HomeMy WebLinkAboutTank Removal Permit - Permits - 6 BIXBY AVENUE 3/10/2020 Make application to Jo cal Nre Departramt.
Fire Department retains on ss in c and li t dt.al apppliation, liues dupcae as perri
91
Commonwealth, ofMassathusetts
Department of Fire ,bervices Board of Fire Prevention
A. 'Wak'u-1h, 114ee;
'CATION and PERMIT AFFLI It
for,sto,rage tank removAl and t'ransportation to approved tank disposal y ordance with the,provisions
of M.G.L.,Chapter 148,Section 38A,52TCM 9.00,application i's hereby made by:
-F-M
el,
T Ira OP
ank Owner Name.(please pfint),
Adidress
X
street state zi Signatm(if applymg forpemidit)
BEL=
Compeny Name Co.oir Indi'vidual
Address iddress
SIpature if applying for permit,Signature it applying io/ppmu
otlier IFCI*Cerfified LSP 4, Other
U rr4 ci*ce��d
Ilk
Tank Location
rz�
Owl,% .01 4,
Tank Capacity, (gallons), zl�z Substance,,' red
'Tank Diinenigions(diameter x length)
Remfwksl-
Fw
Im
'Of
Firm trimporting waste, Z,61> n State Lie,
Hazardous Nvastemanifest#
Approved tank dispilosal yard ,--,T, 'arid#
s Type of inedtgas----::! Tazik-yard addr es
4z
pity or Tovni FDID# Permit#
Date of Issue Date of expiration
Dig safe approval number- Dig 'Toll Free Tel.Number-8100-322-48,44
A A
VSignature/Title of'Officer granting permit
After removal(s)("Consumptive Use"fue],oil tanksexempted)send forin FP-290 signed,by L=al Fire Department to Office the
State Fire Marshal,UST RegWatory Compliance jut,P.O.Box 1,025,Stow,MA 017751*
*International Fire Code Institute
P 292(revisied 4/97)
PL,Storagetank Rev.,0,5128/03