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HomeMy WebLinkAbout0405 WEST MAIN STREET - Health 405 W. Main Street, H annis n A= Ll KawasV, � & K &J` r.: i I i TO ALL NEWJ BUSINESS OWNERS DATE: / ! Fill in please: APPLICANT'S YOUR NAME: (f S SINESS � YOUR OM A1D.DRE S: c CwZ'°S( / )�+' TELEPHONE Telephone Number Home NAME OF NEW BUSINESS ) I DG'S E il-2.1 TYPE OF BUSINESS ' it �S IS THIS A HOME OCCUPATION? *ES I N.O. I C Lovr+ C'a fox 1 r Have you been given approval fro th b i 4ng ivisiq ? YES NO ADDRESS OF BUSINESS f'�Gdl_ d .�� MAP/PARCEL.NUMBER 2 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.. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed ny permit requirements that pertain to this type of business. Authori ✓ed Signature** COMMENTS: 2 40-) A-)u....b aC Z� o S T 2. BOARD OF HEALTH This individual t@ogeoh infor of ermit requirements that pertain to this type of busiypp MUST COMPLY WITH ALL HAZARDOUS MATERIALS - Authorized Signature** REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHO ITY) This individual h svb en infor ed-of the l.''�sie irements that pertain to this type of business. ,Authorized Signature** COMMENTS: Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. Q:\CONSUMER\Lois\CA.Forms\newbusfrm:doc Date: r Z/ Z / 06 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY A/1/67-9 T: NAME OF BUSINESS: �� 1�G BUSINESS LOCATION: OS �n ✓ one ©? INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: ✓ ite EMERGENCY CONTACT nLEPHONE N B R: 3 MSDS ON SITE? Vj TYPE OF BUSINESS: if INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes ma be toxic or hazardous (please list): Laundry soil & stain removers ® �✓N!>f (including bleach) ga -b L65L L Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ,� �k�`"hr4�'�••vr�.n�'i€ 7'R��'�i:,,a�,�,..} "..`erg? '�W`a Date: I Z/ Z / L b TOWN OF BARNSTABLE TOXIC AfND AZA DOUSIMATERI LS ON-SITE INVENTORY NAME OF BUSINESS: � s BUSINESS LOCATION ©` Z0/INVENTORY MAILING ADDRESS: c c�vll .�� TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT lTE �+ONE N B 6R: _ MSDS ON SITE? TYPE OF BUSINESS: �vl�IPSS � ovd INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111 Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following-products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils ,Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicafs (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) . , Swimming,pool chlorine Ca�l_k/y rout:. _ >-- °�..r. < �>.�._ _e — __- �-�__ w_ Batter acid (electrolyte)/Batteries Lye or caustic soda --- Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes ma be toxic or hazardous (please list): I fi J Laundry soil & stain removers... (including bleach) n� � /� ve iC �S Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 7 / V / O L{ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: w eaJr- a QA_*11 •41A� BUSINESS LOCATION: INVENTORY MAILING ADDRESS: �� TOTAL AMOUNT: TELEPHONE NUMBER: 5-08— 737— /q70 -508 -77s 01cl`'17 10Z 4Rzo*-n.s CONTACT PERSON: Am LjG,42 MSDS ON SITE? .AJ®. EMERGENCY CONTACT TELEPHONE NUMBER: TYPE OF BUSINESS: ode er `Le, Ne,e0t . .a.P INFORMATION/RECOMMENDATIONS: ire District: b S S- avYia't.:S ed e.. 5 Waste Transportation: W e-2- Last shipment of hazardous.waste: Name of Hauler: CA Destination: Waste Product: waa*e. ct Licensed? <&DNo NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum ✓ Antifreeze (for gasoline or coolant systems) Misc. Corrosive 4f. a.a�f�lEW USED Cesspool cleaners A&dmatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils r Pesticides NEW USED (insecticides, herbicides, rodenticides) v Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) • a Caulk/Grouv6z"e r Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible • S 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) L2P4NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture.strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers /)'Lc•X �� (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ' Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: West Main Auto Fax: Corp Name: Mailing Address Location: 405 W.Main Street Street: P.O.Box 674 City: Centerville Contact: State: Ma Telephone: = c�� /�i 9417 Zip: 02634 Emergency: SO$ —•7`7$ —'A\q,727 Person Interviewed: Business Contact Letter Date: 7/1/2004 Category: Miscellaneous Inventory Site Visit Date: 71Y2004 I Type: ;Automobile Dealers Follow Up/Inspection Date: ❑ public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed 91 town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: REMARKS: 11/10/98-no repir performed,only preparation vihicles for compliance:sale.Car washing done on-site. Ardex products,waxes,polishes, Satisfactory cleaners in the metal cabinet and dispenser rack. Some MSDS available for Ardex Products. Repair to Goodyear. ORDERS: obtain MSDS for all chemical products. Car washinnio_be done w/water onl .Obtain MSDS from retailers,distributors, suppliers. REMARKS: ---7/ 3/9/99-sells only cars.No maintanence.REMARKS•2000-Just sell cars. No washing or maintenance of vehicles on site. �.1 1;k� c, . � 3 l , s Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials _ ❑ gty's>25 lbs dry or 50 gals liquid but less than 111 gals qty's 111 gals or more description qty, ,• ;;unit of measure antifreeze(for gasoline or coolant systems) 2 gallons motor oil_ _ 55.gallons car waxes and polishes batteries/battery acid Waste Transporter: ✓` 5 Fire District: ;Hyannis Last HW Shipment Date: Waste Hauler Licensed: has___ W, Maio S�� 000 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 0 satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops r A/414/ 0 unsatisfactory- 4.Manufacturers COMPANY � (see"Orders") 5.Retail Stores n ' � /�q � 6.Fuel Suppliers ADDRESS 1✓!� 0.; /r�p.� (;1835: 7.Miscellaneous ,�A A-1 ��"-�TITIESAND STORAGE (IN_ indoors; OUT=outdoors) MAJOR MATERIALSUnderground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 0 DISPOSAL/R.Et;LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer OPublic 0 On-site OPrivate 3. Indoor Floor Drains YES NO 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES INO 1. 2. Person(s) Interviewed Inspector Date TOWN OF BAR,N►JTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH .. :tisfactory 2.Printers Xv may., .�; .� 3.Auto Body Shops � J/�01111A�1_1 , O' (s tisfactory- 4.Manufacturers COMPANY (se `Orders" 5.Retail Stores 6.Fuel Suppliers ADDRESS '1✓1� i N��i Class:. "" 7.Miscellaneous —7 ��N �� 1NTITIES AND STORAGE (IN=indoors;OUT_poutdoors) MAJOR MATERIALS Case I ots L)rums Above Tanks Underip-ound Tanks IN OUT IN OUT IN OUT #&'gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO- 0 Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter r Name of Hauler Destination Waste Product 1. YES INO 2. Person (s) Interviewed Inspector µ Date Date: r7 / V / O c4 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: (A) CLA14 1 A-t� BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: Sb 8— '-737 cl70 .509 -776= 9'9C17 10Z WiWo-»,s CONTACT PERSON: A%fj e4y EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? do TYPE OF BUSINESS: At&� Ae"P.t''�-&0,j'►A o��. s�c.e/iE.�. Nae� . . INFORMATION/RECOMMENDATIONS: ire District: b S .s- asYLrti s s 5 jg&Q 0 Waste Transportation: LA Last shipment of hazardous.waste: Name of Hauler: C'�ec-4q Wix r Destination: Waste Product: wade- o-cA Licensed? es No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. 9 Observed/Maximum Observed/Maximum ✓ Antifreeze (for gasoline or coolant systems) Misc. Corrosive � 2a�I9EW USED Cesspool cleaners ALitbmatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) ID Caulk/Grout/6Zt(e,.r- 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 4414 Paint &varnish removers, deglossers (including chloroform, formaldehyde, cT Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) .a Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: `L"Marine,Gas Stations,Repair BOARD OF HEALTH 0 satisfactory 2.Printers 3.Auto Body Shops . unsatisfactory- 4.Manufacturers COMPANY Ale)f-/��Aao (see"Orders") 5.Retail Stores ­1 6.Fuel Suppliers ADDRESS 05- P-41� —' >K Class: 7•Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case,lots Drums Above Tanks Underground Tanks. IN OUT IN 10UT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil(C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: K f-� CVV weq d DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply e,,, n,,gJ x. O Town Sewer ublic11 t/Q �Laa) a �, .F O On-site OPrivate / p 3. Indoor Floor Drains YES NO 0 Holding tank:MDC_ $'� "yam 0 Catch basin/Dry well cry S Q,5 rr~11It sal¢ 0 On-site system p;r-v duc_tfv 4. Outdoor Surface drains:YES ,�/'NO ORDERS: 0 Holding tank:MDC 0� 1 A4 3 P) q/ C4.4-1 ` O Catch basin/Dry well f &j0, a ! 66 4� —. ",*?S b 0 On-site system �J J 5.Waste Transporter Prod' YES NO 1. 2. Person (s) Interviewed Inspector ate Date: �y TOXIC AND HAZARD US MATERIALS REGISTRATION FORM �yy Ajjju,s �wA5Ak,'o� ep NAMEOFBUSINESS: �5�" 127A i� g�d BUSINESS LOCATION: //�� -��i/ iol MAILINGADDRESS:x"O SeX 617SV I& Mail To: TELEPHONE NUMBER: G Board of HealthTown of Barnstable CONTACTPERSON: 4)MI I P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: lO!/ D xAz- Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES X NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity X Antifreeze(for gasoline or coolant systems) Drain cleaners X NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants C Motor oils Pesticides _)L NEW X USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED 7C Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers X Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) X Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) X Other cleaning solvents X Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: February 5, 1997 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: CBL Enterprises, Inc. dba Cape Cod Powersports BUSINESS LOCATION: 405 West Main Street, Hyannis, Ma. 02601 MAILINGADDRESS: SAME Mail To: Board of Health TELEPHONE NUMBER: 508-771-5900 Town of Barnstable CONTACT PERSON: ,Tack Largay P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 508-362-5917 Hyannis, MA 02601 TYPEOFBUSINESS: Retail Sales - Parts & Service - Boats , Motorcycles& Recreational Vehicles Does your firm store a of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: No TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners y/ NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides ✓ NEW r,/ USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED a/ Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) -I Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda y/ Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS iAM -TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEjA4Tq satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY a Awe?-- .S� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS V r A- 7k Class: 7.Miscellaneous ��ti QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) ` <S 1 � new motor oil(C) y tr ssibr%ydraulic Synthetic Organics: degreasers PW v n P ' � Miscellaneous: bag - to U rV 1 - ' uh l'i rol w v DISPOSA (RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply l (,Town Sewerublic s �- O On-site OPrivate 3. Indoor Floor Drains YES N0�C_ v �� O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES-NO X ORDE O Holding tank:MDCAl O Catch basin/Dry well 1 O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product � YES NO 2. She ;2, 5- PersonWjnt ewed Inspector / Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD_ OF HEALTH X 3.Auto Body Shops �" ' O unsatisfactory- 4.Manufacturers COMPANY—�A M�i� 'L� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS , /IS� `t 'l� _ Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS _ IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: f waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers f Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer �ublic O On-site OPrivate 3. Indoor Floor Drains YES NO V O Holding tank:MDC_ O Catch basin/Dry well O On-site system ,/ 4. Outdoor Surface drains:YES Y NO ORDERS: O Holding tank:MDC ''Catch basin/Dry well -O On-site system 5. Waste Transporter YES NO 2. Person s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: AwrjS Al-b 9 y3M bk4 aywrw i a Mail To: Board of Health MAILING ADDRESS: 6S-- (,J • A lU /CNN15 fijA ' Town of Barnstable TELEPHONE NUMBER: ® 1 2/ 6-2 o o P.O. Box 534 CONTACT PERSON: o A- /� Ip� Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES _��NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of;Healt.h has determined that the following products exhibit toxic or hazardous characteristics and must be registered w �aturoa2 � 1— 1ease put a check beside each product that you store: 5- Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints varnishes sta ins,s, dyes Fertilizers (If stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOXIC AND HAZARDOUS MATERIAL$ REGISTRATION FORM NAME OF BUSINESS: r- Mail To: BUSINESS LOCATION: ► 0 ,,,` 444-4MLS �Ifoard of Health wn of Barnstable MAILING ADDRESS: 4o — 43.0. Box 534 TELEPHONE NUMBER: -111 - Hyannis, MA 02601 CONTACT PERSON: :YA,�L �,/ .- vLrka ("I LA,,�=� EMERGENCY CONTACT TELEPHONE NUMBER: &-0 111 - 5qoo Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES ✓✓ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit to 'c-or haz haracter- istics and must be registered regardless of volume. Please estimate the qua tity besi a product that you store: NOV 3 0 1995 '` 1gI�F134NA'r018�¢ Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department! Canary Copy-Business TOWN N OF BARNS TABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS A Class: 7.Miscellaneous UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATECase lots Drums Above Tanks Underground Tanks IN OUTJ IN JOUTJ IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) waste motor oil motor oil C 1 transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION RE lnitary Sewage 2.Water Supply AAn��, f fl A 3f,� Town Sewer trivate ublic 50 On-site CD�PaNDA' - D 3. Indoor Floor Drains YES Noi, L O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product S NO 1. 2. Al ;td Ile r o terviewed Inspec t TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY M�) T MWt N �Pr (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 90S �� Class: 7.Miscellaneous �y (J�JIS QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS ground IN OUT IN OUT IN OUT #&gallons IAge Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) S� s transmission/hydraulic Synthetic Organics: degreasers - Jv ��isce laneous: 7wU 1 q 1 90 S DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply d—o�A " O Town Sewer OPublic / l�po Gt (�, 'C, O On-site OPri ate 3. Indoor Floor Drains YE N0Y— S CVV -46-. O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC OIEA 10 1 O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler A)estinaiion ,:Waste Product Licensed? Person(s) In ewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY 1), Qin 1t as (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS DS LAY. �-A0.1(1 S{` Class: _`j 7.Miscellaneous H-,, -Yli S QUANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers i C �A C_A CGS n Miscellaneous: �"►'1�1 - �C Gc.lto X DISPOSALIRECLAMATION REMARKS: �^f. 1. Sanitary Sewage 2.Nyater Supply o ' �I`t i `- 0K_.1 l Town Sewer Public L /. O On-site OPrivate 3. Indoor Floor Drains YES N0—)�_ O Holding tank:MDC O Catch basin/Dry well �.x O On-site system 4. Outdoor Surface drains:YES N0� ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter • � YES NO 1. 2. Person(s) Intbrvi wed Inspector Datd Date: 2 9 8 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: /�S� �i'���J Ali) BUSINESS LOCATION: ®Sr MAILINGADDRESS: /2� GdX �� ��'N�/,nyr L �L ��- Mail To: /�� Board of Health TELEPHONE NUMBER: C> 8 -17?6 Z Town of Barnstable CONTACT PERSON:6-M 5/� yiS P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER:,':_�—eP �Zg o"P21 Hyannis, MA 02601 TYPEOFBUSINESS: A,v D J�f-R/A7L, 6:�5tjd Does your firm store a7of the toxic or hazardous materials listed below, either for sale or for you own use? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners ' NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides X NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Cb Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's II' Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Date:jj/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: W N INVENTORY MAILING ADDRESS: POIROA 52:2 H!EJA4.vvis !� & TOTAL AMOUNT: TELEPHONE NUMBER: $) CONTACT PERSON: C200, ' EMERGENCY CONTACT TEL HONE NUMBER: S�®8 �5q7/29 MSDS ON SITE? TYPE OF BUSINESS: Ai/- ]zm P ril a, INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers - Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appl' nt's ignat.. a Staff's Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" F1., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE: 10/06/ Z-010 . Y Fill in lease: , t APPLICANT'S YOUR NAME: •"'v1 � P�'eSlvT (• BUSINESS YOUR HOME ADDRESS: , u 1a0l` IA TELEPHONE # Home Telephone Number: _ Z- NAME OF NEW BUSINESS, '& e _ W Lv✓Nj ,;;N PE OF BUSINESS P-e Dd A(jM"60P�`I1Q _H2OME OCCUPATI N? YES NO AWV K, Have you been given approval from the building division? YES NO _AD O_DRESS F B AlNESS, 0 Ji;�A/,' aL%P/PARCE'L NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM O ER'S.OFFICE divid This in u ha i,nfor an p mit requirements.that pertain to this type of business. rL'J Aut rizad Signatu COMMENTS: 2. BOARD OF HEALTH This individual has been ipiefF5ed of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL (�• Iry(r-1 WAZARDOUS MATERIALS REGULATIONS Authorized Signature** COMMENTS: , 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has�en i f r d of the licensing requirements that pertain to this type of business. uthorized ig COMMENTS: —(,k)d-t �L at-Jo 10-m� b Ct-A,zt �p . �$L\STALL WU5. , .•�� Y 1 Citizen .Request Management , ' Pk h� Request ID: 33697 Created: 2/10/2011 4:09:39 PM Status: Assigned To Staff Assigned To: Stanton, David , Health Office Anonymous: Yes Category: Chapter 108 Hazardous Materials E.C. Date: 2/14/2011 Created By: Stanton, David Citations: Health Office Time Worked: 0 Response Time: 0 Request Location: To be:Hyannis Honda extra building\parking 405 WEST MAIN STREET Hyannis, Ma 02601 Parcel Number: Ma 269 Block: 117 Lot: 000 Request: Colleen Ferguson, Mass DEP called in regards to a complaint of Asbestos being removed by an unlicensed person. Some applied fora waiver to the AQ06. There is a report of broken asbestos containing floor tiles on the second floor in the bathroom, it appears the tiles were removed, no permit. Would like Board of Health to do a site visit and see what is going on, have asbestos tiles been removed, where to, etc. Request Work History: r ,