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Home My WebLink About0210 NORTH STREET - Health n73 ro � 305'_ �-- oo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. .� 200 Main Street• Hyannis, MA 02601 1639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT lED MAC Business Name: -1 %v2 ItISICI Date: 2I2yf�� Location/Mailing Address: rW Contact Name/Phone: en - 4ql - 4136 Inventory Total Amount: 7 a3 MSDS: License#: 1a�� Tier II : A0 Labeling: 9 Spill Plan: L4 S Oil/WaterSeparator: PJA Floor Drains: 4NQ Emergency Numbers: p Storage Areas/Tanks: j &' Emergency/Containment Equipment: Waste Generator ID: IJ Waste Product: Nl�EQaeAmount of Last Shipment/FrequeDo: d Waste Hauler&Destination: aste Dis osal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS:100 00 A&5()S ORDERS: MDJ f2 S PNI A14 1,kM)S INFORMATION/RECOMMENDATIONS: ,1i i S I LSUM IQ- CAA k \i� 4 V �JI V I- Inspector: / Facility Representative:`— n WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS � r °p IKE roy, ; Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 T BARMARS . . $` 200 Main Street• Hyannis, MA 02601 �prEOMP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ! ` j it S-e V6,V-1 — s I&v&,1n Date: —.1) 9 -46 Location/Mailing Address: S ' B Contact Name/Phone: W) y Claimq C1 r, - 15; k ; d ' 71 - I 1 Inventory Total Amount: SIDS: YeS In S 6tJL��' � License#: JV6 L=Y A Tier II : P4 a Labelinct: QC'fa: Spill Plan: b �L3 T' Oil/WaterSeparator: Aq a Floor Drains: N Emergency Numbers: Al 6 eS C'4� Storage Areas/Tanks: Emergency/Containment Equipment: A/0) G` 19% ► ,4--.c- lge,)t,i ) Waste Generator ID: Waste Product: Owe, Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: iY e)I 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 9�5 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/4, , Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants 4,as-4 Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants i� 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 L,-' Miscellaneous FlammablesS*t,, � Put 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,,� �1��5 ✓�. fo (6 hydrochloric acid, other k2n � V I TION )-rc S ) V C 4 r bay )- - o%a- N ERS: -�ak ^�J 1` d� quAl� (,Li erg �t '^1 - -,;I U 6 G, -ro y.e w INFORMATION R COMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °PIKE i° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 9RnRMASSBLE.g` 200 Main Street• Hyannis, MA 02601 1639. �ArFOMP�p`e TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: -7- 11 < S1 b 1 Date: Location/Mailing Address: 2-to IJ0V1 - Sk 4 X AAA-A I Contact Name/Phone: S-vB- -t-7 1- L.*1$S Inventory Total Amount: ^�' 3 4,1 SDS: b �`/ License#: � II nn Tier II : fJ o Labelina: C� Spill Plan: AO o`s�t Oil/WaterSeparator: Floor Drains: ,%,V- Emergency Numbers: Storage Areas/Tanks: Mc. Gkjwv \ Sv V-LJta"x 5}o(Z�4— Emer enc /Containment Eau i ment:,' Waste Generator ID: A Was e Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash y— Motor oils Miscellaneous CorrosivesA-�%\tAC5 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 q(kyg �,tAvk<5 Fertilizers Floor&furniture strippers l js PCB's Metal polishes oe� y Other chlorinated hydrocarbons — Laundry soil &stain removersk 5�1�� (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ��C�oJs c� -t�a�S c.�.1Sc_ 15 -ex0�let11 5pM e kV'- ORDERS: , -ea A w \ —� n,ii - + ,A os 5 O I INFOR TION/RE OMMENDATIONS: O Ate. c S•Q. �il A n . Inspecto \0— Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FIHE►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE,� 200 Main Street• Hyannis, MA 02601 t6'39. O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 7-11 Date: N4f 16 Location/Mailing Address: �Z10 14yP-v-&os Contact Name/Phone: 7-71- (b I inventory Total mount: 32�f a� MSDS: o�` 1�%v-? License#: �� ) � Tier II : D I Labeling: k 0e'k%'. 141?1`55pill Plan: off+ -4►�- Yes a•l Oil/WaterSeparator: A Floor Drains: o Emergency Numbers:_ Storage Areas/Tanks: w+l P&CAC4 1 LJ - v.c, &. Emergency/Containment E ui me t: v< �ll5 a k,r• ,�-.0 Waste Generator ID: N I A Waste Produc : Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. y Antifreeze ?-- Dry cleaning fluids I Automatic transmission fluid 1 9 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) cl Windshield wash 6+,3 Motor oils < % Miscellaneous Corrosives I Gasoline,jet fuel, aviation gas Cesspool cleaners �tf4►�b 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 1 Miscellaneous Flammables I Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers I (including carbon tetrachloride) (including bleach) lk1 Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: c' zs V . c<«- ��2�n�- 1 S C-k- V e t O A ,vL -7 .S o-�r INFO ATION/RECOMMENDATIONS: O S 04—rR Inspector: — 1 + ��-- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS — -- - TOWN OF BARNSTABLE BAR-W Ordinance or Regulation / WARNING NOTICE Name of Offender/Manager n 'h t- ` %�^ E �' 4 Address of Offender MV/MB Reg.# Village/State/Zip Business Name am/pm, on 20_ Business Address z,tn' N -jjl-X" ' 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 DEPI TOWN OF BARNSTABLE BAR-W ' Ordinance or Regulation WARNING NOTICE Name of Of f ender/Manager F, _r Address of Offender /MV/MB Reg.# Village/State/Zip Business Name �" 4 1 '} z � s ' am/,pm, on ` Y 20 r Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense Facts v` e %.� 1 : �/L � �y' �i �r i ✓�rG s s .r n �� , This will serve only' asf a warning. At this timeno 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. Number Fee 1262 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that 7-Eleven Store#25161 210 North Street, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 01/29/2020 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health to t , Town of Barnstable Inspectional Services �f(o _ oFt HKEr BASTABLE film ,'Public Health Division � „.13TAR:F•CEA'-R/ii.lf.'IXl.w:l.li:APortl, O iSMYS r;:lS•OS':k'vl.F•iMEST P.i.?IS^fiL' ��fffJJJ••///..Y��^(((�[[[�///��.CCC��_� 16'S-2GIJ aa- .MAS. Thomas McKean, Director 1639. 200 Main Street, Hyannis,MA 02601 No Office: 508-862-4644 Fax: 508-790-6304 z 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(R S JULY 1 st—JUNE 30th). APPLICATION FEES 1 I CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 X to 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 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 ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ��J/7�/D �. ^A Aj 5. NAME OF ESTABLISHMENT: z — ,�LeVe" 6. ADDRESS OF ESTABLISHMENT: .2/0 ,9,( cd /. "X/ul 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: c� e 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 2—ZeV SAet O�tmRI 06M 10. SOLEOWNER: `" YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF- CORPORATION CORPORATION NAME sogX � SO . _TAjC. PRESIDENT 5W,9/J/,b R A-'AIAAJ TREASURER CLERK _ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • *SIGNATURE OF APPLICANT DATE Q:\Application Forrns\Haz Ma(App Revised 09-10 18.docx Number Fee 1262 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that 7-Eleven Store #25161 210 North Street, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ --------------------------------------------------------------------- --------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ------------------------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. a� 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health E4 I 0d, Vwofor� Unstable / � -- ��3��f 30 egu atory ervices oFt Richard V. Scali, Director , o Public Health Division BARNSTABLE tw.WNS sv-asiie`va-CMV —W.NM B STAB , * Thomas McKean, Director 1639-2014 y MASS. �. 39,E A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 '�L. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGO RMIT 500 or more Gallons: $150.00 ❑ *A late char a 10.00 w' 1 be assessed if payment is not received b Jul 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: II)OIAMM w) v-��/�AY in 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: -�?/D A)DJ'I �'/ 11Y4MZ9 IZ)R 0.2601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: cSLL,1 9'1P_ 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5a 8 2 2 9. EMAIL ADDRESS: /r- 10. SOLEOWNER: YES ONO IF NO,NAME OF PARTNER: 7- l aL L'Vr>U 1 BLOC 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: r SIGNATURE OF APPLICANT \j DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.doc� : . Number Fee 1262 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that 7-Eleven Store#25161 210 North Street, Hyannis, MA �— Is Hereby Granted a License S For: Storing or Handling 26 - 110 gallons of Hazardous Materials. �-- ------------------------- -------------------------------------------------------------------------------- ----------------------------- ---------------------------------------------------------------------------------------------------------- -- ------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- —PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Tow of Unstable n (gyp1-Regulatoervices 6 Z2 `1 o Richard V. Scah, Director t°F r BARNSTABLE Public Health Division + i BPRHSfAB1E•CcHIE0.VILLE•COIUR•MYY.NIS WIRSTIXS HLLLS•f639-20•WEST BpgBiTRWE • an MASSsr E• = Thomas McKean, Director 1639-2014 MASS. 'IEDMP.�p,0� 200 Main Street, Hyannis,MA 02601 575 Office: 508-862-4644 o?v/7' " 4-)09 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES �L, 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. 2. IS THIS A PERMIT RENEWAL? /YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: . i>�-/�I/�I� � i 5. NAME OF ESTABLISHMENT: ,) V)EA 6. ADDRESS OF ESTABLISHMENT: /VoY c�' • , G1 29 M* D260 f 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: " 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 PRESIDENT TREASURER CLERK r 12. IF PREPARED BY OUTSIDE PARTY: ,y NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\I-IAZMAT APP 2017 REVISED.dol � y Number Fee 1262 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable .Board of Health 9 This is to Certify that 7-Eleven Store#25161 C.N 210 North Street, Hyannis, MA Vs, Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ----------------- --------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and 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 a t►+E g rlatoy Services Richard V. Scali, Director BARNMMIA Health Division BARNSTABLE 1639 �� oaama a ao Thomas McKean,Director 1639-201 4 200 Main Street,Hyannis,MA 02601 _ Office: 508-862-4644 Fax: 508-790-6304 ~ �9 vt ;CO APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES P� CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 'rL CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ SA late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: //70h'y;; i? } 9AWAMO NAME OF ESTABLISIIMENT: f��EVEN ?516 1 ( /0 ADDRESS OF ESTABLISHMENT: 1/U 1\90121/1 (S77�'8e, . !� �I/V�U/� h2l MAILING ADDRESS (IF DIFFERENT): r J TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNAT RE OF APLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP R docx Page 1 of 2 t ru . CO ru s Q' ,I AL USE ED Postage $ ru Certified Certified Fee 0 Postmark p Return Receipt Fee Here i= (Endorsement Required) Rest O Zed Delivery Fee (Endorsement Required) r-I p Total Postage&Fees s ru .Vr' Sent To V -. v rl ------------ ------------ r- Street,Apt No.; 707 f � or PO Pei l Box;No. - -- City,State,Z/P+4 9AA-ft'd �� w , D Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece e A record of delivery kept by the Postal Service for two years f Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. w o For an additional fee; delivery may be restricted to the addressee or ` addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,pplease present the arti- Ole at,the post office:for postmarking.•.,lf a-postmark on:the.Certified Mail `receipt is not needed,detach and affix label with postage and-mail. IMPORTANT:Save this receipt and'Weseot it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN:7530-02,000-9047, TOWN OF BARNSTABLE BAR-W 5140 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager /V Vh 01 Address of Offender MV/MB Reg.# Village/State/Zip _ Business Name -7 ram)l p m, o n 'iZ2 2 04�, Business Address ;;,7 (2 A)0 r 4-L Signature oflEnforcing Officer Village/State/Zip dy i ,A ✓1 ; 7- e,01 Location of Offense -7- Vt. 14k Enforcing Dept/Dision Offense z* 4e,( 4 iv 6/1 5 Facts A\A-Ie1odo�a LA J4 11"(4,e, Pf /1, e_ This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agenc Iies 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 Ordinance or Regulation WARNING NOTICE s �1 Name of Offender/Manager = ' .K r ' Address of Offender MV/MB Reg.# Village/State/Zip Business Name '" j �- ' am/pm, on r `' 20 Business Address ; ' � r ° �, _y .' Signature of Enforcing Officer Village/State/Zip ' o t' Location of Offense / Er=forcing Dept/Division OffenseIr* i+ "i�; �' ' ' "{ 'y f v C t( w1 ,r !a i•,d �n+1 y r Facts 1t t 4' � . � ,.♦.�,,,f.A tY1 e �^ `�a ! � . �. •+' ' yY t mat �, /� �• " � j!}o�, t' r':� t.-- 4This 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.