0000 UNK - Burner Installation DIMENSIONS Tank Removed Fro
Width Length ______ j___ 11�1S�1
Tank 1 --- X (no. street)
Tank 2 ----- X ----- (city or town)
Tank 3 ----- X ----- Fire Department / /)
Tank 4 ----- X ----- Permit # --------L_v _
(if applicable)
an 5 ----- X -----
(feet) (feet)
RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK
NAME AND ADDRES ING & SALW!AA '
OF �Y�11�CiF - arm • __
APPROVED TANK YARD a ,
APPROVED TANK YARD NO. _ LY(U),MA 01905
Tank Yard Ledger 502 CMR 3.031111+49jumber. (r /
I certify under penalty of law I have personally examined the u�xound steel_ storage tank
delivered to this "approved tank yard" by firm, corporation or partnership
and accepted-same in cOnfOmmanCe with Massachusetts Fire Prevention
Regulation 502 CM2 3. 00 Provisions for Approving Underground Steel Storage Tank dismantling yards.
A valid 't is by LOCAL Head of Fire Deparhmnt FDIDB to transport
thi _—_
of i tr of approved tank or owners authorized rep�sen 'va;
SIQiA1VRE TITLE DATE
VSICNID
This si r p� disposal nnrst be returned to the local head of the fire departmnt
FDIDM ��ursuant'to 502 CKR 3.00, (EACH TANK MUST HAVE A RQFSPT OF DISPOSAL)
FORM F.P. 291 (rev. 9/88) (OVER) ,