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0485 WEST MAIN STREET - Health
t es��L6 J � a i i (I I �g {M 1 a Date: / a / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SI E I V TORY 41 NAME OF BUSINESS: � 11D� �t�,Ql�!f D.G�„ Q�'i/j[�� BUSINESS LOCATION: 31f WAV MM,� 5t l4" u. Q-2&0I INVENTORY MAILING ADDRESS: pD ,gopc /11 iA-eff 1-1- Ca��ta —b ��- TOTAL AMOUNT: TELEPHONE NUMBER: j-rDe v 77l' ?U33 l S' CONTACT PERSON: b• lTPy0frex1 FhArt EMERGENCY CONTACT�TELEPHONE NUMBER: Sb8 '77/-6-074 MSDS ON SITE? TYPE OF BUSINESS: r�h-1 INFORMATION/RECOMMENDATIONS: YDtid-e nu ldefldnd4ire istrict: a Waste Transportation: No 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 a 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, 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): 025-8 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 f CANARY COPY-BUSINESS 4 Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Cape Cod Commercial Linen Service,Inc. Fax: 508 771-1183 Corp Name: Mailing Address Location: 485 West Main St.,Hyannis Street: P.O Box 111 mappar: 269-223-000-000 City: W Hyannisport Contact: D.Jeffrey Ehart,President State: Ma Telephone: 508-771-5033 Zip: 02672 Emergency: 508-771-5076 Person Interviewed: Business Contact Letter Date: 5/31/2005 Category: ',Dry Cleaner/Laundry Inventory Site Visit Date: 6/22/2005 _......... _.. . Type: Follow Up/Inspection Date: ❑� public water ❑ indoor floor drains ❑ outdoor surface drains d❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑d currently licensed 0 town sewage indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - - 6/30/2006 El on-sitesewage Elindoor on-site syste El outdoor outdoor onsite system - - --- 517/04 Commercial laundry. Has current MSDS on site. Briefs staff compliance: (larger summer staff)about chemical handling and safety. Satisfactory Recommendations: make sure eye wash is working correctly. It was not putting water out all the way on this site visit. Obtain a license when it is due for renewal. 6/24104 Sent license order letter with copy of application and Article 39,sect.13,14. 6/22/05 alp-MSDS on site,large summer staff-do not work with chemicals first hand,it is all pumped into the machines,no dry cleaning performed here.Eyewash station not putting out water all the way-clogged.Recommend posting contingency plan in all general areas of the facility.PPE available to staff as well. Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals gty's 111 gals or more descn tlon � '' unit of measure• _qtY _ ,pa sure,, soil&stain removers(including beach) 258=gallons ......._.. ... . . .. ....... .,._..... ...... . ..........._ __._._........ .... ........_._...... Detergent 275„gallons __ __._.._W .._._..___._W.__._._._.�.... spot removers&cleaning fluids(dry cleaners) 4`gallons Misc.Corrosive 165 gallons _.._.._._.__.._...._...__.._.. _.._.___._...._...._.._...._............_._.........._........_..9_...._..._.._._....._....... ......_............................... motor oil 2 allons Waste Transporter: Fire District: :Hyannis Last HW Shipment Date: Waste Hauler Licensed: No I s Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS (� DBA: Cape Cod Commercial Linen Service,Inc. Fax: 508-771-1183 ' ........ Corp Name: Mailing Address Location: 485 West Main St.,Hyannis Street: P.O Box 111 . . . _............ _ _.... __ _.... _... mappar. 269-223-000-000 City: W Hyannisport Contact: D.Jeffrey Ehart,President State: Ma Telephone: 508-771-5033 Zip: 02672 d7I bS Emergency: i508-771-5076 Person Interviewed: Business Contact Letter Date: \Y 4 _... _. _ Category: der/Laundry Inventory Site Visit Date 5/7 Type: Follow Up/Inspection Date: public water ❑ indoor floor drains ❑ outdoor surface drains ❑d license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc currently licensed ❑ town sewage indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - --'---="�, __._.. 6/30/2006 ❑ on-site sewage El indoor indoor on-site syste ❑ outdoor onsite system N(} 5/7/04 Commercial laundry. Has current MSDS on site. Briefs staff compliance: O (larger summer staff)about chemical handling and safety. Satisfactory Recommendations: make sure eye wash is working correctly. It was &an not putting water out all the way on this site visit. Obtain a license �7q& -U4 bikdo J when it is due for renewal. 6/24/04 Sent license order letter with copy of application and Article 39,sect.13,14. `"�� � - aj ab It _ /10 �JW —do not iyvv ZPV UO 1W jA_MPj1 - 6,w\.t a Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals gty's 111 gals or more _.. escnpton,_a., ram" q " < Y unfit of measure �.ri. laundry soil&stain removers(including beach) 110gallons ...................._..._._.....__.___..___.............___.__...._..__.._.._..__........._......_.......... Detergent 110 gallons other cleaning solvents 55 gallons Soaps&Cond. v_ 110 gallons_..._.__.__.___._......._..._...__..._...... spot removers&cleaning fluids(dry cleaners) 110 gallons Misc.Corrosive __ _217 gallons_ misc.petroleum products:grease,lubricants 0.25 gallons 15 gallons ice MeF ...._...__................__..__...__.._.._..._._.._.___........_.___.__---------.....__....... ._..__. .___.______.... ._._.__..____...__..._...__...__...___...___..__. acquer thinners [ 1 gallons Windshield Wash ( 1.5 gallons ........_____ ____..__.___ .._...._...___..._.._.__...-_.._..........._.___..-___._......._.___ q motor oil _ 3 warts hydraulic fluids(including break fluid) 2 quarts Waste Transporter: Fire District: ;Hyannis Last HW Shipment Date: Waste Hauler licensed: No ....._.........__._.....__................ ..__._..__...,.. �lG(G LW IfKI 0h,LLky1C:;, - otgd6it fgtj 1. Town of Barnstable �tNE T Regulatory Services ,N , Thomas F: Geiler,Director 9 '6 B Public Health Division 2005 PIAY 16 PM 4: 19 �ArFDMA'�a, Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 DIV 508=790-6 4 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 2 Jo0l )-3 DATE S !�V 10j APPLICATION FOR PERMIT TO STORE AND/OR UTLIZE MORE THAN 111 GALLONS OF HAZARDOUS MATEYdALS FULL NAME OF APPLICANTtA(AVC-(J S. J Ralf i / `- NAME OF ESTABLISHMENT .CaI h C ADDRESS OF ESTABLISHMENT 48r W qeC wt`i, J�- TELEPHONE NUMBER -y) I S(J'7 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: r IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. U q—3 3 4 O (4 5C-7 STATE OF INCORPORATION r.l FULL NAME AND HOME ADDRESS OF: PRESIDENT - * S 9h-oL2- Ua11 !Ld C/Ji� vl1 k A�q-�UZ6 5 S TREASURER U je2Efd lA CLERK �b y e T- E a, - GbA-P SIGMATUM OF APPLICANT RESTRICTIONS: HOME ADDRESS d 5. AV& Vr,6l,Y 12cJ 0fk,,,111-e HOME TELEPHONE# SC)r 2P 16 3-� Haz.doc/wp/q I L t y Town of Barnstable t Regulatory Services b� Thomas F Geiler Director -Public Health Division G v G *N sr-sn Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Phone: 508-86,2-4644-`=, Email: health(a�town:barnstable.ma.us - -Fax: 508-790-6304 „- Office Hours: M-F 8:00—5:00 Cape Cod Commercial Linen Attention:D. Jeffrey Ehart June 24,2004 P.O.Box 111 West Hyannisport,MA 02672 RE: Hazardous Materials License Required and OVERDUE ' Dear Mr. Ehart: The Toxic and Hazardous Materials Inventory conducted on May 7, 2004 shows that you have approximately 731 gallons of toxic and hazardous materials being used/stored/generated/disposed of at your place.of business (Please refer to your copy of the Toxic and Hazardous Materials Onsite Inventory): The Town of Barnstable Board of Health has determined that using, storing,generating and/or disposing of over.111. gallons:of hazardous materials per month requires businesses in the Town: of Barnstable to obtain an anhu'al'Hazardous Materials Permit.You were informed on your inventory form that your current permit expired on June 1% 2004. +,,-i al :;ire Please obtain your new permit. You have 14 days to comply. After this time,you may be +0 issued a warning or non-criminal ticket citation in the amount of$75.00 for the first violation and$25.00 for each additional violation. Each day's failure to comply with an q4.e_v order shall constitute a separate violation. Please refer to Article 39: Control of Toxic and Hazardous Materials,Section 13,and Section 14-1, 14-2,14-3, and 14-4(copy enclosed). Passing your Hazardous Materials Inspection and obtaining your license will keep your business compliant,prevent contamination of Barnstable's existing and future drinking water supply, prevent environmental contamination which can bankrupt site owners,lead to future regulatory, and possibly,legal problems, lower or destroy land values, drive out residents and industry, depress local economies and endanger public health. You will receive your Hazardous Materials License certificate after you have passed your inspection and.paid the license fee. Your continued cooperation is greatly appreciated. If you have any questions or need further information,please do not hesitate to contact the Public Health Division. Thank you, a ---�7 .RZ74, Thomas A.McKean,RS, CHO Director of Public Health enc. Hazmat license application Article 39,Sect.13,14 5ee— cA camel� -aq -p`i . f tr F • .fG opE Cfpi < CAPE COD COMMERCIAL LINEN SERVICE, INC. Mailing Address: P.O. Box 111 West Hyannisport, MA 02672 TM LINEN SERVICE Proudly Servicing Cape Cod's Finest Resorts, Hotels, Restaurants and Clubs June 25, 2004 Since 1985 Plant: Mr, Thomas A. McKean, Director 485 West Main Street Hyannis,MA 02601 Town of Barnstable Board of Health _ 200 Main Street - 508-771-5033 Hyannis, MA 02601 Fox 508-771-1 183 CCCLinenService@ool.com Dear Mr. McKean: Today I received your letter dated June 24, 2004 regarding my failure to comply with obtaining a permit to store hazardous materials at my laundry located at 485 West Main Street, Hyannis. I recall meeting with the representative from the board of health on May 7, 2004. -I received a recommendation letter from her the following week;recommending•that our eye wash station be working properly, which it now is. However, I never received a letter/bill from the board for a permit to store these chemicals. I have operated my laundry business at this site since 1985. During this time, I have always abided by any and all local, state and federal guidelines. J Please make this notation in my file. Had I received an application for a permit, I would have completed it immediately and mailed it along with the proper fee. Thank you. L D. effrey E President Cape Cod Commercial Linen Service, Inc. C) �j co X O � co aC � 7 at '04 X A" t'xge C GL. q k � _ 6��OF AV mm 'F" �,mg ttC, a ne 2 /—)'Z• 8. 06 . mg 10 iu, • � s^`5 � "" ��j3 Sri a�' ,p�S,•^ .. � w l. ��iG1`,�,�•c(�r�q� d __ rH I�,�:�Y G�®Y/K•��lr (Y• W LG/�7:/7.Q • � `r/ ., IIF. �/. .a y.:: ems.:'- alY�'J�ry �. �.ta�ctct-cam NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants 1 Engine and radiator flushes / Road Salt (Halite)f1�c�'?Z 3 e a P , Our Mission Cape Cod Commercial Linen Service, Inc.has been proudly providing quality Commercial Laundry Services to Cape Cod's Finest Resorts,Hotels, Restaurants and Clubs since 1985. Cape Cod Commercial Linen Service,Inc.believes that the customer is always #l. The telephone is always answered professionally, with a cheerful and courteous voice.The delivery drivers take the extra step to ensure the linens are properly distributed. Neatly ironed sheets, bright white,soft fluffy towels,and perfectly starched,crisp table linens are the norm at Cape Cod Commercial Linen Service,Inc. "' •-._,,,. - Cape Cod Commercial Linen Service, Inc.,Cape Cod's#1 choice for the Firiest Commercial Laundry Service experience,at a competitive pace. c Gp gE Cps TM LINEN SERVICE INC. D. Jeffrey Ehart President Mailing Address: P.O. Box 111 West{Hyannisport, MA 02672 PLANT: 485 W. Main Street • Hyannis, Cape Cod, MA 02601 508-771-5033 -'Direct: (508) 771-5076 • Fax: (508) 771-1183 CCCLinenService@aol.corn '"�� • C®Py Date: J-'�-O jo 0 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTOR NAMEOFBUSINESS: is -t;z 4417e4? 5&A/)Q,, PY BUSINESS LOCATION: �S` W. INVENT .MAILINGADDRESS: u)• ©2�72 .TOTAL AMOUNT: TELEPHONE NUMBER: ff- `7"?/-5'03 CONTACT PERSON: . J e��nP'4 E'60-4"L- o-nS EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: ' OTHER INFORMATION: 5-- 200 /7'7�� st C P�- Waste Transportation: Ale, 6ctp. wg Ac vl.r s�oaet,{ -Name of Hauler: _ f�/,4 Destination:' Waste Product: Licensed? Yes No 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes /�_ Road Salt (Halite)�S�/'��E- -- Hydraulic fluid (including brake fluid Refrigerants Motor oils Pesticides 3-**.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 detergents Jewelry cleaners Car wakes 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 An other products with " Paint brush cleaners Y P poison labels Floor&furniture strippers (including chloroform,formaldehyde, . _ Metal polishes hydrochl ric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or.hazardous (please list): /11 _l� cad Spot removers & cleanin fluids Misc.: V 5 en', Other cleaning solvents_ a Bug and tar removers F r HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs DBA: C Location: L-( 1C S lit, 19,9lG,<� Site visit date: — 7 L/ • Hazardous Waste Manifests: A/`/ • Employee training documentation (if required): • Hazardous substance spill control and contingency plan: • MSDS on site? 14 • HazMat Inventory records (if applicable): • HazMat Waste Shipping documentation: o • Spill records (if applicable): of i f Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: DBA: C_ Germ( ,%LP�� SPir�N Location: 1'f 255- vt), Date: Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): IN IV" 2. Waste storage areas:/ 3. Satellite accumulation points throughout: 4. HazMat stored outdoors — CHECK OUTSIDE: 5. Shipping and receiving areas: ,V IA 6. Run down of shop activities: Z 7. Housekeeping practices: i Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Cape Cod Commercial Linen Service,Inc. Fax: _ Corp Name: Mailing Address ; Location: 485 West Main St.,Hyannis Street: _._ _.... . .... ....... - - mappar: City: Hyannisport Contact: State: Ma Telephone: 508-771-5033 Zip: 02647 Emergency: Person Interviewed: Business Contact Letter Date: Category: Inventory Site Visit Date: Type: Follow Up/Inspection Date: R1 public water ❑ indoor floor drains ❑ outdoor surface drains d❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc 0 currently licensed town sewage indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -- - ❑ on-site sewage El indoor on-site syste ❑ outdoor onsite system date: 6/19/2004 compliance: Satisfactory A 6. Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 lbs dry or 50 gals liquid but less than 111 gals ❑d gty's 111 gals or more ydescnption - qty:`; , unit of rrieasure laundry soil&stain removers(including beach) 1 drums other cleaning solvents 55 gallons other cleaning solvents i 55 gallons Waste Transporter: Fire District: "1 Last HW Shipment Date Waste Hauler Licensed: N No -- 5e 1-12 j OL P4l u�a -� D CAPE COD COMMERCIAL LINEN SERVICE, INC. HAZARD COMMUNICATION PROGRAM Revised June 23, 2005 Cape Cod Commercial Linen Service, Inc. HAZARD COMMUNICATION PROGRAM I INTRODUCTION II HAZARD DETERMINATION PROCEDURES III LIST OF HAZARDOUS MATERIALS IV PROCEDURES A. LABELS AND OTHER FORMS OF WARNING B. INFORMING CONTRACTORS ABOUT HAZARDS C. CHEMICAL SPILLS AND ACCIDENTS D. CHEMICAL HANDLING, STORAGE, AND DISPOSAL V PERSONAL PROTECTIVE EQUIPMENT VI TRAINING VII APPENDIX APPENDIX A SAFETY COMMITTEE MEMBERS APPENDIX B MSDS SHEETS APPENDIX C F:_MEIIGENC - PHONIE;', NUMBERS I INTRODUCTION Cape Cod Commercial Linen Service, Inc.(CCCLS) seeks to protect its employees from all unsafe exposures to hazardous chemicals known to be present in the workplace. Employees have a responsibility to learn and follow the procedures we have established to assure basic awareness of hazards and safe use of materials in our workplace. To ensure that all avenues are addressed, the following written hazard communication program has been established for all departments at CCCLS. These plans are to be reviewed by the Safety Committee at least every 12 months and updated as necessary to reflect significant changes in the status of our program. A list of the Safety Committee members is contained in Appendix A. The Safety Committee is responsible for seeing that all aspects of the program are carried out. A copy of this Program and the applicable OSHA standards are available in the office of Paul Marcey for review. II HAZARD DETERMINATION PROCEDURES In accordance with the OSHA standard,we will rely upon the chemical manufacturer to identify and evaluate the various hazards of the chemicals they supply to us. The Safety Committee will rely upon information provided on the Material Safety Data Sheet (MSDS). The MSDS is to identify all of the chemical characteristics as required by the OSHA standard. The Safety Committee will insure that MSDS's are readily accessible and that supervisors know their location. A. Respective Department Heads should see that each MSDS sheet is reviewed when received to see that it contains the following information: * Identities used on labels * Chemical and common(generic) names * Physical and chemical characteristics * Physical hazards * Health hazards (signs& symptoms of exposure, medical conditions aggravated by exposure) * Primary routes of entry * Air exposure limits * Carcinogenicity * Emergency and first aid procedures * Date of preparation of MSDS * Name, address and phone number of MSDS preparer or distributor * Any generally applicable precautions for safe handling and use that are known to the chemical manufacturer or employer preparing the MSDS, including appropriate hygienic practices, protective measures during repair and maintenance of contaminated equipment, and procedures for clean-up of spills and leaks. * Any generally applicable control measures which are know to the chemical manufacturer, or employer preparing the MSDS, such as appropriate engineering controls,work practices, or personal protective equipment. * The OHSA permissible exposure limit, ACGIH Threshold Limit Value, and any other exposure limit used or recommended by the chemical manufacturer or employer preparing the MSDS. * Whether the hazardous chemical is listed in the National Toxicology Program Annual Report on Carcinogens (latest edition) or has been found to be a potential carcinogen in the International Agency on Cancer Monographs or by OSHA. B. The Safety Committee will write to the supplier for any missing information. If the supplier does not respond within 30 days the purchaser will be notified to find a new supplier or the Safety Committee will file a complaint with the local OSHA Area Office. C. The Safety Committee will coordinate necessary monitoring for any chemical in the workplace which is questionable or required by law. Monitoring will be conducted in one of the following manners: (1) in-house using Wittenberg University equipment and personnel or(2)by an independent consulting firm. III LIST OF HAZARDOUS CHEMICALS A complete list of MSDS's for all chemicals used within CCCLS will be kept in the office of Paul Marcey. Further information such as the physical & chemical hazards of the chemicals, Detection methods and protective measures for each chemical can be obtained by reviewing the MSDS. Employees are entitled to a copy of the MSDS if they so request. The list of all hazardous chemicals shall be subjected to cross-reference.to the MSDS for each listed chemical. IV PROCEDURES FOR LABELING AND OTHER METHODS OF COMMUNICATION A. Labels and Other Forms of Warning. All containers in the workplace are to be labeled. The purpose of labeling each container is to properly identify the contents of the container so that the employee is warned as to what type of hazard (if any) the contents of the container present. a. Since chemical manufacturers are required to label their containers, CCCLS will use these labels as our primary means of labeling. Such chemical manufacturers are required to label their containers to meet OSHA standards. b. Chemicals removed from the original bottles will be identified by a label which shall contain the name of the chemical, the date on which the label was prepared, and the initials of the person preparing the label. Solutions will be labeled with the identity of the solvent, the concentration of each of the solutes, the date on which the solution was prepared, and the initials of the person who prepared the solution. For those chemicals and solutions for which a significant fire, explosion, health, or carcinogenicity hazard exists,the label shall identify the hazard and the severity of the hazard. For each type of hazard with a solution, the hazard severity information indicated on the label shall be, for that hazard, the most severe hazard indicated on the MSDS for any of the constituents of the solution. The MSDS will be used in each case where a label is lost or illegible. c. The Safety Committee or their designee within the respective departments will ensure that all containers of chemicals in the departments are correctly labeled. Any container which does not have this information may be returned to the supplier, at the supplier's expense. r d. Each Department Head has the overall responsibility of ensuring that all containers of chemicals used in his or her department are correctly labeled. e. Labels are not to be removed from any container, or defaced in any manner. f. Empty containers are not to be re-used to store other materials unless the container has been cleaned, the old label removed, and a new label affixed in its place prior to its re-use. B. Informing Contractors about Hazards. To assist in evaluating potential exposures and to ensure that a contractor's employees are provided with information regarding potential hazards,prior to any contractor entering the work site the Director of Physical Plant, in consultation with the appropriate department head, will notify the contractor of any potential hazards relating to chemicals. The Safety Committee is a resource for the Director of Physical Plant to use to assist in identifying any potential hazards in the work site. C. Chemical Spills and Accidents. a. Should a hazardous material spill or accident occur, immediate attention is required by the person causing the spill to minimize the spread of the spilled material. It is then the responsibility of the person causing the spill to report the spill to the department supervisor. Except for the most minor spills, the department supervisor will arrange for the cleanup of the spilled material. Outside help will be called in to clean up the spill when the extent of the spill or the material involved in the spill are such that inside help is not capable of handling the situation. b. In the event of a hazardous material emergency outside a building, outside help may be called in to help clean up the spill when the extent of the spill or the material involved in the spill are such that inside help is not capable of handling the situation c. After the emergency, a Security Department "Incident Report" will be completed by the Security Department (sample "Incident Report" is shown in Appendix E). All accidents or near accidents will be carefully analyzed by the Safety Committee and the recommendations arising from the analysis will be distributed to all who might benefit from the information. Also, as a follow up to any safety related Incident Reports, a written recommendation will be sent to the Director of Security and a copy filed with the Incident Report for a permanent record. d. In the event of chemical exposure to the eyes, employee will be directed immediately to the "Emergency Eye Wash Station" located next to the tying machine. The employee must flood the effected area for 15 minutes until the chemical is washed out. e. In the event of chemical exposure to the body, employee will be directed immediately to the wash room, either men's or women's, and wash the effected area for 15 minutes until the chemical is washed out. D. Chemical Handling, Storage and Disposal. Materials will be stored, insofar as is practicable, in their original containers. Bottles of chemicals should be placed on the storage shelves in such a way as to minimize the danger of bottles falling off the shelf. Chemicals will be stored on the shelves by chemical property. Highly toxic materials will be stored separately from other chemicals in a room which is locked when not in use. Flammable materials will be stored separately from other chemicals in special cabinets. All chemicals will be examined at least annually to determine the need for replacement and the integrity of the container and label. The proper disposal of hazardous material wastes is necessary to protect people, plants, and animals from harm that could be caused by the improper and careless disposal of these wastes. V PERSONAL PROTECTIVE EQUIPMENT Most personal protective equipment is provided by CCCLS to employees when and where necessary. It is the responsibility of each employee to be certain that the appropriate equipment is worn as necessary. The assessment of any hazards associated with exposure to hazardous chemicals which require the wearing of personal protective equipment is the responsibility of CCCLS. It is the responsibility of each employee to wear personal protective equipment as provided by CCCLS or as required by CCCLS. Eye Protection: Appropriate eye protection is provided to be worn by all persons, when chemicals are handled. For specific regulations see a copy of the "Wittenberg University Eye Protection Policy" attached to the Chemical Hygiene Plan. Hand Protection: Appropriate gloves are provided to be worn when the potential for contact with toxic materials exists. Inspect the gloves before each use. : Use appropriate dust masks when air containment concentrations are excessive. Inspect the dust masks before use. Miscellaneous: Use any other protective and emergency apparel and equipment appropriate. VI TRAINING CCCLS will provide employees with information and training on hazardous chemicals in their work area at the time of employment and whenever a new hazard is introduced into their work area. Annual refresher training will also be given. The Safety Committee will make available to each new employee a copy of the MSDS pamphlet(Appendix D). Our training is to be an opportunity to explain to employees not only the hazards of the chemicals in their work area, but also how to use the information provided in our Hazard Communication Program. This training will be accomplished by the department supervisor in an on-the-job basis. Training will include an opportunity for employees to ask questions to ensure that they understand the information presented to them. Specifically, the training will include the following: f a. The requirements of the applicable OSHA standard 29 CFR 1910.1200. b. The operations in their work area where hazardous materials are present. c. Methods and observations that may be used to detect the presence or release of a hazardous chemical in the work area(visual appearance, odor, monitoring, etc.). d. The physical and health hazards of the chemicals in the work area. e. The measures employees can take to protect themselves from these hazards, including specific procedures CCCLS has implemented to protect the employees from exposure such as appropriate work practices, emergency procedures, and personal protective equipment to be used. f. The details of this Hazard Communication Program; the location and availability of the written program; an explanation of the labeling system and the MSDS; and how the employees can obtain and use the information. g. The personal protective equipment required for the employees specific job (if any). APPENDIX A SAFETY COMMITTEE MEMBERS APPENDIX B MSDS SHEETS APPENDIX C EMERGENCY PHONE NUMBERS APPENDIX A Safety Committee Members Jeffrey Ehart, President Paul Marcey, General Manager Max Cesard, Plant Manager APPENDIX B MSDS SHEETS MSDS Sheets are available for review and are located in the office of Paul Marcey, GM APPENDIX C EMKRCE,�N-C'Y PHONE NUINIBERS Police 91.1 Fire 911 Rescue 91.1 Poison Control 1-800-222-1222 Chemical Emeracnev Assistance 1-800-424-9300 Jeffrey Ehart 508-428-1639(il), 508-776-3066(CELL) Paul Marcey 508-790-0091(H), 774-238-0704(CELL) Ma x Cesar d 508-460-4034(H), 774-238-0705(CELL) Town of Barnstable Regulatory Services YY Thomas F. Geiler,Director B^KASS. Public Health Division► . $ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. � DATE 2 0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT "O,✓C.O eTjjjj l iq ��/ )i 'rJ f'T [:YXIV J ke NAME OF ESTABLISHMENT l CITQ( OCd b 97eru CIS lA ADDRESS OF ESTABLISHMENT J C rl S'/ A40^01 1) • TELEPHONE NUMBER 5Ok M l 5033 SOLE OWNER:—10—YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. V`t 37 STATE OF INCORPORATION M 17 FULL NAME AND HOME ADDRESS OF: PRESIDENT J P Z--�*-eA4 (---)vyt - TREASURER CLERK h SIGNA UR F AP1 LICAriT RESTRICTIONS: HOME ADDRESS oZ'S 5hd Le V 011&�W t d L,3�v�J� • HOME TELEPHONE# Solo V Z4l 16 �j Haz.dodwp/q r MAIL-IN REQUESTS • Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call(508) 862-4644 t , • Date: 5--7-O c/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: CV7nMOt,914at L17&t3 ,5t s 9-1. -`AAC BUSINESS LOCATION: �t 8�" W. INVENTORY .MAILING ADDRESS: P10, 6-ox .TOTAL AMOUNT: TELEPHONE NUMBER: `"0�3�- -7-?1-5'03 CONTACTPERSON: D- J e� ne,4 E60AA- 73/ o-nS EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: FWe 0(57�lGT , OTHER INFORMATION: f e,-,C j� .s LV a e s i v( ,M 5 06- 00 .5 .P� Waste Transportation: A/6 {� c ,;5 _ �4tic Name of Hauler: ly/, Destination - X410 l °r" sf°�` Waste Product: Licensed? Yes No 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes / Road Salt (Halite)/Tce../12e-efE- - Hydraulic fluid (including brake fluid Refrigerants Motor oils Pesticides 3-,1&*.NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diese[fuel, kerosene, #2 heating oil NEW USED 25-aaA 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 e=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 (ina: 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 0 aaZt Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): /1� Spot removers & cleaningds Misc.: S Other cleaning solvents Bug and tar removers TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair BOARD O HEALTH . Satisfactory 12.Printers 3.Auto Body Shops K_"F_� V O unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores COMP6.Fuel Suppliers ADDRESS t�at n !SL Class' 7.Miscellaneous -1 �'liS QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS NM IN OUT IN 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) transmission/hydraulic ,; Synthetic Organics: degreasers Miscellaneous: `10i`1 X �.1 U DISPOSALIRECLAMATION REMARKS: 1. S itary Sewage 2.Water Supply �S )Town Sewer Public ✓Qlz O On-site OPrivate , LIP 'P 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. 1(i4,1 irk fi..1 J\ Q - / 4.2 14 15"nV Interviewed Inspector Date Town of Barnstable °Ft Teti Regulatory Services Thomas F. Geiler,Director BAMSTAMASS. $ Public Health Division i639. RECEIVED .. rECMa'�°' Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 FEB 6 5081790-6304 TOW( OF BARNSTABLE Application Fee: $100.00 HEALTH DEPT. ASSESSORS MAP AND PARCEL No. DATE o2 Wo.>, APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 916Ld+ NAME OF ESTABLISHMENT CG(Ve C0 C kv,tn&-Ccc I Ln Jetl1 u ( ^c v ADDRESS OF ESTABLISHMENT LkW6 - MGt n S Lf-14ay,b i I 1 02-&c/ TELEPHONE NUMBER 5o � T) C CI j 3 SOLE OWNER: vftS NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04 334 W46 STATE OF INCORPORATION H FULL NAME AND HOME ADDRESS OF: PRESIDENT Q S *-e - a✓t- X5 S mu Le V6,11tcl 2d C/ 11- &,q 02-656 TREASURER cJ e C >/' SC4-V-2. CLERK Q 1-. Lev t S a eqlle- SIGIqAPAE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q PadPG�f�Q, Date: TOWN OF BARNSTABLE ��► TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: i r 21n,11A11 � ,� �/r .0.4r C dig �1GL'-e BUSINESS LOCATION: �'- 1'/ENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: -57� 77f " 50031�/O�Il CONTACT PERSON: �Jelw E 11"_f_. lfz Z EMERGENCY CONTACT TELEPHONE NUMBER: JaZta MSDS ON SITE? TYPE OF BUSINESS: / eq INFORMATION/RECOMMEND TIONS: 0, Fire District: r +, AM Wilk rat / wjJJ rr j11 All n t4% 55a 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 5 Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, oth I s 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 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable oF1HE t�� Regulatory Services Thomas F. Geiler,Director • Public Health Division BARNSTABLE, Thomas McKean,Director �Cb 1639.S. 200 Main Street, Hyannis,MA 02601 ArBD Mp`l A Phone: 508-862-4644 Email: healthOtown.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 March 6, 2007 Mr.D. Jeffrey Ehart Cape Cod Commercial Linen Service 485 W.Main Street Hyannis,MA 02601 Dear Mr. Ehart: Thank you for your time and cooperation during the hazardous materials inventory and site visit at Cape Cod Commercial Linen Service on March 5,2007. This letter contains information fiom that visit that will help you become compliant and remain compliant with the Town of Barnstable Code Chapter 108: Hazardous Materials. Enclosed you will find a copy of the Toxic and Hazardous Materials On-Site Inventory form from the visit to your business. Please note the observations identified at your place of business during the hazardous materials inspection listed below: OBSERVATIONS: • Facility is clean and organized • Products are stored in 55 gallon drums properly • All drums are labeled properly • Product is pumped into machines and not handled by staff • Hazardous Materials Permit for 2006-2007 has been obtained On Site Inventory Total The Toxic and Hazardous Materials On-Site Inventory from March 5,2007 shows that you have approximately 587 gallons of toxic and hazardous materials being used,stored,generated and disposed of at 485 West Main St.,Hyannis,MA(Please see enclosed Toxic and Hazardous Materials On Site Inventory sheet). If you have any questions about these problems,the orders and recommendations,or you need fiu-ther information,guidance or assistance,please do not hesitate to contact the Public Health Division. Sincerely incerely A ish"a L.Parkes+ Hazardous Materials Specialist Enc. On-Site Inventory(copy) TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH o' satisfactory 2. Printers 3.Auto Body Shops O unsatisfactory- 4. Manufacturers COMPANY ! /oil =V (see"Orders") 5.Retail Stores / ,J / teAjH�RQ 6. Fuel Suppliers ADDRESS YES U eS7. 164/d Class: Lr+vas: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots' Drums nks Underground Tanks IN OUT IN 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) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: �6-6- G, fiVi-©R1 P&/43nC b._i . , o iv IE Al PP b"r Ale *i,i c-j;e LeW-../L- ev *0� r3 LL-�G�f 6T C ft j,01J D/:-_ C t I AJ& J1170 ®5 iv A-wv 1v w G' 1_7u,&jp vl*iol )rem -/Z 7-Me WASHIT ",f-�WIJS A4 5 AIC 7- i-L i C, JJ_6676 14 PP�W,�IIVA7 _ TvrA-1- /11 .2 600 14*4 c- DISPOSALIRECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply AI-L 1-1cN ic-* S ujc-, /tit .7-He eft v/�lt�ca2i�8tr (yTown Sewer G&ublic O On-site OPrivate 49 ft1 'S i lZ7' 3.Indoor Floor Drains YES NO O Holding tank:MDC_ �� �/ "�' E"'c" P4-,'f J over, O Catch basin/Dry well &&C&7 V E-Z> P// , j P1 i�-L K t r ,vow 0A1 S1 i6, O On-site system a,(/ .s/?r "69A--+2 P, /U'�q�-f G;e*L (�AS, 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC S14- t,t. b WaL 00 7aJ (Catch basin/Dry well o� �ays G&Vg LiCeW&C, Poste �- � �� t?uN�4 y--S +A j D S Pi i,Lr O On-site system 1A1 oe7-boratt- %-UORK 8 5.Waste Transporter i(/LA a� WELL S yV aL6 a c�,o5Eb Fc--n Dk�i. MV: wli ? ✓ eat�Uj Name of:Hauler Destination, Waste Product 2. 4 Person(s) Iilt&viewed V Inspector Da e A n ` Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: e46E 6b �o/�� Ac. 41AJ f7d S&WVI-4r Business Location: //If-6- W&-S i HAIA) sT, �Ss'/ ,►fib /SPa�I/j/f ®Z6�� Mailing Address: 1 99 //f . Wt5f_X yAA^S-FOB D 7-lv72- Telephone Number: ,3 of- 71/' S� � Contact Person: �f���'`1 �H�4RT Emergency Contact Telephone Number: 6ek- 57>&- 7-1/- �V 33 Type of Business: HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts,gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc (�)SS4kico.� 0�u� �vv�A-i2 �ee,,z/e l0 G Auo,eJs /e-P 4 A-ua,v 7W.*U K ov?5��� 6eK_�� S y n/115-/Z7 3- 64144 'P4MK d fi173�,1)E WOr-K AKFAI 5 091 a l/ 160 6AU_,iVJ / e Add aA-z"105 ��t/�L () 160 6tUCAJ_*�A 7 fEZ A<R,5', Q -y Cl) $-6,4 a-6,v b& ea 7371hE Wegie L limos 6-5- u� s s��,i a/eu� 0&7316 e- �A `)5'�-4N 0�7sih�yua DL7'5A-iP� ®�� wow 14 7��` �U� / LASGAZLoti1S 0) /40 Gif ,v 73FW/EL 9E4 (/)le o G Au-oAJ 7jl W&Z 49ZW AG7D YA r£ l e 0 qj A-,'"/JJ r"K - 1 - Misc.Combustibles Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: C9A-zL4AkS Hazardous Materials License Posted es No Contingency Plan Posted? Yes _ Fire District: /�YA M, /S Fire Extinguisher Service Date: J�NL �jO Metal Covered Rag Bin: Yes Ngbsorbent Material Available? Yes Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on sites Ye No LardComputer Access Hazardous Waste Handling Hazardous Waste Generator Identification Number: &�A Type(s) of hazardous waste product(s): Date of last hazardous waste shipment,type of waste and quantity: Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes No If hazardous waste is stored out of doors is it covered from the elements? Yes No Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor? Yes No - 2 - FLOOR DRAINS (Chapter 381) Town Sewer Account Number: W93� Indoor floor drains:C:e No If yes,circle one,does it discharge to a: holding tank dry we on site septic.) S Pf o?I�7 56LaW46c,Ag©/N a 491flrV UIj D e57e 5t7{So�c.S/�Z oUT3/DE �/O+'�K,��hS AS PiIA�LT G�oG%�, Outdoor surface drains: es No If yes,circle one,does it discharge to a: holding tank dry well on site septic. U NKMO tv N FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes l9 Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? Yes & If yes,is it protected from the elements? Yes No If yes,how? Is it on a foundation larger in size than the tank? Yes No COMMENTS/RECOMMENDATIONS/CORRECTIVE ACTIONS &1UfALT .yNF W-1vA 61-1 !S n 667P&S fED /1-Nl) TD/2E' 17' 1.,U AAJ &-�t5/q A-er-&SSA13L6- `� /-0C-*17n,1. 5.�A?7MLy, -r1115 vRZ W& C rrM gAlAl W*lZ- yt/fljetf AXE ITS iT )If�44- 7� A-1fl-5S oY-PHuJG'11S i�.Fl� u�YdQ2Ui��r,u1� �NT�G'7n� L,a�TI-�L iy'F4 UL�T>a�Sr //ONf�Y�iP G4/P� S/iDa-&d 136 Tifk6it✓ /""d /¢NY G-AuNDlly &,a-A) 06 GN e-"t e*t- �k'-Gx( UGC i ljG�.lTfl'/�Ly /��7{�lf>N �/I-� l�l��>�✓ // c,q +A J //YP��v/ohs Cg,�/G2tt�GOFi, Date: 3/ za Public Health Inspector:, Facility Representative: - 3 -