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HomeMy WebLinkAbout2929 FALMOUTH ROAD/RTE 28 - Health 4a 913A i�94 I . j , Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Mahoneys Garden Center .-------------------------------------------------------------------------------------------------------------------------------- 2929 Falmouth Road/Route 28, Osterville, MA .....-------------------------------------------------- ---------------------------------------------------------------------------------------------------- -------- Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to; and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r Town of Barnstable Inspectional Services BARNSTABLE Public Health Division �D.nSTaP E•@h EMLE•CO UR•kT4AhIS f.L'.2SttNlSN'.LLS•OSfRYI1L%•':F.Si B1V5Th9LE BAMWAB 163�(9�-j2014 LF Thomas McKean, Director a,� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ` IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th).. APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2.PERMIT._ 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ l *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. L 2 1 - 62-0 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER`BUSINESS HAS ZQNING/BUILDING"AP 'ROV'AL µFOR-°HAZARDOUS,TMATERIALS STORAGE/USE OFF r,j ;µ ,, � . .M1• - d 7- t t r r `r n S�,L 1( a, r V r 3' as^4 "?fi k N,tft�,_Nl��;t'` :�i� E �j .,4 GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS) YES M NO '..:'� +. .:.s , ::; l� ^'}hf J.. �c n 't•: a � °.,K,_M a,)` ,ti_:` ` .,�.•r'tv v t..,°N L� :� ff a• ;.t *t � o, 4.-. .��. tu@ , "��R: �''N;yrv:„�.g ` ,� t 5. NAME OF ESTABLISHMENT: A4hbt4q(_f � 6. ADDRESS OF ESTABLISHMENT: p C�1't o c ®f Lw/ 9// 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 66"p, 8. TELEPHONE NUMBER OF ESTABLISHMENT: 7 Y 21 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO NAME OF PARTNER: �Z �Gt I-f yw � : y 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: / CORPORATION NAME h6 W 'S -rw c lyu PRESIDENT o Gi 6 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT ,DATE Q:Wpplication FonnsU-taz Mat Appli Draft Jan2019.d0c Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 enRMARr,BLE.$` 200 Main Street• Hyannis, MA 02601 t619- TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 'ec Mn+s Business Name: RCe 5 r , Date: �! l Location/Mailing Address: 410t y,. wh +✓� Contact Name/Phone: N1 — �- Inventory Total Amount: �" 400 SDS: �S License#: �' t� Ca+2. Tier II : U Labeling: Spill Plan: Oil/WaterSeparator: NIA Floor Drains: & SIT'k* Emergency Numbers: Storage Areas/Tanks: Emer enc /ContainmenWEent: IJIMZ. SpILV1 *rft 411d C esmiccttS Waste Generator ID: Waste Product: 11t3 t Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives V� Gasoline,jet fuel, aviation gas 0 Cesspool cleaners Lf Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants,f- 1()o Degreasers for engines&garages ✓ Pesticide dllOnS 30 Pourj4s�n5ecj Caulk/Grout insecticides, h rbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains,.dyes Lye or caustic soda Lacquer thinners _�� Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers t6- Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry,soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: "V& ad�Ol�►r., i-o J INFORMATION/RECOMMENDATIONS: I6 I LQ W{� MI i t n w Od 6 ��( linen", hOb s 1 P ,`r� � -- -Ins ector: Facility Represents ve- r WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS I °a tKE "ry Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. ' 200 Main Street• Hyannis, MA 02601 �prFDMP6 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Ma�ovs ��< .+�. C.e►�-e� Date: �6 t Location/Mailing Address: 2 9 0„ OS}tecv. II.,, Contact Name/Phone: a„r,A- ,v.4,, Inventory Total mount: �OL O&`Cvtk MSDS: Yee, License#: Tier II : l o Labelina: Spill Plan: 1Z S Oil/WaterSeparator: Floor Drains: c9 F ergency Numbers: r_s Storage Areas/Tanks: %GS,1 C4,V4,1 k < .�cr e Q �..k<11V1 Emer enc /Containment ui ment: s o A u- s Waste Generator ID: NIA Waste Product: — Date&Amount of Last Shipment/Frequencx: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ` ORDERS: I INFORMATION/RECOM MEN DATIONS: ov-)w k k -0— ��J1a-,t�oJS C,�tipp�,a. S v&Vicev�c�x o� v�� ����SA 5 I1 �-A C) -51 e,o �kzto oto y nspector: Facility Representative: /00 WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE ropti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • snRMASSBLE. • 200 Main Street• Hyannis, MA 02601 �'�EDru+'tee TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: M W-115 Date: Location/Mailing Address: 2AzQ 1::;0W10a1 — A _ �s�ecv�lle_ Contact Name/Phone: y-i5avc.,5 SJo- y 20 -4q 2$ -7A( -gap--3g t'7 Inventory Total Amount: ` MSDS: je,S License#: 1-7 4 Tier II : Wk Labeling: &4 eu -Ic e Spill Plan: Oil/WaterSeparator: o Floor Drains: - o Emergency Numbers:ye- Storage AreaslTanks:DcvQcvw 0% Emer enc /Containment Equipmen W Waste Generator ID: Ili Wa a Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 1 V o �►.�a�ol ��n ti i 0, 1 Kv�'ot �i 1AC2• �e,1+ 1 0. NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws AAA, hazardous Vial use, 311°I/l�; storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash . Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATI N/RECOMMENDATIONS: 11 u a *� e! ofzT d _ Jr - OV{ IK oaf I !� CQWk tA 1 a t _ Me i'A-5 Inspector: '�, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: 3/ i 7 / I y TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 1t4a-6Mt 6--k,�r4yt- cep&,l BUSINESS LOCATION: 2921 Imalji-k-- IM , INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: -44 L% > It < a,� CONTACT PERSON: $C& �e'cvK, 6 K - EMERGENCY CONTACT TELEPH NE NUMBER: 1$ 1 1-1 MSDS ON SITE? TYPE OF BUSINESS: c,,,, czerv` t2,-s-j, 6- INFORMATION / REC MENDATI NS: ���Q�-CvK�� o sk Fire District: �v V 0 1 �n <, van 11Ai �2C Do Waste Transportation: MIA� 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 Np rti�10< Clnc�, rv� Nwv�+v� StKce- k t—1 The Board of Health and the Public Health Division have determined that thetollowing productp exhibit toxic or hazardous characteristics and must be registered regardless of volume. r 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 Applicant's Signature Staff's Initials Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Mahoneys Garden Center , 2929 Route 28, Osterville,MA Is Hereby Granted a License., For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------------------------------------------------=------------------------------------------------------- --------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health k'I Town of Barnstable Inspectional Services BABSTABLE �t�r� o Public Health Division iSTC`5 MILLS•Gi`EFV;LL:ei:l B4R'i.J�E. LE• Thomas McKean, Director 1639 A 200 Main Street, Hyannis, MA 02601 L Office: 508-862-4644 Fax: 508-790-�3304 '.a APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108; HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125:00 $ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st.. 1. ASSESSOR'S MAP AND PARCEL NO... 2. IS THIS A PERMIT RENEWAL? ✓ .YES_NO. IF YES,' SKIP QUESTION 3. MAC TE 3. FOR ALL NEW PERMIT APPLICATIONS INDICA WHETHER BUSINESS HAS ` �., {S��N �"�ZONING/BUILDING�AP�PROVAL FOR'�RAZARDOUSt'MATERIAI;,S�$TORAG�/4I7SE�OF t �,�e��, 1;� ti tr r ' z :� *GREATER THAN HQUSEHOLD QUANTITIE$£(ZSGALI;Q.NS)�.}t t „YESr °NO £F ti `A yY;.y ._. & �;t>t.."'.siSrr..'�,t,.. ..,:-S�st f..,^�i..::,'"„�i .�«. £.�s'4Y;e•:4„3...a�..r(;, iF,'..ys.S:,.wa l,¢.„3"!:,a,'�n r,�E.T,r_,,,�..r„�':... .., t. 't'r"1_ N,,,,...,, .. =-. . - - x: 4. FULL NAME OF APPLICANT: Gl 0 Vl `} TO o �� 5. NAME OF ESTABLISHMENT: d� b `S U(x��(�r ' l t-✓ 6. ADDRESS OF ESTABLISHMENT:7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ��� - 8. TELEPHONE NUMBER OF ESTABLISHMENT: SQ 9. EMAIL ADDRESS: e 0 rq"An Ak(h b q ti S j 4,✓ of , OnI 10. SOLEOWNER: YES i NO IF NO,NAME OF PARTNER: /fN 11. FULL NAME,HOME ADDRESS,AND TELEPHONE OF: CORPORATION NAME I�. Ll ►'(e J'$ a Lc,�,c_'.l v d -t �s ��i. by , PRESIDENT —TOM vit.5 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT �� DATE � A Q:\Application Forms\Haz Mat App Revised 09-10-1�Jlx* i Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Mahoneys Garden Center 2929 Route 28, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ----------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO ~ Director of Public Health � 1- I Vowof B nsxableegulatoryServices Richard V. Scali,Director Public Health Division BARNSTABLE I enaxsae •rvmrtwue•mruR•!munu w tARNSTABLE. ` Thomas McKeanDUB& ,Director " ° "'�16 9°o 4 s" '- 1659. �s`0� 200 Main Street, Hyannis,MA 02601 ��Ig Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 o V•$ •- CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES,SKIP QUESTION 3. ` Y ' 3 FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS +s , ZONINGBUILDING'APPROVAL FOR HAZARDOUS MATERIALTORAGE/USE'OF GREATER�THAN-.HOUSEHOLD•QUANTITIES (25.,GALLONS)�r YESY '"..`"NO :•'A` a, } " 4. FULL NAME OF APPLICANT: G��y n�1'S Tno CAN Q (od t Is l u'A , 1 n L_ 5. NAME OF ESTABLISHMENT: W 1,tl w KGN` � 610 1 "f nte-r- 6. ADDRESS OF ESTABLISHMENT: 2,qZq F41440A V4 0S4eVV1 ((t- 40, qi;�g 10- r-C.I 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: Tq� 01&1 8. TELEPHONE NUMBER OF ESTABLISHMENT: q qZL/ 9. EMAIL ADDRESS: J �LOhL�v�����1 e CO 10. SOLEOWNER: YESXNO IF NO,NAME OF PARTNER: /DMZ qtc"l+ � 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF- CORPORATION NAME MA-'Ao►nl.H,S Too ffxyt VeLL--- PRESIDENT Tk.,y%,ja�, Ak0.ko KW TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q: Application Fonns�HAZMAT APP 2017 REVI D.do x Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Mahoneys Garden Center 2929 Route 28, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. --------------------------------------------------------- --------------------------- ---------------------------------------------------------------------------_ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health owi� of Unstable TRegulatoervices ° Richard V. Scali, Director & Op THE T !� o Public Health Division BABSTABLE � �•W PpRtlSTn6lF•iFxi­1LLE•CONO•XTux15 ■A grABLE Thomas McKean,Director 1639-2034 39-2"-"'""°'"'"°` MASS. ' 200 Ma1n �g Street Hyannis MA 02601ra �'� 1 rm , G 41'i ° e _w :a+t r p i w r ��- 1 x� ,f tr '3-�''E i.c •4 " ,d r ra t t.V,�i..,,r a�:.' ,p.,•..c74 Y°+' ,.i rrc) ;;i. kFi_.is � a�'.-.-� m s y ,d ,p a ,r '�'k �. - ..-•' '..i�' 508-790'6304 4-`t � . APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ' IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, >Q HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—NNE 30th).. �. a6g APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 v S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A date charge of$10.00 will be assessed if payment is not received by July Ist. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES -NO. .IF YES,SKIP QUESTION 3. 3. FOR ALL-,NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF a GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: rN1h o�r1 -I` 5 iX� 2 cod . 1 jGc✓IG{S , (i1C� 5. NAME OF ESTABLISHMENT: h D-Atq 1 S VKV dw - `tin4z�- 6. ADDRESS OF ESTABLISHMENT: 7i� .�C( I✓ti'I o ��%( ®Sre'V✓l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: _ � y rl�+y1�'I��✓ y .OZ5 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: . �0 vi e(2,� m aV\o yi e- S grdm f o m ` 10. SOLEOWNER: YESINO IF NO,NAME OF PARTNER: ®im CkS ICI Ylfl�� 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME of ov\e--I 15, 'fib G1nc. (Gd PRESIDENT TREASURER CLERK' .: 12. IF PREPARED BY OUTSIDE PARTY: ' NAME: TELEPHONE#: °. COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT �1111d, DATE ro `) 'o?D/ Q:\Application Forrris\I-IAZMAT APP 2017 REVI :docx >' - 1 4 Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Mahoneys Garden Center 2929 Route 28, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f Town of Barnstable • �t ► , Regulatory Services ti Richard V. Scah, Director Public Health Division BAMSTABLE BARrlSABIE•NliFRJiLLE•['DN!f•YYakRA 16.39' � N.1NSi0R5 YJlt5.OSfERV:LLE•W3i BARXSTA&F �fD MA'S A Thomas McKean, Director 1619-211° + D H 200 Main Street, Hyannis,MA 02601 Office: 508-862 4644 Fax: 508-790-630 ► r-• APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE '0 HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 3 Oth). - APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 El CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 15 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by July 1st. 2��r - � ° S°T S5�RS�- ,MAP AND rP C•EL NOz � � :�:�'� �� x. h `�� �trJ ax�.gr.,l.... '��,..:.. ,-... :�p'�r. .> u.., f T'{` .r- r-h:r....A r� -.,.v,;"+� �....-�. 1 I W eidL"? V N.. k. ,.:. .'r +1 V`b�Rp ;,�",'4� t�:•,F :..:?:�—y ...�t .� ."@i' �,:!'Yt e� �` �>:.�r t"'...;5' .�,,,��• ft. :. v J.-'Im �� 1,°drs:�t�4 •C�." d J .��'° �,�, �&.a °�, ' as--s�'2:. R��r,`.�.. .... �` 3..Y. ��y� �e i»��r:.¢ �� � is -.> �., cz : � � `w - r, i �d_/�k. i1.....-..1�.'-..�C' ..........,._ .. - 1. ,4- .�:. k �_„l.S :r.c.k...c...•N� NAME OF ESTABLISHMENT: 02(W ADDRESS OF ESTABLISHMENT: � a-�l 7.v-U4AD� V� O i ���C fi t Ci 6 26 MAILING ADDRESS(IF.DIFFERENT): �Atm/A X Lj TELEPHONE NUMBER OF ESTABLISHMENT: q20L EMAIL ADDRESS: ' VaS u2.S W'J'wvi vrllvl. V7 SOLE OWNER: YES-k NO IF NO,NAME OF PARTNER: � A S �Yl FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 04k�wEyJ 1* cbfy(�- 60V f Stem)f /4L- PRESIDENT ` MAJAri 461d jq t-r0 /✓f (A G?cr fr e2*L- TREASURER CLERK r+.i .a 4 `s - - - - -- IF PREPARED'BY OUTSIDE PARTY: SIG TURF A PLICANT _ Name: ,i Company Address : Telephone#: Email: QAApplication Forms\HAZZAPP Rev16.docx Page 1 of 2 Number Fee 174 THE,COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Mahoney's Garden Center 2929 Route 28, Osterville, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health . 'l Town of Barnstable, K `S Regulatory Services dry p2 3k Richard V. Scali,Director p�}j f�- ` WASS ` Public Health Division s Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. 2-1 -0 2© DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Q��✓I `S �U►%�: ���.0 (:� J�?lei hl� I f1 NAME OF ESTABLISEMENTlqrj bon �Qln ADDRESS OF,ESjAB ., HMENT � d. l�(a �'c j � .� {ram"t....... . f TELEPHONE: .Ni7MBERd i r•,7 b�*} '`._ 7 >:. • :' �.,,;t " .-a.wr •�..:7« .. ." k:.r .�*?5.,`.,c..,. ,. r.,., e f°" .. ��t�' `�1 .e t+�...�a��.�t•?i- �§�+ai5?�.� SOLE OWNER: YES�( NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL . PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04-Z83 13 2-- STATE OF INCORPORATION i FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK , # $ R' SIGNA O AP_ ICANT RESTRICTIONS: HOME ADDRESS w5pA erg HOME TELEPHONE# f kl'70 LOW C:\mche\TemporaryhitemetFfles\OL M3IHAZAPP Rev2015.DOC p�tt ri` r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory.Services Department ~ ' snr aa Public Health Division MASS Thomas A. McKean,CHO s � 200 Main Street, Hyannis, MA 02601 Payment Receipt (Hazardous Materials Payment received: $ 100.00 (Check) on 6/15/201�5 Permit number: 174� j !Check number: 6237 Check amount: $100.00 Name on check: Mahoney's TOO E [Business: Mahoney's Garden Center Owner: KATHLEEN TR ;Address: 2929 FALMOUTH ROAD/RTE 28, Marstons Mills j i Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Mahoney's Garden Center 2929 Route 28, Osterville,MA 02655 Is Hereby Granted a License FOR: STORING OR HANDLING 171 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health MIL L-� �vt wl d Tow. 01 Barnstable S Y to Services To�aa9 F, Gier,DEc#arLl AAETiGT?.AT -abh ,miq �v��� )• 1 �• �,�� 1��3L t S e p Direct.0 2D01'i�S u��-i, Hya A 0�601 ' F� 50�-790-b304 • Ofca: 5a&-B -4644 ASSESSORS MAP At�M P A�.C�+L O. '1 I�O Z® DAT� r TPLICATION FOR PERI�'T TO STORE An/ RUT 1�-()FtE TFLAN NA�fE of APPIIc �J w�IvN y`S is L �� /WC Alm OF ESTAMLEMYf INT 4 Hb '�. idi3ni'wl F.1 .+z ��, �s -�.» �.'4' .t *;. �1� t.,.. ' r ray��r t , q -, r •' r r .a? � � '�s. � A� .� t+5� r� ��q^a� dx .:ts-'T�•x�r���;*��t'ir�• :�d,`�a " :.,A 4 �"�:tz i.:�, �,'".:,! v F'#`•4+:.�„_ �,. t � F - `L,• - + a ry s 'S fii €� K P r it '` �. T�.i�n r�Oitl+1'1 U1i'1u n'rt. ` .. F -�1 _ND HOt A�D1 SS OF. L_ � LF+'APPLICANT IS A PAB , P ART1'I +�5:: 'C'� •� p i Z r lU 1+ API?LICANT IS A C-ORPOAA TION. Ffj) �L IDENTIFICATION NO. d q-n3 Z3 STATE mp OF 2 COgPORATIO�T :PRESID= _.. TL _CI ._ �. .. 4._.....�._.. SIC AT1Ii YLIC107 i 2L�✓�WIB►�-�d Stl yE�T�ICTIO�iS; LO.2�ADDAESS EONS TXLXPBOBI # i -la-dacNT/q r Please m=il the conple,.ed applicaiion fom to the addrzss below. In. addifion, please inc ude the r-cquuK�d fee amount Make check payable.to: Tom of Bamstable. Our nailing address is: Tovm of Banm-table P-ablic Healer Division 200 Main St-wt H79-Mil , lye. 026,01 FOR FAD REQUESTS 0lz L3-7- n11mber is (6008) 790-6-M4. Please fax a canpleted.application forma. La adr--don; you: =u t a•1 the Ie�ed fee amount (see fees at bottom of this page). Please rriake the check payable to: Tovrn of Barnstable. The cherk must be-mailed to the addrass listed above. For further assiL�ance on any it= above, call (508)..0062-4644 I 0 - I _ II Number - Fee 174 THE COMMONWEALTH OFMASSACHUSETTS $100.00 Town of.Barnstable Board of Health This is to Certify that r Mahoney's Garden Center 2929 Route 28 .Osterville;llMA=0265-5 is±Hereby Granted a_License FOR:. STORING OR HANDLING 111,,GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------- -------------------- This license is granted in conformity with'-the Statutes and ordinances relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PA_UL J.CANNIFF,D.M.D. _ - 6/30/2010 JUNICHI SAWAYANAGI _ THQMA$A.,MCKEAN, R.S.,CHO Director of Public Health i L 1 Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable f -Board of Health This is to Certify that Mahoney's Garden Center 2929 Route'28,f bsteiudie,k 02655 . Is Hereby Granted a`License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating thereto., and and expires 6/30/2011. unless sooner suspended or revoked. --------------- WAYNE MILLER,M.D.,CHAIRMAN PAU_L J.CANNIFF, D.M.D_. 6/30/2010 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health ^� Town of Barnstable y-3tL 'ASE NMA�L ALA:: 1 . 1HE rok ° Regulatory Services �� Thomas F. Geiler, Director MAHONEY'S.GARDEN CENTE ! BARNSTABLE, MASS. Public Health Division , 958 E. FALMOUTH HWY 1639• „ E. FALMOUTH MA 02536 • ArFornPyA' Thomas McKean, Director '200 Main Street, Hyannis, MA 02601 ' 0ffce: 508-862-4644 t Faz --SO8—790-6304�--_,-. Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.- i a-.� DATE' •APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT IM�11��E`I�S Thu }P� Gc�✓1 -}- �� �/✓�S �ti1Ci NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT { rr *�5� ✓�.�/{ " /II( t .", .'�,J L�' ``> '�.5-.y xF:.y ,S t, h+ d• �t , 1 k, ,..�:,C � . � fN ic+ �a1} t'': { 8 .'.. Y!' P7"'X" � �_ t:,t .� -J�i � �'w� }�� e 5 S tz�}� 3 �`'�Y T}J3�P�. js E' ,.di a'� d -a �r y.•v i t 4 y � C tdS..:�f •v: rS: .+�5 :° i�` .. r ; s 4 �'` �,d'7 � t` rJ z^` '�3 y s y t'� I �- �a x� y �`41t.,i- c1r' .c a t¢r"s k} :t 37r., ��O*rt x ua:.. ,1 .st ,c "° 1}+r.;,� mn ix? '�s .,;,.e3/, ,�} .�`.:..1+5 x•+ '�: ;f• pr S "TELEPHONE NUMBER ; � SOLE OWNER: YES NOi;, IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL . PARTNERS: ' x � IF APPLICANT IS'A CORPORATION: FEDERAL IDENTIFICATION NO. aq'29 3 STATE OF INCORPORATION '"`A FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER . CLERK IGNAT E OF APPLI T t a RESTRICTIONS: `. 114 IVIE ADDRESS M2.. (4m.SKoK IT bVPOESWI HOME TELEPHONE # . • - .. . • .inn Number Fee 174 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Mahoney's Garden Center 2929 Route 28, Osterville,MA 02655 =' 1s Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity witli the Statutes and ordinances relating there to, and, and expires 6/30/2010 unless sooner suspended or revoked. -------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health o' n of Barnstable Barnstable Regulatory- Services Department • Public Health Division yob ,�39 ;�� 200 Main Street, Hyannis NIA 02601 2007 Offlce: 508-862-4644 Thomas F.Geiler,Director FAX: .508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. �a��® ;LO DATE a1-0 9 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111.GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT�liN-O�JIFi 1 S T�� CAPS C�� f A L440S ILL NAME OF ESTABLISHMENT RD t4 F Y�S ��+0 r�N C Cr TFK _' ;°ADDRESS OI ESTA.BLISIIMI♦ 13 k e _ S_?Y Fea°rX'"`Jt"' 5 ✓.,ts i r ' `N . '. �;, A l S ak § n. x, q.. { y w- .. •3ih A(,' TELEPHONE NUMBER q SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Oaf-2$323y2.. STATE OF INCORPORATION MA FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER . CLERK'. ,K "SIGNAT OF AP STRICTIONS ,, '11: HOME ADDRESS o1 a C�1 (3►�C�cr% r �if fC �7R�t, HOME TELEPHONE Q:\NszmaM2Z Mat Application2008.DOC CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-2380/FAX$(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# r'�z . LOCATION: ADDRESS OF RELEASE: //;2 Z DATE OF RELEASE: 4„ ,�, PRODUCT RELEASED: ESTIMATED QUANTITY,,-Y� --" CORRECTIVE ACTION TAICEN'BY RESPONSIBLE PARTY: r ITJ 71.4-f r 0)•r NOTIFICATIONS: FIRE DEPARTMENT: YESG- NO( ) DATE: ;�� „ 4g- TIME: ;:z u -- NATIONAL RESPONSE CENTER YES( } NO(-)- DATE: TIME: DEPT. OF ENVIRONMENTAL PROTECTION YES( ) NO(,)-DATE:-TIME: OIL SPILL COORDINATOR-. YES( ) NO( i. DATE-.-TIME, TOWN BOARD OF HEALTH: YES( ) NO( DATE; TIME: TOWN HARBORMASTER: YES( ) NO( )yw DATE-.-TIME: OTHER AGENCIES- COMMENTS: REPORTED BY, ` 4 DATE: f rSK--fir,� WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.PI PINK COPY-BOARD OF HEALTH C-C.-MM FORM *58 t � •� CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE,MA. 02632 (508) 790-2380\FAX# (508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F,A Z C 4. LC .A ICtl ADDRESS OF RELEASE:--9.Si tom + DATE (' RELEASE: li cz /c/y PRODUCT RELEASED: we ESTIMATED QUANTITY: t tar, U„1ef CORRECTIVE ACTICfJ TAKEN BY RESPOPISIBLE PARTY: ! NOTIFICATIONS, FIRE DEPARTMENT:YES 00 NO( ) DATE: Z/(I-/ti TIME: -t,f NATIONAL RESPONSE CENTER: YES( NO( GATE: TIME- DEPT. OF ENVIRONMENTAL PROTECTION: YES( ) NO( ) DATE: TIME! OIL SPILL COORD8IATOR: YES ( ) NO( ) DATE: TIME: TOWN BOARD OF HEALTH: YES( ) NO( ) DATE: TIME; TOWN HARBORMASTER: YES ( ) NO( ) DATE: TIME: OTHER AGENCIES: i Z« �. E.is t2c Le.. COMMENTS: c is I ��! ; '< !f l� 7� j, -1 /�,v7 C._-f-n n �•� / -t l .m ..( { REPORT FILED Br: �--,�.�<�.�.�,�� ��� ,.� �� DATE: r WHITE COPY-FIRE DEPARTMENT YELLOW yOPY-D,E.P: PINK COPY-BOARD OF HEALTH C;,,M,M. FORM 58