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HomeMy WebLinkAbout0700 BEARSE'S WAY - HAZMAT emk"s i r '� n �.� , ®/ SMEA KEEPING YOU ORGANIZED No. 10230 H163 O�15T'41NABLE MIN.RECYCLED [NnIATiVE CONTENTlo% comedFumsommg POST-CONSUMER www.dpmgrom.org MADE IN USA GET ORGANIZED AT SMEAD.COM J ' ` Town of Barnstable �pFZHE rp,,� Regulatory Services Thomas F. Geiler, Director BARNSTABLE, r .9 MASS. Ok Public -Health Division �p 1639. ♦� ArFDMA�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILI E MORE THAN I II GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ✓ --- NAME OF ESTABLISHMENT --a ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER:_YYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: ' M IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Haz.docAq/q Nes 0 0 6 • 465 Route 134 a�P P�rgcF G P.O. Box1418 Z a . ® P,TNEY BOWES MR South Dennis, MA 02.660 02 1M 00.440 Address Service Requested ' 0004247045 JUN 30 2010 MAILED FROM ZIPCODE 02660 A0 rr/S A-1L� • -`- lom"1111111111i'llilif i,i„11f,,,11,,,,,i,11i,,111,,,�l,l,I • � )ilii•�����li�i� i;i I�f#! It!!! f��! i !�� fl�� i �, � �� _ _ �� '�. !� ��_ _ __ 1 r Number Fee 1330 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Premium Plywood& Specialties ................................................................................................................................. 700 Bearses Way, Hyannis, MA ............................................................................................................................................................•........... Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 f Town of BarnstableAkAl MA Inspectional Services BARNSTABLE v �� �iSTg15 M1L5 OSERVII.I%�i?'Rf B>AVASiTB E Public Health Division 1639 L✓4 1 • �� Thomas McKean, DirectorMARIL f w S659- .�� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ti 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 g/ �&h 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. 1. ASSESSOR'S MAP AND PARCEL NO. —o6 3 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: A �N e l�Mb2dZ O Q C11GT0f` ZC 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: ()Co 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS:: 10. SOLEOWNER: /YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 'M r kn e_ Lumbe.c-' Oj e0a f --MC, PRESIDENT c C1l'r)Si6 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE lD QNApplication Forms\Haz Mat Appli Draft Jlan20l9.docx i P`pi THE►°k,� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAFMARS. .� 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT .er f0 MAC a Business Name: AnA AE& P�(`Q,m`u f'\J A. Date: I 20 Location/Mailing Address: 10n 'JBfrAf<eS �✓ Contact Name/Phone: k Eoxc S. -;-a-771 92-7� - Inventory Total Amount: 0 ' SDS: C)()�InC_ License#: 133 d Tier II : No Labelina: Spill Plan: 0 eS Oil/WaterSeparator: NO Floor Drains: K Emergency Numbers: iezt Storage Areas/Tanks: '^'wtj)LL% �kLe Emergency/Containment Equipment: SASi�- x Waste Generator ID: N Waste Product: Date&Amount of Last Shipment/Frequency: ff ff� Licensed Waste Hauler&Destination: UIA, r `G t. v- 1+ Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS ��Ve,�lio �arit°S NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: V Road salts grease, lubricants, gear oil Refrigerants egreasers for engines&garages Pesticides: 20 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) //sphalt&roofing tar Swimming pool chlorine ,/Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners — t/ Miscellaneous Combustible Paint&varnish removers, deglossers Jot- 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: no recofhmyafv Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1330 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Premium Plywood& Specialties 700 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------- ----------------------- -------------- ---------------------------------------- --------------------------- ---------- ------------------------ ------------------------------------------------------------------------------------------ - This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health A Town of Barnstable Inspectional Services BARNSTABLEe:e•a Public Health Division �`;°t 539-201 ` `I nnxnrr �nsrs.$ Thomas McKean, Director 'Ten 059. o`` 200 Main Street, Hyannis,MA 02601 "_5 6 v" -r Office: 508-862-4644 Fax:t 508-790-6304 / APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE jam% HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES 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 0 V *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1 QS 1. ASSESSOR'S MAP AND PARCEL NO. D`fi _41// 2. IS THIS A PERMIT RENEWAL? " YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: IW 14fg)e!F �1ua'C 01,oO Pie°. bit-__ 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: D 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 0j— "-171- 7y7Z- 9. EMAIL ADDRESS:I 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK . 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPZvise!d:`18 DATE Ite Q:�Application Forms\Haz Mat App o ,I Number Fee 1330 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that AMA HERO Mgmt-Premium Plywood 700 Bearses Way, Hyannis, MA 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 rdsy • • • S } � wof B nsxable Oct toegulatorygervices 3 3(p THE Richard V. Scali, Director ' OF Tp,_ Public Health Division BARNSTABLE Y BARNSTAELE•f&(fERNLLF•CONR•MYPt3115 BARNgrABM • Thomas McKean Director 1HAB3. A 1639-2014 ptEo > 200 Main Street,-Hyarinis�1VIA 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 g 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. -.9-f� '4D� 2. IS THIS A PERMIT RENEWAL? (/YES_NO. IF YES,SKIP QUESTION 3. . 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 0,?- 7 V 9. EMAIL ADDRESS ; 10. SOLEOWNER: "- S NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T DATE Q:\Application Forms\HAZMAT APP 2017 VISED.d Number Fee 1330 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that AMA HERO Mgmt-Premium Plywood 700 Bearses Way, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. C1` ------------------------------------------------------------------------------- ------------ ---------------------------------------------- ----------------------------------------------------------------------------- CV ------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO (j( T Director of Public Health `, M N M �tiv of B stable / egunlatory`iervices r .Richard V. Scah,Director .JiHE t�r° Public Health Division BARN LE WYNiiFlllC•MViuE•Ccpj- U.kR ewxxacws�s bM Thomas McKean Director "N 6 9.20� 200 Main Street,Hvannis,MA 02601 Office: 508-862-4644 � ( � ' . �l 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 1st—JUNE 3Oth). k APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50,00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 O r CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Q *'A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SFGP QUESTION 3. 3. FOR ALL NEW PER-MIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUAMI TTIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: # 5. NAME OF ESTABLISHMENT: i 6. ADDRESS OF ESTABLISHMENT: I 7. MAILLNG ADDRESS(IF DIFFERENT FROM,ABOVE: S., TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEONVNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME rvt rI f�•t/i�� rryci c7' iG)�It�� '- !���. PRESIDENT c y, TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: I COMPANY ADDRESS EMAIL: r SIGNATURE OF APPLICANT ATE {ll�t• 1 ' Q:\ApplicationForms\IiAZMATAPP2017REVIS docx Number Fee 1330 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that AMA AFRO Mgmt-Premium Plywood 700 Bearses Way, Hyannis, MA 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. m PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health clip Town of Barnstable 3/z211�TME: Regulatory Services • o Richard V. Scali, Director HM"MAS&"ST"BM ` Public Health Division BgNSTABLE i639. .w°"R"s`M��vve�nmwar'smx"�'s �EO a Thomas McKean, Director 1639-2014 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63,04 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE °° HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES 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 xl�rL A late charge of$10.00 will be assessed if payment is not received by July 1st, ASSESSORS MAP AND PARCEL NO. —M� DATE FULL NAME OF APPLICANT: ftwr 1 U9fa- /��(}�i A NAME OF ESTABLISHMENT: �� 'I�LGUGI� Gy v V--)) ADDRESS OF ESTABLISHMENT: (�� MAILING ADDRESS (IF DIFFERENT): / TELEPHONE NUMBER OF ESTABLISHMENT: O� EMAIL ADDRESS': / SOLE OWNER: F/YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME 101w 0194476� l�L 1 T/Z� '�V PRESIDENT TREASURER , ?af r CLERK IF PREPARED BY OUTSIDE PARTY: SIGNAT O ANT Name: Company.Address Telephone#: Email: Q Application Fonns\ IAZZAPP Revl6.docx Page 1 of 2 r °Ft►�ropti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA�BLE.�` 200 Main Street• Hyannis, MA 02601 �'0'fOMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT /n� Business Name: �rfv��JvK Pl Woop- AE o �1V`a•�� .µe,v�t' Date: Location/Mailing Address: v r5,c s 1n5 4.AV%k %l( - Contact Name/Phone: (%C;e.&\iz 5 f I eye,X Inventory Total Amount:230o 9a1 ' ?o-1Sf<1� SDS:.©w114'- SS License $� C +-3 Tier II : inag: Spill Plan: Oi[/Water Separator: Floor Drains: 0 Emergency Numbers: " Storage Areas/Tanks: 1411 ,I t'o 0G+pa.cl4a �'or sA ecety- /-0e.i/ 011k, exu,ot ovc a ►'yllrt y,40 5 Emer enc /Containment E ui ment:'f%(t. C �SD�II s e- Waste Generator ID:_ IA Waste Product: ��} Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash t2. Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: 500I Road salts b4v Ib {��n grease, lubricants, gear oil Refrigerants Degreasers for engines&garages �,►"�k Soo Pesticides:5(,�200 +2.00 30 uoK(b Caulk/Grout ,fpoo\ykl�oox7y�,oCo/ �kC��D insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries wr Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes $�goo Wood preservatives(creosote) Asphalt&roofing tar tgti o Swimming pool chlorine — 1805 Paints, varnishes, stains, dyes qo Xt°0`��`h Lye or caustic soda 9,0 Lacquer thinners 20 -mo kS� Miscellaneous Combustible Paint&varnish removers, Xglossers Leather dyes to Miscellaneous Flammables c s, s� '3oK 16 Fertilizers J5'( �R�Sk�Se Floor&furniture strippers 1P g�,r�`' PCB's Metal polishes 4d �n 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: Of 3 � ar dvS /V(di -e�� S !ceh5� IF -ff v S. ,S , W, D oo►,.L9> SO�1D-� d�it S y CV�� 1 PC t S �t--GOc,�✓c. �v,� inspector: �� S 4,,Af ley 5 �a✓.e. g4C-Z55 `tc, v Representative: ttVb) wv � WS +,Z . WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1047 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Mid Cape Home Centers e. , A 02601 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 June 30, 2008 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f Town of Barnstable oFzHE. Regulatory Services Thomas F. Geiler,Director S MASS. ' Public Health ]Division F Mass• $ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax:..5d$�90-6�q74 Application Fee: $100.00 Ln CD -- � - � � ASSESSORS MAP AND PARCEL NO. 1.3 003 DATE 0--� d0 co --a rn APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT I V l G k���s a .y U M%3 E R- (20 - NAME OF ESTABLISHMENT D C' A PE (2 L M E f- t/ k i N1S ADDRESS OF ESTABLISHMENT 7.OD -- _, TELEPHONE NUMBER -- SOLE OWNER: x YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. a 76 0 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: _. PRESIDENT —1 a.5H t., g TREASURER;2 0-[3 p-T L A.B 91E CLERK. / A ti &R-60 ATE-U A PJON SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS /-)/A- HOME TELEPHONE # P-114 ` Town of Barnstable an IRE F l Regulatory ulator Services o ° °.� Thomas F. Geiler,Director ✓ '"ASTABLE. ' Public Health Division Y� 1639n. 1�g AtfDMA'�p Thomas McKean,Director a(p 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 293/003 DATE 5/26/06 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NICKERSON LUMBER CO. NAME OF ESTABLISHMENT MID CAPE HOME CENTERS 1 ADDRESS OF ESTABLISHMENT 700 BEARSE'S WAY f TELEPHONE NUMBER 508 775-6112 SOLE OWNER: Y YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF AL"L PARTNERS: -., rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04-1672760 STATE OF INCORPORATION MASSACHUSETTS FUEL NAME AND HOME ADDRESS OF: PRESIDENT DOUGLAS B. BOHANNON, 679 SOUTH ORLEANS RD. BREWSTER, MA 02631 TREASURER ROBERT J. LABRIE, 170 ALTHEA DRIVE, CUMMAQUID, MA 02637 CLERK MARIE CREONTE-HANSON, 88-LONGVIEW DR.., CNETERVILLE, MA 02632 `Zo t�-i ? SIGNATURE OF APPLICANT I. 011ve RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Application FormAHAZAPP.DOC II MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. 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, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. 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 Back to Main Public Health Division Page Q Upplication Forms\HAZAPP.DOC CONTROL 263679 NICKERSON LUMBER CO.^ T90915 - Town Town Of Barnstable 0 /c 3/0G 263679 Inv Date Invoice # Aj P/0 # Description Amount Discount Net AMOUnt 0 5/chi?/0G Bt-lR52 36 100.00 0.00 i 00.00 100.00 0.00 100.00 Number Fee 1047 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Mid Cape Home Centers Rte. 132, MA 02601 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 June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 30, 2006 PAUL J. CANNIFF,D.M.D. -THOMAS A.MCKEAN, R.S.,CHO Director of Public Health op TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: I�IcoL L 'f'� MAILING ADDRESS: '7&0 TELEPHONE NUMBER_: CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a YES or NO answer. Use the enclosed envelope for your convenience. If you answered YES .above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF. TOXIC AND HAZARDOUSMATERIALS 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 ✓ check beside each product that you store: Antifreeze (for gasline or coolant systems) Refrigerants y— 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 fuelWood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, lubricants Swimming Pool chlorine . � Lye or caustic soda Degreasers for engines and metal—� Jewelry cleaners Degreasers for driveways &garages Leather dyes Battery acid (electrolyte) �Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s �Car waxes and polishes Other chlorinated hydro- . Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes .tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers R.� Other products not listed (including bleach) RE C E IV E� which you feel may be Spot removers & cleaning fluids HEALTH DEPT, toxic or hazardous (please (dry cleaners ) TOWN OF BARNSTABLE list) _ Other cleaning solvents 'Bug and tar removers Household cleansers, oven cleaners Drain cleaners - Toilet cleaners MAY 1 8 1981 Cesspool cleaners yDisinfectants Road Salt (Halite) TOWN OF BARNSTABLE BOAR ® OF HEALTH ' CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET F I RM ADDRESS ✓-;� , o Major types of materials: 1) /rj`i�F.'� �, — 2, 3) I. Description of material(s) use: II. Storage (denote product by number 'st'ed ab ve) A. Containers met l glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remar.ks/RecommeM. :,.ions 1. Indoor j a) separatt, contained room b) stored in general work area , 2 i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins -f �...✓ 1.r(/�G../,.r/ �!'.a�i'�. III. Disposal ( / A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer r 2. Regular septic system 3. Separate holding tank C. Off-site disposal 1. hauled by own firm r� f 2. hired hauler a) name of hauler b) address or disposal site Person(s) Interviewed `,,_ — — p ;!? ;— Inspector d,& Date l � - _ — — — - - - - 1 P. 30 81 _ _