3 Federal Ct tank j
Make application to local fire department.
e department retains original application and Issues duplicate as permit.
yoga
APPLICATION and PERMIT Fee: 50.00
for steel underground storage tank removal and transportation to approved tank disposal yard in accordance
with the provisions of MAL, Chapter 148, Section 38A, 527 CMR 9,00, application is hereby made by:
Tank Owner Name(please print) VYlC"-,ru Ot Cori X 1-
Signature(II applying for permit)
Address a—,3O V-� 3 &Q—
Street City Stale Zip
Company NamyNLIMITIFU REIVIUviat_AND(DEMOLITION INC, Co, or individual
O,BOX 137F Print
Address MARBLEH AD,5 A 01045 Address
Print
Signature(if applying for permit) Signature (If applying for permit)
I-A-
a>n IFCI'Certified Other Di>IFCI`Certified lc,�LSP # Other
Tank Locations
�:AeOt A00feSS Ully
Tank Capacity(gallons) �- �-7s A5� Substance Last Stored :E��r�
Tank Dimensions(diameter x length)
Remarks:
1 7�
Firm Transporting Waste 1.!n�;tnl :Q d Zo-i?ova f' 0Z,72U, State Llo, #
Hazardous Waste Manifest# E.P,A. # �Y/i'�fr{'/d'�Z(o1'.S?
Approved Tank Disposal Yard U C cry,�c%rS/iz c ry¢//Zu,v Z/Weh- ,rank Yard# /
Type of Inert Gas Tank Yard Address L,Je "
City or Town BX�Qm FDID# 0 9a Permit#
Date of Issue �A? Date of Expiration
Dig Safe approval number: Trenching Permit #
Dig Sale Toll Free Tel.Num r•800.322.4844
Signature/Title of Officer granting permi e` e-
After removal(s) ('consumptive use"fuel oil tanks exempted) send Form FP290 or Form FP•29OR signed by the local fire department to
MassDEP, Bureau of Waste Prevention UST Program, PO Box 120.0165, Boston, MA 02112.0165,
'International Fire Code Institute
TAIIIQ(S) SIZE
' (�j CONVENTS
(6) f
ANC'-PERSON 0-RANTED A PEIt1vfIT844ALL WITHIN 72 NOURS P OVItjE'I`}{E $OS
1�EP,ARTMEN7 WITH A RECEIPT FOR DELI VERY OF SAID TANKS TO TII TON•I'IItE
bESIG.NATED ON THE PEIRWI,T ) E SITE
TH1S 5 7"ION TO BE Fl. LE.D OUT AND SIGNED AFTER AN ON SIT (1f`S?.:E; ;
THE B0`S7ON 1'IItE.DEPAl�' .II C.tYON BY
TYPE
&ETER
METER READING:
�2) % LEL .+•
61,LEL % OXY
(3) % LEL % OXY
(4) % LE.L % OXY
�s) % LEL % OXY
LEL % OXY
APPLICATIONt %:QX;Y
502 CtYM 3,03 (;Ip) ANY EVIDENCE Or SOIL CONTANf7NATION?,YES
IF YOU NOTIFY D.E.P. -- N0"
INSPECTED BY;
Boaton Fir'Dcpar(mcnc f
COMMENTS-;