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Environmental Remediation 2017 - environmentalremediation22011

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BENSALEM TOWNSHIP
Building and Planning Department
Fire Marshal’s Office
2400 Byberry Road ▪ Bensalem Pa 19020
Phone: 215-633-3617▪ Fax 215-633-3662
As a condition of the permit, the Fire Marshals office shall be sent copies of all reports pertaining to
this site clean up.
Office Use Only
All activity must be performed in compliance with International Building and Fire Codes
Fire Official Signature
Date
Building Official Signature Date
Rev 2/2011
APPLICATION FOR ENVIRONMENTAL
REMEDIATION
Permit No:
Date Issued:
Site Location:
Owner Name:
Phone No
Owner
Address:
city, state, zip
Contractor:
Phone No:
Contractor
Address:
city, state, zip
Contractor
License #:
Applicant
Name:
Phone No:
Applicant
Address:
city, state, zip
Description of
Contamination
Cost of
Project::
Duration of
Remediation
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Completed 11 July 2020

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