HomeMy WebLinkAbout1734 FALMOUTH ROAD/RTE 28 - HAZMAT (2) 41
Number Fee
1136 THE COMMONWEALTH OF MASSACHUSETTS $15o.00
Town of Barnstable
Board of Health
This is to Certify that ALL TO RN CENTER VILLE MOBIL
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1734 Falmouth Road, CENTERVILLE, MV M>4
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Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
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Restrictions:
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This license is granted in conformity with the Statutes and ordinances relating there to,
and expires 06/30/2021 unless sooner suspended or revoked.
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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
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Town of Barnstable "
Inspectional Services BARNS ABLE
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Public Health Division
? BAWWABLT, r. Thomas.McKean,.Ditector
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200 Main.Street,Hyannis,MA 02601
Office: SO&862-4644 Fax. "508-790-6304•
APPLICATION.FORYERMIT 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::HAZAIIDOUS`MATOUALS
GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS:
JU.LY last—JUNE 10th).
APPLICATIONTEES
CATEGORY I PERMIT 26-- 110.Gallons $ 50.00 Cl
CATEGORY 1 PERMIT 111 499 Gallons:. $125.00 Ca
CATEGORY 3 PERMIT 500 or more:Gallons: $150 {V4Sr
*A late charge of$10.06 will be assessed.if paU, ment.is not received,by July Ist.
1.. ASSESSOR'SIMAP AND PARCEL.NO. .
1. .IS THIS A PERMIT RENEWAL? X YES!NO: IF YES,SKIP QUESTION 3°.
3.. :FOR ALL NEW PERMIT APPLICATIONS,,INDICATE, WHETHER:BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS-MATERIALS STORAGEMSE OF
GREATER THAN HOUSEHOLD QUANTITLES(25 GALLOONS)'. YES NO.
4.. FULL NAME OF APPLICANT:: Global Montello Group orp
5:: NAME-OF ESTABLISHMENT:: Alltown Centerville Mobil
6. :ADDRESS OF ESTABLISHMENT:; 1734 Falmouth Road, Centerville, MA j
7. MAILING.ADDRESS(IF DIFFERENT FROM ABOVE':'ATC Eclipse 705-A Lakeview Playa Rlvri ,
Worthington, OH, 43085 i
.8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-2510
9:. EMAIL ADDRESS:
1.&SOLEOWNER:.X YES_NO IF NO,NAME OF PARTNER::
111. FULL NAME,HOME ADDRESS;AND TELEPHONE#OF;
i
CORPORATION NAME
PRESIDENT`
- s
TREASURER
CLERK I
12.,IF PREPARED BY OUTSIDE PARTY-.
NAME.Melissa Roberts -Authorized Rep for Owner TELEPHONE* 614-433-0170
COMPANY ADDRESS 705-A Lakeview Plaza Blvd-- EMAIL: melissaxoberts0atcgs.com
Worthington, OH, 43085 i
• SIGNATURE.OE APPLICANT"MdL 'R04VXO DATE 6/4/2020
Q:1Applieaiion FormsWu Mac Appli'Draft Ien2.019sdoex