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Home My WebLink About0292 MAIN STREET (HYANNIS) - Health 292 Main Street, Hyannis —THE STUDIO OF T o _ LQ IUD Q a E-1 i Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS:14+6 L:jOM0 bH I f'Vt✓ SeA BUSINESS LOCATION: 9m�_ mklr� ST UIRNNIS NSA 09kol MAILINGADDRESS: 5ML Mail To: TELEPHONE NUMBER:_ ��5 � �� Board of Health Town of Barnstable CONTACT PERSON: 5601A d 'I�QP�e11( l�1- 1 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 50619t S_ Hyannis; MA 02601 TYPEOFBUSINESS: 60Tt6fWt11C TU00 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES �k 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 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 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 Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's 0.110n 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 fNU-1QF141_W lG ug-SAP (dry cleaners) 1 *01 C KS Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ;V 7 r 4 ' Date. 2 �� TOXIC AND 'HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: SMIo P)LI 'K SEA BUSINESSLOCATION: MAI� S-' lANoks MA 0�o� MAILINGADDRESS: SCE Mail To: Board of Health TELEPHONE NUMBER: Town of Barnstable CONTACT PERSON:.. . �NO94_�!I �P•��e ICAt.r=l p:0. Box 534 EMERGENCY CONTACT_ TELEPHONE NUMBER: -509 19S 531-931 Hyannis, MA 02601 ` TYPEOFBUSINESS`. Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES �L 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: fJ 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 4radiator flushes Road Salt (Halite)t i 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 i Degreasers for engines and metal Printing ink i 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 anon Lacquer thinners Other chlorinated hydrocarbons, 1 NEW USED (inc. carbon tetrachloride) Paint &varnish removers, deglossers Any other products with "poison"labels Paint brush cleaners i (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers i Other products not listed which you feel (including bleach) % may be toxic or hazardous (please list): Spot removers & cleaning fluids . �mro�irlosrhlJC� l. ;�ul� s®��'` (dry cleaners) 14 0t C"S Other cleaning solvents Bug and tar removers t. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS oFINE Town of Barnstable BMMs s SZAB Board of Health '�Fn Me+A P.O. Box 534, Hyannis MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,M.S.P.H. To: CLARKE,WILLIAM T&GLORYA Date Monday,March 05,2001 292 MAIN ST HYANNIS M 02601 RE: Underground Storage Tank at 292 MAIN.STREET(HYANNIS) Map Parcel: 327255 Tank NO: 01 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 30 years old,and has not been removed as required by section 03:subsection 2 of the Town of Barnstable Health Regulation regarding fuel and chemical storage systems. You are directed to remove this tank sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice.. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent Make application to local Fire Department. � Fire Department retains original application and issues duplicate as Permit. \ (2�2 ' GvyY%yY�Q�'GGU�CliG�12 ' ,��e��a��G�;n�rcG'aa� �'rixe �e�uccea — �C aaix�a�C�a�re ✓ 'J�P/1/P/!'LGGdl2 APPLICATION and PERMIT Fee: for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: Tank Owner Name(please print, Clarke X ~ Signature(it apllying forpenn+t i Address292 Main St Hyannis, MA 02601 street city State Zip • • • • • ! Advanced Environmental Service Company Name Co. or Individual i Print Print AddressP•O.Box 472, 197 Great Western Rd. Address So. Dennis, MA Print Print Signature (if.applyin for rnit) Signature (if applying for permit) IFCI Certified Other 'i IFCI Certified �D LSP# Other tr-Tly Tank Location r-292 Main St H3-annis MA 01 Steet�lddress J' G+ty��_ i Tank Capacity(gallons) -Substance-Last-Stored--- Tank Dimensions (diameter x length) I , ) Remarks: Firm transporting waste Advanced Environmental- State Lic. # MV5083856100 i Hazardous waste manifest# E.P.A. # i Approved tank disposal yard J.G. Grants Co. Tank yard # 008 Type of inert gas�✓l �� Tank yard address Wolcott St. , Readville, MA City or Town FDID# PermitR _ A Date of issue F Date of expiration 77 Dig safe approval number: 20011203719 Dig Safe Toll Free Tel. Number- 800-322-4844 j Signature/Title of Officer granting permit After removal(s)send Form FP-290R signed by Local Fire Dept. to/UST Regulatory Compliance Un , L` ° Room 1310, Boston, MA 02108-1618. H�ANNIS FIRE DE ; RT64-UN I �°� iS,l��cv.S JIhI 95 HIGH SCHOOL #;1:). s M HYANNIS, MA 0126,01 :92(revised 9/96) TOXIC AND HAZA:R"OOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Z i `— Mail To: ' BUSINESS LOCATION: 1 Board of Health MAILING ADDRESS: �,, Town of Barnstable � - P.O. Box 534 TELEPHONE NUMBER: tFY Hyannis, MA 02601 CONTACT PERSON: � ._� BWkk_1 EMERGENCY CONTACT TELEPHONE NUMBER: 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: TELEPHONE: Z111- 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: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, '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 07; alnts, varnishes, stains dyes Fertilizers (if stored outdoors) GIM,- 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 TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF FALTH satisfactory 2.Printers / i 3.Auto Body Shops /, /) )/� unsatisfactory- 4.Manufacturers COMPANY 6 V�t o 0� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class' 1 7.Miscellaneous a MO QUANTITIES ANDS ORAGE (IN= indoors;OUT=outdoors) MAJOR TERIALS ,selots Drums Above Tanks Undergroundy Tanks IN OUT IN OUTI 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. (woo) tAy Cx k.kU 0 i f I� II DISPOSALfRECLAMATION REMARKS: L. anitary Sewage 2.Nyater Supply o 46L /x//V r own Sewer Public On-site O rivate / ' 3. Indoor Floor Drains YES NO 0 Holding tank:MDC YoCilOrn 0 Catch basin/Dry well ® `� 0 On-site system 4. Outdoor Surface drains:YES NO 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. uw;�71 4_c> P son (s) In erviewed Inspector Wate -