signature/Title of Officer granting permit_6z?�
After removal(s) ("consumptive use'fuel oil tanks exempted)send Form FP290 or Form 4-290R signed by the local fire department to
MassDEP, Bureau of Waste Prevention UST Program, PO Box 120-0165, Boston, MA 02112-0165.
*International Fire Code Institute
FP-292(revised 3/10)