0020 ANDREW STREET - Burner Installation POWER BURNERS
Name William Pelletier
Address 20 Andrew St.
Date I0-20-49
Name of Burner National 640I7I Kind of Heat Steam
Gals. Stored 295 Cap. of Tank Gals.
Location of Tank Basement Kind of Oil #2
Installed by M. J. Flaherty 2I4I
Inspected 10-20-49 Approved I0-20-49
RECEIPT OF DISPOSAL OF U190iBi a ffiWifW JIft _.
NAME AND ADDRESS M5 COmRiP. h
�jt
OF A1
APPROVED TANK YARD
APPROVED TANK YARD NO. 1114P
//99,, � _
Tank Yard Ledger 502 CMR 3.03 (4) Number: 10, 0 !�/
I certify under penalty of law I have personally examined the underground steel storage tank
delivered to this "approved tank yard" by firm, corporation or partnership
and accepted same in conformance with Massachusetts Fire Prevention
Regulation 502 CMR 3.00 Provisions for Approving Undetground Steel Storage�ank dLpnantling yards.
A valid permit was issued by LOCAL Head of Fire Department FDIDX C yy77 to transport
this tank to this yard. fj
official a of approved tank yard owner or owners authorized representative:
aW170Y3 1-q 9i
TITLE +' DATE SIGNED
This si receipt of disposal mast be returned to the local head of the fire department
FDIDX _____ pursuant to 502 CMR 3.00. (EACH TANK MIST HAVE A RMCEI T OF DISPOSAL)
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FORM F.P. 291 (rev. 9/88) (OVER) H%SSACER1SE11S STATE FIRE MARSHAL'S OFFICE
DIMENSIONS Tank Removed From n _
Width Length ------------ 0 /l _ ----------
Tank gam.I ( jjsa�L (no. street)
QQ//�� (
-------------- r�-------------------
Tank 2 ----- X ----- (city or town)
Tank 3 ----- X ----- Fire Department
Permit # ------
Tank 4 4 ----- X ----- (if appl cable)
Tank 5 ----- X -----
(feet) (feet)