HomeMy WebLinkAbout0181 SPRING STREET - Health 181 SPRING ST. S
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Town of Barnstable
�oF1"E'O�sti Regulatory Servlc�es,Iii u " +
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P Thomas F.Geiler,Directory
Building Division
9 ass.
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WAIF p Mp,�a Tom Perry Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Telephone:
Complaint Description:
FOR OFFICE USE ONLY '
Inspector's Action/Comments Date: Inspector:
x
Additional Info.Attached -
Q:foi�ns:complaint
"
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY Adir/KS JI-t4,"C—AW IXTVr4" (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS /S/ ®'��� • S/'. Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS ,
IN OUT IN OUT IN OUT #&gallons Age Test
l 33�
Fuels:
Gasoline Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) �, 1'i_ PST
alc�
new motor oil(C) sus
transmission/hydraulic
Synthetic Organics:
degreasers
� 1G�2 RCNiJ �r = CXCI rrL 6 c,u
l� /)/gbur2c Ltxe2
Miscellaneous:
S'vR_t7 Pj,,V..r m I G arc.
WM 30
S NM-W f5,+1rVe.r6T
/-Gl4rl..�- df-i7�YGiES `�U � � ✓'-� GL '�
GZ
(7)/Z. 041'IAJ &C*,J6 -
DISPOSALIRECLAMATION REMARKS:
1. !, nitary Sewage 2.W ter Supply '6 6) !A - 0 .
Town Sewer Public 5' ,-C E W 7- 8A-P.P,-7S s-T F &IA' PA i s
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:
Q Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter SiF�-ryn!
Licensed?Name of Hauler Desltih�ttiiw' Waste Product
Person (s) Interviewed Inspector Date
Adam's Small Engine Service
Chain s,Mowers,Trimmers,Snow Blowers,Scooters,&More �N71V 7 0
1.Marine Gas Stations,Re
E COMPLIANCE. CLASS. air p
Adam Fullerton,Owner Ksatisfactory 2.Printers
3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
(see"Orders") 5.Retail Stores
s 181 Spring Street 6.Fuel Suppliers
Hyannis,MA 02601 Class' tleoaiii, 7.Miscellaneous
Phone:(508)775-0231
[TIES AND STORAGE (IN= indoors;OUT=outdoors)
Ob5i OOVM IN_j OU IN OUT IN OUT #&gallons Age Test
Fuels: 6 l y .5-Gasoline Jet Fuel (A) ' "J b .
_ ,Y
wk'Tyclt� Ib
� a ��5 •
eavy Oils: Hq
waste motor oil (C) 75,1lbs. .
10.2 W. 17 9
new motor oil(C)
transmission/hydraulic /fJs•
VT
WSt git
dGce-au�rri�etas�e uPr.svc�
a rk •z� /$�2 3- I 5. �,g �4 b
„.
51,
Miscellaneous: 3 /�
-A (�,eeA bit e t,es f
/`'/O
fit�t' /� U• b5•
/ - ( ,
`71
SPOSArECn2.
ON REMARKS:
1. Sanitary ater Supply Ps
15 Town Sewer Public
O On-site OPrivate
!-faz w
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 cJ ORDERS:
O Holding tank:MDC s e Qi�•'�.
O Catch basin/Dry well
O On-site system
S z z
-2N - - a
u�or! S
5.Waste Transporters — I-Fa
YES/ NO
i. eA--,-
2.
Wa,640,f�_
Person(s)Interviewed Insp 'ct Dr Date
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: Adqm5
BUSINESS LOCATION:
MAILING ADDRESS: r G c�Mail To:
TELEPHONE NUMBER: e3 � Board of Health
Town of Barnstable
CONTACT PERSON: 1 � � � � P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: C. q��O Hyannis, MA 02601
TYPEOFBUSINESS: 5d'y,� I P.l1Q11'1Q reD�!tiC
Does your firm store py of the toxic or hazardous materials listed below, either for sale or for you own
use? 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 otherthan 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 character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils V Pesticides
NEW K USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
5 9 Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
4 Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
` t � rcv:'-... t....,- {'rH �'• 'S f;.NF.. r�.. -A , _ _'.,.i'+, '=45-7
Date: �� Lo 5
TOXIC AND. HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: Adqlns M
BUSINESS LOCATION: CD )
fMail To:
.SO MAILING ADDRESS: � �,� /Y) I J G� Board of Health
TELEPHONE NUMBER: _ v cI 1/ E-3 7`
._�a.CONTACT••P.ERSON. _��. ,.'.,.: , .-�.� ��G�II
Town of Barnstable
k<, P.O. Box 534'
EMERGENCY CONTACT TELEPHONE NUMBER: L ����
ll Hyannis, MA 02601
TYPEOFBUSINESS: 15ry ., i On!p7 InQ P 1►� I
Does-your firm store ny of the toxic or hazardous materials listed below, either for sale or for you owrr� !
�1 use? YES X 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: . i
ADDRESS:
TELEPHONE:
LIST`O'F"TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibittitoxic.or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity:beside the prod
ucfthat`'
you store. NOTE: LIST'INTOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antif reeze(for gasoline or coolant systems) Drain cleaners
NEW USED. Cesspool cleaners
Automatic transmission fluid Disinfectants
*Engine!..and_,.radiator-flushes.::, -:�.--,_— = Road Salt_(Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides j
NEW USED (insecticides, herbicides, rodenticides)
1 � Gasoline, Jet Fuel Photochemicals (Fixers)
5 Diesel fuel, kerosene, #2 heating oil NEW USED
Db 0411 Other petroleum products:-grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
�. Degreasers for engines and metal Printing ink
Degreasers for driveways & garages: Wood preservatives (creosote)
Battery acid (electrolyte).. Swimming pool chlorine
Rustproofers ,.-' Lye or caustic soda
_ 'Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roof ing tar fertilizers
Paints,,varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint &varnish removers, deglossers `
Any other products with "poison`' labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor&furniture strippers hydrochloric acid, other acids).
Metal polishes
Laundry soil.& stain removers Other products not.-listed which you feel
(including bleach) may be toxic or hazardous(please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
„_. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ~
_ o
TOWN OF BARNSTABLE CO PLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH - 3.Auto Body Shops
q� I �e� unsatisfactory- 4.Manufacturers
COMPANY D J6ar�S ��l 1 6'-�J�� O (see"Orders") 5.Retail Stores
- 6.Fuel Suppliers
ADDRESS le 1 � c Class: 7. Miscellaneous
d Wer (2'cA'N-d �dk''^��^ QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS ,.. Imam
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) 54/u.S
AX, 2 ✓'
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
n ✓
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary_..Sewage 2.Water upply
Sewer Mublic
O On-site OPrivate
3. Indoor Floor Drains YES N0
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
7
�J YES NO
2. �f
Person(s) Interviewed Inspector Date
:� �
G
i
f�
l
F
TOWN OF BARNSTABLE PLIANCE: CLASS: 1. Marine,Gas Stations,Repair
BOARD OF HEALTH (Satisfactory 2. Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY ' M.(_ , L1 6i (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS A 11 Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS 'f:
IN OUTI IN I OUT IN OUT #&gallons Age Test
Fuels-.-,,,
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) V
new motor oil (C) �
transmission/hydraulic
Synthetic Organics:
degreasers Xts 140,44
Miscellaneous:
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply Z �hwl1� w►Grn QC
O Town Sewer OPublic 1
O On-site OPrivate /
1!I : D �alZ, w�iS JS
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well t aA
O On-site system Is
i
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC T oJ4:"r 5 >
O Catch basin/Dry well C'..+C6,00
O On-site system
5.Waste Transporter
-L + YES I NO
2.
0"
Person s) Iri rviewed ector Date
l -
MAHONLY & DOUGLAS LTD.
Environmental Services
49 Center Street • Hyannis, MA 02601 -Tel: (508) 775-8880 • Fax: (508)862-2 004
Cc'-U }U
November 11, 1998
Department of Environmental Protection
Attn: Ms. Julie Hutcheson
Bureau of Waste Site Cleanup
Southeast Regional Office
20 Riverside Drive
Lakeville, MA 02347
RE: Release Abatement Measure Plan
181 Spring Street
Hyannis, MA
RTN: 4-14306
Dear Ms. Hutcheson:
On behalf of Richard H. Robinson, Mahoney &Douglas, Ltd. is pleased to submit this Release
Abatement Measure (RAM) Plan to manage soils contaminated with what has been
characterized as a lubricating oil. The subject property is a 0.23 acre parcel. Two specific areas
have been identified, source area #I and source area #2., Location #1 is a 185 square foot area,
while location #2 is an 80 square foot. area. Both locations are to the rear of the rinci al
structure. P P
We have included a RAM transmittal form, Form BWSC-106 as part of this submittal. This
RAM proposes to excavate, stockpile,'transport., and dispose ()f 20-2.5 yd3 at. a recycling/batching
facility. Theodore J. Kaegael, Jr. has bcem contracted to act as the Licensed Site Professional
(LSP) on behalf of the PRh.
Should you have any questions, comments, or require additional information, please call us at
(508) 775-8880.
Sinc ely,
Xv
Dou r as Bill
Vice President
enc:
a -
Environmental Consulting 'V MGL c.21E and MCP Assessments 0 Real Estate Transfer.Screens
Soil and Groundwater Investigations and RemediationS
MAIIONEY & DOUGLAS, LTD.
ENVIRONMENTAL SERVICES
49 CENTER STREET • HYANNIS,MA 02601 • TEL: (508)775-8880 • FAx: (508)862-2304
November 11, 1998
Department of Environmental Protection
Attn: Ms. Julie Hutcheson
Bureau of Waste Site Cleanup
Southeast Regional Office
20 Riverside Drive
Lakeville, MA 02347
RE: Release Abatement Measure (RAM) Plan
181 Spring Street, Hyannis, MA 02601
DEP RTN: 4-14306
Dear Ms. Hutcheson:
This plan serves to fulfill informational requirements for a Release Abatement Measure (RAM)
Plan, as outlined in the Massachusetts Contingency Plan (MCP), 310 C.M.R. 40.000 Section
40.0444. The following is offered in compliance:
PRP: Richard H. Robinson, Owner Mailing Address: Richard H. Robinson
181 Spring Street 1080 River Road
Hyannis MA 02601 Marstons Mills, MA 02648
Tel: (508) 428-8731
DESCRIPTION OF RELEASE:
On July 2, 1998, Mahoney &•Douglas, Ltd. was authorized to conduct an initial site
investigation at 181 Spring Street, Hyannis, MA (the Site) by the owner Mr. Richard H.
Robinson. The Department was notified under the 120 day notification requirement of
the release of a lubricating type oil to soil which exceeded Reportable Concentrations and
affected more than 2 cubic yards.
The current use of the Site is Chris McNulty's service center which provides small engine
repairs, sales and rentals of construction, lawn and garden, household, and floor care
equipment. This Site has been used for the same type of activity since the early 1950's.
The source of the release at the Site has been identified through ASTM Method D3328-78
(mod) GGFID as an oil having characteristics of similar to a lubricating oil in the n-C 20
to n-C 36 range. Two specific source locations have been identified at the Site. Refer to
Figure 1,,the Site Plan. This RAM plan is being submitted to manage the estimated 20-25
yd3 of contaminated soil at the Site following the guidelines and procedures outlined in the
Massachusetts Contingency Plan (MCP) 310 CMR 40.0000. The RAM plan has been
r prepared so that the PRP may properly excavate, stockpile, transport and dispose of the
petroleum contaminated soil (PCS) at a DEP approved recycling facility.
Environmental Consulting + Real Estate Transfer Assessments w Contaminated Site Cleanup 1
Soil and Groundwater Assessments and Remediation
I
November 11, 1998
SITE CONDITIONS:
The Site is a flat area with sparse vegetation consisting of mostly grass. An asphalt paved
area is located in front of the building: Soil conditions are stratified drift with reworked
material (fill) used as a cover material. Figure 2 indicates the Site location on the USGS
topographic map of the Hyannis quadrangle (Revised 1979). Figure 1 represents the
current site plan of the Site indicating all physical structures and source locations of the
contaminated soil.
POTENTIAL RECEPTORS:
Human receptors may be affected at the site due to ingestion or dermal contact with the
surface PCS. There are no environmental receptors, as identified in the MCP, on this site.
The water table has been estimated between 10 and 20 feet below the surface grade.
REQUIREMENT FOR A RAM:
This RAM plan has been developed to minimize or eliminate in an expeditious manner
residual PCS in an attempt to abate, prevent, or eliminate horizontal and/or vertical
migration of petroleum hydrocarbons. The contaminated soil has been evaluated under the
following'analyses: volatile organics by EPA Method 8260; polychlorinated biphenyls
(PCBs) by EPA Method 8082;total petroleum hydrocarbons by ASTM D3328-78 (Mod);
trace metals by EPA Method 6010 and 747 Lcorrosivity;ignitability; and reactivity. These
analyses were conducted to meet the requirements of the state certified recycling facility.
SCHEDULE OF PLAN:
Since Notification to the Department, the Potentially Responsible Party (PRP) has been
actively working to implement and complete the RAM plan. An excavating contractor has
been contacted to excavate the 2 source locations. Mahoney S&Douglas, Ltd. has been
contracted to screen the soils with a photoionization detector (PID) following DEP
procedures for performing Jar Headspace Analytical Screening. Groundwater Analytical
has been identified as the state'certified laboratory where soil samples will be analyzed.
Environmental oversight on the project will be conducted by Theodore Kaegael, Jr., LSP
# 1127. The Plan is proposed to be implemented in the early days of Demember, 1998.
RAM PLAN IMPLEMENTATION:
The RAM plan is being presented to provide, based on initial assessment activities, a
reduction to risks and the cost effective removal of Petroleum Contaminated Soil PCS in
the attempt to abate, prevent or eliminate any threats to health, safety, public welfare or
the environment. The principal objectives of this RAM plan were to remove the maximum
amount of residual PCS at the Site. Confirmatory soil samples will be collected and jar
headspaced at the bottom of the hole and composited on the sidewalls. These field screens
will be used to determine the maximum amount of PCS to be removed. PCS will be
excavated, stockpiled at the Site, and ultimately transported and disposed of at Bardon
Trimount, 230 Great Western Road, South Dennis, MA (an asphalt batching plant).
REMEDIATION OF WASTE:
Excavated PCS generated during the implementation phase of the RAM plan, will be
stockpiled on 6 mil polyethylene and covered with the same as a temporary measure should
a delay in acceptance of the PCS occur at the recycling facility. Upon receiving acceptance
2
November 11, 1998
and approvals based on the laboratory analyses, the PCS will be transported to a state
approved recycling/asphalt batclung facility, Bardon Trimount, 230 Great Western Road,
South Dennis, MA. This activity will be conducted following the Bill of Lading procedures
identified in Section 40.0034 and 40.0035.
REQUIRED PERMITS:
The PCS removal activity will not require any federal permits. A Bill of Lading will be
required under the MCP, 310 CMR 40.0000, for the transport and disposal of PCS at a
state approved recycling/asphalt hatching facility. No local permits will be required.
CERTIFICATION OF SUBMITTAL:
"I, Richard H. Robinson, attest under the pains and penalties of perjury (I)that I have
personally examined and am familiar with the information contained in this submittal,
including any and all documents accompanying this submittal, (ii) that, based on my
inquiry of those individuals immediately responsible for obtaining the information, the
material information contained in this submittal is, to the best of my knowledge and belief,
true, accurate and complete, and (iii) that I am fully authorized to make this attestation
on behalf of the person or entity legally responsible for this submittal. I, on whose behalf
this submittal is made, am aware that. there are significant penalties, including, but not
limited to, possible fines and imprisonment, for willfully submitting false, inaccurate or
incompl e information."
By
Richa d H. Rohinson Date
Owner
Title
LSP OPINION:
This Release Abatement. Measure Plan is being submitted, the response actions that are
subject to this submittal (i) have been developed in accordance with the applicable
provisions of M.G.L. c. 21 E and 310 CMR 40.0000, (ii) are appropriate and reasonable
to accomplish the purposes of such response actions as set forth in the applicable provisions
of M.G.L. c. 21E and 310 CMR 40.0 d (iii) complies with the identified provisions
of all orders, permits ai appr va id ied in this submittal.
Fo hJe &
Ir
L.S.P. Signatur c.Sr
Th ore J Caeg ,Jr., LSP #1127 Da
L.S.P. Stamp:
' j"0 F Mq SS9cyG
c THEODOREJ.
o KAEGAEL JR. v+
f. NO.1127
FOSITE PRID�
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Mahoney Doug / a ,, , Ltd .
environmental Serv / CC5
49 center Street - 'Hyanni ,, MA 02601 Tel : (506),775-8880
Project : Scale Figure
' Pichard H. Pobin5on
1 060 Pi ver Road
Mar5ton5 M1115 , MA `)ource ' 51te Plan of Land at
I d 5pr i ng `7t ree t
Hyannis , MA
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HYANNIS IAA BOR
Mahoney Douglas , Lta .
MASS
Environmental Services
4`1 center 5treet - Hyanni7, MA o2601 . - Tel : (506)775-8880 p d
r
Project : 5cale : Figure
Richard H. Robinson
1 060 River load
Mars rons Mi MA 5ource : U'965 Topographlc Map of 2
Hyannl5 , MA
Massachusetts Department of Environmental Protection BWSC-106
1 Bureau of Waste Site Cleanup
RELEASE & UTILITY-RELATED ABATEMENT, Release Tracking Number
MEASURE (RAM & URAM) TRANSMITTAL FORM 2 -
Pursuant to 310 CMR 40.0444-0446 and 310 CMR 40.0462-0465(Subpart 0) 14106-1
A. SITE LOCATION:
Site Namit:(optional)
Street: 181 Spring Street Location Aid: off Route 28
Cityfrown: _ Barnstable - jay a n n i s ZIP Code: ( ?r U l
❑ 'Check here if a Tier Classification Submittal has been provided to DEP for this Release Tracking Number.
Related Release Tracking Numbers That This RAM or URAM Addresses:
B. THIS FORM IS BEING USED TO: (check all that apply)
® Submit a RAM Plan(complete Sections A.B,C.D,E,F.J,K L and M).e
❑ Check here if this RAM Plan Is an update or modification of a previously approved written RAM Plan. Date Submitted:
❑ Submit a RAM Status Report(complete Sections A,B,C.E,J,K L and M).
❑ Submit a RAM Completion Statement(complete Sections A,B,C.D.E.G,J,K L and M).
❑ Confirm or Provide DRAM Notification(complete Sections A,B.H.K L and M).
❑ Submit a DRAM Status Report(complete Sections A,B,C,E,J,K L and M).
❑ Submft a DRAM Completion Statement(complete Sections A,B,C.0,E,I,.J,K Land M).
You must attach all supporting documentation required for each use of form indicated,including copies of
any Legal Notices and Notices to Public Officials required by 310 CMR 40.1400.
^.. SITE CONDITIONS: �.::•i,, . ;., i,,: .
❑j Check here if the source of the Release or Threat of Release Is known. 1
if yes,check all sources that apply /?❑ UST ❑ PipeMose/Llne = ❑,AST E Drums 'i;.❑ ?ransfortner ❑ Boat
E] Tanker Truck..,.,.❑ Vehicle ;❑ Other Specify: overfilling ' ` 1
ec ali that a Air 'Groundwater Surface Water ;Sediments Soil
Identify Media and Receptors Affected: (ch k PPIY) ❑ ❑ .. .. ❑. ❑ ..
❑ Wetlands• ❑ Storm Drain ❑ Paved Surface ❑ Private Well ❑ Public Water[Supply ' ❑'Zone 2 ❑ Residence
+' ❑. School '�.Tr❑•,+Unkn I M. -Other Specify-, 4I'11„r•)., - ;.��.t. ,.
a Site:' check all that a
Conditions t S
Identify
Release and/or Threat of Release ( pplyr
i iKli^.;. .r;.J ft!'it 9:I?•'�..�Y•:S:P!Zt'4�aEKd Tt/t- :�, .,.,..,,.,� i i• .a,, .. .. .•.
❑•'2and 72 Hour Reporting Condition(s) ® .120'Day Reporting Condition(s) ❑. Other Conditlon(s)
;-.:Descnibe: Release .of oi.I exceeding reportable concentrations which affected
more than 2 yd3 of soil
RAMS may be conducted concurrently with an IRA only with written DEP approval
URAMs may not be conducted if any 2 or 72 Hour conditions exist at the site.
Identify 011s and Hazardous Materials Released: (check all that apply) ❑ Oils ❑ Chlorinated Solvents ❑ Heavy Metals
❑.Others Specify:
D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply)
❑ i Assessment and/or Monitoring Only ❑ Deployment of Absorbent or Containment Materials
❑X Excavation of Contaminated Soils Temporary Covers or Caps
Re-use,Recycling or Treatment ❑ Bioremediation
0 On Site (g) Off Site Est.Vol.: n_2�_cubic yards ❑ Soil Vapor Extraction
Dube: ❑ Structure Venting System
i❑ Store 0 On Site. 0 Oft Site Est.Vol.: cubic yards ❑ Product or NAPL Recovery
k SECTION D IS CONTINUED ON THE NEXT PAGE.
i -
nP i!gr-e 9n4JS- Supersedes Forms BWSC-007,'008, 009 and 010 rin part) Page 1 of 4
Massachusetts Department of Environmental Protection BWSC-106'
Bureau of Waste Site Cleanup
RELEASE & UTILITY-RELATED ABATEMENT Release Tracking Number -
MEASURE (RAM & URAM) TRANSMITTAL FORM _
Pursuant to 310 CMR 40.0444-0446 and 310 CMR 40.0462-0465 (Subpart D) a 14306
D. DESCRIPTION OF RESPONSE ACTIONS (continued):
Landfill O Cover O Disposal Est.Vol.: cubic yards Groundwater Treatment Systems
Removal of Drums,Tanks or Containers Air Sparging
Describe: Temporary Water Supplies
Removal of Other Contaminated Media Temporary Evacuation or Relocation of Residents
Specify Type and Volume: E] Fencing and Sign Posting
Other Response Actions Describe:
See 310 CMR 40.0442 for limitations on the scope and type of RAMS.
See 310 CMR 40.0464 for performance standards for URAMs.
Check here if this RAM or URAM involves the use of Innovative Technologies. DEP Is Interested In using this Information to aid in creating an
Innovative Technologies Clearinghouse.
Describe Technologies:
E. TRANSPORT OF REMEDIATION WASTE: (If Remediation Waste has been sent to an off-site facility,answer the following questions)
01
Name of Facility:
Town and State:
Quanttty of Remediation Waste Transported to Date:
F. RAM PLAN:
Check here if this RAM Plan received previous oral approval from DEP as a continuation of a Limited Removal Action(LRA). —
Date of Oral Approval:
if a RAM Compliance Fee Is required,check here to certify that the fee has been submitted. You MUST attach a photocopy of the payment.
See 310 CMR 40.0444(2)to learn when a fee Is not required.
Check here If the RAM Plan Is proposed for a Transition She. If this is the case,you may need to attach an LSP Evaluation Opinion prior to
undertaking the RAM,If not previously provided. See 310 CMR 40.0600 for further information about Transition Sites.
G. RAM COMPLETION STATEMENT:.••, _ `.
It a RAM Compliance Fee is required In connection with submission of the RAM Completion Statement,check here to certify that the fee has been
submitted.You MUST attach a photocopy of the payment. You ewe this fee when submitting a RAM Completion Statement if you received oral
approval of a RAM that continued an LRA,and have NOT previcusty submitted a RAM Plan and accompanying fee. ;- s
If any Remedlation Waste will be stored,treated,managed,recycled or reused at the site following submission of the RAM Completion
Statement,you must submit a Phase IV Remedy implementation Plan,along with the appropriate transmittal form,as an attachment to the
RAM Completion Statement.
H. URAM NOTIFICATION:
Identify Location Type: (check all that apply) •. , Public Right of Way Utility Easement Private Property
Identity Utility Type: (check all that apply) •.,•• Sanitary/Combined Sewerage Water Drainage ' Natural Gas
Telephone Steam Lines Telecommunications .FJ Electric Other Specify:
Check here if you provided DEP with previous oral notification of this URAM. Date of Oral Notice:
aCheck here if the property owner was NOT contacted prior to irftlation of the URAM. If this is the case,you must attach an explanation of why.
the owner was not contacted,including the date and time when contact ultimately occurred.
Check here if this URAM will occur in connection with the construction of new public utilities. If this is the case,document the nature and
extent of encountered contamination,the scope and expense of necessary mitigation and the benefits amd limitations of project aftematives.
With the exception stated below,the person undertaking the URAM rust provide the name and license number of an LSP engaged or employed In
•1
connection with the URAM:
LSP Name: LSP License Number.
LSP information is not required if the URAM is limited to the ex-avation and/or handling of not more than 100 cubic yards of soil contaminated by
Oil,or not more than 20 cubic yards of soil contaminated either by a Hazardous Material or a mixture of a Hazardous Material and Oil.
Revised 7124M Supersedes Forms SWSC-007, 008, 009 and 010(in part) Page 2 of 4
Do Not Alter This Form
Massachusetts Department of Environmental Protection BWSC-106
Bureau of Waste Site Cleanup
RELEASE & UTILITY-RELATED ABATEMENT Release Tracking Number
MEASURE (RAM & URAM) TRANSMITTAL FORM Pursuant to 310 CMR 40.0444-0446 and 310 CMR 40.0462-0465(Subpart D) 2 -114306
I. URAM COMPLETION STATEMENT:
Check here if this URAM was limited to the excavation and/or handling of not more than 100 cubic yards of soil contaminated by Oil,or not more
than 20 cubic yards of soil contaminated by either a Hazardous Material or a mixture of a Hazardous Material and Oil.
If any Remediation Waste will be stored,treated,managed,recycled or reused at the site following submission of the URAM Completion
Statement,you must submit either a Release Abatement Measure(RAM)Plan or a Phase IV Remedy Implementation Plan,along with the
appropriate transmittal form,as an attachment to the URAM Completion Statement.
J. LSP OPINION:
I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmiMal form,including any and all
documents accompanying this submittal. In my professional opinion and judgment based upon application of(I)the standard of care In 309 CMR
4.02(1),(1)the applicable provisions of 309 CMR 4.02(2)and(3).and(III)the provisions of 309 CMR 4.03(5),to the best of my knowledge,information
and belief,
it Section 8 of this form indicates that a Release Abatement Measure Plan Is being submitted,the response action(s)that Is(are)the subject of this
submittal f)has(have)been developed In accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(i)Is(are)appropriate and
reasonable to accomplish the purposes of such response action(s)as set forth In the applicable provisions of M.G.L.C.21 E and 310 CMR 40.0000 and
(iii)complies(y)with the identified provisions of all orders,permits,and approvals Identlfled In this submittal;
If Section 8 of this form indkates that a Release Abatement Measure Status Report or a UUl/ry-Related Abatement Measure Status Report is
being submitted,the response action(s)that is(are)the subject of this submittal(I)is(are)being implemented In accordance with the applicable
provisions of M.G.L.c.21 E and 31 d'CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set
forth in the applicable provisions of M.G.L c.21 E and 310 CMR 40.0000 and(III)complies(y)with the identified provisions of all orders,permits,and
approvals identified in this submittal;
If Section 8 of this form indicates that a Release Abatement Measure Comp/etfon Statement or a UUllty-Related Abatement Measure
Completion Statement is being submitted,the response action(s)that is(are)the subject of this submittal(1)has(have)been developed and
implemented In accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000.(li)is(are)appropriate and reasonable to accomplish
the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(III)complies(y)with the
dentified provisions of all orders,permits,and approvals identified in this submittal. _
I am aware that significant penalties may result,including,but not limited to;possible fines and imprisonment,if I submit information which I know to be
false,inaccurate or materially Incomplete..' -• - - _ _ . ... .. _�. .. "
Check here if the Response Actlon(s)on which this opinion Is based,If any,are(were)subject to any order(s),permit(s)and/or approval(s)Issued by
DEP or EPA. If the box Is checked,you MUST attach a statement Identifying the applicable provisions thereof.
LSP Name: Theodore Kaegael • Jr LSPtt: 1127 Stamp:
jlephone: (5 0 8) 6 7 5—9 6 0 0 Ext.: �,'(.F10 F M4 Ss4c
FAX:(opdona) 5 0 8 6 7 5—9 6 01 0�� yGd•
p THEODOREJ-
Slgna >ple/ < JR-
�11L27
N0
Date: /! ,3
' yd FGISTEa g5�
An LSP Opinion is not required for a Utility-Related Abatement Measure Not ificat�OSITE PR®E�
An LSP Opinion is not required for a URAM Completion Statement If the URAM Is limited to the excavation and/or handling of not more than
100 cubic yards of soil contaminated by OII,or not more than 20 cubic yards of soil contaminated either by Hazardous Material or
a mixture of Hazardous Material and Oil.
K. PERSON UNDERTAKING RAM OR URAM:
Name of Or
Name of Contact: Richard H. Robinson Title: Owner
Street: 181 Spring Street
Cltyf awn: Hyannis State: MA
r•, ZIP Code: 02601
' 5 0 8 Telephone: ) 4 2 8—8 7 31
P � Ext.: FAX:(optional)
Check here if there has been a change in person undertaking the RAM or URAM.
I
n .,}Q�•?n� Superserb-z c- s RIA/SC-007. nnv a r)10 fin n=vf)
.............
Massachusetts Department of 'Environmental Protection BWSC-106
Bureau of Waste Site Cleanup
RELEASE & UTILITY-RELATED ABATEMENT Release Tracking Number?
MEASURE (RAM & URAM) TRANSMITTAL FORM a - 14336
Pursuant to 310 CMR 40.0444-0446 and 310 CMR 40.0462-0465(Subpart D)
L. RELATIONSHIP TO SITE OF PERSON UNDERTAKING RAM or DRAM: (check one)
® RP or PRP Specify: 0 Owner 0 Operator O Generator O Transporter Other RP or PRP:
Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2)
Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50))
Any Other Person Undertaking RAM or URAM Specify Relationship:
M. CERTIFICATION OF PERSON UNDERTAKING RAM OR DRAM:
I. Richard H. Robinson ,attest under the pains and penalties of perjury(1)that I have personalty examined and am
familiar with the Information contained In this submittal,including any and all documents accompanying this transmittal form,(li)that,based on my Inquiry
of those individuals Immedlately responsible for obtaining the information,the material Information contained in this submittal is,to the best of my
knovrledge and belief,true,accurate and complete,and(III)that I am fully authorized to make this attestation on behalf of the entity legally responsible for
this submittal. IRhe person or entity on whose behalf this submittal is made amAs aware that there are significant penalties,Including,but not limited to,
possible fln d Imprisonment,for willfully subm"ng false,Inaccurate,or Incomplete Information.
X By, Tltle: Owner
(signature)
For: Richard H. Robinson Date: //1/Lll9op-�
(print name of person or entity recorded In Section K) T�
Enter address of person providing certification.If different from address recorded In Section K:
Street: 1080 River Road
cityrrown: M a r s t o n s Mills State: MA ZIP Code: 02648
Telephone: ( 5 0 8 ) 4 2 8—8 7 31 Ext.: FAX:(optional)
YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS
INCOMPLETE. IF YOU SUBMITAN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING
A REQUIRED DEADLINE.
Revised 2124I95 Supersedes Forms 81,4'SC-007, 008, 009 and 010(in part) Page 4 of 4
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH O satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANYCIt f "` �` ( Jet($ (see"Orders") 5.Retail Stores
_ 6.Fuel Suppliers
ADDRESS I?► SA�w ��6 Class: 7•Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels: 74;qt-
Gasoline,Jet Fuel(A)
. 1
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
+(k. a-I- ( >Yes x
new motor oil(C)Z c,Ycfc C: IKSAS
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
Ake* C vTw�C��
I c I
�C4«,VA1A—;.. A(rXPL �e6, Q��l
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply GO v'14 Chv.IJ
O Town Sewer Public _r_P_vv(_(j I C ® C J
fir"On-site OPrivate AA. ir- . 1 -1-.
3. Indoor Floor Drains YES---NO--2""
0-Holding tank:MDC a `
O Catch basin/Dry well S' ed ti yin i u 6 .t't'q'f...td
O On-site system 4 CC14401t;liolV-�) Lf" L044,
%ate
4. Outdoor Surface drains:YES NO O ERS: Z7J-1, 3'1 a"',lrie G+'' t�,Iplae_ p,�
O Holding tank:MDC 0 4a,.�• A7 Sh I s CD r.V dAIC,-ile
O Catch basin/Dry well _ .07 5-- S'yL�e S �„ 6,v
O On-site system �� �E�
gel n
5.Waste Transporter
1. � • *ac �ltTf j ZT ���y� La/� YES NO
13,I CU av WW1 �✓_Q �li
2.
(JA F Vol 3 2
Person(s) Interviewed Inspecto D to
Aw-p : Date:
d
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
e
NAME OF BUSINESS: azcO B/ L /e!Vc",
BUSINESS LOCATION: /fig' I -S'4g?:,l�- -s'T
MAILINGADDRESS: Mail To:
Board of Health
TELEPHONE NUMBER: Town of Barnstable
CONTACTPERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis,.MA 02601
TYPEOFBUSINESS:�1LtiY-r,9L
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? 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: NO
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
S�4� Mo r oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
10 6-AL Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
ri , Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers
Paint brush cleaners Any other products with "poison" labels
(including chloroform, formaldehyde,
Floor & furniture strippers hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS /
f
4_I
-- ,
-
~ . ^
81363-R4747 SAFETY-KiFFN CORD , PAnE 1 Of l
:wOTICF OF l AND [`ISP0S0 | kFxIRICT) 0M o[ WANT[
TO ; S8FETY-KLEEN CORP , EPA TO : M80008846006
128 ELM STREET
BRI0GEWATER , MA _02324
| �---------------------'-- --
� UNDER MANIFEST "NUMBER Y'yl ~-�-7 ) ------- -'--
' -� � LINE NUM
RFTHE GENERATOR NOTED BELOW IS SHlFPINSt0 YOU A RFSTRTCT[ | W
0Kl/ H�<�
`
I�-��pEOERAL AND STATE LAND DISPOSAL RESTRICTION R[9ULATInNS 'TN ACCORDANCE WITH THESE REGV ATIVMS " JHF SFNF |ATVR xFRrRY | <qVrSN0TICE THAl THE WASTE IS RESTRICTED AND THE EPA WASTE CnVFSAND APPROPRIATE TREATMENT STANDARDS RpAS F0 | | 0W3 '
HAZARDOUS WASTE CODES '
�
D001 0018
TRFATABILlTY GROUP : NONW0STK0TE'RS
| UNIVERSAL TREATMENT STANDARDS (U . T . S ) TRFATMFNT ST`AN0ARO CnNCFMT3ATT0M
� A[GUi AT[D CONSTITUENT_-_COMMON
_N0M[ (TOTAL MS/ i ^ UN| FSS NOT og "lC| P " )
GFNERAT0R IS NOT REqUJRED TO / TST UN0rR| y�-�-��-�----------------- ------- ---
MONITOR FOR ALL REGULATED CONSTITUENTS pR^n" ^�N�TJTUFNTS 0pCOUS| Tk[�T[ R N} i |
'on | " `0NO DISPOSAL . ^^
[PA
WASTE UESCRrPTIOH AND. . .. TRF0TMFMT ST0M|`0KU
WASTE TREATMENT/REGUL
�ATORY SU8ChT[G0RY OR C0NCFNTRATI0N OR
C0PF REGULATED HAZARDOUS C0MSTTTU[ HT TFCHNo| nF; COD[
_____ ---------------------------------------
__' _1�_�__�_-____-�`-------- ''-- 'k801 HIGH T0C I5NITABLF CH0RACTFPTSTTC WASTF ' 8ORSS � on CMR /D018
MG /KG
.
'
. '
'
� �
NOTES : ^ THESE TRF0TMFMT STANUARoS P0 NOT PR[ C | V;[ S0| AHl K[ Co»FkY OR �
USE AS FUEL PRIOR TO LAND OISPOSAi .
NEW TREATMENT STANDARDS VNoFV F[UFRAi RUi [S FFFFCTIVF 171g �4^"TREATMENT STANDARDS APPLICABLE IN CrRTAIN 8WSA-AUTH0RI7[0 STATES ,
****AND MEET UNIVERSAL TRFAYMFNT ST8NDAkDS ' - '
' °**-!NEW TREATMENT STANDARDS UNUER` FFOERAL RULES EFFECTIVE 7-8-96 . |
i� — �
no�v "cn / n'
� GENERATOR SIGNATURE ( OPTIONAL):
` NAME G TITLE (0PTI0NAL ) : ___� ` �- ------------------'------ �
SAFETY_KLEEN SAMPLE NUMBER : 66361 9 COM4k0i MUMHFk : ' P311 82-
�
. '
`
'
~ .
'
COMMONWEALTH� • OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
' DIVISION OF HAZARDOUS MATERIALS
S
One`Ninter Street Boston, Massachusetts 02108
,2 n022-03
Please print or type. Form desi ned for use on elite(12-pitch)typewriter.
UNIFORM FIAZAF1D0US.;. 1, Generator's US EPA ID No. upp,Docu t No. 2. Page 1 Information in the shaded areas
WASTE'MANIFEST �D_pl 9 81 9 Q _S of is not required by Federal law.
3. Generator's Name and Mailing Address A. State Manifest Document Number =
A86D ' REVTAL MA J 407
181 _SPRING ST r 4 �{g 3 M o a B ] fen:ID'
H ANNIk ' MA 02601 n
4. Generator's Phone( —
5. Transporter I Com an Name C State Trans.1D
P Comp an 6. US EPA ID Number ' d 1
SAFETY- 1`L ) �3l3n t 1t1
7. Transporter 2 Company Name, U o = 8. US EPA ID Number D.'Trans porter's Phone }0)8 697-464t,
L E ,State Trans.AD
9. Designated Facility Name and Site Address y 1�. US EPA ID Number. w
C\j202203
C) 9AFETY-KLEEN CORD F TransportersPhone( f r
OP 128 ELM STREET' � , �
N 13R ID?GE WATER; :DMA 02324 (d D Cf 00���JJ� G.State Facilivs.lD NOT REQUIRED O
H.Facility's Ph6n'e( ' t+ 7— -C
2.Con m tairs 13' 14. W
LI
c is t:
11. US DOT Description(Including Proper Shipping Name Hazard Cla.•;s and ID Number) 1 Total Unit 00
Waste No °
—_ No. Type Quantity Wt/Vol
a PQ WASTE7. FLAMMABLE LIQUIDS,, . . .
('GAStSLIAID .: 1 `N A S.
0001.` n
G 9 <.4D*11993 G I1 (,D)018, D?001 )� ERG$12L� ) I DM (.. J P DG118 H
H
N b. ��Vj �t)tA S- `'z-Ai'>e m P{3 t .:r Cl✓a S ,o " -c
c E t6l �' 1J'L 1 i}L,
O
fn A
T c.
e r—
O
(Sf R
r
O ` 1
cif d r naru — O
Z r
w - - - - Z
rri
CU
Ja Additional Descriptions for MaterialsUsted Atiove(inaude physrcafstate and hazard code.)t `< K. Handling Codes for Wastes Listed Above,;
a
I, To D�DAI�I�t {-Sp�ID
a. S 0 t/ d.
c O
N �f :.b. C)
15. Special Handling Instructions and Additional Informatierf jt`S'd REQ# 92242630 2-022-03-5903 :.
EMERGDaN�Y RESPr' $60-464-1760( 24 'HR ). I ° �i2d�t EIa"IV 1?I+,SL£ RETURN TO GENERATOR.FOR ,REC'YCLE:. s
QL
G 18. GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment ape fully and accurately described above by
p proper shipping name and are classiffed,packed,marked,and labeled,and are in all respects in propel condition for transport by highway
Uaccording to applicable intematfonal and national gwerriment regulations.
C { If I am a large quantity generator,I certify that I have a program in place to reduce the volume and'tozic,ty of waste generated to the degree I have determined to be economically practicable
0J r: in and that I have selected 6a practicable method of treatment,storage;or disposal currently available to me which minimizes the present and future threat to human health and the environ-
0) '` 7 ment;OR,if,l am a small quantity generator;I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I
ty r; can afford
E
y� f Si
/� /�
/L'. n T .> 6i G -��. gpatu' / ���r� _. ti Month Day DATE t) ar
vA
' J� 'L�j"
' R 17 Transporter 1 Acknowledgement of Receipt of Materials t _� DATE
U A n ted/Type Name` r na r' ,
G .F Month_.4ay Year
18 Transporter 2 Acknowledgement of Receipt of Materials "�� — " , DATE
- R -
E Pnnted/iyped Name : n it Mth D Year
R on a
:r. s,. Signature Y
19. yDiscrepancy Indication Space --
�, u ti
:2-5
p C t.
20 Fadlllty Owner or,Operatcit Certification of receipt of hazardous materials covered by this manifest exc::pt as noted in item 19.
7 ni
T ? t „ DATE
' Y, PnntecT'ped Nan,e ^ Signature 3 i.c' x ct t j f 9 {r / j Month Day Year
z .1 1. / p:+ ',�.r JJ t. .,.� .. I ,�' -�i t. , i .� ,r t'.•,. '•1 .r, �r t`+,
Form Approved.O B No.2050-0039.Expires t-30. 6., t
1 EPA Form 87 10 21(Rev 9 88)Previous editions are obsolete 1P R QL .A,3 000023 1�18 2 l I
i f < "_ Siff L. .A 000066 3151.9
s ,
. g ;' r COPY>�: ' i=AC LITY MAILS TO EP:ERA T OR
DUNS NO.05106-0408 FED.ID NO.39-6090019
1000 North Randall Road �WyE SCHEDULED EE SCHEDULED
0111111111
Elgin,Illinois 60123-7857 FOR SERVICE CALL TRANSPORTER SERVICE WEEK TERRITORY -
cc
5Ut 6i17-464C :;c7if t3ERF,I><.I+r 56— 14c:" L W
C 2—Q 22—Q 3-5SI(i�—7 CREDIT
PREV.BALANCE I SAL OVER 60 DAYS O
U ABCD RENTAL �
T 1121 S P R i N� S f . BUTYPESINESS SVC.P/C PROD.PCOUMN
U
O HYANNIS Ms+ 02601 U4 -'1i.d Yc�- 2ci Go,
M TAX EXEMPTION NUMBER
E •
R
SERVICE DATE SALES REP NO. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE CODEC' CODE' SERVICE TAX C.O.M.S.TAX PRODUCT TAX
22-00b—.5090
SERVICE/ 5 V"�t SALES TOTAL V1M SOLVENT SERVICE CHANGE 01A14iE INV. PROMO MSDS
DEPT PRODUCT c ouAN. CHARGE TAX CHARGE DISCOUNT LEAN SPENT •OF SKDOr CC TERM SERVICE TERM Scn,--1 CODE NO. kELE --e- NJ
N U M 5 E R UNIT P R I C t EKs INMAL ITT W*) � ' O1vEN
1 0 434aa8 1. 006b301 2ecQc0 % � ❑
2 ❑
3 ❑
El
5 _ ❑
6 I T'''' ` ' vJ
8 ❑
9 - ❑
10 ❑
11 ❑
12 ❑
CHECK GOOD POOR YES NO YES NO
DECALS UINK
PUCE ❑ r❑ MACHINE PROPERLY GROUNDED ❑ ❑
TOTAL-SERVICE/PRODUCTS APPROPRIATE MApUNEC CONDITION ❑ ❑ AND LGIBLE
BOXES 8 CLEANLINESS LOCAL PHONE NO.STICKER I Z
MANIFEST NO. USEPA TRANSPORTER ID NO. GENERATOR USEPA ID NO. GENERATOR STATE ID NO: LAMP ASSEMBLY ❑ ❑ EMERGENCYINSTALLED
SING SPENT SOLVE:.WETS
iLUStl4SU5202 p:HJyd11s6 U17 CONDITON OF UC;;NO"'_MtMTFD ❑ ❑ ACCEPTANCE°ifE°" n ❑IU
C
11.US DOT DESCRIPTION INCLUDING PROPER SHIPPING NAML,HAZARD CLASS,AND ID. 12.CONTAINERS 13, TOTAL 14.UNIT SK DOT nJMBER �,1 C (I 5 1 CcRncY THAT MY TOE LLB
\ j N . TYPEQUANTITY WTNOL WASTE STREAM.q ARE WITH,N
Y^ (1ii L C �I lr, l��"' � qzj. CbL Ili t I �S Oar_Go IEsr;E wuowlnc 0
A. 3 V]� ' Iq3 -3 P� ) ) DDI�' 1�UU1 J 6 1 -I ,j� l oTo /M Z
� _ U
Y
B. U>v ) '� i e� )1 9 1 D D�� 2'12 6 1 L�`' I 22U 1w.f O LZOO LB9,M0NTH
cn
INITIALS W
C• GREATER THAN 22DO LBsJMONTH Q
U)1c
D. - P1mALS p
DESIGNATED FACILITY NAME AND ADDRESS USA EPA ID NO. Q0
STATE ID NO. W 0
CASH ❑ TOTAL RECEIVED APPLY PAYMENT TO: I AGREE TO PAY THE ABOVE CHARGES AND TO BE BOUND BY THE TERMS AND TOTAL CHARGE G.�y V r
CONDITIONS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS DOCUMENT. (FROM ABOVE) V >h
CHECK NUMBER ❑ PLEASE CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE a:TODAY'S SERVICE/SALE W Q
INDICATED IN THE PAYMENT RECEIVED SECTION.THE INDIVIDUAL SIGNING THIS WM DISCOUNT -, LLJ d
❑PREVIOUS BALANCE AS FOLLOWS LDR MESSAGE DOCUMENT Is DULY AUTHORED TO SIGN AND BIND CUSTOMER TO TTS TERMS. (FROM ABOVE) N
• WbOuL
INVOICE# j AMOUNT$ I INVOICE S I AMOUNT$ L L A 1-4 0 T 1R t Q•D 71i�b"�'��"�'•"�4 p'�" �• � �'��
,-m—�, ,° ^�_'."'® �.�.91 dT TOTAL DUE
PREVIGUS - MANIFEST CODE SEO# ((�(f / (`//
CREDIT .. S O USA 19 d 39 1
CA D Print Custom# Nt1TIRe
—7 QREQFT CARD NO AMEXS(P /
VISA 1���1.• USA 196391
M EMERGENCY •• By:
Customers Authon'led Re a tl e•
CUSTOMER REFERENCE
INFORMATION ° I THI.R Ar.RFFMFNT r.ONTINl IFR 0KWTWF RFVFRCF CIf1F
P(Ae P2,e)6Use)(,1._
:��� 4d--- S 0,, s
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
/BOA (�F EALjH 0, satisfactory 2.Printers
3.Auto Body Shops
lb Q t3 O unsatisfactory- 4.Manufacturers
COMPANY p' �� ' ' (see"Orders") 5.Retail Stores
09- 6.Fuel Suppliers
ADDRESS.P1 S'Pntx: J/- Class: i 4 7 7•Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
'MAJOR MATERIALS . , ,
.7 IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel'(A)
Diesel, Kerosene,#2 (B)
Heavy Oils:
waste motor oil (C) s'S'
r4
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellanequs: '
` c �. .
DISPOSAVRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply "W"I'' i � ,4 t1f f 11ke S.,/Y� —r _. .
Town Sewer ANublic 9 t
O On-site OPrivate
3. Indoor Floor Drains. YES NO , 9
O Holding tank:MDC C
O Catch basin/Dry well ( v
O On-site system
4. Outdoor Surface drains:YES NO O ERS: r�t�
O Holding tank:MDC 60Ur1 6 v `Z?Aj
(Catch basin/Dry well keA� J a
O On-site system
AO
5.Waste Transporter
Name of Hauler 1 ' o
d License
1.
vVAJ d`- d t� YES NO
2. J� � - }}
P k
lrv� <� 1�2 i'
Persons ii�._`
ewed' Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: ABCo Rental Center, Inc. Board of Health
MAILING ADDRESS: P.O. Box 1312 Hyannis MA 02601 Town of Barnstable
TELEPHONE NUMBER: ( 508 )775-0615 P.O. Box 534
CONTACT PERSON:
Richard H. Robinson 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 quantities 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: 181 spring St. Hyannis, MA 02601
TELEPHONE: ( 508 ) 775-0615
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 "110 tt d
va4u Q2, - Please put a check beside each product that you store: .---
C_
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid J�% Toilet cleaners FEg 2
Engine and radiator flushes Cesspool cleaners . 2 1994 .
Hydraulic fluid (including brake fluid) Disinfectants
X Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
X Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
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
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
71
TOXIC AND HAZARDOUS,MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: ABCO Rental Ceriter, ,Inc. Board of Health
MAILING ADDRESS: I .o• Box; 1312: ''; Hyanr s, ice. '0201 Town.of Barnstable
TELEPHONE NUMBER: (508)775-0615 ,, P.O. Box 534
' '' 'Richard `li. . Robi.ns.on 14 'Hyannis,MA02601
CONTACT PERSON:
Does your firm store any of the'toxic'or hazardous materials listed below, either for safe or for
your own use, in quantities totalling, ati,any time, more,than'50 gallons Iiquid.volume or 25pounds dry
weighty YES NO ,
t
This form must'be returned to the,Boar6of Health. regardless of ayes or no answer. Use the
enclosed envelope for your,convenience
:� s��t�xc 'x��e.
` 4 If you answered YE-S above;ple"ase,lndreate,lfthematerals are stored at a site other than youry
mailing address:
ADDRESS.
1'8 Spri°n 5t. Iyann,S IviA` 02.601
{s: TELEPHONE: (50`8 )775-0615
LIST OF TOXIC'AND HAZARDOUS MATERIALS
The Board of„Health has determined that the following products exhibit toxic or hazardo6sN.
characteristics and must be registered _b. d
Please out,. checktb.esge ideach product that,you store
Antifreeze for asoline or coolant systems) Drain cleaners
'
( g y ) .
Automatic transmission fluid Toilet cleaners ,, >
Engine and,radiator.flushes n: Cesspool'cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor"oils/waste oils Road Salt (Halite)
,., Gasoline, Jet,fuel �v Refrigerants
x Diesel fuel,kerosene, #2 heating oil Pesticides (insecticides;°herbicides, .
:- Other= etroleurn rqqu Irease, lubricants rodenticides
g engines hotochemicals (fixers and developers) g,,
De reasers for en Ines and metal P
Degreasers for driveways'&garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers '' Swimming pool chlorine
Car wash detergents Lye°or caustic soda
Carwaxes and polishes Jewelry cleaners f
.,As halt &,roofing,tar p ,g. ,, Leather dyes
Paints, varnishes,.stains, dyes Fertilizers (if stored outdoors)
'Paint & lacquer thinners PCB's
Paint & varnish!removers, deglossers°� Otherch b" ated hydrocarbons'
Paintbrush cleaners (Inc. carbon tetrachloride)
Floor & furniture.strippers '` Any other products with "Poison" labels
Metal polishes >Af} (including'chloroform, formaldehyde, `I
Laundry soil &Pstain removers hydrochloric acid, other acids)
(including bleach) f Other products not listed which you feel may
Spot remover!'& cle'aning fluids ; be toxic or hazardous (please list):
(dry.Cleaners) .���
Other cleaning solvents
Bug and.tar removers
Household.cleansers, oven cleaners `
White Copy-Health Department/ Canary Copy-Business.
r
TOWN.OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
2. nters
BOARD OF HEALTH ' satisfactory 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY �2o (see"Orders") 5.Retail Stores
6.Fuel Suppliers
I
ADDRESS I S Class: 7.Miscellaneous
QUANTITIES ANDS ORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS 1 ,
IN OUTI IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste�motor oil (C) cam:
new motor oil (C)
trarismission/hydraulic
Synthetic Organics:
degreasers O
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
Town Sewer $(Public
0 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_�L ORDERS:
0 Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
i 1 ' � �
YES NO
1.
2. A cal. v
'— °t
PeisZfi (s) Interviewed Inspector J Date
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
r
NAMEOFBUSINESS:J� ,�� IJ(�( i'S
BUSINESS LOCATION: W_ �/� '��
MAILINGADDRESS: Mail To:
TELEPHONE NUMBER:
Board of Health
� �" 7� � Town of Barnstable
CONTACTPERSON: f wof412 P.O. Box 534
EMERGENCY CONTACT TELEPHONE (NUMBER: - Hyannis, MA 02601
TYPE OF BUSINESS: ,
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? 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 character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Aspiihalt & roofing tar Fertilizers
Paints, varnishes, stains, dyes PCB's
LactIuer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride) .
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners
(including chloroform, formaldehyde,
Floor & furniture strippers
hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH Of satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
S' s/VvP� 0 (see"Orders") 5.Retail Stores
COMPANY 0 �i I
t 6.Fuel Suppliers
ADDRESS /?I r Class: 1 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT-outdoors)
MAJOR MAT IALS 1
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels: t
Gasoline,kef-FtieljA�L_
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic -
Synthetic Organics:
degreasers
v
M' cellaneo s: V e's
$ oc;"
vw
r 1,-?.F
DISPOSAL/REC;LAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply r
Town Sewer 'ublic ��
O On-site OPrivate
3. Indoor Floor Drains YES N0_
O Holding tank:MDC
O Catch basin/Dry well L
O On-site system
4. Outdoor Surface drains:YES NO_k_� ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter A4,,f ,4,
- 6 I
Name of Hauler1 °:
., YES NO
2.
Person s) Iritepliewed Inspector Date
I ' �Chras:Mc
4 . Nulty',ServZce,Center
SMALL ENGINE REPAIRS `
#k Y SALES&RENTALS } y
CFiRIS McNULTY f
181 SPRING STREET '
,'HYANNIS,MA 02601 (508)775'0615
{r r FAX(508)790-'9219 {
TOWN OF BARNSTABLE eOMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
����
O unsatisfactory- 4.Manufacturers
COMPANYLI/o " A-11414 (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS ' Class: 7.Miscellaneous
5�222�9 QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR&�TERIAL'S @ KK
IN OUT IN OUT IN OUT #&gallons Age Test
� Fuels:
Gasoline JvtcFfie"A-)z-
Diesel, Kerosene, #2 (B)
Heavy Oils: y
waste motor oil (C) �
new motor oil (C)
Azaaswiesieq/hydraulic
Synthetic Organics:
degreasers
X
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
*Town Sewer Public ,
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
XES NO
2.
Pe o nterviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF-HEALTH � 3.Auto Body Shops
unsatisfactory- 4. Manufacturers
COMPANY i I s 's O (see"Orders") 5. Retail Stores
�£ 6.Fuel Suppliers
ADDRESS Ig I n \ S�Ni2Class: "i - 7. Miscellaneous
c�rlc<S 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: j5
waste motor oil (C) xt
new motor oil (C) X
transmission/hydraulic
Synthetic Organics:
degreasers
I
� x
Miscellaneous:
rz
DISPO ECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
Town Sewer VZublic
O On-site OPrivate ��' 1S€�
3. Indoor Floor Drains -YES NO
O Holding tank:MDCVt
O Catch basin/Dry well 1 �j A01 � �7S
O On-site system AVM` ICI-6(k
4. Outdoor Surface drains:YES N0 ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
� �
S NO
i. AA1jr-'N 4hkC ��� _
2. �< <
(S
Person(s) Interviewed Inspector Date