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HomeMy WebLinkAbout0594 BEARSE'S WAY - HAZMAT � N °FIME Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARM'ASSBLE$ 200 Main Street• Hyannis, MA 02601 �'"rFOMA'�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: — 0 ih 6 e- Date: 1l tl.(DQn Location/Mailing Address: Contact Name/Phone: M—7'f� r 914 Inventory Total Amo t: Ill MSDS: S License#:gals Tier II : Labelina: Spill Plan: Oil/WaterSeparator: A A Floor Qrqins: AW Emergency Numbers: $_ Storage Areas/Tanks: �J Emergency/Containment Equipment: AM Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: �A Other Waste Disposal Methods: F� 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 V Other cleaning solvents&spot removers ngine and radiator flushes ug 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: O 0 Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F IKE loyti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMASSBLE.g' 200 Main Street• Hyannis, MA 02601 �pfFOMP'+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Q, ® l n Date: Locat-on/Mailing Address: v4/ a;I, Aloft, 15� Contact Name/Phone: -fy YihC� �15YtD�,� Inventory Total Amount: C�\ao SDS: Lf Grp "'e'0* License#: Tier II NIA Labeling: - Spill Plan: _v Oil/VVaterSeparator: Floor Drains: Emergency Numbers: Storacie Areas/Tanks: �00 0V Emergency/Containment Equipment: Op SWI Waste Generator ID: &aste Product: Date&Amount of Last Shipment/Frequency- Licensed Waste Hauler&Destination: Other Waste Disposal Methods: IVIA 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 P solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) L/ Windshield wash Motor oils Miscellaneous Corrosives /Gasoline,jet fuel, aviation gas Cesspool cleaners V 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 VLMiscellaneous 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: INFORMATI N/RECOMMENDATIONS: %IXetJ N,.VM On 100 Inspector: Facility Representative: �-- WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM: LE.� 200 Main Street• Hyannis, MA 02601 '" t6jq TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'�s Business Name: "1 Q4 a a4, Date: 2 2 7 Location/Mailing Address: 0 q J4 V2 a►I nt k2,,) s ¢-n Contact Name/Phone: So 9 - -7� 1 -�3 b 7 D InventoryTotal A ount:, 1. I�O I b SDS: -e5 - C n�- .we.\o, ,Ae' License#: Tier II : Labeling: Spill Plan: 'Yes —4,, Oil/WaterSeparator: A Floor Drains: Emergency Numbers: it Storage Areas/Tanks: 1 U O w ke wVL — S~� I C--oA %, cavLcs; -,< W FP--f- Ch1Ue Emer enc /Containmen E ui ment: S OA t A--e, Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destinati : Other Waste Disposal Methods: wa �\ v.e, v a"O 0(4I &4 .5 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 3 Dry cleaning fluids Automatic transmission fluid (o Other cleaning solvents&spot removers &4- '1 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) I 1 Windshield wash 11L, A'1 IL4 Motor oils to- fiZ Miscellaneous Corrosives 1, ba„\ e-44%,-� Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants 4 + 1 a-Z Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages I � 1 p esticides: 130 00 I Caulk/Grout % -�I insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals ixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes tioa Wood preservatives(creosote) Asphalt&roofing tar ?� ��lo,s �y Swimming pool chlorine x Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners S �s �� 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) 444 VIOLATIONS: ORDERS: IN ORMATION/RECOMMENDA IONS: 0,11 SeCc-^,k&-c-4 o LJ O'g av�\AJ Inspector: I L \j C�I S Die. O U Vl��eCee�Facility Reprgg,sentative: ol l�il WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °Ftro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • MASS. .A 200 Main Street• Hyannis, MA 02601 ,b M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CEO MA'S p '�(f Business Name: - l74.V I Covw a KV o q 1r115 , Date: �2� / Location/Mailing Address: a 4 hnr-S a, I -e-we..we,�5 ° Contact Name/Phone: o - -9 (6 - K>,) ✓K4K Invento Total Amount: k qP.1 t0k4-AA Ds: /�� _ License Tier II : Labeling: �'� a 40PSpill Plan: OilM'aterSeparator: IA Floor Drains: a Emergency Numbers: Storage Areas/Tanks: 5 Q.I lvwt-vwV-v%o St L ,f +"JPo-, - aw 1,5,e- s 4( GowkoyHGlS tr+"� Eme enc /Containme E ui ment: CbSo<6 -wAS 5,Ke ewtplbyy�s �2how Waste Generator ID: tQ11A Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Othe,Waste Disposal Methods: C Coo aiof,/s� ,ovt, e rAA <-1 Ae, (►�y b! c,v\y � 5-tip V, b.c- 41•S,pos---k LIST OF TOXIC AND HAZARDOUS MATE f IALS 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 3 X3 Za S Dry cleaning fluids I- Automatic transmission fluid <k Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers * Hydraulic fluid (including brake fluid) Irti — - Windshield wash 7,4 S II Motor oils Skla Miscellaneous Corrosives g���{ 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 J ID Pesticides: I Caulk/Grout I insecticides, herbicides, dentici ISO I�ti, Battery acid (electrolyte)/batteries Photochemicals(Fixers) �941 Rustproofers Photochemicals(Developer) �— Car wash detergents y Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes30 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: 1Q o © a -T d4. - Inspector. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 R""MAC`E' 200 Main Street• Hyannis, MA 02601 t6.3 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: V- av o &0 4 g A v v,t s Date: 20 Y Location/Mailing Address: J L C e ,1Vt t 5 Contact Name/Phone: Kt .�12g 1,S -Z'i'1-7,1(b 1 Inventory Total Amount: � I�J MSDS: License#: IJ Tier II : tj n Labeling: D Spill Plan: Oil/WaterSeparator: 10a Floor Drains: o Emergency Numbers: 2S Storage Areas/Tanks: ti 10m- Emer enc /Containment E ui me t: Waste Generator ID: Ili 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 to 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 �i- 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: 00V&-c oca 0\46A ORDERS: 'l�y I LE _C4<- 11A kPOICS << '-\A-VAll� 1`" V''1t INFORMATION/RECOMMENDATIONS: 0(t- cm 06u.t.0 Inspector: \ Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS y' Date: 3 /21 / 13 TOWN OF BARNSTABLE ll #I 7/13 TOXIC AND HAZARDOUS MATERIALS5 � yFORM NAME OF BUSINESS: Q- t1aul Com an -a� 4r,ri,5 BUSINESS LOCATION: 5'9 fe INVENTORY MAILING ADDRESS: 54-m e— TOTAL AMOUNT: TELEPHONE NUMBER: SDS - 7-7 I - 7 7 4- oq (Ij CONTACT PERSON: AA,e % 4.,4- EMERGENCY CONTACT TELEPHONE NUM R: MSDS ON SITE? TYPE OF BUSINESS: rye ,54 ye.5 - o►tI1 ►.cs— INFORMATION / RECOMMENDA ONS: K%/ ac eP(6,eeJ5 Fire District: -�i CeSI�.� �m r ce.vt� �' ���eruA.x.�' e.V2� c',e.v►1ov i e,I Ion., oc yL& a n � LX54e- o 0l 'e, 1 VLL-4-p— 1`Q4Ji(-eW4yt[ . `0, 1 �rol1©�-.>,p I,ti I vyto��}1.►_ . �v��o< -�ov'� �o�►t U¢�•�tL�Q r Waste Transportation: /yL Last shipment of hazardou=aste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum ;ZNEW eeze (for ggas�ine o s) Miscellaneous Corrosive I l USE ? �S `c 1 Cesspool cleaners Automatic transmission flu, SII�Ii3 Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides �EW,5 ZUSED RS-��a� 30118 -3; (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation ' Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil I�� ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) / 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 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 Laundry soil &stain removers II (including bleach) 160(7 qa fa a..vt9-4a, k 4 Spot removers &cleaning fluids (dry cleaners) 11 G e�S�� b y 1',�.e� �.c�Qar�rvu ►1� Other cleaning solvents Bug and tar removers �-��- 3 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1215 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis .-------------------------------------------------------------------------------------------------------------------------------- 594 Bearses Way, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 - 499 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 G .r: 1 ti Town of Barnstable Inspectional Services BARNSTABLE Public Health Division ° 16tC11„t°�3« - - 1639 2014 h'� M ' Thomas McKean, Director lJ 'Argo1639. 200 Main Street, Hyannis,MA 02601 ; Office: 508-862-4644 Fax: 508-790-6304 ram. 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 l st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑/^� �� CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ D2 — *A late charge of$10.00 will be assessed if payment is not received by 1st. ' 1. ASSESSOR'S MAP AND PARCEL NO. aq i)- 04�k 2. IS THIS A PERMIT RENEWAL? ✓YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. - 4. FULL NAME OF APPLICANT: �A-wud rip ar)�j Uwe cza 5. NAME OF ESTABLISHMENT: (L-i -d Moyt na- = rtc2, r f Al::wn n► S 6. .ADDRESS OF ESTABLISHMENT: 44I.X01n S1 MCA �oZ(Q01 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: end ��• 7��fY, �l� M G 0Q351 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: -to_ 10. SOLEOWNER: VYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIOXNAME ' - PRESIDENT TREASURER CLERK yf,, C-k-v�!Q— 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT ��-- DATE U CAUsers\872000\Down1oads\Haz Mat App Revised 09-10-18.docx F � MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, NIA 02601 Y FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. In addition, please mail the required fee amount. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. • -- - _ --_ For-further-assistance on-any item-above, call (508) 862-4644 • CAUsers\872000\Down1oads\Haz Mat App Revised 09-10-18.docx Number Fee 1215 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis 594 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 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 U-Haul®Team Member I Since t n Al ff � � L PORSCHIA PIERCE " Executive Assistant U-Haul Company of Southern Mass&Cape Cod 403 Bedford Street Abington,MA 02351 Ph:(339)469-2964•Toll free:1 (866)729-2943 Cell:(508)723-5631•872_ea@uhaul.com uhaul.com Town of Barnstable Inspectional Services BAMSTABLESHE Tp w L•cm.m• nnkr- Public Health Division t5liuf 5:3 9]014+ vAJ.ti B MHABLE' Thomas McKean, Director Lt.) y 9�A i639' 200 Main Street' �H annis'MA 02601 TED MP'� t„.. 1% Office: 508-862-4644 Fax: 508-790-6304 tom• 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 MI Y 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 51VSN F f CAA CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ �Q���- (11 i 1 *A late charize of$10.00 will be assessed iif1 payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. . d9 5 (Au 2. IS THIS A PERMIT RENEWAL? V YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: M `h^p- WA 5. NAME OF ESTABLISHMENT: N`OV 1 YIC, t� � 1rC�Gl� -(�11 S 6. ADDRESS OF ESTABLISHMENT: A ht MCA 09L(O-01 tj 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: -�03 �r(A -P�b(no►1,mcl S. TELEPHONE NUMBER OF ESTABLISHMENT: ��5 `7-7 I q 9. EMAIL ADDRESS: Q 0,@ LKXIW 3 CI)m 10. SOLEOWNER:ZYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF- CORPORATION NAME - 'ma 0-od PRESIDENT IC Ov TREASURER i CLERK }� r 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN --P� =— DATE J JQ I IOI Q:\Application Fonns\Haz Mat App Revised 09-10-18.docx $/0),Q * too:, Of B suable lek atory rvrces Richard V Scab;bireetor Public".Rea h Divis1O.n B,ADXT TABLE AS&K 8\CYSM4[> 'IUE:4TI7a•.t•4fU+"n5 Thomas Xc canJ,=Director n+ `ar ayaae'.es runst"t MASS � � 200 Ma'm* Stree H annis MA"0G"01 Officc: 5.0MV-4644, Fax. 508-790-mO 4 APPLICATION FOR PERMIT TO STORE`ANTWO"R UTILIZE HAZARDQUS MATERIALS' IN ACCORDANCE WITH THE TOWN.OF BARN STABLE GENERAL C)RD"INANCE,CHAPTER 108' HAZARDOUS MATERIALS;ALL"BUSINESSES;THAT HANDLE OR;STORE:HAZ.ARDOUS' MATERIALS GREATER.THAN:HO.USEHOLD"QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT (RUNS JULY 1st-JUNE 3flt1t)', APPLICATION FEES CATEGORY 1 PERMIT '26— 110 Galloris $ 50.00 ❑ CATEGORY 2 PERMIT 111—499 Gallons.. $125.00 U=S. CATEGORY 3 PERMIT 5.00 or more Gallons: S150.00 ❑ *A late"clime of S10 04 will be assessed ifpayment i not.received ba4u1vIst. L ASSESSOR'S MAP AND PARCEL NO. Q9 3 - 0- (p 1 IS THIS A PERMIT RENTMA0 YES"_NO. IF YES,"SK :QUESTION 3. 3. FOR"ALL NEW PERMIT,APPLICATIONS,INDICATE WHETHER BUSMISIS'HAS ZONING/BUILDL TG:APPROVAL FOR HAZARDOUS'MATERIALS STORA"GE%USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 40 FULL NAME OF APPLICANT: -MJ luid of.' & oQ 5. NAME:OF ESTABI:ISHMENT: - 1+ l af)� Y � i S 6. ADDRESS OF ESTABLISHMENT;s S. 1" D 6� 1. MAILING ADDRESS(IF DIFFERENT FROM:.ABOVE .8. TELEPHONE NUMBER OF ESTABLISHMENT: (Sc*) -ij I - q �L-1 9. EMAIL ADDRESS::. JQ— h ` _�,": ..cnyy) 10._SULEOWIlIt; 1YES NO IF NO,.NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND .TELEPHONE-#OF: CORPORATIO (j`NAME - 0i' 0(�(� PRESIDENT mc> M .La TREASURER 12: IF PREPARED BY OUTSIIIE PARTYi NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL. SIGNATURE OF APPLICANT ti— DATE 5 Q:Vlpp jc.ation FormsWIAZMAT.APP 2011R;EVISED.docx M.,.4 Town of Barnstable Bamstablea Regulatory Services Cft togM MAIMr Public Health Division r Thomas McKean Director 'I m'y 2007 he "r,ln 200 Maui Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 1,2018 NOTICE HAZARDOUS MATERIALS RENEWALS All businesses that handle or store hazardous materials greater than household quantities are required to obtain an annual permit with the Public Health Division. Your current permit to store and/or utilize hazardous materials will expire on June 30, 2018. The fees are outlined below based on Category. A$10 late fee will be assessed if payment is received after July 1 St 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 If you have any questions or concerns, please contact Health Division at 508-862- 4644. Thank you. Sincerely, Thomas McKean Public Health Agent Q:UiaanaANotice Letter for Renewals 2018.doex • Number Fee 1215 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis 594 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 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 Number Fee 1215 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis 594 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------ ------------------------------ -------------------------------------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------------------------_------------- This license is granted in conformity with the Statutes and ordinances relating there to,and \q 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 Ilre U-Haul®Teas)Me bee s � PORSCHIA PIERCE Executive Assistant 111�-'U-Haul ompany of Southern Mass&Cape Cod C .-.403 Bedford Street Abington;MA 02351 Ph:(339)469-2964•Tn'^a�uhaul com2943 Cell:(508)723-5631•C uhaul_com v v CA V-, ar 4 Tow of B stable ReguUory Semces , ,THE Richard V. Scali, Director ( �''" Public Health Division BARNSTABLE (� / • I// WXSTntllf•CFxfEleVlLL--CON11-H M51:15 / i\BAIiN6I'ABLE. • MRSM-5 nws•nsi:wlue•resl ec+.xsra \ Thomas McKean, Director .1639-2014 Oren 639. s 200 Main Street, Hyannis,MA 02601 575 Office: .508-862-4644 on-7 - oC 0 v 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 V" S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?-V—/ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. -II 4. FULL NAME OF APPLICANT: LK-V&d C m c 5. NAME OF ESTABLISHMENT: ��,- 11 ►UV(p(� �•I(�� �ST()Y( � ( - Q,yun•i S 6. ADDRESS OF ESTABLISHMENT: 5q -0 S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: - I IM S. TELEPHONE NUMBER OF ESTABLISHMENT() l -7) - CI-7 tQ-7 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME - _ C Gk., PRESIDENT M CLk- TREASURER CLERK Ch L cL, ' 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: ' COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT -eQ� ,cam DATE I a QAApplication Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1215 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis 594 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------ ----------------------------------------------------------------------------------------------------------- -------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 03/16/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO � � Director of Public Health I Town of Barnstable oFtKE►� Regulatory Services Richard V. Scali,Director a; .� ` `" MASS.`E' ` Public Health Division BARNSTABLE MASS. A 1639• `e0 nOWRsIM ULE 111L3-CIN0SL 111:LLE,w5T 2Rfi1i11P I� '°'en,rto+s Thomas McKean, Director 6Dg' n+ 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 » too H APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY.1st—JUNE 30th). i APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 �L CATEGORY 3 PERMIT 500 or more Gallons: $150.00 1 ❑ • A late charge of$10 00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE -7 (�A l FULL NAME OF APPLICANT: a o I ('6032LO V C f &tt_w -17� MCI . Cape � 1 Uq NAME OF ESTABLISHMENT: tAcw moV(rn a ndGff C -F- fly"n) ADDRESS OF ESTABLISHMENT: 5 mn IS V`'LG dtaD i MAILING ADDRESS (IF DIFFERENT): 40 n ArOl 0-1 TELEPHONE NUMBER OF ESTABLISHMENT: Cas) EMAIL ADDRESS: �7a- Ezor e Oy-k 'f - CO►yi SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ( ()mp2LV CrF SOL41A-M /q4 l CC) PRESIDENT © " t Cc, TREASURER YScylla, p CLERK 'H�r<rkEc, IF PREPARED BY OUTSIDE PARTY: IGNATU OF APPLIC NT Name: ,. Company Address Telephone#: Email: Q:\Application Forms\ HAZZAPP Rev 16.docx Page I of 4 :� 1d Town of Barnstable Office: 508-862-4644 MRegulatory Services Department Fax: 508-790-6304 ;.� Public Health Division ? Thomas A.McKean,CHO 1659, r` 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 3/16/2016 Check number: D872-10295 Check amount: $125.00 Name on check: U-Haul International Inc. Business: U-Haul Moving and Storage of Hyannis Owner: THIRTEEN SAC SELF-STORAGE CORP Address: 594 BEARSE'S WAY, Hyannis Ncte: Category II .. __--------- - _ ............ ..... . ... .. - - - Fee Number 1215 Number THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that U-Haul Moving and Storage of Hyannis 594 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- --------- ------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and 9 and expires 06/30/2017 unless sooner suspended or revoked. .1 ________________________________________ 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 kf i Town of Barnstable � >rw , Regulatory Services Richard V. Scali,Director ,k • DARMADt& : BARNS LE MAMr Public Health Division y � t6)y. �0 aan•.ar•am ut•m.urncw•s pa. p�FD►AA'l� \ aewms is'r�iv��:ss wrsu t Thomas McKean,Director i 200 Main Street,Hyannis,MA 02601 �a = Office: 508-862-4644 `�� Fax: 508-790-6304 E 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). i APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 1 l 1 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0 i A late charge of$10.00 will be assessed if payment is not reccived by July 1st. ASSESSORS MAP AND PARCEL NO. DATE - I I FULL NAME OF APPLICANT:y Qr n1 oan V rv1 Of S. MCI�Q and C Yl'P Cp j NAME OF ESTABLISHMENT: U7_d u y f'YlOyIra QX1 d Y�I,Q� 0- /Q.nn1 S ADDRESS OF ESTABLISIIMENT:5y „a rye Wa,1JL -HVa a I , a 02661 MAILING ADDRESS(IF DIFFERENT): 46'S -rbl' 0 01A 02-251 l TELEPHONE NUMBER OF ESTABLISHMENT: LSb� 1 771 - 9 (Q.-] EMAIL ADDRESS:_ 872^ EA-@ U 0j- . Corn SOLE OWNER: /YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION.4AME a ��y�)') V S• rn p f (2aa 06 d PRESIDENT K O-Y n b CA TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE O PPLICANT Name: Company Address : Telephone#: Email: QAApplicalion Fonnr-1HAZZAPP Revl6.doex Page 1 of I TOWN' OF BARNSTABLE — UNDERGROUND FUEL AND CHEMlICAL STORAGE REGISTRATION o e MAP NO 1Jl PARCEL NO. ADDRESS OF TANK: `�_ r� fSrs '�`7 I VILLAGE: Number �tr��t MAILING ADDRESS J�( IF DIFFERENT FROM ABOVE) fJ OWNER NAME: L./IT�`� � t © �tr ' PHONE INSTALLATION DATE: �(y-�`" - BY: yef ' Y� r I"!STALLER ADDRESS: !� t� F ' f`%-�lic( CERT.NO. { " -• , . *TANK LOCATION: (DLOCPR I NK TANK LOCATION WITH mmn"KCT TO nu Z LD S.NO) CAPACITY Ay-� TYPE OF TANK ' WY _..AGE..-----.���'_ YRS.. FUEL/CHEMICAL r TESTING CERTIFICATION C J PASS [ ] FA-It---DATE-` LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND tilc� ZONE OF CONTR I BUT I ON [ f] YES `[s!]I NO DATE TO. BE REMOVED i FIRE DEPT. PERMIT ISSUED [ -j YES C ] NO DATE CONSERVATION C t--7"1CHECK IF N/A DATE�� 3 . w BOARD OF HEALTH TAG NO. C ] .DATE }� //1 AI z" * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD � 0 s w TOWN OF BARNSTABLE UNDERGROUND-FU.ELYAND CHEMICAL STORAGE REGISTR� v9 TION t% MAP NO. _ PARCEL N0. ADDRESS OF TANK: VILLAGE: V19AIAMS MA I L I NG ADDRESS .( I F D I FFFERENT FROM-"ABOVE`): t fj OWNER NAME: o ��'`u/ ` 6" U!" ;` ' T PHONE: / `/C1415Vz 1/ 76) INSTALLATION DATE: a l � BY: Irlf 'C �JS INSTALLER ADDRESS: CY �/ �'•� ��'I i'J; CIJ -CERT.id0. *TANK LOCATION: (omooR Z aG TANK LOQAT i ON W S TN RQ_OPQOT TO aU I"o S NO) CAPACITY 12,'©00 TYPE OF TANK CRP AGE YRS. FUEL/CHEMICAL TESTING CERTIFICATION [ ] 4PASS C ] FAIL A)/Jl LEAK DETECTION C 3-CHECK IF N/A'--'-TYPE/BRAND ,ZONE OF CONTRIBUTION [ ] YES NO DATE`T'O BE REMOVED II FIRE DEPT. PERMIT ISSUED Gl]YES C ] NO DATE 9 CONSERVATION [�] CHECK IF ., DATE /��� a /ram/ )yY y yl/J BOARD" OF HEALTH TAG NO. C ] DATE / PLEASE PROVIDE A SKETCH SHOWING THE. TANK LOCATION ON THE BACK OF THIS CARD C c1� o j, TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATI N MAP NO. •, PARCEL NO. g ADDRESS OF TANK: J �' / '" �` "' �� � '' -- - VILLAGE: Y4A1#1,S Number ltr��t j MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : OWNER NAME: ( ),aqjl 0, �� PHONE: INSTALLATION DATE: I ° rck l" J : ' CERT.NO. 1 L. *TANK LOCATION: (0K0CRI,=K TANK LOCATION WITH RR6.F'KCT TO RUILOINO) CAPACITY �#© TYPE OF TANK AGE �� YRS. r U. /CHEM I CAL K�Po TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ vi, CHECK ,IF N/A t TYPE/BRAND R 1%]ZONE OF CONTRIBUTION �1 s' [ j1\,,, ES [ NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [ Y`] YES [ ] NO ' DATE CONSERVATION [+-J' CHECK IF N/A DATE T' / BOARD OF HEALTH TAG NO. [ ] DATE 71S * ,PLEASE PROVIDE A .SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD �J�S�s �!� �_ i `� TOWN OF BARNSTABLE - `UNDERGROUND FUEL .AND CHEMICAL STORAGE REGISTRATION V MAP NO. PARCEL NO. ( f ADDRESS OF TANK: t �i 1 �r�Cr -��_ ""-1 �-IL,LAGE r - Numbwrt '+. f YYtr�40l Ke 'MAILING ADDRESS ( IF DIFFERENTtFRO,M ABFFOVE)� ` 11! t ?�� ➢! OWNER NAME: 1 `u .'-:�.�� J ------PHONE-: li ���� � /J f INSTALLATION DATE: �/ ` BY: t�/flf�J ��t� � INSTALLER ADDRESS: r-,15 FIPCCI- AAc . . Q CERT.1 . )TANK"LOCATION: _ -_�--- /'' ( (DC�QFR I a.0 T K LOQAT I ON WITH P4GOP,QCT TO mU S LD 2 NO) CAPAUI TY �IGC� TYPE OF TANK AGE YRS. FUEL../CHEM I CALF TESTING'- CERTIFICATION [ ] PASS C ] FAIL DATE ��� LEAK DETECTION B4 CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ V] NO DATE TO BE REMOVED FIRE DEPT. PERMIT I SSUED I [v'`] YES ` `[ 3 NO DATE v' DATE I CONSERVATION [ ] CHECK IF N/A , HOARD OF HEALTH TAG NO. ` [ ]- 'DATE PLEASE PROVIDE, zA SKETCH SHOWING THE- TANK LOCATION ON THE BACK OF THIS CARD c w r r p .-•.+.a vv.ar r1�V,u�l l.l'►7 � 11V C.• t . _ ! 94_:3edrse—s Way, Hv�r.ni, \ . %c6G�T— '', e a t f _ p TO k UIIIIIIIIIIHAU Y ,e ICJ: �SI�` :/� ` '�j/t/iS.. /y,/5 j5. • • ' SUBJECT D 60 r�Y DATE REPLY NECESSARY? YES NO ........,._.-..... ... m _. . .... ---- �� This r�/�'�' 7 �� - _ �..._... __.:..... _ W........ �......._.. _ ......._. _ .._ ._ _. __. /(0/ o/&cs D�' ci9e`r� /i1r !W/GL rllplilli�ve Sc _/'��v�i ^,_...__ %Wc/,oril/i_5 1,4,V' ..M . "Si*6NE .., .,. _._,....,._-__ __..TITLE DEPARTMENT _ ��' COMPANY.NAME�'� -�� --� � CO:NOREPLY 70 ► {Xi"T'/ /y�j U-HAUL CIaf�76g OF HYANNIS Raw HYAWWat MA ,026 p� . . DATE a ,s SIGNED ,.,__.,,..__.....__, ,.... — ' TITLE/DEPARTMENT '.::; COMPANY NAME - AM-31521W REV:8.771 IN U.S.A. 1 4 To Oate 2� Time 1 E YOU WERE OUT M of- Phone-- Area Code Numbe Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message � 9 � Operator No. 2725.5 CHARLBEFS, INC. Hyannis. Ma. 775-2810 Orleans, Ma. 255.3232 To ' Date Time WHIL YOU WERE OUT M of— Phone _ Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Mess Operator No. 2725-5 CHARLBEFS, INC. Hyannis. Ma. 775.2810 Orleans, Ma. 255.3232 TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL 67 (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. / 76 2. 3. �� DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS I h 3 V MEMBER 'PE[ INC. l-K"41 345 7-JECCO, IN NORTIHBO O EST MAIN MASSACHUSETTS 01532 TEL: (617) 393-2537 SERVING THE PETROLEUM INDUSTRY EQUIPMENT SALES, SERVICE, INSTALLATIONS March 22 , 1982 Hyannis Board of Health 397 Main Street Hyannis , Ma 02601 Att: Mr . Jacobi RE: Seafood Products, 594 Bearses Way, Hyannis, Ma. On 3/8/82, Zecco, Inc, performed the following work at the above location. A. 1-4, 000 gallon Waste Oil Tank. Capped and air tested at 5PSI. for 2 hours . Results : Tank and piping tested Tight. B. 1-10 ,000 gallon Regular Gas Tank. Pumped out contaminated water, capped and air tested at 5PSI for 2 hours . Results : Tank and piping tested Tight. Please find copy of results enclosed. Note : Increase in water on 10 ,000 gallon tank due to drain down of tank walls and bottom from pump out of tank approximately 15 minutes before test, Sincerely Robert Troiano r RT/m lg Enclosure 1 e _ j. - .. ,�.n ;:. ! I Y S �y'{.;F tviA e::Ya�` st�Y�`���n I ' !`��{"�,a'x3k�.>°i'�t �•.'A �` -. s.. ! It t v1�' K � i"SS 11�•'' 1 as'z `��' '' t` ZE • , �� Y, R 11 : e x '. t5`�'' '` .•t•,.�L.�Yi, r 1. .(,{I p 1 ., t Ia ��!�' a f i I I:ir s ??.hr s�°b'e-`_x1.X�+•ay ^• 1a l�• .1 .�;•' r�' Oi► O 1 r_ . •r r ,l=}' f.h y _.�` 1 '; 1. t 617 1 .. s c r-: I\ 1/ r'•� ( � `ry' Q_ � ., � "'I''j 1MSFii� !e ^� 'ro "ID�,�' Mrs Or Ao cf Aw, 4 d r ff .�t aa.y � � [•a.tL ��+:ls{� h t �L � 1 d,� k.� 5k1 f '17 1 ��� t .. it` Ff'�� � A. � *M"�. S t f,sf�1rytzy ���i'��1•ksA•C��s;�'c 1 t�l� �a ` Sead /j� , ���'•bo �r f �• K''Lil, j� Vlz�� � rf ar .f`-.•,i' }� •. .. - : '. � -':� a �, a, ...ail 2�1 �r Sr+,��# }va: x �.� 01 iv Va ob f '�q ) w = 1. rJ uj1 1 �gw C n A- KS G�Ct1 I��RK: y } oar •' - �� 1 .� a f F } i t 1, f i r SEAFOOp PRODUCTS, INC. ' j 59 BE^ARSE'S WAY i, k P IYANNIS MASSACHUSETTS 02601 TELEPHONE 617-77173463 i September 28 , 1981 ;;'P ,x M Alfred Buck1 er.,' Chairman Beard of Selectmen f Town of Barnstable Hyanni s MA 02601 i{ { Dear Mr . Buckler : We :are in receipt toiday of al lie t:te'r from the Board of Health is in r`ega,rds to our Biel tan la ale hve received from them a card to :fi 11 -out and 'i t wa8 ven f to the Fire Departme;bt.;' If there is ; any part'-i cul ar ithTng that they want done , name-1 a Kent' Moore t.esting', '• `f ybu would be so kind as to let us: know who does that we would be pleased to do so . Our tanks .were inspected when we purchased the property and all records were given to the Fire Department as they were' the ones that wanted them . Sincerely yours , -- - SEAFOOD PRO,QUCTS , INC :' t} y I George A . Colley Fresident E , cc : Board of Health . • TOWN OF BARNSTABLE ` UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ' ADDRESS VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL Ay r/ �I9® 0 &I'le. (Give same information for any additional tanks on reverse side of card) / DATE OF PURCHASE OF EACH: 3. 4. DATE OF FIRE DEPARTMENT PERMIT: rL,19676 TESTING CERTIFICATION SUBMITTED: v' - PASSED DID NOT PASS NAME '7� LOCATIONAu c • 500 Rutherford Ave, Charlestown, Mass. s= 2 " ., i l_ 5 b00K & PAGE--DATE GRANTED AvIOUN'I' STORED 77/114 4/18/63; 10,Q00 gallons DATE PAID ti 1973 1974--ivia.rch <<- AI APR. 31977 APR ) 'r 1.9�8 SEAFOOD PRODUCTS, INC. S94 BEARSE'S WAY HYANNIS, MASSACHUSETTS 02601 TELEPHONE- 617-771-3493 TELEX- 9S-1109 Barnstable Board of Health Barnstable , Massachusetts ATTN : John Kelly Zecco , Inc will perform the work which includes : 850 gallons of gas and water to be pumped out pressure test 1 10 ,000 gallon fuel tank 1 4 ,000 gallon waste oil tank The above work will be performed by a date not later than March 9 , 1982 . ZECCO , INC . SEAFOOD PRODUCTS , INC . SENDER i Compteiss Items 1,2,and 3. o Add your address in the-RETURN TO"spaoe to � - ra►erse, 1. The following service is requested(check one.) X�D Show to whom and date delivered............e� a ❑ Show to whom,date and address of dellvery.-4g ❑RESTRICTED DELIVERY Show to whom and date delivered...........`d ❑ RESTRICTED DELIVERY. Show.to whom,date,and address of&dvery.S_ (CONSULT MSTMASTER FOR FEES) 2. ARTICLE ADDRESSED TO: Mr. . George A. Colley,Pres. c Seafood Products,Inc. 594 Bearse' s Way, HYANNIS , 3 ARTICLE DESCRIPTION: m REGMTEMD NO. I CERTIFIED NO. WWRED ND. 0019854 (AhveYs obtain signature of addreme or egenrt ga a I have received the article described above. sn SIGNATURE ClAddresree i Authorized a3mt C 4. DATE OF DELIV V POSTMARK ."� 5. AODRE3S4C96Wo4&,I7y0MWjjjW _ � v% t `cl� ��• I�/Jf�� yq E. UNABLE TO DELYVER BECAUSE: CLERK'S D e tMTtAk S ��. 7e304Ca9 UNITED STATES POSTAL SERVICE li OFFICIAL BUSINESS PENALTY FOR PRIVATE SENDER INSTRUCTIONS USE TO AVOID PAYMENT OF.POSTAGE S= Print your name,address and ZIP Code in the space below. ®®® • Complete items 1,2,and 3 on the ravens • Attach to front of article if space permits, otherwise affix to back of article. • Endorse article"Return Receipt Requested' adjacent to number. RETURN 'g TO BOARD OF HEALTH I (Narm of Sender) TOWN OF BARNSTABLE I P. 0. Box 534 (Street or P.O Box) HYANNIS MA 02601 a (City,state,a9d ZIP Cis) I - 1 ' - '• .. ' - .. #' • �'•_ 4 •fir - - g ' June is, 1981 Mr. George A. Colley .. Pre iddent t : v Seafood, Products, xnc�` 54 :8earse's Way Hyannis, Ma.,,,, v Dear. Mr,' Colley. t .`fie• are,' in receipt of your lotter`of Jung 1„�1 1981. req,ardi ncj the, ,underground -fuel storage tanks •on your-property ' We have no records ofthe hanks"-`being tested at the time CSK Realty acquired the 'property., "K. Accor g •to our records,•':you.*tanks are "fifteen years age and must be tested immedi atel t2si sic „the Kent-Moore Pressure. w` 7 • 'Zest_ or an empty tank may• e_ tested by a 5 PSG Air Pressure` Test ., Also' we are :.enclosing another card please fill oizt ..the proper d- -information- and return, to us as `soon, as Possible, Failure to 'Comply. could r€su'at• in the revocati ion © 'any,per tits "issued you. by :the 'Towns 4 > _ dory:struly yours - John M, Kelly` Director, of 'Publi.0 Health encl., I- card" ^ M' l V RTIF ED" MAIL fly •-,e r f4k `. } :rrUa•w+�wr� r ■iri ire.rr ri +w�"•""' r SEAFOOD PRODUCTS, INC. S94 BEARSE'S WAY HYANNIS, MASSACHUSETTS 02601 TELEPHONE- 617-771-3483 June 1 , 1981 Mr . John M . Kelly Town of Barnstable Board of Health 367 Main Street Hyannis MA 02601 Dear Mr. Kelly : The tanks in the ground were inspected when CSK Realty took possession of the Hood property . You will find that your records will verify this fact . Sincerely yours , SEAFOOD PRODUCTS , INC . George A . Colley President GC : af 7 ' May' 29, 1981 7. Mr. George Colley + W Seafdod Products, ?nc. 594 Se''arse's Way` Hyannis -, Mao-, r r' Z ;. Dear, Mr. Colley Ve have.been^ notified :that` you ,now own• the underground fuel storage,tanks 'located at'`-594 ,Beswee4 s .Way, Hyannis. ' Y Enclosed, is a copy of .a_Board ok .Health regulation, effective February" 14, -1980,. governing underground` fuel -and chemical storage, Please fill out- the enclosed card.', ' tIto us listing, D any underground storage tanks •located on this property. Any tanks f ifte.en -Of years'of :age ;or,older with .capacit es ' greater' than '500 gallons" "must' be tested using, ,the .Kent-Moore Pressure-Teat" ` ;fin' empty tank "y be -tested by 4a °5 PST _Air- 'ressure Test.,y is testing should" be done'-immediately Very truly yours Jahn M. keily Director' of -Public Health encl 3, ' E ' IQAJ�7F LJ A-ION H7�n�1l^�P. u�or3 ram, Trc� 70t� liair� :=t, !'.J1J Main .`'.'�'F, - - - Hyannis Hvarz.ni S 9 I'l !, RBI' ?'1 pAr T�1'i S`MIRED [!/ 77/ Mo rrli ^-? 1966 DATE ?ATE' 1973 1 j MAR - 7 19 75 APR 2 21976 c :� 1977 _ HP Hood Inc 500 RUTHERFORD AVENUE • BOSTON MASS • 02129/(617) 242-0600 EXECUTIVE OFFICES March 17, 1980 Board of Health Town of Barnstable P.O. Box 534 Hyannis, MA 02601 Dear Gentlemen: This is to inform you that H. P. Hood Inc. no longer owns any property in the town of Barnstable, therefore we will not be returning the form listing any underground storage tanks. I have forward the card, the Board of Health letter and the Board of Health regulations to the owners of the property.at: George Colley . 594 Bearse's Way Hyannis, MA 02601 Sincerely ours, QAAX- � James M. Lesser Admn. Asst., Government Relations ������ �- ��-- S �� /� - ��� a �°' � �,� �-� l ���- ��� � �_ - ��� .N V - '!,� -- �� � � � �� � '��� �� "7 � I 3c,( 6 31� � � i T "f TOWN OF BARNS ABLE � V UNDERGROUND FUEL AND CHEMICAL STORAG SYSTEMS NAME. ADDRESS LLA4 VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL �( liC fr f 60 �D �1 Q,S Ili( ! • SS k9l co I Z4-0— (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 4. f 9� DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS A P P ' C V E D Barnstaole Conscrvation Commission c � Signed. - • Da e HAZARDOUS WASTE MANIFEST AND SHIPPING PAPER MA 00,8 MANIFEST NUMBER NAME MAILING ADDRESS PHONE NUMBER STATE/E.P.A. I.D. NO:---": o H GE ERAT R w z p r - Y� ( /l `) 77 1 4P,? Lam.J �I w z IL dW PRIMAAS"TRANSPORTER �� K pm Z -3 _ . . I7) . 3 '. lc�, wog ,�o} W� CONTINUING TRANSPORTER !o w z w ( I f Wp1-t9 ow W a 5 f ,�I� 0 V Z U. W H.W.F. wfl t% oSf L / -+ ,e� 1 s.O O m" WIF MOR97THAN ONE MANIFEST/ TOTAL NO, OF THIS FORM IIMANIFIEST NO, OF FIRST FORM DATE SHIPPED MONTH DAY r AR EXPECTED ARRIVAL �MfOJNTTH� DAY YE R w t p� SHIPPING PAPER IS USED: A FORMS ARE Li'J NO. IS W ( L J J DATE L�� 1 L N_z a O a D.O.T. HAZARD /N.A, UNIT CONTAINER E.P.A. WASTE DESCRIPTION OR WASTE a W w ir a o U.S. D.O.T. SHIPPING NAME WT./VOL, UNITS O CLASS NO. CODE NO. TYPE'. NO. ANALYSIS IF WASTE IS N.O.S. w a a (� F O H j O ki 0042 W W U z NJ J0 2. Z m Q Z t W a W II I I I ' f I co z t- 4 =W w At z_ Q Y (7 Ll 5. _aw p; p - - U.Q Q O U O Q SPECIAL HANDLING INSTRUCTIONS INCLUDING ANY CONTAINER EXEMPTION-; AND EMERGENCY RESPONSE INFORMATION: 0 o (L Ow0Z rncrca Z� =Wcrli IN THE EVENT OF A SPILL,CONTACT THE,NATIONAL RESPONSE CENTER,U.S. COAST GUARD 1-800-424-8802 O �_O REOurRE LaeELS THIS IS TO CERTIFY THAT LAM THE PRIMARY DATE SHIPMENT•ACCEPTED STATE COMPANY No. FOR TRAILER, DATE OF DELIVERY LLjW TRANSPORTER AND HAVE ACCEPTED THE > MONTH DAY DAY EAR VEHICLE �MAAR,INE OR RAIL � ,�� MONTH DAY YEAR �W FORDESCRIBEDSPORT ENT IN PROPER LED H. IF. � I I4 L9_>,!4 LD L�J. t/'� `6i r / 1, ,�` U, I I `I '"� FOR TRANSPORT TO THE IDENTIFIED H.W.F. 0 J YES NO SIGNATURE OF TRAN PO TER DATE SHIPMENT ACCEPTED STATE COMPANY N0. FOR TRAILER, DATE OF DELIVERY �a PLACARDS REOUIRED THIS IS TO CERTIFY THAT I AM THE CONTINUING MONTH DAY YEAR MARINE OR RAIL. Z� I TRANSPORTER AND HAVE ACCEPTED THE MONTH DAY YEAR QQ tT' DESCRIBED SHIPMENT IN PROPER CONDITION I I i VEHICLE wo j"w­— FOR TRANSPORT TO THE IDENTIFIED H.W.F. SIGNATURE'OF TRANSPORTER ) INDICATE ANY DIFFERENCES BETWEEN MANIFESTAND SHIPMENTiAND LIST REJECTED MATERIALS,INDICATE DISPOSITION OF.,REJECTED SHIPMENT HANDL!NG METHOD W 4 Li W =a I CERTIFY THAT THE DESCRIBED WASTB(S)WAS DELIV ED BY T AFOREMENTIONED DELIVERING TRANSPORTER AND THAT THE INFORMATION ON�THIIS. 2. �5. �+� 0 FNE MANIFEST IS CORRECT TO THE BEST OF MY KN WLEDGE. es V SIGNATURE MONTH DAY YEAR LABELMASTER I DATE CHICAGO,IL 60626 - 3. GENERATOR COMPLETED COPY GENERAL INSTRUCTIONS: HAZARDOUS WASTE MANIFEST'AND SHIPPING PAPER 1:�(PORTANT: Read all instructions before completing this Continuing Transporter's Name: Description or Was''.Analysis if Waste is N.G.S. form. Enter the name of.your continuing transporter. Enter descripti or,or analysis for any waste which does not - have a U.S D.O.T. Shipping Name. If waste is a liquid, enter "t This_manifest contains seven copies. To Insure that 9 Transpo rte rls Address:' - its specific gravity. ^• each copy Is readable the manifest must be completed with Enter the mailirYg address of your transporter's facility. a typewriter or by pressing firmly with a ball point pen. -�'"'^• --� Special Handling Instructions Including Container Exemptions; And . . The instructions for the generator, transporter(s) and 4r Transporter's Phone Number: Emergency Response Information. f "hazardous waste facility (H.W.F.), are on the back of each Enter tine telephone number including the area-code of your Enter any container exception and any expected problems in - copy of the form. The information required tor.each entry \ transporter/'s facility. landing; include specific properties of the waste not identified .++ on these forms are included in these 'instructions. The J' by the U.S. D.O.T. Hazard Class leg. cancer causing) and a descrip- manifest number in the upper right hand corner of this form ,�` Transporfer's State/EPA I.D. No.; - tion of containers marked OT in the container type column. Enter is preassigned by the state in which the waste is generated. Enter the State/EPA identification number for your transporter. emergency response information regarding protection of the Public H.W.F. (Jame: t - and emergency personnel and containment to be employed An case of The seven copies of this manifest are intended to be - spillage; include telephone numbers for key personnel. filed with the appropriate party as they are completed. As Enter the name of the hazardous waste tactlity receiving the manifest proceeds, the copies will be removed back to your waste. Generator Signature: _ • front. The shaded portions of this form are intended for HW Enter the signature of the individual responsible for hand- data processing; it is important that numbers appear in the _ . .F. Address: lin the waste. - hash marks and the digits and at the far right of each closure. Enter the address of the hazardouswaste facility receiving 9 An,e—ple for—i./vol. is I ,5,01 . If more than six your waste. - _ Date: 1 waste streams are listed, or if more than two transporters are - - Enter the date that the generator shipped the waste used, an.additional manifest form will be needed. If an ad- H.W.F...F. Phone Number: _ diti one I copy o 's needed for a continuing transporter, the en- Enter the telephone number including the area code of the PY ' 9 P 9 Generator's Emergency Phone: orator or. rimer trans orter will rovide the necessar hazardous waste facility receiving your waste. p y p p y photo Enter the telephone number of the individual to be called copy. The disposition of each of the.,numbered copies, as thev H.W.F. Site State/EPA I.D. No.:. in the event of spillage or other emergencv. are completed, is as follows: - r Enter the State/EPA identification number of the hazardous I. ORIGINAL: , waste facility. z . TRANSPORTER SECTION The original stays with the waste from generation to corn- _ - pletion by the hazardous waste facility. When the manifest is Total No. of'Forms: • Enter the number of manifest forms used for this shipment: Required Labels: completed, the hazardous waste facility will mail this copy to - . Indicate whether the containers are marked and labeled as the state where the waste was generated. Form No.: - - required in 49 CFR§172 Subparts D and E. , 2. Destination.State: - Of the total number of manifest forms used., enter the number, Placards Required: When the hazardous waste facilit com letes his section . of this form. Y P Enter the names of placards used for the waste shipment as of the manifest, he mails this copy to the state where his Manifest No. of First Form: : appears in 49 CFR§172 Subpart F. facility is located. If this shipment contains more than one form, enter the manifest number of the first torn. Signature of Transporter: p 3. Generator Completed Copy: � � -� �� - Enter the signature of the individual responsible for ship- When the hazardous waste facility completes his section of meni of the waste. .the manifest, he mails this copy to the generator of the waste. f Date Shipped: _ Enter the date the transporter took the waste from your site. Data Shipment Accepted: 4. H.W.F. Copy: - ! - - - Enter the date the transporter accepted the waste. When the hazardous waste facility completes his section of the manifest, he keeps this co for his records. Expected Arrival Date: P PY Vehicle I.D. Number: • Enter the date you expect the.hazardous waste facility to Enter the two letter abbreviation for the state of vehicle 5. Transporter Copy: recelve your waste. - registration and the company identification number for the trailer.When the transporter has completed his section of the man- . i.fest and transfers the waste to the hazardous waste facility, U.S. D.O.T. Shipping Name: Date of Relive he keeps this o for his records. Enter the U.S. D.O.T.Subpis Shipping, Name for your waste as ap- pears Delivery: P copy �- �- Enter the date the transporter delivers the shipment of waste in 49 CFR§172 Subparts A, 4 and C. - 6. -Generator State: . ' i to the hazardous waste facility or the continuing transporter. generator has completed section of the When the man- D.O.T. Hazard Class: "I 9 P • Continuing Trans orter Si nature: ifest and transfers his waste to the transporter, he mails this Enter the U.S. D.0.T Hazard Class for your waste as appears _ P 9 P The transporter receiving the waste from another transporter •copy to the state where the waste was generated. in 49 CFR§172 Subparts A, 8 and C. shall sign the manifest. 7: Generator Con U.N./N.A. No.: When the generator Date of Acceptance: Prator has completed his section of the meni- Enter the United Nations Identification Number or North P - America Number as appears in 49 CFR§172 Subparts A and U. continuing wn irg transporter, who accepts waste shipment from ,fast and transfers his waste to the transporter, he keeps this - another transporter, r transpsp orter, shall enter the date hea accepted that ship- copy for his records. = Tent. Enter the total weight or volume of•the waste: - Continuing Transporter Vehicle I.D. Number: GENERATOR SECTION s_ Units: - Enter the two letter abbreviation for the state of vehicle Generator's Name: Enter the units as listed for quantity of Graste(s). Units registration and the company identification number for the trailer. Enter the name of your facility as appears in the EPA noti-, of measure which must be used for this manifest and appropriate - - codes are: Peunds(lb), Tons(ton), Gallons (gal), and Cubic Date of Delivery: f ication package. Yards (yd). - - Enter the date the transporter delivers the shipment to the hazardous waste facility. Generator's flailing Address: - - Enter the address of your facility. � Unit Code: - Enter the appropriate code for each of the units used: ,• flAZARDOl1S WASTE F C.I LITY Generator's Phone Number: Ib(P), ton I T), gal(G), and yd(Y), /(.� Enter the telephone number including area code�for your t Shipment Problems: facility. - Container No.: Enter the number of containers In the waste shipment which Enter any differences between manifest and shipment, Iist Generator's Site State/EPA I.D. No.: - this manifest accompanies. - rejected materials and reasons for rejectlon, and indicate the r disposition of rejected materials. - Enter the State/EPA Identification number for your facility. � t Container Type:, ,., , ' ..y r - Prima}- Trans oiler's Name: Identify the type of container(s) used for this waste using `Handling Method: Y P the following abbreviations: DR=Drum, TR=Truck, CA=CartonG= Enter the Handling Method for each waste as described, in Enter the name of your primary transporter. , D 40 CFR§265 Appendix - Bags, PT=Portable Tank., CT=Cargo Tank, TC=Tank Car, and OT=Other. 1, Table 2. Transporter's Address: if Other (OT) is used, explain under Spacial Handling Instructions. P Signature: .Enter the mailing address of your transporters facfllty. E.P.A. Waste No.: Enter the signature of the individual at the hazardous waste • Transporter's Phone Number. Enter the EPA hazardous waste number as appears to 40 CFR facility responsible for the receiving and disposition of the waste. Enter the telephone number including the area code of �, .z, §261 Subparts C and D.• , _ . 'Date of Signature: your facility. _ Enter the date that hazardous waste facility accepted the Transporter's State/EPA I.D. No.: shipment. ' Enter the State/EPA Identification number for your transporter, + rE �Ii I cif Ti i ,. • ., 1 �QQ, Q.', 81� J.7� 258 r` ! ouND T 'Cf " . T Rot) a (/f) R - DV S or T ..� F F�t� a rt TOST6 }� 0(1)Mim' ! N�S1-a^CCST I , i c�-cn Fa�Ck� • i I � �. t i i I ! i � I •'I .. � l Y i I I i � I •�• j I i i i ...�.....� r •: 1 ,. •ti� I i I I CYO ✓ oa�� i n� f_ , ! 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