HomeMy WebLinkAbout0041 ROSARY LANE - Health 41 ROSARY LANE, HYANNIS � `
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: 5--/;�—iS� Fill in please:
P APPLICANT'S YOUR NAME/S: —T c iy
fBUSINESS YOUR HOME ADDRESS: �Z3 w i i Z t:, +� i L
rog M/A 04(.'31
r - S
TELEPHONE # Home Telephone Number S o� '7 7 1 t/- '7
NAME OF CORPORATION:
NAME OF NEW BUSINESS`=;ni TYPE OF BUSINESS Ll+r,,)fc;};i)e
IS THIS A HOME OCCUPATION? YES No
ADDRESS OF BUSINESS % ! v� La-- / N N �S �+� MAP/PARCEL NUMBER 3 LI O 1. � (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COP )M SSI NER'S OFFICE
This individu((al h b onf a of ny rmit requirements that pertain to this type of business.
Au orized Sign;-Cure
COMMENTS: r' i t ' ( (� 6c,���ea t
2. BOARD OF HEALTH.
This individual has`be AK
red of the permit requirements that pertain to this type of business. "y.g.Lm snocwK',4u
Authorized Signature** l lv rniJM A 1dW00VSM1
COMMENTS:
3. CONSUMER AFFAIRS'[LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
YOU WISH TO OPEN A BUSINESS?
For Your,Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you
must do by M.G.L.Zit does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office,.l st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: // 6 13 Fill in please:
ip!1 APPLICANT'S YOUR NAMES:
BUSINESS YOUR HOME ADDRESS- �,.a� �� L1ci`i v.s b N . c7Z 63 O
Ealrrr '> 1ci rhea �o -7�d�ll��
" khy� TELEPHONE # Home Telephone Number
NAME OF CORPORATION:.
NAMEiOF:NEW BUSINESS:: �� TYPE.OF BUSINESS r,
IS THIS A HOME OCCUPATION'; YES NO 7L
11II�J -�C�
ADDRESS OF BUSINESS � i 1 k " Kn,r /+� - MAP PARCEL NUMBER `1 "I OJ Assessor
( 9)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you rmay need. You MUST GO TO 200 Main St. (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this tovuin.
1.. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual has 1FL�'ee /A�oyr/rn ��/(y1f►the permit requirements that pertain to this type of business. A MIL ST�,;,0 (.PLY WITH
ALL
JS
Authorized Signature**
COMMENTS:
3. CONSUMER AFFAIRS(LICEN G AUTHORITY)
This individual has&n i o d f the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
c/ -J-0
o
OIL . WASTE OIL OIL FILTERS ANTIFREEZE WASTE
ANITFREEZE
GASOLINE WASTE GAS DIESEL FUEL W/W FLUID ATF
�%vP �fP��s�p_17 �zy Ivc— l� car G
'5/a C",q o.-x �Av)
HYDRAULIC/ MISC. MISC. MISC. MISC:
BRAKE FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM
(GEAR 01L/GREASE/
LUBRICANTS)
•e
FREON ACETYLENE CAR WASH CAR WASH PAINTS/
WAX DETERGENTS THINNERS
SEALANT CLEANING BATTERIES/ POISION/TOXIC -CAULK/.GROUT
SOLVENTS BATTERY
ACID
FERTALIZERS WASTE SOLVENT BLEACH DISH WASH AND MSDS
DETERGENTS
MANIFESTS
Af V 5-0 F 7 7/5-jl-
7 us
HCRA urn
7e/�hevlRgMRAJV. T
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Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUnS MATERIALS ON-SITE INVENTORY
NAM F N -JU/Vf 6kLA/Vb I /nl 61G
E O BUST ESS 7
BUSINESS LOCATION: ' INVENTORY
MAILING ADDRESS: As- Ar30v TOTAL AMOUNT:
TELEPHONE NUMBER: OSL- O- /pp — /Vd C7kU_ LS
CONTACT PERSON: @ w//6#,Wa "6 -S /
G,1(ub�cs 2>rVH of W*sTr ..
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: +wb i_/i? av eAt-# V,6s, 1w f 81w&x7f
INFORMATION/RECOMMENDATIONS: ?/fcfi �m'�'�v�s9 A/2� y� >a Fire District:
nA--TE, 4 collexeD AA16 8/-J /S .4v.4rL�Bc�, /��25'0�o��a� /s Aura-1nA5C-
TI/2? TRarEb E7 l3r/ PR�/�u oG y-y� j��y�LcPr2�
P&AIX5. /T fS UNC���fZ Ar- TX/S 77"C' /� 9�E`!3y-�/�DuzT /S r4 H'�Zlpeh" W*-97E,
7-/1E rA-c./1_l7-y /5 CAI /75 o.W'v S6_P77 c- 6y5 1&_l--t
WasteTransportation:/�9 g3ss Last shipment of hazardous vpste:
Name of Hauler: %2/vHA11,C 1C Destination: c4 R
Waste Product: 1 z-A,,e&vs Licensed? es No
�
NOTE: Under the provisions of h. 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. Pdb W//u fia)ew wore
Observed/Maximum Observed/Maximum 4a^y5/V&,off�un 776S
Antifreeze (for gasoline or coolant systems) Misc. Corrosive W1 f7j,1,..) ONE R-91J7#
NEW USED Cesspool cleanerselu6lZ 71 D��-r�Rt/���rG
Automatic transmission fluid Disinfectants /,;,�P"Z
/4,47 sus w,�
Engine and radiator flushes Road Salts (Halite)IWV W .
Hydraulic fluid (including brake fluid) Refrigerants _
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas =r (Fixers)
Diesel Fuel, kerosene, #2 heating oil /3 NEW USED
Misc. petroleum products: grease, P�1�r
��s Developer)
lubricants, gear oil -9s NEW USED
nd NHS />v Pas r�
Degreasers for engines and metal D/ r.6
Printing ink eo vs5, .,ocr
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,
T�1 Fes/(-At�c/�ga-t"s L�l3��u�T
Misc. Flammables�ej-4:-;!�,111_-rS.�AIK v 4-S#CS &Al i) hydrochloric acid, other acids)
MkWy c00rX1AJWS
Floor &furniture strippers A945 o9sotE Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers G�i�C LOit/`s
/30�TP ue�2 d-[.CoNoL /fit Pl..4C�M�a�►T-�003
(including bleach) � 9.!5T C,/1'LLdA/ boWAS o /)t&_rj WASIC
Spot removers & cleaning fluids `/�j/f5 l'�u/2R�a1sy A SAH19a D,c V4
(dry cleaners) VIA-STL /3 13E//)(- ANA'LYZ
Other cleaning solvents 5 ZIMS ks ,fir// b-6UJJI4/k�TE, C01j6DOil
Bug and tar removers ��E r� �-�,��� d v,�L t�/:�5 /,t/ST 4zeb S I Lve-K)
Windshield wash IAA
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
;T ;
10. 2009 i : 28PM M DEP No. 9479 P. 1
COMMONWEALTH WEALTH OF MASSACHUSETTS
fl n EXECUTIVE OFFICE OF ENERGY&ENVIRONMENTAL AFFAIRS
N ,
_- DEPARTMENT Off' EN VIRONM ENT L P R.OTIEcrjiON
SOUTHEAST REGIONAL OFFICE
4 7 20 .Riverside Drive, I,akeville, MA 02347 508 946-2700
LAN A.BOMXia
;,Stint•+rr:[tr Sec:!n:ti;[rr
r'.?WJRF-A•'.r LAURIE 33111t",i
lie�atcnnnt 4 mzrrnor
COID1S116,aaC•11EY
cF
pt"
?:l FAX COVER SKEET
P.h:`C k. (-508) 546-2565 TELEPHONE # (508) 946-2351
FA
yAr
2/10/09 FROM: Roberta Edwards
1
:. P*IL SASE DELIVER TO- Barnstable Hard of Health 508 790 6BO4
ktI
1 . ''41'.`'a h' MK 3ER OF PAGES s 6 (INCLUDING COVER PAGE)
I
t 11`1XV':2 CALL IP YOU D® NOT RECEIVE COMPLETE FAX.
i
e, of moncompliance w 1lif�sl�:a c , instant offset Press
F.rr
J
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1
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This idr.,rina:ioa is ovailoble in alteroato formate Call Donaed M.Gomes,:ABA Gaordivatar at 617-M-1067.TDD Service-1-Of.0.29 ,".07. j
DEP or the Word Wide Vfeb: h-dp:/AvAw.mss5.gov/deg
i 4 Ai Primed on Pecycm Paper
t & r,. ?009 : 29PM MASS DEP — k 9479 P, 2
s) �
_ �
COMMONWEALTH OF MASSACHUSETTS a
EXECUTIVE OFFICE OF ENERGY & EINIRO J
_ E DFPARTMENT OF EwYRONIVIENTAL PRO
SOUTHEAST REGIONAL OFFICE J�
-- — r
. 20 RIVERSIDE DRIVE, LAEEVILLE, MA 02347 50
>f
.j ;fir' L.PATRICK c
{, i�Dl:,✓.Ar. 111NA.BCy�VT:F;.k
i Ctka�rstr► sectetary
r R ]0Y'11111Y P,'kTUI�3r LAURIF;
e:4,wint diiovernor
u February 4,2009 1
'Mare Sunderland
Instant oIl-set Press,Inc.
i I.11 Roswy Lan—i-
:i,.ts
TICEOF NONCOMPLIANCE NON
`ar Noncompliance with M.G.L. Chapter MassDEP Facility ID No.358470
1.1.1 arr.d 310 CMR 30.000
x Air tus'
EI2P-SIv1
r, r Hazardous Taste Clam rfitafilon:
!;l EPA ID No.: MV5087715355
�I�rdous`Waste:�I�QG
p�o
De, r l&. Sunderland:
'jr.ti
Ya :M1ir losed p1ca,9e find a Notice of Noncompliance,an important Iimgal document.
Fa;
:-' On November 7,2008, a representative of the Department of Environmental Protection (MassDEP)
;1 �;d,:r�.ufotVd a. Bureau of Waste Prevention (EWP) Environmental Results Program inspection and
# observed or determined that activity occurred at Instant Offset Press, Inc. in noncompliance with
one or more laves, regulations,orders, licenses,permits, or approvals enforced by the MwsDIEP,
k t1P ) T�l�1I�`I FOR UDUCING THE_FACILIT'Y'SENVIRONMENTAL IMPACT
,r B, modifying the facility's processes and/or waste generation practices, you may be able to
r•Ldt.lce or eliminate the environmental regulatory requirements and fees that apply to this facility.
4H, 'llie,se can include requirements to notify the MassDEP, obtain MassDEP permits or other
§ if royals, manage wastes in specific ways, and file reports on your operations with file agency.
I<n*dd9.tion, these options may improve your product quality and/or process efficiency, and save
k
irtt ,
inforninon is iavailable in atternote formaR Ci30 NAM NJ,Ciorns,ADA Coordinator at TD00 866.539-7622 or 617=574-6961,'
DEP on the yWadd Wde Web' http'/Hwaw.mass.gov/dep
Printed on Recycled Paper
rEx
kif
10. 2009 1 . 29PM MASS D E P No. 9479 P. 3
. ; jJ1-;N1 Implernenting these options may assist or contribute to correcting the violations described above.
A 9 _ I
In addition, tracking the facility's use of hazardous substances and reviewing that data
penodically may lead to the identification of additional opportunities to reduce the quantity and
,fLt ifi E �Cjx1city of materials used, and of hazardous wastes generated.
I'E t inforn`tation on reducing hazardous chemical use and/or waste generated,you may contact:
The Office of Technical Assistance(617-626-1060) for free, CONFrDENTIAL technical �
i .° assistance including on-site assessments, financial evaluations, the handbook"The Practical �
' E : ' Guide to Toxics Use Deduction",and other resources.
11ie Toxics Use Reduction Institute(978-934-3275) for courses for certified Toxics Use
i1i Reduction Planners".
i '
rl�+.
,E ;; MassDFEP's Toxics Use Reduction Program (617-292-5982)for guidance material on the
Toxics Use Deduction Act requirements.
9
If you have any questions regarding this matter,please contact Steven Risi of this office at(508)
�,1-6-2774.
[[ t. F
V truly yours,
1
yeti Gregg M. unt, Chief
BWP Compliance and Enforcememt Section
9'p 1-I;SlI ure f
Y�; �zE# �gF'I}!itsttu�t t�f�et FsesssUie.D2-CW-2009.doc ,
CIS'RTIFIEID MAIL NO. 7008 0150 0003 5433 4740
ta.
,
14, cc: MassDEP-SERO ec: ILIA Office of Technical Assistance �
f 4 Atm.: Carl 1Vatho Attn: William McGowan
,02, Attn: Regional Enforcement Office �.
iVlassDEP-511120id, �
i'a t :lc: Barnstable Board of Health Attn: Deneen Simpson.,1E0
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( �. 10. 2009 1 29PM MASS DEP No, 9479 P. 4
NOTICE OF NONCOMPLL4NCE
THIS IS AN IMPORTANT NOTICE, FAILURE TO TAKE ADEQUATE ACTION-
:04� ? R 'SPONSE TO'PHIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES, "
IIi, Elased on the MassDEP's investigation on November 7, 2009, noncompliance occurred or was
olmrved at Instant Offset Press, Inc., to noncompliance with one or more laws, regulations,,,
5" ort:lers, licenses, permits or approvals enforced by the MassDEP.
1"his Notice of Noncompliance describes (1) the requirement violated, (2) the date and place the
o'iassDEP asserts the requirement was violated, (3) either the specific actions which must be taken
q
firYr in order to return to compliance or direction to submit a written proposal describing how and when
YOU plan to return to compliance, and (4)the deadline for taking such actions or submitting such a
t i 1{ lie required actions are not completed by the deadlines specified below,an admini adve penalty
F § � Yay be assessed for every day after the date of this Notice that the noncompliance occurs or
' nues. The ?AassDEP reserves its rights to exercise the full extent of its legal authority in
art ,,.i-n �d
N' oy er to obtairt Ball compliance with all applicable requirements, including, but not limited to,
r riniinal prosecution, civil action including court-imposed civil penalties, or administrative
P° g P
;,l action, including administrative penalties imposed by the MassDEP.
is
Qpp , KAME OF ENTITY(S)IN NONCOMPLIANCE:
I! Instant Offset Press,Inc., Facility III No. 358470
li'(D Q�+z'I 10N�'S) WHERE NONCOMPLIANCE OCCURRED OR WAS OBSERVED:
R„ t V . 41 Rosary Lane
Hyannis,MA 02601
YI-EN NONCOMPLIANCE OCCURRED OR WAS OBSERVED:
� 7 : November 7, 2008
! � OF NONCOMPLIANCE:
71
Cli "61low; violations were observed relative to Hazardous Waste:
ItrsLmt Off set Press, Inc. was accumulating two, 55 gallon drums of waste fixer in the
r �' "r'V hazeTdous'waste accumulation area and failed to label the drums. This constitutes a
t condition of noncompliance with 310 CMR 30.353(6)g which references 310 CMR
t 30.692,
4
X ,
10• 2009 i : 29PM MASS D E P No, 9479 P. 5
aa 2
Instant Offset Press,Inc. failed to post a sign with the words "HAZARDOUS 'WASTE"at
slit the hazardous waste accumulation area, This constitutes a condition of noncompliance
Aith 310 CMR 30.353(6)h which references 310 CMR 30.341(4).
On November 21, 2008, Instant Offset Press, Inc. shipped the 2 drums of waste fixer
.' 0- fi ite usine a licensed hazardous waste transporter in accordance with the requiremEants of 310i
l 1 't t: fbllowing violation was observed relative to Air Pollution Control:
,
Instant Offset Press,Inc. failed to submit a 2008 printers compliance certification by
r: September 15, 2009 in violation of 310 CMR 70.00 and 310 CMR 7.26(29).
p m . �_
F' On November 25, 2008, Instant Offset Press, Inc, submitted the 2008 compliance
' c v^.1--ifcation.in accordance.with 310 CMR 70.00 and 310 CMR 7.26(29).
Y 5j j.
I� r 0 l T FN AND THE DEADLINE FOR TAKING SUCH ACTIOP�f S
i` �.
�: fl�cv following action(s)to be taken have individual deadlines associated with them. Your
; `;, : ` r� r,ip �y shall take the necessary steps to correct the violations within the specified deadlines a� I
j Y catcyd and shall return to compliance with the requirements described below. . Tlie MassDl✓1'
t r,,, alatiokis at 310 CMR 5.09 resume receipt of this Notice of Noncompliance, if delivered b
' ,y p p p y �.
t Jc ��
l 'iP Y T-vi filar mail, mire business days after its date of issuance.
W.
'#{ i
F ttrfh(-3FI.IIM, YOUT company shall submit a written response within fifteen (IS) days of receipt
+ f'iftis Notice, acluiowledging receipt of this Notice, describing the actions already taken, and
r :1 actions intended to be taken in order to achieve and maintain compliance with the
a c,,
'1
�'�:f3Li a °d(liu Waste
r• � t
L f
1: Within seven (7) days of>eccipt of this Notice, Instant Offset Press,Inc. shall ensure that I`
l ` any waste generated at the facility is properly characterized, handled and stored-in
rompliaice with the applicable requirements of the Massachusetts Hazaxdolks Taste
Ali{ Regulations as contained in 310 CMR 30.000.
,At,hi-Paiflution Control
t4 l
Wittlaiin one (1) day of receipt of this Notice, Instant Offset Pass, Inc. shall ensure, that
H{ all facture printers compliance certifications will be submitted by September 15' of that ,
year iri accordance with 310 CMR 70.00 and 310 CMR 7,26(29). ;
{ i9 rI.
Mir, 25. 2009 1 : 17PM MASS DEP No. 9867 P. 1/3
4'
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENERGY&ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
SOUTHEAST REGIONAL OFFICE
20 Riverside Drive, Lakeville, MA 02347 508 946-2700
DEVAL L.PATRICK LAN A.BOWLES
Governor
Secretary
TIMOTHY P.MURRAY LAURIE BURT
Lieutenant Governor
Commissioner
FAX COVER SHEET
FAX # (508) 946-2865 TELEPHONE # (508) 946-2851
DATE: 3/25/09 FROM: Roberta Edwards
PLEASE DELIVER TO: Barnstable Board of Health 508 790 6304
TOTAL NUMBER OF PAGES: 3 (INCLUDING COVER PAGE)
PLEASE CALL IF YOU DO NOT RECEIVE COMPLETE FAX.
Return to Compliance, Instant Offset Press
i
I
i
This information is available in alternate format.Call Donald M.Gomm ADA Coordinator at 617-55&1057.TDD Service-1-800-298-2207.
DEP on the World Me Web, nitp://www.rnass.gov/dep I
PHnted on Recycled Paper Il
I
0t r. 25. 2009 1 : 17PM MASS DEP No. 9867 P. 2/3
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENERGY & ENVIRO RS
tipDEPARTMENT OF ENVIRONMENTAL PRTr.
SOUTHEAST REGIONAL OFFICE Copy
20 RIVERSIDE DRIVE,LAKEVILLE,MA 02347
DEVAL L.PATRICK TAN A.BOWLES
Governor
Secretary
TIMOTHY P.MURRAY LAURIE BURT
Lieutenant Governor Commissioner
March 20,2009
Marc Sunderland RE: BARNSTABLE--BWP
Instant Offset Press,Inc. 310 CMR 30.00
41'Rosary Lane 310 CMR TOO
Hyannis,MA 02601 .
RETURN TO COMPLIANCE
Air Ouality Status:
Hazardous Waste Status:
EPA ID MV5097715355
Hazardous Waste:VSQG
DEP Facility ID#358470
NON-SE-09-H003-27AM
Dear Mr. Sunderland:
On February 11, 2009, Instant Offset Press, Inc. submitted a letter to the Department of
Environmental Protection(MassDEP)addressing the labeling requirements and hazardous waste storage area
requirements.The purpose of the submittal was to demonstrate compliance with the requirements outlined in
MassDEP's "Notice of Noncompliance" effective February 4, 2009, relative to the Hazardous Waste
Regulations as contained in 310 CMR 30.00.
Based on the submittal of the information,relative to the Hazardous Waste Regulations,the
MassDEP has determined that the violations cited in the Notice of Noncompliance referenced above have
been corrected.
Should you have any questions relative to these issues at your company, please contact Steven
Risi of this office at(508)946-2774.
V ry truly yours,
Gregg M. unt,Chief
Compliance and Enforcement Section
H/SR/re
RTCAnstant Ofrsa Press
This information is a railable in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-S56.1057.TDDN 866-539.7622 or 617-574-6868.
DEP on the Wottd Me Web: hnp;//www.masss.9ov/dep
Printed on Recyeled Paper
ftar. 25. 2009 1 : 11PM MASS DEP No. 9861 P. 3/3
2
ec: DEP-SERO
Attn:Deneen Simpson,REO
cc: DEP-SERO
AT TN: Laura Patriarca
Carl Natho
fc: Barnstable Board of Health
I
1R—Cv'D ON Rk HAZ .
StW.CN2000576
saphira violet Finisher 20 ltr(Pro)
MATERIAL SAFETY DATA SHEET
:ei+lelberg' USA InG
10of) outanberg r,�rivp
Kennesaw; GA 30144
TRANSPORTATION EMERGENCY NON TJRAN rORTXr1vN
CALL CllEMTRE:Ct 800-424-9300 HP.ALTH EMERGENCY PHONEi (30.3) 45.23-5711;
T[QTRTNATIONAL: 703-527-3607 HEIDELBERG INFORMATION: (888) 472 9655
1. CHEMICAL PRODUCT ID101TIFICKTTON:
PR,2DUCT NAri1E... ... ..: Saph ra Violet Pro:Finisher
PRODUCT coor... . .... .: EJ$97000 LCiJf[V7000
CEEMIC,AL FAMILY. . . . • .. Arp1V?n11a phorochemiral. solution
RT79TNP.gS GROUP..... .. Consumables
AQ A MSDS NUMBER... ;. 7.12C.001
2. C0tdP0SX'I`rQ /INF0W4AT20N ON 1=RZDI8NT5s
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3. HAZARDS IDENTIFICATION&
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POTENTIAL HEALTH EFFECTS:
ROUTS C ' NJ'kY: >. , , _.. • . , . . . . ....: Ry,- and..skin contact, inhalation of vapors or
miesta,. accidental ingestion.
171 AIAN EFFECTS AND SYMPTOMS"OF C2VJ}lEY,kaCSMi3}RE:
TNUALATToN.. . ..A . I ...:, : , : Potassium nitrate may be irritating Lo OW muc._,u:s
membranes of the respiratory t_auL with Symgtomo of roughing and nasal, &AchargQ.
ACCTg SKIN C,CNTACT. . .. . . . .. . . . . coat ac.,r. with potassium nitrate may cause irr tatior.
x,:co :ltiing in xecid ning; drying and itching.
ACUTR EYE CONTACT.. ... .. . ... . ..: Contact .with pc);aL4u uae.uitratfs may c auce eye irritation:
resulting in �ititigil'11j, Leard.nri ind reddening..
C_'IIZO-14IC INGESTION. . . . ... . . .. . . . RePeated or prolonged overexposure to 'potassium nitrate
easy _'aUoo metliamog.iolainAymi A rAri Itinq in a. decreased-to ability of red Llvod tjLllo
to transport oxygen and cyanosis (bIkA.ish to oil ur1e34_r opr-•.oia:l +~i�.oaemrr,.�nce� whan
nitrate reducing basCericL in the otomach C..nvert: the nitrate into the more toxic
nitrite. rymptom,4 mzay nau ea, vomiting, dizziness,. irregular heart beat
and brearbAng; coma and:.possibly death.
712c.001 Approval Data: 01/17/2003
Page 1 of 4
Tl,+,��`
CARCINLX;ENICITY, ;. .... . .••.•• The components of this product are rust listed by
]titc or regulated as a carcinogens by OM,
MEDICAL CONDITIONS
AIaGRAVATR5 BY EXPOSURE....... : Persons with pz'eexisLini) Gyc, okka or re piratai7j, trRct
disorders may 1E mure vusceptiblc to. the ef.fper.n o.f this: product.
q. FIRST AID MEASURES.
FInLT AID FOR EYES-- : In care of contact, immediately flush eyes with plenty of
for at least IS minutes. Call a physician..:
FIRST ,'AID FOR 5XIN. .... .: Flush affected axvas promptly with water and noAp for 15
minutes. Remove contamintuLed clothing. .in case of c-rmtinued irritation consult
y�hy:sciau.
FIRST ATR FOR INHALATION., if inhaled, ,remove to ,fresh air. It. not brQdL)1111cj,
givg artificial respiration. If breathing iu alfSicult; give oxygen. Cell
a physician..
FIRST AID FOR tP swallowed, rinse mouth with plenty of water, call a
PhyFiciari.
S. FIRE FZGXTIMG MEASURE9t
FLESH POINT.... . ... .... .. ....-Nuwt ombustid7le
EXTINGUISHING MEDIA. .... . . .s Material is,not combustible. Use extinguishluU media
Fui.r.atsl.a for other combustible materials in Lhe area.
SVEC:IAL FIRE FIGHTING PROCEDURZS3 Evacuate personnel. Lv i safr area. Keep personnel
removed and upwind of tire. Wcox :pelf-c-onta.ined breAtl+in, alaparatus.
6. ACCIDENTAL R}2t SUS XgAuVRt S.
SPILL OR LEAK PROCEDURES.......... . . . Use appropriahA PERSONAL PROTECTIVE EQUIPMCNT
during cl-aan up, nikP Spi11. Prevent liquid from entering aewers, watcrwayr„ or
low :areas. soak up with sawdust, sand, Oil diry or other absns•kwnt•. material. Vor
disposal see section 13
7. . HANDLING AND STORAQZ:
$TORAGE TEMPMTURE(MIN/Mnx) : Storw between 40 F (4.4 C) and s0 p (26 C) .
Prefcrrcd storage in at AR F (24 C) .
S14ELF i,TPF..... . . ...—...... Not Established
SPECIAL 3ENSITIVIVf.....—...,: K,.4p Prom 2reezing.,-
ILANDLINC/STORAGE PRECAUTT.ONS: AVOid eye and skin contact, and store in weil-•vexrtil.ai,ed
arwa. Kccrp conra:iner ri.ghrly closed. Do not store with iacumpaLiblc materials, no
not store or consume food, drink or tobacco in area where they may become
contaminated with this.material . For incompatibles see section. 10.
OTPE:R. NrTFS. . .... . .... . ....,. Keep out of the reachoof children.
S. PERSONAE. PROTECTIt1Ns
PR(YPXCTIv!.' CLUrRING REQUIREMENTS-, Splash protection rC:i.uirnd fo.-r eyp.c, e.q., eye
glasses with side shields or UuUUIes. b'or skin protectirn use chemical resistant
gloves and ayrwu�; e.g. made of neopronas, rubber or vinyl.
V.ENTILATIUN R8QUSRRM'RNT-9—..;.... .....: Use sufficient :tgvn4 al room v+ nt.ilation
and/car local exhaust to ftintain airborne levels of v.'gxjrLi below applicable
exposure limits (see Section 2) .
RF..S:IRATOR. REQUIREMENT'S. .. .... „ ,: Unger normal conditions of use, re.s_y ruLov
protection ins not rsqul:rAd.. If respirators are used; laotituta a Program
hi accordance with OSHA standard 291-'VR1010.134,
9. PHYSICAL AND CARKICAL PROPgA'!IES:
PHYSICAL FORM. .. ... .... . .. . Liquid
COLOR. ..... .......... . . . .. Yellow
ODOR.... . . . ... . . . . . Faint Odor
CPR _ .. . ~6"
71.2c.001 Approval date: 01117f2003
Page 2 of 4
BOILING POINT.. . . . ..... .. . Greatex than 212 F (1.00: C.')
MELTINC/FREEZING POINT....:. 800.ow 32 F (0 C)
SOLUBILITY IN WYfER ..... Soluble
SPZCZVZC GRAVITY . . ......... 1.05
BULK DENSITY. . . . . . . ... . . . .. : NOr rtipp.liCAKA
VAPOR PR SSURH Not Established
10, STABILITY AND REACTIVITY4
STABILITY.. .. ..... ..... .... This is a stable material-"
11121MOUS POLYMERTZATION...` Will not occur.
INCOMPATIBILITIES. .... .. ....: Strong bares oxidtzorg
INSTABILITY GCONDITToNS.. ....; None: known.
llEcOMPOSIT'ION PRODUCTS. ... .., CO. CO2, oxldbs of :nitrogeri amA ol-tik-r potentially toxic
iumuu.
11. TOXICOLOGICAL INFORMATION-
NO ANIMAL TOXICITY INFORMITTON AVA LABLE,
12. ECOLOGICAL: INFORMATION: - -
NO ECOLOGICAL 1NFO9MX'ftQN AVATLA&LE
13. DISPOSAL comsi?ERATZONs
WASTE DISPOSAL METHOD. . ... . .: RactovAr-nonusaole free liquid and/or couLam.i-,"iLcd
water, and dispose of in an appxr.)ved quid permitted tra.ar..mrnt jsyerem
nemovu nQ."uWable 1 r lid( muter a.T. And/or contaminated soil, .for disposal in
an mj.j)r-c)vf rd arid permitted• land.fill. Discharge to sewer may require
a 'proval of permitting authority and uuiy•.rcquixe pretreatment.
14. TRANSPORTATION INFORMATION:
`PFTWNTCAL SHIPP= 'NAME.... ... .: Not'Afpylicatale
PRODUCT LABEL... .......:.. ...... : Saphira Violet Pin Fitisher
DOT (DOMESTIC SVPZFACE):
HAZAnD CLAY OR DIVISION Mon-R+�c �.1-ar.eci
IMO / TMDG CODE. ('MAN)
--------------------
HA'ZF.RV (:LA88 PIV ST(1N NITMBER.. _: Non�Regulated
ICAO / IATA (A,r"R).
-----------------
HASAML) CLA a:3_0INT.8TOW NUMBER... Non-Regulated
11, REGULATORY TXFORKATSON;:
OSHA STATUS,> . . . . . . . . . .. . ..... This product is hawardvuu wide: the c-riterie� of
Lilo Pedcrsl OSHA Hazard C`Ymnunicat:ion atanda.d 29
C:FR 1910..1300.
T_vCA V.rA'1U8... , . , ,, On TSCA Inventory
,2FR.CLA REPOP.TADLE .OUANT TY...: None
Z-ARA TITLE III:
SECTION 302 RXTb Km4LY
WA7.ARW,(TS SUBSTANCES..: None
SECTION 311/312
1MZARD CATECORIES. . .. . : TrftAdiate Realth hazard
ECTTTQN 313
TOXIC 04SMICr3LS.., None.
712c,U01 Approval Bate: 01/17/2001
Page of 4
1
RCRA STATUS. . ..' .. ..... in ice purchased form, this product
would not be a hazardous waste either by listing
or by characteristic. However, under RCRA, it is
the responaibili4y of the yroduc;t uaOr to
determine at t}1e time of dixPnctal, whether a
material containing the product or derived from
the product should be classified as a hazard""
wajLe, (40 CFR 261..:20-:24)
The following chemicals are specifically listed by individual states, other
product specific health and safety data .in ciCtier uC4tiono of the M808 may also
be agylicauiu for 0t.ate requirementn. Fcyr ARrails. an.your regulatory
rerr,irements you s'hnuld contact the appropriate agency in your jtate.
COMPONENT NAME
/C.AS NUMBER C:C%N(!*rPPATT0N STATE CODE _
'dater
7732-16-5 80 - 90 $ PA3, NJ4
Maltodextrin
-9050.36-6 5 - 10 V PA3, NJ4
PO=yethylene glycol
2$322 68-3 5-1.0 PAS., NJ4
floc-Issiaam NitratA
7557-73-i 1-.5 PAI,, MA, rill
,t3A Massachusetts Hazardous Substance Li,ol:
:till - New Jersey HazardQus Subat�uacc Liot
IJ4 New Jersey Other - :ir,r-lurlod in s predominant ingredients > I
"Al .Perdlrylvariia 'Razardnua Substance List
PA3 Pennsylvania lion-hazardcus present at Tt or ureutcr,
16.. OTXER INFO3ZMATION s
HIS RATINGS: Heulth ?lammability. Reactivity PitrAanal Prot
1 0 0 B
O=Minimal 1-43ight 244oderate 3=$eTioxi 4=$mvt rt:
B=Sat'ety Gldsu a' CIOvc3
Heidelberg's method of hazard communication is comprised. of Product Lrrbeic anti-
Material Safety Data Sheets., HMIS ratings are provided by 4ir i InIherg a3G a cuntomer
sa:vice.
RRASON FOR ISSUE. .. .... . . Change::in compcsiticn
PREPARED BY. ... .. ... Shannon Simpson
APPROVTD BY. . ... . ... . . . . M1ko i�atrick'
APPROVAL 'OA'.CR.. . . . . .. . . ... :' 01/17/2001
SUPERSEDES DATE. .. ......... . 06/13/2002
MSDS NLhtBER. . .. . . . . . . . .. ... 34515
','hie informAtion iA Furnished without warranty, expre-used vx implicd, except
that it is accurate to tkva best kuvwlud�;ie of He delberg I,1.Sle corporation. The data on
this sheet relates only. ta the SpeGi:Ii[ material designated' here n. Heidelberg USA
Corporatiuu a4uu nc3 no, legal refponAihili:ty for use or reliance upon these
data.
712c,001 Approval Bate: OIA7/2003
Page 4 of 4
i
LLB1.
-
sty
�
,fix .�+ ..`.-A, +r�,,t;,_��s.°,o- S,:% G,,..�,�•ice
AAE2 A '
6 X .7t a�;f. -.. '•R r.`,.:, 4:,.•s,. ,sr•-• i^,'+r=.:,_,;F i+9.+`1c.a'-::
30TTCHER ALCOHOL REPLACEMENT 30.03
I:CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
Jlanufacturer. Bsttcher America,Inc. Product Name: BOTTCHER 3003
36ttcher America,Inc.,4600 Mercedes Drive, Belcamp,MD 21017
?roduct Number.23046 Date Prepared: 00/0/12005
Customer Information Phone•Number. 11410-273-7000
CHEMTRECO:24 Hour Emergency Transport Phone Number: 1-800-424-9300
3'E COMPANY:24.Hour Medical Emergency Phone Number: 1-800.451-8346
2.' COMPOSITIONIINFORMATION ON INGREDIENTS
Chemical Name CAS- OHSA PEL ACGIH TLV Weight% .
2-BUTOXY ETHANOL 111-76-2 120mg1m'TWA 121 mglm3 50-70
ETHYL-2-HYDROXY-PROPIONATE 97-64-3 N.E. N.E. 30-40
3s HAZARDOUS IDENTIFICATION
Emergency Overview:WARNINGI This product is combustible.
POTENTIAL HEALTH EFFECTS
Eye Contact:Causes severe irritation and burns, experienced as discomfort or pain, excess
blinking and tear production,with marked excess.redness and swelling.
Inhalation:High concentrations of vapor cause Irritation to the respiratory tract, experienced as
nasal discomfort, discharge, chest pain,and•>oughing;Headache, nausea,vomiting, dizziness,
and drowsiness may occur. -
Ingestion:� Moderately toxic.May cause headache,dizziness,in coordination,nausea,vomiting,
diarrhea and general weakness. Ingestion of significant quantities may result in red blood cell
hernolysis.
Skin Contact:May cause irritation or reddening with itching: '
Signs And Symptoms Of Exposure: Eye irritation,'respiratory irritation',central nervous system
depression, dermatitis,.difficulty.breathing, nausea, diarrhea, headache, blood in the urine,
kidney and liver damage.
4.FIRST AID MEASURES
Eye Contact:Immediately flusheyes with.plenty of water for at least 15 minutes while holding
eyelids apart. DO NOT remove contact lenses,if wom.' Get immediate medical attention,
preferably from an ophthalmologist.
Inhalation:Remove to fresh air. If not breathing, give artificial respiration. If breathing is difficult,.
give oxygen. Get medical attention immediately.
Ingestion: Seek medical attention or contact a poison control center for advice about whether to
induce vomiting. If conscious,give two.glasses of water.If individual is drowsy or unconscious,
do not give anything by mouth. Place individual on left side with head down.
Skin Contact:Wash skin with soap and water. Wash contaminated clothing before re-use. Get
medical attention if irritation or allergic reaction develops.
Aggravated Medical Conditions: Skin contact may aggravate an existing dermatitis.
Supplemental Health Information: None of the components in.this product is listed by IARC, NTP,.
or OSHA as carcinogen.
y'13�ttcri rAtb.f b. lacerpenl
� .� - - -
�'iM;4.F � �ti "+.;'ii.i ., ��n•� -..3 _> _. _ �r r�:_5....,_.:Fkc::'• 3 .. -
:L�.LCSn i'c.- �f:% �1:.i lvn~• K�•i''r^�Y_'�.�,f� f!iy'!._•iS`' fi
s.:.'.,�ir �'rr�++�;.5.:.1�a-yi..i*.,,7.''-''•^.-3 '.,'�cf��7:K�7`t.�'3i..a ,�}.S7:S:: 1'''. . ,Rf.-,`±°y
tE FIGHTING MEASURES
:MABLE PROPERTIES
,Point: >61°C- Flash Point Method:TCC Auto ignition: N.E.
IA-(2-butoxy ethanol) UEL: 0.6
Wishing Media:Apply alcohol-type or all-purpose-type:foam, carbon dioxide or dry chemical
ial.Fire-Fighting Procedures: Firefighters should wear proper protective equipment and self-
,ntained breathing apparatus with full-face piece in positive pressure mode.Move containers .
)m fire area if it can be done without risk. Use water to keep fire-exposed containers cool. Do
►t direct a solid stream of water Into hot, burning pools; this may cause frothing and increase
e intensity.
;ual Fire And Explosion Hazards: Combustible liquid.The components in this material may
'oduce a floating fire hazard in'extreme fire conditions..
bustion Products:Carbon monoxide and carbon dioxide.
CCIDENTAL RELEASE MEASURES
s To Be Taken In Case Material Is Spilled-Or Released: Eliminate all sources.of ignition
iding pilot lights.Review fire-and explosion hazards and safety precautions before proceeding
cleanup. Use appropriate personal protective equipment.Avoid contact with skin and eyes.
the spillage. Dike the spill. Prevent liquid from entering sewers,waterways or low.areas, .
orb spillage in inert material. Soak up with sand, or soil. Remove non-usable solid material
for contaminated soil for disposal in an approved and permitted landfill. Discharge to sewer
sires approval of permitting authority and may require pre-treatment.. Recommend incinerate in
mace where permitted.
`IANDLING AND STORAGE
!cautions To Be Taken In Handling And Storage:Combustible. Store in a cool, dry,well
itilated area. Keep containers closed. Do not store with incompatible materials. Do not store or
2sume food,drink,or tobacco where they may become*contaminated with this material.
ier Precautions: Containers of this material may be hazardous when empty since they may
stain.product residues (vapor,liquid, and/or solid).All labeled precautions must be observed
ien handling, storing and transporting empty containers.due to product residues. Do not reuse
stainers.Triple rinse before disposal. Dispose of in a licensed facility.Recommended crushing
other means to prevent re-use: Store separate from oxidizing agents.
•ocess Hazard: Sudden release of hot oiganic chemical.vapors or mists from process equipment
)erating at elevated temperatures and pressure, or sudden ingress of air into hot equipment
ider vacuum, may result.in ignitions without the presence of obvious ignition sources.
EXPOSURE CONTROL/PERSONAL PROTECTION
ERSONAL PROTECTIVE EQUIPMENT
respiratory Protection:A self-contained breathing apparatus is recommended when handling the
concentrated product in high vapor.concentrations.
fentilation: Local exhaust ventilation is recommended.Ventilation must be adequate to keep
hazardous ingredients below their exposure limits and.to prevent vapors escaping into the
workplace air.
'rotective Gloves: Butyl gloves are recommended.
.ye Protection: Safety.glasses with side shields (or goggles),
ether Protective Clothing or Equipment: Rubber apron.
`y;.8ottah"60iq`(=i 0 IWtiWO003:-
iygienic Practices: Use good personal hygiene when handling this product.Wash hands
Br use, before smoking or using the toilet
tering Controls: Facilities storing or utilizing this material should be equipped with an
:wash facility and a safety shower.
Lire Guidelines: See Section 2.
YSICAL AND CHEMICAL PROPERTIES
.rance And Odor. Clear liquid, specific smell. Solubility In Water: Miscible
I�P_oint_153-1710 C- Vapor Pressure: 1.2 min Hg Specific Gravity: 0.94
g Point:Not applicable Freezing Point N.E. Evaporation Rate: N.E.
Density: Heavier Than Air Percent Volatile: 100 Ph:Not applicable
ular Weight Not applicable Pounds Per Gallon: 7:87 Other Properties:
. is 944.0 g/L or 100% or 7.87 lb. /gal.
TABILITY AND REACTIVITY
ity - Stable
itions To Avoid: Do not distill to dryness. High temperatures in the presence of strong bases.
ipatibility: Strong alkalis,strong.oxidizing agents, and acids.
rdous Decomposition Or By Products: Carbon dioxide and carbon monoxide.
rdous Polymerization:.Will Not Occur.
titions To Avoid: None known.
(OXICOLOGICAL INFORMATION
_COLOGICAL INFORMATION
DISPOSAL CONSIDERATIONS
ierate in a furnace where permitted under Federal, state,.and local regulations.At very low
:entrations in water,the glycol in this product is biodegradable.in a'biologicai_wastewater
tment plant.
TRANSPORT INFORMATION
material is regulated by the U.S. Department of Transportation(DOT) only when transported
ulk container shipments of greater than 149 gallon capacity. Reference 49.CFR 172.504(f)(2).
never,pursuant to 49 CFR 173.150(b),"limited-quantities"offered for transport via aircraft may
subject to DOT regulation.
'non-bulk shipments less thaml19 gallons: For Bulk shipments greater than 119 gallons:
iT Class: NOT REGULATED DOT Shipping Name: COMBUSTIBLE LIQUID, N.O.S.
zard Class:NOT APPLICABLE (Contains Ethyl Lactate and 2-Butoxy Ethanol)
1 No.: NOT APPLICABLE Hazard Class: COMBUSTIBLE
,eking Group: UN No.: NA 1993
ride No: Packing Group: III
Guide No.: 128
ate:; .;1%0.5 .rv� - BotteFi � _'aefici= Via. "trdehk0iD3..__`:; Pa
.. -..�:�u`Ev. .., . -is"'tiy Hra. r.-:t�c_,;yi{•: ..,.�zf��iy..=°•,^w,��-.,�.'„��,t q�� _�,�,�..;:,.t�:?+�'?it�.:�citay.-. ������ '...
i.•REGULATORY INFORMATION �,'.••
3CA:All ingredients in this finished product are listed on the EPA TSCA INVENTORY.
%RA TITLE III:This product contains 2-Butoxy Ethanol which is listed under Sara Title 313.
'kLIF. PROP. 65: NONE
NRCINOGENICITY: NONE OF THE COMPONENTS IN THIS CHEMICAL IS LISTED BY IARC,
FP, OR OSHA AS A CARCINOGEN.
CAQMD Rule 443.1
lotochemicaily Reactive: No
aximum Grams of VOC per Liter. 787gm/L
3por Pressure: 1.2 mm Hg@ 20 Degrees C
:. OTHER INFORMATION (HMIS)
ealth`. 2
lammability: 2
eactivity: 0
�otective: C
1THER ADDITIONAL INFORMATION:The information can herein is based on the data
vailable to us and is believed to be accurate.However, no warranty is expressed or implied-
�garding the accuracy of this data or the.results lobe obtained from the use thereof:We assume
o responsibility for.the injuries from the.use of the product described herein.
- a.�_,..��tom.• o(tChlcI� j, y'acernen�3D03
Page .4�'4
Material Safety Data Sheet ���'Saphira Violet Plate Developer
SUSID:000000011739
Version 1 Print Date i_2 2 2100";
Revision Date 02-09-2007
= SECTION 1. PRODUCT AND COMPANY IDENTIFICATION
Identification of the substance/preparation
i g ; Product name Saphira Violet Plate
MSOS Number 000000011739
Use of the Offset plate developer concentrate
S u b st a n c e/P reparation
Product code ELNJL, LXAZW, P4KLK, LXELK
Synonyms Saphira Violet Pro Developer
Business group GS
Company/Undertaking Identification
Distributed By: Manufactured By:
Heidelberg USA,Inc. Agfa Corporation
1000 Gutenberg Drive NW 100 Challenger Road
Kennesaw; GA 30144 Ridgefield Park, NJ 07660
Transport Emergency Non-transportation
Call CHEMTREC +1 800 4249300 Health Emergency Phone +1 303 6235716
International.-+1 703 5273887 Agfa Information Phone: +1 201 4402500
SECTION 2.COMPOSITION/INFORMATION ON INGREDIENTS
i -
CAS-No. Concentration 10%]
® Sodium sulphite 7757=83-7 >= 10.0 - <=20,0
Hydroquinone 123-31-9 >= 1.0 - <=5.0
Sodium hydroxide 1310-73-2 >= 1.0 - <=5.0
Water 7732-18-5 >= 80.0 - <=90.0
SECTION 3. HAZARDS IDENTIFICATION
The product as a whole has not been tested. This hazard information is for the individual ingredients. '7
Emergency Overview
Form Liquid
Colour Colourless.
Odour Odourless.
DANGERI
Corrosive.Irritating gases/fumes may be given off during burning or thermal decomposition.
May cause respiratory tract bums. May cause allergic respiratory reaction. Causes skin irritation.
May cause allergic skin reaction. May cause eye burns.
Potential Health Effects
Primary Routes of Entry Eye contact. Skin contact. Inhalation of vapours or mists.
Accidental ingestion.
Aggravated Medical Condition : Persons with preexisting eye,skin or respiratory tract disorders
may be more susceptible to the.effects of this product.
Acute health effects
REG NOAM 1/8 EN
r
Inhalation
Sodium sulphite Is expected to-be irritating to the respiratory tract with
symptoms of coughing,sore throat, and runny nose. May
cause an allergic reaction in some asthmatics and sulfite
sensitive individuals. Possible symptoms include
bronchoconstriction, sweating,flushing, hives, rapid heart rate,
decreased blood pressure and anaphylaxis.
Hydroquinone Is expected to be irritating to the respiratory tract with
symptoms of coughing,sore throat, and runny nose.
Sodium hydroxide Can be irritating to the mucous membranes and respiratory tract
with symptoms of coughing,sore throat and shortness of breath.
Skin contact
Product:Can be irritating to the skin with symptoms of reddening, itching,and.swelling.
e Sodium sulphite May be irritating to the skin with symptoms of reddening and
itching. May cause.skin sensitization with symptoms of rash,
itching, hives, and swelling.
Hydroquinone Can be irritating to the skin with symptoms of reddening,
itching, and swelling. May cause skin sensitization with
symptoms of rash, itching, hives, and swelling.
Sodium hydroxide Can be severely irritating to the skirl resulting in burning,"
reddening, swelling and blisters.
Eye contact
• Sodium sulphite May be irritating to the eyes with symptoms of reddening,
tearing and stinging.
• Hydroquinone Can be irritating to the eyes with symptoms of tearing,stinging,
reddening, and swelling.May cause corneal injury.
• Sodium hydroxide Can be severely irritating and corrosive to the eyes resulting in
burning, reddening,swelling of the eye and surrounding tissue
and possibly permanent injury to the cornea.
Ingestion
o Sodium sulphite May cause gastrointestinal irritation.
• Hydroquinone May.be harmful if swallowed with symptoms including nausea,
Vomiting, drowsiness,dizziness, disorientation,bluish skin
color,and.stomach pain.
Chronic health hazards
Inhalation
e Sodium sulphite Repeated or prolonged exposure may cause an allergic
respiratory reaction in previously exposed individuals.
• Hydroquinone May cause pulmonary edema with symptoms of breathing
difficulty and tightness of chest,
Skin contact
m Sodium sulphite Repeated or prolonged skin contact may cause allergic
reactions with susceptible persons,
• Hydroquinone Chronic intensive skin contact may cause dermatitis.
Eye contact
Hydroquinone : Contact may cause brownish discoloration of conjunctiva and
comes. Repeated or prolonged.eye contact may cause
photophobia(sensitivity to light). Repeated exposure may
cause intolerance of the eyes to light.
Carcinogenicity
The components of this product are not listed by NTP, IARC or regulated as a carcinogen by OSHA.
REG NORM 2/8 EN
44
4
SECTION 4. FIRST AID MEASURES
Eye contact Rinse thoroughly with plenty of water for at least 15 minutes
and consult a physician.
Skin contact Wash immediately with plenty of water.and soap. If symptoms
persist, seek medical advice.
Ingestion Rinse mouth with plenty of water.Seek medical advice.
Inhalation Take person to fresh air. If necessary, seek medical advice.
SECTION 5.FIRE-FIGHTING MEASURES
Suitable extinguishing media All extinguishing media are suitable.
Specific hazards during fire In case of fire,thermal decomposition with emission of
fighting hazardous fumes is possible(e.g. S02).
Special protective equipment Firefighters should be equipped with self-contained breathing
for fire-fighters apparatus to protect against potentially toxic and irritating fumes.
Additional advice i c Product is not combustible:
SECTION 6.ACCIDENTAL RELEASE MEASURES -
Personal precautions See section 8.
Environmental precautions For waste disposal see section 13.
Methods for cleaning up Dike the spill if necessary, Soak up with absorbent material.
Collect large spills into a properly labelled and sealable
container. Prevent release into the drain,soil or surface water.
Additional advice Wash away residues with plenty of water.
SECTION 7. HANDLING AND STORAGE
j
Storage.
Advice on common storage Store away from strong acids and strong oxidizing agents(e.g.:
sodium hypochlorite).
Requirements for storage Keep container tightly closed. Protect from direct sunlight,
areas and containers
SECTION 8.EXPOSURE CONTROLS/PERSONAL PROTECTION
Exposure Limit Values(US.)
Components CAS-No. Values ! Type Revision Basis
• I
Date
Hydroquinone 123-31-9 2 mg/m3 TWA 2002 ACGIH
2 mg/m3 PEL 061993 OSHA Z1
2 mg/m3 TWA 1989 OSHA Z1A
1 mg/m3 TWA 012006 ACGIH NIC
Sodium,hydroxide 1310-73-2 2 mg/m3 CEIL 2002 ACGIH
2 mg/m3 PEL 061993 OSHA Z1
2 mg/m3 CEIL 1989 OSHA Z1A
Exposure controls
Hygiene measures Observe normal precautions when handling chemicals,Avoid
inhaling vapour.Keep away from foodstuffs, drinks and tobacco.
Respiratory protection Appropriate respiratory protection and/or exhaust locally.
Under normal conditions of use, respirator protection is not
required. If respirators are used, institute a program in
accordance with OSHA standard 29CFR101 10.134.
Hand protection Use chemical resistant gloves. In case of prolonged immersion
or frequently repeated contact use gloves made of the
materials:butyl rubber(thickness>=0.36 mm,breakthrough
REG NOAM 3/8 EN
time>480 min), nitrile rubber(thickness>=0.38 mm,
breakthrough time>480 min)or neoprene(thickness>=0.65
mm,breakthrough time>240 min).For intermittent splash
protection corresponding gloves with breakthrough times>60
min can be used.Avoid gloves made of: natural latex.
Eye protection Safety glasses.
Personal protective Employees should wash their hands and face before eating,
equipment drinking,or using tobacco products. Educate and train employees
in the safe use and handling of this product. Emergency showers
and eye wash stations should be available.
SECTION!9.PHYSICAL AND CHEMICAL PROPERTIES
Form Liquid
Colour Colourless.
Odour Odourless.
Vapour pressure 23.00 hPa at 20°C(68'F)
Relative density 1.144 at 20°C(68 OF)
pH'(25'°C 77-`F) _ =_ 12.7 ( vU�
Melting point/range <0°C (<32°F)
Boiling point/range > 100"C(> 212 OF)
Relative vapour density Not applicable
Flash point Not combustible.
VOC content 2.6%;VOC content excluding water
SECTION 10. STABILITY AND REACTIVITY
Stability , The product is stable under normal conditions of storage and
1
-use. 1
Hazardous decomposition Hazardous decomposition products
products Sulphur dioxide
Thermal decomposition : Not applicable
Conditions to avoid Avoid contact with strong acids and strong oxidizing agents
(e.g. sodiumhypochlorite).Remove all chemicals and rinse the
processing tanks thoroughly with water before using any
cleansing products.
SECTION 11.TOXICOLOGICAL INFORMATION
Toxicity data specific for individual ingredients in their pure state:
Acute oral toxicity
• Sodium sulphite LD50 rat 3,560 mg/kg
® Hydroquinone 11350 .rat: 320_mg/kg_.
Sodium hydroxide LDLO rabbit 500 mg/kg
Acute dermal toxicity
r Hydroquinone LD50 cat 5,970 mg/kg
Carcinogenicity
Hydroquinone Formation of benign kidney tumors occured only after
nephropathy developed and only in one strain of male rat.
Additional effects have been reported,Although an increase in
leukemia was reported in the female F-344 rat,this result was
not reproduced in a subsequent study. There was no evidence
of cancer in male mice following chronic oral administration..
Increases in primarily benign tumors were noted in female
mice,although this finding was not reproduced in a subsequent
study. No tumors were reported in mice following long-term
dermal application.
Toxicity to reproduction
RE.G NOAM 4/8 EN
If
a Hydroquinone : Has not caused reproductive effects in male or female animals
when administered orally at.dose levels not causing systemic
toxicity in the mother.
Mutagenicity
Hydroquinone Studies using the'Ames'test were generally negative.There is
some evidence for mutagenicity from studies in animals, in
isolated cells taken from animals and plants, and in other
microorganisms. T
Teratogenicity
• Hydroquinone Has not caused birth defects when administered orally at dose
levels not causing systemic toxicity in the mother.
Chronic toxicity
Hydroquinone Adverse kidney effects have been observed primarily in one
strain of male rat(F-344).following chronic administration of
oral doses. Nephropathy did not occur in two other strains of
rats,mice,or dogs.
Other information
There is insufficient scientific evidence for classifying hydroquinone as a suspected carcino-or
mutagenic substance in humans. Epidemiologic studies over a.period of 48 years;wherin-during
manufacturing and use of hydroquinone-more than 800 human individuals were daily exposed at
significant airborne concentrations(greater than the occupational threshold of 2 mg/m3),
demonstrated that such exposure is not associated with the induction of cancer in humans.
Hazard labelling of this preparation: see section 15.
SECTION 12, ECOLOGICAL INFORMATION
Elimination information(persistence and degradability)
Biodegradation
Hydroquinone OECD 301 D Assessment of biological degradability
>80%after 28 d
Ecotoxicity effects
Ecotoxicity data specific for individual ingredients in their pure state:
Toxicity to fish
•Sodium sulphite Species: Leuciscus idus(golden orfe)
LC50:>220 mg/i/96 h
.Hydroquinone Species:Brachidanio rerio(zebra fish)
LC50: 0.1 mg/1/96 h
•Sodium hydroxide Species: Leuciscus idus_(golden orfe)
LC50: >.133 mg/l/48 h
Toxicity to daphnia
•Sodium sulphite Species: Daphnia magna(water flea)
EC50: 273 mg1U 48 h
•Hydroquinone Species: Daphnia magna(water flea)
EC50: 0.3 mg/l/48 h
•Sodium hydroxide Species: Daphnia magna(water flea)
EC50: > 100 mg/l/48 h
Toxicity to algae
• Hydroquinone Species: Selenastrum capricornutum(algae)
EC50: 0.3 mg/I/72 h
Toxicity to bacteria
•Sodium sulphite Species: Pseudomonas putida(bacteria)
EC50: 770 mg/l/17 h
REG NOAM 5/8 EN
SECTION 13.DISPOSAL CONSIDERATIONS
Waste disposal methods
Waste disposal should be in accordance with existing federal,state and local environmental control
laws. Discharge to sewer may require approval of permitting authority and may require pretreatment.
Empty containers.
Recondition or dispose of empty container in accordance with governmental regulations.
US. RCRA Hazardous Waste Classification(40 CFR 261) �r
When discarded in its purchased form,this product meets the criteria of corrosivity, and should be
managed as a hazardous waste(EPA Hazardous Waste Number D002).t
SECTION 114.TRANSPORT INFORMATION
CFR ROAD
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class : 8
Packing group III
Labelling No. 8
CFR RAIL
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group III
Labelling No. 8
CFR_INWTR
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group III
Labelling No. 8
TDG_ROAD
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group 111
Labelling No. : 8
TDG_RAIL
UN-No : 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group : III
Labelling No. 8
TDG_INWTR
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group Ill
Labelling No. 8
IMO J IMDG
UN-No 1824
Proper shipping name SODIUM HYDROXIDE SOLUTION
Class 8
Packing group
Labelling No. 8
REG NOAM 618 EN
fFa s
r '
EmS F-A,S-B "
ICAO I IATA cargo aircraft only
UN-No > 1824
Proper shipping name Sodium hydroxide solution
Class 8
Packing group Ill
Labelling No. 8
Packing instruction 821
� I
ICAO 1 IATA.passenger and cargo aircraft
UN-No 1824
Proper shipping name Sodium hydroxide solution '
Class 8
Packing group III
Labelling No. 8
Packing instruction 819
SECTION 18. REGULATORY INFORMATION
U5.Toxic Substances Control Act(TSCA) - E
All of the components of this product are listed on the TSCA Inventory.
US,OSHA Classification
This product is hazardous under the criteria of the Federal OSHA Hazard Communication
Standard 29 CFR 1910.1200.
US.EPA Emergency planning and Community Right-To-Know Act(EPCRA)SARA Title III
Section 302 Extremely Hazardous Substance(40 CFR 355,Appendix A)
m Hydroquinone - Threshold planning quantity, lower value:500 Ib5
Threshold planning quantity, upper value: 10,000 Ibs
US.SARA 311/312 Hazard Categories
Immediate Health Hazard,
US.EPA CERCLA Hazardous Substances(40 CFR 302)
v Hydroquinone Reportable quantity: 100 Ibs
.. Sodium hydroxide,- - Reportable quantity: 1,000►bs -
US.California Prop.65
This product does not contain any chemicals known to State of California to cause cancer,_birth
defects or any other harm.
State.Right-tow<now Information ,t,
The following chemicals are specifically listed by individual states. Other product specific health
and safety data in other sections of the MSDS may also be applicable for state requirements. For
details on your regulatory requirements you should contact the appropriate agency in your state: s
US. Massachusetts Commonwealth's Right-to-Know Law(Appendix A to 105 Code of.
Massachusetts Regulations Section 670.000)"
CAS-No. Concentration [%l
'H'ydroquinone 123-31-9 >= 1.0 - e <=5:0
® Sodium hydroxide 1310-73-2 >= 1.0 - 5.0
r US. New Jersey Worker and Community Right-to-Know Act(New Jersey Statute Annotated
Section 34:5A-5)
CAS-No. Concentration 1%]
Sodium hydroxide 1310-73-2 >= 1.0 - <=5.0
US. Pennsylvania Worker and Community Right-to-Know Law(34 Pa.Code Chap.301-323)
CAS-No. Concentration [%]
u . ' REG—NOAM 718 EN
a Hydroquinone 123-31-9 >_ 1.0 - <=5.0
® Sodium hydroxide 1310-73-2 >= 1.0 <=5.0
US. Rhode Island Hazardous Substances Right-to-Know Act(R.I.Gen. Laws Section 28.21-
1 et.seq.)
GAS-No. Concentration rib]
Hydroquinone 123-31-9 >= 1.0 <= 5.0
Sodium hydroxide 1310-73-2 >= 1.0 - <=5.0
US. Massachusetts,New Jersey, Pennsylvania or Rhode Island Right to Know Substance
Lists:See Section 2.
Canadian WHMIS Classification
D1 S : Toxic Material Causing Immediate and Serious Toxic Effects
E Corrosive Material
Canadian Environmental Protection Act(CEPA)
i
All components of this product are on the Canadian DSL list.
SECTION 16.OTHER INFORMATION -.
US. HMIS Rating
Health 3
Flammabilit 0
Reactiy ity................._............................................................................ ..._...__:._
(0= Minimal, 1 = Slight,2=Moderate, 3=Serious,4=Severe)
US, NFPA 704M Rating
Health 3
Flammability 0
Reactivity 0
(0= Insignificant, 1 =Slight,2= Moderate, 3=High,4=Extreme)
Agfa Corporation's method of hazard communication is comprised of Product Labels and Material
Safety Data Sheets. HMIS and NFPA ratings are provided by Agfa Corporation as a customer service.
This MSDS is replacing Agfa MSDS number 745G.002
Section(s)changed compared to the previous issue: 1,7, 16
This information is furnished without warranty,expressed or implied,and is believed to be
accurate to the best knowledge of.Agfa Corporation.The data on this MSDS relates only to
the specific material designated herein.Agfa Corporation assumes no legal responsibility for
use or reliance upon these data.
REG NOAM 8/8 EN
7/20119 14:47 5087717738 SUNDERLAND PRINTING PAGE 02/03
MATE,RIAL SAFE TY DATA SHEET
;.
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SLn![]OR EPIUNTING M COMPANY,INC. JNFOIZMAIFION PHONE: (20',.) 47&.5600
1QC11_�Q:�i1.�.�II T SSTREETEMERG 'KFCY PI',ION,E: (20'.) 47'5-5600
'"'!i T)C,71":;;i;CrJ�lf:®9 NJ 0`1608 DATJ1?,PREPAREA: Nn�'ernber 15,2007
I-iMIS: H1 _rl_ RO
y;;• i
FIRO'Ol;CT CLASS: Oxidizing Offset[nlcs
1 RAIDL N.a.M.R: Elite LT Process Ink
PRO.�LDIU("1 NUMBER: YC-3091;YC-3144IR/Sl;DRD-9029;DRD-9'117(13/S):MBE-/1 a�1;AE-332
SECTION II—HAZARDOUS C0Y0NE_,q TS
1 This product is not considered hazardous under the OSHA Hazard Communication Standard,2{)CIrR 19i0.1:'00.
SECTION III—PHYSICAL DATA
1� O'tr ,'.V.I tlfh:ulYTU,A1 ' .j'.':;.' •a'A.•`'Wl.,'k'�? _
t z i9 I 0111J11t Ului Scl9..L`,�JE( I+Ya 520-57Q I i v '"G „ I II 1' I I rrk`p+�u,�l •:
( ; V. ,'i?!+)v0)er BENS "Plr°v'S.AIR: FFleavier Ydd4&w da � 91✓xx9 firm s141z' La754:I,q L
$ 1LII�F�lIIl1 IDIF;I�uITY Vv.WATER: Heavier
EgrAP(Auk'ICIfDvmn,VS.BUTYL ACETATE: Slower .se¢�,�oca�vi4�r 0.97? 0:9.77 1,023 1.0., 1.008 �1.03
! 8k ks�,,` UUKILiK"§-4'IN 4WA`6'1L11Z: None
'.�oS��i 5.13 3. 3 Q _ y.5z 5 2 9.•40 8.6:
SOL
in,PE0k�C �It Crqu
olored
d PasteAFFEA&I 1i ails i bm� i 1.67 1.6'6 2,30 2,15 1.66 IS -
k Fy g*^a re"u JAW I,1771,8S rsruu;xl,ard wing SPA Method 24 �Ynt+iviln?ltli.r 20.52 20.,71 26,96 25.18 19.78 21.6
SECTION IV—FIRE AND&;ail LgS� ION D!kTA
rF ` ;rjij! OSHA. CLASS III B DOT: Not Regulated ,FLASH.PT.(OF) >200 LPL- >\Io Data
„ I 1 (Methad used): SETA.C.C.
'TIN�IMI,SHII:NG MEDIA- Use fog, foam,CO2 or dry chemical
i<{' UNUSUAL lI)<I7I AND EXPLOSION HAZARDS: Dense smoke may be generated when burning,
I 1:,;
i ir s I
krh4; 9? C YAL-FIRR FIGHTING PROCEDURES: Fire fighters should be equipped wIT11 selF-4:ontained breathing ,a11pzrih w nY►d turns it
1ci ;gent. �F,:tt�r >kvfty may be used to cool closed containers to prevent pressure build-up ana•II po.mble auto-ignition when exposed a
I a � �'� e-DL rye heat. When water is used fog nozzles are referable,
SECTION V—HEALTH HAZARD DAtk
Because of the defat6lig properly in certain ingredients[ skin contact aaRy rlssu:.t in dryness=d/ r
deltrtatitis may develop with prolonged expos:are. Eyc irritation is also possible.
'Mr.>t DI(:.41 (;tDNYDITION (PRONE To AGCRAVATION .BY EXPOSURE: It is expdr.ied that skin. contact may aggrawal, : a
t•:.I¢ :e3ilstin,�den-tatitis.
4ri
l 1 I,D'g•;PI�JfTV'la�l l ":ld.(J�rT)E(S)OF ENTRY: DERMAL
14M EIRIGEN CN'AND]FIRST AID PROCEDURES:
1't i "Ni ,Br�laalatiiosu lerr�wv,^.1Frosn exposure,restore breathing. Call physician.
,,;.
Byos: p1tulq wi"h water. for 15 minutes. Call physician.
Sldw, t;Vash wide snap and water,remove contaminated clothing.
';: ', `' Inrpes'llotl C30 NOT INDUCE VOMITING _-- -- --
`1 SECTION V1—REACTIVITY DATA -----
' P12i,➢ C T'.�lWLITT : STABLE ...�,.
IDt' O
+; i I 'I,' CCDNl�I"1116NS TO AVOID.- Heat,sporks and open rlan,ee• '
R
E l izfl $IA'ARDO-dJS DECOMPOSITION PRODUCTS: CO,CO2 andNx.O on burning.II
21
ram•
IN i 1 'y'f.I�iAZAR.IY,nIS P43ILY,.M3F.RIZATION: Will not occur.
f' I t"qii
.•� Tit { i yr i�1 5 11
P�lt~e 1 o:f 2
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= 117l2009 14: 47 5087717788 SUNDERLAND PRINTING PAGE 0310:3
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SU.PER113R Plrinfiing Ink Company,hir.
'. November 15,2007
(p i �i °a F SECTION V11—SPILL,OR LEAK PROCEDURES
`'P1ROC11DUR'} lR�I3)EA' 16Yt1TE1ctIAl S;I'DLI�ED OR RLY.LABEI): Wipe u, - Dispose utf wipers in rontainera. approved for a:•
r;,l p n P 1P y
d1Vtl5,r.r,,uIs'_PO5At,METHOD: In accordance with Federal,State and Local re ulations.
i 1 ► i h r I SECTION V — SP)MIAL PROTECTION INFQRC dATI01�
1 t t 1131 VEN Iff,ATION:�Under normal conditions, general ventilation or local exhaust ventilatiom or as =_pccifiud by Local or :3t. :e
k '`,nOTECTi'1'111 CLOVES: Required i"or prolonged or repeated contact.
I , v
' N-b I RESPIRATORY TRY PROTECTION- None required normally.
?1%1 t;I'Id'C3I�kl,t�'I➢Q)N: Pduae required in normal usage.
i t � Q'I'HE11 1�RQ1T FC iI I4'� EQUIPMEN None
.
- -- - SECTION IX m- SPECIA.L PRECAUTIW(;�—__—
r HA•M•V(; AND 9'IO.1 AOE: Store in sealed containers away from heat, quarks, opil+n tlnreres, an3 o�icli2i:ng matenalca, F: e
r; r rl extfngui,::her readily a•vail,ahle and personnel trained in its proper t.asc.
PPJ.7,CAVT10N1Sz FOR, INDUSTRIAL USE ONLY. DO NOT TAKE INTERNIkLLY, DO NOT REUSE CONTAP'41 R
;For,01.1.ER 1'1:IRPOCrS.
' i t SECTION X OTi? +I2 RE,(aUg AT®III'C®N'M®I..S _ —
tt I { i °S1.CT CDN 313 SIJ'P LIEM NOT IF ;This product contains the. following toxic o:heniicals that are Subjioot to the-re pnrii.:g, 1
{� 1. req,ureirt.,}5ts ci"3 ctann'31 I the EsnerEetray Pldnnimg and Community ltight•to-KnovJ Act;of 1)86 and 40 CF'R'37;1:
Im�QsL)Kpble Subslarnge 1°lo by yVe;�d�4
�1 � ;
xft Manganese Compound 1.2
060
Vdl oe Sulphri.or ?tiriting knk Conipaiiy Inc, Relieves the data ser forth herein are accurate ail. of the date Hereof, Superior Peintini;, I' k
lk 'i E 'ytti.Co:nparty Inc. makes no w�tYanty wit respect thcPeto and expressly disclaims air liability ia•:1r reliance thereon, :3i:•eh data are oflttr d
f1'A1
� stilly fo:r your co9ngidee FI[t'ot7,tnVESttgOtlf9[t and verification.
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r
41 ]rosary Lane d Hyannis, MA 02601
Phone: 508-771-5355 & 508-790-1.1.00 / Tax: 505-771.-7788 `
m.ai].@su.n.d.erlandprinting.com
ALPHA ANALYTICAL
Eight Walkup Drive
Westborough, Massachusetts 01581-1019
(508) 898-9220 www.alphalab_com
MA:M-MA086 NH:2003 CT:PH-0574 ME:MA0086 RI:LA000065 NY:11148 NJ:MA935 Atmy:USACE
CERTIFICATE OF ANALYSIS
Client: Triumvirate Environmental Laboratory Job Number: L0901520
Address: 61 Inner Belt Road Date Received: 06--FEB-2009.
Somerville, MA 021.43 Date Reported: 12-FEB--2009
Attn: Ms. P4eghan Sur.yar Delivery Method: Alpha
Project Number: T58695 Site: INSTANT OFFSET PRESS
- ALPHA SAMPLE NUMBER CLIENT IDENTIFICATION SAMPLE LOCATION
t
L0901520-01 T58695 WATER HYANNIS, MA
A
t
I, the undersigned, attest under the pains and penalties of perjury that, based upon my personal inquiry of those responsible
for obtaining t:he:informati-on, the material contained in this report is, to the best of my knowledge and belief, accurate and
complete. This ce rti.i i.cate of analysis is nol complete unl e.^,s this page accompani.es any and all. pages of this report.
---- Authorized. by:_ � � So•f//??2tt� -- --- --
— --
l
Tech�Representative
02.12091.3:1.B raq; .l of 1 .
l '
ALPHA ANALYTICAL
NARRATIVE REPORT
Laboratory Job Number: L0901520
The' samp.le was received in accordance with the chain of custody and no significant
deviations were encountered during preparation or analysis unless otherwise noted below.
TCLP Metals
L0901520-01 has elevated detection limits due to the 10x prep dilution required by the
sample matrix.
TCLF Mercury
L0901.520-01 has an elevated detection _Limit for Mercury due to the 5x prep dilution and 2x
analytical. diulti.on required be the sample matrix
The WG352403-4 MS recovery associated with L0901520-01 is outside the acceptance criteria
(Oki) due to sample matrix._The LCS associated with this batch is acceptable; therefore, no
:Further action was taken.
02.12.0913:18 Page 2 of '? — - -
ALPHA ANALYTICAL
CERTIFICATE OF ANALYSIS
i -
MA:M-MA086 NH:2003 CT:PH-0574 ME:MA0086 RI:LAO00065 NY:11148 NJ:MA935 Army:USACE
Laboratory Sample Number: L0901520-01 Date Collected: 06-FEB-2009 08:30
T58695 WATER Date Received. : 06--FEB-2009
Sample Matrix: WATER . Date Reported : 12-FEB-2009
Condition of Sample: Satisfactory Field Prep: None
Number & Type of Containers: l-Amber
PARAMETER RESULT UNITS RDL REF METHOD DATE ID
PREP ANAL
TCLP Metals by 1319.
3
TCLP.Extraction 1 :131.i oz,>o 11: o _.
Arsenic, TCLP ND mg/]. 1.0 1 ro1.oB 0211 10:30 0212 10:10 MG
Barium, TCLP 0.58 mg/1 0.50 1 6010H 021.:1 10:30 0212 10:1.0 Ms
Cadmium, TCLP ND mg/1 0.10 1 6010B 0211 10:30 021210:10 MG
Chromium, TCLP ND mg/I 0,20 1 601OB .0211 1.0:30 021E 1.0:1.0 Mc
Lead, TCLP ND mg/l 0.50 1 6010B 0211 10:30 0212 10:10 Mc
Mercury, TCLP ND mg/I 0.0020 1 7170A 0210 10:30 0211. 13:29 E7
Selenium, P 0.58 mg/l 0.50 1 6010B 0211 10:30 0212 10:10 Mc
Silver, TCLP 10 mg/l 0.10 1 6010B 0211 10:30 0212 10:1-0 MG
r
Comments: Complete list of References and Glossary of Terms found in Addendum I
02 09.13:7.2 PagJ 3 of.. 7 - .
i
ALPHA ANALYTICAL
QUALITY ASSURANCE BATCH DUPLICATE ANALYSIS
Laboratory Job Number: L0901520
Parameter Value 1 Value 2 Units RPD RPD Limits
TCLP Metals by.1311 ;'for sample(ss) 0.1 '(LO901520-01, WG352 0. 3)
Arsenic, TCLP ND ND Mg/1- NC 20
Barium, '.TCLP 0.58 0.55 mg/1 5 . 20
Cadmium, TCLP ND ND mg/1 NC 20
Chromium; TCLP ND ND mg/1 NC 20
Lead, TCLP ND ND mg/1 NC 20
SelE:nium, .TCLP 0.58. 0.57 mg/1 2 20
Silver, TCLP 10. 10 mg/1. 0 20
T.Cli'P. Metals by .:131;1.`for sample(:s) Ol :(L0901520-01,'<WG352903-3)
Mercury, TCLP ND, ND mg/1 NC 20
A
f ,
0212091.3:18 Page 4 of 7
ALPHA ANALYTICAL
QUALITY ASSURANCE BATCH SPIKE ANALYSES
Laboratory Job Number: L0901520
Parameter % Recovery QC Criteria
TCLP Metals .:by 1311 LCS;..for'sample(s) 01 :(WG352.4.9:7-2),
Arsenic, TCLP 100 75-125
Barium, TCLP 95 75-125
Cadrrium, TCLP ' 98 75-I25
Chrcmium, TCLP 97 75--125
Lead, TCLP 97 75--125
Selenium, TCLP 95 75-1.25
Silver, TCLP 1.00 75-125
TCLP Metals-by 1311 LCS for samples) 01 '(WG3.524.03-2)
Mercury, TCLP . 102 , 80-120
TCLP Metal:s.:by. 1311 :SPIKE-for .sampl.e.(s) 01 (L0901520 01.i WG352997 4)
Arsenic, TCLP 110 75-12.5
Barium, TCLP. 87 75-125
Cadrrium, TCLP 93 75-125
Chrcmium, TCLP 90 75-125
Lead, TCLP. 91 75-1.25
Selenium, TCLP 112 '75-125
Silver, TCLP 1.00 75-125
TCLP Metals by 1.311 SPIKE :for, samples) 01 `;(L0901520, 07,. WG352903-.9)
Mercury, TCLP 0 70-130
0217.O'l73:18 Page 'i of 7 .
ALPHA ANALYTICAL
QUALITY ASSURANCE BATCH BLANK ANALYSIS
Laboratory Job Number: L0901520
PARAMETER RESULT UNITS RDL REF METHOD DATE ID
PREP ANAL
Blank Arialysi's for's'ampl, (9 01 (WG352997 1,)`
TCLP Metals by 1311.
TCLP' Extraction i 'isti o210 15:15.
Arsenic, TCLP ND mg/1- 0.10 1 601.0E 021.1 10:30 0212 10:01 MG -
Barium, TCLP ND mq/l. 0.05 1 601.0B 0211 10:30 0212 10:04 MG
Cadmium, TCLP ND mg/1 0.01 1 600P 0211 10:30 021.2 10:04 MG
Chromium, TCLP ND mq/1 0.02 1 6o1.�P. 0211 10:30 0212 10:04 MG
Lead, TCLP ND mg/1 0.05 1 6010B 0211 10:30 0212 10:04 MG
Selenium, TCLP ND mg/l 0..05 1 6010B 0211 10:30 0212 10:04 MG
Silver, TCLP ND mg/1 .0.0.1 1 .601.OR 0211 1.0:30 0212 10:04 MG
Blank Analys>s for -sample(s) Ol '(WG352''403 1)'
TCLP Metals by 1311._ _
TCLP Extraction..
r' 1311 0210 ].1:30
Mercary, -TCLP ND mg/l 0.0002 :1 7470A 021.0 19:30 0211 1.3:26 Ez
y
0212091.3:18 Page 6 of 7 -
ALPHA ANALYTICAL
ADDENDUM I
REFERENCES
l:. Test Methods for Evaluating Solid Waster Physical/Chemical- Methods. EPA -SW-
896- Third. Edit=ion. Updates I IIIA, 1.997.
GLOSSARY OF TERMS AND SYMBOLS
REF Reference number in which test method may be found.
METHOD Method number by which analysis was performed.
ID Initials of the analyst.
ND Not detected in comparison to the reported detection limit.
NI Not Ignitable.
ug/cant Micrograms per Cartridge.
El The analysis of pH was performed beyond the regulatory-required holding
time of 15 minutes from the time of sample collection.
LIMITATION OF LIABILITIES.
Alpha Analytical.,` Inc. performs services with reasonable care and diligence
normal to the analytical testi.ng' laboratory industry. in the even't of an error, the
sole and exclusive responsibility of Alpha Analytical, Inc., shall be to re-perform
the work at it's own expense- In no event shall Alpha Analytical, Inc. be held
Liable for any incidental consequential or speci.al damages, including but not .
limi,=ed to, damages in any way connected with the use of, interpretation of,
information or analysis provided by Alpha Analytical., Inc.
We s:r_ongly urge our clients to, comply with EPA protocol regarding sample
volume, preservation, cooling, containers, sampling-procedures, holding times
and splitting of samples in the field:.
02120913;1fl Page '7 of 7
I
j Massachusetts Department of.Environmental Protection Certificate/Lab ID: M-MA086.
Drinking Water
Microbiology Parameters: SM9215B; MF-SM9222B; ENZ,SUB, SM9223; EC-SM9221E; MF-SM9222D;
ENZ. SUB. SM9223;
New Hampshire Department of Environmental Services Certificate/Lab ID: 200307.
Drinking Water(Inorganic Parameters: SM621513, 9222B, 9223.B.Colilert, EPA 200.7,-200.8, 245.2, 110.2, 120.1,
150.1, 300.0, 325.2, 314.0,.SM4500CN-E,A500H+B, 450ONO3-F, 23206, 2510B, 2540C, 450OF-C, 5310C,
21208, EPA 331.0. Organic Parameters: 504,1,524.2, SM6251B.)
Non-Potable Wafer (Inorganic Parameters: SM9222D,, 9221B, 9222B, 9221E-EC, EPA 200.7, 200.8, 245.1,
245.2, SW-846 6010B, 6020, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 150.1, 300.0, 305.1, 310.1, 325.2,
34 0.2, 350.1, 350.2, 351.1, 353.2, 354.1, 365.2, 375.4, 376.2,405.1,415.1,420.1, 425.1, 1664A, SW-846 9010,
9030, 9040B, EPA 160.1, 1.60.2, 160.3, SM426C, SM231013, 2540B, 2540D, 4500H+B,450ONH3-H, 450ONH3-E,
450ONO2-B, 450OP-E, 4500-S2-D, 5210B, 2320B, 2540C, 450OF-C,,5310C, 5540C, LACHAT 10-117-07-1-B,
LACHAT 10-107,-06-1-B, LACHAT 10-107-04-1-C, LACHAT 10-107-04-1-J, LACHAT 10-117-07-1-A, SM4500CL-
E, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D. Organic Parameters: SW-846 3005A, 3015A, 3510C,
5C306;8021B,8260B, 8270C,�8330, EPA 624, 625,608, SW-846 8082,8081A.)
Solid & Chemical Materials (inorganic Parameters: SW-846 6010B, 7196A, 7471A, 7.3.3.2, 7.3.4.2, 1010, 1030,,.
9C10, 9012A, 9014, 9030B,_9040, 9045C, 9050C, 1311; 3005A, 3050B, 3051A. Organic Parameters: SW-846
3540C, 3545, 3580A, 5030B, 5035, 8021B, 8260B, 8270C, 8330, 8151A, 8082, ' 8081A.)
New Jersey Department of Environmental Protection Certificate/Lab ID: MA935.
Drinking Water (inorganic Parameters: SM9222B, 9221 E, 9223B, 92158; 450ONO3-F, 450OF-C, EPA 300.0,
200.7, 2540C, 2320B, 314.0, 331.0, 110.2, SM21208, 2510B, 5310C, EPA 150.1, SM450OH-B, EPA 200.8,
245.2. Organic Parameters: 504.1, SM6251B, 524.2.)
Non-Potable Wafer(Inorganic Parameters: SM5210B, EPA 410.1, SM5220D, 45000I-D; EPA 300.0, SM2120B,
SM450OF-BC, EPA 200.7, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM450ONO3-F,450ONO2-B, EPA 1664A,
SM5310B, C or D, 4500-PE, EPA 420.1, SM450OP-B5+E, 2540B, 2540C, 2540D, EPA 120.1, SM2510B, SM15
426C, SM92210E, 9222D, 9221B,9222B, 9215B,2310B, 2320B,450ONH3-H, EPA 350.2/.1, SM5210B,SW-846
3015, 6020,•7470A, 5540C, 450OH-B, EPA 200.8, SM350OCr-D, EPA 245.1, 245.2, SW-846 9040B, 3005A, EPA
601 OB, 7196A, SW-846 9010B, 9030B. Organic Parameters: SW-846 82608, 8270C, 3510C, EPA 608, 624,625,
SW-846 5030B,8021B, 8081A, 8082, 8151A,8330.)
Solid & Chemical Materials (Inorganic Parameters: SW-846 9040B, 3005A, 6010B, 7196A, 5030B, 9010B,
9030B, 1030, 1311, 3050B, 3051, 7471A, 9014, 9012A, 9045C, 9050A, 9065. Organic Parameters- SW-846
8021B, 8081A,8082, 8151A, 8330, 8260B,8270C, 1311, 3540C,3545, 3550B, 3580A,5035L, 5035H.)
New York Department of Health Certificate/Lab ID: 11148.
Drinking Water (Inorganic Parameters: SM9223B; 9222B, 8215B, EPA 200.8, 200.7, 245.2, SM5310C, EPA
314.0, 331.0, SM2320B, EPA 300.0, 325.2, 110.2, SM212013, 450OCN-E, 450OF-C, EPA 150.1, SM4500H-B,
450ONO3-F, 2540C, EPA 120'1, SM 2510B, Or Parameters: EPA 524.2 504.1, SM6251B:)
Non-Potable-Wafer-(Inorganic-Parameters:. SM9221E, 9222D;-9221B;9222B, 9215B,EPA 405:1; SM5210B; EPA
410.4, SM5220D, EPA 305.1, SM231OB-4a, EPA 310.1, SM2320B, EPA 200.7, 300.0, 325.2, LACHAT 10-117-
07-1A or B, SM4500CI-E, EPA 340:2, SM450OF-C, EPA 375.4, SM15 426C, EPA 350.1, 350.2, LACHAT 10-107-
06-1-B, SM450ONH3-H, EPA 351.1, LACHAT 10-107-06-2, EPA 353.2, LACHAT 10-107-041-C, SM4500-NO30F,
EPA 354.1, SM4500-NO2-B, EPA 365.2, SM4500P-E, EPA 160.3, SM2540B, EPA 160.1, SM2540C, EPA 160.2,
SM2540D, EPA 200.8, EPA 6010B, 6020, EPA 7196A, S1M350OCr-D, EPA 245.1, 245.2, 7470A, 110.2,
SM2120B, 335.2, LACHAT 10-204-00-1-A, EPA 150.1, 9040B, SM4500-HB, EPA 1664A, EPA 415.1, SM531OC,
EPA 420.1, SM14 510;C, EPA 120.1, SM2510B, EPA 376.2, SM450OS-D EPA 425.1, SM5540C, EPA 3005A,
3015. Organic Parameters: EPA 624, 8260B, 8270C, 625, 608, 8081A, 8151A, 8330, 8082, 8021B, EPA 3510C,
5030B, 9010B, 9030B.)
Solid'& Hazardous Waste (Inorganic Parameters: EPA 9040B, 9045C, 1010, 1030, SW-846 Ch 7 Sec 7.3, EPA
6010B, 7196A, 7471A, 9012A, 9014, 9040B, 9045C, 9065,.9050, EPA 1311, 3005A, 3050B, 3051, 9010B,
9030B. Organic Parameters: EPA 8260B, 8270C, 8081A, 8151A, 8330,'8082, 8021 B, 3540C,3545, 3580, 5030B,
5035.)
Analytical Services Protocol:CLP Volatile Organics,CLP Inorganics, CLP PCB/Pesticides.
Rhode Island Department of Health Certificate/Lab ID: LA000065.
Refer to MA-DEP Certificate for Potable and Non-Potable Water.
Refer to NY-DOH Certificate for Potable and Non-Potable Water,
Pennsylvania Department of Environmental Protection Certificate/Lab ID: 68-03671. Registered Laboratory.
Certificate/Approval Program Summary
Last revised December 31,2008
The following list includes only those analytes/methods for which certification/approval is held.
For a complete listing of analytes for the referenced methods,please contact your Alpha.Customer Service Representative.
Connecticut Department of Public Health Certificate/Lab ID: PH-0574.
Drinking Water (Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual
Chlorine, Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium,
Cadmium, Calcium, Chromium„Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel,
Potassium, Selenium, Silver, Sodium, Thallium, Vanadium, Zinc, Total Dissolved Solids, Total Organic Carbon,
Total Cyanide, Perchlorate. Organic Parameters: Haloacetic Acids,_ Volatile Organics 524.2, Total
Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane(DBCP), Ethylene Dibromide (EDB).)
Wastewater/Non-Potable Water(Inorganic Parameters: Color, pH, Conductivity, Acidity,Alkalinity, Chloride, Total
Residual Chlorine, Fluoride, Total Hardness, Calcium Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl
Nitrogen, Nitrate, Nitrite, O-Phosphate, Total Phosphorus, Aluminum, Antimony, Arsenic, Barium, Beryllium,
Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium,
Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Strontium, Thallium, Tin,
Titanium, Vanadium, Zinc, Total Residue(Solids), Total Dissolved Solids,Total Suspended Solids (non-filterable),
BOD, CBOD, COD, TOC, Total Cyanide, Phenolics; Foaming Agents (MBAS), Bromide, Oil and Grease. Organic
Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane, Toxaphene, 2,4-D, 2,4,5-T, 2,4,5-
TP(Silvex), Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines,. Nitroaromatics &
Isophorone, Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons,Volatile Organics.)
Solid Waste/Soil (Inorganic Parameters: Lead in Paint, pH, Aluminum, Antimony, Arsenic, Barium, Beryllium,
Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium,
Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin,Vanadium, Zinc,
Total Cyanide, Ignitability, Phenolics, Corrosivity, TCLP Leach (1.311), Reactivity. Organic Parameters: PCBs,
Organochlorine Pesticides, Technical Chlordane, Toxaphene, Extractable Petroleum Hydrocarbons (ETPH),
Dicamba, 2,4-D, 2,4,5-T, 2,4,57TP(Silvex),Volatile.Organics,Acid Extractables (Phenols), 3.3'-Dichtorobenzidine,
Phthalates, Nitrosamines, Nitroaromatics&Cyclic Ketones, PAHs, Haloethers, Chlorinated Hydrocarbons. ),
Maine,Department of Human Services Certificate/Lab ID: MA0086.
Drinking Water(Inorganic Parameters: SM9215B,9221 E, 9222B, 9222D, 922313, EPA 150.1, 180.1,300.0, 353.2,
SM213013, 2320B, 4500CI-D, 4500CN-C, 4500CN-E, 4500E-C, 4500H+B,4500NO3-F, EPA 200.7, EPA 200.8,
245.1. Organic Parameters: 504.1, 524.2, SM 6251B.)
Wastewater/Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664A, 350.1, 351.1, 353.2, 410.4, 420.1,
Lachat 10-107-06-1-B, SM2320B, 2340B, 2510B, 2540C, 2540D;' 426C, '4500C1-D,. 4500CI-E, 450OCN-C,
4500CN-E, 4500E-B, 4500E-C, 4500H+B, 4500Norg-B, 4500Norg-C, 4500NH3-B, 4500NH3-G, 4500NH3-H,
4500NO3-F, 4500P-B.5, 4500P-E, 5210B, 5220D, 5310C, EPA 200.7, 200.8, 245.1. Organic Parameters: 608,
624.)
Massachusetts Department of environmental Protection Certificate/Lab ID: M-MA086.
Drinking Water
Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI)
(EPA 200.7 for: Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitrate-N, Nitrite-N,Fluoride,Sulfate)
353.2 for: Nitrate-N, Nitrite-N,- SM4500NO3-F,4500E-C, 4500CN-CE, EPA 180.1, SM2130B, SM4500C1-D,
232013, SM2540C, EPA 150.1,SM4500H-B.,
Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics) .
(504.1 for: 1,2-Dibromoethane, 1,2-Dibromo-3-Chloropropane),SM6251B,314.0.
Non-'Potable Water
Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn)
(EPA 200.7 for: AI,Sb,As,Be,Cd,Cr,Co,Cu,Fe,Pb,Mn,Mo,Ni,Se,Ag,Sr,TI,Ti,V,Zn,Ca,Mg,NaK)
245.1, SM4500H,B, EPA 120.1, SM2510B,2540C, 2540B,2320B, 4500CL-E,4500E-BC,426C, SM4500NH3-
BH, (EPA 350.1 for: Ammonia-N), LACHAT 10-107-06-1-B for Nitrate-N, SM4500NO3-F, 353:2 for Nitrate-N,
SM4500NH3-B,C-Titr, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E,4500P-B,E, 5220D, EPA 410.4, SM
5210B, 5310C,4500CN-CE,2540D,4500CL-D, EPA 1664, SM14 510AC, EPA420.1
Organic Parameters:(EPA 624 for Volatile Halocarbons,Volatile Aromatics).
(608 for: Chlordane, Aldrin, Dieldrin, DDD, DDE, DDT, Heptachlor, Heptachlor Epoxide, PCB-Water)
600/4-81-045-PCB-Oil
CHAIN OF CUSTODY
PAGE tOFt
•� Project Information
•• • • �.
e .e e s ❑ FAX ® EMAIL ® Same as Client info PO#:
Westbo=04 MA Raynftam,MA Bedford,NH ® ADEx ❑ Add'1 Deliverables
TEL 50"98-9220 TEL 508-622-9300 TEL: 603232.8247 Project Name::t -
FAX_608408.9193 Fnx:508.8223288 FAX:603.628-224t Regulatory RequirelmentsIReport
Client State/Fed Program Creteda
InformationProject Location; �}/ C�
Client:Triumvirate Environmental,Inc. Pr 'ect#: ep Q�J . ; •-• t o
Address:61 Innerbelt Road Project Manage 2 ❑ Yes ❑ No Are MCP Analytical Methods Required?
Somerville MA 02143 ALPHA Quote#;Triumvirate Environmental,Inc: ❑ Yes ❑ No: Are CT RCP Reasonable Confidence Protocol R wired?
Phone:617.628.8098 . . ANALYSIS
JE1
SAMPLE HANDLING
Frl"don
Fax:617.62B.t3099 ®Standard ❑ Rush(ONLY lFPREARPROVEDi a Done
Emai(: 11Y1f^ �(��l5f Y1 V►YU [GYM L $j,p`� ❑ Not Needed
Q Lab to do
❑These samples have been Predously analyzed by Alpha Due Date: Time: _ Preservation
Other Project Specific Requirements/Comments/Detection Limits: O Lab to do
�..� !Please Specify
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IS YOUR PROJECT linquished By: ^^�� DateTmee ived By: Da/te[Time _
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v TOWN OF BARNSTABLE
LOCATION L{\ SEWAGE # 9:5�—.fib
VILLAGE W �3 ASSESSOR'S MAP & LOT9 �-4728
INSTALLER'S NAME & PHONE NO. COVJ7-
SEPTIC TANK CAPACITY o oro
LEACHING FACILITY:(type) (I— (size) ,I
NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER
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DATE PERMIT ISSUED: l
DATE COMPLIANCE ISSUED: l9f,S 4
VARIANCE GRANTED: Yes No
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
3-3 P0 TOVYN OF BARNSTABLE
Z� lir�tintt f OV Uivj-Vv!3aT1Vvr1w Tomitrnr#inn rnmit
Application is hereby made for a Permit to Construct ( ) or Repair (14 an Individual Sewage Disposal
System at
411 Pn,SyNcOC 4
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Location-i�• --....----dress or Lo No.
owne Address
.........Cogs .--••--..0&=...... ° .. �t�--------/ f -.../-7 ................
Installer Address
Type of Building Size Lot............................Sq. feet
-. Dwelling—No. of Bedrooms-----------------------------------------_-Expansion Attic ( ) Garbage Grinder ( )
a`4 Other—T e of Building No. of ersons---------------------------- Showers
YP g -------------------••--••--• P _...._............._......-•------(---->..— Cafeteria-(----
dOther fixtures -------------------------------------------------------------------------
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length________________ Width---------------- Diameter---.------------ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit..----_..._______--- Depth to ground water........................
a -•••--••--•------------------------••----•-•----•--•-•••----••--•-----•---•-......---------..................................................................
0 Description of Soil--------------------------------------------------------------------------------------------------•-------------....-----------------------------------............•...
x
U
w
U Nature of Repairs or Alterations—Answer when applicable.z'3 W._...-4 �k-__-_.-..�roM-_..._• -t_dJ-------5,u-`T - c-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health.
+ Signed ......... ---------- .........4 .....
Application A
PP Approved BY .......�� ..�. .�...A_ ......... ... ....
Application Disapproved for the following reasons- ---------------------------------------------------------------------------......................................................
...................... . ..................... ..................................... . ... -- . ................................ ........................................
Permit No. -----7--Y----
S�.S,.................. Issued .. .........- -- -- ..............-- - -[e ...
Date
4 3 L( _ v�
No... J...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
�" ���Irk 1-•-r;U� �2�.,
Appliration for Dijpmml Nor1w Tomitrnr#inn ramif
Application is hereby made for a Permit to Construct ( ) or Repair (1$ an Individual Sewage Disposal
System at:
.....
/6 Location•A dress or Lot No.
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Owner Address
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
dOther fixtures -----------------•----------------------------•-•-------------------------------------- --------------------•---------•--•--------•------------------
w Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitv............gallons Length................ Width-.--_--__---_-. Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..................................................................."...... Date------------------.........--...........
Test Pit No. I................minutes per inch Depth of Test Pit---_-_____.__.------ Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-•-•---••-•-----------------•-••••••••-•-•-----••-----••--•---•-•••••-••---.....•••-•--•-•-----.............••--•••••••-=-•••••......•........-----.....••--
0 Description of Soil.............................................................................................................. .........................................................
x
w
UNature of Repairs or Alterations—Answer when applicable.?QQfi...._. ---------- 0.0......G"it0.') ._...SA-,r,e 22ac
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Agreement-.
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board of health. /
Signed �.r r .... .....
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......
Dar,I
Application Approved By .........�,�_J -,.,. _-� y
Dare
Application Disapproved for the following reasons: ..... ............................. -- ..... . .--. ................................
--------------------- --------------------------- -----------
..--------
------------------ --------
.---------------------------------
--------------------------------------------------- --------
-.................
..............
Permit No. c1 _.....�3------------------ Issued .................................................. .IYa[e
......'..... ....... Dace JI
.4------ ----------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
QllErtifi atr of 01.1omplianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ! )
by - 0...f...4 .......... -sue----.................--....----------------......------------------------------------------------................. .... ...... ._............................ .
Installer
at "7;;�-_b-----------�FJ S3±r ------------- s►�'�,.•a--------------( .----------------.......---------------------------------------------............--------------------------
has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ---------1.t-/ n....j .•'-S.Q dated ..........------------.._............._.....
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE....._..../-------c~.�- r-G .... Inspect r— ...... %� � 1y�,
-- --------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Rapmal Workii Tono#rudion rrmit
Permission is hereby granted....... _____�,N S777` -----
to Construct ( ) or Repair ( 'an Individual Sewage Disposal System
atNo....- t. �...►v r�.,5---------------------------------------
Street
as shown on the application for Disposal Works Construction Permit N .9y"5.1__,.__ Dated------- L. ......•..
�� l L/....... L/••----••-•................................. v Board of Health
DATE------�.._...__....�---• ---r- ,
FORM 36508 HOBBS 6 WARREN.INC.,PUBLISHERS ,
TOWN OF BARNSTABLE
f�f�
LOCATION ` N V&Sko.` l*vJ e SEWAGE
VILLAGE ASSESSOR'S MAP &,L + f �
OT �
INSTALLER'S NAME & PHONE NO. ` Ae_jCe'* (? wJu7- 17/. y/2.0
SEPTIC TANK CAPACITY i,CPO 0
LEACHING FACILITY:(type) (size) o
NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER
C '
BUILDER O OWNt
'DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 19 ,S q
VARIANCE GRANTED: Yes No
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Barnstable Assessing Search Results Page 1 of 2
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Owner: 2006 Assessed
Values:
SPALT,JAMES TRS&
33 ROSARY LANE Appraised Value Assessed Value
Map/Parcel/Parcel Extension Building Value: $507,600 $507,600
344 /028/ Extra Features: $0 $0
Outbuildings: $0 $0
Mailing Address Land Value: $ 116,200 $ 116,200
SPALT,JAMES TRS&
SPALT, PETER TR Totals $623,800 $623,800
41 ROSARY LANE
HYANNIS, MA.02601
2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation)
Community Preservation Act Tax $ 122.39 Fire District Rates Town
Barnstable-Residential $1.90 $6.31
Barnstable-Commercial $2.51 Commei
Hyannis FD Tax(Commercial) $ 1,559.50 C.O.M.M.-All Classes $1.06 $6.54
Cotuit FD-All Classes $1.33 Persona
Town Tax(Commercial) $4,079.65 Hyannis-Residential $1.61 $6.49
Hyannis-Commercial $2.50 Other R;
W Barnstable-Residential $1.60 Commur
W Barnstable-Commercial $2.46
Total: $5,761.54
Construction Details
Building Property Sketch Legend
Building value $507,600 Interior Floors Concr Finished
This property contains multiple
Style Office/Warehs Interior Walls Minimum Please use the navigation below the sketch to I
Model Ind/Comm Heat Fuel Gas
Grade Average Heat Type Hot Air-No Duc
Stories 2 AC Type None
http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO6map.asp?mapparbac... 11/8/2006
Barnstable Assessing Search Results Page 2 of 2
Exterior Walls Concr/Cinder Bedrooms 00
Roof Structure Gable/Hip Bathrooms 0 Full
1 3. 3 �3iH}fl�w, � i�&l7 9` PY�iYfl
Roof Cover Metal/Tin living area 5585
Replacement Cost $452888 Year Built 1983
3 �3 aH!(a➢f 7 13 ' f 3��i, f `
Depreciation 14 Total Rooms
Land
... .......... ......... .... .......... ..
CODE 3160
Lot Size(Acres) 0.71
Appraised Value $ 116,200
Additional Sketches 1
Click Here for print version that displays all
Assessed Value $ 116,200
View Interactive Maps
Sales History:
Owner: Sale Date Book/Page: Sale Price:
SPALT,JAMES TRS& Jun 15 1989 12:OOAM 6467/ 171 $ 1
SPALT, MARILYN May 15 1985 12:OOAM 4551/320 $ 1
SPALT,JAMES&PETER TRS Mar 15 1984 12:OOAM 4032/352 $0
SPALT,JAMES Oct 15 1982 12:OOAM 3582/304 $ 19,288
Extra Building Features
Code Description Units/SQ ft Appraised Value Assessed Value
Property Sketch
Legend
BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished)
BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished)
CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished)
(Finished)
FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story
(Unfinished)
FCP Carport GRN Greenhouse UUA Unfinished Utility Attic
FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story
(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Open or Screened in Porch TQS Three Quarters Story(Finished)
http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO6map.asp?mapparbac... 11/8/2006
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MATERIAL SAFETY DATA SHE
ET Bo
�L S � n l GAL �i�� aa-th
BOTTCHER FOUNT 3002
JL
1.CHEMICAL PRODUCT AND COMPANY IDENTIFICATION s uo 3
er America,Inc., Product Name: BaTTCHER FOUNT 3002
Manufacturer. BBttch MD 21017
Date Prepared: 04I15/2005
Bbttcher,America,Inc.,4600 Mercedes Drive,Be camp,
Product Number. 23045
Transport Phone Number. 1.800 g346
9300
Customer Information Phone Number:1-410 273 7000 0
CHEMTREce-24 Hour'EmergencY phone Number: j-$
3 E COMPANY:24 Hour Medical Emergency TS
2.COMP OSITIONIINFORMATION.ON INGREDIEN ACGIHTLV Wei t%
CAS OH SA PEL N.E. 5-10
ChemicalName 77-92-9 N E N.E. 540
CITRIC ACID N.E. N.E._ 1-5
SODIUM NITRATE 42% MIXTURE N-E- N.E. 1-5
ANIONIC SURFACTANT N.E. N E 1-3
2-HYDROXY-PROPIONIC ACID MIIXTURE N.E.
PENTASODIUM DTPA
3.HAZARDOUS IDENTIFICATION
POTENTIAL HEALTH EFFECTS
Eye contact:May cause irritation. May
cause irritation to respiratory tract.
d hani
Inhalation:Low haza irritaor t
ion to he gas n estiilinnal.tm t.
on.
Ingestion.May causemay cause skin imtati
Skin Contact:Prolonged exp os rue Ey
Of,Exp a and skin irritation with abdominal pain,vomiting an
Signs And Symptoms
diarrhea upon ingestion.
4.FIRST AID MEASURES
h eyes with plenty of water for at least 15 minutes.Get immediate
Eye Contact: Immediately flus y give artificial respiration. If
medical attention.
Inhalation:If symptomatic,remove to fresh air.
medical attention immediately- or poison control
breathing is difficult,give oxygen-
Ingestion: if swallowed,.give victim a glass of waterymouth
th t anlunconscious person.
center immediately.Never give an byaline sklin cleaner.
kin with plenty of water and wash wattention f irritation develops- Was chronic
Skin Contact: Flush s physician or have
contaminated clothes before reuse. Get medics product
Aggravated Medical Conditions:Individuals who are before using this the
care of product
s listed by IARC.NTP,
ailments,should consult a physician
Supplemental Health Information:None of the components in this pro
or OSHA as carcinogen.
5.FIRE FIGHTING MEASURES
FLAMMABLE PROPERTIES applicable .
. Flash Point Method- Not applicable Auto ignition: Not
.,Flash Point: NonflammableUEL:.Not applicable
"LEL: Not applicable cause of the fire.
Extinguishing Media: Any applicable to the primary '
Page: 1 /4 .
B�ttcher Fount 3002
Date:4/15105 -
v,l
____L3
MATERIA
L SAFETY DATA SHEET Boucher
S ecial Fire-Fighting Procedures: Wear self-contained breathing apparatus and protective clothing
P
to prevent contact with skin and eyes. ,
Unusual Fire And Explosion Hazards:'None
Combustion Products: Carbon dioxide,carbon monoxide.
6.ACCIDENTAL RELEASE MEASURES
ew fire and Steps To Be Taken In Case Material is Spilled Or Released, �v. i appropriate perso all protective
osion rds '
P
and safety precautions before proceeding with cleanup
equipment.Avoid contact with''oin ar as.Absorb spillageeyes.Stop lin inert'ma material. Soak up with sawdust,
entering sewers,waterways orsolid material and/or.contaminated soil for
sand,or other absorbent material. Remove dell.Discharge to on-usable . sewer requi es approval of permitfi g
disposal in an approved and permitted
authority and may require pre-treatment.
7.HANDLING AND STORAGE
Precautions To Be Taken In Handling And Storage, Store in a cool,dry,well-ventilated area. Keep
containers closed. Do not store with:incompatible
comp tibl d With`th's materialstore or consume.food,drink,
or tobacco where they may become
Other Pecautions-All labeled precautions must
siduesSTrip erinse befored when e disposal.ng,storing and
transporting empty containers due to product re
8. EXPOSURE CONTROL 1 PERSONAL PROTECTION
PERSONAL PROTECTIVE EQUIPMENT
ed in the intended way,no respiratory pr
otection is
Respiratory Protection:When this product is us
anticipated:to be necessary.
am volumes.per hour.Ventilation rates.should match
Ventilation:Good ventilation of 10 ro .
conditions of use.
Protective Gloves:Latex, rubber,or neoprene waterproof gloves are recommended.
Eye Protection: Safety glasses with side shields(or goggles).
res are required.-
Other Protective Clothing or Equipment
good personal hygiene when handling this product.Wash hands
WvrldHygienic Pracfice g or using the toilet.
after use, before smoking, g 9 ed with an
Engineering Controls:Facilities storing or utiliziri this material should be equipped
eyewash facility and a safety shower.
Exposure Guidelines: See Section 2.
9. PHYSICAL AND CHEMICAL PROPERTIES
Odor: Green, clear to light hazy liquid,with specific smell.
Appearance And Solubility In Water.,Complete, not soluble in apola solvents. C Specific Gravity: 1.12
° Vapor Pressure: 18mmHg
Boiling Point: 100 C Feezing Point: Evaporation Rate: N.E.
Melting Point:Not applicable 'Ph:-3.16'
Vapor Density: N.E. Percent Volatile:70.4
Molecular Weight: Not applicable Pounds Per Gallon: 9.32
Other Properties:VOC=0
10. STABILITY AND REACTIVITY
Stability 'Sfable
Conditions To Avoid:None page:.2/4
4/15/05 ���BMW�herunt 3002
Date:
SB� C�MA
TERIAL SAFETY DATA SHEET
er
Incompatibility: None
Hazardous Decomposition Or By Products: None
Hazardous Polymerization:Will Not Occur
Conditions To Avoid:None
11.TOXICOLOGICAL INFORMATION
12.ECOLOGICAL INFORMATION
This product is biodegradable.This product does not contain heavy metals or halogenated
is product into the environment.
solvents.Do not release th p
13.DISPOSAL CONSIDERATIONS
The referred options for disposal are to send to licensed reclaimers,or to permitted incinerators.
p.
Any disposal-practice must be in compliance with federal,state,and local regulations.Do no
dump into sewers,ground,or anybody of water.
14.TRANSPORT INFORMATION
DOT Class:NOT REGULATED
Hazard Class:NONE,
UN No.: NOT APPLICABLE
Packing Group:
Guide No:
Ship Name:
15.REGULATORY INFORMATION
finished product are listed on the EPA TSCA INVENTORY.
TSCA.All ingredients in this
ara
SARA TITLE III: Sodium Nitrate is listed as a Nitrate Compounds,Water Dissociable under STA.
Title 313. osition
CALIF. PROP.65: Product contains a Water a d ToxicCEnforcem Enforcement Act of 1986 rorr Prop um N
The State of California s Safe Drinking
ation.This regultion does not address d
65 requires the following inform
therefore,even trace amounts o f the chemicals included on Proposition 65's list of chemicals
st be noted
th the
known to the State in California to cause
cancer
contains T sodium NTA u known to heiState of
"Safe Harbor"wording.WARNING.T p
California to cause cancer,birth defects or other reproductive harm.
CARCINOGENICITY:NONE OF THE COMPONENTS IN THIS CHEMICAL IS LISTED BY IARC,
NTP, OR OSHA AS A CARCINOGEN.
SCAQMD Rule 443A
Photochemically Reactive:a Liter.0 gm/L°
Maximum Grams of VOC p
Vapor Pressure: 18 mg H9 @ 68'F
16. OTHER INFORMATION(HMIS)
Health: 1
Flammability: 0
Reactivity: 0
Protective: B
Date:4115/05 Bottcher Fount 3002
Page: 314
MATERIAL SAFETY DATA SHEET Boucher
OTHER ADDITIONAL,INFORMATION:The information contained herein is based on the data
available to us and is believed to be accurate. However, no warranty is expressed or implied
regarding the accuracy of this data or the results to-be obtained from the use thereof.We assume
no responsibility for the,injuries from the use of the product described herein.
Date:411 5/05
Bbttcher Fount 3002 • Page:414
CO.l1_%10.N%WEALTH OF MASSACHt;SETTS
_ EXECUTIVE OFFICE OF EI VIROINMENTAL AFFAIRS
F DEPARTMENT OF ENVIRONMENTAL PROTECTION
� r
4s ONE'"'INTER STRFF:'. BOSTON :ALA 0210c t617j 292-550.,
TRL DT CONE
Secre•ar.
ARGEO PALL CELLUCCI DAVID B STP. .'HS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART'A
CERTIFICATION
Property Address: 41 Rosary Lane , Hyannis Name of Owner Hudson Corp.
'- '_
Address of Owner:
Date of Inspection: 313�a- 6
Name of Inspector:(Please Print)Wm. E . Robinson Sr.
I am a DEP approved systern inspector rsuant to Section 15.340 of Trde 5,(310 CMR 15.000►
Company Name: Wm. E . Robinson Septic Service
Mailing Address: PO Box 0 9, Centerville, MA
Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site Zses
disposal systems. The system:
_ Conditionally Passes
Needs Further Evaluation By the Local Approving Authority s
Fails
Inspector's Signature: Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (30)days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttre
system owner and copies sent to the buyer, if applicable, and the approving authority.
NOTES AND COMMENTS
,. D®�
d .
revised 5/2/98 Page Iof11
H •
ii =f• ied o^Recvdrd Pam,
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
'roperty Address:4.1 Rosary Lane , Hyannis
Jwner: Hudson Corp.
Date of Inspection: 3_i3-ac--
INSPECTION SUMMARY: Check (A,/ B, C, or D:
A. SYS PASSES:
I have not,found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. S STEM CONDITIONALLY PASSES:
One'or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system. upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate es, no, or not determined (Y. N, or ND). Describe basis of determination in all instances. If "not determined',explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2ofII
~ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(cort mwd)
Property Address: 4.1 Rosary Lane , Hyannis
owrter: Hudson Corp.
Date of Irtspeabon:
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
v
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health,safety and the environment.
1) YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303 11)(b)THAT THE SYSTEM
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 Meet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
a
.t
2) YSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or
tributary to a surface water supply. ,
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revise:. 9 2 96
Page 3 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 41 Rosary Lane , Hyannis
owner: Hudson Corp.
Date of Inspection:
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will bb necessary to correct the failure.
Yes No
Backup of sewage into facility-or system component due to an overloaded or-clogged SAS or cesspool.
_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
a
Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_.
_ Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
_ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion.of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must in icate either "Yes" or "No" to each of the following:
T e following criteria apply to large systems in addition to the criteria above:
T e system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
ealth and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within.400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply-
_ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of t e Department for further information.
revised 9%2/96 PaRc4ofII
I
SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM.
PART B
CHECKLIST
Prop"Address:41 Rosary Lane , Hyannis
Owner: Hudson Corp
Date of Inspection: 3
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No '
Pumping information was provided by the owner,occupant, or Board of Health.
— None of the system components have been pumped for at least two weeks and the system has been receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
Jf — As built plans have been obtained and examined. Note if they are not available with NIA.
— The facility or dwelling was inspected for signs of sewage back-up.
— The system does not receive non-sanitary or industrial waste flow.
V — The site was inspected for signs of breakout.
— All system components, excluding the Soil Absorption System, have been located on the site.
v The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
/ The size and location of the Soil Absorption System on the site has been determined based on:
Existing information. For example, Plan at B.O.N. +
— Determined in'the field (if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
(1.5.302(3)(b)l
v - — The facility owner (and occupants,if different from owner) were provided with information on the proper nwintanaacj-0f
SubSurface Disposal Systems.
rev. sea 9/2/98
Pacc 5 or 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
►rop"Address: 41 Rosary Lane , Hyannis
Owner: Hudson Corp.
Date of Inspection: 3—/3- 6ru0
FLOW CONDITIONS
RESIDENTIAL:
Design flow: p.d./bedroom.
Number of bedrooms(design):_ Number of bedrooms (actual):_
Total DESIGN flow
Number of current r sidents:_
Garbage grinder ly or no):_
Laundry(separate ystem) (yes or no):_; If yes, separate inspection required
Laundry system' spected (yes or no)
Seasonal use (y s or nol:_
Water meter r adings, if available (last two year's usage (gpd): 1 Q99 6, 000 gal.
Sump Pump yes or no):_ 1998 9, 000 gal.
Lest date f occupancy:
COMMERCIAL/INDUSTRIA
Type of establishment: /°. r✓� C,r I
Design flow: gpd ( Based on 15.203)
Basis of design flow t:2
Grease trap present: (yes or no) &
Industrial Waste Holding Tank present: (yes or no),et--o
Non-sanitary waste discharged to the Title 5 system: (yes or no)k a
Water meter readings, if available:
Last date of occupancy:'---1 3-;--
OTHER: (Describe) 1
Last date of occupan y:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
"g7g
System pumped as part of inspection: (yes or no) li�)
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF YSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no) (if yes, attach previous inspection records;if any)
I/A Technology etc. Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components, date installed(if known)and source of information:
Sewage odors detected when arriving at the site: (yes or no),�L C)
revised 9/2/9E Page 6(if II
a
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(eontinued)
`ropertyAddress: 4.1 Rosary Lane , Hyannis
Owner: Hudson Corp
Date of Inspection: 3—/ A o2 v—trs
BUILDING SE ER-
fLoc:ate on sit plan)
Depth below g ade:_
Material of co struction:—cast iron—40 PVC other(explain)
Distance fro private water supply well or suction line
Diameter
Comments: I ondition of joints, venting, evidence of leakage,-etc.)
SEPTIC TANK:_
(locate on site plan)
Depth below grade:
Material of construction: ✓concrete—metal—Fiberglass —Polyethylene—otherlexplain)
h�—o
If tank is metal,list age_ (sage confirmed by Certificate of Compliance_ (Yes/No)
Dimensions:
Sludge depth: �3 '
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness: 3�$
Distance from top of scum to top of outlet tee or baffle: r '
Distance from bottom of scum to bottom of outlet tee or baffle: /d
How dimensions were determined: 6 yk ey )A h lu
;omments:
(recommendation for pumping, condition of inlet and Pullet teV.or be as, depth of liquid le el in relation to outlet iJr vert, structural integrity,
evidence of leaka e, et ), D b—D• ` d o o A !� 45,
N,-S
GREA E TRAP:
(locate on site plan)
Depth low grade:_
Material of construction: concrete—metal—Fiberglass —Polyethylene—otherlexplain)
Dimen ons:
Scum hickness:
Distan a from top of scum to top of outlet tee or baffle:
Distan a from bottom of scum to bottom of outlet tee or baffle:
Date o last pumping: `
Comm nts:
(reco endation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity,
evide a of leakage,etc.)
revised Page 7of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,
PART C
SYSTEM INFORMATION(continued)
+rop"Address:4.1 Rosary Lane , Hyannis
Owner: Hudson Corp.
Date of Inspection:3 /3—;2-G-c% -O
TIGHT HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection)
(locate on it plan)
Depth belo grade:_
Material of onstruction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm prese t
Alarm level Alarm in working order: Yes_ No_
Date of pr vious pumping:
Commen .
Iconditi n of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: V
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, eviden,�of solids carryover, evidence of leakage into or out of box, etc.)
PUMP C MBER:_
(locate on site plan)
Pumps in orking order: (Yes or No)
Alarms in working order(Yes or No)
Commen S.
Inote co dition of pump chamber, condition of pumps and appurtenances,etc.)
revises 9/2/98 Page 8orn
i
Y. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
'ropertyAddress: 4.1 Rosary Lane , Hyannis
owner: Hudson Corp
Date of Inspection: 3
SOIL ABSORPTION SYSTEM(SAS):.
(locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type: ( ,• t.
leaching pits', number:
leaching chambers, number:_
leaching galleries,number:_
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool, number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of pond' g, damp so'I conditio e f vegetation, etc.l
z, e1 on rr eJr %a 1'
vO
C POOLS'—
(loca a on site plan) t
Numbe and configuration:
Depth•t p of liquid to inlet invert: F
7epth o solids layer:
)epth o scum layer:
Dimensi ns of cesspool.
Material of construction: e
Indicatio of groundwater:
inflow (cesspool must be pumped as part of inspection)
Com en":
(no condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRI _
(loc to on site plan)
Mat rials of construction: Dimensions:
Dep h of solids:
Co ments:
(no a condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
revises
Pegc 9 of 11
kz
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM '
PART C
SYSTEM INFORMATION(continued)
''roperty address:4.1 Rosary Lane , Hyannis
JWrW: Hudson Corp.
.Date of Inspection: 3-13
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
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revised 9;2/98 Page 10of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(corttinued)
roP"Address: 41 Rosary Lane , Hyannis
Owner: Hudson Corp.
Date of Inspection: 3.
NRCS Report name
Soil Type_
Typical depth to groundwater
USGS Date website visited }
Observation Wells checked
Groundwater depth: Shallow Moderate f
Deep
SITE EXAM Slope
Surface water
Check Cellar '
Shallow wells
Estimated Depth to Groundwater Ll_�Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
L/Observed Site (Abutting property, observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health E
Checked FEMA Maps
Checked pumping records
Checked local excavators, installers
Used USGS Data
Describe how you stablished the High Groundwater Elevation. (Must be completed)
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};
revise;: 9/2/96
Page 11 of 11
Marc Sunderland
ph 508-790-1100
fax 508-771-7788,r
k email sunprint@capecod.net
41 Rosary Lane
Hyannis,MA 02601
g
yp
SUNDh12LANU 4�'
PRIN"PING
Instant.Off
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY&& &•� (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS `' ,11 Class: �2 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR RIALS-
• -
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2(B)
Heavy Oils: I '
y/ to ino )
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous: '
/7ff
J4 r_*4
DISPOSALREC:LAMATION REMARKS:
1. Sanitary Sewage 2.Nyater Supply 44,
'
O Town Sewer ublic �.
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 NOZ ORDERS:
O Holding tank:MDC 0=4 e,
O Catch basin/Dry well G� —
O On-site system
5.Waste Transporter °
Name of Hauler Destination Waste Product. ,d
1.
J
2. �- �-`
Person(s) Interviewed Inspector Date