HomeMy WebLinkAboutReceipte of Disposal of Underground Steel Storage Tank - Correspondence - 1749 SALEM STREET 11/9/2021 RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK
FORMERLY CONTAINING FLAMMABLE LIQUIDS
,
NAME AND ADDRESS OF APPROVED TANK YARD:
Approved Tank Yard Number:
Tank Yard Ledger Number(527CMR1.0066,21I8.2)'
|certify under penalty uf law that | have personally examined1he undergroundsteel sto tank delivered
to this"approved tank yard" by(firm, corporation orpartnership)
and accepted same in conformance with 527 CMR 1.00�66,21.7.7 Provisions for Approving Underground `
Steel Storage Tank Dismantling Yards.A valid permit was issued by the head of the LOCAL fire
departmeniFD|D#
to transport this tank tothis yard.
Name and 0i 1 l title of approvedtank yard owner or owners authorized representative:
Signature : 'tie Date signed:
TANK DATA: TANK REMOVED FROM:
Previous contents: J 1��, City and Town: j—
Length: Notes:
Date Received:
Serial#(if available):
EACH TANK MUST HAVE A RECEIPT 0FDISPOSAL
Ovvnmr/<Jperotor|s responsible for notifying the Department ufEnvironmental Protection:
Department of Environmental Protection
BU[eouofVVaSinP[eVentinn - USTProgrann
Boston, K4AD2112