HomeMy WebLinkAbout0048 LOMBARD AVENUE - Haz Mat ����" _ /�
7
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EMCrosby Boatworks, Inc.
.................................................................................................................................
48 Lombard Ave#4, West Barnstable, MA
Is Hereby Granted a License
For: Storing or Handling 111 -499 gallons of Hazardous Materials.
Restrictions:
...................................................... .............................................................................................................
This license is granted in conformity with the Statutes and ordinances relating there to,
and expires 06/30/2021 unless sooner suspended or revoked.
JOHN NORMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2020 PAUL J.CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
1
Town of Barnstable
Inspectional Services tB�ARtNSTABLEBLE5 M1YaMPublic Health Division '"n��N `E
$ = Thomas McKean,Director w
i 39. `� 200 Main Street� Hyannis,MA 02601
t�7
P,r
Office: 508-862-4644 Fax: 508-790-6304
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r-
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS r
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 ilvs
CATEGORY 2 PERMIT 111 —499 Gallons: $125.001—Fj C,�`1�--
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. I 50 Tom';
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: OUt��- 1 ' l ��
5. NAME OF ESTABLISHMENT: J
t
6. ADDRESS OF ESTABLISHMENT:
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE2,;
�• �s
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS:
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME I'J
PRESIDENT GR94,- i
TREASURER or x �`
CLERK �► '�
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
• SIGNATURE OF APPLICA DATE
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave #4, West Barnstable, MA
Is Hereby Granted a License
For: Storing or Handling 111 -499 gallons of Hazardous Materials.
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2020 unless sooner suspended or revoked.
----- ---------------------------
PAUL J.CANNIFF,D.M.D,CHAIRMAN
P -
DONALD A.GUADAGNOLI, M.D.
I'p 07/01/2019 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
r
Town of Barnstable Ir
Inspectional Services BARNSTABLE
V`'THE� �MRNSTfl_E CE#:iE".\'1:1-CO'UR•riY;fik_
o Public Health Division
5175
BARNgrABLE, ' Thomas McKean, Director
°rfora`0� 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-JUNE 3 Oth).
APPLICATION FEES
p CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 PVT
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL?/YES_NO. IF YES, SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD,QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: Ou
5. NAME OF ESTABLISHMENT: 1 �.
6. ADDRESS OF ESTABLISHMENT: 4I9 LOM� Ave=w . W eS+ ra-5.4GL b e,
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: an�!� amct�rsbx,4apon
10. SOLEOWNER:/YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT '• jl`e
TREASURER
CLERK •` p "
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS
SIGNATURE OF APPIL T � DATE I IL9
Q:\Application Forms\Haz Mat App Revised 09-10-18.docx
1
sa
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
a
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave#4, West Barnstable, MA
Is Hereby Granted a License
For: Storing or Handling 111 -499 gallons of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2019 unless sooner suspended or revoked.
----------------------------------------
PAUL J.CANNIFF,D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2018 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
I - -
�towegiaatoryYervlcesof Bnslable
Richard V. Scali, Director
Public Health Division BARNSTABLE14
• BARNgrABLE, Thomas McKean anFt+saele•rtmEnnut•mruR•Nvaxxls
"" ° ^'�. . •� n, ',
MASS. A � Director
1639-2014 (`,Y
- - -- -- '°rEc ,,• -- - — 200 Nlain-St-reet,Hyannis NU 02601-- - - - -- - -- - -
-n
_
Office: 508-862-4644 1 Fax: 508-790-6304w h"r�
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 3 Oth).
APPLICATION FEES
CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00
CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 V S
CATEGORY 3 PERMIT 500 or more Gallons: $150.00
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: Edward M- VS / 4 :re.
5. NAME OF ESTABLISHMENT: , M., (.n2S{7/.l h()
tc�/'
�
6. ADDRESS OF ESTABLISHMENT: qS Lo _hn M aN01 veTUk-s4- /ri'1 S
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: Pao f�j-11k-h al's ��k
8. TELEPHONE NUMBER OF ESTABLISHMENT: 36 c9-? 100
9. EMAIL ADDRESS: karen ,n'lrrds b" f/,uackcC , UKn
10. SOLEOWNER:_LYES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME E.M p b w S
PRESIDENT p ► (e Q o��
TREASURER �� •
CLERK •i �� +
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS
SIGNATURE OF APPLICA WAITE"is
Q:\Application Forms\I-IAZMAT APP 2017 REVISED.docx
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave#4, West Barnstable,MA
Is Hereby Granted a License
For: Storing or Handling 111 -499 gallons of Hazardous Materials.
----------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------- ----------------------------------------------------------
Zt
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2018 unless sooner suspended or revoked.
•_ ----------------------------------------
Q
PAUL J.CANNIFF,D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2017 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
P D 4a-4-
"Row of B n �(C-
eg atory erviceslces
Richard V. Scali, Director
SINE
Public Health Division BARNSTABL ;
BnRN5r:.6lF. Ni[RVILLE.CONII•M"u.t:
BwMSTABLE, Thomas McKean,Director N .�R.�1 39a 2�4m3r ee:.Nsr et,
MAS I."
ec 5 s 200 Main Street,Hyannis,MA 02601 �Dg N
OG v/ Oc ofg
Office: 508-862-4644 Fax: 508-790-63:V�04
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 3 Oth).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. l$c.J Q LIX400
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: �Or w r- O-fus b(/,
5. NAME OF ESTABLISHMENT: R. I P l. bfA 9bua-7�L/wack .j—nL
6. ADDRESS OF ESTABLISHMENT:
7. MAILING ADDRESS DIFFERENT FROM ABOVE: ON-6 OQ
8. TELEPHONE NUMBER OF ESTABLISHMENT: t OLO
6
9. EMAIL ADDRESS: �J ,
—r
10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT Cr0 ✓ Q
TREASURER . H
CLERK .. ,., a
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL.-
SIGNATURE OF APPLICAN •10V 7
Q:\Application Forms\HAZMAT APP 2017 REVISED.docx
.k
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave #4, West Barnstable, MA
Is Hereby Granted a License
For: Storing or Handling 111 - 499 gallons of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
--- --- ---------------------------------------------------------------------- -------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
,g 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
BIKE►� Regulatory Services
Richard V. Scah, Director
MAS& Public Health Division �° BAMSTAB
1639. �0� wr�-oxsA°usW�uEm 'xnn
'QED ,Is Thomas McKean, Director e 163-20 4
200 Main Street, Hyannis,MA 02601 V
Office: 508-862-4644 Fax: 508-790-6i"4
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth).
APPLICATION FEES
CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ '
CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ;EJ V' u
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. 13�Q N 2hQoDATE
FULL NAME OF APPLICANT: 8d wo-`d-
NAME OF ESTABLISHMENT:
ADDRESS OF ESTABLISHMENT: oil, wegf "le-,
MAILING ADDRESS (IF DIFFERENT): 10�10,
TELEPHONE NUMBER OF ESTABLISHMENT: R Q- �2 l oD
EMAIL ADDRESS: �'a-►'`P�Z�dI CC.lZ3Sf�Du��r1iGS, C.Q
SOLE OWNER:_V/ YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME v
PRESIDENT �JG
TREASURER rl �
CLERK a
• IF PREPARED BY OUTSIDE PARTY:
�-' UP� C T Name:
Company Address
Telephone #:
Email:
Q:\Application Fonns\HAZZAPP Rev 16.cocx Page 1 of 2
sa
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave #4, West Barnstable, MA
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 6/30/2015 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
613012014 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
V Town of Barnstable
°FIME T°w� Regulatory Services .
Richard V. Scali, Director _
" '"M A. ` Public Health Division
i°lFo N►o�° Thomas McKean, Directoi
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO.(SSn�{ i� DATE �N
APPLICATION FOR PERMIT TO STORE ANVOR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT J
NAME OF ESTABLISHMENT gm oj�psb4 zw&br*�"
ADDRESS OF ESTABLISHMENT (,
TELEPHONE NUMBER �QO - b �-?1 OD
SOLE OWNER:--V—/YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION A1.5s acG wse#
FULL NAME AND HOM ADD SS O ,�-
PRESIDENTE 2dDMM- $hl -to a tt OS ✓l
TREASURER 41 it IO�
CLERK %4 IZ u
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS 3g LJ4
HOME TELEPHONE#
J:U-3AZAPP.D0C
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P £��€ ..�
rn
1-iiJGct,1
Ba s�W PdbU� ealth Divii�io.I 508=8-62=46
Tas e Dame:
Phone: !s s✓ _ -- E'�
�I I ng d a a g hazardbus matey aYwaste storage area, location
€� a s€�r n sca e er aieria s, e e S, fre alam. s.QfP esent"
ac :evactan rote of affl3cble l
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Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks,Inc.
48 Lombard Ave #4, West Barnstable,MA 02668
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 6/30/2012 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
6/30/2011 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
-7(ai�
Town of Barnstable
�1HE ray, Regulatory Services
ti
Thomas F. Geder,Director
$"M LE, Public Health Division
i639• ���
'OrF039 Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. ��5�6�7 9� DATE �Z/Z/
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NA OF ESTABLISHNT
ME ME ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER� DO. � 7 l
SOLE OWNER:aC YES NO
IF APPLICANT IS A PARTNERSHIP FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. -7 1
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF: /J Imo- ' , �,,
PRESIDENT UA-Ja(�[ K VITA(- i .J Q. �7 M�fC)(.17 ' I l O,S k%4
TREASURER ,
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE ^ -yam' "Q
Haz.doc/wp/q
i
CONTI GENCY PLAN
Emergency Coordinator, Name: ,ra.�
Address: LGe,.-41 ,yE Y
Daytime Phone: 8 34�2- 71 ez,
{ Evening Phone: 51 Y 197 - 7 s 7
i
Fire Department: Ille d -- J S<< Sze' ���Z—32 y 1
Barnstable Public Health Division: 508-862-4644
DEP 24 Hour Spill Hot Line: 88 -304-1133
I Waste Hauler: Name: ;S�1-e
I
Phone: Ovev
Building diagram indicating hazardous material/waste storage area, location
of absorbent scavenger materials, fie extinguishers; fire alarms (if present),
and evacuation route (if applicable)
V70v::>
6® v,4t ,
PIS'
i
i
r
Actions to be taken to control a spill or release and preventing it from
reaching a catch basin, sewer system or the ground.
1
leAe
Y'nraceess
I
1
Number Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave#4, West Barnstable,MA 02668
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
----------------------------------------------------------------------- ----------------------------------------------------------------------------------------
---------------------------------------------------------------------------- ------------------------------------------------------------------ -
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 6/30/2010 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAU.L J.CANNIFF,D.M.D.
12/15/2009 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
ri
. • .a - •
oy ro Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARMA�BLE.g` 200 Main Street• Hyannis, MA 02601
Leo +' TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: M• (fr.S Date:
Location/Mailing Address D $o
Contact Name/Phone: Akel -a i o ,c - ,r
Inventory Total Amount: -~��A.1 MSDS: BS r w6V S License#: g �cZ
Tier II : 1�o Labeling: 'JE fah•\ bl-Y,���5�,,9 Spill Plan: e-S
Oil/WaterSeparator: t3 Floor Drains: IJv Emergency Numbers: HAS
Storage Areas/Tanks: g- kw--- • 5` &1 0w V~,A.. ke S' 1 a sol µc.
Emergency/Containment Eguioment:.EL"4-am-4,5 - �L6 4A,1 DgiA, 4e441.w ", 'A 4o, 59 �c.rQsm,ti �•k�F«'
Waste Generator ID: (o$ 00 Waste Product: 26;, o+ �� awk,C<ee--JR-,
Date&Amount of Last Shipment/Frequency: C1 `� I 5 S 1 b tit scrk e w r ��k� r
Licensed Waste Hauler&Destination: �`e � <�a..-,& ` VI, -N•� 2n� � ��v��
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
S Antifreeze 7 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 r5
Motor oils %U kg-ow4,sL-c+,� wash Miscellaneous Corrosives,<bl `mow`
Gasoline,jet fuel, aviation gas ��°`S Cesspool cleaners
Die effuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines &garages 10 Pesticides:
Caulk/Grout 4%1\u1, S insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries J� Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes �!� Wood preservatives(creosote)
Asphalt&roofing tar L-10t2o���ti Swimming pool chlorine
Paints, varnishes, stains, dyes roc {7 Lye or caustic soda
Lacquer thinners w-r � at�"- Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flamma.bles S 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: S 4o< a-IV DVAkmact,5
r •► S o S 'r a 1 , �"-e- 4
!S. �g �,��°���Cc�A�.�dQc>�S WCc�i#nspector — 1 . k—CcUL �Q,
Ra ak QaE�ws�cJo\�Ta�ts � `tA-*,ok
D 15 g�9,1 Facility Representative:
V-2p 1'71
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE BAR-W 5141
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name am/pm, on 20_
Business Address
Signature of Enforcing Officer
Village/State/Zip
Location of Offense
Enforcing Dept/Division
Offense
Facts
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
_ * TOWN OF BARNSTABLE BAR-W 5141
Ordinance or' Regulation
WARNING .NOTICE
Name of `Offender/Manager`,
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name , am/pm, on 20_
Business Address
Signature of Enforcing Officer
Village/State/Zip
Location of Offense
Enforcing Dept/Division
Offense
Facts
`F-This will serve only as a warning. At. this time no legal action has been taken.
It is the goal of Town agencies to' achieve voluntary compliance of Town
` Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
TOWN OF BARNSTABLE BAR-W 5141
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name am/pm, on 20_
Business Address
Signature of Enforcing Officer
Village/State/Zip
Location of Offense
Enforcing Dept/Division
Offense
Facts
- a
-'This will serve only as a warning. At this time no legal action has been taken.
,,,,It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
TOWN OF BARNSTABLE BAR-W 5141
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name am/pm, on 20_
Business Address
Signature of Enforcing Officer
Village/State/Zip
Location of Offense
Enforcing Dept/Division
Offense
Facts
k
' This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
°p ISE r°k� Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARMASS. ` 200 Main Street• Hyannis, MA 02601
�ArEDMP� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: G•M- C,ro 6104 lDo u+W cleS Date: t I r8 rS�
Location/Mailing Address: -/t a 2 D o r l
Contact Name/Phone: Nt (-(-05bjD - b - t`o/a aflEep
Inventory Total mount: ^� �0 43 MSDS: 7CS ' kv-b"" In License#: re-
Storage Tier II : Labelin 5`fe—dk1Cv�S Spill Plan:Oil/WaterSeparator: �1 Floor Drains: Emergency Numbers:Areas/Tanks: <J e! e- — m`l I aVA%R< ,i 1 i �aot�tsl�o far
-iy
1 w n+tic�
Emergency/Containment Eq ipmen't: l tt,Q2 t7N, 5���-•r �a,lablp�
Waste Generator ID:My4'o83b8']t D Waste Product:' V1kw.r/P4t-t+i P4V+i tkd&UkV os�ot 1
Date&Amount of Last Shipment/Frequency: it J' a1Ve► SS -d 4s 2X/y
Licensed Waste Hauler&Destination: sa�e ♦I��^-- �avt�s�a�
Other Waste Disposal Methods: GQ,ey loy lo,,w-Fy as
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.
y? Antifreeze 10 Dry cleaning fluids
Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (in luding brake fluid) Windshield wash s
tap Motor oils 5,k f l Miscellaneous Corrosives 1 o H,111 1�-I��'<
50465 Gasoline,jet fuel, aviation gas 1V- �3o nl Cesspool cleaners ble"-\B-
Diesel fuel, kerosene, 42 heating oil Disinfectants
Miscellaneous petroleum products: '�S y Road salts
grease, lubricants, gear oil Refrigerants
\� Degreasers for engine.&garages��4xh6r,,,J Pesticides:
Caulk/Grout /cl� insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries 15 Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents ? b.A+,9 Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar ,�,a\A-C'7 Swimming pool chlorine
\oo Paints, varnishes, stains, dyes� goo�w�\0 Lye or caustic soda
4o Lacquer thinners op Miscellaneous Combustible Seecosols
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:
INFORMATIONJ RECOMMENDATIONS: aA 40 14)5z! Q C,�v�t5 — i,7 �^- `'-tp�
'^�7 Inspector`
/ Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS
� ��
\ Number
Fee
1018 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that EM Crosby Boatworks, Inc.
48 Lombard Ave #4, West Barnstable, MA
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2016 unless sooner suspended or revoked.
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
07/01/2015 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
X
�1
Town of Barnstable
Regulatory Services
• Richard V. Scali,Director
' g"M'
9$ MASS& Public Health Division
1639. �
a Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.0.0
ASSESSORS MAP AND PARCEL NO.&5C-JqA n0 DATE (e
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT ?) �
TELEPHONE NUMBER t5 y 2 ` -360
SOLE OWNER&YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.(2q 58Q l ?
STATE OF INCORPORATION & ' "��
FULL NAME AND HOME ADDRESS OF:
PRESIDENT, ��, . �.(�Q�L�L�c.�t
TREASURER ��
CLERK ,
.Af
SIGNATURE OF APPL T
RESTRICTIONS: HOME ADDRESS Q,v'e, Q,Stv�
HOME TELEPHONE# :7q- q5?7- 75 In
C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP ReQOI5.DOC
•WKWE ro Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
+ RnRMASS .
- � 200 Main Street• Hyannis, MA 02601
Eb pt `0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: E, CO6� 900 WD&S Date:
Location/Mailing Address: +9 Lo,,- 4�4 Ave , C, �v(5`j 1e— FD B>x SS I
Contact Name/Phone: NC&Q Ctosbv SOS-(A 7/oD
Inventory Total Amount: MSDS: L5 License#: e-)e�
Tier II : Labelina: J Spill Plan: V -2
Oil/WaterSeparator: tJ A Floor Drains: 00 Emergency Numbers: A-fz _
Storage Areas/Tanks: I rV -5 s See.
Emergency/Containment Equipment:
Waste Generator ID: MV-50213�,21fi n n Waste Product:
Date&Amount of Last Shipment/Frequency: o %
Licensed Waste Hauler&Destination: a..,
Other Waste Disposal Methods: A-. ,e11_
LIST OF TOXIC AND HAZARDOUS MATERIALS IV p 1M/n o� G`n tA f� <. S I�1G2 1�
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws o MA, hazardous material use, th 4 � ova
storage and disposal of 111 gallons or more requires a license from the Public Health Division. 31 3 y
✓ 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
Gas ,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 V Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
J Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS: A
ORDERS: Q- � �.A�ar�.rs ,N.a��c•a s ae cw..-� u� e a\
FORMATION/RECOMMENDATIONS: o i
Inspector:
�Q Q Q;J�� QLC��Mv I�,-C t o►ti t�v`- I a a
Of Cv(`�L�av1� Qalv�- ��t p`j Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Date: 3/
TOWN OF BARNSTA►BLE ,,r, ,,V%,
TOXIC AND HAZARDOUS MATERIALS FORM
NAME OF BUSINESS: �•M• <o b �oa,�'tJo�1Gs
BUSINESS LOCATION: `/S Lowt,j2arX,4yc , L)gsf &rrtsf"/e INVENTORY
MAILING ADDRESS: -POjsok -!5-St TOTAL AMOUNT:
TELEPHONE NUMBER: 5'0$-3(62- 7100 "J ;�yy w ow5
CONTACT PERSON: A a� (�z-SSA/ � s-vnlc`�
EMERGENCY CONTACT TELEPHO E NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: 6oct+ /KaiK e-yuanGe— wJ ►r' Ye---c,
INFORMATION / RECOMMENDATIONS: ' AUke- 5'ure,a ll eo Q,►tiers/c1r�,rts Fire District-
e a Ca__�abr�t.Q orcec_-V1y2)fr*P.rly AsOx c4 a.ny ,3"4,0- — Otsf kgryl� 101e.
-J) Ve r ►g 6'M it�r
�rJ � MQ.sS,d�Pa H� r�a��.T�/ 9�lee.rt..y/��-�✓re a� sorbe,.�s ote a.✓a.,�461e,�+'�4re�ts o�
as i I,-I' �1,wra. hA,�rwt.J- t S s o .�, d< •� .
Waste T .Gre kD#N1 JSa8368_�i oo Last shipment of hazardous waste: i I9 i
Name of Hauler: :a,Ct+g W ee.Yv Destination: Crr.n.s+on.,
Waste Product: WG,Sfe eo". Licensed?& No _P1j6CBq6o2�:?YZ-
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
3 Antifreeze (for gasoline or coolant systems) 2 Miscellaneous Corrosive Q
MnJr,4-t,t 0-41e
CINEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts(Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
g 0"NEWi*s Lit/USED 5rj-1 (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 l/p Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
ID Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
52r Lacquer thinners/ (including carbon tetrachloride)
❑ NEW O USED ss9``t Any other products with "poison" labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes ''II
Laundry soil &stain removers
i1 (including bleb) t-) V'k .4ACAP�'6 vim,
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers ur ,.�K, coy.{-.�,n s , �.y►,��,�, � -�o �,
Windshield wash p
l'S
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials