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0155 OLD YARMOUTH ROAD - Health (2)
�s� oEA ya ,m�.�k 2� Yn� IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 RnRMSTRLE.� 200 Main Street• Hyannis, MA 02601 �" t639 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT RFD PS Business Name: 1l Date: Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: �1 MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: II Flood: Qf C) Emergency Numbers: Storage Areas/ranks: etM Fa Me, C bt Emergency/Containment Equipment: 5pee�q( N Waste Generator ID: 13Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: POther 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 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 wimming 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: e 0.d �V7f i ,, Inspector Facility Representative• ' WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Y _ p`pfIKE TOK� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 Y BARMAN LE.$ 200 Main Street• Hyannis, MA 02601 i639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rf0 MPS Q �y Business Name: Ao capL w e Date: OI 17 Location/Mailing Address: — I Contact Name/Phone: �D$'7 I -3,117 Inventory Total Amount: <2�5 SDS: e5 License#: � Tier II : wo Labelina: Spill Plan: Oil/WaterSeparator: N Floor Drams:s: Emergency Numbers: Storage Areas/Tanks: S r Emergency/Containment Equipment: DDi flmi H Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: lv 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 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 V Miscellaneous Combustible3-0 Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 0 Inspector: Facility Representative:resentative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °PINE rohti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 Y BARBLE. MASSg! 200 Main Street• Hyannis, MA 02601 .639.e�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MAy / Business Name: i ( ,q 2i Date: 4 t y t 7 Location/Mailing Address: t IR V1tV111 Contact Name/Phone: ax a i+�- Inventory Total Amount: ^' l�� SDS: OAAIV-1—OLLcZS 5 License#: �2. Ti 1 er II : - l Labeling: b Spill Plan: Ye-,, Oil/WaterSeparator: lk Floor Drains: No Emergency Numbers: e5 Storage Areas/Tanks: A as 4AANV5 le-11 1I0�S o-r- OJT Emergency/Containment ui ment: r ow 9 Waste Generator ID: MIA Waste Product: Date&Amount of Last Shipment/Frequency: C�iJ rJ" Licensed Waste Hauler&Destination: 011V-)67L- Other Waste Disposal Methods: --11 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: ORDERS: INFORMATION/RECOMMENDATIOpN 01 Q JVW S Q W Vk fJ� 5 _ Inspector• 4-0-- Facility Representative WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FIKE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 sn"MAC`��,; 200 Main Street• Hyannis, MA 02601 s659. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT QED MPS a �,/ Business Name: j) CA WZ)A Date: /�Zg6 Location/Mailing Address: I Ol �< o 15 Contact Name/Phone: reo I a v+A 6-4 VV, v% SoA -7-7 1-12 t t 7 0 - �qoo 14 Inventory Total Amount: �� MSDS: �� License# > Tier ll : Labelina: OK Spill Plan: +o Ate_ Oil/Water Separator: Floor Drains: N o Emergency Numbers: Storage Areas/Tanks: wk c. �w �K cc�, c -Q� a Jokes Emer enc /Containme t E ui ment: �<y- 6J�ea�Liv� ovL 5 2 Waste Generator ID: Waste Produc : Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destinati m Other Waste Disposal Methods: o -C Cv-lt rK-�"n,tin-, 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: 1 Caulk/Grout I 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 -�5 Paints, varnishes, stains, dyes 3� Lye or caustic soda 11.0 Lacquer thinners/-(tJ-jLt-cs/ I ��s Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes �i Miscellaneous Flammables ti 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: ar I Gu< �G2 S ��c 5 vvt a f tag �, s a Zdvl.Q,t;epC-J 4�owL'�'� ��5 0Vl Inspector: ` Cl 1 Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS SPILL CONTINGENCY PLAN Emergency Coordinator, Name: �" V Address: W 6V ' ' % Daytime Phone: 50,,% 9D I —Z • Evening Phone w Fire Department: Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 . Waste Cleanup: Name: I S T� Phone: Building g g uildin diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). O K'� r I c'e '_ c p�y M 'i IPA XrlAVIS b e R 107, Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. Is cor�Th.c-T W�Z���S rh �Te�� k� 'Vo Date: / Z- l 13 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS )) MATERIALS REGISTRATION FORM NAME OF BUSINESS: d1I 6,4 .e- "vl BUSINESS LOCATION: /SS ba Y-A-rVX0L)fL 5 INVENTORY MAILING ADDRESS: cf4y,, — TOTAL AMOUNT: TELEPHONE NUMBER: 3S03 _ 77/ -%2 117 (521,1 CONTACT PERSON: f�o l A V%&Q rrAVdI v`- EMERGENCY CONTACT TELEPHONE NUMBER: Sob- 400-Y 60,5- MS S ON SITE? TYPE OF BUSINESS: Ue lei I O(K)'s� �o INFORMATION / RECOMMENDATIONS: �/I vI54-,bfal rc, ,MS. 6 ,3 e-iS Fire District:=+L' �ia�.y'oQoys ,M�,��',�)s ✓�o tom ��,oQ ,v` o�-�.r �o C'e.��c� Waste Transportation: 6A Last shipment of hazardous waste: Name of Hauler: 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) 20 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 y Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 1,3 Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) 3 Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes No a'o,�G�a � G �r►a�-1 Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) ,K V•Lv6ly ,�� A �►/ Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials a YOU WISH TO OPEN A BUSINESS? ` For Your Information: Business certificates [cost$30.00 for 4.years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-'it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Jr" GI Fill in please: APPLICANT'S YOUR NAME/S: C x £O BUSINESS YOUR HOME ATRESS• 014 l `3TX�77a�1/f1Vt� ' TELEPHONE # Home Telephone Number n;? —4rY) —4690S� v "4• A• =ME OF CORPORATION: F 1 D ors SS. a p..�rvD 361 NAME OF NEW BUSINESS i9'LC C` L�L6�-� TYPE OF BUSINESS IS THIS:A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS �S f1G Y MAP/PARCEL NUMBER / [Assessing) When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street] to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM R'S OFFI This individual �a$ n infcn f y rm' requirements that pertain to this type of business. A1lutr gnatur COMMENT 2. BOARD OF HEALTH MUST COMPLY WITH ALL This individual has been je# rr}{�,cJ,of the permit requirements that pertain to this type of business. .A7ARDOUS MATERIALS REGULATIONS Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LI NSIN AUTHORITY) This individual has bet infor d e licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Hazardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists 1. ✓ W rking Phone Number ✓'Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? If none, note that. isposal Information -where and who? If none, note that. >� pplicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. R _ Date:6 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: S 1�17 INVENTORY MAILING ADDRESS: 64114E7 4S 7F60L&- TOTAL AMOUNT: TELEPHONE NUMBER: 5D?-7-21-Z//7 CONTACT PERSON: &ff'/ D �UIN EMERGENCY CONTACT TELEPHONE NUMBER: �00¢OtQ— &Q MSDS ON SITE? TYPE OF BUSINESS: Gt/ 71/y6- y-P-S INFORMATION/RECOMMENDATIONS: Fire District: r Waste Transportation: Last shipment of hazardous waste: Name of Hauler: 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 L Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive f� NEW ❑ USED Cesspool cleaners Qt— Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) 2 L_ Hydraulic fluid (including brake fluid) Refrigerants j 6S otor Oils Pesticides NEW 4USED (insecticides, herbicides, rodenticides) .�,•G Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) i ( Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Photochemicals (Developer) Iscellaneous petroleum products: grease, 606qubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal C�II Printing ink Degreasers for driveways &garages Wood preservatives (creosote) `r �aulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda 4 Rustproofers Miscellaneous Combustible T Car wash detergents Leather dyes T Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's flL Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 2 �� Lacquer thinners (including carbon tetrachloride) C¢] NEW ❑ USED Any other products with"poison" labels _ (including chloroform, formaldehyde, Pairif&varnish removers,,deglossers hydrochloric acid, other acids) Miscellaneous. Flammablesk Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): .. Metal polishes Laundry soil &stain removers (including bleach) s� Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers J Windshield wash WHITE COPY-HEALTH DEPARTMENT./CANARY COPY-BUSINESS Ap cant's Signa re Staff's Initials r TANKS ON SITE 5/6/11 I (8) ARGON 337 CU FT (9)ARGON/CO2 337 CU FT (3) ARGON 150 CU FT (8)ARGON/CO2 150 CU FT (3) NITROGEN 337 CU FT (3) HELIUM 337 CU FT (4) CO2 50 CU FT (12)OXYGEN 337 CU FT (3)ACETELENE 350 CU FT (6)ACELELENE 139 CU FT V / q - `°Ft �ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7 BARMASS. .g! 200 Main Street• Hyannis, MA 02601 �A'FOMP�& TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 11� Business Name: e, Q./ U Date: Location/Mailing Address: 1SSD6 Contact Name/Phone: &D--6-/71141,11 Inventory Total Amount: <,Ib MSDS: uf, License#: 11 Tier II : Labelin Spill Plan: e Oil/Water Separator: MA. 'D FI or Dr ins: Emergency Numbers: Storage Areas/Tanks: dl UJI P Emer enc /Containment Equipment: f VCU Waste Generator ID: J Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: I 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. 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: Lai ` Inspector: r Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that All Cape Welding .------------------------------------------------------------------------------------------------------------------------------- 1 SS Old Yarmouth Road, Hyannis, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------- ----- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 T Town of Barnstable of Inspectional Services BARNSTABLE Public Health Division MR4.TRBE 4T639- M1Y"KN'S 1639}-72014014 r amwerABLE, = Thomas McKean,Director HAM s659. 200 Main Street, Hyannis,MA 02601 6 a !.) - t~ 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 _ ___-CA-TEGORY._2-PERMIT -_11.1_�--499-Gallons: _ $125 OJ - - n CATEGORY 3 PERMIT 500 or more Gallons: $130.00 *A late charge of$10.00 will be assessed if payme�,ntt i`s,not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. ���➢ IrI J'f I 2. IS THIS A PERMIT RENEWAL? v1 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: PW\ i � [9.1�i� 'f ►2.S �• +� f� ll�l t< < J 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: tn5 0`6 2 4maAL& 2 1 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: _I f\ �6(� -UV CA d,ADJ Cam. 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK • 12.'IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: SIGNATURE OF APPLICAN DATE W �© Q:Wpplication Forms\Haz Mat Appli Draft Jan20l9.docx J� Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that All Cape Welding 155 Old Yarmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. --- -•---------------------------- -------------------------------------------------------------------------------- ------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health f 08/08/2019 12:08PM FAX 5087712165 ALL CAPE WELDING 16 0001/0001 . . 1 Y is Town of Barnstable . Inspectional Services BARNSTABLE c raw �y Public Health Division Inss.tou �� BAR M+AS& 1 Thomas McKean,Diicctor 1e79 �•� 200%i.a Su•eer,, Hyannis, MA 02601 c:r Office: 508-862.4644 FAX: 508.790-6304 APPLICATION FOR PERMIT'I'O 5"'O"RE AND/OR UTILIZE HAZARDOUS MAT RiALS IN ACCORAANCL W'ITl•I,ri-,tC TOWN Or$AfCNSTAE3L'G GLN_R.AL ORDINANCE;CHAPTER 108, HAZARDOUS MATL•R1ALS,ALL BUSINESSES TFIA'T IIANDLF OR STORE IIAZARDOl1S MATERIALS GREATER THAN HOUSE-HOLD QUANTITIES ARE RFQUIRGID TO OBTAIN AN ANNUAL PERMIT(RUNS 1ULY Ist—JUNE 3001). APPLICATION FLIES CA'17EGORY I PERN-11IT 26- 110:Gallons: $ 50.00 '°,;;,;" CATEGORY 2 PERMIT 111 —490 Gallons; $125.00 El CATEGORY 3 PI?ItMI'f 500 or ni)rc Gallons: b 150.00 Qyi *A late charge of$10.00 will be assessed iifpz;ytnent is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A P[.WIT RENEWAL? YES NO. III'YES,SKIP QUESTWN 3. 3. FOR ALL NEW PERMIT APPLICATIONS, I:NDICAU W1-TTST,HI!.12 M SINESS HAS • ZON)NG/BUILDING APPROVAL FOR IIAZAIt))Ol'IS,MATr!,R.IA.LS STORAGE/tjs.c4 OF GRATER THAN HOUSEHOLD QUANT"ITTES(25 (.'AI I,ONS)?._ YES NO. 4. PULL NAME OF APPLICANT: _ (-&&�VAy " — S. NAME OIL IrSTA.BLISHMENT: Au C'/t &, lti..L-'l.✓)IA.,'a G, ADDRESS OF ESTABLISITMENT: r✓t��� ,' •� . 7. MAILING ADD l'RE SS (IF DIFFEREW FROM A130Vli.c o. TELEPHONE E HONE NUMBER OF ESTABLISHMENT: ;"�(. 7 / / /,/ ). EMAIL AD DR);:S$: 41.41A- ..p L_' _ � ?LA. /10 •_____ 10. SOLEOWNER: AE$—NO IF NO,NAME OF)"ARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE{f OF: CORPORA•r10N NAME; .� _ FI�ESWE'N'I' 7) 9,Al/V1 TRLASURER, ft7. 2 EV/G CLERIC 12. IF PIU1,11A,RED BY OUTSIDE PARTY: NAME: TICLEI"YIi,ONE#: COMPANY ADDRESS _ EMAIL; SIGNATURE OF APPLICA '� DATE Q:\Applicntion f ormsll•L•iz Mal APP Revisal ...10.1 .dncx _��' Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $50.0o Town of Barnstable Board of Health This is to Certify that All Cape Welding 155 Old Yarmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- --------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health [;Ir 2 R Towtl of B nsxable P egwatory Services Richard V. Scah, Director I.A ' Public Health Division BAMSTABI�E . anansaete. rmnnue mrurr �� 1 Thomas McKean, Director MARSI l"M - 9"0.4" .xva�w�s 'W" -- -- - - - 116j¢- `0$ - - --- -- --- - - ATEo a -.- - - --200 Main Street)Hyan cus�Iv1A 02601---- -__ .------_--- ���- �� Office: 508-862-4644 Fax: 508-790-6304:rE: APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ° HAZARDOUS MATERIALS t;�I �x IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 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? V YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. r 4. FULL NAME OF APPLICANT: (�j 5. NAME OF ESTABLISHMENT: 14V �� kt 40 � 6. ADDRESS OF ESTABLISHMENT: �•7� Oj� G� Ie1J 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: -7/ 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: y YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Rj Off�� PRESIDENT ll A) TREASURER , 7 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.docx JUM 20 it 7 PM12:191 4 Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that All Cape Welding 155 Old Yarmouth Road, 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 036/30/2018 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 act' . �w of B stable egaatorySemces Richard V. Scali, Director BARNSTABLE Public Health Division = maxsrnn -.:E.rru;.n�•cmun•ircnxrxs w RNffrABLE. Thomas McKean, Director5N1i]r9�201gvresr ea.xsras � $ 3g9�-72q0 i639 ♦� dJU1J 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 oV-7 Pek9D/ 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 f �� 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? V YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Al,L 1i-P /mil it✓5 /dl� 5. NAME OF ESTABLISHMENT: Alf" �c f /G74-XK.6 6. ADDRESS OF ESTABLISHMENT: / jam 06z) G1&94WCT�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 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE_ Q:\Application Forms\I-IAZMAT APP 2017 REVISED.docx Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that All Cape Welding 155 Old Yarmouth Road, Hyannis, MA 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 Regulatory Services _----_.-- °� Richard V. Scah, Director BARNSMBM ` Public Health Division BARNSTAB 16g9• `0� °P.un"nwar �v�`:°w's°unn' u' Thomas McKean, Director 1639�20 14 200 Main Street, Hyannis, MA 02601 d�,�'�(� � Office: 508-862-4644 D Fax: 508-790-6 GJ t� 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 cc � CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 (, v 0' 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 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: _ 5Z)3^ -7 ((7 EMAIL ADDRESS: f��@ I SOLE OWNER: 'EYES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME ,Ghi Ny I/LV SDO��-fit PRESIDENT C w TREASURER you CLERK I/l N . IF PREPARED BY OUTSIDE PARTY: (tj4tF APPLICANT Name: Company Address Telephone#: Email: Q:\Application Fonns\HAZZ.APP Rev I6.docx Page 1 of2 Ys1 Number Fee 1221 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that All Cape Welding 155 Old Yarmouth Road, Hyannis, MA 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 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 05/03/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable �tHME r Regulatory Services Richard V. Scali, Director B"x" Public Health Division BARNSTABLE -c .i6 9 0� sannsTne .�rtvKue•mnrt•n unzs �. 3 A� wasvaaruis•oshx,ue•wre.rxsrae Thomas McKean, Director 1639-20M, F-+ 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 w+ rr• W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 �`�'` CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed ifpaMent is not received by July 1st. ASSESSORS MAP AND PARCEL NO. fTE Z� FULL NAME OF APPLICANT: L NAME OF ESTABLISHMENT: t"1 1. c� � W' 'RLb N �$ ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: I f L L SOLE OWNER: VYES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME log- US 1 S 1 FS F36 IAVhF'i � PRESIDENT >, J TREASURER CLERK IF PREPARED Y OU SIDE PARTY: (tSIG�tTIRVOF APPLICANT Name: \ Company Address\,,,- Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 r ti Town of Barnstable Office: 508-862-4644 .. Fax: 508-790-630.4 Regulatory Services Department Public Health Division MASS, Thomas A.McKean,CHO s 200 Main Street, Hyannis, MA 02601 o Payment Receipt .Hazardous Materials Payment received: $50.00 (Check) on 5/2/2016 'Check number: 10836 Check amount: $50.00. Name on check: All Cape Industries Inc. `Business: All Cape Welding Owner: ROLAND] GAUVIN Address: 155 OLD YARMOUTH ROAD, Hyannis T01IVN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET e FIRM `ADDRESS Major types of materials: 1) 2) 3) 4) 5) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility e%r # Remarks/RecommeTiU 7_ons 1. Indoor a) separato, contained room b) stored in general work area VJ i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit ] r B. On-site disposal 1. Town sewer 2. Regular septic system 3. Separate holding tank C. Off-site disposal 1. hauled by own' firm 2. hired hauler a) name of hauler b) address or disposal site Perso.n(s) Interviewed��rM2qZ _VA_ �_ Inspector _ _ _ Date �./ � r,, 6 30 81 satisfactory_ ,,., • _^ 2. printers B-OA R D OF HEALTH f- ' 3. . Auto rody Shops ti. 0 unsatisfactory- 4. Manufacturers COMPANY (see"Orders") S. Reta�.l Stores 6. Fuel Suppliers ADDRESS Class: 7. Misc llaneous QUANTITIES AND STORAGE (IN'--indoors; OU1•=outdoor MAJOR MATERIALS Case lots Drums AboveT•anks Undetground Tanks IN )UT 1 I N fi qe l loner a t3 Fuels: Gasoline, Jet Fuel (A) L , ' 1 •Diesel., Kerosene, A2 B) -Heavy Oils: — waste motor oil (C)/ i,:.w motor oil (C) transmission/,hydraulic - I — `-�Synthetic Organics: Nti degreasers � — V-- MiscelIffteous: _ 1 DISPOSAL/RE�('I J1TIUN y 1. Sanitary Sewage 2. Ww Su PI rI RE�V'RKS: CX y _ Town Sewer public Tt, / 7, .t, Qn-site Q Priv to 3. Indoor Floor Drains: YES NO _ _« ��Ill .,•4;t1�= O Holding tankt, MUC '~ ' �� jc O Catch basin/Dry well PL"' On-site system-i �F3EiiS: A, Outdoor Surface drains:YES/k NO IloldinE• tank: MUC - Catch basin/Dry well �_ ; '(, �� '` �` ` QOn-site system S. Waste Transporter I���/Y LAM C,UuGt 'jRamm of Hauler- J Licensed? k� -lle-5tinatInn NO erson s) ni.ery ewe • Inspector Date % 1 J G TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 4Z Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: l L� 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 i Please put a check beside each product that you store: ✓ Antifreeze (for gasoline or coolant systems) V Drain cleaners V Automatic transmission fluid "`toilet cleaners Engine and radiator flushes Cesspool cleaners ✓ Hydraulic fluid (including brake fluid) V Disinfectants ✓ Motor oils/waste oils V/Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil ✓ Pesticides (insecticides, herbicides, ✓/Other petroleum products: grease, lubricants rodenticides) V Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink 1/ Battery acid (electrolyte) V' Vood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes 1/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): ry cleaners) Other cleaning solvents Bug and tar removers _Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN N OF BARN►JTABLTVIOMPL.JANCE: CLASS: 1.Marine,Gas Stations,Repair sfacto 2.Printers BOARD OF HEALTH 3.Auto Body Shops ` atisfactory- 4.Manufacturers COMPANY "Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /v�v - 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drurns Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) lu F f new motor oil (C) transmissiaydraulic Synthetic Organics: de�r�aserS .. qr Miscellaneous: 17 C. i ZISPOSAIMECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer ublic �-�- On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system '^ 4. Outdoor Surface drains:YES I` NO ORDERS: O Holding tank: MDC atch basin/Dry well /V On-site system 5.Waste Transporter Name of Hauler Destination 1. �---! � •�L�o;Cf��l 7 �.LeC-- YES NO 2. Per n (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: XZ1 C.4eto Board of Health MAILING ADDRESS: !3✓`J ® � ' sP Town of Barnstable TELEPHONE NUMBER: -7-71,- V1 P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 i Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities tots i , 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 s_ el°rara star `Id Please put a check beside each product that you store: U Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid ✓ Toilet cleaners Engine and radiator flushes Cesspool cleaners i.� Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) A/ 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) V 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) i v Other cleaning solvents ug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business F .. 1'WL-(-.x...'n;.•7'h�r„,.'",ny'r,"n dr.y:.-...rY. '3+a�s•.y.M•.,: !:'..�rw--r-.+:t" �„-?»'h.,-.rs^ .k• ,.... "n-.•�`+f'.,,,..... ,,:a;�r«+.._,,, -.`56.-..' J ..d` - r '> �►s..-.ice.y► TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,"Repair atisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY, Fr��: r «/ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS / sue f ` f t Class: 7.Miscellaneous QUANTITIES A_ ND'STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undergn-ound IN OUT IN OUT IN OUT #&gallons Age Test Fuels: A . . Gasoiine, Jet Fuel(A) w Diesel, Kerosene, #2 (B) Heavy Oils. " waste motor oil (C) � 06 new motor oil (C) transmission/hydraulic Synthetic Organics: U degreasers, , t" /14 4(1°° A x 14V ' Ile Miscellaneous: t _ r DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply - O Town Sewer ,OPublic ;0 On-site OPrivate °'3. Indoor Floor Drains YES NO O Holding tank:MDC ! O Catch basin/Dry well r O On-site system 4. Outdoor Surface drains:YES VNO ORDERS: �O Holding tank: MDC �' ✓,r / .� �.. Catch basin/Dry well ,� , � , O On-site system 5.Waste Transporter Name-of Hauler Destination Waste Product 7 YES NO 2. f f: Person (s) Interviewed Inspector Date