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OWNERS NAME: �Big J% AMom7hLIe
SEWAGE PERMIT NO. : 95-d33 NEW: REPAIR:-_V,' _
DATE ISSUED:_,3 A/ Z DATE INSTALLED:
INSTALLERS NAME: �AS� 'S /�Uc,�in v� 11r -
INSTALLATION OF: /�yk��,aA,lc� _P ��n + 3 D �SPrc fit' .
f WATER TABLE: 6LFINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE: ��
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Town of Barnstable
Barnstable
Regulatory Services Department
a Maw
. Public Health Division a�
aAaNsrABU,
"� - 200 Main Street,Hyannis MA 02601
1359. Aim
2007
Office: 508-862-3644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. DATE
r�i PLIC:ATION ]FOR PERMIT TO STORE Aiol�/O� [� iLIZI
MORE THAN I II GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NA 1 OF ESTABLISHMENT Q/1Le AaA
ADDRESS OF ESTABLISHMENT Z fT1Y® �1 •
�O�-
D d
T:CI�IP=FiOT��;i�uii�G.3EIt ,
SOLE OWNER: YES ✓NO
• r,a �
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESSI OF ALL:.
PARTNERS:
11 *13 CIO
d c
IF.APPLICANT is A CORPORATION: FEDERAL IDENTIFICATION NO*
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
IGNATU r AWrICANT
RI+?S,TRCTIONS HOME ADDRESSS I� 0 .
sq
HOME TELEPHONE# et
JAinspection handoats\Haz Mat AppIication2008.DOC
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Corporations Division
Business Entity
.o
ID Number: 043462450 Request certificate': New'search l
Summary for: SSRB, INC.
The exact name of the Domestic Profit Corporation: SSRB, INC.
Entity type: Domestic Profit Corporation
Identification Number: 043462450 Old ID Number: 000000000
Date of Organ nation �n Massachusetts fr >.®3�
18�:.199:9
Last date certain:
Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00
fThe location of the Principal Office:
E
Address: 27 COUNTY RD
City or town, State, Zip code, MARION, MA 02738 USA
Country:
IThe name and address of the Registered Agent:
i
i
Name: BARRY A SMITH
'Address: 27 COUNTY RD C/O BARRY SMITH
I
I'City or town, State, Zip code, MARION, MA 02738 USA
Country:
The Officers and Directors of the Corporation:
8 0 ® 0MIA
- � ,PRESID`ENT BAR�RY A„ SMI�TN 2"7FCOU;NTYRD..,MARION ; MA 0;2738�U.SA
TREASURER ROBERT\/ SULLIVAN 23%PROSPECT Al/E ROSLINDALEMA"02131,
_. �. � ..... . ��A
SECRETARY ROBERT VSULLVAN 23 PROSPECTAVE ROSLINDACEMA 02131
U"M
j DIRECTOR ROBERT V SULLIVAN 23 PROSPECT AVE ROSLINDALE, MA 02131
USA
DIRECTOR BARRY A. SMITH 27 COUNTY RD., MARION, MA 02738 USA
14 9 \Y
TOWN OF BARNSTABLE COM ANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH � ry 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANYCOR (luya- kz Th (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS I V NC0 6f4 'P Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS flyff fffiflm
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A)
Diesel, Kerosene, #2(B)
Heavy Oils: 0
waste motor oil (C) ",'+
ISO
new motor oil (C)
iSt�l i, S 1
transmission/hydraulic ,
Synthetic Organics:
degreasers f jl1 Cd'—� &2�42!'2L)
S
Miscellaneous: S (a
1 G✓
1l
�O
(1wk /cubU IbAxt
30 ct
4o I
skx�' 'SVpPL'0' �10 —�
DISPOSAIJR C TION REMARKS:
1. Sanitary Sewage 2.Water Supply 4 SS a�i wQrk
O Town Sewer ublic
XOn-site OPrivate
3.Indoor Floor Drains YES N0-74 �4S`�.S
O Holding tank:MDC
O Catch basin/Dry well S-f-s-
O On-site system
4. Outdoor Surface drains:YES NO,)!( ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
'9aSK
YES No
2.
erson s I er'ewed Inspector Date
r -
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
],
satisfactory 2.Printers
BOARD OF H T 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY ' (see"Orders") 5.Retail Stores
�p 6.Fuel Suppliers
ADDRESS / �I Class; 7.Miscellaneous
�'�!'Z�QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors)
MAJOR MAT�IALS •.
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A)
Heavy Oils: ✓�/ �,
waste motor oil(C)
new motor oil (C)
transmission/hydraulia,
Synthetic Organics:
��-easessr
114
�L, x
Miscellaneous:
Lz�
,CAA 1/0 e,4�� 1.61
*019
�00
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water SupplyV-4el-l—of. &:6,�_
L
O Town Sewer 4private
ublic r —On-site
."Indoor Floor Drains YES NO11 _ e
O
Holding tank:MDC_
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES N0� ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
YES NO
2
��
Person(s) Interviewed Inspector Date
5
TOWN N OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY ! fa e9 (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS p Glass: 7.Miscellaneous
ANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS r
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline;JetFuel-(A
.�iesel;K�osgne;#� 1.
Heavy Oils: lo
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
ea - &ho I e
Miscellaneo
!�5V
ti
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer Public
'` On-site QPrivate
/11
3. Indoor Floor Drains YES f NO - U
O Holding tank:MDC_
Q Catch basin/Dry well
Q On-site system
4. Outdoor Surface drains:YES NOZ ORI) RSA•_ / n
Q Holding tank:MDC i'"L -%G-�d'
Q Catch basin/Dry well
O On-site system
5.Waste Transporter
_AZ 1 YES N0
2.
loe
erson( rviewed Inspector Date
TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") . 5.Retail Stores
6.Fuel Suppliers
ADDRESS _l �'Yi IC�L3t/ �rL ALP Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MAT IALS
IN OUT IN I OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
/x`
transmission/hydr
Synthetic Organics:
degreasers
0
iscellan s: e
P1
r , �
e'G .
DISPOSAIIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer OPublic
O On-site OPrivate
3. Indoor Floor Drains , YES NO
O Holding tank:MDC_
O Catch basin/Dry well
O On-`site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
YES NO
1.
2.
er n W rvfed Inspector Date
i
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Rep r
BOARD OF HEALTHsatisfactory 2.Printers
3.Auto Body Shops
17> 0 ff�'' unsatisfactory- 4.Manufacturers
COMPANY A /�� �W �0�, (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 4I " Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
iC
waste motor oil (C)
/5-0
new motor oil(C)
5—T
1—35— Y-
transmission/hydraulic
Synthetic Organics:
degreasers
6e-C— o-r IL,
Miscellaneous: Z
mu
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply "C/�L G RWAL17 Z. JDJ
O Town Sewer Public { Cu.do tia s i it C/ a4"l
P(On-site OPrivate
cx�t�
3. Indoor Floor Drains YES N0
O Holding tank:MDC_
O Catch basin/Dry well
9,11On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC " 1 o,X�C 3� "MC744ho
O Catch basin/Dry well (A/g93 Oil "
O On-site system
5.Waste Transporter
YES NO
2. <
,.;;:. ,Verson(s)*rvilewed Inspectidr Date
D
fk
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
s- Mail To:
NAME OF BUSINESS: �� �'I` Board of Health
MAILING ADDRESS: G�W/ h Town of Barnstable
TELEPHONE NUMBER: I�- fJ P.O. Box 534
CONTACT PERSON:
Hyannis, MA 02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quan ees totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the
enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid
volume or 25 pounds dry weight. Please put a check beside each product that you store:
-/An ifr z t ee a (for gasolene or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
;L cow r,I Engine and radiator flushes Cesspool cleaners
,):,go � Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road-Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
_ i/ Other petroleum products: grease, lubricants rodenticides)
f V Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
c/ Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
.� Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
L/ Bug and tar removers
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE 'COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH Satisfactory 3.Printers
dy Shops
O unsatisfactory- 4.Manufacturers
COMPANY .c�, p' (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS _ / r6 Class: �' 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS -. . , 1 ,. • ,
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (13)
Heavy Oils:
waste motor oil (C)
�)_®
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply c�Lo
O Town Sewer /Opublic
�;(On-site OPrivate
3. Indoor Floor Drains YES N0*�;4
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank: MDC
O Catch basin/Dry well
O On-site system.
5.Waste Transporter
Name of Hauler1 • Prod
YES NO
1.
_ / —
Person (s) Interviewed U Inspector Date
L) -7 73�, �--
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 3.Printers
.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY �x d (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
Utj� q QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS
IN OUT IN OUT IN. OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils: .53-- Y
waste motor oil (C)
new motor oil(C) t<
transmission/hydraulic 7 O
Synthetic Organics:
degreasers
Miscellaneous:
L �
l�
zit
la ` Z -7-9 16
, sr
DISPOSAIJRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply .S
.O Town Sewer ISWublic
�.0n-site OPrivate
3. Indoor Floor Drains YES-No
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES_kNO O ERRS:
O Holding tank:MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
YES NO
2.
P so nterviewed Inspector Date