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HomeMy WebLinkAbout3848 FALMOUTH ROAD/RTE 28 - Health c38�{�' I i i i S M EA® KEEPING YOU ORGANIZED No.10334 2453L MADE W USA GET ORGANIZED 9 SMEAD.COM Number Fee Number THE COMMONWEALTH OF MASSACHUSETTS $150.00 1139 Town of Barnstable Board of Health This is to Certify that Walgreen Eastern Co., Inc../RITE AID STORE#10192 .-------------------------------------------------------------------------------------------------------------------------------- 3848 FALMOUTH ROAD, MARSTONS MILLS, .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 `°aIKE A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • sARNn LE. • 200 Main Street• Hyannis, MA 02601 OMn+"�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: i Do A -4 (of I Date: Location/Mailing Address: J\a(SiQM (01,910yftablE, rrckAt ` v4 n CO ctm'e1AJ Contact Name/Phone: a 0 'Joo, MI r d -- - _ S - 4 InventoTotal Amount: SDS: License#: I M Tier II : D Labeling: I'e. Spill Plan: Oil/WaterSeparator: Floor Drains: h7 Emergency Numbers: Storage AreasfTanks: VO1,M �USe, i�h Emergency/Containment ui ment: Waste Generator ID: 0 4 Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: cle&h U&rbarrnv,`r0 U`ceS N L 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 t- 3 Engine and radiator flushes Bug and tar.removers Hydraulic fluid (including brake fluid)3 �— Windshield.wash to Motor oils /6 �G Miscellaneous Corrosives bru Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oils v7 Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&.garages v�— Pesticides: I C)qquuN Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers hotochemicals(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 - s 9�llas Paint&varnish removers, deglossers Leather dyes —Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's eta' polishes —�` G Other chlorinated hydrocarbons �. � kILM Laundry soil &stain removers © 4-io (including carbon tetrachloride) #0 (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: V -Vo ih. 10CA CR, 'YJe, eW 4f o ` f co fib ? k onc- Vs1t #, N a recomw kL41vn5 Inspector: A�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS THE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 snRMABLE.�` 200 Main Street• Hyannis, MA 02601 039. MP TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED '� ,,//�� nn Business Name: R t t K 1 5+a fe OI Z Date: I q 18 Location/Mailing Address: o a s`-vL Contact Name/Phone: sOg-'�2$-352 S ��.s+� Barrekk Inventory Total mount: =500 led SDS:66e P +'t` 5 lk'e' License#: CCL+,3 Tier II : Labelina: To A-e- oo w tAaA Spill Plan: Y2S Oil/WaterSeparator: Floor Drains: Emergency Numbers: ��GS Storage Areas/Tanks: V)" ,e,6LU4 : po� Emergency/Containment Equipment: ot1Qe v�k5 Waste Generator ID: L100 2 oq Waste Product: Date&Amount of Last Shipment/Frequency: k51171 ',WNS v.<ke rl Licensed Waste Hauler&Destination: w a oc Kek Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Iv V via, DY C,k/�V-5A - NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid' (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including'bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 0 t 55 vf-,5 p< IS , vu- 2 . Inspector. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"M��E. ' 200 Main Street• Hyannis, MA 02601 t639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO MPS a ,(� Business Name: n I f---A, S+ # 01 2-� Date: Location/Mal ling Address: 38e{8 . A. M . Contact Name/Phone: _ awv- moon& . Vim, < •SDS- Y28 -3S2s' ►�S P a��rQ Inventory Total Amount: LMSDS: I�5 License#: Tier II : v �i Ida I Labeling: k� �4�L '1 Spill Plan: yL Oil/WaterSeparator: Floor Drains: o Emergency Numbers: eS Storage Areas/7anks: 2.0 eOt k\ -+-ST a Ian -4e- Goy a�.tit,•! — <w\ � -a. l Emergency/Containment Eq ipment: J P I1 \ w,•K I u..,Q-ei 4 I; Waste Generator ID: M L30 021''A 09 Waste Product: M\Sc- Date&Amount of Last Shipment/Frequency: 1 1 Ci .,Q,�}t rl� Licensed Waste Hauler&Destination: a,.-�0 o--5 Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS a ✓-"-q 1�Gln a" - �- ti�'•���o`r y• NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: No te7e7v4e, 6,c Cf-cv Inspector: ` Facility Representative. WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p IKE►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE, ` MASS 200 Main Street• Hyannis, MA 02601 .b,q.n TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO MPS Business Name: 911e- P�, Date: Location/Mailing Address: 3M 2> Map{ y,-s N1-115 Contact Name/Phone: 5+0<fe— V l Invento Total Amount: t �t�1 MSDS: .&5 n License#: j 13� Tier II 0I Labeling:�yk5,ke �algeled� \ Spill Plan:, e Oil/WaterSeparator: p� Floor Drains: a mergency Numbers: e5 Storage Areas/ranks: 12 9.o wl j 1 M c� Emergency/Containment Equipment: \1 V1,. ,, 'So k 4r- Waste Generator ID: O p 2.1 b Waste Product: WMck CPkk%\ 0"tv- ,,X Corr Date&Amount of Last Shipment/Frequency: I 1-1 4—114 ! . H H I'v- Licensed Waste Hauler&Destination: COL a t,5t 7 e& Lkk W* Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS V.l,�I Cl�l�vj 1n)�' ColeoCe4P,, owlcp—4;,t e-jrcevL�� 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 �1iLtl�1� 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: INFORMATION/RECOMMENDATIONS: 0 OS <eW ,A k I Inspecto, Facility Representative: �l WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS l(� TOWN OF BARNSTABLE S Date: 3 lo� �,410M TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: RIte,Aj- BUSINESS LOCATION: 5 qq2 T: tal x,04,.. rl/ A . INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: * a43v,., oorte.. EMERGENCY CONTACT TELEPHONE N MBER: MSDS ON SITE? TYPE OF BUSINESS: �WCyha� r Al ,S o,t" IN INFORMATION / RECOMMEND TIONS�ww Cnk, �s.w` c Fide Dist cf: t- `,�.r� ,cwo k %5 v,CQ-k , o Sk l.nn•k fin,- OS 4rv�,< vt L C-O M M VlvW-\OL-C kPi C Waste I z 3 t l 3. tAA(. 'bov o-XI y�O Last shipment of hazardous waste: Name of Hauler: Destination: ;5Q ma- Waste Product: Licensed es No AVM -> 'g0?31 56(o NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS wobuy.b,4 The Board of Health and the Public Health Division have determined that the folloing products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive Q NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Fixers Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Date: 3 / ,��/ /� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS NAME OF BUSINESS: Aid #/0/9 2 FE-G '1 S`T-P-- '( 6Aj BUSINESS LOCATION: 3W.? /a,/ynouK �� fWars' nj /hr/6 Jjft, 0,;1.6`a' INVENTORY MAILING ADDRESS: 30 ,„ ,� / ,1� � ,�,� /�, /j 1A /2a�% TOTAL AMOUNT: TELEPHONE NUMBER: (5Drv) L19,L- ��a5 CONTACT PERSON: Scplc �e �a�%a- i t {7�rccarI EMERGENCY CONTACT TELEPHONE NUMBER: 717 -9-75 X7-,,�43 MSDS ON SITE? TYPE OF BUSINESS: / 911C r K!E� INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Me-d WA Of— Last shipment of hazardous waste: a�a3/fS Name of Hauler: cGalrvMeaj - /�Ic Destination: g.Q L? v; Waste Product: M-z&- wJ q-d Unlyei-34( P--,,kLicensed? 1�,3 No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum \1 Observed / Maximum e1 ' Antifreeze (for gasoline or coolant systems) ti/ Miscellaneous Corrosive AfNEW ❑ USED AI A Cesspool cleaners Automatic transmission fluid Disinfectants �} Engine and radiator flushes Road salts (Halite) I/ Hydraulic fluid (including brake fluid) Refrigerants I/ Motor Oils Pesticides XNEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas N Photochemicals (Fixers) 14A ❑ NEW ❑ USED Diesel Fuel, kerosene, #2 heating oil Miscellaneous petroleum products: grease, -NIA Photochemicals (Developer) IJIA lubricants, gear oil I VA ❑ NEW ❑ USED Degreasers for engines and metal I/ Printing ink AMA Degreasers for driveways&garages Wood preservatives (creosote) V Caulk/Grout I/ Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers I/ Miscellaneous Combustible o/ Car wash detergents Leather dyes Car waxes and polishes AJIAFertilizers t,/ A Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners iVIA (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, A 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) I/ Other cleaning solvents Bug and tar removers Windshield wash ALL WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applic 's Signature Staff's Initials Date: 3 /5'" TOWN OF BARNSTABLE - TOXIC AND HAZARDOUS MATERIALS CAN-S4ITE-1N-VE-NTQR, NAME OF BUSINESS: Ai-le- rl,cJ # /o i 9 2- �► St,r 4,�, - BUSINESS LOCATION: 3,'y8 Y=cnd . /Mars nJ ^IIJ, 1V4 02&yB INVENTORY MAILING ADDRESS: 3o A,4r•- /ne- 1'�aj.,yv //, /1 1,4 /7ol/ TOTAL AMOUNT. TELEPHONE NUMBER: _�500 CONTACT PERSON: S Aan a a i a-4j EMERGENCY CONTACT TELEPHONE NUMBER: 7/7 -975" 9"&y3 MSDS ON SITE? TYPE OF BUSINESS: � �I '/�/1c�ir►lc���, INFORMATION/RECOMMENDATIONS: Fire District: { Waste Transportation: M e J pch/c%e- p Last shipment of hazardous waste: � � - Name of Hauler: /n✓ heaj7L /nc. Destination: 4—:4 De fn Waste Product: ► a,d l rlIyeelAt U- 3kLicensed? `3 No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. , e Observed / Maximum Observed / Maximum ✓ Antifreeze (for gasoline or coolant systems) ✓ Miscellaneous Corrosive ✓ ONEW ❑ USED N A Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes t/ Road salts (Halite) Hydraulic fluid.(including brake fluid-,).' Refrigerants .: F Motor Oils Pesticides XNEW ❑ USED ✓ (insecticides, herbicides, rodenticides) h/ A Gasoline, Jet fuel,Aviation gas N A Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, IVIA Photochemicals (Developer) j lubricants, gear oil ❑ NEW ❑ USED ' Degreasers for engines and metal Printing ink Degreasers for driveways &garages AJ 74 Wood preservatives (creosote) Caulk/Grout k-11, Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda A Rustproofers ✓ Miscellaneous Combustible ' L/ Car wash detergents Leather dyes Car waxes and polishes A/ A Fertilizers t j,/ A Asphalt&roofing tar a A_ PCB's ✓ Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners /, IA (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, N/A Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel' A/A Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes S Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) ✓ Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Walgreen Eastern Co., Inc../RITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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 06/30/2020 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 Town of Barnstable �. J Inspectional Services BARNS LE FTHE Tp annr,rne=-�rui•cv:+.n•.a.nnk= �Y Public Health Division 0� l019-7014 191 3 aL. R BARNSCABLE, Thomas McKean Director V �'' M y Ass. $ ' r�w 1639. ♦0 Arfa �a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 h� 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,6r *A late charye of$10.00 will be assessed if payment is not received by July 1st. f4(A1&*7 � b�tt•3a-�i�4-3 1. ASSESSORS MAP AND PARCEL NO. M 2. IS THIS A PERMIT RENEWAL? Y 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: s�_ �/I �j�p//�� q(�/ �/� CD't W " 5. NAME OF ESTABLISHMENT: J/r7RITE Y'AID#1*0192 3848 FALMOUTH ROAD 6. ADDRESS OF ESTABLISHMENT: MARSTONS MILLS, MA 02648 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: P.O. ox 901 8. TELEPHONE NUMBER OF ESTABLISHMENT: Deerfield, .IL 60015 `tazlicer�se�enew�(s@walg reens.:;cm 9. EMAIL ADDRESS: 10. SOLEOWNER: 1/ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: .. taxlicenserenewa s wa greens.com SIGNATURE OF APPLIC ). DATE MAY 29 91 Q:\Application Forms\Haz Mat App Revised 09 t0-18.docxjylynn Los Santos License Specialist 847-315-3376 I ����. 7 �wiuf B,.gnstable e�;n. atory , ertitces Richard V. Scali,Director �► ' Public Health Division Thomas McKean,Director ' y etA:ri a... u 200 Main StMel,Hyannis,annis,MA 02601 I Office: 5OH-862-4644 Fax: 508-790-6304 AP1' ICAT ON' 012I'.CRM1T'Gp STORE AND/OR 9jRt E RAZACt:DOI:fS 1ti9:A:TERIALS IN ACCORDANCE WITH'FI-IE'POW'N OF13A'k'NS7"AII'LE QffiNE'C'AL ORDINANCE,CHAPTER 1o8, HAZARDOUS MATERIALS,AI,L BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER TITAN FIOUSE1101.D QIJANTITfL?S ARE REQUIRED'['()OBTAIN AN ANNUAL PERMIT(RUNS JULY Ist.-JUNE 30th). APPLICATION FEES CATEGORY t PERMIT 26 — 1 10 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 1 11 —499 Gallons: $125.00 ❑ 1A CATEGORY 3 PERMIT 500 or more Gallons: $150,00 � ty'� *A.lrttt charge. "ill be atilt sse(F if 0XV,11 e:stt i5 1101 recc;.ived bX hly Ist CA�1�e'� 1. ASSESSOR'S MAP ANI)PARCEL,NO, 058039002 2, IS THIS A PERMIT RENEWAL? V YES—NO. IF YES,SKIP QUESTION 3. • 3, 1,OR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER'THAN HOUSEHOLD QUANTITIES(25 GALLONS)?_YES_NO. 4. FULL NAME OF APPLICANT: Kimberly Dascoli 5. NAME OF ESTABLISHMENT: DBA Rite Aid#10192 6, ADDRESS OF ESTAI1LISHMiENT: 3848 Falmouth Road,Marstons Mills, MA 02648-5707 7, MAILING ADDRESS (Ile D1I+'FERENT FROM ABOVE: 300 Wilmot Road MS#3301 Deerfield,IL 60015 8, TELEPHONE NUMBER OF ES'TAIILTSHMENT: 508-428-3525 9. EMAIL ADDRESS:. kim.dascoli@walgreen.com 10. SOLEOWNER: _ _YLS NO IF NO, NAME OF PARTNER: 11. Jr,LILL NAME,HOME ADDRESS,AND TELEPHONE H OF: CORPORATION NAME Walgreen Eastern Co. PRE SIDI N'T TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: _ TELEPHONE,#: COMPANY ADDRESS ,MAID,: SIGNATURE OF APPLIC�INTan$ A I L29 (';�Usrr;tin:;oll ik'd1;.pf::uaa nrd'!Ar r ,i1�1.�Shis�lr )'Qyijp a q ppr,,at Fll�(;ns�.: ii d.aN{rYnk\l8,ti1{$i}r#� Ic1F1i��iA+IAT,iI°N:!Cl i'/El1`V l�t_:1•ti;:: 3 d E` 1 WALGREEN EASTERN CO., INC. OFFICERS AND DIRECTORS TITLE NAME ADDRESS NUMBER Ownership 108 Wilmot Road President & Director Richard Ashworth Deerfield, IL 60015 (847) 914-2500 0% 108 Wilmot Road Vice President John Saylor Deerfield, IL 60015 (847) 914-2500 0% 108 Wilmot Road Vice President. Alan Nielsen Deerfield, IL 60015 (847) 914-2500 0% 108 Wilmot Road Treasurer & Director Todd Heckman Deerfield, IL 60015 (847) 914-2500 0% Vice President & 108 Wilmot Road Secretary Joseph Amsbary, Jr. Deerfield, IL 60015 (847) 914-2500 0% 108 Wilmot Road Director Alexander W. Gourlay Deerfield, IL 60015 (847) 914-2500 0% 1 License Automation Page 1 of 1 License Automation Location Search License Search Check Request Check History New Locations License Type State Sales Tax IDFederal ID Dist Account Change Notifications License Image Search License Search Results Location License Lic Mult License Renewal License License Location Address Ci ST Type G Ind Lic. Exp Due Rene Amt 1 60- 2841 ROUTE Y H UTH MA MA HAZARD L 0 06/30/19 06/15/19 /19 $150.00 773 RITL E' 119505 520 W MAIN BARNSTABLE MA HAZARD L 0 06/30/19 06/15/19 C05129�50.00 >>> ST MAT [RITEAm -#10189--% 360 HAZARD 17837-5 BARNSTABLE HYANNIS MA MAT L 0 06/30/19 06/15/19 05/29/19$�150.00 >>> RD RITE Am # 918 ROUTE Y OUTH HAZARD 5-S 6A P MA MAT L 0 06/30/19 06/15/19 05 /19 $150.00 ,,, -AID :#10-192� 3848 MARSTONS HAZARD 19947 S FALMOUTH MILLS MA MAT L 0 06/30/19 06/15/119 05/( 29/19i $150.00 >>> RD 5.29.19 Kay Please Mail Licenses and any future applications To: Kaylynn De Los Santos License Adm License Specialist,inistration PHONE#(847)-315-3376 Plalgreen CO. FAX#(847)-368-6525 Deerfield,d60015 3215/ Bog 901 *1 will be out of the office on Fridays* De taxhcenserenewals@walgreens.com(Group email) httP://licenseautomation.waIgreens.com/LicenseAutomation/servlet/waIgreens.1ic... 5/29/2019 Tripp,Vanessa • From: De Los santos, Kay <kaylynn.delossantos@walgreens.com> Sent: Thursday, July 25, 2019 12:16 PM To: Tripp,Vanessa Cc: Dascoli, Kimberly; Hora, Lisa Subject: BARNSTABLE HAZARD MAT renewal Attachments: (L)BARNSTABLE MA HAZARD MAT Local renewed 05.29.19(592854267).pdf Importance: High Good morning, There had been a little over payment of the :I;.[;�1.T.,;.1;T.t,:t.��_;\;[„�;1:;'renewals for stores: .oc =io � D A ddr s 6 Sy ' yygp.,... � � �..Fe�v' ,/.u.o/' .✓/ ..w///.,,..,.. -.e�.NE i..ful A ,..e:'enkMt ° �....,:�iiLw.,.6.u?x.e ' RITE AID 1;54 520 W MAIN ST BARNSTABLE MA BARNSTABLE #10190 <RITE AID 360 BARNSTABLE BARNSTABLE MA BARNSTABLE ' #10189 RD RITE AID 3848 FALMOUTH 1.9`47--=-'- #10192 RD BARNSTABLE MA BARNSTABLE • June 5`h was the 1 st check received,which attached should be the initial application that was sent. Then the 2°d June 24`h, was the other application and check that was sent. - Kim , can you please attach (if available) the application and check that was sent to verify the checks that were sent. - If not,Vanessa please send a copy of all documents sent from Walgreen Co., so we can keep record. Since both payments have been processed, the renewal period is covered for this year and upcoming. To avoid crossing this bridge again ,License Administration usually does renewals for the stores for Rite Aid and Walgreens. Please let me know if there are any issues and concerns. Thank you, qa" a paver& day! Kaylynn Pe Los Santos License Specialist, License Administration .Walgreen CO. 300 Wilmot Road, MS 3215 / PO Box 901 Deerfield, I L 60015 1 PHONE # (847)-315-3376 FAX# (847)-368-6525 *T will be out of the office on Fridays* • P Trus- ted since 01" taxlicenserenewals@walgreens.com (Group email) CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 • €�ayrrErs , a j W >' ,- ii'_,. Pay Check Pay Type Permit Owner Business Location Parcel Pay Date Amount Method Number ............ _ s :alar;<<.us 2019- BROt:1LEY-COTUIT Rite Aid 3840FALMOUTH 058039002, 4;Gi24QOI14 $150 ChecK 0007193124 to Receipt 2020 LLC101J2 RrvADfR IE 23,I•aatc>r<s .s «Y .;?z.flogs 201 9- 3Yt 1K R_A= INC Rile Aid 11 JdE� MAIN 259�"1 26:24,019 $1:v CheCK 00071931241 H Rec4ip ;aYil'is 2_12v =1G1'11 STREET,Hyannis rQi Rem*.) .za.tS€rt,s 2019- PORKK,,. AV T Rile Aid 3,63 BARNSTABLE :10120 .a 24.2019 $1-0 C.herk C007193124 t _...._ ?..[ftfiais 2U20 PARK A,DANI[-L 1 c.101,8ri iC.`(5[1.NY22ntt€S TRS Friday,Jul 12, 2019 09:54 AM Faymenis Pay Check Pay Type Permit Owner Business Location Parcel Pay Date Amount Method Number c H?2,aiL1;-s 201"9- BROMLEY COTUFF R:teAid 3b,u AL!.':Oi1TN r, 03ai02 6;0 '2019 51i 0 Check N€ r� zer�3r 3 i m ......... ,aI., afs 2D20 L LC 1-182 RCAD R t 23;412 siG S 0011742370 tv},iis • v + 'fl'Lciuc 2Di9- C iti?BRI=iG=ASSOC RI Aid 2 WEST .,AIV 2i�"i113 Go:DS.' 019 515" Cheek �i'1 i MRef..,�.. ... M.ate,�ats 2020 LP #101 "3 3'.,50 �!rcr__T.i rar=.nis 117,2 0 ........... H RetE?p. is z a C 0 is 2019- PORKKA.s AVID T 3 Rite Air 363 BARNST.ABLE 310120 013 05+2019 a150 Check NT:'' 2,r.20 PARKK.A,DANIELJ -4.101691 ROAD ,:1}arnis ",f;i1742370 TRS Friday,Jul 12,2019 09:54 AM Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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 06/30/2019 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 ee -a T�wgi%t Bl rsicese egu atoty etvlces Richard V. Scali, Director ; r Public Health Division BA NI STABLE ? ongNareu�e, I Thomas McKean Director .. p`bA `"tOL - `� 200 N''Iain Street Hyannis,MA 0260'I �60 MA'S' ' y ' I Office: 508-862-4644 Uax: 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 Ist—JUNE 30t17). , I APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $1 ❑ �j CATEGORY 3 PERMIT 500 or more Gallons: 150,00 � Lp- t *A late charge o(10.00 will be asseised il'payment is not reccrvc by July ist. i 4 1. ASSESSOR'S MAP AND PARCEL NO. 058039002 2. IS THIS A PERMIT RENEWAL? V YES i 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: Kimberly Dascoli 5. NAME OF ESTABLISHMENT: DBA Rite Aid#10192 6. ADDRESS OF ESTABLISHMENT: 3848 Falmouth Road, Marstons Mills, MA 02648-5707 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 300 WilmotRoad MS#3215 DeerFeld, IL 60015 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-3525 9. EMAIL ADDRESS: kim.dascoli@walgreen.com 10, SOLEOWNER:—YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: A:ORPORATION NAME Walgreen Eastern Co., Inc. PRESIDENT Richard Ashworth,70 Tournament Drive North, Hawthron Woods; IL 60047, 847-914-2500 TREASURER. Alan Nielsen, 1263 Williamsburg Ln., Crystal Lake, IL 60014, 847-914-2500. CLERK N/A 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT 7kT.0 iUserxl[)ecnllik\Apol)ata`J,Heal\y[icrosoCl\,Vinr!ews\Tenipnr i rnu:, ,1 fifcx\Conlenl.0;itlnok\Btvff>f749H_\HAZVA I'AP[2Oi 7 REVISED docx . K Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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 P��I���K� bo�tv�i ytoa r ' Town of Barnstable aF E►okti Regulatory Services Richard V. Seali,Director ��� Public health Division BT rBp A'�A Thomas McKean Director 200 Main Street,I-lyannis,NIA 02601 Office: 508-862-4644 1"ax: 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 HOUSFHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN 1 ANNUAL PERMIT(RUNS DULY Ist---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 N # A Infe eharge of 510 00 will-be assessed if yment ts`not lec jved Uy}11y [si:.. ASSESSORS MAP AND PARCEL NO..-058039002 DATE June 5, 2017 FULL NAME OF APPLICANT: David W. Crozier NAME OF ESTABLISHMENT: Maxi Dtuq, INC./D.B,A. Rite Aid Store#10192 ADDRESS OF ESTABLISHMENT: 3848 Falmouth Road, Marstons Mills, MA. 02648-5707 MAILING ADDRESS(IF DIFFERENT) i TELEPHONE NUMBER OF ESTABLISHMENT: 508-428-3525 EMAIL ADDRESS: EHS@a riteaid,com SOLE OWNER: X_YES_NO IF NO,NAME OF PARTNER FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Rite Aid Corporation Attw EHS 30 Hunter Lane, Camp Hill, PA 17011 PRESIDENT Kenneth.Black,Office Address:30 Hunter,Lane,.Camp HD,.PA 17011 TREASURER Matthau srhr�g�iPrTntitra a {G�ss 30}unierliscts�amf�811 PA 1704M CLERK Daniel Miller Offfice Ad ra4c:30 Hunter Lane.Cwllill PA 17011 IF PREPARED BY OUTSIDE PARTY: SW7A, 'U-I2 QF APPLICANT Name: . (� o Company Address :,- Telephone it: Email: CATempltlAZZAPP Rev I6.docx Page 1 ol'2 Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INC./RITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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 l� r Town of Barnstable IHE rowti Regulatory Services h °* Richard V. Scali, Director BARNSTABLE, + MASS. Public Health Division i639• 'OrFn 39. 0. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fad 508-790-6304 s . F+ Application Fee: $4 0-.00 m' N o� ,l�l �'iso•Dd ASSESSORS MAP AND PARCEL NO. 058039002 DATE June 1, 2016 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT David Crozier NAME OF ESTABLISHMENT Maxi Drug Inc. /DBA Rite Aid Store# 10192 • ADDRESS OF ESTABLISHMENT 3848 Falmouth Road, Marstons Mills, MA. 02648-5707 TELEPHONE NUMBER 508-428-3525 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black, Office Address: 30 Hunter Lane, Camp Hill,PA. 17011 TREASURER Matthew Schroeder, Office Address: 30 Hunter Lane, Camp Hill, PA. 17011 CLERK Daniel Miller, Office Address: 30 Hunter Lane, Camp Hill, PA. 17011 • ' SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# L:\Re1Lcg\HL\ENVIR0NMENTAL\East Coast States\Massachusetts\Invoices & Pennits\Hazardous Waste\2016\2016 Applications\Town of Barnstable\10192 Application.doc MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: Town of Barnstable ' Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page g L:\Re1Leg\HL\ENVIR0NMENTAL\East Coast States\Massachusetts\Invoices & PennitMazardous Waste\2016\2016 Applications\Town of Barnstable\10192 Application.doc Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 ,* Regulatory Services Department MMSTABM Public Health Division MAS. Thomas A.McKean,CHO d39. 200 Main Street, Hyannis,MA 02601 Payment Receipt ;Hazardous Materials Payment received: $150.00 (Check) on 6/7/2016 Permit number: 1139 ;Check number: 0006649086 Check amount: $300.00 Name on check: Rite Aid HDQTRS. Corp r ,Business: MAXI DRUG INC./ RITE AID STORE #10192 Address: 3848 Falmouth Road , Marstons Mills _............._ .............- ......... .. . _.......... ._............. _.. .............. ...._ ............� • • i v� Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INC/RITEAID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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.CANNirr,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health a'� Town of Barnstable °Ft Regulatory Services • °� Richard V. Scali,Director a" MAS& Public Health Division �fD MA'S A 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. 058039002 DATE June 4, 2015 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT David Crozier NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10192 . ADDRESS OF ESTABLISHMENT 3848 Falmouth Road,Marstons Mills,MA 02648-5707 "TELEPHONE NUMBER 508-428-3525 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address: 30 Hunter Lane, Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address: 30 Hunter Lane, Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address: 30 Hunter Lane, Camp Hill,PA 17011 • STIOTATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# L:\Re1Leg\HL\ENVIR0NMENTAL\East Coast States\MassachusettAhivoices&PermitsUurisdictions\Town of Barnstable\10192 6.4.15.doc S Office: 508-862-4644 4� T Town of Barnstable Fax: 508-790-6304 .� Regulatory Services Department snttwstnnl Public Health Division y Muss. Thomas A. McKean,CHO a 3��` 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received:$100.00 (Check) on 6/17/2015 Permit number: 1139 Check number: 0006443080 Check amount: $300.00 Name on check: RITE AID HDQTRS. CORP. Business: MAXI DRUG INC./ RITE AID STORE #10192 ;Address: 3840 FALMOUTH ROAD/RTE 28, Marstons Mills 7 • • Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS, 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 6/15/2015 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r� `y ,, Town of Barnstable Regulatory Services - Thomas F. Geiler,Director ;'"R' �` Public Health Division . i634 �0 630 . 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. 058039002 DATE June 12,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10192 ADDRESS OF ESTABLISHMENT 3848 Falmouth Road,Marstons Mills,MA 02648-5707 TELEPHONE NUMBER 508-428-3525 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address:30 Hunter Lane,Camp Hill,PA 1 011 y SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# RETAIL SAFETY. NIANIIAL i Store:;10192 Rite Aid Risk Management Department SPILL CONTINGENCY PLAN. Store Manager Dawn Mooney: Name 508 428-3525 Phone# Guy Suffoletto.` District Manager Name 508 996 3549: One# Jeff Schares Regional Vice President Name 401 821"2569 Phone Local Emergency Contacts I�I-AL 911 508 775=1300 Fire Department Phone#.! Police Phone # 508 775 0387 Hospital Phone# 508 771 1800 Spill Response Procedures REQUIRED EQUIPMENT: 1 Contact Store Management, 2 Put on gloves,goggles and apron, 0 Chemical Cleanup KIt 3 Contain the spill with a mop or absorbent❑>Apron `materials,. Bucket 4 Cleanup the spill,as directed, using generous. ❑ Mop amounts of water; 5 Clean the area thoroughly, ❑Water -b Clean all safety equipment and rinse out all absorbent materials that are reused JANUARY l 2013 ITT Environmental Flealth.&Safety Number Fee 1139 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUNG INC./DBA RITE AID STORE#10192 3848 FALMOUTH ROAD, MARSTONS MILLS,MA 02648 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 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 4/1/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r I Town of Barnstable Regulatory Services Thomas F. Geiler,Director '"�'"s'9 s6s . r Public Health Division 9 MA33. , �� Fc ram" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 058039002 DATE March 20,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10192 ADDRESS OF ESTABLISHMENT 3848 Falmouth Road,Marstons Mills,MA 02648-5707 TELEPHONE NUMBER 508-428-3525 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.042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address:30 Hunter Lane,Camp Hill,PA 1 011 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # •M F .y RETAIL SAFETY MANUAL Store 10192 Rite Aid - Risk Management Department .Z. -N. SPILL CONTINGENCY PLAN' Store Manager Dawn Mooney Name 508-428-3525 Phone# :Guy Suffoletto District Manager: Name 508-996-3549 Phone# Jeff Schares Regional Vice President` Name 401-821-2569" Phone# Local Emergency Contacts DIAL 911 : 508-775-1300 Fire Department Phone# 508 775-0387 Police Phone# 508 771-1800 Hospital one#' Spill Response Procedures. REQUIRED EQUIPMENT: 1. Contact Store Management; 2 Put on gloves,goggles and apron, ❑ Chemical Cleanup Kit 3 Contain the spill with a mop or absorbent ❑`Apron" materials; 4 ❑ Bucket Clean up the spill, as directed, using generous ❑ Mo amounts of water; P 5 Clean the area thoroughly; ❑ Water 6. Clean all safety equipment and rinse out all absorbent materials that are reused.,.,.. 1ANUARY 1,2013 107 Environmental Health&Safety