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3900 FALMOUTH ROAD/RTE 28 - Health
3R�O ��►'nDu-t�. 1�Cc.�f �� � i � L Ed)col 1--9 a,- r CutLess File Folders 48420 Tops-Pmducts.com/Pendaflex MADE IN USA 30016PCF P4 INE roy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMA1& 200 Main Street• Hyannis, MA 02601 1659. �iD'ED MPy a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cu 4 #qG6 Date: ko Location/Mailing Address: 13 99 Contact Name/Phone: Inventory Total Amount: SIDS: onllnQ License#: 1107 Tier II :_No Labeling: Wfi k1l Spill Plan: a P"a. Oil/WaterSeparator: N A Floor Drains: To , Emergency Numbers: Storage Areas/Tanks: dyl d Emergency/Containment E ui m t: Waste Generator ID: Mac 20A 9 Waste Product: oU� �kti Date&Amount of Last Shipment/Frequency: 3,�3 Licensed Waste Hauler& Destination: Other Waste Disposal Methods: IST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage rand disposal of 111 gallons or more requires a license from the Public Health Division. — J/ L Antifreeze ry cleaning fluids i/ .Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes EEBug and tar removers Hydraulic fluid (including brake fluid) indshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil 'sinfectants Miscellaneous petroleum products: 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 1/ 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: 6 %=p CL. Inspector- Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FTHE A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMs�Le.� 200 Main Street• Hyannis, MA 02601 1639. �'p�EDMPy�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: SFo S"p Date: Location/Mailin Address: 3q0 Fa- vvtd-J ._ 1R M. A Contact Name/Phone: ore, ,r-.F c .S'�16 --Y2 s� 5 0.O1 VPs V e.-;-r —wk.,a v`ti4b< Sa ti�.�c Uo�. ,j QSS�• w.��. ack 1 Cee I : a^-' Inventory Total Amount: SDS: `/t-5 a•?- License#: O-7 Tier II : v Labelina: d'e&Q%k ,\,)&A � Spill Plan: ZS Oil/WaterSeparator: kS Ow`4 Wv)'CQ Floor Drains: Emer encv Numbers: Yes StorageAreas/Tanks: eU) 1n70�7k�- far w<�uA pxe4 iv^ 'VIROe 1 a� Emergency/Containment Equipment: `tea! C -Ir "e o 5 %114 Waste Generator ID: Waste Product: �5 Date&Amount of Last Shipment/Fr quency: 0"'�\r✓(-Q,D AA, V OAA-+fin . Licensed Waste Hauler&Destinati Other Waste Disposal Methods: <_� 5+e.<.c.ync\2i 00 LIST OF TOXIC AND HAZARDOUS MATERIALS` N/-ink, -r, IA S�°�'CQJ-A �� S�v l°`��y `"' 'c� NOTE. Under the provisions of Ch. 111, Section 31, of the Genetal Laws ofA, 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: INFORMATI N/RECOMMENDATIONS: -D r \62 \l 9 .1 A-�ak,oVi.N VlV 2tiLT - Oq Inspector: /��I„acy�.�l� e7 acility Re resentative: 4u 1+5 WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSYNESS 0�wtr 5 Ivle a$ ,(- Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop & Shop Store #066 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and N 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 Town of Barnstable F Ta, Regulatory Services Richard V. Scali, Director BAINSTA MA.I BARNSTABLE m� Public Health Division iSx^+;45daEdt YEYf Y.5 yLyY f•k:c: . 3 ♦ xas» a g a�i _- rssie sx mt QED MAC A :s .ata Thomas McKean, Director � 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-J UNE 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. ASSESSORS MAP AND PARCEL NO. DATE IU FULL NAME OF APPLICANT: -7� of NAME OF ESTABLISHMENT: 5l0 Jh J` and �o ADDRESS OF ESTABLISHMENT: ��j � ��,;,o y,�l,, k� ( �y�r MAILING ADDRESS DIFFERENT):IF ( D /1Tr�XOcs ll/t)�ncv �cc�jy�c ���i TELEPHONE NUMBER OF ESTABLISHMENT: O --_L/�g EMAIL ADDRESS: sshe,Sna.00�Ic 4,. S/olPi-ian ��l c� �cJ, rani SOLE OWNER: Il YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF- J� CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: • SKGNATURE OF APPLICANT Name: ou- -- Company Address Telephone#: Email: CATemp\HAZZAPP Revl6.docx Page l of i MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the- required fee. 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. 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 C:\Temp\HAZZAPP Rev 16.docx Page 2 of 2 y III 9 Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop& Shop Store #066 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. -----------------------------=- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 03/01/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable ►w,ti Regulatory Services Richard V. Scali, Director '" E MAS& ' Public Health Division B�AMST y a9s. g' i639 Thomas McKean, Director ' a 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-79djJ304 i� APPLICATION FOR PERMIT TO STORE-AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 10.8, 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 • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. �t�-n V—OD/ D'ATE �9 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: c r1 ADDRESS OF ESTABLISHMENT: Jam/O© MAILING ADDRESS (IF DIFFERENT): 3$S- a ` LIB j e TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: S ne,s�v SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ez �C PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: • SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email: C:\Temp\HAZZAPP RevlUocx Page 1 of 2 Fl a j�a 9'4t� MAIL-IN REQUESTS PleafK mail the completed application form to the address below. In addition, please include the required fee. 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. 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 CATemp\HAZZAPP Rev16.docx Page.2 of 2 y°FIKEloy�b Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 eA"MAC`E$ 200 Main Street• Hyannis, MA 02601 �•�rFOMP�& TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: "P Date: Location/Mailing—Address: 3 6>0 o✓•f� a•r5; aKs V11, �r'S Contact Name/Phone: ctJe- r S - 2 /.27 Inventory Total Amount: M �t vSDS: `IDS-d H-��µ--��a,�Q�� License# p O-A+3 Tier II MIA Labeling: ('t ka 1 Sill Plan: o I tu., ,w Oil/Water Separator: ►A Floor Drains: - bHs,k-e- Emergency Numbers: o K / Storage Areas/Tanks: ike&N\ oca no.< C-1- a KEY 6 C 1 Emergency/Containment E ui pment: U v,VJOL%k ab le,—w.11 G ova w� �hlQv�i r5 Cc11 Waste Generator ID: 01A Waste Product: �11ti15C Ytii X-e � �o.�s Date&Amount of Last Shipment/Frequency: Qro n, �a,�a S } ��'vsv� 5 Licensed Waste Hauler&Destination: �V C S Other Waste Disposal Methods: lx)� 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 Y7 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: da K s{o� � f1 k2 � J•CnppS "�b�'a �I slv�� O `� +�Jk. � . h- ��S 4-o � v�� �ol�Mak�g�-fig, � q� 1Ie& Fa p-Representative: ant ��5 vkat�C"MS 1ice��c_. -�� WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSES$ ,56 V m . �)"e- k4lll-vim I^— ! i ►i- w . /mil so ►�� — , C �vGe, ce- Date: Y 12�/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 01 J In,.p BUSINESS LOCATION: 39oD a1 .,4f,. R .+ ar�-fv�as ,leg INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: �Q-10 �J�a ,( Tq : j, ;t EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: S�Q�1�� -k c5 - o►��� INFORMATION / RECOMMENDATIONS: l�ez� 9arrtit�-}- sell nlait�. �' t Fire District: i l �V1VG `D! 7 a ro Ci }� S of R , 3� C /�- VA 5 I o,r� W�Q tvAV-e K 69-- 6'.V 'C S 1: — d 1 0 �ajN.Ci o ��n e< P ,. Cam„ A020%5 c m-ax �,iK4'9 wvlA1�c- Ssre. gvC� -\I1 ALA 4- \� ��h acZ e-q sw\ 5 ors G4 Waste Transportation: o Last g ipment of hazardous vtraste: Name of Hauler: 1,t)a�f� gcvt,�'h�cc.�c_ ogAx Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS 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 Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing,ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, , Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers�► V&;(- A.bpit.l may be toxic or hazardous (please list): Metal polishes V06+1k4L LZ-C4v�S� �ti �J Kk!W ConRl .v,�c-Q Laundry soil & stain removers ° (including bleach) ,��'towt :0 6 1 7--71D-�,Sq$-7 Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers t✓ cC,,. iv It, r ��S W y Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials ()S� ppiME fps Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • �R.ASS.LE$ 200 Main Street• Hyannis, MA 02601 �p 2639.p�0 'FOMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: _ <Skcysa 5 Date: cA `-8 LI Location/Mailing Address: 6q(\0 ��\t��c�u y� �a�� rn On 0 C Contact Name/Phone: =A116 t71 1R Inventory Total Amount: 4 MSDS: CA'At License#: 1),d7 Tier II : N o Labeling: LkC,3 Spill Plan: UU Oil/WaterSeparator: AMA Floor Drains: NA Emergency Numbers: � Storage Areas/Tanks: 121 V�.pty Emergency/Containment E ui nt: ` Waste Generator ID: qlhipkrz ic- all i bl Waste Product: Date&Amount of Last Shipment/Frequency: to ` d% Licensed Waste Hauler&Destination: leaV" r\005k, ON AS -In Nb4lm '.a Other Waste Disposal Methods: . LIST OF TOXIC AND HAZARDOUS MATERIALS CUM an erIV1eh 0y+ NOTE: Under the provisions of Ch. 111, Section 31, of the General La s 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: nQ1>`S 4AL Inspector: Facility Representativ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS C r Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop & Shop Store #066 ......---........................................................................................................................ 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. .................................................................................................................................................................... Restrictions: .------............................................................................................................................................................. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i Town of Barnstable Inspectional Services BARNSTABLE �fNE Tq�, w.1Y.ia9l[•cE?.TElnUE conirt•rx4nnls Public Health Division 1639-201a2014 4e1 1 Thomas McKean Director ' � o •� 200 Main Street,Hyannis,MA 02601; ►'4' Office: 508-862-4644 Fax: 508-7.90-6304 APPLICATION FOR TERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS I 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 3Ath), APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50:00- CATEGORY 2 PERMIT .141 —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 JuIV Ista 631'900 g 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: 5. NAME OF ESTABLISHMENT:. Ls D°h '�h n D i4 6. ADDRESS OF ESTABLISHMENT: Moo 4ounnoa.� /"a. S M 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:. 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER:ZYES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS;AND TELEPHONE.#:OF: CORPORATION NAME 4.g6 o- PRESIDENT TREASURER CLERK :12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#. .. COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 6 �- Q'W A li Draft Jan2019.docx PPlication Fortns\Haz Mat PP• t Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop & Shop Store #066 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------- ---------- - - ------ ----- ..- ------------------------- ------------------------•-------- ---------------------------------- -------------------- ------ -------------------------- -------------------------------------------------------------- --------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 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 I m Town of Barnstable Inspectional Services BARNSTABLE 4 • �, Public Health Division BARNUMBLB. r Thomas McKean Director IMAM � McKean,.Director 200 Main Street, Hyannis,MA 02601 :' r+ Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY Ist-DUNE 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 t� �Cij�l nr *A late charge of$10.00 will be assessed if payment is not received by July Ist. 6wgaea'i'�'�"' 1. ASSESSOR'S MAP AND PARCEL NO. 6 59-o fi-00( 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: �'l-� �D:D --kO �o 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: �UCA' YY� [�dA 'ld I�1Qi�S�C1 I rt``� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: The Stop&Shop Supermarket Company LLC — Attn: Susan Fox-License Coordinator 8. TELEPHONE NUMBER OF ESTABLISHMENT: 1385 Hancock Street Quincy,MA 02169 'w Phone: 617-770-6010 9. EMAIL ADDRESS: Email: Susan.fox@retailbusinessservices.com 10. SOLEOWNER: ✓YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE��F: CORPORATION NAME � ,c —13 PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 7h9L9 QAApplication Forms\Haz Mat App Revised 09-10-18.docx The Stop & Shop Supermarket Company LLC Officers and Managers Title Name President Mark J. McGowan Treasurer Derk-Jan Terhorst Secretary __-- Assistant Secretary Maria Silvestri Managers: Mark J. McGowan Wven Kienzie rk-Jan Terhorst Stacy Wiggins Robert Yager All Officers & Managers of The Stop & Shop Supermarket Company LLC have the following business address: Stop & Shop Supermarket Company 1385 Hancock Street Quincy, MA 02169 617-770-8708 • I Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop & Shop Store #066 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 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 ti �, .. $15D CAK od E 0+8q-�i ,8 Vwofor Brnsxable eg atory ervices Richard V. Scali,Director o Public Health Division BAMSTABLE BA NSPABLE. " Thomas McKean,Director Nn� 1 u-� ♦ ♦ M4RSi01R MIL'S•OSfE0.VIl1E•tlT3T BpRNSi46E - 1659. A s`0� 200 Main Street, Hyannis,M 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 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 ,1 V-S . *A late charge of$10.00 will be assessed if payment is not received by 1st. 1. ASSESSOR'S MAP AND PARCEL NO. / 2. IS THIS A PERMIT RENEWAL? V YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HA7_.ARI)OTTS-MATFRTAT.S_STORA.GEIUSE-OF_..— GREATER THAN HOUSEHOLD QUAN f 1 STOP & SHOP STORE #066 4. FULL NAME OF APPLICANT: 3900 FALMOUTH ROAD - ' 5. NAME OF ESTABLISHMENT: MARSTONS MILLS, MA 02648 6. ADDRESS OF ESTABLISHMENT: Sd Op + Sb,v P Ce, 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: t3�Z5 K okAcoc Fc S+. (�,x,rcy rnA Uat tog A-rl7V: LrcenS?ny p•ept 8. TELEPHONE NUMBER OF ESTABLISHMENT: Lo 1.7- 7`7 0--%-T 0$ 9. EMAIL ADDRESS: Vvp p Q��1a�1 f�wSgf:les� s�rviGPS. Com 10. SOLEOWNER: /YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: a CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN I�:7* DATE Lf /11 Q: Application FormsOAZMAT APP 2017 REVISED.docx The Stop & Shop Supermarket Company LLC fficers and Managers Title Name President Mark J. McGowan Treasurer Derk-Jan Terhorst Secretary Mark Messier Assistant Secretary Maria Silvestri Managers: Mark J. McGowan ,ven Kienzle erk-Jan Terhorst Stacy Wiggins Robert Yager All Officers & Managers of The Stop & Shop Supermarket Company LLC have the following business address: Stop & Shop Supermarket Company 1385 Hancock Street Quincy, MA 02169 617-770-8708 • AIN 20 20-t-f PM12:114 Number Fee 1207 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Stop & Shop Store#066 3900 Falmouth Road, Marstons Mills, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------ ------------ ----------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06130/2018 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 LeruA TRowr1�of hnstable dpp-75?3a10 egu atoervlces Richard V. Scah, Director .THE T� P� • Public Health Division BABSTABLE BARNSfABLE. ' PPRYSAOIF..N1lR 1LLG•COTUI1-151:13 Thomas McKean Director HRRSUi YLL31639 2014:SI P4 rySfea•c MASS. ) i6eJ!/eJ 4 -fD 39. �`� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 CW-77—c,?0/v 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 P( J-S - *A late charize 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? V YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:�o�ofiS�d p 5L)o-e/jr,at�1,4. Ca . L. L C 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 376D T�Z�`.?oJ�E� I� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:138� ��� LI cenyi k S',� �rru��,� r1�oal�9 fie f 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Sshe, s)re, cz �6 �c�. l®in 10. SOLEOWNER:_ZYE S 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: SIGNATURE OF APPLICANT UJW-,(-- DATE U Ito (f) Q:VWpplication Forms\HAZMAT APP 2017 REVISED.docx The Stop &Shop Supermarket Company LLC _ _ _ _ Compliance Department .�'�#� �5'1!I�,� Ahold USA Retail 1385 Hancock Sty • Quincy, Mass 02169 • - r.r Date: T, Dear Agency Representative, My name is Ashlye Brennan, I am the Licensing Manager for The Stop &Shop Supermarket Company LLC. The purpose of this letter is to submit a renewal (s)to your agency for our store location. We ask that all future communications regarding licensing/pemaitting for our store location(s)be addressed to my attention at the address below. Should you have any questions now or in the future,please feel free to contact me at 617-770- 8708 or a shlye.brennanna,ahold com. I appreciate your help with this transition. Sincerely, Asblye Brennan • Manager,Licensing The Stop&Shop Supermarket Company LLC 1385 Hancock St. Quincy,MA 02169 617-770-8708 617-689-4061 fax 617-770-6980 fax ashlye.brennan@ahold.com J The Stop & Shop Supermarket Company LLC Officers and Managers TITLE Name Division President, Stop & Shop New England Mark McGowan Division President, Stop & Shop NY Metro Donald Sussman Chief Real Estate Development Officer James J. Sylvia Senior Vice President, Real Estate Timothy Mahoney Treasurer, Stop & Shop NY Metro Christopher Asmis Assistant Secretary Steven F-Rowell Assistant Secretar y Gail Goolkasian sistant Secretary Caroline Woodward n ' ; se p Managers: General Counsel and Secretary Thomas A. Hippler Division President, Stop & Shop New England Mark McGowan Division President, Stop & Shop NY Metro Donald Sussman All Officers & Managers of The Stop & Shop Supermarket Company LLC have the following business address: Stop & Shop Supermarket Company 1385 Hancock Street Quincy, MA 02169 617-770-8708 i _ . WYNN &WYNN,P.C. ATMRNaS-M-LAW l 310 Barnstable Road, Hyannis, MA 02601 (508) 775-3665 (508)477-6179 Telecopier(508)775-1244 Michael C.Akashian William G. Kenney John J.O'Day,Jr. Raynham Office: Tammy L.Arcuri Walter J. Korzeniowski Kevin J.O'Malley 90 New State Highway Marylin A. Beck Catherine M. Kuzmiski Thomas E. Pontes Raynham,MA 02767 Mark W.Bennett Joseph P.McKenna,Jr. Michael J. Princi (508)823.4567 John F.Cascione' William E. McKeon,Jr. Jeanne M.Quinn Telecopier(508)822 4097 Frederick Chirigotis Christine M. McLaughlin Janice E. Robbins Boston Office: Charles W. Cobb Brenda J.McNally William Rosa 84 State Street Dino M.Colucci— James K.Meehan James H.Sandman Boston.MA 02109 Stephen J. Duggan Robert F.Mills Leonard Schneider (617)742-7146 Stephen J. Durkin Lawrence P.Mongeau' Nancy McGuirk Silvia Telecopier(617)742.6712 Richard T.Gallone' Charles D.Mulcahy Michael F.Walsh Fall River Office: William J.Gately.Jr.' Laurie Phillips Mullen Paul F.Wynn 222 Milliken Blvd.,P.O.Box 2640 Douglas A. Hale Catherine C. Murphy" Thomas J. Wynn August 31 , 1990 Fall River,MA 02722 Mark R. Karsner Charles A.Murray. III (508)678-5639 Telecopier(508)677.0344 Admittrd in Marhasrtls and Rhidr Island ••' sw Idmmrd n Mavrarhasrtfs and Nru Hampshire• New Bedford: Admtlfrd w M¢ ha ,Jts.Rhmlr Aland and F(on'hn (508)999.6969 ..� Mr. Henry Cui Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Region Lakeville Hospital Lakeville, MA 02347 Re: BARNSTABLE-WSC/SA-4-0825 Cotuit Landing, Route 28 NOTICE OF RESPONSIBILITY/CONFIRMED DISPOSAL SITE Our File No. 9783*1 Dear Mr. Cui: This will confirm our conversation of August 30, 1990 wherein you agreed to extend the time to prepare the Phase I - Limited Site Investigation of the subject property. As I informed you on the telephone, Attorney Michael Princi who was handling this matter is currently on active duty as he is a member of the National Guard Reserves. I will advise Attorney Princi to contact you upon his return from duty. Thank you for your courtesy and cooperation in this regard. Sincerely, WYNN MD WYNN, P.C. Robert F. Mills RFM:db cc: D nald S. Berry, Esq. ichael P. Carvalho Board of Health, Town of Barnstable Mr. Warren Rutherford, , Town Manager Barnstable Board of Selectmen Jonathan L. Moll , Esq. Commonwealth of Massachusettsy Executive Office of Environmental Affairs Department of lnvii onmental Protection ' M Soie St. Regional Office William F W Govem« Daniel S.Greenbaum commfee*W April 21, 1992 Juniper Properties Company RE: BARNSTABLE--WSC/SA-4-0825 39 Holton Street Cotuit Landing, Route 28 Winchester, Massachusetts 01890 WAIVER APPLICATION APPROVAL M.G.L. , Chapter 21E and MCP, 310 CMR 40.000 ATTENTION: George D. Whitten Gentlemen: The Department of Environmental Protection (DEP) , pursuant to the Massachusetts Contingency Plan (MCP) , 310 CMR 40.537, hereby approves the Waiver Application for the referenced non-priority disposal site subject to the conditions of the Waiver Application, the Disposition form and the following: 1. The Waiver Application Disposition form (Section VIII) must be countersigned and returned within ten (10) days of receipt of this letter to the DEP, Southeast Regional Office, Lakeville Hospital, Lakeville, Massachusetts 02347, ATTENTION: Site Support Section-Waiver Unit. Please keep a copy of the form for your records. 2. All document submittals sent to this office must be referenced as a "Waiver Site" with the DEP case number. 3. The Phase II - Comprehensive Site Assessment shall fully delineate the extent of contamination in the soil and ground :rater both on and off the property. All remedial response actions shall be in accordance with the phased MCP process. 4. The Phase III study must be completed in order to determine the Final Remedial Response Plan (FRRP) for this disposal site. 5. Commencing the date of the countersigned Waiver Application Disposition form, you shall submit, at six (6) month intervals, a report updating the status of all actions taken at the site until implementation of the FRRP. Lakeville Hospital • Route 105 9 Lakeville,Massachusetts 02347 • FAX(508)947-6557 9 Telephone(508)946-2700 -2- 6. Any proposal to transport contaminated soils from this site to any other location in Massachusetts must be approved by this office. Unapproved off-site disposition, including treatment, reuse or disposal, may constitute a "release" of oil or hazardous material and create a new "site". Approval of such a proposal should not be construed as approval of the FRRP for this disposal site. Soils contaminated only with virgin petroleum oils may be handled in accordance with DEP's "Management Procedures for Excavated Soils Contaminated with Virgin Petroleum Oil, " under Chapter 21E, Policy #WSC-400-89. Soils contaminated with other oils or hazardous materials require site-specific approval. Remedial response actions such as on-site treatment or reuse at approved asphalt batching plants are preferred. In-state landfill disposal will only be considered if documentation is provided that all available and applicable treatment or reuse options are not feasible. Proposals to treat, reuse or dispose of contaminated soils outside of Massachusetts must conform to all applicable in- state and out-of-state regulatory requirements, but do not otherwise require approval from the Regional Office. 7. You and your agents must also continue to evaluate the need for a short term measure ("STM") as defined in 310 CMR 40.542 and notify the Department immediately if an "imminent hazard" exists at the site. You must submit a proposal to perform the STM if one is deemed necessary. No STM may be commenced without prior Department approval. This evaluation must continue throughout the remedial response action for this site. 8. This office may conduct detailed audits of selected waiver sites on a random basis which shall include review of the remedial response action(s) , required documents, and the completeness and adequacy of each relative to the MCP. -3- Should you have any questions regarding this matter, please contact Henry Cui of this office at (508) 946-2882. Very truly yours, l obert E. bonovan, Regional Engineer for Waste Site Cleanup D/HC/rr Enclosure: Waiver Application Disposition Form CERTIFIED MAIL JP656 840 989 RETURN RECEIPT REQUESTED cc: BWSC - Boston ATTN: Waiver Unit (Enclosure) Goodwin, Procter & Hoar Exchange Place 53 State Street Boston, MA 02109-2881 ATTN: Donald S. Berry Goldberg-Zoino & Associates, Inc. The GEO Building 320 Needham Street Newton Upper Falls, MA 02164 ATTN: John J. Balco Board of Health Town Hall 367 Main Street Hyannis, MA 02601 Barnstable Board of Selectmen Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Mr. Warren Rutherford Town Manager DEP - SERO - Data Entry r DANIEL S.GREENBAUM Commissioner GILBERT T.JOLY 0 Regional DirectorG`!V . u February 1, 1991 Estate of Elizabeth C. Hayden RE: BARNSTABLE- WSC/SA-4-0825 160 Pine Street, Apt. 20 Cotuit Landing, Route 28 Auburndale, Massachusetts 02166 NON-PRIORITY DISPOSAL SITE/ GROUNDWATER MONITORING ATTENTION: Ms. Catherine Hayden M.G.L. , Chapter 21E and Executor. MCP, 310 CMR 40.000 Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup, (the "Department") has classified the above referenced disposal site as non-priority in accordance with 310 CMR 40.544 and determined that further ground water monitoring at the site is required. A notice of press release relative to the site classification will be sent to you shortly. In response to the Department's May 21, 1990, Notice of Responsibility, Geotechnical . Consultants of Massachusetts, Inc. in North Andover, Massachusetts on behalf of Cotuit Landing Joint Venture submitted a report titled "BARNSTABLE-WSC/SA-4-0825, COTUIT LANDING, ROUTE 28, PHASE I - LIMITED SITE ASSESSMENT, SITE CLASSIFICATION FORM, PRELIMINARY SITE ASSESSMENT FORM" dated August 15, 1990. The report provides 'evidence that a chlorinated hydrocarbon release has occurred at the site. Along with the report, the Interim Site Classification Form indicates that criterion number three (3) has been met. Contrary to the report, the Department has determined that the subject site is not located within the Zone II for the Cotuit Fire District's main pump station and well field at Lovell Pond, and therefore, criterion number three (3) is not met. Consequently, this site is classified as non- priority. On December 19, 1990, 'a Department representative visited the site and observed the operational process at the Landing Cleaners: At that time, it was noted that waste water generated from the dry cleaning machine was being collected in drums. In addition, documentation indicates that the contaminated sludge and liquid in the on-site septic tank was pumped out in March 1990. Removal of the apparent source of the chlorinated hydrocarbons in the ground water should result in attenuation, over time, of the low level of contamination encountered. To verify this, the Department Recycled Paper 2 _ requires you to have the ground water sampled in July 1991 and January 1992. Sampling shall be by a Massachusetts certified laboratory using EPA Test Method 601 with the results submitted to this office. Thereafter, the Department will re-evaluate the site status. Please be advised that your liability for the chlorinated hydrocarbon release at the site is the same as described in the May 21, 1990 Notice of Responsibility sent to Juniper Properties Company of Winchester, Massachusetts (copy enclosed) . If you have any further questions, please contact Henry Cui at the letterhead address or at (508) 946-2882. All future communications regarding this site must refer to site number 4-0825. Very truly yours, Jq' epf F. Kowal, Chief Site Support Section K/HC/re Enclosure CERTIFIED MAIL #P253 153 005 RETURN RECEIPT REQUESTED cc: DEP - BWSC - Boston . Division of Response and Remediation Goodwin, Procter & Hoar Exchange Place 53 State Street Boston, Massachusetts 02109-2881 ATTN: Donald S. .Berry Geotechnical Consultants of Massachusetts, Inc. Willows Professional Park 799 Turnpike Street North Andover, Massachusetts 01845 ATTN: Samuel A Fusco, P.E. Board of Health Town Hall 367 Main Street Hyannis, Massachusetts 02601 y - 3 - cc: Board of Selectmen Town Hall 367 Main Street Hyannis, Massachusetts 02601 ATTN: Mr. Warren Rutherford Town Manager Juniper Properties Company 39 Holton Street Winchester, Massachusetts 01890 ATTN: George D. Whitten DEP - SERO - Data Entry DEP - SERO - RCRA ATTN: Gerald Monte W p j�f Jsul`�cevd�C�e�tan DANIEL S.GREENBAUM Commissioner GILBERT T.JOLY Regional Director.10211> OPY-v January 17, 1991 Juniper Properties Company RE: BARNSTABLE--WSC/SA-4-0825 39 Holton Street Cotuit Landing, Route 28 Winchester, Massachusetts 01890 NON-PRIORITY DISPOSAL SITE/ GROUNDWATER MONITORING ATTENTION: George D. Whitten M.G.L. , Chapter 21E and MCP, 310 CMR 40.000 Gentlemen: The Department of Environmental .Protection, Bureau of Waste Site Cleanup, (the "Department") . has classified the above referenced disposal site as non-priority in accordance with 310 CMR 40.544 and determined that further ground water monitoring at the site is required. A notice of press release relative to the site classification will be sent to you shortly. In response to the Department's May 25, 1990, Notice of Responsibility, Geotechnical Consultants of Massachusetts, Inc. in North Andover, Massachusetts on behalf of Cotuit Landing Joint Venture submitted a report titled "BARNSTABLE-WSC/SA-4-0825, COTUIT LANDING, ROUTE 28, PHASE I - LIMITED SITE ASSESSMENT, SITE CLASSIFICATION FORM, PRELIMINARY SITE ASSESSMENT FORM" dated August 15, 1990. The report provides evidence that a chlorinated hydrocarbon release has occurred at the site. Along with the report, the Interim Site Classification Form indicates that criterion number three (3) has been met. Contrary to the report, the Department has determined that the subject site is not located within the Zone II for the Cotuit Fire District's main pump station and well field at Lovell Pond, and therefore, criterion number three (3) is not met. Consequently, this site is classified as non- priority. On December 19, 1990, a Department representative visited the site and observed the operational process at the Landing Cleaners. At that time, it was noted that waste water generated from the dry cleaning machine was being collected in drums. In addition, documentation indicates that the contaminated sludge and liquid in the on-site septic tank was pumped out in March 1990. Removal of the apparent source of the chlorinated hydrocarbons in the ground water should result in attenuation, over time, of the low level of contamination encountered. To verify this, the Department Recycled Paper 2 - requires you to have the ground water sampled in July 1991 and January 1992. Sampling shall be by a Massachusetts certified laboratory using EPA Test Method 601 with the results submitted to this office. Thereafter, the Department will re-evaluate the site status. Please be advised that your liability for the chlorinated hydrocarbon release at the site remains the same as described in the May 25, 1990, Notice of Responsibility. If you have any further questions, please contact Henry Cui at the letterhead address or at (508) 94672882. All future communications regarding this site must refer to site number 4-0825. Very truly yours, J epI F. Kowal, Chief Site Support Section K/HC/rr CERTIFIED MAIL #P253 147 782 RETURN RECEIPT REQUESTED cc: DEP - BWSC - Boston Division of Response and Remediation Goodwin, Procter & Hoar Exchange Place 53 State Street Boston, Massachusetts 02109-2881 ATTN: Donald S. Berry Geotechnical Consultants of Massachusetts, Inc. Willows Professional Park 799 Turnpike Street North Andover, Massachusetts 01845 ATTN: Samuel A Fusco, P.E.. Board of Health Town Hall 367 Main Street Hyannis, Massachusetts 02601 Board of Selectmen Town Hall 367 Main Street Hyannis, Massachusetts 02601 ATTN: Mr. Warren Rutherford Town Manager r r - 3 - Estate of Elizabeth C. Hayden. 160 Pine Street, Apt. 20 Auburndale, MA 02166 ATTN: Ms. Catherine Hayden, Executor DEP - SERO - Data Entry DEP - SERO - RCRA ATTN: Gerald Monte t Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F. Weld G.mor on October 13 , 1993 Juniper Properties Co. RE: BARNSTABLE--WSC/SA-4-0825 39 Holton St. Cotuit Landing Winchester, Massachusetts 01890 3000 Falmouth Rd. Waiver Site, Remedial Response Action Completion Statement Acknowledgement, M.G.L. , Chapter 21E and 310 CMR 40. 000 ATTENTION: Peter Brown Controller Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , pursuant to the Massachusetts Contingency Plan (MCP) 310 CMR 40.537 (12) hereby acknowledges receipt of a;Remedial Response Action Completion Statement relative to the approved waiver application for the above referenced waiver site. The date of your acceptance of the Waiver Application was March 18, 1990.. The completion statement was submitted to the Department with a cover letter on October 1, 1993 . Please be advised that this acknowledgement of receipt of the. completion statement shall not be construed to mean approval of or concurrence with the remedial response action selected or decisions based thereon. Be further advised that this office may conduct a detailed audit of the waiver site which may include review of the remedial response action(s) , required documents, and the completeness and adequacy of each relative to the MCP. Should you have any questions regarding this .matter, please contact Mark Wood of this office at (508) 946-2874 . Very truly yours, Gregg Hunt, Acting Regional Engineer for Waste Site Cleanup H/MEW/jt 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 0 Telephone (508) 946-2700 r -2- CERTIFIED MAI1 #P808 782 678 RETURN RECEIPT REQUESTED cc: Board of Health Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Susan G. Rask, Chairperson Barnstable Selectmen Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Jacalyn A. Barton, Chairperson GZA GeoEnvironmental, Inc. 320 Needham Street Newton Upper Falls, MA 02164 ATTN: Paul Reiter DEP - Boston - BWSC ATTN: Waiver Unit DEP - SERO - BWSC ATTN: Data Entry 4 /� � �� _ � � t Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection ' E P i Southeast Regional Office WNllam F.Weld Govemor Trudy COPY SsSecretary,tary,EOE EOE A David B.$truhs Commissioner January 12, 1996 Cotuit Landing Joint Venture RE: BARNSTABLE--WSC-ASM-4-0825 Juniper Development Group Cotuit Landing Attn: Mr. Peter Brown 3000 Falmouth Road 39 Holton Street NOTICE OF AuDIVREOuEST FOR Winchester, Massachusetts 01890 SITE INSPECTION M.G.L. c. 21E and MCP, 310 CMR 40.0000 NOTICE OF AUDIT This is an important notice. Promptly respond to any requests contained herein. Dear Mr. Brown: Massachusetts General Law Chapter 21E requires the Massachusetts Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , to audit response actions not approved by the Department at sites of releases of oil or hazardous material to ensure that these actions are being conducted according to .M.G.L. c. 21E, the Massachusetts Contingency Plan (MCP) , and other relevant laws and regulations. The MCP at 310 CMR 40. 1100 establishes procedures for conducting such audits. The site referenced above has been selected by the Department for an audit. The audit will be conducted by Department staff in the Southeast Regional Office in Lakeville. The audit will initially focus on the Response Action Completion Statement submitted to the Department on October 1, 1993 for the site. Additional response actions may also be evaluated as appropriate. This Notice describes the scope of the audit and the type of audit activities the Department initially intends to perform along with your responsibilities and relevant deadlines. A fact sheet and flow . chart that describe the audit process are also included as part of this Notice. Note that, during an audit, response actions can proceed as planned unless you are otherwise notified by the Department. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 9 Telephone (508) 946-2700 -R: -2- Pursuant to M.G.L. c. 21E 2 Request for Site Inspection. §§ , 4, and 8, 310 CMR 40.0166, and 310 CMR 40. 1120 (1) employees, agents, and contractors of the Department may enter any site or vessel to investigate, sample, or inspect any documents, conditions, equipment, practice, or property as part of the audit. The Department requests an appointment to inspect the site on January 24, 1995, at 9:00 a.m. , and discuss issues relevant to this audit. The inspection will be conducted by Mary Ellen Smith of the Audit and Site Management Section. Your consultant or one of his representatives are requested to attend. Please call Mary Ellen Smith within seven (7) days of receipt of this Notice at (508) 946- 2864 if you will need to arrange an alternative date or time. The Audit shall consist of the following activities: ■ A review of relevant documents in the Department's file for the subject site, specifically: The report titled "Waiver Submittal Phase II - Comprehensive Site Assessment Cotuit Landing Barnstable, Massachusetts DEP Site No. 4-0825" prepared by GZA GeoEnvironmental, Inc. , dated September 1993 . ■ A site inspection to gauge monitoring wells MW-1 through MW-9 as described in the report titled "Waiver Submittal Phase II - Comprehensive Site Assessment Cotuit Landing Barnstable, Massachusetts DEP Site No. 4-0825" prepared by GZA GeoEnvironmental, Inc. , dated September 1993. ■ A visual inspection of the onsite buildings. The Department requests that you or your consultant provide all equipment necessary to conduct the above. Please submit any additional documentation associated with the response actions performed at the site not previously submitted to the Department which you would like to be included as part of the audit, to Mary Ellen Smith of this office within ten %- 01 days of receipt of this Notice. Any submittals made in response to this Notice must contain the enclosed certification of submittal per 310 CMR 40.0009. At the completion of this phase of the audit the Department may: (1) issue a Notice of Audit Findings which may include a statement of violations or deficiencies and steps to correct those violations or deficiencies. (2) request a meeting with you, and if you choose, a representative, to discuss response actions and other supporting evidence to demonstrate compliance and then issue a Notice of Audit Findings. -3- (3) conduct further site investigations and then issue a Notice of Audit Findings. (4) issue a Notice of Audit Findings that sets an Interim Deadline to correct violations or deficiencies or to prepare an Audit Follow-up Plan. (5) initiate enforcement actions listed at 310 CMR 40. 1140(2) if violations of M.G.L. c. 21E or the MCP have been identified. If you have any questions regarding this Notice or any of the requirements contained in it, or believe that you cannot comply with its requirements, please contact Mary Ellen Smith at (508) 946-2864. The Department appreciates your anticipated cooperation in this matter. Very truly yours, Joseph F. Kowal, Chief Audit & Site Management Section K/MES/ka Enclosures: Fact Sheet Flow Chart Certification of Submittal CERTIFIED MAIL # Z 169 751 035 RETURN RECEIPT REQUESTED cc: Mr. Harold Tobey, President Town Council Town of Barnstable Town Hall 367 Main Street Hyannis, Massachusetts 02601 Board of Health Post Office Box 534 Hyannis, Massachusetts 02601 ATTN: Brian Grady, Chairman Mr. Paul Reiter GZA GeoEnvironmental Inc. 320 Needham Street Newton Upper Falls, Massachusetts 02164 DEP - Boston ATTN: Steve Winslow DEP - SERO - Data Entry IL Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F. Weld Govemor Daniel S.Greenbaum "R� r ! O D October 13 , 1993 Juniper Properties Co. RE: BARNSTABLE--WSC/SA-4-0825 39 Holton St. Cotuit Landing Winchester, Massachusetts 01890 3000 Falmouth Rd. Waiver Site, Remedial Response Action Completion Statement Acknowledgement, M.G.L. , Chapter 21E and 310 CMR 40.000 ATTENTION: Peter Brown Controller Gentlemen: The Department of. Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , pursuant to the Massachusetts Contingency Plan (MCP) 310 CMR 40. 537 (12) hereby acknowledges receipt of a Remedial Response Action Completion Statement relative to the approved waiver application for the above referenced waiver site. The date of your acceptance of the Waiver Application was March 18, 1990. The completion statement was submitted to the Department with a cover letter on October 1, 1993 . Please be advised that this acknowledgement of receipt of the completion statement shall not be construed to mean approval of or concurrence with the remedial response action selected or decisions based thereon. Be further advised that this office may conduct a detailed audit of the waiver site which may include review of the remedial response action(s) , required documents, and the completeness and adequacy of each relative to the MCP. Should you have any questions regarding this matter, please contact Mark Wood of this office at (508) 946-2874 . Very truly yours, Gregg Hunt, Acting Regional Engineer for Waste Site Cleanup H/MEW/jt 20 Riverside Drive • La'keville,Massachusetts 02347 9 FAX(508)947-6557 • Telephone (508) 946-2700 ,. -2- r�, CERTIFIED MAIL #P808 782 678 RETURN RECEIPT REQUESTED cc: Board of Health Town Hall 367 Main Street ' Hyannis, MA 02601 ATTN: Susan G. Rask, Chairperson Barnstable Selectmen Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Jacalyn A. Barton, Chairperson GZA GeoEnvironmental, Inc. 320 Needham Street Newton Upper Falls, MA 02164 ATTN: Paul Reiter DEP - Boston - BWSC ATTN: Waiver Unit DEP - SERO - BWSC ATTN: Data Entry I i r' Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office Willlam F.Yield Govemo, Trudy Co.e Secretary,EOEA David Commissions. MarchCommissions. March 11, 1996 Mr. Peter Brown RE: BARNSTABLE--WSC-ASM-4-0825 Cotuit Landing Joint Venture Cotuit Landing Juniper Development Group 3000 Falmouth Road 39FHolton Street NOTICE OF AUDIT FINDINGS/SITE Winchester, Massachusetts 01890 CLOSURE, M.G.L. c. 21E and MCP, 310 CMR 40. 0000 NOTICE OF AUDIT FINDINGS Dear Mr. Brown: On January 12, 1996, you were notified that the Massachusetts Department of Environmental Protection had begun to audit cleanup actions conducted in response to a release of hazardous material at the above-referenced site. This Notice informs you of the results of the Department's audit. The Department finds that the audited actions currently comply and sufficient information has been submitted. Therefore, no additional actions are necessary. The Site Memorandum (Attachment A) describes activities Department personnel performed during the audit, summarizes relevant site information and identified a deficiency that you have already corrected. We appreciate your cooperation in responding to this deficiency in a timely manner. Finally, in Section VI of the Site Memorandum, the Department has provided additional observations and recommendations related to the implementation of requirements applicable to your actions. The Department provides those comments to assist you and your LSP to better understand appropriate interpretation of the Massachusetts Contingency Plan. Those comments do not constitute violations or deficiencies. Therefore, you do not need to respond to them. The Department now considers the audit initiated for this site on January 12, 1996 to be complete. The Department also acknowledges that the site has achieved a level of No Significant Risk. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947.6557 9 Telephone (508) 946-2700 ' v I -2- LIMITATIONS The Department relies upon the accuracy of the information reviewed during the Audit, including information submitted during the course of the audit, to make these findings. These findings do not: (1) apply to actions or other aspects of the site that were not reviewed in the Audit, (2) preclude future audits of past, current, or future actions at the site, (3) .in any way constitute a release from any liability, obligation, action or penalty under M.G.L. c. 21E, 310 CMR 40.0000, or any other law, regulation, or requirement, or (4) limit the Department's authority to take or arrange, or to require any Responsible Party or Potentially Responsible Party to perform, any response action authorized by M.G.L. c. 21E which the Department deems necessary to protect health, safety, public welfare or the environment. If you have any questions regarding this Notice please call Mary Ellen Smith at. (508) 946 - 2864. Please reference the Release Tracking Number 4-0825 in any correspondence regarding the site. Very truly yours Joseph F. Kowal, Chief Audit & Site Management Section K/MES/cb Attachments: A. Site Memorandum CERTIFIED MAIL NO. P 606 844 592 RETURN RECEIPT REQUESTED cc: Mr. Harold Tobey, President nrm Council Town of Barnstable Town Hall 367 Main Street Hyannis, Massachusetts 02601 Board of Health Post Office Box 534 Hyannis, Massachusetts 02,601 ATTN: Brian Grady, Chairman Mr. Paul Reiter, LSP GZA GeoEnvironmental. Inc. 320 Needham Street Newton Upper Falls, Massachusetts 02164 f -3- cc: DEP - Boston ATTN: Steve Winslow DEP - SERO ATTN: Regional Enforcement Office Data Entry i I Attachment A SITE MEMORANDUM I. ACTIONS AUDITED The Audit included a review of the following: ■ Transition Provisions - Waiver Completion Statement ■ Comprehensive Response Actions - Phase II Comprehensive Site Assessment ■ Risk Characterization II. AUDIT ACTIVITIES The Audit consisted of the following activities: ■ A review of relevant documents in the Department's file for the subject site, specifically: The report titled "Waiver Submittal Phase II - Comprehensive Site Assessment Cotuit Landing Barnstable, Massachusetts DEP Site No. 4-0825" prepared by GZA GeoEnvironmental, Inc. , dated September 1993. ■ A visual inspection of the on site buildings. ■ A Notice of Audit dated January 12, 1996. ■ A meeting between Mary Ellen Smith representing the Department, Peter Brown representing the Juniper Development Group and Mr. Paul Reiter, the LSP of Record for the site to discuss site history, current site conditions and preliminary findings of this audit. ■ A site inspection on January 24, 1996 that included a site walk over, inspection of the former dry cleaning facility and' insp.ectior. of some of the monitoring ;,;ells on site. III.SITE SUMMARY/SITE INSPECTION The site is located on a portion of the property located in a mixed commercial/residential area of the village of Cotuit, in the Town of Barnstable. The property has been developed as Cotuit Landing, a strip mall shopping center. The property consists of three buildings, paved parking and 'landscaped area. The three ,r i -2- buildings consist of eleven store fronts. The closest sensitive receptors are the Hayden Wellfield located approximately 2,000 feet north-northeast and Mills Pond located approximately 1,500 feet northeast of the site. Groundwater at the site flows away from these sensitive receptors towards the southeast. On April 28, 1992, the Department granted a Waiver of approvals. As you are aware, the approved Waiver provided you (you as used in this letter refers to Juniper Development Group) an opportunity to proceed with the cleanup process on an expedited schedule by not requiring Department oversight and approval of further site assessment and remediation activities. Under the Waiver, the remedial response actions were. to be completed within five (5) years of Department. approval, of the waiver application. Response actions at the site proceeded in accordance with the phased MCP process and documentation of the full extent of contamination and risk to public health and the environment have been submitted to the Department. The strip mall was developed in 1978, prior to development the site was an undeveloped wooded area. There is no change in the foreseeable use of the property. Contamination at the site consists of chlorinated solvents primarily in the form of tetrachloroethene. Contamination at the site resulted from a former dry cleaner which disposed of waste into a sink which discharged to an onsite septic system. Contamination exists in the area surrounding the leaching field and septic tank. Upon the discovery of the release the septic system was pumped out and the cleaners installed a carbon activated filtration system in its sinks. A total of nine monitoring wells have been installed on site. Levels on contamination have been monitored since 1989 and contamination has continued to decrease over time. The 1992 data (most recent data on file) indicates tetrachloroethene contamination at 15 ug/l or 15 parts per billion (ppb) which is above the GW-1 ground water standard of 5 ppb. However, the results of the risk characterization shows that the risk posed to human and environmental receptors from the residual contamination are below acceptable risk levels for both current and foreseeable uses. IV. SUMMARY OF DEFICIENCIES Although one deficiency was found, no further steps are necessary to correct this deficiency since it was corrected during the course of the Audit. -3- 1. Monitoring wells were not properly secured and lacked locking caps. On February 28, 1996 the Department received documentation the monitoring. wells at the site had been equipped with locking caps. VI. ADDITIONAL COMMENTS Additional Comments. The list below contains observations and recommendations from the. Department on the actions that were audited. These observations and recommendations do NOT constitute deficiencies or violations and require no response to the Department from you. Instead, they are included to help you and your LSP better understand the Department's interpretation of M.G.L. c. 21E, 310 CMR .40.0000, and ocher requirements applicable to the site. 1. During the site inspection it was noted that there was a floor drain located in the former dry cleaning location. It was recommended that floor drains be closed in accordance with the Underground Injection Control (UIC) Program 310 CMR 27.00. The UIC Program regulates discharges to shallow "injection wells" such as dry wells, a septic system tied to floor drains, and oil/water separators leading to a leach field. On February 28, 1996 the Department received documentation of the "Notice of Plumbing Inspector Approval to Seal Floor Drain" in accordance with 310 CMR 27.000. 2. If groundwater monitoring or sampling is not to be conducted in the future then the Department recommends that the monitoring wells on site be decommissioned in accordance with the Department's "Standard References for Monitoring Wells" Policy, WSC-310-91. rP z MATERIAL SAFETY DATA SHEEP FABRITEC INTERNATIONAL MSDS No.: 334-A-0 200 Industrial Rd. Date: 2-04-88 Cold Spring, Ky. 41076 Page: 1 of 2 Finergency Contact: Harold E. Mains (606) 781-6200 1. PRODUCT NAME a HAZARD SUMMARY 673 L' . CCRCLA Ratings (0-3) NFPA Hazard Rating (0-4) health U Unknown Health U Unknown Fire 2 Moderate Fire 2 Moderate Reactivity 0 Minimal Reactivity 0 Minimal Persistence 1 Slight 2 UAZARDOUS COMPONENTS I TWA (OSHA) Petroleum Solvent (140 Flash) 75.0 500 ppm CAS 1 64742-88-7 Other non hazardous ingredients 25.0 --- Ingredients not identified are proprietary and non hazardous. All ingredients "pear on the EPA TSCA inventory. . 3. PHYSICAL 3 CHEMICAL DATA Appearance: Water white mobile liquid Evaporation rate: (Butyl acetate - 1): 0.03 Odor: Petroleum, Oily Vapor density (Air - 1)t approx. 5 Boiling Point: 370-450'F (188-232C) Solubility in water: Slight pH: Not Applicable Specific gravity (Water - 1): 0.81 %volatile: 75% 4. FIRE EXPLOSION 6 REACTIVITY HAZARD DATA Flash point: greater than 140'F (60C) TCC Flammable limits: ; Not determined for product, limits for solvent (1 - 64 in air) OSHA flammability Class III A Fire Fighting Melis (1984 Emergency Response Guide Book, DOT P 5800.3)t Dry chemical, carbon dioxide, water spray or foam. For large fires use water spray, fog or alcohol foam. DOT (Hazard Class. Combustible Special fire-fighting procedures: Wear self contained breathing apparatus. Unusual fire anq, explosion hazards: None Stability: Sta le Incompatibility Strong oxidizers: Explosion hazard. Strong reducing agents: explosion hazard. Decompositionproducts: Thermal decomposition may release toxic and/or hazardous gases. Polymerization Wi11 not occur under normal conditions. Conditions to void: Flay be ignited by heat, sparks or flames. Vapors may travel to a source of ignition. Container may explode in heat of fire. Run off to sewer may create fire or explosion hazard. 5. HEALTH HAZARD DATA WARNING! MAY CAUSE EYE, SKIN AND RI-SPIRATORY IRRITATION. MAY DE HARMFUL IF SWALLOWED. Signs and s m toms of overexposure: Eyes: Liquid and vapors - may cause irritation with redness, tearing and blurred vision, repeated or p olonged contact may cause conjunctivitis. Skin: Prolon ed contact may cause defatting of skin which can lead to irritation and/or dermal tt a. Ingestion: M y cause gastrointestinal irritation, nausea, vomiting, diarrhea and central no system depression with dizziness, weakness, fatigue and headache. A piration into the lungs may result in chemical pneumonitis which may be fatal. f MSDS No: 334-A-0 Page 2 of 2 5. HEALTH HAZARD DATA - CONTD. .Emergency and First Aid Procedures Eyes: Wash eyes with water for at least 15 minutes, get medical attention. Skin: Remove any contaminated clothing, wash area with water or soap and water for at least 15 minutes, get medical attention. Inhalation: Remove to fresh air. If breathing has stopped, give artificial respiration. Get medical attention. Ingestion: Treat symptomatically, get medical attention immediately. If vomiting occurs, keep head lower than hips to prevent aspiration. 6. SPILL AND LEAK PROCEDURES Remove sources of ignition. Small spills: Absorb on rags and clean rags in cleaning unit. Large spills: Contain and transfer to container for use or disposal. Waste disposal method: May be considered ,a hazardous waste, dispose of according to all applicable regulations. Incineration in permitted facilities or disposal in permitted land fill are preferred disposal methods. 7. SPECIAL PROTECTION Ventilation: Local exhaust system. Respirator: The following respirators are recommended and ranked in order from minimum to maximum protection. Type 'C' supplied-air respirator with full face piece. Self-contained breathing apparatus with a full face piece operated in pressure- demand mode. Eye Protection: Wear chemical tight goggles when handling product. 8. TRANSPORTATION DATA DOT hazard classification 49 CFR172.101: Combustible liquid DOT labeling requirements 49 CRF172.101 and 172.402: None Abbreviations: TLV - Threshold Limit Value ACGIH - American Conference of Governmental Industrial Hygienis s CERCLA - Super fund act NFPA - National FIre Protection Assoc. Mg/M3 - Milligrams per cubic meter of air We cannot anticipate all conditions under which this information and our''tproducts, or the products of other manufacturers in combination with our products, may be `used. We accept no responsibility for results obtained by the application of this information or the safety and suitability of our products, either alone or in combination with other products. We sell the products without warranty, and buyers and users assume all responsibility and liability for loss or damage arising from the handling and use of our products, whether used alone or in combination with other products. t I I a IIYTERIYATIO/YAL FABRICARE IIYSTITCITE The Association of Professional Drycleaners and LaunderersBULLETIN ` • • 01990 IFI . 12251 Tech Road Silver Spring . Maryland 20904 • WI/622.1900 Disposal of Separator Water The majority of drycleaning plants dispose of sep- areas currently regulated at a zero ppm discharge arator water to sanitary sewer systems. Other plants limit. discharge water to septic systems,and in a few cases, Contact your state association or your local POTW directly outside. Based on our current research, we for specific wastewater r0gillations for your area. believe that alternative methods of handling separa- However,even if your wastewater is allowed to enter for water pose fewer environmental risks than dis- a sanitary sewer system,you should be,considering charging to a sewer or septic system. other methods of disposal. In the past year, there have been an increasing The amount of water produced from this separator number of reports of groundwater and soil contain- varies with each equipment type.The average yearly ination from perchloroethylene. Several of these water levels produced by the still, tumbler, and instances have been blamed on leaks from sanitary vapor adsorber separators are as follows: sewer systems and/or drainage from septic systems. still - 25 gallons/year While the pert that was found in the sludge of tumbler -25 gallons/year several sanitary sewer systems may have possibly vapor adsorber -450 gallons/year come from the discharges of other industries, there The total amounts of solubilized pt7in water at i may be no way of establishing that it was not from a saturation levels of 100 to 140 ppm will give 0.4-5.6 drycleaner's separator water. fluid ounces of perc discharge per year. This quan- With septic systems,the problems of perc accumu- tity varies with specific drycleaning equipment lation in sludge—and the potential for the discharge types. of perc through the drainage field—are even,.more After extensive testing and review,IFt believes that severe.We know of some recent cases where this has the most environmentally sound option for occurred, resulting in an expensive clean up effort. wastewater disposal is evaporation or aeration. We Because of these potential difficulties and the pos- have discussed with s Air Office Me benefits sible liabilities, IFI strongly recommends against associated with vaporizing the perc. Their prelimi- discharging separator water to septic,, systems. Sim- nary response was that evaporation or aeration does ilarly, IFI strongly recommends against "direct dis= not appear to be a problem and would not be ex- charge"—that is, where separator water is sent di- peeled to contribute to any additional air emissions. rectly to the outside environment. This is because the perc discharged to a sanitary With either sanitary or septic systems,blockage of sewer is generally considered to evaporate at the the perc outlet from a water separator can go virtu- POTW. ally unnoticed.Large quantities of perc are then sent Based on our understanding of the Resource Con- directly down the drain. IFI recommends collecting servation and Recovery Act.(RCRA)regulations',sep= the water in a container and not discharging it di- arator water maybe classified as a hazardous waste. rectly to the sewer so that this mishap can be pre- If so, RCRA reguTaMn- -511Id en require that vented. separator water discharge be piped directly into the sanitary sewer connection.However,this would not Dryeleaning Wastewater/Hazardous protect against the problem of a perc discharge re- Waste Regulations re- sulting from a separator blockage. g Further, if separator water is classified as such, — The federal government assigns to local "Publicly then evaporation or aeration would be consid=d Owned Treatment Works" (POTWs) the task of reg- treatme� a czar ous was e. is would re- elating wastewater. Drycleaners are specifically ex- quire extensive perms reatment facility". empt from the federal pretreatment standards and IFI believes very strongly that evaporation or aera- wastewater discharges are generally permissible. tion is the most environmentally responsible dis- However, an increasing number of POTWs are im- posal method,and we are now reviewing these op- posing local restrictions to drycleaners that dis- tions with EPA's Waste Office. charge into the sanitary sewer system, with some IF1 Fabricare News4uly 1990 9 Met s of Handling Separator The total cost of the tank,air stones, and tubing was W er less than$20. Procedure. Water samples were collected from over vaporation 50 drycleaning plants.Each water sample was placed Evaporation is one method of wastewater disposal in the tank and aerated for periods of time from 150 that is currently being used by some drycleaners in to 455 minutes.The amount of water aerated for each v our industry. The separator water can be evaporated sample varied between one and three liters or 0.3 and on a hot plate or with the use of a steam coil. There 0.8 gallons. The pressure of the compressed air was are also patented devices that can evaporate separator controlled between 10,15,and 20 pounds per square water. inch(psi).A personal sampling pump was placed on We have tried hot plate evaporation at IFI.We placed top of the tank to measure the perc vapor levels being 0.5 gallons of water in a stainless steel container. An released into the air due to aeration. 865 watts laboratory hot plate was used to heat the Testing. The water samples were analyzed before water. We were able to evaporate the water in four and after aeration using a gas chromatograph. This hours.The level of perc in the air above the container was done so that the reduction of perchloroethylene was eight ppm over the four hour period. in the water samples after aeration could be deter- If this method is used, the temperature of the hot mined.The method detection limit on this analytical plate must reach 2120 F. This is the boiling point of instrument ranged from 0.5 to 5 milligrams per liter water;therefore,this temperature is needed for evap- (mg/1) or 0.5 to 5 parts per million,(ppm). The water ration to occur. -44t:;u e..,L uvr Aa 3^or9ia amplgfi tested mayjstiilmc6htainasmaller amounts of --� ---�--:Yy .-:........r perc that..cannot-be-detected by our instrument. . Cooling Results. We were most interested in looking at the Cooling towers have been use y some drycleaners reduction of perc in the water samples after aeration. to evaporate separator water. However, this practice Of the fifty samples tested,every sample decreased in may contribute to corrosion of the tower. Addition- its concentration of perc after aerition. .Before aera- ally, we know of at least one report of perc accumu- tion,the samples had an average concentration of 168 lasing in tho towor wator tray. We do not rocommond mg/1 of perc.The aerated samples averaged nine mg/l. this disposal option. Fifty-four percent of the samples .had perc levels reduced to zero mg/l, while 66 percent were reduced Carbon Units to one or less mg/l. Of those samples that decreased There are patented devices on the market that pass to zero mg/l,parts per billion levels were detected. the separator water through a type of carbon filter.IFI We found no trends in perc reduction when aerating tested one of these units several years ago. We found a sample using longer time periods. However we did t that it was difficult to determine when the carbon find that the largest reduction of perc from the water - filter had become saturated with perc. When satura- will occur in the first hour. Also, differing the psi tion occurs, the carbon filter is ineffective and must range from 10 to 20 did not aid in removing the be disposed of by a hazardous waste disposal firm. amount of perc in the samples. The quantity of perc vapors released by aeration was Hazardous Waste Disposal Firm measured for each sample.The average level of perc Another option to consider is a hazardous waste in the air above the tank was 2.2 ppm over the aeration disposal firm.The separator water could be picked up time period. This.level is very low when it is com- with your other waste. This option could be expen- pared to the amount of perc vapors released into the sive but, nonetheless, it is a method of disposal. air from other drycleaning operations. Overall, aera- tion contributes little to no additional air emissions. Aeration Some.questions have been raised as to the reason 11:1's Technical Services Division conducted a®gidy why all samples tested-did..notreaoh,t-he zero mg/1 oethy'llene-in sep level of perc. One is that cosolvents on'reducing the conCentmof perchtor arator wate rby�using-diffusion aeration. The study used in, various spotting chemicals and detergents was conducted to test the effectiveness of aeration as may be causing the perc to become more water solu- a means of removing volatile organic compounds ble. If in fact the cosolvents are causing.the problem, from the wastewater. The principle of aeration is to then a.thorough cleaning of the water separator and vaporize the residual perc in the water with the use refilling with clear water should cure the problem.We of diffused air or bubbles. are doing further research work on this. If you plan on using aeration in your plant you may Equipment. A simple, inexpensive aeration system want to have your water analyzed. IFI can analyze was created by using a 5.5 gallon aquarium tank and water samples to determine the perc content. Water three 6.3 inch aquarium air stones. Plastic tubing was samples can also be sent to an outside testing labora- used to connect the air stones to a compressed air tory for analysis. source, such as an air line from finishing equipment. This bulletin was written by Dana Cloutet,IFI Research Chemist. �j Printed in the United States.All rights reserved.No part of this work may be reproduced in any fern or by electronic or mechanical means including information storage and re-trieval systems without permission from the publisher. 7/90 HW11 10 IFI Fabricare News/July 1990 Air j11 ENVIRONMENTAL NEWS Backed by Governor Michael Dukakis in their stills using a procedure devel- Employers Cited L; and Attorney General James Shannon, oped by IFI several years ago. (Continued From Page 5) the Strike Force has been charged with : the responsibility to treat anyone who NEFA Environmental Affairs Director, in the workplace of Material Safety Data ! dumps toxic waste as a"Violent Crimi- Lana DeRosa,said"with so many alter- Sheets with information about hazard- ' nal".The Attorney General has pledged natives and claims,the issue of legal water ous chemicals. According to the Boston that 'Ile Strike Force will bulldoze disposal is becoming confusing.We are and Washington based law firm of Foley, through the bureaucracy in pursuit of pleased that IFI has agreed to focus their Hoag,and Eliot, OSHA proposed over prosecutions and convictions." immediate attention on this problem and S1 million in penalties for violations of 1.1 ,i I �." we hope to see some firm guidelines the standard in 1988;incIdding1citations 4� While theseare tough words and objec- emerge from the association's efforts." issued to employers for will violations,,,1'11 tines;l'NEFA ExecueWv Vice President which carries penalties of up to$10,000. Roger,Schilling said,' "they should have According to DeRosa, drycleaners are It More than 6000 employers were cited for little effect on drycleaners who are han- becoming increasingly aware of the need not developing awritten hazard commu- , dling their waste properly. Perhaps this for proper waste water disposal. "With nication program. Nearly 5000 had failed ' new'commitment to enforcement will IFI's involvement now,"she said,"per- to provide employees with information I 1 help bring these people into compliance haps we will have solid information with and training on hazardous chemicals in i 1 and lead them to face the same econom- which to answer these quarries." their work area. Approximately 2500 -;', ics'of responsible environmental prac- had failed to label hazardous chemicals tices faced by the vast majority ofdryclean- Environmental Charges and maintain required Material Safety ers.'It may be that in Massachusetts the Data Sheets. f 1 � � time for a free lunch is over,"Schilling Hurts Major Firm (` concluded. A.more aggressive enforcement by OSHA, Camel City Cleaners and Launderers of 'J)upledwith theemergenceofemploy_ee ' IFI TO FOCUS Attention On Winston-Salem,N.C.may be one of the sa ety and health as a key workplace,is- first major businesses in the fabricare ue,a sre two compelling reasons for en- Wa to Water Disposal P _�___� industry to suffer from tightened envi- suring-tharyour plant is to compliance ronmentai enforcement. According to. wrtfsthis s andard. I NEF h s earne that th IFI Board Associated Press reports the firm laid off requested that IFI develop a comprehen- 70 of its 120 employees last month in a By fall,an estimated 500 drycleaners in ' : sive statement about how to dispose of major restructuring of the company. Last the northeast will have'attended the I,a drycleaning wastewater in a legal man- year, Camel City Cleaners had been NEFA/Safety-Kleen Right-to-Know '� ner.,-The concern for such a statement charged with illegally dumping hazard- seminars designed to cover in depth the ''; was first voiced by the NEFA Environ- ous waste. With legal fees topping new OSHA .recpuirements.,;Such,infot-_ �; mental Affairs Committee. Acting on $300,000 the company pleaded guilty to mation is more important'than ever in-, this c6n6ern,'the NEFA Board of D,irec-,.154 the reduced charges because they could light of OSHA's commitment to enforce- !' tors requested that IFI District I Direc- hb'longer-affor&to contest the case.. ment. i tor,-Paul Ceccarelli carry this request to the IFIBoard of Directors. NEFA Executive Vice President Roger I '.! , 1 Schilling warned that drycleaners regard- Bay State Assembles - During an Environmental Affairs Com- less of size,should pay close attention to Strike Force i mittee meeting last month,the problem environmental management techniques. Of was ed In the face of governmental budget cut- A 34 member Strike Force made up of FLh. It was determined that evapora- backs,environmental officials are becom- prosecutors,scientists,investigators,and tion either by boiling or use in a ing more enforcement minded than ever police officers have been assembled by tow on metho Some to showcase the examples of what can Massachusetts environmental officials to members mix their spotting c emicais occur if you are not in full compliance. enforce environmental laws. with this water while others dispose of it Page Number 6 North East Fabricare Association i 1 r MATERIAL SAFETY DATA SHEET FABRITEC INTERNATIONAL MSDS No.,: 334-A-0 200 Industrial Rd. Date: 2-04-88 Cold Spring, Ky. 41076 Page: 1 of 2 Emergency Contacts Harold E. Mains (606) 781-8200 1. PRODUCT NAME 6 HAZARD SUMMARY 6 7 3 4�L -, t. � Y CERCLA Ratings (0-3) NFPA Hazard Rating (0-4) health U Unknown Health U Unknown Fire 2 Moderate Fire 2 Moderate Reactivity 0 Minimal Reactivity 0 Minimal Persistence 1 Slight 2 HAZARDOUS COMPONENTS 8 TWA (OSHA) Petroleum Solvent (140 Flash) 75.0 500 ppm CAS 4 64742-88-7 Other non hazardous ingredients 25.0 --- Ingredients not identified are proprietary and non hazardous. All ingredients appear on the EPA TSCA inventory. . 3. PHYSICAL & CHEMICAL DATA Appearance: Water white mobile liquid Evaporation rate: (Butyl acetate = 1): 0.03 Odor: Petroleum, Oily Vapor density (Air = 1): approx. 5 Boiling Point: 370-450'F (188-232C) Solubility in water: Slight PH: Not Applicable Specific gravity (Water = 1): 0.81 %Volatile: 75% 4. FIRE EXPLOSION 6 REACTIVITY HAZARD DATA Flash point: greater than 140'F (60C) TCC Flammable limits: Not determined for product, limits for solvent (1 - 68 in air) OSHA Flammability Class III A Fire Fighting Me��}}ia (1984 Emergency Response Guide Book, DOT P 5800.3): Dry chemical, carbon dioxide, water spray or foam. For large fires use water spray, fog or alcohol foam. DOT Hazard Class Combustible Special fire-fighting procedures: Wear self contained breathing apparatus. Unusual fire and' explosion hazards: None Stability: Stable Incompatibility Strong oxidizers: Explosion hazard. Strong reducing agents: "explosion hazard. Decomposition roducts: Thermal decomposition may release toxic and/or hazardous gases. Polymerization Will not occur under normal conditions. Conditions to void: May be ignited by heat, sparks or flames. Vapors may travel to a source of ignition. Container may explode in heat of fire. Run off to sewer may create fire or explosion hazard. 5. HEALTH HAZARD DATA WARNING! MAY CAUSE EYE, SKIN AND RESPIRATORY IRRITATION. MAY BE HARMFUL IF SWALLOWED. Signs and s m toms of overexposure: Eyes: Liquid and vapors - may cause irritation with redness, tearing and blurred vision, repeated or p olonged contact may cause conjunct+vitas. Skin: Prolon ed contact may cause defatting of skin which can lead to irritation and/or dermal tis. Ingestion: M y cause gastrointestinal irritation, nausea, vomiting, diarrhea and central nervous system depression with dizziness, weakness, fatigue and headache. A piration into the lungs may result in chemical pneumonitis which may be fatal. I MSDS No: 334-A-O Page 2 of 2 / 5. HEALTH HAZARD DATA - CONTD. Emergency and First Aid Procedures Eyes: Wash eyes with water for at least 15 minutes, get medical attention. Skin: Remove any contaminated clothing, wash area with water or soap and water for at least 15 minutes, get medical attention. Inhalation: Remove to fresh air. If breathing has stopped, give artificial respiration. Get medical attention. Ingestion: Treat symptomatically, get medical attention immediately. If vomiting occurs, keep head lower than hips to prevent aspiration. 6. SPILL AND LEAK PROCEDURES Remove sources of ignition. Small spills: Absorb on rags and clean raga in cleaning unit. Large spills: Contain and transfer to container for use or disposal. waste disposal method: May be considered a hazardous waste, dispose of according to all applicable regulations. Incineration in permitted facilities or disposal in permitted land fill are preferred disposal methods. 7. SPECIAL PROTECTION Ventilation: Local exhaust system. Respirator: The following respirators are recommended and ranked in order from minimum to maximum protection. Type 'C' supplied-air respirator with full face piece. Self-contained breathing apparatus with a full face piece operated in pressure- demand mode. Eye Protection: Wear chemical tight goggles when handling product. S. TRANSPORTATION DATA DOT hazard classification 49 CPR172.101: Combustible liquid DOT labeling requirements 49 CRF172.101 and 172.402: None Abbreviations: TLV . Threshold Limit Value ACGIH a American Conference of Governmental Industrial Hygienic s CERCLA - Super fund act I NFPA s National FIre Protection Assoc. Mg/M3 W Milligrams per cubic meter of air I We cannot anticipate all conditions under which this information and our products, or the products of other manufacturers in combination with our products, may be `used. We accept no responsibility for results obtained by the application of this informatio6 or the safety and suitability of our products, either alone or in combination with other products. We sell the products without warranty, and buyers and users assume all responsibility and liability for loss or damage arising from the handling and use of our products, whether used alone or in combination with other products. i i o 'I IATERIAL SAFETY DATA SHEET Essentially equivalent May be used to comply with OSHA's � to OSHA 174 form Hazard Communication Standard IDENTITY, (As.Used on Label and list) I CO silo' CI-!!#� action I ,anufacturer's Name Emergency Telephone Number R. Street 8 Co., Inc. 1-800-228-5635 .ddress (Number, Street, City, State, and Zip Code) Telephone Number for Information ,25 Enterprise Drive 1-708-571-4242 Date Prepared ,ak/hook, Illinois 60521-1917 February, 1992 :;ection II -- Hazardous Ingredients/Identity Information lazardous Components OSHA PEL OSHA STEL ACGIN TLV ACGIN STEL CAS ft X Glycol other* Not Estb. Not Appl. Not Estb. Not Appl. 9002.92.0 c3 )they ingredients not found on the most recent MSL. This ingredient is listed in the table at 40 CFR 372.65 (SARA, Title'I11, Sec. 313) and exceeds the de minimis concentration defined at 40 CFR 372.38. ;ection III -- Physical/Chemical Characteristics Soiling Point Specific Gravity (H20 1) OF, Initial. 250 1.01 Vapor Pressure (mm Hg) Melting Point 2 200C, Estimated. 8 Not Applicable. .--- Vapor Density (AIR = 1) Evaporation Rate (Butyl Acetate = 1) 0.3 Estimated, Initial. 0.2 Solubility in Water pH Dispersible. 7 Appearance and Odor %Volatile (by Volume) Amber liquid; slight chemical odor. 9 Section IV -- Fire and Explosion Hazard Data Flash Point (Method Used) Flammable Limits LEL UEL None (PMCC). Not Applicable. ---- ---- Extinguishing Media Carbon dioxide, dry chemical, foam, water spray or fog. Special Fire Fighting Procedures Not Applicable. Unusual Fire and Explosion Hazards None. ✓�ttion V -• Reactivity Date STATICOL Stabil ty Unstable Conditions to Avoid Stable X Heat, sparks, open flame. i 'ncompatibility (Materials to Avoid) Strong alkalies, strong oxidizers. iazardous Decomposition or Byproducts Carbon dioxide, carbon monoxide, oxides of sufur, hydrogen sulfide, oxides of nitrogen. tazardous Eftyur Conditions to Avoid 'olymerizationot Occur X None. section VI -- Health Hazard Data 2oute(s) of Entry: Inhalation? Secondary. Skin? Primary. Ingestion? Unlikely. Health Hazards (Acute and Chronic) inhalation: Not likely to be a hazard at ordinary temperatures. Skin: Prolonged or repeated contact may cause dermatitis. Eyes: Liquid may cause slid temporary damage. Ingestion: Pneumonitis, pulmonary edema and central nervous system depression. Available date does not indicate adverse health effects from chronic overexposure. Carcinogenicity: NTP? No. IARC Monographs? No. OSHA Regulated? No. Signs and Symptoms of Exposure Inhalation: Headache, drowsiness, nausea, vomiting and fatigue. Skin: Irritation. Eyes: (Liquid)-Pain and irritation. Ingestion: Nausea, vomiting, creeps and diarrhea. Vomit may be aspirated into lungs, causing chemical pneumonia. Medical Conditions Generally Aggravated by Exposure No data available. Emergency and First Aid Procedures • Inhalation: Remove to fresh air. If breathing stops, give artificial respiration. Call a physician. Skin: Remove contaminated clothing. Wash with water. Eyes: Flush immediately with water for at least 15 minutes. Call a physician. Ingestion: Call a physician immediately. Do not induce vomiting unless instructed to do so by poison center or physician. Section VIi -- Precautions for Safe Handling and Use Steps to Be Taken in Case Material Is Released or Spilled Evacuate the area, ventilate and avoid breathing vapor. Contain spill. Wear protective equipment (Sec.Vlll). Clean up area by mopping or with absorbent material and place in closed containers for disposal. Avoid contamination of ground and surface waters. Do not flush to sewer. Waste Disposal Method Recovered liNids may be sent to a licensed reetaimer ncineration facilit onsult f ral, state and local disposal authorities for approved procedures Contains r material a azardous waste. Precautions to Be Taken in Handling a Store in labelled, tightly sealed containers in a cool, well ventilated area. Do not cut or weld full or empty drums. Other Precautions Do not spray. Do not wear contact lenses. Avoid breathing vapor and contact with skin and eyes. Section VIII -- Control Measures Respiratory Protection None required under ordinary conditions. Ventilation Local Exhaust Not applicable. Special Not Applicable. Mechanical Satisfactory. Other Open doors and/or windows. Protective Gloves Nitrite. Eye Protection Chemical goggles or face shield. Other Protective Clothing or Equipment Eye wash station. Work/Hygienic Practice Wash thoroughly after handling. Do not smoke in presence of vapor. Do not eat or drink in work area. After emerger actions: Call the emergency medical information number on the front of this she or a physician immediately. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: ��/ .4-14.,4 e '�"' Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: a-- /411fZf P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 �� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) �5 Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE C MPL.7ANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 3.Printers dy Shops unsatisfactory- 4.Manufacturers COMPANY l' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fue S. GG line,Jet F ) iesel, Kerosen #2 (B) /1/,a ���e'e'e' ice: � t✓� �_. - �� wast C) w motor oil (C) trans ission/h raulic Synthet' O ganics: degreas s r M' cellaneous: DISPOSAI✓RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply c91P L7 {J' D0 O Town Sewer 'Public '�4�(� `ti� �� ('3GQ03\__5QC1\ XOn-site OPrivate 3. Indoor Floor Drains YES NO,w O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination 1. �2. ers n s) Interviewed Ins ector ate