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HomeMy WebLinkAbout1149 FALMOUTH ROAD/RTE 28 - HAZMAT 11�14fAWFt+okq-Ww-t - 7 C WI TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager rwr,vi k. , ,1,e.f r Address of Offender MV/MB Reg.# Village/State/Zip Business Name `'�-- f`/•�V vt._ :btu ;am/pm, on l21�`� 20 Jh Business Address t 1 q "t 7 P& Signature of ,Enforcing Officer Village/State/Zip 02 L13z-- / �f Location of Offenses Enforcing Dept/Division Offense J()e�; - ���. '. �tis;:. o `'14 Pei 4- YL "2d I Facts /N(A .(FX 11 a 1-a IM �,T-F�l +r: t�.a l f>c�T �i 1 . �1✓X / 1/�' 1 a I YI V fJ N, X- 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 ' �"� Ordinance or Regulation WARNING NOTICE Name of Offender/Manager j o G� ,1'`� r. Address of Offender MV/MB Reg.# Village/State/Zip �^ t- _ w� , > am/ m 1 ! ? 20 !{ Business Name p � on Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense " to a � NA Enforcing Dept/Division + � Offense 1 ` ro / :, �,, j ^ ; Facts k, t h4 tz. 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. 2 2-q -- 1 d c -- o2 oFIKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAW%. 200 Main Street• Hyannis, MA 02601 039. �plEDMA�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT l . Business Name: t /"n' Date: C618191 Location/Mailing Address: I I qq b Contact Name/Phone: 3o Inventory Total Amount: A9 MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: NIA Floor Drains: Ift Emergency Numbers: Storage Areas/Tanks: r k" Emergency/Containment Equipmen : Waste Generator ID: Waste Product: I Y Date&Amount of Last Shipment/FrequencX: 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 7dAntifreeze disposal of 111 gallons or more requires a license from the Public Health Division. 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 otor 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 ye or caustic soda Lacquer thinners Miscellaneous Combustible --Maint&varnish removers, deglossers Leather dyes iscellaneous 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: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS ® � �7f?.c� a111 o`�SUes eX01- Sly °TIME Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARM s5R`"E.g. 200 Main Street• Hyannis, MA 02601 1639, ptFOMP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: 07l6 Location/Mailing Address: I Contact Name/Phone: 75' Inventory Total Amount: 0S MSDS: v Jl7 !6' License#: Tier II : NO Labeling: Spill Plan: QfS Oil/WaterSeparator: Flo r Drains: Emergency Numbers: Storage Areas/Tanks: bICK Emergency/Containment Equipment: a Waste Generator ID: Waste 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 ydraulic fluid (including brake fluid) Windshield wash Motor oilsMiscellaneous 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: OHME Inspector: Facility Representative: 47 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS INE�ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. 200 Main Street• Hyannis, MA 02601 �A s679.s�0 rFOMA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: . Dater - - OO -a�L 6 Location/Mailing Address: I, 4q Contact Name/Phone: g ORC s -2 _ 9 -'rT0,2>` '7767-lyn Inventory Total Amount: MSDS: License#: 1'3 y Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste 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 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: Inspector: Q C-T Facility Representative: 117 WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS .+ ,ieft, oil .5t)t�5 'r '°FIKE*ow Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE. k 200 Main Street• Hyannis, MA 02601 MASS .gyp %639.A�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT lf0 MPy Business Name: ',g Y, ��.r 110. rc,"� 't tt�-'t` Dater Location/Mailing Address: i'd ') 9 C "J LA JI , ymq 6 2& '�.A Contact Name/Phone: Sit, V " 7 !S- Inventory Total Amount: MSDS: License#: 13'1 Tier II : Labelin : Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste 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 l Dryclean'ing fluids Automatic transmission fluid -, Other cleaning solvents&spot removers Engine and radiator flushes Bug an Par removers Hydraulic fluid (including brake fluid) ', -,Win shi I d wash Motor oils , `. Miscellaneous Corrosives. Gasoline,jet fuel, aviation gas R,-., ' �. Cesspool cleaners Diesel fuel, kerosene, #2 heating oil rDisinfectants..-f i ;- � z Miscellaneous petroleum products: I Rbad salts grease, lubricants, gear oil Refrigerants _ De Egreasers for engines&garages VPesticides: L r I Caulk/Grout j.. insecticides,'herbicides, rodenticldes f ,/ - Battery acid (electrolyte)/,batteries �� , PhotochemicalsT(Fixers) Rustproofers Photochemicals.(Developer) A Car wash detergents �_ _ � Printing ink Car waxes and polishes i' i Wood presee�rvatives(creosote) Asphalt&roofing tar ' } Swimming pool chlorine Paints, varnishes, stains,dyes Lye or caustic soda Lacquer thinners I Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Floor&furniture strippers ' P PCBs Metal polishes Other chlorinated hydrocarbons .Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison Iabels'l' ' (including chloroform, formaldehyde, �f hydrochloric acid, other acids) VIOLATIONS: 1 ORDERS: i INFORMATION/RECOMMENDATIONS: j Inspector:: Facility Representative: 6 WHITE COPY- HEALTH DEPARTMENT'/CANARY COPY-BUSINESS IME F, BA MASS. * Town of Barnstable i63q. 10 ArFDN1i•'�A Inspectional Services Public Health Division Thomas McKean, Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Co February 20, 2020 Zahid Rashid Centerville Food Mart 1149 Falmouth Road Centerville, MA. 02632 Mr. Rashid, Thank you to you for the cooperation of Rajan Giree letting us perform a required hazardous materials yearly inspection. This letter contains information from that visit that will help you to become compliant with the Town of Barnstable Ordinance: Chapter 108 Hazardous Materials Enclosed are copies of Chapter 108: Hazardous Material Ordinance and a copy of labeling requirements for all waste products in your shop. I have also enclosed a spill plan/contingency plan that is required. Please note the problems identified at your place of business during the hazardous materials inspection and the corresponding recommendations listed below.- PROBLEM: • Material Safety Data Sheets not available during visit. ORDER: • Massachusetts General Law-Right to Know Law states that " MSDS's should be filed in an organized manner at a central location in the workplace so that the employer can easily provide an MSDS if an employee requests one" • Town of Barnstable Ordinance Chapter 108: Hazardous Material section 108-4 (B) Inventory and registration states that the "material safety data sheets shall be made available upon request of the Health Department. PROBLEM: 0 Fire Extinguishers are not recharged to current date and are not readily assessable. i 4J ' ORDER: • Please have all extinguishes..re-charged, assessable, and clearly marked with placard. PROBLEM: • Business license issued from the clerk's office not visible ORDER: • Please post current business license PROBLEM: • Spill/Contingency Plan must be posted. ORDER: • Make and post plan, guideline enclosed to make it easier for you PROBLEM: I Spill kit and absorbent pads, speedy dry not readily available ORDE • Make spill kit and supplies readily available and out in the open Again thank you for your continued cooperation and I will be back on March 19th, 2020 between 9 AM and 230PM for a final inspection report. I realize that the quantity fluctuates during the year and the total may seem high in February, but this quantity reflects the yearly average. If you have a difference of opinion, please feel free to contact me directly. Your current license is valid until May of 2020 and is good up to 110 gallons of materials. If you have any questions about the problems, the recommendations, or you need further information, guidance, or assistance,please do not hesitate to contact me directly. Respectfully, chester.johnson@town.barnstable.ma.us 508-862-4645 C. Gus Johnson Hazardous Material Specialist `pftKWE � Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MAT LE. • 200 Main Street•Hyannis, MA 02601 MASS. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: VUryIt Date: q Location/Mailing Address: ' w _ Contact Name/Phone: ; Inve to Total Amount: �1� SDS: Qe5 License#: 1305 Tier II :_ 0 Labelino: J qt� Spill Plan: Oil/WaterSeparator: M Flo r Drains: Emergency Numbers: � . S Storage Areas/ranks: �� nlJ J Emergency/Containment E ui nt: I d S Waste Generator ID: AIA Waste 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, storag7and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Vol- Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: V 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 V 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: Qr Zf CR Inspector: Facility Representative: �. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°F1Me ro�ti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMASS. .� 200 Main Street• Hyannis, MA 02601 �A�FOMA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �21✓��2lJ \`� F'oo� Q<k _ Date: 2 5 1's Location/Mailing Address: wn-A1-5 Contact Name/Phone: �a�- 1�-�A-�ne� d 8 —7 S-Ng j Inventory Total Amount: ^^ ` 'rl �"���`\D SDS: ko b t"�- owl (License#: Tier II : Labeling: 6ML Spill Plan: +a 0 Oil/WaterSeparator: hJ lvk Floor Drains: Emergency Numbers: � Storage Areas/Tanks: Emergency/Containment Equipment: vD �� ►��� ` �<°���" �) eye ►�azl�- o,� Waste Generator ID: r Waste 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 3 Engine and radiator flushes Bug and tar removers �- Hydraulic fluid (including brake fluid)1- 33 Windshield wash IS+ ZO Motor oils 2 i Miscellaneous Corrosives t Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Z Dis,infectants y 1 Miscellaneous petroleum products:,L I Do 10 Road salts to e> 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: ti. d o L 1 0"'A a V,6g= Do 50 kcv— k y-, 3V-) t4ee 0 1 t4 /A�r Inspector:. Facility Representative: 4 /1;0� WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1341 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Centerville Food Mart ............•.................................................................................................................... 1149 Falmouth Road, Centerville, 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 Town of Barnstable • Inspectional Services BARNS LE .^ l ISTAME-CFMMIALIE•CONR-1Y—Is �. Public Health Division "M>s ,5":�•639-2 4 Y � 1639-2014 1 BAMSTABL& = Thomas McKean, Director . 200 Main RFD Street' Hyannis,MA 02601 ,.. �f 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 "h GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st—JUNE 30th). APPLICATION FEES /VW G� CATEGORY 1 PERMIT 26— 110 Gallons: $ .00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 El ( � a 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? 1/ 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)?- i�J�_NO. 4. FULL NAME OF APPLICANT: / /-S ,/ic.�G-• 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: —//�� 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 6—ce? 7Z J — Z� 9. EMAIL ADDRESS: 10. SOLEOWNER: ES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#O : CORPORATION NAME C PRESIDENT TREASURER CLERK lly& • 12. IFrPREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE O Q:Wpplication Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1341 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Centerville Food Mart 1149 Falmouth Road, Centerville, 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 Town of Barnstable a E Inspectional Services BARNSTABLE _ram Q`t � MRNST .10.CE;05E. -e.UE IR•HTNihI q.pSTCki NIJ.S.GSTCiN.LLE.n'iT BfAri:'s.E o„ Public Health Division �= 9 BARNSrABLE, Thomas McKean, Director ., `l'ArE03 `` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-630f .w 4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE '` HAZARDOUS MATERIALS1 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 MY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 VGr �{ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ . CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ S *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. =.q — /00 00 d-- 2. IS THIS A PERMIT RENEWAL? (/ YESI 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: A-I �, �/NC• 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7.. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 6gz1A 8. TELEPHONE NUMBER OF ESTABLISHMENT: Q� ZZ5 74 g9 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER S4ye",4% AASIWl2 CLERK S 61gwa2r i?s7 f; o 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE o .� 10 Q:Wpplication FormsU'1az Mat App Revised 09-10-18.docx Number Fee 1341 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Centerville Food Mart 1149 Falmouth Road, Centerville, 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 TRowr of Barnstable J eg atory ervices Richard V. Scali, Director ' oFzKE " Public Health Division BARNSTABLE • WN57ASLIE lLEitVILLF•CONK•OMNS BARNSTABM Thomas McKean, Director NARSmMILS16W�R Oa{;`�'�'AELE ArEo�0. - - .200 Main-Street,,Hyaxuus�MA-02(i0T-_ - --_._-------__- 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 CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 V• S 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? L,-6S_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: 6 ' eye,, 5. NAME OF ESTABLISHMENT: r&rllzlGe'- ITWO 6. ADDRESS OF ESTABLISHMENT: 1�y / � ��?a�t / 'y/ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �f1y7 � F//liL�'- Aw 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: �1� U/L�� �7 /y�, l,® �J/>L • l�iY 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT _ -< TREASURER CLERK ��►.,��,iy,-J 12. IF PREPARED BY OUTSIDE PARTY: _ NAME �: TELEPHONE#: 725-/ • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN , DATE Q:\Application Forins\HAZMAT APP 2017 REVISED.d c 4�. L Number Fee 1341 THE COMMONWEALTH OF MASSACHUSETTS $50.0o Town of Barnstable Board of Health This is to Certify that Centerville Food Mart 1149 Falmouth Road, Centerville, MA T 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 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 02/14/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r ` r owns of Unstable egu atory ervices Richard V. Scali, Director Public Health Division BARNSTABLE • Iit ""� � �xa"sis'ars x¢i.sa"os`°`i a�u xxsi ownsr� 1` BARNSTABLE, Thomas McKean,Director 1639_2014 , 200 Main Street,Hyannis,MA 02601 �Dg Office: 508-862-4644 Fax: 508-790-630:4,' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE �x.ay HAZARDOUS MATERIALS GTI 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: $ 50.00T CATEGORY -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 Ist. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES ""' 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: zz !z 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 6a4?2T&2& a SZ 8. TELEPHONE NUMBER OF ESTABLISHMENT: �� 7Z- a9,2- 9. EMAIL ADDRESS: CZ4�ry � 10. SOLEOWNER: �- S NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF CORPORATION NAME 5. .V.1411er, /lye- PRESIDENT TREASURERa /�� CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE Q\Application FormsViAZMAT APP 2017 REVISE ..docx Number Fee 1305 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that 7-Eleven 1149 Falmouth Road, Centerville, 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 06/30/2018 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 �3-ago- TRowr�of B n eg atory ervlces Richard V. Scah, Director j c Public Health Division BARNSTABLE BAHNSIAtlIE•iENiERVILE•CONIi H1'N.t li p �� • r Thomas McKean, Director NARiIUliMlLLi1 39- 0 4V(c'S14?4ii4 E 1 •x Al fo 039. s`e� 200 Main Street, Hyannis,MA 02601 0 -aor� Office: 508-862-4644 as/� Fax: 508-790-6304-4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 1,&i 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 n CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 VIS . dl 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 ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: Q 6. ADDRESS OF ESTABLISHMENT: /�� -/ M1M 0U-jj TOGS j-F Chit. 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\HAZMAT APP 2017 REVISED.docx Number Fee 1297 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that A Concrete Answer 445 Osterville-West Barnstable Road, Osterville, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. (� ---------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity will► 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 Tow1� of Unstable / Gh��Regulatoervices Richard V. Scah,Director IME r Public Health Division BARNSTABLE BARYSg6lk•iFNfF}:YILL£•CONR•NTnn(:IS BARNBTABLE. • vras;w.s Hus•es:nviue•vr-s(n�gn 16 Thomas McKeanMASS, , Director 1639-2014 16 ,�a`� 200 Main Street, Hyannis, MA 02601 ��Ig ' M� -tea Office: 508-862-4644 / Fax: 508-790-3304 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 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 � 5. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge o $10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. l 00 3 2. 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 STORAGEIUSE OF . GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: (°(N�c(f f p_hjSIi1/M 6. ADDRESS OF ESTABLISHMENT: q 4 S' OSJ2v J JC f }- r3y�,�p�� Ir _y1( S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: Z4 Z P& M IM , 10.iA- 6Z( V S. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 6, EMWf aKSIAYZ Ot� 10. SOLEOWNER: YES, NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME IA ..i�1k1 . PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS_ EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISAD.docxfL "J r �Y Number Fee 1305 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that 7-Eleven 1149 Falmouth Road, Centerville, 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 FINE rqk� Regulatory Services Richard V. Scah, Director '" MASS' BARNSTABIE ` Public Health Division MASS uaeus•nu![•cervnew!!c.tUrui r:rcar:rvs . ��A 1639• �0� .wnslaysr:us•osreav:ue.wsraxsrne• Thomas McKean, Director 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 b/Z 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 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 Jules Q ASSESSORS MAP AND PARCEL NO. DATE U FULL NAME OF APPLICANT: — l NAME OF ESTABLISHMENT: 1 1 `-I �', ` 4 "� � 'e o ►'�'� a ` ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF iDIFFERENT): J�M C- TELEPHONE NUMBER OF ESTABLISHMENT: S C)-6 e)`)S 7 y 9 EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: a c p ' FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: Wl 1cc CORPORATION NAME S a w..e a.� A ��o ✓� f-�- 6� PRESIDENT _ TREASURE CLERK IF PREPARED BY OUTSIDE PARTY: SIG TU AP ICANT Name: !h Company Address : j Telephone #: Email: Q:\Application Forms\HAZZAPP Rev 16.docx Page 1 of THE F, M�MASS.ABLE. * Town of Barnstable � i639. ♦� ArFo �a Inspectional Services Public Health Division Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 gj5n Lax: 508-790-6304 Uj copy February 20, 2020 Zahid Rashid Centerville Food Mart 1149 Falmouth Road Centerville, MA. 02632 Mr. Rashid, Thank you to you for the cooperation of Rajan Giree letting us perform a required hazardous materials yearly inspection. This letter contains information from that visit that will help you to become compliant with the Town of Barnstable Ordinance: Chapter 108 Hazardous Materials Enclosed are copies of Chapter 108: Hazardous Material .Ordinance and a copy of labeling requirements for all waste products in your shop. I have also enclosed a spill plan/contingency plan that is required. Please note the problems identified at your place of business during the hazardous materials inspection and the corresponding recommendations listed below: PROBLEM: • Material Safety Data Sheets not available during visit. ORDER: • Massachusetts General Law-Right to Know Law states that " MSDS's should be filed in an organized manner at a central location in the workplace so that the employer can easily provide an MSDS if an employee requests one " • Town of Barnstable Ordinance Chapter 108: Hazardous Material section 108-4 (B) Inventory and registration states that the "material safety data sheets shall be made available upon request of the Health Department. PROBLEM: • Fire Extinguishers are not recharged to current date and are not readily assessable. ORDER: • Please have all extinguishes re-charged, assessable, and clearly marked with placard. I PROBLEM: • Business license issued from the clerk's office not visible ORDER: • Please post current business license PROBLEM: • Spill/Contingency Plan must be posted. ORDER: • Make and post plan, guideline enclosed to make it easier for you PROBLEM: • Spill kit and absorbent pads, speedy dry not readily available ORDER: • Make spill kit and supplies readily available and out in the open Again thank you for your continued cooperation and I will be back on March 19th, 2020 between 9 AM and 230PM for a final inspection report. I realize that the quantity fluctuates during the year and the total may seem high in February, but this quantity reflects the yearly average. If you have a difference of opinion, please feel free to contact me directly. Your current license is valid until May of 2020 and is good up to 110 gallons of materials. If you have any questions about the problems, the recommendations, or you need further information, guidance, or assistance, please do not hesitate to contact me directly. Respectfully, chester.johnson@town.barnstable.ma.us 508-862-4645 C. Gus Johnson Hazardous Material Specialist cSA'V Custom Coating/Rhino Inspection 1-22-20 Chris Vangelder, Good day to you. I conducted a required Board of health Inspection at your new business on Warehouse road today. Your sons were very helpful and assisted me today. There are a lot of problems on bringing this location up to code with the Town. I will list several of them here and it will be a start. On the Town's web site are the specific rules of what is required. I also have attached blank forms for you to use in the endeavor. 1. You have to secure a business license from the Town's Clerks office for this location, this will trigger the next steps in this process and they will assist you in doing so. ** 2. You have to register with the Mass DEP for a hazardous waste permit ID. ** 3. There is no fire suppression equipment on site at all. Egresses are not labeled, a fire department inspection will be required as part of the aforementioned procedures. 4. Product labeling is non-compliant and there are no MSDS available to employees, as well as a spill plan and emergency contingency plan in place and posted ** 5. There are flammable materials that are not secured and/or marked and safely stored in a secure non-flammable steel locker. 6. With the work being done at this location, there should be an eye wash station. 7. Each item listed above is not all the violations that have to fixed, but, each department that you visit to obtain permits will be more than helpful'in making you compliant 8. We realize how hard it is to conduct business this day and age, but we are here to help you comply in the easiest, most cost effective and safest way possible. 9. Please keep me posted on your progress, BUT, please start this procedure ASAP. I will check back with you periodically during the next Month and you should be able to complete it within 30 days. I have you on the list to contact February 25th by phone to set up an inspection. Respectfully, C. Gus Johnson Hazardous Material Inspector 508-862-4645. chester.Johnson@town.barnstable,ma.us p r . gym. 6 p -a)a 7-5-.s 2c, a &"-q, TOWN OF BARNSTABLE C MRUANCE: CLASS: 1.M ri�,Gas Stations,RepaT�n nters BOARD OF HEALTH satisfactory 3.2.Auto Body Shops unsatisfactory- 4.Manufacturers `COMPANY .c��idit - �Pli (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS I Class: 7.Miscellaneous � ! QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) _ XI /j transmission/hydraulic ' Synthetic Organics: degreasers 1 asc laneou : aAA -3 lkw IL 1)Atn-m"N -- 11-pU S?A.o4) %e - �G DISPOSAL/REC;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply 'Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES N0_ O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES XNO ORD RS' O Holding tank: MDC Y Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination YES I NO 1. 2. Person (s) In erview d Inspector Date