TANK REMOVAL FIRE PERMIT To:178.12249908 ;9787459402 # 1/ 2
02-16-18;02:39PM;From: ....... ..-.�. .. . ....... .._....., .....,..
VwKe aPP410adon to 1¢cal Ftrd DOIArtrnent.
Fire DepwtmeM retalds driginal aiplication and Issues dupliaate.as pemqL
APPLICATION and PERMI'I� Fee: -
Womge rank removal a0d transportation to approved tank disposal yard in accordance with the provWons
MA.L.-Chapter 148,Section SBA;527 CMR 9.00,application is hereby made by,
i w*Own w Name(please pMt) t pvll"",:•.�..c_ `•�rAiA4 X ermit- 791 "'.0L "L
AddressV'7 �. Wt•9 �I Sika
l p so..r «y—�" oar.` ;zw
Co.or lndivtdual
t`,Cnrpceny ,`..
i AddCil.`Ss V AQdt�B56 ._ i
i
Si9at+M(ff WP1Y 19 fo nmm*) Signature Of vOyln$for pem*)
F�Certifbd oromer O l CI Cwtifled O LSP*_ Other
T&*tcoatlort
Tdnk CaWfty P7 -- S�tarwe fast s^teZW 1' f
Tank Dlmeneiwa.(dameter x length) ` 1 2S^— �
t i t7 261 `1St) '"-ve
f
ll�. aa� �LX�ofa�,��Cr)•..t EP.�,.� M1'��.t�5Ga-71Q�_ .
A;vrovad tank dlaposat yard m t.n j C h ,00 Yank yard#* 1`•
if ;-ice of Inst,pas L 0 a^ zsnk yard adaress ��► �'Co�4� �-- �1/t°�'e f f' !
OEM SALEM YiKb i>rrP ni m&NT q
ttyor7'own >?IRBPREVEAMONDIVMONFORT AVZIUZ
Fi3it]: �g�S J t>emtit# f ^` I
1 Date of bwe q Date of expwon -- - ---
( DiQ a>rt approval number
TOO i Free ret.Number-800.322-4844 '
S 919naiure!'nft of 0trowgrarong pam*
83
Aftr removal(s)sand Form FP--2908 signedby f;Dear Rm Dept.to MST atcuy G mpltanca Unit,One Ashburton Place,
RWM 1910,Boatcm.MA 02108-1618.
•3
To:17812249908 ;9787459402 # 2/ 2
02-16-18;02:39PM;From'. . ......_ - - - ,• ..,. . .. . . .•.. •._.. ���
Oaft appileation to logi Fine Dopartment.
E Fite Department retairistid'rigtrta!appAcitian 3d issues dupllcate.as Permit.
SPP LICATION and PERMIT Fee:
r storage tank removal aad transp 'on to approved tank disposal yard In accordance with the provisions
f MA.L•Chapter 148,Sec fon 38& 27 CMR 9,00,application Is hereby made by:
{ Tank Owner Name(please print)\:L4,114% �b; "�- Vt C� X [�''' m'� �- '� qq
(� Address wJ °`�
s _. '27P
CamAanyNamr j'.X ik. E Co.or IndMdualPft
i
Address li If.PI1J YJLt ( n Pf j 1 � Aidress !
Signature(If applying to a ? - Signature Of applying for perroh)
FCt certdled Other t3 iFCI Cerdited Q LBP# , Other
r ii �
i Tank LocaG� 'v!�' +Ref t
. ab i
Tank Caopaeity(9WIons) subvtw=List stored 7 r
} Tank Dlmarrstors•(cHameter x length) -�•--
} Ra3rrrsrtcz ��D►tD 7�S'� 7�G— �87�� �p "1 �. .
i Firm transporting wame.UM 0419 AL I nL state uc.#_, 43I a--2-fJ .. }
H=araws.wa:;te
Approved tank dW0881 yard Air- ICI Tank yard#
Type of inert qtr 0'. Tank yard address Lt�>1eco el -S4-.
f • '
SALEM FIRL DaAK 1''MaWNT1 �^
*or7'owrr— NDDI3i:Ib� FDtQ#_
= Date of[mug 29 FORT AVE AM. pc t 1B bate of awration <-I
.fltg safe approvat nucrtberi Safe Tae Free Tel.Number-800.322-4844 '
. e
swatrae/True of amcer granting permit
Af;w removal(a)send Form W2q0 t signed b}r�, Dept.to tvfr Re lot,Compliance Urrtr,One Ashburton Place.
r%om 1310,BoStOn,MA o2•ioB-7a 18.