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0778 MAIN STREET (OST.) - Health (2)
/�4Zm�— �`���o� 7� -- -- --- - \ `1 �� ma"in S�4q��6 s� I(� f� �,� U Number Fee 1185 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL & SON, INC. .------------------------------------------••---•--------.......----------...---•-------------------••-•-•----------------..-•--- 778 MAIN STREET, OSTER VILLE, 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 A :� Inspectional Services BARNSTABLE F ^ r t4RY5TS WILL-051IL LCt Fit•FY0.SM Public Health Division MRSR#Ic 415.639-2014'F_S 9aWV5 &E 1639-2014 STABLE1 Thomas McKean,Director ' pie ,.`� 200 Main Street, Hyannis,MA 02601 N Office: 508-862-4644 _ Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS s;.E 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 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2,PERMIT_a 4 m 111=499 Gallons:. 00_�3125. CATEGORY 3 PERMIT 500 or ore Gallons: MOM — ❑ �' -" *A late charge of$10.00 will be assessed if payment is not received by July 1st. �(4 1. ASSESSOR'S MAP AND PARCEL NO. I"I /04 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. ,,: :, . , ,,, `., •<s,,, •_ fir NT: _..... ��;.. ..:`:a-... ... 4. FULL NAME OF APPLICA ' l�(�•Y '� F �1 And JOn, 1 n t, 5. NAME OF ESTABLISHMENT: Car i F. Ricd t 11 And Jon , Inc., 6. ADDRESS OF ESTABLISHMENT: `11 f'lCiil� s r OJ}ewi 11,c� 11'lp OZ(�5 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 507 4A T U RPS' 9. EMAIL ADDRESS: i Irl,h Cam 10. SOLEOWNER:-)(-YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TE EPHONE#OF: CORPORATIO NAME F. h G ) so Inc PRESIDENT 5124 TREASURER M 5'101� CLERK 12. IF PREPAW BY OU SID NAME: a.. ifs`' - TELEPHONE#: D 'Z 9y'��S• O �.`l COMPANYADDRESS A#j4 EMAIL: Qt4C0 yfj SIGNATURE OF APPLICANT _ DATE Ii 8 IAOAD Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1185 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL& SON, INC. 778 MAIN STREET, OS TER VILLE, 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 R. Town of B'arnstable �. - Inspectional Services B INS Public Health .Division � o, BAILNSTABLE, Thomas.McKean, Director SAT i639 a`0 200 Mi ain Street,HS;annis,1\1A 02601 _ Fb µAy Office; 508-862-4644 Fax: 508-790-630-1 APPLICATION FOR PERMIT TO STORE ANWOR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE; CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT I-IANDI OR STORE 14:AZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st JUNE 30tn). APPLICATION FEES CATEGORY l PER-MIT 26— 110 Gallons: S 50.00 C -EGOR 1, 2 I?1<,1 ;'L'IIT t.t t —499 Vallo:7,: i25.tlfJ... . , CATEGORY 3 PERMIT 500 of more Gallons- $150.00 (_7 �•� �, *A late chai-,oe of S10.00,will be assessed.if payment is notrecei:ved by July lst. 1. ASSESSORS MAP AND PARCEL No. z 2. IS THIS A PERMIT RENEWAL? YES _NO. :I:F YES,SK:IF'QUESTION 3. 3. FOR ALL NE NY PERMIT APPLICATIONS,INDICA•I`E IWIIE THER BUSINESS TIAS ZONING[HUI DING APPROVALTOR HAI.ZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: OE3ltt Sov :TAIC. 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7� 6 fl6 n ST 1� 7. MA,ILIN.G ADDRESS (IF DIFFERENT ABOVE: 8. TELEPHONE NUMBER OF ES'T,ABL;ISIIVIENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: 4' Y.I S NO IF,N`O,NAME OF PARTNER: 1.1. FULI,NAME, ROM:E ADDRESS,AND TELEPHONE 1i'OF: CORPORATION NAME- Cruz! - PRESIDENT Ceti � TREASURER e ev?ta CLERK 1.2. IF PREPARED BY OUTSIDE PARTY`: 11 NE ` COMPANY ADDRESS EM-AIL: I _ SIGNATURE OF APPLICANI�'� .DATE 08-19-2019 h Q:`Application Foin,!Mi u Mai App Revised 09-10-18.docx Town of Barnstable Inspectional Services BARNSTABLE F SHE Tp�� w s e�euiis�c�nu�n��.•a=�.e Public Health Division '639- 0< y 9BARNSTABLE,$ Thomas McKeanMASK , Director 039..E e. 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 1st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26 110 Gallons: $ 50.00 ❑ CAI -GOO-7-2-PERMIT- 111 -'499 Gallons: $i25.00- - Al 6T 01h- -.W CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ ..�Z0 *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: .,q71 F IZ/ao S� ayG 5. NAME OF ESTABLISHMENT: l 6. ADDRESS OF ESTABLISHMENT: 77 f1dVV ST , �l9-OZc 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S b-j Zt,-(0 3� 9. EMAIL ADDRESS: C&a 1146i4. i-GV-1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME CAYt l p 121 e yll !, ScnJ _704 PRESIDENT C4,I ►�Z�6 TREASURER ,— N?�z CLERK Goa, 2t 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: . LSIGNATURE OF APPLICANT DATE - - Q:\Application Forms\Haz Mat App Revised 09-10-18.docx +CENTERVILLE-OSTER'VILLE-MARST013 S MILLS FIRE DISTRICT 1875 ROUTE 28 CERTERVILLE, MA 02632 (508).790-2380/1'AX0008) 790-2385 OEL/HAZARDOUS MATERIAL RELEASE FORM F.A.# nr_f0 LOCATION: ADDRESS OF RELEASE:,R —__--.._- Fire ._--. Road DATE OF RELEASE n� ^7��►r, PRODUCT RELEASED ESTIMATED QUANTITY ���Ions CORRECTIVE ACTION TA th BY RE806N8IBLE PARTY __...__..o .y a...... _ry s..:—�^-d -..,. „r---_ ,.a, in place NOTIFICATIONS: FIRE DEPARTMENT: YES(. ) NO( ) DATE: IME: ,T,,R,� NATIONAL RESPONSE CENTER YES( ) NO(' �ISATE:'- TIME: a tJ DEPT.OF ENVIRONMENTAL PROTECTION Y4?1,,.` NO( ) DATE;,�,_TIME: - . ._ OIL SPILL COORDINATOR: YES( ) DATE: TIME:yL TOE N BOARD QF HEALTH: YES(X N D ATE: n P�TIME:,,;A% TOWN HARBORMASTER: YES( ) NOW DATE -" -' TIME:'-L OTHER AGENCIES: COMMENTS ..... .,.. . ... .,.,._.... �� . . ,,...,., ,.. .. YY111 wv�.. war.. — hazard ti 4Li.. �.i i a..WV Y.11 �F J!/VJ4.J.. ♦ REPORTED BY ,9 r D ATE:- untly v. •ayscacy, � .., , V7/ G/�7V WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH C-O-MM FORM ' A� 0*1HE TON, r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 NSTA• BA MARq LE. ` 200 Main Street• Hyannis, MA 02601 7 MASS. 0P i639 M TOXIC HAZARDOUS MATERIALS INSPECTION REPORT rE0 P AND rr Business Name: 11 BUJ I'• D - Date: Location/Mailing Address: mck S4- Me Contact Name/Phone: E69 — — 6 3 Inventory Total Amount: (� SDS: On License#: Tier II : N 0 Labelino: �- Spill Plan: Oil/WaterSeparator: lJ Floor Drains: 0 _ Emergency Numbers: U t Storage Areas/Tanks: %dCt$�e ` Emergency/Containment Equipment: Waste Generator ID: MVSb`K 4A 0� Waste Product: p0(beC[7Yh Date&Amount of Last Shipment/Frequengy: 15 0alto1� 'Woo? 6 mr VT Licensed Waste Hauler&Destination: SRC Lo e11J;ron�''�f1�G11 R(V►'b(s 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 S CS 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 otor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil�S` 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 T 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/RECOMMENDATIONS: W=LoM"Ac'.a,iimr A� �4�t Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS f ex Drum Disposal Work Order Prepared by: Jay Wuoti Client: Riedell & Son Inc. NRCJob #: 82307-0110 Day & Date: Client Contact/Phone: Max Harris/ (508)428-6365 Client.PO'#: ' Work Order#: Site Contact/Phone: T&M Depart Shop: U NRC Project Manager: Q Contract Arrive,at Site 1 Ad � Scheduled Date: Prevailing Wage Depart Site: Start Time: At Shop On Site Shop/Next Job: Job Location: 778 Main Street Osterville;''MA.02655 Scope of work: Label and.load (1 x 55)Waste Oil with Petroleum Distillates No replacement drum needed. Have all paperwork signed. Labor : Y Disposal: osal: Name Qty. Hours Qty. Type' - Facility Manifest# Oil w/Petro Dist. EV 1;: 003712664GBF ' r , Equipment: Materials:. Equipment Name . Qty. Desc./Eq. # Hours Qty. Item 1 Manifest FSM-026 Drum label Hazardous FSM-016 1. . . Drum class label flammable Solids FSM-016 Description of-service performed: 1 Profile Land ban . �d 55-gallon drum:. Steel-w/bungs FSM-008 Poly liner:FSM-030 Overpack.drum FSM-012 _ s _CLIENT; THE ABOVE ITEMIZED MATERIALS, EQUIPMENT ' Checklist: AND LABOR ARE VERIFIED AS CORRECT Agent for letter on filer Name/Title:. Replacement drums needed#: Air Signature: -- Verify contents of drums { Date. I / Q Verify condition of.container Please.print or type.dorm d&Ned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3 Emergency Response one 4. am es Tracking Number p WASTE MANIFEST xt S? - 35 E4 f 5.Generators Name and Mailing Address g. ti: Generator's Site Address(if different than mailing address) ^^_ FR ow, Arpuo O 3 Generator's Phone: Z (� 6.Transporter 1 Company Name U.S.EPA ID Number _ p 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number , IMAY�TCA4 VT Facility's Phone: " t ti e.. t it. ? Vic, 8 Y c)" ?T f 0 5 2 ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,.ID Number, - 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes cc No. .Type � Quantity :_ Wl.Nol.. _ Uj Z 2. LLJ 3. 4. ( O 5t 14 Special.Handling Instructions and Additional Information „z 't cto<rm fan,I -'"f t g,-t I P4 :r,x j,Iwn wsy'3,sslri iv:4'x 01 7..�" l7 — C R �? N._ O 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to.the terms of the attached EPAAcknovAedgment of Consent: I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)1s true: ; Generator'slOfferor's Printed/Typed Name Signature Month Day . Year 16.International Shipments .F— - ,. ❑Import to U.S. - ❑Export from.U.S. ;Port of entry/exit:'." Z Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Ej 1 Transporter 1 PrintedLryped Name Signature Month Day Year t r'• Z Transporter 2 Printed/Typed Name Signature ' Month's Day Year • 18.Discrepancy �... } . 18a.Discrepancy Indication Space ❑ ❑Type.Quantity" yp Residue El Rejection ElFuIlRejection ❑ . Manifest Reference.Number. - H 181b_Altemate Facility(or Generator) U.S.EPA ID Number , ar � Facility's Phone: ;. w 18c.Signature of Alternate Facility(or Generator) Month Day' Year Z r O y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) V LU 1. 3. 2. 4. V n _ 20.Designated facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Q Printed/Typed Name Signature Month.:- Day Year . EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY 4 -1 `°Ft rokl Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"RM� E.� $ 200 Main Street• Hyannis, MA 02601. �'DrfDMP+",0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Car - Date: Location/Mailing Address: 77`a 4L,.1. '5 Contact Name/Phone: e-Ae-1 I -y2 -bibs el I �O -:zqq- 20 ws� a�cc�S Inventory Total Amount: 7 lat MSDS: Je-S �gLCk 5�5 License#: Tierll : Labelina: b --f—W64eA6 Spill Plan: 5 1� a,� Oil/WaterSeparator: A Floor Drains: Emergency Numbers: OK Storage Areas/Tanks: a,7kL a'—�—G �b�,,,, 0,4RO� < 6� cet�w�-� a�a Emergency/Containment Equipment: kkk o ,ke-- w k+I vv b o A- 5 \K\ Waste Generator ID: Waste Product: ��o Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 1tia ova- save gXLIST OF TOXIC AND HAZARDOUS MATERIALS 1 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 55,k.10 A-Z o a• 7.o 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 SS wxtk.9, ✓ 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 A-11, LikOA VDegreasers for engines&garages Pesticides: Caulk/Grout %v,&-g 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: . tza, l , a,c N r Lai lL5:w k -v EQ RM TIO /RECOMMENDATIONS: al m 5 o r c N,- < 4VVk\A o ¢�k p y — 4vk e5 :�c< l 5 0`5 Inspector: I ' L-,q\4e e— ����b�c.U�-k 5 a�v�LLL.►now.vCav���s. / - Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Oc t. 25. 201 b 9.31 AM h. 3940 P. 2 Neste Illiformation Profile Form ENPRO Services of Maine,the. ENPRO Services ofVermout,Inc 106 Main Street 54 Avenue D 111PI&W al BA S.1Portlalad,ME 04106 Williston,VT 05495 Phone:207,799,0850 Fax: 207.779.5565 Phone;802.860.1200 Fax:802.860.7202 MtD 019051 069 YTR000517652 Profile#: Riedell.001V Process Code: FLFi Approval'Code: 1,Generator Information: Generator Namc: Brgdg&S.on Im Mailing Address: -778 Main Street City: Ostemlle State: UA Zip: 026% Phone: 508428-OW Site Address:778 hMM Street City: Oslervitla State: IAA Zip: 02655 Technical'Contact: Phone: T Site EPA ID: MP5084MO334 NAILS Code: Z.Biding Informetlon: Customer Name:ENPRO Services,Inc. Address: t14 Bridge Road City: Salisburyisbun'' State: MA Zip: OAK 13iiling Contact: T Email: Phone: 978 465-1595 Fax' 978 465-2050 3.Waste Description: Common Name of Waste; tNaate t)'ds Cwl Ith.etrc4min dis<lilates Process Generating WW'e HYA,-M&W oils 4.Physical&Chemical Properties Color: Rrnwn Odor ❑None Mild Q Strong Describe: Flash <100 )3TU/lb ❑ Solid . Free Liquids? Wes U No Point(F') ❑>100-140 ❑<2000 R Liquid %Solids ioa.ao %Liquids ❑>140.200 ❑4000-6,000 ❑ Sludge Will waste dump out of drums? (RYes ❑No. ❑>200 ❑>6,000-10,000 Q Semi-solid Is the waste pumpablc? 5JYes ❑No ❑NIA P>10000 ❑ Powder Debris?(List type in Section 7) OYes IR No ❑N/A Ca teas Is the waste dusty? DYes IR No Specific Gravi!1 pH Other Com orients ❑ <0.8 (Light oil) ❑ Low (V;atei} ❑ <2.0 Total cyanides (pp"') •n.nn Total sulfides (ppm)-A� ❑ 0.8-1.0(Water based) ❑ Med .(Pump on) Q >2.0-5. PCBs .(ppm)—UD-- ❑ >1.0 (Chlorinated 0 High (Molasses) >5-9 Total Halogens IMOC (%) eg . Solvents) N/A ❑ >9-12.49 Total VOC (ppm) 6-00 NIA -❑ ] 12.5 5.Hazardous Properties: (Check all that apply) None ❑ Radioactive ❑ Pyrophoric a Oxidizer Q Water Reactive p Dioxins l] Explosive ' Q Medical Wastellnfectious ❑ Shock Sensitive ❑ Air Reactive 0 Reactive Cyanide ❑ Reactive Sulfide ❑ Asbestos Ben2ene NESHAP ❑ Pe'sticide/Herbicide ❑ Peroxide Forming Compound 6,Regulatory StaW (Checkarl thatapply) Y N Cr USEPA Aamdous Wasta per 40 CFR 261 (If yes list codes) pnn, 0 J Do any state waste codes apply? (If yes list codes) ❑ Is this waste subject to land ban restrictions? Is this a ❑wastewater non wastewater ❑ Q IfDO01-D043,are any underlying hazardous consihuents(UHQ present ❑ Does this waste contain VOC°s > 500 ppm (subpart CC) Form Code Source Code Oct, 25. 2016 9:31 AM k 3940 P. 3 Page 2 of 2 Ad warms -ENPRO Profile 9: Riedell-001\1 7.Composition of Waste:(List:all haz.And non-hat,Constituents) W,motor 80.00- 00.00 % % petroleum Dlstlllates 10,00- 20.00 % % Water 1,00- 10.00 % - % % % 8.DOT Shipping Information:(include PG,'UN/NA,and Haz.Class) RO UN1268,WASTE Petroleum products.n.o.s, T 3,PGn R.Q(100lbs) Poison Inhalation Ha2.ard: D YES R NO Zone: Method of Shipment: 0 Bulk Liquid D Huck Solid W Drums ❑Other Container type size: 65 Gailon metal Drum Volume per shipment: 0 Q Gallons 0 Tons ❑ Drums ❑ Other Frequency: D One Time ❑ Vdeekly D Monthly ❑ Quarterly 0 Yearly ❑ Other Does this material r uir;,s. special handling? ❑Yes 3 No lfyes,explain: 9.Inorgante Metals: Q None Q TCLP ❑ Totals ❑ Generator Knowledge in mg/l D004 Arsenic(5mg/1) 0,00 D011 Silver(Smgil) 0.00 Manganese g,Ql D005 Barium(100mg/1) no Aluminum 0.00 Molybdenum 0.00 D006 Cadmium(1mg/1) _LU Antimony 0.00 _ Nickle 000 D007 Chromtum(5mg/1) em Beryllium 0.00 Thallium0,00 D007 Chromium-Hex 0.00 Cobalt 0.000 Tin J D008 Lead(5mg/1) 0.00 Copper o.on Zinc o00 D009 Mercury(0,2mg/1) 0.00 DON Selenium(1mgA) 0.00 10.Organic Compounds R None ❑ TCLP D Totals ❑ Generator Knowledge in mgll D012 Endrin (0.02) 0.00 D023 o-C'resol (200) 0-00 D034 Hexachlorocamna (3.0) n.an D013 Undanc (0,4) op o D024 m•C7eml (200) n nn D03514ethyl athyl kcmnc (200) _aAo.._ D014 Nl4oxychtor (10) nnn D025p-Cresol (200) Man D036Nitroben2ene (2) .Up; D015 Toxaphene (0.5) n,nn .- 0026 Cresol (200) o an _ D037 Pentachlorophenol (100) n nn D016 2,4-D (10) . n nn D0271,4-Dirh1orobtrLwne (7.5) n nn D039 Pyridine (5) n on NO 2,4,5 TP 8 Rvev (1) o gn D028 1,2-Dichloroethane (0.5) n an D039 Tetrachloroethylrne (0.7) D018 Beaune (0.5) nnn D029 1,l•Diehlomethylene (0.7) nn D0407Yichbroethylem Epp 13019 Carbon Tcuachloride(0.5) win D030 2,4 Dinitrotolo= (0.3) Pon D041 2.4,5-Trichlomph-ol D020 Chlordane (0,03) nnn D031 Heptachlor(&epoxide)(0,008) _aA D042 2,4,6-Trichlorophcnol gnu D021 Chlorobenzene.(100) n nn _ D(132 Hexachtorobenwne (0.13) 0.00 DD43 Vinyl Chloride pn D022 Chlamfarm 6.0 A033 1lexaehl°robuladiene 0 11.Attached DDcuffients: ❑ Lab Data ❑ MSDS 0 Packing List ❑Other 12,Generator Certlfleatiow I hereby certify that I am the agent of the generator,and warrant on behalf of the generator,that all information submitted herein and attached documentation contains true,accurate and complete description of this material. Any sample submitted for analysis is representative of the material being offered for approval. All relevant information regarding known or suspected hazards in the possession of the generator has been disclosed. I will notify ENPR.O of any changes in generator status,any information on this form,or any information on attachments:This certiScation and signature apply to this form,to all attachments checked in Section 11,and to the land disposal restriction notification(I-DR)generated from this information, Signature. Printed Name Tiyio Date act. 25. 2016 9,32AM k 3940 P. Carl F. Riedell&Son, Inc. 778 Main St Ostervllle, MA 02665 December 16,2015 RE, Modell&Sons,Inc, 778 Maln St Ostervllle,MA 02658 To Whom It May Concern: ENPRO Services, Inc, (ENPRO), Is authorized to sign any Non-Hazardous&Hazardous Waste Manifests, Waste Material Profile Sheets, Bills of Lading and other relevant paperwork, as agent for Carl F, Kledell & Son, Ino, In relation to the management and/or shipment of oil and/or hazardous waste material by �NPRO to permitted waste disposal facilities from the above referenced project location. Zk A )ate of gnatu d S ut . f Max Harris General Manager Carl F.Riedell&Son,Inc, Printed Name �,°title'` Generator C:1UsmNax\AppDat$\Localwicrosoft\Windoivs\Temporary Tntei»et FileslConteal,Ontloakl7AX11t3.tJGK18696.I S(Carl F Riedell Son'1ne}AFAC t a. \- \�\ Number Fee Iles THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL & SON, INC. 778 MAIN STREET, OSTER VILLE, 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 : Town of Barnstable Regulatory Services • °� Richard V. Scali, Director sUNAB& ` Public Health Division gym: '°rEc► " Thomas McKean,Director ,d 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 I-ax: 508-790-6304 Application Fee: $100.00ro ASSESSORS MAP AND PARCEL NO. / D DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �Q,e J -T NAME OF ESTABLISHMENT • ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER d • U2Z- &36b,T SOLE OWNER:YYES • NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 67. :zq �Lp(pQ STATE OF INCORPORATION _" 9 FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP Rev2015.DOC IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS . . ' 200 Main Street• Hyannis, MA 02601 Eor'wA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cat-C I . Rio 11-1J 56x..tr:7�c. Date: IZ / Location/Mailing Address: 777S Ml a iv-Sk �-- Contact Name/Phone: IQAI i 4AJ q2 -6365r— C,-II S46-2911-r.5-2.0 Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: 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 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: 2 T' J I1; 6niq Ant sv� ` X or t C 6 1 ao r d ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE ropes . p ` Town of Barnstable k F # Office:508-862-4644 Gy o� a Fax:508-790-6304 s ' : Public Health Division ^ BARNSTABLE. MASS, 200 Main Street• Hyannis, MA 02601 1, �p.1639. rFOM TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: nC. Date: !2 �.. Location/Mailing Address: "7-7S M a iv,_ Sk , I I,-- Contact Name/Phone: Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: . Other Waste Disposal Methods: a , A, 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 y grease, lubricants; gear oil, Refrigerants Degreasers for engines&garages Pesticides: ` Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers ti Photochemicals(Developer) ` Car wash detergents Printing ink Car waxes and polishes { Wood preservatives(creosote) + Asphalt&*roofing tar Swimming pool chlorine Paints, varrfishes, stains, dyes ,` Lye or caustic soda :. Lacquer,thinners .1 Miscellaneous Combustible y ,;.` -Y Paint&.varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers ` Floor&furniture strippers 5k , PCB's F Metal-polishes Other chlorinated hydrocarbons f Laundry soil &stain removers,: (including carbon.tetrachloride) (including bleach) Any other products with "poison•labels y (including chloroform,formaldehyde, hydrochloric acid, other acids) :E VIOLATIONS: & 'f t a: '? n u� J p l '.%7Yi ',•/ Jt t +In A, •1-, -k a �0 4r.r ` J"p.• 1Q ,M rv-e�'n-A hvl/ E,+v ^i �wh Ftirt� � Ir��� ItitGi ORDERS: F INFORMATION RECOMMENDATIONS: i 'Inspector: ' - ;, +. , 4. ' `"Facility Representative:• WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS.' _' `. • t •" � `' ,,�• is p IKE r Town of Barnstable Office:508-862-4644 III, Public Health Division Fax:508-790-6304 • BaRMARq ' 200 Main Street• Hyannis, MA 02601 "rf039n+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: jqPeAJ1 'Q,,w�. 4o Date: Location/Mailing Address: 77 i .S e< d Contact Name/Phone: &2�j ei l S o8-4 Z�-�34�� Ste- 'Al "40 SZo Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: 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 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) VIOLATI NS: A- J A, 001 IVkQt&1&K5 '�"e k -- QQ LjOJ w It w %e-I a -) ORDERS: A • �' a, �l J 6%.7 ,c A- .r=a— . 0- © oIti k I IN ORMATIO /RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS a . `oFt ►,,� a r x " Town of Barnstable Office:508-862-4644 c Fax:508-790-6304 •�• Public Health Division BARMAv%. 200 Main Street-• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS/INSPECTION REPORT ► Business Name: ;' rq1t J&J1 4016>►•t Date: Location/Mailing Address: '77a+,�s� Contact Name/Phone., V � A&1 -500-µZia- 31,S' ��-�`��-�aZc> Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: " Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: x Waste Generator ID: Waste Product: `Y Date&Amount of Last Shipment/Prequency: 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. Antifreezes N ' 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 �f Refrigerants ° Degreasers for engines&garages Pesticides:, Caulk/Grout' insecticides, herbicides,rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) ; Rustproofers Photochemicals(Developer) r 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 F " 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: laj ,m 0 �Ve N1 l 11n ck I eat \J"c- as F`":*e_,Q' JC0+M.c- W1V_VL a yl 044AX<' 002-• In)a M-4 5 PJj. t c l A I (P44-e- 0 tl+M ORDERS: O.Ctisn COtnnDl +, Se r.� ,,�e,�i�Q f IN�ORMATIONJ/RECOM ATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT Y CANARY COPY-BUSINESSe } = . - , .1 � .•x . Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALSki6lifi&h&I FORM NAME OF BUSINESS: Car I e,A// BUSINESS LOCATION: 779 41Ivt. . , 06fef✓, 11e-- INVENTORY MAILING ADDRESS: sty- TOTAL AMOUNT: TELEPHONE NUMBER: -3'0"0- 'f28 3 (, CONTACT PERSON: See 'e- uJD EMERGENCY CONTACT TELEPHONE NUMBER: 5��e-2 9y- 52n MSDS ON SITE? TYPE OF BUSINESS: -Plo lb►rc YGg INFORMATION / RECOMMENDA IONS: Fire District: 4►� ,' reed Sclu,r?�Ic.Q a� as21 o a ve_ 1,34 10, 1 ,5 1 629m✓V( �CvKeUe - �Z4."re e- o,14o 61. S ar W- SS It 1 ,K ¢c o 04-04"AI fe05 oK s, mr asf S veers. Waste Transportation: AW ew4_ j►•t_ /4ee—Last shipment of hazardous waste: /9 Name of Hauler: 9/ )Qco Destination: Waste Product: 04,51e_ a i l Licensed? Yes No -NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, azardous 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 Obse ved / Maximum ArntE/eeze (for ga line or coolant systems) Miscellaneous Corrosive W �S ED 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 64114005 Laundry soil &stain removers (including bleach) 'o� Spot removers&cleaning fluids I (dry cleaners) �s �2g�lrGy�c�e✓ o( be-e-vovRZ, hot..e.✓er Other cleaning solvents �f Bug and tar removers lame 10 OWL OD CI, 14V4 v1VO4oV q Windshield wash �( �J-�"v(''Z )V102V1 t o /�'� �f 6V WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap licant's Signature Staff's Initials Lm Number Fee 1185 THE COMMONWEALTH-OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL &SON, INC. 778 MAIN STREET, OSTER VILLE, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ----------------------------------------------------------------- --------------------------------------------- ------------------------- ---- ------_-- --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ' owll of Unstable eg8atory ervices Richard V. Scah, Director Public Health Division BARNSTABLE • WNSTMB -CFeRERVLLIF.Q7NR=MN15 SARNSTABIX s Thomas McKean, Director "�°"'"'�139"•O-WEVMASS. 9RFMS MF - - .•� ATEo�s _ aui treet— yanrus, Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). } APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: -$ 50.00 ❑ _ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if a ment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. I -7 // 0& 2. IS THIS A PERMIT RENEWAL?L YES_NO. IF YES, SHIP 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: ��r� /� /���� ai2d lam, /ate 5. NAME OF ESTABLISHMENT: 1 "/�L/ /� Gl y► /h 6. ADDRESS OF ESTABLISHMENT: k)rlX N,4;2i fh-&?4 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: - �d - �1•�d (�3�.Sr 9. EMAIL ADDRESS: M& 6) 10. SOLEOWNER:X_YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TEL RHONE it OF: CORPORATIO tjAX ,C / y, e' PRESIDENT / 7 TREASURER 1! CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT Q:\Application Forms\HAZMAT APP 2017 RE .docx A , Number Fee 1185 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL & SON, INC. . 778 MAIN STREET, OSTER VILLE, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ----------------------------------------------------------'..------------------------------------------------------------ ---------------------------------------- This license is,granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ------------------------------------------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health TRowr�of Barnstable eg atory Services Richard V. Scali, Director . ofI rqy, o Public Health Division BARNS_ LE. • � enznsinul.e.cE++rrrv1�[�rt•mu:tysnn ` , • Thomas McKean, Director :639-20-20 McPSS:$MILLS•S1•IrSf PS?YSfR&E 14 •66 200 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 DULY 1st-JUNE 30th). 0 /7-,X APPLICATION FEES -CATEGORY 1 PERMIT 26-110 Gallons: $ 50.00 - ❑ - CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 0 V.S. CATEGORY'3 PERMIT 500 or more Gallons: $150.00' ❑ *A late charIze of$10.00 will be assessed if payment is not received by july lst. 1. ASSESSOR'S MAP AND PARCEL NO. �/ lV a 7 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: I lel Lip �yI�'• 5. NAME OF ESTABLISHMENT: - 1, ,/ / /2C/G(2ell Ck 6. ADDRESS OF ESTABLISHMENT: Ildl MAI.A.1f e fk 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NU-NIBER'OF ESTABLISHMENT: . )Uf i1e2k &3&f 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND T EPHONE#OF: J CORPORATION NAME r .PRESIDENT r l/ !/ • / 7 Clf 4 •��?'�{ TREASURER /7 C L y�g sy CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE QAApplication Forms\HAZMAT APP 2017 REV SED.docx Number Fee 1185 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CARL F. REIDELL & SON, INC. 778 MAIN STREET, OSTER VILLE, MA Is Hereby Granted a License For: Storing or Handling Jrl 1 499 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 I ` I J ' Town of Barnstable Regulatory Services Richard V. Scali, Director Z `"M AS& Public Health Division BARNS LE 039. �0� wWas"miar osaruifD.sie nnsi� Thomas McKean, Director 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 • t� 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 ANNUALPERMIT(RUNS-JULY 1st—DUNE 30th). APPLICATION FEES CATEGORY I-PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: *$125.00 .S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by Jules ASSESSORS MAP AND PARCEL No. I I D DATE FULL NAME.OF APPLICANT: NAME OF ESTABLISHMENT: �C,e/ 2od1/I 6 eodl r/in ,b� e ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: .tUb EMAIL ADDRESS: G) _ "1126e .tl SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK • _ IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email: Q:\Applicaiion Forms\HAZZAPP Rev I6.docx Page 1 of 2 1 h cy� r Town of Barnstable Office: 508-862-4644 .. Fax: 508-790-6304 Regulatory Services Department «.. L& Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $11.25.00 (Check) on 6/17/2016 Permit number: 1185 (Check number: 12964 Check amount: $125.00 Name on check: Carl F Riedell &Son Inc. i jBusiness: CARL F. REIDELL&SON, INC. Owner: SHARRON E TR (Address: 778 MAIN STREET(OST.), Osterville J� I ii " 1 L- -----•- -- --. .. - - ----._._...__--....-.__... _.-----.... ------- -...._.-........_........._....__...._......_._._...._..----- CE93TERVILLE-OSTERVILLE-MARSTOWS MILLS FIRE DISTRICT 1875 ROUTE 28 CEVITERVILLE, MA 02632 (508) 790-2380/FAXD(50) 790-2385 OILMAZARDOUS MATERIAL RELEASE FORM F.A.# f7A LOCATION: ADDRESS OF RELEASE: DATE OF RELEASE: 5�-;7 7,-I 7 j PRODUCT RELEASED: /n. Sn%,u ESTIMATED QUANTITY: 1 _/ sjfA,L CORRECTIVE ACTION TAKEN BY RESPONSIBLE PARTY: . j NOTIFICATIONS: FIRE DEPARTMENT: YES(N NO( ) DATE: �` 4 TIME- NATIONAL RESPONSE CENTER YES( ) NO(W) DATE: TIME: DEPT.OF ENVIRONMENTAL PROTECTION YES( ) NO(X) DATE: TIME- OIL SPILL COORDINATOR: YES( ) NO(k) DATE: TIME- TOWN BOARD OF HEALTH: YES( ) NO(00 DATE:-TIME- TOWN HARBORMASTER: YES( ) NOW DATE: TIME OTHER AGENCIES, COMMENTS I /°A 7,n t ,kIS C`'P+l \ CfeAin /-Vi X I)m7,RA t_S REPORTED BY l'sI _['..f-ll ` DATE: ;5f 2. WRITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E!P,.,` "RINK COPY-BOARD OF HEALTIi C-O-MM FORM #58 v