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Home My WebLink About1734 FALMOUTH ROAD/RTE 28 - HAZMAT 13 l Fq i�62 14-(t i a f ji ti �I I i -TOWN OF HA NSTABLE - UNDE RGRUUND FUEL AND L11l_Iti. C:ICI.. S f ORIII,E REG i S I Rl1T ION jk: A � L' MAP NO. � PARCEL NO . I_�Z TAG N0. /3 A ESS OF TANK: �� j V I LLAGE: l4�mb�r Ytr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: _ PHONE: INSTALLATION DATE: 'FEBY: INSTALLER ADDRESS: CERT .140. *TANK LOCATION: ABOVE LO�� ( ow=cm I=w TANK LOCATION W I-r" maoPQCT TO mU I LD I NO) CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL F 1 a o TESTING CERTIFICATION PASS [ ] FAIL DATE Awfl / 2- LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND z ZONE OF CONTRIBUTION [ ] YES [/3 NO DATE TO BE REMOVED � 1 FIRE DEPT. PERMIT ISSUED [ PT-YES [ ] NO DATE 04 >a T Vii /Z CONSERVATION [CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD I UWN OF BARNSTABLE - UNDERGHOUND FUEL AND LF EN ' (_01.. S I OROUE REG IS 1 RA F ION MAP NO. C� 7 F'ARCE.L: NO. 3��-.-- _ TAG NO. A DRE!S OF 'TANK: /7,3� �ig�7Jo�.9�1� /L VILLAGE MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: '� 1I 0 T T .// PHONE: �c{��/r�� 7�,C .D r INSTALLATION DATE: _ BY: INSTALLER ADDRESS: I60 X � f �'�iovl'/) /.z CERT.1\10. *TANK LOCATION: ABOVE OW < DCmQfO Z-n�`C TANK LOCAT Z ON WITH iRQOPQCT TO mu I Y"ec"S' CAPAC IJY v TYPE OF TANK /2i. �s AGE YRS. FUEL/CHEMICAL �F ""1,2 o o ?Wo- @ o►--P TESTING CERTIFICATION P"I PASS [ ] FAIL DATE _ )_ ��1 2- LEAK DETECTION [, ] CHECK IF N/A TYPE/BRAND G�fc7L✓�ty�G /�,ol lJ ! ZONE OF CONTRIBUTION [ ] YES [V/] NO DATE TO BE REMOVED 6 1 f FIRE DEPT. PERMIT ISSUED [ -]- YES �( ] NO DATE 0C9--/Z0T CONSERVATION [ ']'CHECK LF-- /N A DATE J� BOARD OF HEALTH TAG NO. [�'� DATE * PLEASE PROVIDE A SKETCH SHOWING. THE TANK LOCATION ON THE BAC.K_ OF _.THIs,.r.ARn_ � 1 HUUND FULL AMD � [URoGE nE� |5lRor lON UWN OF BARNSTAB E �� _ ' MAP NO. PARCEL NU / �A� N0 � — _ _�� - �- A'D8RESS OF TANK: tv 41 VlLLAGE : , MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) :INSTALLATION DATE: � / INSTALLER ADDRESS: CERT.140. *TANK LOCATION: '-__ . _ � ^ o==cpqX -rxc�~ wl`" mwom=m-r r" =", � CAPAClT v PE OF | YRS, FUEL/CHEMICAL �' ow° | TESTING CERTIFICATION [~^] PASS [ ] FAIL DATE � LEAN DETECTION [ ] CHECK IF N/A TYPE/8RAND ZONE OF CONTRIBUTION [ ] YES n/ ] NO DATE TO BE REMOVED - FIRE DEPT. PERMIT ISSUED [ +]' YES [ ] NO DATE - CONSERVATION [ --+'-HECK IF ' /A DATE BOARD OF HEALTH TAG NO. [ ' ] DATE * PLEASE PROV%DEIA SKETCH. SHOWING THE.JANKt.LOCATlON ON.IHE.8Ar-K.OF~THz-cz.,oa.pn^—~^^� TOWN OF BARNSTA'MB LE� UNI��UND F UEL AND CHEl�t:C'0l.. S I ORAIUE REG I STR(20 ION �U-)O ad�P?ICa y' JAP NO. � PARCEL NO. /JZ. TAG NO. (1"; ADDRESS OF K: 12L T/9�!'yJ�Gf �.(� VILLAGE: �vumb�r Ytr��t MAILING ADDRESS ( IFDIFFERENT FROM ABOVE) : OWNER NAME: (?!d i4/Aa/V�p� PHONE : 7�/^ �T_�,� INSTALLATION DATE: ,3 BY: . INSTALLER ADDRESS: 6 ( //.�,� ,ERT.IVO. *TANK LOCATION: ABOVE E_LOW� < D C m O A I C T A IC L O O A T I O N W I T H A Q O P G C T T O =LJ I L D I N O) CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICALa�Q� 42 Jo TESTING CERTIFICATION [ PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ /NO DATE TO BE REMOV D FIRE DEPT. PERMIT ISSUED [ ✓J/ Dt YES [ ] NO DATE _ 2¢ o/ 20-3 � �2 CONSERVATION [CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD i OWN OF BARNSTABM LE UNDE RG GUUND�yFc�UEL AND. t�HEN ! l:0- ti 1 01-3 0E REG L S1 RCO I UN 4 /� - {,�C} � � C.y� �� AP NO. -��.. PARCEL NU. 1� ^ TAG NO.. O ADDRESS OF K: �� 3� /t',��j)r>G�/f� ✓� VILLAGE: MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : _/ 7 OWNER NAME /a /��/v�p� r _ PHONE: _16- 17/ � V • INSTALLATION DATE: L BY: I ..• li�J11 INSTALLER ADDRESS: D �( ��` V�//o CERT .NO. i *TANK LOCATION: ABOVE (-BELOW (ommom I DC TA If I.00AT I om W I TN RQoPQCT TO aU I LD I NO ) CAPACITY TYPE OF TANK SAGE YRS. FUEL/CHEMICAL OF /;Z 0-ruJo AIL nlTESTI(�G CERTIFICATION [ kT PASS [ DATE LEAK DETECTION [ I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ 1/1 NO DATE TO BE REMOVED c�f FIRE DEPT. PERMIT ISSUED ( -I I YES [ ] NO DATE o 3 CONSERVATION [✓J�CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE ,PLEASE PROVIDE A SKETCH SHOWING THE TANK. LOCATION ON THE BACK OF THIS, CARD JOWN OF BARNSTAB E UNU-F-F?GldUUND F-LIEL OND L SIOROGE ION (i ryl NO. cp' CEL NO.PAR TAG NO. wo c ADDRESS OF -rr(NK: VILLAGE:- ,.MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: (I lA4 PHONE: �5 INSTALLATION DATE. )J 2- BY: &--,,x (,, ERT .NO. INSTALLER ADDRESS: *TANK LOCATION: ABOVE mu L-n CAPACITY 76)0-&> TYPE OF-TANK AGE YRS. FUEL/CHEMICAL of /'2) a yll Plaq�Llm TESTING CERTIFICATION [ ^jPASS FAIL DATE LEAK DETECTION C I CHECK IF N/A TYPE/BRAND 2�lCe ZONE OF CONTRIBUTION I YES I I NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ -f" YES C I NO DATE CONSERVATION [ -f'CHECK IF N/A DATE BOARD OF HEALTH TAG NO. DATE PLEASE PROV-I.DEA ,,SKETCH,,:SHOWI.NG.. THiE.-.T.ANK.-*,LOCA--T,.ION..:.ON-.,.THE,-,,R,A(,'K-,,6.nF .,.T,.HT--C-:Z,.-,r.a.P.T).tp„...--*,X'�A 1 OWN OF BARNSTABLE - UNDE RGKUUND FUEL ANU CHEM! (-'01L S 1 0ROUE REG 1 S f R!'+T I ON MAP NO. laj7 PARCEL. NU. � 03 TAG NO.-.,43 ADDRESS OF TANK:1�,� iu,Ll� V I LLAGE: fVumb�r Ytr��t MAILING ADDRESS JJ( IllF DIFFERENT FROM ABOVE) : _ OWNER NAME: e"w PHONE: INSTALLATION DATE: 3D BY: ' INSTALLER ADDRESS: S C E R T .N 0. *TANK LOCATION: ABOVE BELOW F7 I a G T A N K L O C A T I O N W I T H n m=m Q C T T O a u I L D I O) CAPACITY/O 122 TYPE OF TANK AGE YRS. FUEL/CHEMICAL °--6eu TESTING CERTIFICATION [.,-J' PASS [ ] FAIL DATE 71301/z, LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ✓ '' ZONE OF CONTRIBUTION [ ] YES Vlf"NO DATE TO BE REMOVED a► FIRE DEPT. PERMIT ISSUED [✓ YES [ ] NO DATE 4PO .� CONSERVATION [r] 'CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD c 1 UWN OF BARNSTABLE - UNUERGHUUND FUEL ANI..) ti I ORAGE RE( I S-1 R(-',l 1 ON MAP1 NO. 6 PARCEL. NO. _l o TAG NO. ADDRESS OF TANK: V I LLAGE: IVumb�r Y tr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: lI/0��i"��/S/7`P (� �. / PHONE / 75r INSTALLATION DATE.- Sv Z BY INSTALLER ADDRESS: 4`.X*TANK LOCATION: ABOVE CELOW <�D•C--�"b R4�I aC TAN IC LOCAT I ON W I TH 1\GOI?QCT TO mu I LD I 0 ) CAPACITY A910Z�19 TYPE OF TANK /i 7 1 AGE YRS. FUEL/CHEMICAL C�iifro TESTING CERTIFICATION PASS [ ] FAIL DATE 2- LEAK DETECTION [ 1 CHECK IF N/A TYPE/BRAND c ✓ lam/ .t riC-c �� ZONE OF CONTRIBUTION [ ] YES [ -'-'] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ ✓j YES [ ] NO DATE CONSERVATION [ ,.CHECK IF N/A DATE BOARD. OF HEALTH TAG NO. [ ] DATE PLEASE PROVIDE A SKETCH SHOWING. THE- TANK LOCATION ON._ THE BACK .OF THIS. CARD, _ .. s . ~ | UWN OF 8ARNSTABLE - UNDER6HUUNU FUEL (-)ND LoEn | /.i S [ORAGE REF� |STn )riON ' _� MAP NO y O. ' �� 'VAG NO. ADDRESS OF TANK: VILLAGE: | _w�4t | .MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: PHONE: INSTALLATION DATE -/ � INSTALLER � � ' *TANK LOCATION: ABOVE t-oc^rzo" ^,,," �==v-sr=r ,� =", CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL � TESTING CERTIFICATION [ ~] PASS [ ] FAIL DATE | � LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND � .�, . ZONE OF CONTRIBUTION [ ] YES [ °^] NO DATE TO BE REMOVED FIRE DEpT, PERMIT ISSUED [ �I YES [ ] NO DATE �. . CONSERVATION [ =z �HECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE � * PLEASE--pROVIDE^A.',SKETCHL,SHOWlNG-THE^�A0k,-k '` I�Q0 ^` w ��..zw�cz-�o,A",n� -``| J OWN OF BARNSTABLE - UNDERGHUUND FUEL AND LHEM T LOL STORAGE RELY I S-T RA-1 ION MAP NO. PARCEL. NU. _ TAG NO. ADDRESS OF TANK: VILLAGE: f`+um �r mtr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: HONE : INSTALLATION DATE: 0-ToBY: —1Gc2�c'�,rWi INSTALLER ADDRESS: v- 'CERT.NO. *TANK LOCATION: ABOVE; BELOW ( O a m a�w-s a s T A N K lL O C A T I ON W I T H m m o m a m T T O m U I L m I N O) i. CAPACITY TYPE OF DANK r� AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [J] PASS [ ] FAIL DATE 313a1�1� LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ✓ 1, ZONE OF CONTRIBUTION [ ] YES [ ell-�'NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [WIT YES [ ] NO DATE CONSERVATION [✓j CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE i * PLEASE PROVIDE ,,A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD I UWN OF 'BARNSTABLE - UNDE_RUHUUND FUEL AND ti 1 OROGE RE6 I S I R4',T ION MAP NO, PARCEL. NU. 1 _ TAG NO.3f ADDRESS OF TANK: VILLAGE: - MAILING ADDRESS ( IF/DIFFERENT FROM ABOVE) :OWNER NAME: V�yf� -! '✓✓T� � � HONE: � �.1 ��'7"./ . .7 � INSTALLATION DATE: sAo b z, BY: INSTALLER ADDRESS: � r,. J - r �' � 'CERT.NO. *TANK LOCATION ABOVE q, ( owma O l DG TANK LOCATION W Z TH RQoPQCT TO MU I LLD I NO) CAPACITY TYPE OF TANK _ �c._�)4,c-s AGE YRS. FUEL/CHEMICAL — C1b -� TESTING CERTIFICATION [�] PASS [ ] FAIL DATE; LEAK DETECTION C I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED C✓r YES [ ] NO DATE 7 ? f CONSERVATION ( CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE 1 >k PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK._OF THIS CARD_, � ` |` WN OF~ BARNSTA ` E - UNDERGHUUND FUEL `N0 �o�n| ioi 9lORAGE R�� |STR4TlON � - _- .. � MAP NO, PARCEL NO. y ----- TAG NU. ADDRESS OF TANK: VlLLAGE : ..MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : *TANK LOCATION: ABOVE ELOW CAPACITY,?'(500 TYPE OF TANK AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [-/i PASS E I FAIL DArE LEAK DETECTION C I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION C I YES P"I NO DATE TO BE REMOVED OWNER NAME: 6145��,64/ FIRE DEPT. PERMIT ISSUED [°I YES [ ] NO DATE _ CONSERVATION [^^'J CHECK IF N/A DATE � BOARD OF HEALTH TAG NO. [ ] DATE Town of Barnstable - Office:508-862-4644 Public Health Division Fax:508-790-6304 t;&`RM^TB`E$ 200 Main Street• Hyannis, MA 02601 qp t6M A�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT fF0 MPS r7 Business Name: All own Date: Location/Mailing Address: - Contact Name/Phone: Inventory Total Amount: d8 MSDS: PS License#: Tier II : K-fA Labeling: Spill Plan: Oil/Water Separator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: v ai ` .y 0 �' IV q 000 i0ccb (dS I W51m, fW504 UST Emergency/Containment Equipmen Gi^ K a— 'Waste Generator ID: Waste Product: t+�A kcerj 1501 1(1 - 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 V Hydraulic fluid (including brake fluid) Windshield wash — V 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 ye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCBs 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: 'Lz Ah CA' Dj- rernmintakaWl Insp c�� V �-•----..._.. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS i °f� rod Town of Barnstable Office:508-862-4644 Public Health Division Fax:508as0-6304 BARMAq E. • 200 Main Street• Hyannis, MA 02601 �OrFOMn+" � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: t✓1 Date: q Location/Mailing Address: ° ° 76.q-A Contact Name/Phone: Inventory Total Amount: �,500 SDS: S License#: 6 Tier it : NO Labeling: f'f' i Spill Plan: Oil/WaterSeparator: d1A Floor Drains: M0 Emer enc Numbers: e,. Storage Areas/Tanks: 15-0 1 i PS2 �po0 10,000 I 4k ,W `00c\ Emergency/Containment Equipment: 5 , Ll-I L- Waste Generator ID: Ardo1'0 I- Ll,iiIj�LQ Waste Product: Date&Amount of Last Shipment/Frequengv. Licensed Waste Hauler&Destination: `q Mef" 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 fro 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 Z 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: tar b')a D Inspector: Facility Representatives 5" WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS - ^ Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. ` MASS. $ 200 Main Street• Hyannis, MA 02601 �A f6}9•pie 'Eon+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 0 Business Name: ` Date: 6 d Location/Mailing Address: 7 0� ' 7G - 6V% w 62CA LVO Contact Name/Phone: Inventory Total Amount: \SDS1 License#: 3 s Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: ® Emergency Numbers: Storage Areas/Tanks: 0 Kqr becitI Cu I E &tck 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, stor`ag�nd disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze V/ 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 (j 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) V Any other products with "poison labels" C) 6A 1Nc`�L6h;ei6 (including chloroform, formaldehyde, rv-u&, hydrochloric acid, other acids) VIOLATIONS: ORDER (ILN:FORMLATION/RECOMMENPATIONS: f1v Mmd arw// 3tafV U !i Irnspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I wod- 1H FINE To Town of Barnstablle� Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE. • 200 Main Street• Hyannis, MA 02601 �°rEOMn+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Q, ~ Date: Location/Mailing Address: rVlyl �( Contact Name/Phone: � � 1,"0 , 776 — `,-Aq Inventory Total Amount: ySDS ® `��"��n� �� License#: 1341 _ ` Tier II : Labeling: ( e Spill Plan: Oil/WaterSeparator: IVIA Floor Drains: Emergency Numbers: Jam' Storage Areas/Tanks: Emergency/Containment Equipment: C� Waste Generator ID: NIA Waste Product: IVIA 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 y Other cleaning solvents&spot removers Engine and radiator flushes ug and tar removers Hydraulic fluid (including brake fluid) Windshield wash V Motor oils 910 Miscellaneous Corrosives asoline,jet fuel, aviation gas Cesspool cleaners iesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) �,�, 1- , VIOLATIONS: 5 0111 ) Ii- I eAv(ft►", S a- ORDERS: d' L)i I0 INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS / IME*okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MASSBLE,g' 200 Main Street• Hyannis, MA 02601 t639 s TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT z,I rJ1—7 Business Name: ev441e;Irvd l.e. 06+ I Date: 2 07 �I- Location/Mailing Address: I"l a 0 lQ e r-j Ile, reiww►pox' We-L- �v�s P.1 - fetes Contact Name/Phone: S�'o{.e w�- <= �•a+nv-a- o T-TS 2S-IO Ewv. Cow f I QKcz,Gl o 6a l C"rrav- pp Inventory Total Amount: �o �•Z� MSDS: `e,-7- N1�o� License#: 11310 C�`�3 Tier II : My Labelina: Ce-ka.\ a'W4-5kk, Spill Plan: Oil/Water Separator: Floor Drains: M2 Emergency Numbers: "41-S Storage Areas/Tanks: 19K v < o us aS SK Emergency/Containment Equipment:*\,o- Waste Generator ID: Waste Product: Date&Amount of Last Shpment/Frequencx: o 04n2 5 +s Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Ao Ma)'or /;Mevv� '710e-C 4,3-f/�t oyL NOTE: Under the provisions of Ch. 111, Section 31, of the General L ws of MA, hazard us material use, V storage and disposal of 111 gallons or more requires a license from the Public Health Division. J 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 se 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" 1 n (including chloroform, formaldehyde, CZ C,OL °tee 2I I b I � hydrochloric acid, other acids) VIOLATIONS:�-AA\) L1 COM4!D'11&,A� V�'f�i� C'�cjv�� `7 uviayeL,tA)�olQ . , ,MsI�S �ncc�Qfa 5 S. ORDERS: e-� co �25 D � 0 S -� � -� < a �¢ q . e,a.r uJ -L 0 k VV4U-e -V"V1Ak 1LO 11 + ;.n 13 C11L vac k-t' i V--��,�.tee. o n,l ' wta+I COP INFORMATION/RECOMMENDATIONS: c+,\ o & v4c I a ,4i c. - Vc I x v �j�.r✓�'�'O �'j`��..~ �C�L��`',P'-e,S a re,s��kS �r Inspector: La�.l1LIlL Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health S- This is to Certify that CENTER VILLE MOBIL 1734 FALMOUTH ROAD, CENTERVILLE, OH Is Hereby Granted a License �- For. Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- - WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 06/30/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable • ��t *°�ti Regulatory Services i Richard V. Scali,Director A��(j MA.%SL BALE. • �L�L�.t]Ll $ Public Health Division LE A fD1AP�1639. Thomas McKean,Director 'b 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 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$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE 5/19/2016 FULL NAME OF APPLICANT: Global Montello Group Corp. NAME OF ESTABLISHMENT: Alltown Centerville ADDRESS OF ESTABLISHMENT: 1734 Falmouth Rd., Centerville MA 02632 MAILING ADDRESS(IF DIFFERENT): c/o ECS Eclipse, 705-A Lakeview Plaza Blvd., TELEPHONE NUMBER OF ESTABLISHMENT: (508)778-2510 EMAIL ADDRESS: SOLE OWNER: X YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SI NAT OF APPLICANT Name: Wendy Morgan . Company Address : 705-A Lakeview Plaza Blvd.,Worthington,OH 43085 Telephone#: (614)433-0170 Email: wmorgan@ecsconsult.com C:\Temp\HAZZAPP Rev I6.doca: Page 1 of 2 °P IKE AG Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRM�LE.$! 200 Main Street• Hyannis, MA 02601 Fo3,9.�'�. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cew+e<�J,1[•e— M,k, I Date: 3 2 y /6 Location/Mailing Address: 1-13y Fat w�o,r1-l.,l2� , �°o►ti+• ✓vux 1 1: 6,1 bQr,o V"-,A,r•- Qo t Contact Name/Phone: 64eba.I rs.E•YIV.Co 54cve.Ckafrox- ,, S bane s 1 r,avlt. ' L2-4 1 f �/ S-b&-"7 7.!r-2 5-1 O Inventory Total Amount: ^� n�qa MSDS: ley License#: t t 3(� Tier II : ` Labeling: 9©D C��a� l Spill Plan: Y-9-6 Oil/Water Separator. Floor Drains: A 0 Emergency Numbers: yes Storage Areas/Tanks: 0,gww>k k<c&Atcet\vk-utowd&eq Covtkk%W. J-, &-J 0�5, Emergency/Containment Equipment: W%k S a-N 5 g ,\l �5 Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: NO \ ,tie a_ + D t � 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. 3 Antifreeze 3 Dry cleaning fluids \y Automatic transmission fluid l 2 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) I100 Windshield wash 2f.x6 = t%5?0?0 9A1,P-41 1.0 Motor oils 6 X3-t It 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 7, Miscellaneous Flammables le Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons 13 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) 3 Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: C.o o �yJ�g �, <vv►�S t� hcauG��/ o�,��a+�nN�u� Inspector: �� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1136 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that CENTERVILLE MOBIL 1734 FALMO UTH R O AD, CENTERVILLE, NC Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------------------- ------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. J 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO A,� Director of Public Health i - -2015 14:30 From:BARNST HEALTH 15087906304 To:O P.1/4 ~= -, Town of:Barnstable • �� Regulatory Services Richard V. Seah, Director } Public Health . � `p Thomas McKean, Director 200 Main Street, Tlyawiis, MA ()2601 =� 011ice: 508-862-4644 n`` Fax: 508-790-6304 mr� Application Fee: $100.00 ASSESSORS MAI"AND PARCI+L NO. / � ( � DATE 6/12/2015 OW, APPLICA'riON FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN II I GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Global Montello Group Corp NAME OF ESTABLISHMENT Alltown Centerville • ADDRESS OF ESTABLISHMENT 1734 Falmouth Rd.,Centerville MA TFTYPI-I0NT.NUMBER 508-778-2510 SCrLK OWNER:x YES NO IF APPL1CAN1'1S A PARTNERSTUP, FULL NAME ANT)HOME ADDRESS ON'ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAI,IDENTIFICATION NO. S'1'ATF. OF INCORPORATION FULL NAME,AND I10IMP,ADDRESS OF: i PRESIDENT fREASUR-CR CLERK • ST[TNA'r JRE OF APPLICANT i-TOME+'ADDRP.SS TTOME TELFPHONF # 888-674-7601 Q\AppiiclGun Fon icAHAZAPP.l7(Y' °F1HEr° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 . eae As�LE. ` 200 Main Street• Hyannis, MA 02601 1 639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT FD MP'�n Business Name: Ca4-1rv\(1-e- M ado,� Date: ✓ ✓S f5- Location/Mailing Address: 1734 V�-lw.e,rV, ✓ C,-,d-e<-14,- Mad : 6!1164rec, 1/eeoQ¢r- Roo-(- Contact Name/Phone: Mar- Rh1n��J��I, I�A�oha l Ce��,Q►� - S�f-e.�� CG�efl,� G b4i P't -fir FloI- �z� (ofo5o o� P -5'�0�-► �Sla �4y �zs/y c. Y+00+6Vt_ Inventory Total AZ n't:* ^-30o a MSDS: 0 License#: 1(�- Tier II : AJIA Labelina: ©K Spill Plan: o�oo�e,,-% Y�eS Oil/Water Separator: A31 A Floor Drains: Emeraencv Numbers. sae Storage Areas/Tanks: tioc,S}-a-(;c . +vec +otr Emergency/Containment E ui ment: 14 5 .1( 60 - ,n Vt S Waste Generator ID: a 45 31VI `zo 2 Waste Prod ct: Date&Amount of Last Ship ent/Frequency:-> a-< . e ✓ 1 1 1:30 1 ma sJ Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �0 Ywk' Of ��`�`g NOTE: Under the provisions of Ch. 111, Section 31, of the General Laves 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✓ht00 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 y Laundry soil &stain removers / (including carbon tetrachloride) (including bleach) ✓ Any other products with "poison labels" per (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: A W R yf2 O'I Co4AL, 5 �e.q o. ,I x- Wet,5ie a rem-= ✓1 , e(,M A dAJ<TE1A . a, o C0,7 I o 0 ORDERS: M616 Ayt ali _e_-- o d; +a a INFORMATION/RECOMMENDATIONS: 4- z I iS- AlliSS g 5-50 Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Please print or type.(Form designed for use on 91i.v (12-pitch) e Form Approved.OMB No.2050-0( UNIFORM HAZARDOUS I I-Generator ID Number 2 Page I of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST JiA L, 9 G B I _ T 5.Generator's Name and Mailing Address Genmroec,Site Address(if different than mailing address) Generators Phone: 6-Transporter I Company Name U.S.EPA ID Number 4t 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA 10 Number Z Facility's Phone: a f xv I I t ga, 9b.VS,DOT Description(including Draper Shipping Name,Hazard Class,ID Number, 10.Containers if,Total 12.Unit 13.Waste Codes HM and Fading Group(if an N 0. Type Quantity wtjvol. y/ LU Z 2. 4. 14.Special Handling instructions and Additional Information 15, GENEPATORIS!OFFERORIS CERTIFICATION: I hereby declare that fhe contents of this consignment are fully and accurately described above by the proper shipping name,art are classified,packaged, marked and labelediptararded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknoviledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanifty generator}or(b)(if I am a small quantity generator)is true. Gerierator's/Offeror's Printedi typed Name Synature Month Day Yea a 16.International Shipments I- D import to U.S. ❑Export from U.S. Pod of entrylexil: iZ Transporter signature(for exports only): Date leaving U.S.; Cr17.Transporter AcknoMedgmerit of Receipt cf Materials, U.1 Transporter i pr1ritediTyped Name Signature Month Day r Yea 0 Z Transoorer 2 PrinlediTyped Name signature /* Month Day Yea 18.Discrepancy D Full Rojeion I Ba-Discrepancy Indication Space El amity El Type El Residue [:],Partial Rejection F Manifest Reference Number: l8b.Alternate Facifiry(or Generator') U.S.EPA!D Number ua Fadlitys Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Ye; Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w 2. 3, 4, 20-Designated Facility(Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in stern 18a PrintedrTyped Name Signature Month Day Yea EPA Fornn 8700-22(Rev.3-05) Previous editions are obsolete. GENERMOR'S INMAL CO ;y M i TMC ENVIRONMENTAL �sNuitona cove Fie""�""' ``'UW`�5°2"� Drum Disposal Work�Oeder � �raxs�a.9� Asa a s t Challenge us. Count on US. Prepared:by:. Jay Wuoti � 1` + MCJob Day&,Date: r=Client: FM Facility Maintenance w J_ t. t-1 52763344 t Client Contact/Phone: Client PO#: - Work Order manager on du far signature I Site Contact/Phone: g _ . 9 T&M Depart Shop: j Robin CostaUl TMC Project Manager; €�Contract .. Arrive at Site: Scheduled Date: Friday January 30,2015 []Prevailing Wage Depart Sine: Start Time: At Shop On:Site Shop/Next Job. i P lVobil-1734 Falmouth Road Centerville,,Ma 02632 6 Job Location: i Scope of work: Upon Arrival/Departcre from' phone cia1888-674-7601, SR# 1-1252763344 ; Label and Load,1 x 55)Gasoline and.Spee~dl i Leave replacement Drum, loosen ring for store use K - j ' Have all paperwork signed. T& D to Northland Labor: Disposal: fi i Name Qty.; ,Hours'- = Qty, Type FaciJ'ity{ Manifes t, .r i ."" t •s � at i 55 gal Northland P0671 ' t ; Equipment: Materials =' Equipment Name Qty. Desc_IEq.# Hours Qty. item Manifest'FSM-026 i l - � Drum label Hazardous FSM-016 1 Drum class label:narpmable Solids FSM-016 1" - Profile i Description of service,performed:_ � e 1, Land barn t'"r V711t%A I g $ 1 55-gallon drum ` Steel FSM_010 3 � E Poly liner FSM-030 - a —'" '` Overpack drum FSM-012 { , . " <f_ 1. CLIENT. y r r THE ABOVE ITEMIZED MATERIALS, EQUIPMENT= Checklist AND LABOR ARE VERIFIED AS CORRECT. t ! 0 Agent for letter on file: t I Name/Title: Replacerrent drums needed#. `.� . a I Signature [:],Verify cortents of drums Da ❑ VerifY condition of container # 4 x _ r - YI Page 1 of 1 Lavelle, Timothy From: SCharron@globalp.com Sent: Monday, January 26, 2015 9:55 AM To: Lavelle, Timothy Cc: aduffy@allianceenergy.com Subject: Global Montello Group Corp- Mobil Station 2729, 1734 Falmouth Road, Centerville Timothy- We spoke last spring following your inspection of the above station. I work in the environmental compliance group for Global. understand that you recently inspected the site and that you are looking for a separate binder of just SDS' for the site. I spoke with the Territory Manager(Ashley Duffy) and she was able to get copies of SDS'for all materials used or sold at the site and wilA place them in a dedicated binder at the site this week. We have typically only put fuel and cleaning supply SDS'at the site because of our interpretation of OSHA requirements exempting the fuel supplies that are packaged for sale. As an FYI, in addition to the GHS training all employees were subject to when that regulation became official, employees additionally receive online training on various topics including safety related items. The drum barrels have additionally been picked up/exchanged. I understand the delivery company is being re- sent to the site as they didn't put the new barrels into the containment. Please give me a call at the below number if there are additional concerns you have. thanks —""h �, Stev,en D. Charron, PG, LSP Environmental Manager Global Partners LP I P.O. Box 549290 1 800 South Street, Suite 500 Waltham, Massachusetts 02454 781-786-6320 (office) 1 781-697-1253 (cell) 781-398-9270 (fax) e-mail: scharron@globalp.com 1/29/2015 n -i` Date: / / TOWN OF BARNSTABLE �.,o„— TOXIC AND HAZARDOUS MATERIALS R FORM NAME OF BUSINESS: b, I BUSINESS LOCATION: \?3`-f t alr�� , Ce�l�e��l le� INVENTORY MAILING ADDRESS: 44-v— — -ke a,`l*&c .era, I q,<, A% 11 TOTAL AMOUNT: TELEPHONE NUMBER: S05- -7 7 - 2S/ O �Gg 3 IJoriS CONTACT PERSON: n yr�5 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 945 5 ��1-�ow l�►tye n��nGe. s'I�T2 c�,� I aNFORMATION / RECOMMENDATIONS: '�/�vstebfg►►t �oww haaa�o�s � Fire District: IM_ �i�2�ia�s pcCn�.}� 2)Sj� ,�CoQy a�'SD�l1 Q larc w►t aQP�rvl } e,lla01��a�-�oK,, s) CerLfef�/�ll� dlous rJ4�t�cQ��►�s 5fore� e J¢�oor5 Mo6t b� ►K Slco,t�a c�/ coves►►1/►t2r1 4 �ISDor��►I aE?r,,�c. �fo�tl� t Dl�� enz��✓ �('J►� �vts�� ✓,e�locJ covl,�a►nru.►Z.-�- b�Zr��(, CJiaK�� 5Waste Transportation: OtaJ&I 1&10 ur, Last shipment of hazardous waste: Name of Hauler: 5 brt - Destination: Waste Product: oK y,6 Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws erial use, 3 i3 1� storage and disposal of 111 gallons or more a month reE a icense from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS r�'►�� lJr.D'� e- The Board of Health and the Public Health Division havmined that the follo`nring products ex iblt toxic or hazardous characteristics and must be registered regar Observed / Maximum Observed / Maximum ;Z7 Antifreeze (for gasoline or coolant systems) i Miscellaneous Corrosive l�J NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Mo or Oils 4 I A<J,-S Pesticides W IS L�USED r-y"1P�y� Sy , - P1I insecticides, herbicides, rodenticides 1,3 NE ( ) 145 Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) / Diesel Fuel, kerns ne, #2 hF. ng oil ❑ NEW ❑ USED cV%-cte.'"-1 1, }�,�.�r"' Photochemicals (Developer) Miscellaneous pXoleum products: grease, 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 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers 2 hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers �� may be toxic or hazardous(please list): Metal polishes �,b� S&+j��-e� ��JI�{� oyl �f'0✓✓►�Jl 1�. �'fo`�-S,L 2 Laundry soil &stain removers (including bleach) L,.— JY1-5b5 61v16&-< C.Vaz Spot removers&cleaning fluids /�,� (dry cleaners) IVA<*L ,�'wt,��o�'ee5 pC 145 )l06,0`�0►1¢ ?)Jv1 L Other cleaning solvents Bug and tar removers A) (het e,m qyi I Ce-6+5 (Ye e,L 6/f e- Fo 1$2> Windshield wash �� 6i.`�" -eA6`�' ee r5 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Sig ature Staff's Initia s Please print or type.(Form designed for use on elite(12-pitch).typewrlter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Nu mb WASTE MANIFEST U 1 L 2 0 3 GBF 5.Generators Name and Mailing Address Att:9.12�ie Chxroff Generators Site Address(if different than mailing address) 0,iobai Nidri(ello i3roup C'Etq; llcibil StAtdor,-*272� 410.41 V%fiar.,":'V��e-k. 3Uite 4-,6 i?i4 P84_rioud)Rr)adl �"";altnsro MA 0,245 MIA 0215!32' Generators Phone: 6.Transporter 1 Company Naffie U.S.EPA ID Number I'v! A R G 3 G 17...11 2 '1...2, 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S;EPA ID Number FadlitesPhone: Q f! A rT t t C1 A 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. 1110,,RCRA,am'.�PDCJT-;Di�-,,soiid5, 0 XV-00 Z 2. LU O 3. 4. 14.Special Handling Instructions and Additional Information 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled1placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. 'rratoes/Offeroes Printedrryped Name I I nature Month Day Year C, P6.4nternational Shipments 1:1 Import to U.S. El Export from U.S. Port of entrylexit: Transporter signature(for exports only): Date leaving U.S.: UM 17.Transporter Acknowledgment of Receipt of Materials 'W'- Transporter 1 Printed/Typed Name SIgnat1'--,, "I Month Day Year 0 1, 0" Z Transporter 2 Printecirryped Name Signature Month Day Year < 18.Discrepancy 1 Ba.Discrepancy Indication Space El Quantity 0 Type Residua ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 1 8b.Alternate Facility(or Generator) U.S.EPA ID Number LL Facility's Phone: Lu 18c.Signature of Aftemate Facility(or Generator) Month Day Year Z 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) U3 LLJ 1, 2. 3. 4. 20.Designated Facility Ow_oer,or-Operato&jQertific Fon of receipt of hazardous materials covered by the gfimfest except as notedlj6ltem 10 Month Day y arnf,l kSignature PrintedfTyped N A, EPA Form 8700-22(Re'v.3-06�Previous edgianTare obsolete. TRANSPORTER'S COPY T:a AM Pie r ppe TMC ENVIRONMENTAL V ty nedf ke(1 n Fy 1. Generator's US EPA ID No. Manifest Doc.No. 2. Page 1 BILL OF LADING f ITMC'. �0�2'� 3. Generator's Name and Malting Address -"M Chaff o 1734 Faknouth Road GPI Mofftft Group Corp. 4. VWWMM P48i Cerderv�e 02632 5, Transporter 1 Company Name 6. US EPA ID Number A,Transporter's'Phone 7. Transporterany ama omp 8: US PADI Number B. Transporter's Phone ArJ111 . . . . . . . . . . . _ y 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone GIMI CW"rft%LLC WChurch Sftid '618 438.8670 Shtppl g Name end Description 12.Containers 13, 14. No., Type Quantity Total Unit " a. UN12M,Gaoft Mb tM 3.PGN G b• E N E R A c. T O R d. D. Additional Descriptions for Materials Listed Above E. Handling Codes 1)(L)24 Ian&MMaW Rory► „ 15.Special Handling Instructions and Additional information TMC PROJECT #1012-003 RC L3733 16.GENERATOR'S CERTIFICATION:.I cartify,the materials described above on this manifest are not su iect to federal,regule ns for reporting proper disposal of Hazardous Waste. Printedrryped Name Signature Month Day Year T 17.Transporter 1 Ack wledgement of Receipt of Materials APrintedlTyped Nam Signature Month Day Ye r S0, R18.Transporter 2 Acknowledgement of Receipt of Materials F T Printed/Typed Name Signature Month Day Year O R 19.Discrepancy indication Space F A C I ' L 20.Facility Owner or Operator:Certification of receipt of materials covered by this manifest except as noted' am 19. T y n a Signaturdow.,111, D..J Year di _8 Y- 81 Oi in ORIGINAL-RETURN CO GENERATOR Ra W ., 81 81 ,_ 1 Page 1 of 3 Lavelle, Timothy From: SCharron@globalp.com Sent: Tuesday, March 04, 2014 2:58 PM To: Lavelle, Timothy Cc: Taronza.graves@gilbarco.com; aduffy@allianceenergy.com Subject: RE: Global Montello Group Corp -Mobil Station 2729, 1734 Falmouth Road, Centerville - Requested information by Town of Barnstable Public Health Div Tim - Below is the contact for the mailing of the renewal. f Taronza L. Graves-Compliance Analyst Gilbarco Veeder-Root Compliance Management Services 7300 West Friendly Avenue,MS F-76 ' Greensboro,NC 27420-2087 Office: (336)315-2888 Fax: (336)547-3384 www.gilbarco.com The later in the week next week to inspect the better,just to make sure the drum is moved. Also if you provide a date/time I can make sure the managers are present. thanks Steven D. Charron, PG Environmental Manager Global Partners LP 1 404 Wyman Street, Suite 425 1 Waltham, Massachusetts 02451 781-786-6320 (office) 1 781-6917-1253 (cell) 1 781-398-9270 (fax) e-mail: scharron@globalp.com From: "Lavelle,Timothy"<Timothy.Lavelle@town.barnstable.ma.us> To: <SCharron@globalp.com>, Date: 03/04/2014 10:41 AM Subject: RE:Global Montello Group Corp-Mobil Station 2729,1734 Falmouth Road,Centerville-Requested information by Town of Barnstable Public Health Div Thanks, Steve. I think that covers everything. I plan to revisit the facility sometime next week to make sure that corrections have been made there. i 3/10/2014 t Page 2 of 3 Yes, there is a renewal. It's an annual permit that expires June 30th every year. The admin staff usually starts mailing out the applications in May. If you have a specific address where you'd like it sent, please let me know. Tim -----Original Message----- From: SCharron@globalp.com [mailto:SCharron@globalp.com] Sent: Monday, March 03, 2014 6:15 PM To: Lavelle, Timothy Cc: aduffy@allianceenergy.com Subject: Global Montello Group Corp - Mobil Station 2729, 1734 Falmouth Road, Centerville - Requested information by Town of Barnstable Public Health Div Mr. Lavelle-- As a follow up to our call last week, I am forwarding additional documentation and information to address your comments on the haz materia inspection form. Waste Manifests: Attached are copies of manifests generated since we purchased the site from ExxonMobil in September 2010. Note that the larger volume liquid waste manifest was from the cleaning of the former gasoline USTs as part of a UST field replacement we did since purchasing the site. Spill Plan: Attached is a copy of our spill response directions we post at the site. I've asked our Territory Manager(TM) covering that region to re-train the new store manager on the location of this document the site. Permit: / completed the application and forwarded to Taronza Graves of Gilbarco-VeederRoot CMS, the firm we use to file all our permits and track their due dates. She was getting a check cut this week and will file the permit with your department on our behalf. Drum Outside of Secondary Containment: I've placed a service request with our waste vendor, TMC, to address this issue. I'm told that the drum was delivered and staff started adcing water to it prior to it being put in the containment, which made it impossible to move at that point. The TM w II remind the on-site personnel to not to add any waste to a drum not located in containment. Spill Absorbents Present in the Dispensing Area: The TM informed me that the store personnel have cleaned up this material. The TM has reminded the on-site personnel of the need to clear: up this material immediately after application to avoid impact to storm water. Safety Data Sheets-Availability to Staff I checked with our TM and she informed me that after our fall training on the GHS, she obtained copies of SDS' from our vendor that supplies cleaning supplies to the stores (Industrial Solutions). These SDS' are stored in one of the three compliance binders we maintain at the site. I believe this addresses all of your concerns; please advise if you have any questions. Also, could you let me know whether the permit issued will need to be renewed (so Gilbarco can add to their tracking)? 3/10/2014 Page 3 of 3 thanks Steven D. Charron, PG Environmental Manager Global Partners LP 1 404 Wyman Street, Suite 425 1 Waltham, Massachusetts 02451 781-786-6320 (office) 1 781-697-1253 (cell) 781-398-9270 (fax) e-mail: scharron@globalp.com 3/10/2014 i Town of Barnstable Office: �-864644 Public Health Division Fax:508-790-6304 98ARMAT,S L .�" 200 Main Street• Hyannis, MA 02601 '639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT )EG MA'S Business Name: t) Mo5 Date: Location/Mailing Address: -n14 R Contact Name/Phone: s0r-115"Sfb Inventory Total Amount: �,6� o MSDS: License#: 11S Tier II : 11,o Labelina: Spill Plan: Oil/Water Separator: glA Floor Drains: Emergency Numbers: Storage Areas/Tanks: gi I f IK Emergency/Containment Equipment:— Searx 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 any NOTE: Under the provisions of Ch. 111, Section 31, of the Ineral Laws of A, 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 ch'iorinated 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: INFORMATI N/RECOMMENDATIONS: Or M V ` it '10c) a Inspector: kJ9K Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS r Please:ptiftl or Form App[oved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.GeneialorlD Number 2.Page 1 of 3,EmergancyrRespitnse Phone p Number 4.Manifest Trackin p c WASTE MANIFEST M XJ �'A D S $,, "Z .8 ;5=..� Q SM8994672 5 U 9 GD( 5.Generators Name and Melling Address Alt.lemle Cook Generators Site Address(i€different Olen mailing address) aGi= ,GtO CO -ARM-OM729 +,173r0 Falmouth Roed � t CenMPf+one1MA.02-454� n 6;Transporterl compalrytTaft ��p/+ �..w .�{`�+ _ U.S SPA ID,Number tt, 'NWEeld Env�nretitiiifSery, .��i� i�i,°¢ � •ma 3 m>.�.�_.:f"'wr •o-, _.'' r .Ap, 0 \ C - 7.Transporter 2 Company Noma .- ..� s. U..S.EPAID ummber� 5 a B',Designated Facility Name xW Site Addrasa U.S.EPA ID Number ' r °ENF!RO EI IC S OF VERMONT;,INC.,,. �1'U t�NJE 14, fML1.18TON11R Il548;S,+ iact►1fq ..�' .•�- � • ga 9b;U S B6T D9Sdhphon`'6nG;,ng Pieper Shipping Name,Hazard Class,ID Number, 10.Containers. 11 Total 12.Unit HM and PadQn9 Group('rf any)) No: Type Quantity WI.No 13.Waste Codes L 71 a; � �+�1R�QsL�UIhV3y.`176,VINE SOIId3 toit�lr►��mmb quid n Q.s. ,° ; f E'YtYIr rr7. `I11 ''h► r1 F' Sx I "; iyt%y.. q' +s t'rr"�":;+it py{`,;+ d. �`^. i sS 001 i1�,p► P �P�`�� kVriY�YrY9s VY+3V,tffl�lOpJIN9Q g{\iBitt,*r t�,p,��, li€i,°Fs� bd �,'� k R �,+' � � +� a �6•Ybr�� .n i».,a d a�xff�> dry � +;�i �':� � :� Ii17yf�`fD nZ�rle�lQl1lt�bFlA)�`� °t 43€ *ram^�,` �». „+ ® ;w, s "n z _ �r 4. . _ 14.Specie Handing Instwoons'N Addifionaf In am)akon C . t }F p(%Q_ NT-0Ow>�l°TOW1 )1 ERC#133 2)(L) if b ( c�cENa �, 1314)r7a i2wsFtPi O 15. GENERATOR'$IQFFFROWS CERTIFICA710N: I hereby declare that the contents of this consignment are fully and accurately descriCed above by the proper shipping name,and are cdaSsilEed,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the Contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. i'certify that the waste minimization statement identified In40 CFR 262.27(a)(if I am a Igge quaniity generator)or(b)(If I'am asmali quantity generator)isbue. Aelaku°sR)fferofs driyped 1 Signal.4 Month Day Year AA j 10:1 emaUruretShipmeri� Import to U.S., ❑Export from U.S., Port of entrylexit: Tierl9pertef`stgr ature(toraiyrdtte.only) Date tpwing:U,S 17.Transporter Acknowledgment of Receipt of Materials Tla ptxteri P led/Tyllf ,tgna Month Day Year Gail Tra � r � � ns t 2 Piirltedlt Hama. Month Day Year. 16.Discrepancy 16e.Discrepancy Indication Space quantity Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Referanoe Number, r 16b.Alternate Facility(or Qo.naretor)' U.S.EPA ID Number V 1,!!dkly t Phone: w IftiSignakre ofAhemaW Mo w(or@mearatdr) Month Day Year:: �. 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and r.ecyd k,4 systems) 7 13. 4 1 (� - t h20.Designated Faclliry Owner or 0pa Wr Certification of receipt of hazardous materials covered by the manliest except as noted in Item 16a O Pnn Name ature WO Day year c EPA"Fomt 8700 22�Rev;12-17) PreAoys edifions.are obsolete. DESIGNATED FACILITY TO EPKs'e-MANIFEST SYSTEM I E h i r Us 0 Drum Disposal Work Order Prepared by: Thomas Jordan client: Global Montello Group Corp Job#: 146855 Day&Dates -246 lient Contact/Phone: Client PO #: Work Order#::1-4658308382 ite Contact/Phone: []T& M Depart Shop: _. RC Project Manager: Contract Arrive at Site: 2 IQ cheduled Date:,. Prevailing Wage Depart Site: 13G� tart Time: At Shop On Site Shop/Next Job: fiSRD Job Location.Mobil #02729 -1734 Falmouth Road, Centerville, MA 02632 c pe of work: Upon Arrival/Departure from ell phone dial (888) 674-7601, SR# 1-4658308382 abet and Load (1 x 55) Gas Solids, and (1 K,55) Gas and Water.. rop off 2 replacement drums. Loosen lids'and labels. ,ign Paperwork "As Agent For". Have Stolie Manager sign DWS. Labor: Disposal: ame Qty. 1 ours Qty. Type Facility Manifest# Gas Solids EVI 006247509GBF Gas Water ,EVI 006247509GBF Equipment- Materials: quipment Name Qty. ' Desc./Eq. # Nours Qty. Item ,c- ( 1 Manifest FSM-026 2 Drum label Hazardous FSM-016 2 Drum class label Flammable Solids FSM-016 Description of service performed: Profile Land ban 2 55-gallon drum Steel FSM-010 Poly liner FSM-030 t Overpack drum FSM-012 2 Drum Label - Non Hazardous FSM-016 2 Drum Class Label-Flammable Liquids FSM-016 _._ Non-Haz Manifest __ ... CLIENT: THE ABOVE ITEMIZED MATERIALS, EQUIPMENT hecklist: AND LABOR ARE'VERIFIED AS CORRECT. Agent for letter on file: Name/Title. JC.f Replacement drums needed #: Signature Verify contents of drums 13 Verify condition of container Date:_ 'a�.....-. Number Fee 1136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CENTER VILLE MOBIL 1734 FALMO UTH ROAD, CENTERVILLE, OH Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------- -------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/3012020 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 Inspectional Services BARNSTLE Public Health Division �' '" ''" • g 8„ Thomas McKean, Director r 200 Main Street, Hyannis,MA 02601 Office: 508-862-4W Fax, 508-790-6304 t a4 APPLICATION FOR PERNIIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALSy 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 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 RV Gr *A late charize of$10,00 will be assessed if paw is not received by July 1st. P f 2Lf i12 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,YNDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: Global Montello Group Corp. 5. NAME OF ESTABLISHMENT: Alltown Centerville Mobil 6. ADDRESS OF ESTABLISHMENT: 1734 Falmouth Road,Centerville,MA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:ATC Eclipse,705-A Lakeview Plaza Blvd,Worthington,OH 43085 S. TELEPHONE NUMBER OF ESTABLISHMENT: (508) 775-2510 9. EMAIL ADDRESS: 10. SOLEOWNER: X 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: Lauren Robison-Authorized Rep. for Owner TELEPHONE#: (614),433-0170 COMPANY ADDRESS 705-A Lakeview Plaza Blvd,Worthington,off 43085 EMAIL:Lauren.Robison(1,atcgs.com • SIGNATURE OF APPLICAN&w�'L �DATE 05/20/2019 Q:1Application FonnsTaz Mat App Revised 09-10-18.docx r � IRV e e The petroleum industry leader for compliance and fuel management. May 28,2019 Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 RE: Hazardous Materials License Renewal—Global Montello Group Corp. 1449 Iyannough Road 1734 Falmouth Avenue To Whom It May Concern: ATC Eclipse is an environmental and compliance consulting firm retained by Global Montello Group Corp.to assist with their storage tank compliance program. In this role, I am writing to renew the Hazardous Material Licenses for the above-referenced facilities. Please find enclosed the documentations and remittance needed,as follows: • 1. 2 Hazardous Materials Applications 2. Remittance in the amount of$300.00—Check#124425 Our client requests that the new permits and future renewals be sent to my office at the address below for processing and distributing to the sites: Global Montello Group Corp. C/o ATC Eclipse 705-A Lakeview Plaza Blvd. Worthington,OH 43085 Thank you for your assistance. If you have any questions or need any further information, please feel free to contact me at 614-433-0170. Sincerely, ATC Eclipse Lauren Robison Compliance Analyst Enclosures 705-A Lakeview Plaza Blvd. Worthington, OH 43085 0: 614-433-0170 F: 614-433-0217 OATCGroupServices.com Number Fee 1136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CENTER VILLE MOBIL 1734 FALMOUTH ROAD, CENTERVILLE, OH Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------ --------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 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 r l6a4(08 Vwofox� Brnstable egu atorp Services ofYKe r Richard V. Scali,Director Public Health Division BARNSTABLE - 1 = 9n NIAS etE = Thomas McKean,Director 1639-2014 'Dreo �° 200 Main Street;Hyannis,MA 02601- --— ----. - -- Office: 508-862-4644 c3L 16 Fax 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIAL'S 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 Ist—NNE 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 v'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. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SHIP 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: Global Montello Group Corp. 5. NAME OF ESTABLISHMENT: Alltown Centerville Mobil 6. ADDRESS OF ESTABLISHMENT: 1734 Falmouth Road, Centerville, MA 02632 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVEATC Eclipse, 705-A Lakeview Plaza Blvd.Worthington, OH 43085 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-2510 9. EMAIL ADDRESS: 10. SOLEOWNER: X 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: Lauren Robison-Authorized Representative TELEPHONE#: 614-433-0170 COMPANY ADDRESS 705-A Lakeview Plaza Blvd, EMAIL: . Worthington, H 43085 SIGNATURE OF APPLICANT DATE 5/14/2018 Q:1Application FoimsIHAZMAT APP 2017 REVISED.dom Number Fee 1136 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that CENTER VILLE MOBIL 1734 FALMOUTH ROAD, CENTERVILLE, OH .� Is Hereby Granted a License � For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------- -----------1------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- This license is ranted in conformity with the Statutes and ordinances relating there to, and g h' , and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN V DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI y THOMAS A.MCKEAN, R.S.,CHO i Director of Public Health I �-- �d1 Regulatoryowr of B4rnstabl e ervices d3aa-- Richard V. Scali,Director oF�'4y - i Public Health DivisionTE � ` �aas�ams�attRear.€csrutr-H��. BABNSTABM Thomas McKean Director ° 7 MASS. A ) 283➢-2Q34 �'Driro "`0 200 Main Street;Hyannis,MA 02601 Office: 508-862-4644 eAlq-6D/9 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 El CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 IN *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Global Montello Group Corp. A ,�I,, 5. NAME OF ESTABLISHMENT: Alltown Centerville P W COI ��—�)I�� l I 6. ADDRESS OF ESTABLISHMENT: 1734 Falmouth Rd, Centerville, MA 02632 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:C/o ATC Eclipse,705-A Lakeview Plaza Blvd,Worthington,OH 43085 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-2510 9. EMAIL ADDRESS: 10. SOLEOWNER: X 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: Sarah Beaumont A..+V, tggg. TELEPHONE#: 614-433-0170 COMPANY ADDRESS 705-A Lakeview Plaza Blvd, EMAIL: sarah.beaumont(cD-atcassociates.com Worthington, OH 43085 SIGNATURE OF APPLICANT At� S �-- DATE 5/24/2017 C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx ti. TOWN OF BARNSTABLE � �GA3 UNDERGROUND FUEL AND CHEMICAL - GE S S � A- �C �--D NAME o b c.► ; 1 3 � alZ, (fit-�S) ADDRESS �5�� A� o�*'� VILLAGE c-t-'►�e-r' LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: t ff OR CHEMIC/�AL p d g ► ' v I O .-Z. (Give same information for any additional tanks on reve se side of card) DATE OF PURCHASE OF EACH: a 8 3 2 f 1193 3. 19 8 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS Ci-P7 .70 n�, use A p p R 0 V E D Barnstaile Conserrv�tiva .omission signed is TOWN OF BARNSTABLE --� UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS D f NAME Mobil oil Corporation ADDRESS 1754 Falmouth Road (Rte. 28) VILLAGE Centerville LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL West side of building 5, 000 gasoline 10 steel West side of building 10, 000 gasoline 11 steel West side of building 10, 000 gasoline 11 steel East side of building 500 . waste of 0 s ee West side of building 1, 000 fuel.,. oil Atiie 11 steel (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 1971 2. 1969 3 1969 4 1971 5. 19 6-9 DATE OF FIRE DEPARTMENT PERMIT: 3/21/6 8 ; 3/2 4/71 TESTING CERTIFICATION SUBMITTED: N/A - Age of tanks less than 15 years. PASSED DID NOT PASS NAME LOCATION ��. Mobil Oil Corporation 1754 Falmouth Rd, at Old Stage Rd. 611 North Ave. Centerville Wakefield, Mass. 018$0 BOOK & PAGE _ DATE GRANTED AMOUNT STORED 37/112 2/5/32 77/90 11/17/60 addll. 77/195 3/21/68 addfl. t 77/245 3/24/1971 add1l. 5,000 DATE PAID 1973 - April 30 MAR 23 MAC > 1974 FEB 231977 M,k' ,975 MAR 8 19l8 TAR 1 ' 197 - - WA tA T-T- illl L WAA; D. Mou T U M I s- ...$lt,�."sl IV- vl iiS 'fie 7,r ' g 541 tl J1.v.dir I y Y J 05 E P C. PETAJQ�-11 ;IZA V; ol 47,63 n. 41, W Oil �LSOLIM '-,%pA C(L .CT A 4, 7,P;- (114:i 47:lll I UV(06TS 47, 5 E DE TAI L) 6 I N2K 1 n- pC >IA In Jg . ..... ..... L E %,1W y 46; W. •w +JYFl -k;�.':-� 'r_%47 Ali -A ---'F is I rir.Yf,,�t X4. .-.' ak P pT IN- fvj 404 Wil -51-i 4 11;1, i 11- -, P , u Yi I......... & Ak r V ' TOR P, WT OUT, I WA, .7 -bg, LOP 400 w-,TW1 W FWTUM- LIT d MOP/ . A �w Pe.Jry U . `• •, s 3 4 t.,f rJ. ' lZ a`}� r-k ,y t. ,sa,�y�r {rAyt '.�s r ,�+;,.,,y .,rw tt ,�1. }et t :{t € �, � �7 { f �t t f. ( L: 3 • rr � ti 1 _ L ;1 `eC l�. ry Yh. } f aE:' \ ! , 1 4 • f • FINISH F it 20♦/rA,1/r � t YVto N31 ,• `, 6 'ntA')'PST t- - f e EXTQA HEAVY ClF IIJLET 4fi "Er,,, ;t „ LOIJCt` BEIJb'CL� C.I. TEE j LEVEL e,.,,s..r}�'�"�"" a l r t f• .. .. J i OUTLET.TO. • a t+"3' r vf'�'e ns 51 r f 1x ,•EMA HEAVY t C.I. PIPE ' 4 8 ,to.ZED Iu'PLACE COIJCeETE; Bp SOLID s� r•C01,ULTE:BMS W1 FULL MOURED JOINTS j> s SFpp `b HOW.'AI{1D VEQT•,PLASTERED IfJSIDE. J ' `` ftMI - Pe RED ICe Y/ e�\r� . ///�./y��k'�J a,1 IIJSI PO A ric DE.,. QTLAUE) CEMEUT M02TAe -:,' .r •tea R."pig ` J' 4 sx -T " SMALL CUISIST .t L.AWDSCAPE „k OF I PAQJ 'Cf�1EIJT AQEA '` P Ql" 1JD, ' C,COM. { t,�,fz ReTS I BAUD. CEMEUT Bela HOLLOW COWP-ETE CJWDR Qb o U QY �/■� y^n 1,y^1 •y�sy�,. Y zt -..e•f brE 'ffi' .tC,, -Da Tf W ri l,7•'+T IWT rr �C�TE• a b t.J f li 1 ..`r .NY¢ +}'A f �hV t S �T L F BE USyD - .. .. «�4.1.'-!�ts�kx i� wtl a��g. r•{ ++X^,ta'�.� (;{t4 4 �`}� t G LICQETE COIJSTQUCTIOIJ SNAI�� BC IU ACCOpD ,iCE UIITN THE MA•SSAC14USETTS : FUEL=CTAS �LUtulBit. COC :� .r"} s o i tt rF E Y 5 f k+ r 5�; a {t4"D13 xt "L � tf iF�,at"I�;}r.'` - H »*sew ; C ASOL�N y OIL SEPA AT:O ` BELow 'Y J '7LL,.w , r .t � �y rc f ''.".b t r�lyv�a{ �'A �•i.fw+�t yy .J � `� f t 4 . y iS6J. lM � � f s{f �rti x T��A]: p D�{" rl 'i d s• k.,t ` elfs S`D�TA ` i 1 ip,Jfi 3 � r< ki A✓ t - �t�T� t�;(�t,e v d+��';.SC!�# r l�j �yxr• t 5^ is Ak i � �- � e,y, Ytg m ��.�+,-i ya'r�J .��, �_l r'Jf1 r} 4�`t,x flx��S y?t.t�1'�4. x + ! 3 } s �• J , A -ati sl''4 tf .( tti% t,�� '�.-t d� �"��+a'2,#y'�,�r-}; r,•Y'�'�.�'r,�� s's'#c�sdd',r a�{ 'rJ'�q �4�- 1' !,? ' ;2 } t I -. 3 yysy,y _Ni;}:,4; Ty» ,'', � "`'�' P•�!.: �t rJ''' v S t` J : !: s it .,.t 5 `` :t . a , ,>;.raf xe �-�" J.. ��xy+,,wF�'Yrt�r,� z,�f:�Y,a'�t,� 4df'�Slfs 'v. r• :_,} f - �: 7 ; e J -, t{f j v Jf.', :{ �� :. t� - `,1 .X t,;�tx•T f }}.��ht }yv��t�3(t x ei✓`�! k t r, _. `� J.�k4 �, „� -�.,? w' � *� §`*..r•� Viz° -ti $,p a�St ty'Y'•�•�' �rkt�,,�her "{' t�i F c f �; - p t,. 4 N� } Y r: •a{{{,,, 'f i-�a-�,b Y'• ��uMr. ?d y,J ( ,t J c 1 1 r N. } � 5 �. ? 4 Gf "'3• �({I�n.., dr s {p.•''r z 1-� ; '� t - t- t i t 1`•` 59'�t .�31p s T•`r3Prf*y • "-I? t 1F411it .t sit t '�i!`e 1 { r��Hy rt 1"e: 4 �r1f.t7• ^' L,A.,!'�tnp">F .l ,Y f" s ;tl�f 1 } ' 7, J.V/ Y "•a r �' f J +a ',, {y�y��r�iM�z st�f{y, r,'fy's , .r}74r,t�'�,c ,.j fa sts�.,,t�l �-,F c 5 � , s 't n !- t � fi�'CPe'�, � ! r! - 1 .k Y 4x, t E +' j{ P y .:.� •r{'•.y X+2 ta. e .ex�P.d ya b�^ya ,yyy � 2 ►i:Li�' , J ,.1 iY td J4 e { ¢t .t •' tfi 'ry s{F - w; ,•s.". i .t PEh 345 ZEST MASTREET ECCO, INC. NORTHBORO IMA SACHUSETTS 61532 TEL: (617) 393.2537 SERVING THE PETROLEUM INDUSTRY EQUIPMENT SALES, SERVICE. INSTALLATIONS UNDERGROUND TANK OR PIPING AIR TEST REPORT— ---.----- L /vJOLaIL: LOCATION: ; j; r / �`/� '' DATE � Product Tank Prod..-:level Water level Time Pressure "Chancre Size start finis start finis start finis start finis rod.wat r i. ' I i. ( :MARKS: MECHANIC: THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA S 1 I R ERFORMED O i' I I PUMP,LIFT,COMPRESSOR.ETC.) ORDEWORKR NO. A li ; ';'WORK REPORT CONTRACTOR f J !< MAJERIALS USED-INCLUDE DESCRIPTION AND QUANTITY LOCATION DATE 1 334 1S4 2 OSMS N 0 AGOSTINO 0 RT 28yOLO. STAGE NUMBER C E IFT R•L E RA 0261.2 8 0 ARHlypl DEPARTURE --CMR TRAVEL NOUNS HOURS NOUNS (� NAME CLASS TIME TIME LE SIGN TORE THIS TO CERTIFY THAT WORK'WAS SATISFACTORILY COMPLETED IN INDICATED TIME. ,CO4062 na V to SENDER: Complete items 1,2.3 and'41 T C Put your address in the"RETURN TO"spaee.lbn the 3 reverse side. Failure to do this will prevent this card from W being returned t.-4 you.The return receipi°fed&ih Orovide 00 a you the nrme of the person delivered to and4the,date7of. —� delivery-For additional fees the following services are available.Consult postmaster for fees and check boxes) < for service(s) requested. 08 1. KX4how to—horn,date and address of deliverv. w 2. ❑ Restricted Delivery. 3. Article Addressed to: Manager Henry's Mobil Station i 1754 Falmouth Rd. CENTERVILLE Ib1A`02632 4. Type of Service' Article Numbev �❑y�Registered ❑ Insured P 522 444 257 XXXertlfled ❑ COD ❑ Express Mail Always obtain signature of addressee or agent and DATE DELIVERED. 0 5. Sig at e— Addressee j ako 9 X / - en 6. Signature— A t. m X 7. Date of Oelieryj � t,% n� p 4 6 to C Z 8. Addressee's Address(ONLY if req u5o m t" m UNITED STATES POSTAL SE j OFFICIAL BUSINESS SENDER INSTRUCTION r�. ' �'` -�- ■""`°'" Print your name,address,and ZIP Cdde'r� he' All-- space below. `�i^ �• r...- —�_ �o "'�----`". • Complete items 1,2,3,and 4 on the ra'v"- • Attach to front of article if space permits, PENALTY FOR PRIVATE otherwise affix to back of article: USE,$300 • Endorse article"Return Receipt Requested" adjacent to number. RETURN TO BOARD OF HEALTH- TOWN OF BARNSTABLE (Name of Sender) P. O. Box 53.4 (No.and Street,Apt,Suite,P.O.Box or R.D.No.) HVANNTg MA 091;01 0534 f' (City,State,and ZIP Code) I P, 522 444 257 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Se M r., Henry's Mobil Station v Street and No. d) co P.O.,State and ZIP Code O d c7 Postage $. to * Certified Fee. Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered c" Return receipt showing to whom, o� Date,and Address of Delivery T TOTAL Postage and Fees $ 1.65 U. c Postmark or Date E E Mailed 3/5/85 0 F, STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1.`If yotr'want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article ley ing the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) v 2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card, Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. i • I• 3 p` a . ` i„` ,.yr; •e � ` .-� S - r ' d W` �`•,� t ; •. ; + °��. f .��3t-f� u �� a is � i4 ,r.� °'�� i 3 � '� Sh r' �h .' 1 .> . .r f r4r f aF ° riF ♦'! �: j r: �,. ��. ^c�• [yf y ?,. s i. r , !, f >.,.� a rir �q'-y 4 J r�• g «'s 4� y r,c -ii �,3'.�> �`�": .. _ f .y � _ _ "_ ifr;'. .:r ._,.• s;�• x,_ 3 "... r,.a C y sa' s +$ . i c. _ + - " i. •c ..i >i> • S � �s .�`..•rj' � "F }r .a-. ; v =. 'A- t :;y � 4 r�" � ! - - � 4 r { '. ., •cri 1 .µk"Y"`* r !. .' x �. Y'•f�,�1 r x • ;ac � :� ri:' >r. a «•- i � s- ♦ 4 �'•� ,r+P ',5 qN�w � '•y`� tr�:-��h !°' .- a � ' "" r � .• t W � ".aik.e ,�, >{kY: �` l'?��_ r 1"'�;:,'�+_ '+d� t•�e:'� ",� a 3 A` t ,t .: r •Ls.,} f-'< r s. `�` . a ! �rcw ,t ..-' ite.t +«c i'f's f5+.i,-1 , +•-�� "I 2 ! ,.•f � ',Y�. Y[ v. ,s Ems"+.• s f .SA', 4:h ,� ° .. �.;}. : P cy ° :� _r i =, rS P;- s ,j s v ! � �, &�"",h �{ kr`n '. �ew''�r.. ra � r' y w .{ z♦ r.�..4 _:March 5,{19$5 .'kI Ir �$.. , ." x i r., •�:. y fa rP' + i..c a d ; '' .�a3-. ' ,�, r a - a. �•-c, r3 r a S• t t�, .' t:; »:.i d 4 "` s 4 x ?"e-i Manager a f KHenr 's MobillStation t " 4� "F ,a , • 17.54 Falmauth•:Road a 4 � rile M r Cente v 1 A 02632 ' . k . Dear�Sir i ,4-7'- .� ! d•.. r i fills`^ >�> t v ' �; :'f3- "" ,i 4, Y. '.R .i,. r•r.. a #�,^, fi r4.. l;r} '` ! i s -�. &." r yr -r ... a };•> �� ;our recor`dg Indicate that you have aq i,000 el oil unde �und tankoa :the` , s� :>west side otL the building at 1754 Palrriou oad, Cervitle,'v hi is sixteen'{ears,.; of age. $ i A' 4 F• 1h f °. kTR ZR C S, f ri h2 F i "� >.' •' ++• - t. - r �' _ r . ♦�� [ S a �� >. rf' a � r�l � i' + irF'r y> �tT Townlyreguiations r64uire'all tankstfi years ''f a e, ,or'older, to':be tested usin g g ' a the Kent.Moore;Pressure Test tirtif =th }. tik empty, 'a 5`PSl'=Air Pressure TesC " may'be used. A•copy of,our regulation is a {, �"°� ",� �� •'F� ,,,:�fif., ..� .-• "r r•f '•• w > •..rs v 9�r'. ,� �•.. You"are:'directedi to have s tank t a t d by a 1; I985. °Please submit�Cesting _results and. their inter re ion id."this of xprio June 1, 1995 t�♦ ' A -+ a _� �'--'• P ': ,• �j, f1C,,. ,__.a r" Failure to< o so°could. r it in$legal.acCio and 'the_penalty of a'fine:;'Each separate _ '_ 'days failure Co,comply w t' an order shall nsfftut�-a separat':vio aEion y ..• -r'.oA !,� + '� _ _ ',tq c�„ a i'"A, } •-w,. �° * Ott z' r.. d '".� � i� -,i" r `'4 '� F,'r : Yourmay re > a ring u re t and df Health if;written petition requesting s <sae fs re dowith n-�seve n m r aftereceipt of this order 3 `' "c'LL;~' t r. , ' ,y aa`' r .? - 'f, P$ ♦e i F v-.,� f ° For 'you onvenience w x_r fy • have enclosed a' listing of :coFt�panies� whop perform :.this `f ' r `testing, ou may utilizea tother concerns qualifiedtoAperPocm this'`testing ., r . 9 �A -:� �. - � !yr .•�� rti 3, `-" y, n; i> "� f ry+a "Very•"trul ours;, i, _ '' > .4`a r�r: . > + 4 .'.. ,�' ry 4 - •f P' -fx k `4r, �t•• P ;a �r.. . �r �.. .E a-.. a rr-: .p w' � .d'! ,° x•.+ s -•e- s, zf:,1. � ,�, � -��t r �[1 �;,�:. �"J. s' c �'. ♦p r � s t'r'. 7 •. �3� �.* ^t:.. _- � Y♦ !"..'� � .c, - n B � -;.,,r �. f �,� ¢ *..t, 2 �_ r.•i� � t' � 5�.Y c +r '{ m _ y--.. � ;" ..,XA Y. °i � � ,'.� FP'.x° r John M.Keyl Diiector of2 'ublic>IIealth n } r r for _ r -'Robert t.Chiltis, Chairman f, _ ♦t Ann°Jane 'Eshbaugh t a - D C !. !« f E. rr c• P . f Y $r i r + .... r ..`tom � C S"$r*� 5 :.fix !' e :� rt'r Grover.C '-M,. Parrish, M- D a Ji Y -, r `BOARD OF`-HEAITH° TOWN OF,BARNSTABLE JMK/mm � encl..•2 d�,.�..♦bd� ,f ;t tL.= J; f. �^ �-P y t _ - t- Z �y �`t r - - a,� ��• ta. � - f i• .' ` ' A� ..'� -i r � S i -' v + 'I' uenterville t Mobl Oil Corperation _ V 6 i F A TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY ,-� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ` r Class: 7.Miscellaneous /Y1IQUAN ITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MA ER S Drurns Above Tanks Underground Tanks '00 IN OUT IN OUT a _ T #&gallons Age Test Fuels: asoline, #2 (B) AeftV ` 1 // rTA Heavy Oils: i waste motor oil (C) l {i' new motor oil (C) transmission/hydraulic,;3� Synthetic Organics: degreasers Miscellaneous: &�� A& ;W�, s,a,a DISPOSAVRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply L O Town Sewer ublic On-site OPrivate 3. Indoor Floor Drains YES NOZ O Holding tank: MDC O Catch basin/Dry well 0 On-site system Cr 4. Outdoor Surface drains:YES VNO ORDEIfS. ' O Holding tank:MDC " Catch basin/Dry well �7, f--- O On-site system 5. Waste Transporter I &-far- Name of Hauler bestination Waste Product YES NO 2. V, P s n ervie Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: vAME OF BUSINESS: � Board of Health MAILING ADDRESS: _/'`�;V 6!� , 4In%7 � Town of Barnstable t TELEPHONE NUMBER: 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: t 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 store --'- Please put a check beside each product that you store: V Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants #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) 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) LZ Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business t r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: �e11ry5 /'Gv�i 1 '72q MAILING ADDRESS: 2-3- Cen'fie r-olle•, TELEPHONE NUMBER: ,r7�5 -23-6 S CONTACT PERSON: *nry 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 ny 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: Si�ri►� 0/1 TELEPHONE: i 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasline or coolant systems) Refrigerants Automatic transmission fluid Pesticides (insecticides, ; . Engine and Radiator flushes herbicides,rodenticides ) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease reo , Swimming Pool chlorine lubricants Lye or caustic soda Ii Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored i Rustproofers Car wash detergents outdoors) {{ Car waxes and polishes PCBs Other chlorinated hydro- Asphalt & roofing tar carbons Paints on , tetrachloride)varnishes, stains, dyes (inc.carb I Paint and lacquer thinners Any other products with j Paint &: Varnish removers, deglossers Paint brush cleaners "poison" labels (including , ' Floor chloroform formaldeh de& Furniture strippers � hydrochloric acid, other j Metal polishes acids) Laundry soil & stain removers'— (including bleach) Other products not listed Spot removers & cleaning fluids which you feel may be (dry cleaners) - E E I V E ® toxic or hazardous (please Other cleaning solvents HEALTH DEPT. list) g TOWN OF BARNSTABLE I Bug and tar removers Household cleansers, oven cleaners ' Drain cleaners Toilet cleaners l Cesspool cleaners MAY 8 1g81 Disinfectants 1 Road Salt (Halite) i ' - TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL bF TOXIC :AND HAZA OUS MATERIALS - INSPECTION SHEET 41 FIRM ADDMSS`:. `d . Major types of materials: 1)01 2) ,Ru 3) 4) 5) b) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal lass a er lastic • .� ,.� ,� � P P P cans,bottles,jarsl� .� drums,barrels f aboveground tanks :k p tan underground ks {, � � p. , F � . bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility v/or.# Remarks/Recommendations 1. Indoor a) separate, contained room - b) stored in general work area •i) . inadequate-ventilation i ii)Jloor--drains, i i)= inadequate-`f-ire=protection- 2. Outdoor , a) ,uncover-ed ,_ exposed:,tz w:eatherf j F _ - ti)'geruious surface/catch=basins= III. Disposal A. Reclamation/Recycling unit jr B. On-site disposal -1. Town. sewer ` /1 2. Regular septic system A-4-,_i 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 f�S 1 Person(s) Interviewed ► Inspector "_ _.- - - -d�"E-. - =..- - ,/� L Date . , — fl - - - - - - .�=- - - 1 CENTERVILLE-OSTERVILLE FIRE REPORT ALARM 71' INCIDENT LOCATION j TYPE OF CALL-..".—11JVI(, REPORTED BY:.: TELEPHONE: (� ADbRESS: N�._ AT SCENE: TELEX: DATEITIME OF INCIDENT: MO: DAY: YEARj� DAY OF WEEK: DATEITIME. OF IN TIGATION: .(�,'�„e„ DISPATCHER• \J. iCrLCC STILL: L HOW REPORTED: PHO NE: RADIO: OTHER: VILLAGE: CENT OST. MILL is S OTHER WEATH ERCL4,1LWIND:� @ l FRi BUILDING FIRE: . TYPE OF CONSTRUCTION: DIMENSIONS:. OWNER: D.O:B 4 r 9dd+-ess: ._ TEL#: Tenant: D.O.B. : Address: TEL#• ) Y E UIPMENT: Year:: Mak e:- Q Model: Serial# VEHICLE FIRE:' Year: ar: Make: Models Style: REG.41: Color: VINr BRUSH/GRASS FIRE• rea/.Size: x Class: Cost: INVESTIGATIO , Other outside fixes, misc. , explain: t CAUSE 0 IGNITION: I. I S—L3, �1 c�T 0-1— WAT&Q_ P_ �� `Zt�J 9J O QJ►.1 tJ t 1.)C- O U 1-C?�"`«{� i"lC��7 l L i IA'C- AT-Tia rS Oe� AT(OrJ, Z�uTc ZU N� IdJTU .A i C�1.5 !v•n S CLU7J,J .NCo'i�W1�1 �T QAI iJ 'I rJ TM 1��e � TLl71J Qi i- etj&n `T(:� �s A-T-i ors _c) p`TI f-j '-cam N - Igo � *d�-row r) A�� REPORTED BY: CHIEF DATE: i �' Awl ,. WVVN--- Uf-..---I3AHN5IABLL--. _,luunrt;jmu risi Q satisfactory 2. printers , BOARD - Or HEALTH � 3. fat o . Cody Shops � unsatisfactory- 4. F nufacturers COMPANY (see"Orders") S. Reta�.l Stores �. 6. Fuel Suppliers AUGP. SS (',� 2'1 'E71 L,>u tom( Class: 7. Flisc llaneous QUANTITIES AND STORAGE (114=indoors; OU1•=outdoo MAJOR MATERIALS Case lots Drums AbdveTanks Undetgroued Tanks . )UT' Fuel s IN— r- 1 6 Re 1112nejAze L Gasoline, Jet Fuel (A) ! , Diesel, Kerosene, 12 (0) Heavy Oils: _ waste motor oil (C) ! new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers . Miscellaneous: U1 SPUSAUUIEW I ut KS 1 1. Sanitary Sewage 2. Water Supply Town Sewer �-�public 0�,.• On-site (1 private 3. Indoor Floor Drains: YES O holding tanks, MUC O Catch basin/Dry well 0 Un-site system3._'I3EItSi..__—...___..._...._ .._--._�... .._...._ _ - __ 4. Outdoor Surface drains:YES NO lluldinL• tank: MUC 0 Catch basin/Dry well QOn-site system _-•"`- S. Waste Transporter r. �- ` �. • Llcertsedl Name of Ha �ler ��ina f nn •. Aar. YFS —NIL_ �1 Spector Uate I` � CENTERVILLE-OSTERVILLE FIRE REPORT ' ALARM#: INCIDENT LO ATION �I�, , TYPE OF CALL•:' A� REPORTED 'BY:, _ TELEPHONE: ADDRESS: Al_, AT SCENE: D.O.B. :' TELEV DATE/TIME OF• INCIDENT: MO: DAY. YEAR: �j�. DAY OF WEEK: SV DATEITIME. OF IN TIGATION: .f�,�„� DISPATCHER• \J iCr1.CC STILL: AL HOW REPORTED: PHONE: RADIO: OTHER: VILLAGE: CENT V OST MILLS_ OTHER WEATHER LW /i/ IN) r BUILDING FIRE: TYPE OF CONSTRUCTION: DIMENSIONS:. OWNER: D.O.B-.: Address:.._:,........_.. ._. TEL#: Tenant: D.O.B. : j Address: TELII• EQUIPMENT: Year:: Make: Model: Serial# VEHICLE_ FIRE:' Year: Make: Model: ' Style: REG.#: Color: VIN: BRUSH/GRASS FIRE.: Area/Size: x Class: Cost: INVESTIGATIO Other outside fires, misc. , explain: CAUSE O IGNITION: DAP GE: , I tJ— SsQ i 0rJ .D:p CX--�> C'&A D �� P i2.1�11? A? //�� . ialSgiicN, 00 to `rb rt-ri o N Tc) r\C i r rJ _C-T-3/13 �)O (�u�►Lfjcr'z 1 a 1 _ , � F � - � Nr•42A enc)U�S t.J�� REPORTED BY: CHIEF DATE: TOWN OF BARNSTABLELounsatisfactory- ANCE: CLASS: 1. Marine,Gas Stations,Repai.r factory 2• Printers BOARD OF HEALTH 3. Auto Body Shops 4. Manufacturers COMPANY /jam see"Orders") S. Retail Stores 6. Fuel Suppliers �.�f,� ._4 7. Miscellaneous ADDRESS ��-��;;;� �� .[ � Class QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbdveTanks Underground Tanks IN OUT IIN IOUT ( IN OUT izallons Aee rest? Fuels: �., Gasoline, Jet-Fuel _(A) Die�9e1,Kerosene;-#2 (B) Heavy Oils: waste motor oil (C) ' new motor oil (C) t , transmission/hydraulic ] Synthetic Organics: degreasers Miscell nepus• 24 DISPOSAL RECLAMATION REM KS: 1. Sanitary Sewage _ 2. Water Su }-'' F A,A) O Town SeweT-'�� Pub 1 i c `ZUi-G- -site O Pri -- r 3. Indoor Floor Drains: YES NO 4 Holding tank: MDC OCatc asin/Dry well n-site system - 4. Outdoor Surface drains, C O Holding, tank: MDC -- O Catc as in/Dry well On-site system A'7� __�.----- 5. Waste Transporter Licensed? Name of Hauler. ]Z�sr,nation 12 23 81 Perso (s) Interviewed Inspector Date INE rohti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAq .A 200 Main Street• Hyannis, MA 02601 039. �A'FOMP+a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: All 6n t4jl- Date: Location/Mailing Address: 11, U*tVilk0). Contact Name/Phone: SC) -77 -3510 Inventory Total Amount: NO 1u10S MSDS: S License#: lie Tier II : NO a,M Labeling: Spill Plan: 0 Oil/WaterSeparator: 5 Floor Drains: Emergency Numbers: ec S Storage Areas/Tanks: Emergency/Containment Equipment: S411 KU& S Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequencx: d`k Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS N C" ,-� �� NOTE: Under the provisions of Ch. 111, Section 31, of the Gbneral LawA, 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: h 05103 CQ oter W O r '' r I Y `0+►s `I'hf Q� A40VI- &efda&kwn. skjc, (ta - OS Inspector: Facility Representative:ni� d.//�/.(Z WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS