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HomeMy WebLinkAboutNotification fo Storage Tanks Regulated undeer 527 CMR 9.00 - Permits - 1 MASSACHUSETTS AVENUE 1/9/2007 '� �_ � - y+-�.-:�..✓�r.rw v.-V<Iv f���' G4W:JCGGi�iLWVri�7 j- -C J (��J,��/fir/d�/ Cpxecu rice ��ce o TWO(9ae�� G�C�'��✓te�u�a�/� �pQt��i�cr�zce `Llircttt Notification for Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form, signed by local fire department,to: Mass. UST Program,Dep7Fire of Fire Services,P.O. Box 1025- State Road, Stow, MA 01775 Use Form FP-29OR to notify of tank removals or closures in place. Received: C( b7 Telephone (978) 567-3710 ept. 1D# 4� � f a (Fire Department retains one copy of FP-290) ept. Sig, _ ❑ A. New Facility(see instructions,#f1) ❑ B. Amended IV C. Renewal INSTRUCTIONS; Form FP-290(Notification for Aboveground and Underground Storage Tanks)is to be completed for — each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than five tanks are owned at this location,photocopy the following pages and staple continuation sheets to the form. The FP-290 A. Facility Number must be completed in duplicate. Although the form may be photocopied,the facility owner or owner's representative must sign each copy separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded B. Date Entered to the local fire department,who will check all information and certify the forms. The fire department will retain one copy of the FP-290 for its records,and the facility owner shall be responsible for forwarding the other copy to the C. Clerk's Initials Dept.of Fire Services at the addres.,above. The focal fire department will issue the permit portion of the FP-290, however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit. All questions on this form are to be answered.Incomplete forms will be returned. D. Comments 1-New Fa0ltyr'means a tank or tanks located at a site where tanks have not been previously located. 2"Facility street address"must include bath a street number and a street name. Post office box numbers are not acceptable,and will cause a registration to be returned.If geographic location of facility is not provided,please indicate distance and direction from closest Intersection,84, (facility at 199 North Street is located)400 yards southeast of m n a (Intersection). INFORMATION' NotfficationRequired x i n:(a)afarmorrosidentialtankof1,100gallonsorlesscapacityusedforstoringmotor aboveground Fire Prevention Form FP-290 is to be used as Notification,Registration,and Permit for fuel for rloncommercialpurposes,or(b)a tank used forstoring healing oil forconsumptive CodeofMasachnd uettsRegnations9.00.Nd storage sandtatednk abovesrendordunder527 use on the premises where stored arenotrequiredtoberegisteredunder527CMR9.00. Code of Massachusetts Regulations 9.00.No regulated aboveground or underground storage tank facility shall be installed,maintained,replaced,substantfally modified or PQnatles:Anyownerwho knowingly falls 10notifyorsubmits false Information shall besubject removed without a permit(FP-290)issued by the head of the local fire department. to a civil penal ly not to exceed$$25,000 for each tank for which notification is not given or for The owner of any storage facility shall wilh$n seven working days notify the head of the which false information is submitted.(MGL Chapter 148,section 38H,527 CMR 9.0o) local fire department and the Dept.of Fire Services of any change In the name, Aboveground Storage Tanks address,or telephone number of the owner Or operator of a storage fadlity,subject to 527 CMR 9.00 requires the registration of any aboveground storage tank which meals the regulation by Chapter 148,Mass.General Law and by 527 CMR 9,00. following definition:a horizontal or vertical lank,equal to or less than 40,000 gallons Underground Storage Tanks capacity,that is intended for fixed installation without back fill above or below grade,and is Each owner of an underground tank first put into operation on or after Jan.1,1991, used for the storage of Hazardous Substances,Hazardous Wastes,or Flammable or shall.within thirty days after the tank is first put into operation,notify the Department of Combustible Liquids. Fire Services(the department)of the existence of such tank,specifying,to the extent Exception 91:Aboveground tanks of more than 10,000 gallons capacity regulated by 520 CMR known,the owner of the tank,date of installation, capacity,type,location,and uses of 12.00(Requirements for the Installation of Tanks Containing Fluids Other Than Water in such tank.Uy no later than Jan.31,1991,each owner of an underground storage tank Excess of 10,000 Gallons)are not required to be registered under 527 CMR 9.00. that was in operation at any time after Jan.1,1974, regardless of whether or not such lank was removed from beneath the surface of the ground at any time,shall notify the FxQep ion fit_(a)a farm or residential tank of 1,100 gallons or less capacity used far storing department of the existence of such tank,specifying,to the extent known,the owner Of motor fuel for noncommercial purposes, or (b) a tank used for storing heating oil for the tank,date of installation,capacity,type,and location of the lank,and the type and consumptive use on the premises where stored are not required to be registered under 527 quantity of substances stored in such tank,or which were stored in such tank before CMR 9,00, the tank ceased being in operation if the tank was removed from beneath the surface Pt,a tiq% of the ground prior to the submittal of such notice to the department.Such notice shall n 1 • Regulations who shall, knowingly as laces any rule i regulation made by the Board of Fire also specify,to the extent known,the date the lank was removed from beneath the Prevention Regulations shall,except as otherwise provided,be punished by a line of not less than and hundred dollars nor more than one thousand dollars. (MGL,Chapter 148,section surface of the ground prior to the submittal of such notice to the department.The operator of any lank that has no owner or whose owner cannot be definitely 10U,and 527 CMR 9.00) ascertained,shall notify the department of the existence of such tank,specifying,to the Where to Notify?Two completed notification forms should be signed by boih'the tank owner extent known,any information relating fo ownership of the lank,and date of and the local fire department.One copy will be retained by the fire department,and the tank Installation,capacity,type,and location of the tank,and the type and quantity of owner shall send a separate copy to the address at the top of this page. substances stored in such tank,or which were stored in such tank before the tank When to Notify?1.Owners of storage tanks in use or that have been taken out of operation ceased being in operation if the tank was removed from beneath the surface of the roust notify within thirty days. ground prior to the submittal of such notice to the department.If the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to Owners and Operators of Regulated Storage Tank Systems must maintain records the department,such notice shall also specify,to the extent known to the owner or certifying that all leak detection,inventory control and tightness testing requirements operator,the date the tank was abandoned in the ground and all methods used to for the Regulated Storage Tank System are current.These records must be readily stabilize the tank after the tank ceased being in operation. available for Inspection. L OWNERSHIP OF TANK(S) If. LOCATION OF TANK(S) Owner Name(Corporation,Individual,Public Agency,or Other Entity) if known,give the geographic location of tanks by degrees,minutes,and seconds.Example:Lat.42,36, 12 N Long.85,24, 17W Latitude Longitude C T t ' v r Slreel ddress Stan a and directron from closest intersection(see ins ructions#2) l.S�' Vt✓ . Facility Name or Company Sile identifier,qt applloabie sty late Zip Code � 3 . Street Address(P.O.Box not acceptable-see instructions 42) ounly t ✓' q. City State Zip Code Phone Number(Include Area Code) Owner's Empbyer Federal ID N County FP-PQO(r rle.d Il1091 S III. TYPE OF OWNER IV. INDIAN LANDS '71 Federal Government ❑ Commercial ❑ Tanks are located on land within an Indian Reservation or on ❑ State Government (storage and sale) other trust lands. 13�Private ❑ Local Govemment ($forage and use) ❑ Tanks are owned by native American nation, tribe, or Individual. V. TYPF- OF FACILITY Select the Appropriate Facility Description: (check all that apply) Gas Stalion Marina Truckingll'ransport Petroleum Distributor Railroad Ulllflies Airport Federal- Military Residential Aircraft Owner industrial Farm Vehicle Dealership Contractor Other(explain) VI. CONTACT PERSON IN CHARGE OF TANKS Names�JG( �� ^�� f,l�yt Address: Phone Number (include area code): Job Title:A-P 44 3 H a!Jar 00 f t ��_ Horne: - y 2 RA t'-V Buslness: "PI.- VII. FINANCIAL RESPONSIBILITY ❑ I have met the financial responsibility requirements in accordance Willi 527 CMD 9.00. — Checkallthatapply: --_..- —.._ ------ �------------ ❑ Self Insurance ❑ Guarantee ❑ Letter of Credit lr Commercial Insurance ❑ Surety Bond ❑ Trust Fund ❑ Risk Detention Group ❑ Slate Fund ❑ Other Method Allowed - Specify VIII. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1. Tank site located in wellhead protection area o Yes XNo ❑ Unknown 2. Tank site located In surface drinking water supply protection area ©Y99 KNo 0 Unknown 3, Tank site located within 100 feet of a wetland ©Yes 13�(No © unknown 4. Tank site located within 300 feet of a stream or water body X Yes ❑ No © Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank ldentification Number Tank No.,...__1__.,. Tank No, 2- Tank No.3 Tank No.LL_ Tank No.57- 1. Tank status a.Tank mfr's serial # (it known) b. Currently in Use E::: .= c. Temporarily Out of Use (Start Date) d. Permanently Out of Use E::7= e, Aboveground storage tank (AST) Or ❑AST /MIST 0 AST EfT C]AST 0- AS S UST T UST AST U5T Underground storage tank-(UST) � � Cf A � 2, Dale of Installation (ma./day/yr.) (, Lq2 3. Cstimated Total Capacity (gallons) Cr oacl d, UGO �G`c.C.0 aO c.co j FP.90n t—'4 H 4 t K]Rl �� . TYPE OF .OWNER AV. INDIAN LANDS i Federal Government ❑ Commercial ❑ Tanks are located on land within an Indian Reservation or on (storage and sale)Slate Government other trust lands. El Local Government ❑ Private ❑ y Tanks are owned b native American nation, tribe, or individual. (storage and use) V. TYPE OF FACILITY Select the Appropriate Facility Description: (check all that apply) Gas Station Marina Trucking/Transport Petroleum Distributor Railroad Utilities Airport Federal- Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other(explain) V1. CONTACT PERSON IN CHARGE OF TANKS Name: Address: Phone Number(include area code): .lob Title: Horne: Business: Vil. FINANCIAL RESPONSIBILITY ❑ I have met the financial responsibility requirements in accordance with 527 CMR 9,00, ------------- ----- —.......-- --- -----._......_.. ---._ Check all that apply: ❑ Self insurance ❑ Guarantee ❑ Letter of Credit CI Commercial Insurance ❑ Surety Bond ❑ Trust Fund ❑ Risk Retention Group ❑ State Fund ❑ Other Method Allowed - Specify 1 I Vill. ENVIRONMENTAL. SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1.Tank site located in wellhead protection area Q Yes ❑ No ❑ unknown 2. Tank site located in surface drinking water supply protection area ❑Yes D No 0 unknown 3,Tank site located within 100 feet of a wetland a Yes C No Q Unknown 4. Tank site located within 300 feet of a stream or wafer body 0 Yes ❑ No ❑ Unknown IX. DESCRIPTION OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No.L Tank No. Tank No. Tank No. Tank No. 1. Tank status a. Tank mlr's serial It (if known) b. Currently in Use [7= 0 0 c,Temporarily Out of Use (Start Date) d. Permanently Out of Use e. Aboveground storage tank (AST) or Q AST UST 0 AST DUST C7 AST IJ LIST Cl AST r]UST CT AST 0 UST Underground storage tank-(UST) 2. Date of Installation (mo./day/yr.) 7 �. 3. Estimated Total Capacity (gallons) '�o acyo Tank ldenfification Number(cont.) Tank No—f— Tank No.--?_ Tank No. lank No. L-(— Wank No.� 4. Substance Currently or Last Stored a. Gasoline F' MV n Marina " MV :;1 Marina r;, MV rl Marina r-1 MV FD Marina C7 MV C Marina Motor vehicle or other use other C other 0011161 ❑ other U other b. Diesel E= Motor vehicle or other use Li MV Mar€na ', MV Marina r7 MV C Marina C MV C Marina ❑ MV 1J Marina :,other C other n other G other ❑other c. Kerosene E= d. Fuel Oil` '`Consumptive Use"tanks need not be registered. "Consumptive Use'fuel used exciusively for area heating and/or hot water. e. Waste Oil 0 �� f. Other, Please specify Hazardous Substance ��— � (other than 4a thru 4e above) CERCLA name and/or CAS number ---------------- ------------ ------ ------------ Mixture of Substances u Please specify 5. Material of Construction-Tank(mark Only one) Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel Composite (steel with fiberglass) E= ( _� Fiberglass reinforced plastic (FRP) Concrete 0 Unknown E= F 0 Other 1 E= 0 0 Please specify 6. Type of Construction-Tank (mark only one) Single walled 0 �� Double walled Unknown 0 Other 0 0 0 0 0 Please specify Is tank lined? JKYes ©No Yes © No O�Yas ❑ No XYes D No AYes D No Does tank have excavation liner? Cl Yes C] No ❑ Yes C1 No C1 Yes D No a Yes ONO D Yes © No FP•290(revised 11/96) — L In tV ("OVA A Tank Ideritlfication Number(cunt.) Tank No, Tank No. Tank No. Tank No. Tank No. 4. Substance Currently or Last Stored a, Gasoline Motor vehicle or other use n MV �f Marina El MV 0 Marina n n Cl MV Marina MV n Marina ©MV C)Marina -other C olhor o other ©other other b. Diesel �y._..,�--� E-- _�� Motor vehicle or other use MV !-1 Marna !A MV 0 Marina 0 MV 0 Marina 0 MV f;Marina ❑MV t7 Marina `�othar 0 other © other Cl olhor 0 olhar C. Kerosene d. Fuel Oil �... E._`....= ' 'Consumptive Use'tanks Head riot be registered.. Consumptive Usa'fuel used exclustvaly for area heating and/or hot wafer. e. Waste Oil f. Other, Please specify Hazardous Substance (other than 4a thru 4e above) CERCLA name and/or CAS number -- __....--- `------ ———-------- ———— ——--- fvtixture'of Substances Please specify 5. Maternal of Construction-Tank(mark only one) Bare steel (includes asphall, galvanized and epoxy coated) ...-� Cathodically protected steel Composite (steel with fiberglass) Fiberglass reinforced plastic (FRP) � L Concrete Unknown Other Please specify i. Type of Construction-Tank (mark only one) Single walled ,] E-.= -_, 3 Double walled 3 Unknown _ a Other Please specify u IS tank lined? AYvs 0 No ❑ Yes 0 No 0 Yes © No ❑Yes U No ©Yoe CJ No p Does tank have excavation1iner? U Yes CJ No ❑Yes ONE) © Yes 1-J No U Yes ❑Na O Yee El No r .290(revised 1 1196) Tank Identification Numbor(cont.) Tank No.___�_ Tank No.__�_ Tank No. 3 Tank No. Tank No. ..S 7. Material of Const action-Piping(mask only one) Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel [ t� Fiberglass reinforced plastic (FRP) Flexible 0 ( � Copper 0 � Unknown ___ Other Please specify 8. Type of Construction-Piping(mark only one) Single walled E= Double walled u Unknown Other 0 0 Please specify Has piping been repaired? G'Yes X No r, Yes K No U1 Yes KNo G Yes -_ flo G Yes 5VNo Is piping gravity feed? =1 Yes JVNo ©Yes ;Y\Na 1EJ Yes �KNo D Yes /5KNo U Yes KNo Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping 0 manufacturers B. Installer certified or licensed by the implementing agency C. Installation inspected by a registered engineer D. Installation inspected and approved by [� the implementing agency E. Manufacturers' installation checklists 0 0 0 have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A. Double-wall Tank- interstitial monitoringEl 11 ' B. Approved in-tank monitor o C. Soil vapor monitoring (check one below) 0 Monthly 0 Continuous i E. Inventory record-keeping and tank testing 3 F. Other method allowed by 527 CMR 9.00. E Please specify I q FP•290 frnvia.d 11MM i Tank Identification Number(cunt.) Tank No. Tank No. Tank No. Tank No. ~ 7. Material of Cortsitt3ction-piping(mark only one) Tank No. Bare steel (includes asphalt, galvanized and epoxy coaled) E= F-= Calhodically protected steel E� L Fiberglass reinforced plastic (FRP) ET�� E= r—= Flexible Copper Unknown E:7 E--,._.._.�= -__E== Other = E= E==-i Please specify 8. Type of Construction-piping(mark only one) Single walled _ � E= Double walled E= Unknown Olher E= Please specify Has piping been repaired? ❑ Yes IkNo D Yes F1 No O Yes D No C7 Yes ❑No ❑ Yes 0 No Is piping gravity feed? ❑Yes j(No ❑ Yes 0 No ❑ Yes ONO 0 Yes E! No © Yes Ct No Date X. CERTIFICATION OF CoMPLIANOE 1. Installation A. Installer certified by tank and piping __ manufacturers B. Installer certified or licensed by the implementing agency C. Installation inspected by a registered engineer D. Installation Inspected and approved byJ the implementing agency C. Manufacturers' inslallation checklists [� have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2. Tank Leak Detection Tank Tank Tnnk Tank Tank (mark'oniy one) A. Double-wall lank - Interstitial monitoring B.Approved in-tank monitorV..4,, 'N a C.Solt vapor monitoring (check one below) El 0 a Monthly © Continuous E, Inventory record-keeping and tank testing El 0 ❑ F. Other method allowed by 527 CMR 9.00. r Please specify Fr•29n frevlAa�l 1 Ils]gl - T7nk Identification Number(cont.) Tank I`fo. Wank No.—,2-- Tank No.� Tank No. Tank No, 5- 3. Piping leak Detection (mark only one) piping Piping Piping Piping Piping A.Pressurized a. Interstitial space monitor ❑ ❑ �❑ ❑ ❑ b. Product line leak detector ❑ C❑ ❑ [❑ ❑ (mark all that apply below) ❑ Automatic flow restriclor" ❑ Automatic shut-off device" O Continuous alarm* Also requires annual test of device and piping tightness test or monthly vapor monitoring of suit. B. Suction: Check valve at tank only ❑ �❑ ❑ ❑ ❑ (Requires interstitial space monitor or line tightness test every three years) Interstitial space monitor ❑ Line tightness test C. Suction: Check valve at dispenser only x x (No monitor required) ❑ ❑ ❑ ❑� i D. Other method allowed by 527 CMR 9.00. Please specify d. Date of last tightness test (tank & piping) 5. Gravity feed piping ❑ ❑ ❑ ❑ ❑ 6. Spill containment and overfill protection Tank Tank Tank Tank Tank A. Spill containment device installed VAJ B. Overfill prevention device installed 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records ❑ ❑ ❑ ❑ ❑ reconciliation B. Mechanical tank gauge and records C❑ ❑ ❑ ❑ ❑ reconciliation C. Automatic gauging system ❑� ❑� ❑ 8. Cathodic Protection (if applicable) Tank Piping Tank Plping Tank Piping Tank Piping Tank Piping A. Sacrificial Anode Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ B, Impressed Current Type [A R] FA [A W ❑ N ❑ I A] ❑ C. Date of Last Test Certification of Compliance No.: i X1. CERTIFICATION (Head and slgn altor compleling all sections) NOTE:Roth the copy being son(to the Dept.or Fire SaMcos and the copy retained by the local lire deportment must be Ngeed soperataly. A photocopied signature will not he accepted on either document. i I declare under penalty of perjury that t have personally examinod and am lamlilar with the Information submitted In this and all attached documents,and that basted an my �. Inquiry of those Individuals Immediately responslblo for obtaining the fnfommuon,I believe 1hal the submitted Information Is true,accurate,and complete, Name and official title of owner or owner's aulhorlzod k representative(Pdnt) Signature t Date: _4 9=� f 14 i !2�2 •� r FP-290(revised 1 V96)r �Tank Identification Number(conl.) Tank No.L Tank No. Tank No. Tank No. , Tank No .— I Piping Leak Detection (mark only one) Piping Piping Piping Piping Piping A. Pressurized a. Interstitial space monitor ❑ ❑ ❑ (� ❑ b. Product line leak detector ❑ ❑ ❑ ❑ (mark all Ilia(apply below) CI Automatic Ilow resirictor' Q Automatic shut-off device' • Continuous alarm' Also requires annual test of device and piping lightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only ❑ ❑ (Wequires interstitial space monitor or ❑ ❑ ❑ line lightness test every three years) ❑ Interstitial space monitor ❑ Line lightness test C. Suction: Check valve at dispenser only(No monitor required) El ❑ ❑ ❑ ; D. Other method allowed by 527 CMR 9.00. Please specify 4. Dale of last lightness test (tank& piping) 5. Gravity feed piping .❑ Li ❑ El El 6. Spill containment and overfill protection Tank Tank Tank Tank Tank A. Spill containment device installed ❑ ❑ ❑ B. Overfill prevention device installed ❑ ❑ ❑ ❑ r ' 7. Daily Inventory Control (mark only ane) A. Manual gauging by stick and records El ❑ ❑ ❑ reconciliation B. Mechanical tank gauge and records C❑ ❑ ❑ ❑ ❑ reconciliation C. Automatic gauging system ❑ ❑ ❑ ❑ 6. Cathodic Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping': A. Sacrificial Anode Type ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ U B. Impressed Currant Type Fx] a ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ C. Date +,( Last Test �• � Q.__. r— ^. —�'�. ...._ ^. .�.— —_... Certification of Compliance No.: x1, CE nTIFICATiON (Fiend and sign niter completing all sections) N07't=:Uolh Eh*copy borne sent to the Dept.of Fire servioea end the copy retained by the local fire doporlment mual be w tined aepnfulaty, A phriloonplod elpneluttlf will net hw eaeRpled On either ftaumenl. i dorlare under penalty or padury that I have personally oxamined And am familiar with the Information submlllad in This end all allached documents,end that based on my tnQuiry of those individuals Immodwely raaponsible for oblalnfng the Inlonrmlion,I bollava ihal the submitted information Is true,accurate,and complete. Marne and official lille of owner or ovrnads authorized representative(Print) Signaiu Rota: 'P-290(revised i it9G) ' AIM .;.,_ _ _._ r✓`fr��i` `�i�%%777i2�t"iirzi��� ry v ��� —!C _._. .._ .... _ ... ---- -- - _ 4 JV ": ��: �l'r< !(%7�/ITI,E.?-9 !� ,✓CGUt/Gf.' .�ci��d r �/� �"" ��--,,C�� ,,++ ��// ,/ / / . APPLICATION FOR PE1�N117' To Maintain, do Existing/New Storage Tank Facility RogUla#ed under 527 CMR 9.00 To. Head of Fire Deparlment City, town or district: Date: application is .hereby made for a permit to maintain an exisling/new storage tank facility as required by 527 CMA 9.00; Location of property: ,y.,�.�-••-- 5tfael address � OY/ner of property: �. Fuif name of p9rattq,Crm nr aorporafron �" Number of storage tanks: „ aboveground ttncf�;rcrrn+arid &gnature of oftener or authorized representative: � Fee paid:, (rvi.G.L. Chapter 148, section iOA. (Fire Deportmem's copy-,To be filed tvkh FP-290, Pat! t) . .%--1;.�.�� �` lC, .��1JJ�•7?LC77LiC�2Cr,(r•� �����G(.La:LC7.CfLL!%��Lc•:1• _ . .�. _---- `';',r' t r. !•>-/��r. �r.( c�" %ic�l a --",cw fft, ` %.' - i PER M Al r To Maintain an Existing/New Stahage Tahk facility i far Storage Tanks Regulated wider 527 CMR 0.00 iri accordance vvith the provisions of 527 CMR 9.00 this permit to maintain an existing/new storage tank facility , is granted to: Location of properly: �� 5 ree!address 0YV11er of property ,...� Fu;r,:amn vl parson,rum or carporanon Number of storage tanks: _ aboveground � underground Fai.ility to be rnairltained in accordance with the restrictions described below: MUST MAINTAIN COMPLIANCE WITH M-. G.L. CHAPTER 148 SECTIONS 9 10A„ a:nd_5 2 7 CMR 5, 8 9 { F FE=e paid: S /r,5 (Ad G.L. Chapter 148, section 10A) i This perrriit :•vilt expire ; Data Sgrnarura vl Ncao of Fire Depattnran;or appoinrea densrsd _ _ (Owner's couy— To he pcsfcd Pt the storege facility)