HomeMy WebLinkAbout2964 FALMOUTH ROAD/RTE 28 - Health 2964 Falmouth Rb,
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Jan, 17. 2007 11 : 58AM MASS DEP No, 1262 P. 2/6
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COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL
DEPARTMENT OF ENVIRONMENTAL PR Copy
SOUTHEAST REGIONAL OFFICE
2 47 509,
DEVAL L.PAMCK LAN A BOVaZS
Governor Secretary
TIMOTHY P.MURBAY ARLEEN ODONNELL
Lieutenant Gwamor Commisaionar
January 12,2007
Mr.Frederick Tobin RE: BARNSTABLE-BWSC
Bartlett Realty Company RTN: 4-19395 '
1290 East Main Street 2964 Falmouth Road
P.O.Box 3067 NON-SE-07-3T-004
Stamford, Connecticut 0690.5-0067
NOTICE OF NONCOMPLIANCE
THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN'RESPONSE TO
THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES.
Dear Mr.Tobin:
The Massachusetts Department of Environmental Protection, Bureau of Waste Site Cleanup
("MassDEP'% is task ed with ensuring the permanent cleanup of oil and hazardous material releases
pursuant to Massachusetts General Law Chapter 21E("Chapter 21E'). The law is implemented through
regulations known as the Massachusetts Contingency Plan,310 CMR 40.0000 et seq. (the"MCP').
Through the MCP, MassDEP is currently regulating a release of hazardous materials that has
occurred at 2964 Falmouth Road,Osterville,Massachusetts: MassDEP was first notified of the release on
October 7,2005.
MassDEP's records indicate that you (as used in this Notice, "you" refers to Bartlett Realty
Company)am a Potentially Responsible Party("PRP")for this release.
This Notice is provided.to inform you that you are not in compliance with the MCP. MassDEP
has no record of your completing the response actions required by the MCP to address this release.
Attachment A of this Notice is a Noncompliance Summary sheet that outlines the provisions of
the MCP that you have`n�ottcoMW_witb. Contained within the Noncompliance Summary are the
necessary action(s) you must compete to return to compliance. Additionally, there is a prescribed
deadline for your completion of the action(s).
MassDEP may assess a Civil Administrative Penalty potentially in excess of several
thousand dollars if you continue to be in noncompliance with the violation(s)cited herein.
This loformadon b available in alternate format Call Donald M.Gom ADA Coordinator at 617- 6-1057.TDD service-1-400-29&2207.
DEP on the World Wide Web; http;/twww.rnese-gov/dep
a Printed on RagcW Paper
Jan, 17, 2007 11 : 58AM MASS DEP No. 1262 P. 3/6
Y
Page 2
Notwithstanding this Notice of Noncompliance("NON"),MassDEP reserves the right to exercise
.the full extent of its legal authority in order to obtain full compliance with all applicable requirements,
including,but not limited to,criminal prosecution,civil action including court-imposed civil penalties,or
administrative penalties assessed by MassDEP.
Finally,Attachment 2 of this Notice is a fact sheet containing supplemental information regarding
this NON.
If you have any questions regarding this matter,or if you would like to discuss compliance with this
Notice,please contact John Handrahan, at the letterhead address or by telephone at 508-946-2883.All future
communications regarding this matter must reference Release Tracking Number 4-19395.
Very trul yours,
d M.R.Martin,Chief
Site Management&Enforcement Section
M/JHhe
\\dep-fF-lak-001VHandrahan$\Enforcement\Enforcement Letters\19395.1D.N0N.4.doc
Attachments: Attachment 1:Noncompliance Summary Sheet
Attachment 2: Supplemental Information Regarding this Notice of Noncompliance
CERT>FIED MAIL 70041350 0004 4565 8785
fc: Board of Selectrnen
Board of Health
ec: DEP-SERO
Attn: Brad Lacoutore,REO
Attn: Data Entry
cc: DEP-SERO
Attn: Regional Enforcement Office
Jan, 17, 2007 11 : 58AM MASS DEP No. 1262 P. 4/6
AT rACHMENT 1
NoncE oF N NCOMPLIANCE
NONCOMPLIANCE 3UMMA�Y
ENTTTY/.P4:)TENTIALLYRESPONSrl3LE PARTY IN NONCOM
Bartlett Realty Company
1290 East Main Street
P.O.Box 3067
Stamford,Connecticut 06905.0067
LOCATION WHERE NONCOMPLIANCE QCCURRED OR WAS OBSERVED:
4-19395
2964 Falmouth Road
Osterville
DATE(S)WHEN NONCOMPLIANCE OCCURRED OR WAS OBSERVED:
October 17,2006
DESCRIPTION OF AQ=OR CONDITION RESULTING IN NONCOMPLIANCE:
1. You have not submitted a Response Action Outcome(RAO)Statement,Tier Classification Submittal
or Downgradient Property Status Submittal to MassDEP. One of the above referenced documents is
required to be submitted to MassDEP within 1 year of notification that a release of oil and/or
hazardous material has occurred,as is required by 310 CMR 40.0501(3).
DES ON OF REOUEUMENT NOT COMPLIED WIC'
1. Pursuant to 310 CMR 40.0501(3), except where a site has filed a Response Action Outcome(RAO)
or a Downgradient Property Status Submittal, all sites for which MassDEP receives notification of a
release or threat of release of oil and/or hazardous material pursuant to 310 CMR 40.0300 on or after
October 1, 1993, shall be classified as either a Tier I or Tier II disposal site in accordance with 310
CMR 40.0500. A Tier Classification submittal and, if applicable,a Tier I Permit application,shall be
submitted to MassDEP within one year of the earliest date computed in accordance with 310 CMR
40.0404(3).
DESQLIPTION AND DEADLINES OF ACTIONS TO BE TAKEN:
To avoid imposition of a Civil Administrative Penalty potentially in excess of several thousand dollars
for violations of the MCP,you must complete the following action(s)within"_thir"ly.(30)=days of your
receipt of this NON:
1. Submit to MassDEP either a Response Action Outcome Statement, Downgradient Property Status
Statement,or a Tier Classification with,if necessary,a completed Tier I Initial Permit Application.
All items must be prepared in fall accordance with the MCP.
Notwithstanding this NON,MassDEP reserves the right to exercise the full extent of its legal authority to
obtain full compliance with all applicable requirements,including but not limited to,criminal prosecution,
civil action including court-imposed civil penalties, and Civil Administrative Penalties issued by
MassDEP.
Jan, 17. 2007 11 : 59AM MASS DEP No, 1262 P. 5/6
ATTAR MENT 2:
SLTPLEMENTAL JNFgZMAT1QN REGARDING THIS
L�LOTICE OF NONCOMPLIANCE
This attachment further explains why this Notice of Noncompliance(NON)has been issued to you.
Whv was I issued this NON?
MassDEP's records indicate that you have not submitted one or more of the documents listed in the
attached NON. This NON was issued to inform you of this fact and offer you an opportunity to come
back into compliance by submitting the missing information to MassDEP by the deadlines specified in the
NON. You are listed in MassDEP's records as the person who is responsible for cleaning up the release
cited in the attached NON. For example, at the time you or another party notified MassDEP that the
release occurred, you either informed MassDEP that you accepted responsibility for the cleanup or you
were sent a'Notice of Responsibility"(NOR)by MassDEP informing you that we found you responsible
for the.release. In either case,MassDEP has reason to believe that you are an owner,operator,generator,
transporter, disposer, or person who otherwise caused the release or threat of release of oil and/or
hazardous materials cited in the attached NON. This means that,under Section 5 of M.G.L.Chapter 21E,
you are a Potentially Responsible Party (PRP) and liable for response action costs associated with the
release. As a PRP, you are required to conduct and complete certain response actions outlined in the
MCP to clean up the release of oil and/or hazardous materials expeditiously.
What happens if I fail-to_cQ ply with or respond to the NON?
You have 30 days from the date you receive the NON to comply. If you fail to comply, you will be
assessed a penalty by MassDEP.
Your total penalty exposure can be considerable. .For example, penalties can be assessed for each day
you remain in noncompliance. Note that MassDEP is allowed by law to back calculate daily penalties to
begin on the date you received the NON. You can be penalized thousands of dollars should you fatil
to comply with or respond to the NON by the 30-day deadline. Please refer to the Civil
Administrative Penalty Statute, Chapter 21A, Section lb and 310 CMR 5.00, the Civil Administrative
Penalty Regulations,for complete details on the Administrative Penalty rules.
When the cleanup cont ctor finished the work in the field,I thoueht my deallnQs with MassDEP
were finished.What more do I have to do?
This is a common question asked when a NON is received. PRPs often think their dealings with
MassDEP are over when, for example,the fieldwork is completed by a cleanup contractor. Examples of
this type of fieldwork include cleaning up a spill from a saddle tank leak on a roadway, or removing
contaminated soil from a tank grave during a tank replacement or oil-contaminated debris from a storage
tank after a fire. The fieldwork may be complete,but you still must submit some paperwork to MassDEP
to prove that the cleanup was undertaken in compliance with the MCP.
The MCP includes deadlines by which you must complete response actions and submit information about
those response actions to MassDEP. We track the progress of cleanups by checking to see if you are
sending information about your cleanup progress to MassDEP on time. For example,if we do not receive
a Response Action Outcome Statement(RAO)before the 1-year anniversary date of the release,we must
assume that the environmental cleanup has not been completed. For work to continue after the 1-year
anniversary date of the release, the MCP requires that you submit a Tier I or Tier 11 Classification to
MassDEP. If MassDEP does not receive either an RAO or Tier Classification by the 1-year anniversary
date, we must assume that you are not implementing any cleanup at all. Without your cooperation in
obtaining the cleanup information,MassDEP does not know whether serious environmental problems are
being addressed. If work is not being performed, MassDEP must take action to ensure it happens. On
Jan, 17. 2007 11 : 59AM MASS DEP No. 1262 P. 6/6
the other hand, you may have finished the cleanup but neglected to forward the cleanup documentation
required by the MCP.
What do I have to do to comply with the NON?
First, all response actions not directly managed by MassDEP staff must be overseen and directed by a
"Licensed Site Professional" or LSP. LSPs are licensed by the Commonwealth, and their stamp and
signature are required (together with yours) on all but one form you must submit to MassDEP. If you
don't already have the forms and information required for you to comply with this NON, contact the
consultant and/or cleanup contractor who worked on your cleanup. If you have not undertaken any
cleanup work,contact an LSP immediately. A list of LSPs may be obtained by calling(617)556-1091 or
viewing the list on the Internet at http://www.state.ma.us/lsp.
The documents you must submit to MassDEP require LSP stamp and signature. For example, when a
cleanup is completely finished,the MCP requires that you submit a document called a"Response Action
Outcome" (RAO) to MassDEP in which you attest that you have completed the cleanup in accordance
with the MCP. If you do not submit an RAO to MassDEP, the case remains open in MassDEP's files
even if the fieldwork is completely finished. If you received this NON and you think the fieldwork is
completely finished, call your cleanup contractor and LSP to find out how to have an RAO prepared and
submitted to Mass.DEP.
If more environmental studies or cleanup are needed (for example, following the initial cleanup of a
highway spill or soil contamination found daring a tank replacement), you must submit forms describing
your plans to continue the work in a timely manner. Again,these forms must contain an LSP's stamp and j
signature, and be co-signed by you. Depending on the circumstances, the possible submittals are an
Immediate Response Action (IRA) Plan, IRA Status Report, IRA Completion Statement, and/or a Tier
Classification Submittal and Tier I Permit Application.
You should also be aware that MassDEP does not become involved in or help mediate billing disputes
with insurance companies, cleanup contractors, or LSPs. A common response to a NON is that an
insurance company is slow on paying cleanup bills or will not cover various cleanup costs. We also hear
that cleanup firms and LSPs will not send in RAOs and other forms because their clients have not paid
their bills. These matters must be resolved privately by you. You ultimately must comply with the
attached NON or be subject to significant penalties from MassDEP.
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Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS $15o.00
Town of Barnstable
Board of Health .
This is to Certify that BARTLETT TREE SERVICE
.--------------------------------------------------------------------------------------------------------------------------------
2964 FALMOUTH ROAD, OSTERVILLE, MA
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Is 'Hereby Granted a License
For: Storing or Handling 500 gallons or more 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
All }
Town of Barnstable
Inspectional Services BAMSTABLE
Public Health Division rs°u•'t639-301 9-2014
r stntvaT►st� � Thomas McKean
gb ` '
Director
o . 200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax:, 508-790-630.4
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 El
--CATEGORY-2 PERMIT. 1-11 499 Gallons: , $125.00
CATEGORY 3 PERMIT 506 or more Gatlons: $150.00 --- V pdth
*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.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
. ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: The F. A. Bartlett Tree Expert Company
5. NAME OF ESTABLISHMENT: The F. A. Bartlett Tree Expert Company
6. ADDRESS OF ESTABLISHMENT: 2964 Falmouth Road, Osterville, MA 02655-1233
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: P.O. Box 177, Osterville, MA 02655
8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-2397
she wood bartlett.com
9. EMAIL ADDRESS: � Y _. ....
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: _
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: `
CORPORATION NAME The F. A. Bartlett Tree Expert Company, 1290 E. Main St., Stamford, CT 06902
PRESIDENT James B. Ingram 7 Swallow Ln. Westport CT 06880
TREASURER Carol J. Donnelly, 83 Autumn Ridge Rd. Trumbull CT 06611 ,
CLERK Carol A. Kiiek 10 Sable Rd Norwalk CT 06854
12. IF PREPARED_ BY OUTSIDE PARTY:
` ! NAME: TELEPHONE#:
COMPANY ADDRESS `- EMAIL:
SIGNATURE OF APPLICAN DATE 6/5/2020
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx Matthew Farin, Exec. V.P.
18 Boggs Hill Rd., Newtown, CT 06470
r
Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTHROAD, OSTERVILLE, MA
Is Hereby Granted a License'
For: Storing or Handling 500 gallons or more of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------- ----------------------
--------------------------- --------------------•---------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
e
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.,CH()
Director of Public Health
J
�I1
i
Town of Barnstable
Inspectional Services BARNSTABLE
YaPS1C�i tl S.St.FFAIL•N 'L"39tmGXiF
-15
Public Health Division t639-zo,< a
'"R', Thomas McKean,Director
9� s639. �0� ?
Arlo �s 200 Main Street,Hyannis,MA 02601 �
r:.
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
RMY 1 st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
-- CATEGORY2-PERMIT= 1-11-=4-99-Gallons:-- __$-12-500- ❑ __ .. _.. .--
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 VST
*A late charge of$10.00 will be assessed if payment is not received by Jules rcl
1. ASSESSOR'S MAP AND PARCEL NO. CPR —0(3
2. IS THIS A PERMIT RENEWAL? V 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
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: The F. A. Bartlett Tree Expert Company
5. NAME OF ESTABLISHMENT: The F. A. Bartlett Tree Expert Company
6. ADDRESS OF ESTABLISHMENT: 2964 Falmouth Road, Osterville, MA 02655-1233
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: P.O. Box 177, Osterville, MA 02655
8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-2397
9. EMAIL ADDRESS: sheywood@bartlett.com
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME The F. A. Bartlett Tree Expert Company, 1290 E. Main St., Stamford, CT 06902
PRESIDENT James B. Ingram, 7 Swallow Ln., Westport, CT 06880
TREASURER Carol J. Donnelly, 83 Autumn Ridge Road, Trumbull, CT 06611
CLERK Carol A. Kijek, 10 Sable Rd., Norwalk, CT 06854
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL;
SIGNATURE OF APPLICANT DATE 5/17/2019
Q:\Application Forms\Haz Mat App Revised 09-10-18.docx Matthew Farin, V.P.
18 Boggs Hill Rd., Newtown, CT 06470
Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS $15o.00
Town of Barnstable
Board of Health
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTH ROAD, OSTERVILLE, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials,
_------------------------------------------------------------- ------------------- ------------------ - --------- -------k r
--------------------------
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
-� �l So chK# 2130&
TRowrI of Barnstable
eg atoty emces
Richard V. Scali,Director
Public Health Division BAMSTABLE
lFhLLCCN .v.
�,BT,��. = Thomas McKean,Director ""�"'"���'H�.��w�,.. t.v{
MAH3 p tea-xcia
off•` 200 Main Street,.Hyannis,MA 02601 dIISJ7�d
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS rk�
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 l st—NNE 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
*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.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONINGIBUMDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEMSE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
•
4. FULL NAME OF APPLICANT: The F.A. Bartlett Tree Expert Company
5. NAME OF ESTABLISHMENT: The F.A. Bartlett Tree Expert Company
6. ADDRESS OF ESTABLISHMENT: 2964 Falmouth Road, Osterville, MA 02655-1233
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: P.O. Box 177, Osterville, MA 02655-1233
8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-2397
9. EMAIL ADDRESS: sheywood@bartlett.com
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME, HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME The F.A. Bartlett Tree Expert Company, 1290 E. Main St. Stamford CT 06902
PRESIDENT James B. Ingram, 7 Swallow Ln.,Westport, CT 06880
TREASURER John E. Slgnorini 661A Heriage Hills Antelope Circle, Somers, NY 105879
CLERK__ _ Carol A. Kiiek 10 Sable Rd.. Norwalk. CT 06854
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
• SIGNATURE OF APPLICANT DATE
QAApplication Fonns\HAZMA,r APP 2017 REVISGDAm
Matthew Farin, V.P.
18 Boggs Hill Rd., Newtown, CT 06470
�f
Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS $15o.00
-Town of Barnstable
Board of Health
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTHROAD, OSTERVILLE, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------.-------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2018 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
e T ijoZ gy Nnf
Tpwrx of B4rnstable
egulatory Services
Richard V. Scali,Director
Public Health Division BARNSTAB
wnsi�•,]wn»tuc.cmun•h+..w�
Thomas McKean,Director
16 200 Main Street,Hyannis,MA 02601. h
-c
Office: 508-862-4644 Fax: 508-790-6304'^
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 91?
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 DULY l st—JUNE 3.0th). 6?7 aas
APPLICATION FEES
CATEGORY I PERMIT 26— 110 Gallons: $ 50.00Y ❑
CATEGORY 2 PERMIT 111 —499 Gallons:. $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 del' -
*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?_L YES_NO. IF YES,STOP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIAL_S STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: The F.A. Bartlett Tree Expert Company
5. NAME OF ESTABLISHMENT: The F.A. Bartlett Tree Expert Company
6. ADDRESS OF ESTABLISHMENT: 2964 Falmouth Road, Osterville, MA 02655-1233
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: P.O. Box 177, Osterville, MA 02655-1233
8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-2397
9. EMAIL ADDRESS: sheywood@bartlett.com
10. SOLEOWNER: YES NO IF NO NAME OF PARTNER:
11.-FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME The F.A. Bartlett Tree Expert Company, 1290 E. Main St., Stamford, CT 06902
PRESIDENT James B. Ingram, 7 Swallow Ln., Westport, CT 06880
TREASURER John E. Signorini, 661A, Heriage Hills,-Antelope Circle, Somers, NY 105879
CLERK Carol A. Kijek. 10 Sable Rd Norwalk, CT 06854
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS ^EMAIL:
SIGNATURE OF APPLICANT DATE 6/6/2017
Q:1Application Forms\HHAZMAT APP 2017 REV]SED.docx
Matthew Farin, V.P.
18 Boggs Hill Rd., Newtown, CT 06470
Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTH ROAD, 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 6/30/2015 unless sooner suspended or revoked.
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
9/5/2014 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
�M
Town of Barnstable
� �► tOwti Regulatory Services
Thomas F. Geiler,Director
BARNffAMAW ' Public Health Division
y RSS
1639.
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. ®3 DATE J !l Y'
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE
THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT S%e.y�n C• ��c—�c w VC-(
NAME OF ESTABLISHMENT
a go e ^. �a c rr
ADDRESS OF ESTABLISHMENT 2-7(,y ?41M a vs',sa 4,1; o2G SS
TELEPHONE NUMBER
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. Ge'o`L:!�`I'{C,v
STATE OF INCORPORATION Co-,r)
FULL NAME AND HOME ADDRESS OF:
PRESIDENT —Tqm c �A �o'�✓� `� SGo�/dow Gn. d✓C�A'crt �/. CJGd-,PD
TREASURER :r0gp. S. <)/lar:n•'a �o�lt�f A+ iojoA. a .s Soyha.r. ./V- /0.�'e
CLERK ��cc.[ _ !I(, Ca��, /a V /� �r ., 3" Ge, 9 t-6
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS �U ram`` pla: �. ' o�• . y �'r�
HOME TELEPHONE# (5&E) i►t L /"►� ,out f
°FIKE row Town of Barnstable Office:508-862-4644
Public Health Division Fax:508as0-6304
• BARMS�LE.A 200 Main Street• Hyannis, MA 02601
163
9.
TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rF0 MA'S
Business Name: �Q�k�e �k�cee_ �X -� 5 Date:
Location/Mailing Address: ZIt,L4 Fo-1v�,*-A-(,— Y -Qsfc�r�tile�
Contact Name/Phone: 5-aeve, eyweox Aqg- $'08- y2.$-23'r-7 �A11 ec'��°►�.
Inventory Total Amount: & 11AVCA'S" 91�� SDS: e k w S 1n o License#:
Tier II : t Labeling: V0k&%1 hL,\t4'%A*-ISM Spill Plan: Ye-5
v
Oil/WaterSeparator: Floor Drains: IJ n Emer ency Numbers: Y615
Storage Areas/Tanks: cw��n- �coDaY , A1.5��c�c�+,M,12�, ,WIks� 6l�Q�I. 1
Emergency/Containment Equipment: � r� 1k �4�k.,�
Waste Generator ID: Was a Product:
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: ,\ \�
LIST OF TOXIC AND HAZARDOUS MATERIALS Nb OA �b.( C v�A m. % �Kv� -ov �exc�k
NOTE: Under the provisions of Ch. 111, Section 31, of the General Law of MA, hazardous aterial 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:
IN ORMATION/RECO MENDA IONS: ley,
�g v Ong
Inspector: t , L
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Number Fee
1172 THE COMMONWEALTH OF MASSACHUSETTS $150.00 9
Town of Barnstable
Board of Health
s
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTH ROAD, OSTERVILLE, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
---------------------------------------------------------------------------------------------- -----------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2017 unless sooner suspended or revoked.
------------------------------- --------
WAYNE MILLER,M.D.,CHAIRMAN
G
PAUL J.CANNIFF, D.M.D.
07/01/2016 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
• Town of Barnstable
Regulatory Services
Richard V. Sca1i,Director
`9,, Public Health Division BARNSTAB
Thomas McKean,Director 16S-201"
200 Main Street,Hyannis,MA 02601 p..
Office: 508-862-4644 Fax: 508 74004
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 1st-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 V '�
• A late charge of$10.00 will be assessed if payment is not received iv JuIy 1st.
ASSESSORS MAP AND PARCEL NO. DATE
FULL NAME OF APPLICANT: The F.A. Bartlett Tree Expert Company
NAME OF ESTABLISHMENT: The F.A. Bartlett Tree Expert Company
ADDRESS OF ESTABLISHMENT: 2964 Falmouth Road, Osterville, MA 02655-1233
MAILING ADDRESS(IF DIFFERENT): P.O. Box 177, Osterville, MA 02655-0177
TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-2397
EMAILADDRESS:- sheywood@tiartlett:coni -
SOLE OWNER: YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME The F.A. Bartlett Tree Expert Company, 1290 E. Main St., Stamford, CT 06902(203)323-1131
PRESIDENT James B. Ingram, 7 Swallow Ln.,Westport, CT 06880
TREASURER John E.Signorini,661A Heritage Hills,Antelope Circle,Somers,NY 10589
CLERK Frederick M.Tobin,116 Camp Ave.,Darien,CT 06820
IF PREPARED BY OUTSIDE PARTY:
SIG ?O 'APPLICANT Name:
i � Company Address :
Matthew Farin, V.P. Telephone#:
18 Boggs Hill Rd., Newtown, CT 06470 Email:
Q:\Application Forrns\HAZZAPP Rev I6.docx Pagel oft
F
V Fee
Number
1172 THE COMMONWEALTH OF MASSACHUSETTS = 1oo.00
Town of Barnstable
Board of Health
This is to Certify that BARTLETT TREE SERVICE
2964 FALMOUTH ROAD, 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
o.
Town of Barnstable
Regulatory Services
� -
Richard V. ScaIi,Director
RAID` tom. Public Health Division
` Thomas McKean,Director 4
n
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 t ', Fax: 508-790-6304
vyy�
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. . ( DATE �J
I
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
III GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT The F.A. Bartlett Tree Expert Company
NAME OF ESTABLISHMENT The F.A. Bartlett Tree Expert Company
• ADDRESS OF ESTABLISHMENT 2964 Falmouth Road. Osterville, MA 02655-1233
TELEPHONE NUMBER 508-428-2397
SOLE OWNER: YES X NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 06-0254490
STATE OF INCORPORATION Connecticut
FULL NAME AND HOME ADDRESS OF:
PRESIDENT James B. Ingram, 7 Swallow Ln. , Westport, CT 06880
TREASURER _.Tohn F.- si Qnnri ni _ 661A Heritage Hills, Antelope Circle, Somers, NY 10589
CLERK Frederick M. ToI I, 116 Camp Ave. Darien CT 06820
• SIGNATURE OF APPLICANT
Matthew Farin, V.P.
RESTRICTIONS: HOME ADDRESS_- 18 Boggs Hill Rd. , Newtown, CT 06470
HOME TELEPHONE# 203-323-1131
C:\cachc\Temporary Intemet Fi1es\0I.KD3UiAZAPP Rev20IS.DOC
°aIKE Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMARRAS- ' 200 Main Street• Hyannis, MA 02601
�ArFDMP+a`e� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: cLxc�'��2f�- 1 few r}5 Date: 2
Location/Mailing Address: 2% N 1 1m,*j'HL P , M. M. MQr1 fo t7st�r�� I�
Contact Name/Phone: .54,eyg- W rh a r S-65-Vz - 7
Inventory Total Amount: r, �2�, ��M � MSDS: f5 License#: -7'Z
Tier II : ; k. Labeling: Goo Ct Spill Plan:
Oil/WaterSeparator: Floor Drains: N o Emergency Numbers: e 5
Storage Areas/Tanks: AD k G�
Emergency/Containment Equipment: k k. A-1n u < < AA 6 ?i
Waste Generator ID: A, tt- Waste oduct:
Date&Amount of Last Ship ment/Frequ cy:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: 11
LIST OF TOXIC AND HAZARDOUS MATERIALS Nv v tia v,( e�v, y i�n ��n�I P��p� Si v cz 14---
NOTE: Under the provisions of Ch. 111, Section 31, of the eneral Law s9 of MA, hazardous m terial use, i t.1)t&&(ov&.
storage and disposal of 111 gallons or more requires a license from the Public Health Division. tit L. -5 �ylq„`
Antifreeze Dry cleaning fluids
Automatic transmission fluid Other cleaning solvents&spot removers I
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
mar 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:
INFORMATION/RE OMMENDATIONS: NO t66%t o ig -
. :
Inspector:
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Chemical Inventory
Pesticides
Description Quantity Unit
Adorn Fungicide 12 x 1 gt/case 1.37 gal
Agri-Fos, 2 x 2.5 gal/case 3.75 gal
Arbotect 20S (4x1 gal/case) 1 gal
Astro(,4xl gal/case) 10 gal
Baseline, 4 x 1 gt/case 17.12 gal
Cambistat,4 x 1 gal/case 0.75 gal
Cleary's Clearspray,2 x 2.5 gal/case 3.75 gal
Conserve SC, 4 x 1 gt/case 1.25 gal
Daconil Weatherstik, 2x2.5 gal/case 2.5 gal
o Direct Drift Retardent(12xl qt/case) 0.5 gal
Distance IGR,4 x 1 gt/case 1.75 gal
Foam Fighter(12x1 gt/case) 10.5 gal
Impel Basal Oil,2x2.5 gal/case 6.25 gal
Lucid, 4 qts/case 1.75 gal
Merit 2F 0.5 gal
Myclotect,4 x 1 qts/case 1.5 gal
Pentra-Bark, 1 x 12 gt/case 9.25 gal
Promot MZM, 2.5 gal jug 5 gal
Pyganic Crop Protection EC 5.0 3 gal
Pyronyl Crop Spray, 10 x 1 gt/case 3.75 gal
QP Mefenoxam, 2 x l gal 2.5 gal
QP Propiconizole, 2x2.5 gal 20 gal
Rainbow Horticultural Oil,RTSA,2 x 2.5 gal/case 85 gal
Round-Up Pro Max, 1.67 gallon 1.67 gal
Spray-Aide (4x 1 gal/case) 0.5 gal
m Spreader Sticker, 4x1 gal/case 8 gal
Sulfur 6L, 2 x 2.5 gal/case 5 gal
Talstar P, gallon 70 gal
s Tank Cleaner 12 x 1 gt/case 1 gal
Transfilm 7.5 gal
Vapor Gard(5 gal/pail) 27.5 gal
Xytect 2F, gallon 4 gal
Total: 317.91 gal
Badge X2 l0lb/bag 60 lb
_Compass Fungicide per pound 3 lb
Damminix-384 tubes/case 22.38 lb
Dithane T&O(4x12 lb/case) 262 lb
Kocide 2000, 30-lb'bag 25 lb
Lepitect infusible, 20 packs/box 6.34 lb
Pageant Fungicide 4 x 12 lbs/case 37.5 lb
Pendulum 2G 401b bag 8.5 lb
Page 1
Permanone Tick Spray, 12 cans/case 3.25 lb
QP TM 85,4 x 5.5 lb/case 11 lb
Safari 20 SG, 4 x 31b bags) 16 lb
Snapshot 2.5TG Herbicide 501b bag 50 lb
Talstar EZ, 25 lb bag 2 lb
Vine-X herbicide RTU 16oz can x 12/case 1 lb
Wasp Freeze (12 cans/case) 8.75 lb
X-Clude (12 cans/case) 20 lb
Total: 536.72 lb
Fertilizers
Description Quantity Unit
Caltec 2.5 gal
Hi-Phosphorous 2x2.5 gal/case, LIQUID 6.25 gal
Iron Chelate (Glucoheptonate), 2x2.5 gal/case 2.5 gal
Mn Chelate 5% 2x2.5 al/case 10 al \ l
_ � g g
Organic Iron 5%, 2x2.5 gal/case 17.5 gal
Total: 38.75 al S
g �
Bartlett Boost NK, 30-0-12 4350 lb b
Biochar 2100 lb
Boost Natural 11-0-5 4325 lb
Epsom Salts (50 lb pail) 100 lb
Lime,pelletized, 50#bag 320 lb
N 38 Nitroform, 50 lb bag 50 lb
Tiger 90,pelletized Sulfur, 50 lbs/bag 125 lb
Total: 11370 lb
5-110 bkk
Page 2
Date: 31a 1 1 I`f
TOWN OF BARNSTABLE--r- �3 f�7�� W
TOXIC AND HAZARDOUS MATERIALS V FORM
NAME OF BUSINESS: 84"rAl cw
BUSINESS LOCATION: INVENTORY
MAILING ADDRESS: TOTAL AMOUNT-
TELEPHONE NUMBER: 50$ -gE60 q1 30 14A t 00.5
CONTACT PERSON: �� moo C akk
EMERGENCY CONTACT TELEPHO E NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: �Z4,YKAI
INFORMATION / RECOMMENDATIONS:' �fs )qcytrcad Av%,fl IxV Rory Fire District:
yvaw�l iL��s 11s 4n/Cal/ d ek Ce,<- wt - o Cno'k l#'I-e— 1hs, $oe ;� -A,t 0--o-yvl y►'1
Waste Transportation: N 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. n
LIST OF TOXIC AND HAZARDOUS MATERIALS ^ 3te. °�` ' I AVZWv -o4/ + Sty*iiltlo94�
} t r1--`x
The Board of Health and the Public Health Division have determined that the following products exc
hazardous characteristics and must be registered regardless of volume. v����°`�'�`�' fi��
Observed / Maximum Observed / Maximum Q e\aw
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
Mo or 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 I CANARY COPY-BUSINESS Applicant's Signature Staff's Initial
of"'E�wti Town of Barnstable j U.S.POSTAGE>>PITNEY BOWES
Public Health DivisionG�
' BARHSTARLE. 200 Main Street �®MASS. /_
0lto,'ARa+°, Hyannis,MA 02601 ZIP 02601
02 11N $ 000.48° .
0001.38.3424 AUG. 15. 2014.
o2 of F-1 VVLdJ+L—
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Wi!-TU K'N TW:5F 1ti D;E aW,`
NO 'sMAIL RE C.EP TAC-LE 1
UN.A_3-LE TO FORWARD
iCai.r R.c l:Af.Rs—>- .Rfa .,'m,d:a:-• ate";:q=.r�c.e-..-- :a..s----�f.:ic.. -.z
_.
TOWN OF BARNSTABLE BAR-W 4 213
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager S`�ZJ�. �� �„�pp� May. ,�
Address of Offender MV/MB Reg.#
Village/State/Zip 11
Business Name ,�aC- ZkT �•(e2 �jc•p-�-n�� 5 " amJ15D on 8 /Sr 20
Business Address �q%q F'a-'ytioJ�� �rX
Signatur o En orcing Officer
La�tll-e—
Village/State/Zip M0..(Skoy�g M,�1s � MAI ' 02�`��
Location of Offense �G ��E� 1 cee- J�v�p�'c. H �
Enforcing Dept/Division
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Offense �Q����� `�o V�{a% nG� cc�J�C OAS ytiae�, 5 1 0- Q cLa
Facts VJ k TL o
Vj I+�\-k- '7
This will serve only( as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
T:MEA
KEEPING YOU ORGANIZED
10334
2PIL
GETOR ATS61l aCOM