4 Abbott Street Fire.Department retains-origina I application and issues duplicate'as Permit.
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:.APP LICATION and PE,RMIT Fee: �
for storage-tank removal and transportation to approved tank disposal yard in accordance:with the.provisio►is
of M.G.L.Chapter 148, Section 38A,527 CMR 9.00,application Is hereby made by:
Tank0wnerN pleas rant " `�
somi
KL
Address
X ws +iWP r emi
S&M C watt, —zip
Company�Name �� /\Lu AV Co.or Individual
Address �1.SIV A WS I:L—t �. I��a 'V N Address
Pew
Signature(if I g for pe ) Signature(If appty(ng.for pemntt)
O IFW nifiad Other O IFCI•Certified O LSP# Other
a"
Tank Location
) 13 l�01 �
sre.��eaess �.
Tank Capadly(gallons) 7-6- Substance Last Stored o L
Tank Dimensions(diameter x length), �x )(6 0
Remarks:
IM
Firm transporting waste, "� iq L A I GA State Lk;.# �� v -( ! 'r
_ ) L J (�
Hazardous waste manliest# O �� E.P.A.#_n 1Z 6 / 7 0 G7 y 9 3 1
Approved tank disposal yard I un.A yq S' Tank yard# 0
Type of inert gas Tank.yard address
C1tyorTown ��c-L~m FDID# 09Z58
Permit#
Date of issue 1 Z" (o 3 ,
Date of expiration
Dig safe approval number. Dig Safe Toil Free Tel.Number-800-322-4844
Signature/Title of Officer granting permit F1pe— ,
After.removal(s)("Consumptive Use'fuel oil tanks exempted)send Form FP-290R signed-by Local Fire Dept.to UST Regulatory
Compliance Unit,Department of Fire Services,P.O.Box 108.State Road,Stow,MA 01775.' .
•Intematlonal Fire Code Institute
FP-292_frewsed W)