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HomeMy WebLinkAboutTank Closure Permit - Permits - 3 MASSACHUSETTS AVENUE 12/3/2009 Make application to localFire Department. Fire Department retains original appplication and issues duplicate as permit. w Commonwealth of Massachusetts Department of Fire Services Board of Fire Prevention �- APPLICATION and PERMIT Feed p for 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: � r / �b Tank Owner Name(please print) �C¢I,r w i r �!c,`f r Address -3 M/9ss 41--I(f X Street City State Zi Signature(if applying for permit) Company Name Mfi f T fr-) Co.or Individual ( /vs o vie Rroo,^ 1 Address Address Signature if applying for pemiit Signature if applying for permit ❑ IFCI*Certified other IFCI*Certified LSP 9 Other 7Tank Location MASS Tank Capacity(gallons) J/ ©Ov Substance Last.StoredvC Tank Dimensions(diameter x length) IVS�• /.2 l Remarks: Firm transporting waste jyti 00 f o 7j'A ge [ j r-r- S Late Lic.4 Hazardous waste manifest ft E.P.A.# �'7J-b s-, ,313/` Approved tank disposal yard Tank yard 4 0 0/'( Type of inert gas Tank yard address /S- All eb F0f�b -4 V City or Town ,�Ilp 1 IJ e i FIND# Q� /l�r Permit 4 Date of issue / Date of expiration o-_ Dig safe approval number: Q 0 0 Dig S Toll Free Tel.Number-800-322-4844 Signature!Title of Officer granting pen-nit After removal(s)("Consumptive Use"fuel oil tanks exempted)send form FP-290 signed by Local Fire Department to Office of the State Fire Marshal,UST Regulatory Compliance Unit,P.O.Sox 1025,Stow,MA 01775. *Intemational Fire Code Institute P-292(revisied 4I97) PLStoragetank Rev:05/28/03 Make application to,loeal Fire Department. Fire Department retains original appplication and issues duplicate as permit. r Commonwealth of Massachusetts Department of Fire Services Board of Fire Prevention APPLICATION and. PERMIT Feed a for 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: e - � r Tank Owner Name(please print) Mi.°/`r'1m,,4 C 0/�/f e Address -3 1"19SS / (f A/b -4--.9410 tj F." X Street City State Zi Signature(i£applying forperntit) Company Name MA r T[i--' Co.or Individual ks do"f plpo:^ 1 Address Address IJ 0/n?� I&p,v C Signature if applying for pernvt Signature if applying for permit IFCI*Certified other IFCI*Certified LSP# �" Other Tank Location M s s A Tank Capacity(gallons) 1/ d ov Substance Last.Stored duel Tank Dimensions(diameterx length) f rf 1.2 Remarks: w Firm transporting waste jay Cj r-e- State Lic.# Hazardous waste manifest# -7— E.PA.# 7J-6 s-,,3 J3! Approved tank disposat yard 680 Tank yard# Type of inert gas Tank-yard address M 6,©Fpj� City or Town f 0 • ,4,�1t>O L) FDID# 0,,210 Permit# Date of issue Date of expiration = _ Al- -if-) Dig safe approval number: Q 0 v Dig S Tpll Free Tel.Number-800-322-4844 Signature I Title of Officer granting permit After removal(s)("Consumptive Use"fuel oil tanks exempted)send form FP-290 signed by Local Fire Department to Office of the -- State Fire Marshal,UST Regulatory Compliance Unit,P,O.Box 1025,Stow,MA 01775. *Intemational Fire Code Institute P-292(revisied 4197) PLStaragetank Rev:05126103 T_ANKDAjTA TM REI NED P_QM Gallons SS -- Ave, ow Strw) Previous contents i mete �h {may or Tour*) Date Received �` n Fire Department Permit# ,..,� Serial tic:Yailbk) Tank IM.#(Form FP 90) Owner/Operator to moil revised copy of Notification Form OW",or PP2 1R)to:UST Compliance, Office of the State Fire Marsh ,P.O.BOX 1$25 State Road,Stow, MA 01775-