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0138 OST.-W.BARN. RD - Health
a ®- Number Fee 1301 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Ernest B. Norris and Son, Inc. .-------------------------------------------------------------------------------------------------------------------------------- 138 Osterville-West Barnstable Road, Osterville, MA ----------------------------------------------------------------------------------------------------------------------------------------=------------------------------- - Is Hereby Granted a License For: Storing or Handling 26 - 110 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 Town of Barnstable Inspectional Services BARNSTABLE tuan,,o E , hcown61 Ws tDK kL.99 l:•Y?RST EPublic Health Division 63-2014 � A. aTnstE, Thomas McKean, Director ° + snntv 200 Main Street, Hyannis,MA 02601 h� r.a Office: 508-862-4644 Fax: 508-790-6304 C. 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 m�4 r j,h 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.- 1;-okoQ 7 2. IS THIS A PERMIT RENEWAL? 'I/YES_NO. IF YES,SKIP QUESTION 3. 12( 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 5. NAME OF ESTABLISHMENT: ,Ci'rzf" C3 y,-(f If So a ("c • ¢- 6. ADDRESS OF ESTABLISHMENT: • Qfiero I G- M19m 0 345-5 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: N 8._ TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: // (7 P&lid rc;lJ, 0n-, 10. SOLEOWNER: !/YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: ✓' CORPORATION NAME Pf-n& B. toor%is PRESIDENT G'r9��r�✓l� TREASURERT CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS MAIL: SIGNATURE OF APPLICANT DATE Q:Wpplication Fonns\Haz Mat Appli Draft Jan2019.docx �r Number Fee 1301 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health Certify that n Inc. This is to ert Norris and So fi! Ernest B. No 138 Osterville-West Barnstable Road; Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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. ---------------------------------------- i; 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 .1. Town of Barnstable �t �t Inspectional Services BARNSTABLE enawsrna!e•cK+rc.'e. cou FnYumr- '�. a.Ps*c5 urs.usxrue•w_arafn--,a+-e o Public Health Division :39-2014 AIAM B,► grABLE, ` Thomas McKean Director , 200 Main Street, Hyannis,MA 02601 ; -0 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE I 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 I st-JUNE 3 Oth). t APPLICATION FEES CATEGORY 1 PERMIT . 26-.110 Gallons: $ 50.00 1�14 � CATEGORY 2 PERMIT 111 -499 Gallons: $12500 ❑ ram CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. /.2o1007 2. IS THIS A PERMIT RENEWAL? ✓ YES—NO.-IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ' ` '' ZONIIVGBUII.DING APPROVAI:aFORHAZARDOUS MATERIALS STORAGE/iTSE ff., M " Yfr'iS:li n ,,,, nxX,# G'REATER}THAN HOUSEHOLD;QUANTITIES (ZS GALLONS)?.. 1'ESI � k[r->,i ` �i=�'.��,.� ,'v.'�.ey�: ih. -'.'� yf€+ r f 4 •s r�'. i >{- 'ua%u 9 t..i a -a 5 a�s. F` ,J. S*r`" u. 9 -}" a t`�; -J. ,:i o6 P�.. 3.l {`;,.yx,iNr<..:. � t.�"*44.: �.. �t. u�f7', �d� } �§kF Py'k.+•',.Sn �' �..-:t Z �.§;"'r q� ' ' Pb t rr7�tY {'.-.: t, M:; '§M.kLv 6.Pf�;-�f:..,yG....,. .. ...S.r ..;.;Y`,>. ;R.. ,...... ^.J..,.. r..r.!c1 i ._,i:,:: -,.,,:;+?�J ....aw;G ,Kr .:�:• �15 ,lti y.T r.'. .EIS g,Gs:;i*w*d 21 J.�'-.<LL,:`+� it 5�_...sk �.��c:�1sk y- 4. FULL NAME OF APPLICANT: Cr� G I�. �IShWoa +� 5. NAME OF ESTABLISHMENT: .Crnes f 13. ilk o rr tS t '�o h Tyler 1 3e 6. ADDRESS OF ESTABLISHMENT: OS4eryi Rc m !9 dA66S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: J 0&- YaS- /All S 9. EMAIL ADDRESS: 10. SOLEOWNER: ✓YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME .0-r n rrf- 43• Vy rr%P (son, T A:C, (Sa,,7tc ajdre r.5 g�p PRESIDENT Gr ,4 a1. Hs/,us�rrhC TREASURER CLERK.._. 12. IF PREPARED BY OUTSIDE PARTY: NAME: w - TELEPHONE#: COMPANY ADDRESS EMAIL: ,d SIGNATURE OF APPLICANT DATE �'/7 / Q:\Application Fonns\1-1az Mat App Revised 09-10-18.docx Number Fee r 1301 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Norris and Son Builders J 138 Osterville-West Barnstable Road,Osterville, MA 1s Hereby Granted a License . For: Storing or Handling 26 - 100 gallons of Hazardous Materials. --------------------------------------------- --- --- --- _- - -=---- ----- -------- ----- ------- --- - - ---- This license is granted in conformity with the Statutes and ordinances,relating there to,'and or r and expires 06/30/2017 . unless sooner suspended or revoked: ........................................ WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.K.D. 07/01/2016 JUNICHI SAWAYANAGf THOMAS A.MCKEAN,R.S.,,CHOr Director of Public Health _ l Town of Barnstable �tMME ro Regulatory Services IMA �o Richard V. Scah, Director Public Health Division B STABLE �}i639• u�wrsaArse nip.os Earu mwM'sr'auns� •fo ry11+`p Thomas McKean,Director - 109-2014 r 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 �V/ ~ . rJ� — Fax: 508-790-6304W W 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). APPLICATION FEES .CATEGORY 1 PERMIT . 26— 110 Gallons: $ 50.00 '(.I. ' CATEGORY 2 PERMIT 1117499 Gallons: $125.00 ❑ • CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ late charge of$10 00 will be assessed if payment is-not received by July 1st i }t �ti N. ' � AS.SESSORS MAP AND PARCEL N_O i r.'. O C7�I''r+ DATE f "x ' `• FULL NAME OF APPLICANT:NAME OF ESTABLISIEVIENT: �r .S-� �, (J�rr l_sue S6 �r�c ADDRESS OF ESTABLISHMENT: C '�erV�.i I e MAILING ADDRESS(IF DIFFERENT):�c..nw TELEPHONE N TMBER OF ESTABLISHMENT: EMAIL ADDRESS: l no r r Is, cc)rn SOLE OWNER: Y/ YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: I)6 OS %►I CORPORATION NAME -B,Gydrrl3 # S , acr"y)*oe PRESIDENT (1'-rar!5 TREASURER CLERK. . w . IF PREPARED BY OUTSIDE_ PARTY: " SI ATURE JQF Of CANT Name: Company Address Telephone#: Email: Q:Application Forms\I-IAZZAPP Revl6.docx Page I of 2 10: 31 1 P�°ptHE T°y,� 1 J Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMT,% . A � 200 Main Street• Hyannis, MA 02601 4p 163 9. p�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED P'� Business Name: E�d Oro ' QA� u'&K Date: �?+3 Location/Mailing Address: VV &4(n5hi if Contact Name/Phone: qlg—gi Inventory Total Amount: �°'o SDS: License#: Tier II : NO Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: AYQ Emergency Numbers: _ Storage Areas/Tanks: ; w Emergency/Containment E ui m t: iit Waste Generator ID: Waste Product: AlDate&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 10W 41 �r� LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storag7Antifreeze d disposal of 111 gallons or more requires a license from the Public Health Division. 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 V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil J 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 /1 Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible aint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons �L Laundry soil &stain removers (including carbon tetrachloride) (including bleach) I Any other products with "poison labels" ",u tono a�he%; (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFO MATION/ EC MMENDATI NS: ►Ii Diu l t. Inspector: Facility Representative: ,40-4. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 1HEro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. • 200 Main Street• Hyannis, MA 02601 0 039. .0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT lFD MPS Business NameoA occ.S !i 5 h. 8 V,\rQ2r3 Date: / 2 f ►�/z r Jib Location/MailingAddress: 13 -} , _ a� to n 2{' a., Q_. � ems}' M ,8 v 1�2 ✓l5`I' � � � 4 � Contact Name/Phone: C<A.1,Q A4XA0o0 A : fDb- c-7-'6 II(p Sv$ 24-1-, 5S9$ c-e-l'k Inventory Total mount: 4 p,� SDS: d�5 5+4 e 5�5 License# r '�J > Tier II : 0 Labelina: ra�� �r bc-1 Spill Plan: 0 Oil/WaterSeparator: <J� �Floor Drains: tJ a meroency Numbers:�— Storage Areas/Tanks: 1 1 Emer enc /Containment E ui ment: Av 1?4r Waste Generator ID: MIA 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 3 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) I I Windshield wash � Motor oils 1 Miscellaneous Corrosives k 3 � -r I Gasoline,jet fuel, aviation gas -- Cesspool cleaners 3 Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages � ` Pesticides: q Caulk/Grout/ad- -,•.ties 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 Z Lacquer thinners Miscellaneous Combustible Z Paint&varnish removers, deglossers Leather dyes I Miscellaneous Flammables I 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: ©Vk oC o v, LC ORDERS: 4- .7 M tvILotsc O 2-- MIow�m k����� r� a �o- -� -� L 1t1Si Jv�. ,1 So T 7 oso.l - INFORMATION/RECOMMENDATIONS: \ 0A\ <-J v ,n�ro�c r�o v\ o C Voal ,eD A,o � Inspector: Y't ��Q'�arty CO Jt er.FGr- Ib � W t��v�,'7 0(�5, t) �a��j1A S�o ��5 Facility Representative:�/, P05 "/CA 4�g K.c-YI WHITE DOPY- HEALTH DEPARTMENTA�Y COPY-BUSINESS Number Fee 1301 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Norris and Son Builders 138 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 i s -c-hK=tr j Voeg8atoryw of Btrnsxable emces THE Richard V. Scali,Director OF Public Health Division BAMSTABLE �S Ma BARPMBLE, Thomas McKean,Director 1639-2014 i0le659. c 200 Main Street, Hyannis,MA 02601 575 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 MY 1st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 OV.S. 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. /go zou 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: C rzZi G Ili . 5. NAME OF ESTABLISHMENT: hr / 38 0g. e(v(re 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 1/1 � �,6 h yr rr. L . cb►-Y, 10. SOLEOWNER: DYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: 116r CORPORATION NAME ke nes f 8, fyorri,f S c Soh, /he . C Sam e a—.4: e e2 o a,6b rye PRESIDENT A). q r,4 L,l TREASURER CLERK . 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Fonns\HAZMAT APP 2017 REVISEDAUX JU 20 2017 PH 12:14 Number Fee 1301 THE COMMONWEALTH OF MASSACHUSETTS $50.00. Town of Barnstable Board of Health This is to Certify that Norris and Son Builders _ 138 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 V Tow of B nstable Regulatory ervices �oFt r Richard V. Scah, Director v Public Health Division , BARNSTABLE • EPNY.SABIE•3xfERVILLE•COUR•ilY4hTi15 qp ?IkR51CFf5 MILS•OSi9'-201•W:51 R.V.If5TR4E Gira BA"STABLE, Thomas McKean, Director ,b,,55.77Zo,s , 039• °Ten 200 Mai Street, Hyannis, MA 02601` M NO Office: 508-862-4644 � Fax: 508-790.-6304 -r9 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-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. Ago ICU-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. y 4. FULL NAME OF,APPLICANT: rat q N .' Sh c r) Y -I-I-� 5. NAME OF ESTABLISHMENT: Er n-e-f C;V-,r i �Tac 138 ash-V0I-e., des-- _1?>0_r 0 S461-e JCO&A 6. ADDRESS OF ESTABLISHMENT: n S f--r y 1,I I e_ M A C7 P4,55 7. MAILING ADDRESS.(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS:. I h4 el n j2•r r iS , C.o rn 10. SOLEOWNER: YES NO IF NO;NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIONNAME &_nt•5} � �� Soh` ?nc. (S 6(,9 ago � PRESIDENT C-rc, TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE# .. COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Fon-ns\IAZMAT APP 2017 REVISEDA cx w,