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Home My WebLink About0122 LAFRANCE AVENUE - Health Y LaFRANCE A TEWE% Flnnis Lel ID 270-318 I I I . dcdt - -,l d" alga'n � y, � - a"�._ n�` ... ....•,.. ..,o ,...;:-w-,-R.,A.�r .,o,;, . Date- Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to / clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask _(M64/_Vehicle Washing/Rinsing? -give a vehicle washing policy and Jexplain it Attach the.Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which -it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1°`FL., 367 you must do by M.G.L. Main Street, Hyannis, MA 02601 (Town Hall) DATE:C)gIOCI ZLO Fill in please: arm<'wP , ti '',` APPLICANT'S YOUR NAME/S: Vjw Cf_.zi l4,}yt'ta9tdi., BUSINESS YOUR HOME ADDRESS:AMR f, C� v�yjtilS 1 r l i; �2 ✓�, S l \� TELEPHONE # Home Telephone Number `7 7 �,Q 7- NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS L; MAP/PARCEL NUMBER 'I [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have.the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has i -o ed of permit req ui t ' f '�`1� � '��I �&U` ION Auth sized Signature** RULES AND REGULATIONS. FAILURE TO cO�,n TS: C,-,,. Y MAY RESULT IN FINES. ; J / 2. BOARD OF HEALTH This individual ha rmed of the permit requirements that pertain to this type of business. MUST COMPLY WITH AL L � VV�I(( �I Authorized Signature** HAZARDOUSARDOUS MATERIALS REG' COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has t1h.in& licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: p ' 4 i BUSINESS LOCATION: !lam INVENTORY MAILING ADDRESS. � `'I [. TOTAL AMOUNT: TELEPHONE NUMBER: (2`7� t407 l5Q9A CONTACT PERSON: N r c_,!7>s A l ynr, EMERGENCY CONTACT TELEPHONE NUMBER: (77t4) ,`�� MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMEND IONS: Fire District: Waste Transportation: Last shipment of hazardous waste: P P Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111; Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED insecticides, herbicides, rodenticides Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers {{Asphalt & roofing tar PCB's 1157-jLPaints, varnishes, stains, dyes Other chlorinated hydrocarbons, .Lac er thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes may bet i or hazardous (please list): Laundry soil & stain removers to- (including bleach) w Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i i Hazardous Materials Inventory Sheet Checklist 1---- -Date e- ®.. Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask -40: Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it _Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. r YOU WISH TO OPEN.A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: - 6 - 13 Fill in please: APPLICANT'S YOUR NAME/S: S t1 BUSINESS YOUR HOME ADDRESS: Vr '.ks aw _ . r 4/444 TELEPHONE # Home Telephone Number SO NAME OF CORPORATION: NAME OF NEW BUSINESS 01 S QA S TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES wo ADDRESS OF BUSINESS - 2 MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual h n info d f t per it requir2pnents that pertain to this type of business. Authorized nature**COMMENTS: MUST"OMPLY WITH ALL r . NLUULATIOCIq 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has l `n in rpne o the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date:7-/ZA /20 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: /z TOTAL AMOUNT: TELEPHONE NUMBER: (G��o 81 //0 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: - MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) 0 Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? EMain r Information: Business certificates (cost$30.00 for 4-years). A business certificate ONLY REGISTERS YOUR NAME in tow r YOUt do by M.G.L.-it does not give you permission•to'ope.rate.) Business Certificates are available at the Town Clerk's Office, 1°` FL.[367h reet, Hyannis, Mq.0260'I (Town Hall) n u li+ Fill in Vlease! APPLIGANT'S YOUR NAME: 9US1NES5 YOUR HOME AD R s .2 E s: I 715-5824 TELEPHONE if Home Telephone Number SQ8 7� S Fr*JAME OF N*:EW BUS4MES5IF allSINE-8: THIS A HOME OCCOPA.T, IV? ' . YES NO_..: i have' o�b �� ve�� pvcval �Lttc�"-� rock 2 �1 ;AID ADDRESS RESS -OF-BUS ."ItV ES5 'L v'Q.�►C :NIAP/PARCEL NUMBER— When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations bf the Town of Barnstable. This form is intended to assist you.in obtaining the information you May need.. You Rd. & Main Street] to make sure you have the appropriate permits and licenses.required tollegally operaUST Ote Your�❑ uses ess (cornern this town. armouth 1. BUILDING'COMMISSIONER'S OFFICE This individual has been inform.ed•of any permit requirements that pertain to.this type,of business. Authprized Signature*. COMMENTS: 2. BOARD OF HEALTH This individual has ee info d of th pe it equireme that pertain to this type of business. uthorized ignature** MUST COMPLY WITH ALL COMMENTS: . 47AWUS MATERIALS REGULATIONS 3: CONSUMER AFFAMS [LICENSING gIJTHORITY This individual h en info of the lice g it ents that pertain to this type of business. Authorized Signature.* COMMENTS: Hazardous Materials Inventory Sheet Checklist ' Date ]��EWActuaAmounts Physical Street Address-Check database to ensure it exists orkingPhone Number l -(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information-location of storage,how long Is storage for? If none,note that. �- isposai Information-where and who?If none,note that. Applicant Signature-understand what.is listed and noted Staff Initial-any questions,know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and / explain it-note that it was given t/ Attach the Business Certificate with your sign off and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. Date: 3 / 3 /08 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: A Li I Ivla BUSINESS LOCATION: 12 La amce- Ave , gTny"'s MA INVENTORY MAILINGADDRESS: QU � (rarnco ko- ,1+,c�.iam.4C 8A TOTAL AMOUNT: TELEPHONE NUMBER: (56R) 715 58a4 CONTACT PERSON: grb A Queroz EMERGENCY CONTACT TELEPHONE NUMBER: 12 497 8321 MSDS ON SITE? TYPE OF BUSINESS: Pb W46A INFORMATION/RECOMMENDATIONS: A (1 Colds t)4,eJ at r_U4e[m,2r6 Fire District: i ��noelr�. Waste Transportation: Last shipment of hazardous,waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31 , of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 6 Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents 62en/o r6c,QRoa Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS • - .4.. .'./ .. _ •.^W'.�'R.AWvU".q-T i�1`°"':J A'�'^., 9aM'at ;y �vi.ir..'J-Y� it 77.777 . Date: 3 / 3 / 09 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: R•/-I• P6641d BUSINESS LOCATION: I;A hR PO,"Ce INVENTORY MAILING ADDRESS: 1;<g LL I'(Y`We Ave , 4 oha 'S NA TOTAL AMOUNT-- TELEPHONE NUMBER: (su) 775 Ssay CONTACT PERSON: �reNo ��erp'Z EMERGENCY CONTACT TELEPHONE NUMBER: 171 87 8321 MSDS ON,SITE? f; TYPE OF BUSINESS: Pa�h�ih4 a�- S INFORMATION/RECOMMENDATIONS: ,�•rodu . � c�S u5�o( CuS�oV�P� Fire District: p�oPe��c Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's _a Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, . : Lacquer thinners (inc. carbon tetrachloride) _NEW__:.0 _-USED. Any_other_p(oducts\ktb. poiso.n. .I:abels---- U Paint & varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers, (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents 13Re.�o Q R C•z 4 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS