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HomeMy WebLinkAbout0730 BEARSE'S WAY - HAZMAT Z N Y-)2 I fizg l �- ' . z Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape & Islands Tire Alignment Shop .-------------------------------------------------------------------------------------------------------------------------------- 730 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 Town of Barnstable Inspectional Services BARNSTABL,E WNSTAK Public Health Division E 5E0.YUL�FRBARNR5481E 1639-ZOlb 1 Thomas McKean, Director RFD aHAM 16 9. ,� 200 Main Street, Hyannis,MA 02601 CO h ~Office: 508-862-4644..j Fax: 508-7946't304 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 d VV-p0(C k1C-* CATEGORY 3 PERMIT 500 or more Gallons: - $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:. 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: &Lai /& 4 p G 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: .Qivnz� 8. TELEPHONE NUMBER OF ESTABLISHMENT: ���' I�J�' o UG 9. EMAIL ADDRESS: r-re 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME L,Q PRESIDENT i TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE ! Q:Vlpplication Forms\Haz Mat Appli Draft Jan20l9.docx Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape & Islands Tire Alignment Shop 736 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 Town of Barnstable Inspectional Services BABSTABLE 'THETp� BM.S a=_•ce+ri:L.cman,mnxrcr o Public Health Division NMS1Cti AtLL5.639-20L 4'viEA3 9S a:E (rBARNgrABLE. Thomas McKean, Directors iOrE1 3.ia`0 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-7E90-6304 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 �IULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 x VQ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 1993 J 2. IS THIS A PERMIT RENEWAL? 1/ YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: D N q 4_j oe�'*e, R a v 1-4 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: -730 Ae�q'-S-es' &;4net�5 44oq oa,�6/ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: s - 8. TELEPHONE NUMBER OF ESTABLISHMENT: CSOS) 9. EMAIL ADDRESS: C TI /`G qn Co N! r, . n e t 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: Ai cA el Sou r` ai) G4- Lj 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 1-96 Inc. a ka C 4ge � i re- PRESIDENT o u v It N TREASURE 6 v2 o 62111 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN � DATE S /i I Q:�Applization Forms\Haz Mat App Revised 09-10-18.doex Ma Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape & Islands Tire Alignment Shop 736 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 do cQIdchK • �t0ew of B nsxable P f q� giaatoryYervices Richard V. Scali, Director �t�r� Public Health Division BARNSTABLE • 4 KMST .l"-IfEAY1LLP.CONIT.NYMTIIS �9rABM Thomas McKean, Director "�° '�� .�� UU MAC � 1639-2014 -- - --- - 9 i6 .- • _ '°Tenr�a+°� 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 �d V's . CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: -DO(A G I ffS B O U R G A U 5. NAME OF ESTABLISHMENT: CAPE £ I S I a n d s lire- 6. ADDRESS OF ESTABLISHMENT: 73o BeAr Atq O 2(001 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: CSo ) -7 7 S 6 O (6 9. EMAIL ADDRESS: C', +, re. I @ c-o m Ca St . /12- 10. SOLEOWNER: YES V NO IF NO,NAME OF PARTNER: ,/"�;G(„a m� (�g u R q A-u 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:CORPORATION NAME L R A 11 c b 6 a CA pe l a nA-s Tire- PRESIDENT T) ov g 14s ov«a a v 1-f ly Eairwati D,- Ac-sfyiet-AiA oxlg3 TREASURER eM;r- 'IFteI e ov!fjz. '{" 9 Jenn Fa-r(1Rv¢n MA 0271°I CLERK 12. IF PREPARED BY OUTSIDE PARTY: / NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT/i/ DATE Q:\Application Forms\HAZMAT APP 2017 REVISE .docx �1 Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape & Islands Tire Alignment Shop 736 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 06/30/2018 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 T 3 TQ,7 Nr s r 'TRown�of Unstable egu atoervices Richard V. Scah, Director "o Public Health Division BARNSTABLE • BARNSTABLE, - Thomas McKean,Director rc0.5.W5F�1639 200114Y';$1 P4'ryiT5 F639. ,�>`� 200 Main Street, Hyannis,MA 02601 �7g 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 DULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 0 V-S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: L R 6 I N c - -D o U G, I AS -Bo lA r Q kA I✓fe S 1CL 5. NAME OF ESTABLISHMENT: d 6 a' C Iq Pe 6. ADDRESS OF ESTABLISHMENT: L 'A-Ges 60 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: C S 6,�) -7 S 9. EMAIL ADDRESS: �e S 3`I' (a co tA ca Sr t Corrpa�a+-ivn / lf 10. SOLEOWNER: YES,/ NO IF NO,NAME O 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME R et h e d b a (' a e f 1.5 t411 IS I r� PRESIDENT 17 u As yr au i4 l Air w �I? r,� r'' R oa-143 TREASURER �e t go v t ✓ '1 SennIc 6fob Alt --S"�S7 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE QWpplication Forms\IAZMAT APP 2017 REVID !� / Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health o This is to Certify that Cape & Islands Tire Alignment Shop 736 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 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health IF r 2- _ Town of Barnstable �IHE Regulatory Services Richard V. Scah,Director MAS& Public Health Division BAMSTABLE .16J9. '�fD MA't a Thomas McKean,Director 1639-2014 575 200 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 3 Oth). 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 l FULL NAME OF APPLICANT: Iff a S i s o k R D vJ . ` d `s T e NAME OF ESTABLISHMENT: L R� �n� d 6 a C �a�►� � � s ►- ADDRESS OF ESTABLISHMENT: .173o L4 y 03 n rl r.5 A 6 00,Z66 MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: (SD S) -7-7 S- 60 EMAIL ADDRESS: CA -e 5 a 3 y C2 L o n�`�ca 5f , q e�f SOLE OWNER: YES V NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME L R 6 l kr c c9 a. C c ( n l5 T r e- PRESIDENT Du rc, qI-� TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: MN TU F APPL T Name: otkA Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev I6.docx Page 1 of 2 t Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department , ,, Public Health Division ASS, Thomas A.McKean,CHO b19..a`° 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $125.00 (Check) on 6/9/2016 Permit number: 1100 i Check number: 2612 Check amount: $125.00 Name on check: LRB, Inc. j !Business: Cape&Islands Tire Alignment Shop Owner: GILBERT C TR i 'Address: 730 BEARSE'S WAY, Hyannis ----- --- - -.--- - — --- ._...............------- _ .. .. --- ------..__ • • Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that LRB INC., CAPE& ISLAND TIRE 730 BEARSES WAY, HYANNIS,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 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r./ r� Town of Barnstable y � ^ Barnstable �VE Regulatory Services Department bvAm Public Health Division BARN BU. MASS. 639_���� 200 Main Street, Hyannis MA 02601 , Fp 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX; 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE &a I APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT -J)o u cI I a 5 B o u P,g aLA NAME OF ESTABLISHMENT LRF3 I ti c Aa C A Pe k I S a n S T re- ADDRESS OF ESTABLISHMENT 930 g eo rs es way 1A y iq t1A,-5 A 4 _O D-(0 ) TELEPHONE NUMBER S O 1 -7-7-5 SOLE OWNER: YES v/NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0 9 6 ,2 0.3 STATE OF INCORPORATION A CI 11 '2- FULL NAME AND HOME ADDRESS OF: ,- PRESIDENT `as Qau( 'a,,Nlt I V Fa'.rw r� Ve At,(is f Pol9 3 TREASURER ;G e ou of. J e.A fN r, Ve -44A 0,allk9 CLERK SIGNATURE OF APIAICANT RESTRICTIONS: HOME ADDRESS -a D v� HOME TELEPHONE# (SoTr) S 6 I Sl g 0 (o J:linspection handouts\Haz Mat Application2008.DOC lot or-,' S�. SPILL CONTINGENCY PLAN Emergency Coordinator, Name:Address: /at Pawa S Q ce I Daytime Phone: Sos--1 7S-60&& Evening Phone: SaS • 3L If - Fire Department: 147,4rn,S F.At LpAgt,• e&4 Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: YNo A ) Phone: sad-3�(,-G73y Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). 19 i �VQ �-ctions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. MaR;a l ,�✓� 5 �pa�•�� S p, I I w, � P P�' Gp.(( Nyann�g Fries ���a�c�rH�'- Tr F'R� d.�P���w«►•� rs . Ala 4- w t did c%N av CPA S kll t?"OV,0 �� ANa dis�Sr of /��Sd,t��aN� w�,4�tRi,�� ire A Te J ANd SM le d Gall Frn- PrtlZ Number Fee 1100 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that LRB INC., CAPE& ISLAND TIRE 730 BEARSES WAY, HYANNIS, MA 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 6/30/2015 unless sooner suspended or revoked. ?' ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �r + y Town.of Barnstable °FIRE r Regulatory Services ti Richard.V. Scali,Director B"x"x `E, ' Public Health Division '°rEa 59. ° 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 6 J 'O ,! APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS. OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT DO tj Q la S go t4aacia H NAME OF ESTABLISHMENT U9 &c dXa C410e s n'�Zh dS j re_ ADDRESS OF ESTABLISHMENT 7 3 0 &A rs e s n n�s A n o� � � I TELEPHONE NUMBER (SO S ) r7 15- (o 0 6 6 SOLE-OWNER: YES ✓NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. t4 b - 0 q 6 a 0<3 6 STATE OF INCORPORATION j / /�0 /iz FULL NAME AND HOME.ADDRESS OF: PRESIDENT o efts QoUr qul ►y Fw Dr�Ve A of TREASURER IAJ ;s e u i- -a f Tenna- Drive `E ; r ho om o a-► 11 CLERK 0-1 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS �OV e HOME TELEPHONE# (5 e s I - Si"80 6 Q:\Application FormMAZAPP.DOC o� SPILL CONTINGENCY PLAN Emergency Coordinator, Name: �� R,'s P VIE�P�0 Address: Jul Pdwa 510 ee l Daytime Phone: Sos-17S-600 Evening Phone: Cab - 3Wf - iraSL Fire Department: 47ArVA,s Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: �, y_No Phone: f4-3.G-(. 73y Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). 0 !V Op _�'7 Lr ctions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. � ,�� `�►�soa�a►� Ma�R;al �� 5„V.F&V'� Sp, () w, 9 ��� f � C A�✓ Gayc gyarnrs F,m arP,40tm - � I 1 Fl a I, dRO 1.V 4wA dl`S�Sf of �hfd�Cbla^'I /rlA�lCRl�4l %N 4ORA5p, y I _ 7,441Afr RAC 77d Sc,a 1e d /��vd G,all fo►ri. PrZI� �� Town of Barnstable OFSHE r Regulatory Services v � "(P ° Richard V. Scali,Director t 1 BAMSraBLE, P� S. ,ter Public Health Division iDlen '�° Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Camiff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS l WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored; transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2 - 3: 1. . Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2014. A late charge of$10.00 will be assessed if payment is not.received by Judy 30, 2014, Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, ww.ton.barnstable.ma.us , which is located under the E-Code w vw section if you should have any questions or concerns. QAHazmat\Haz Mat Permit Letter.DOC j . FTKE A Town of Barnstable Office:508-862-4644 °* Public Health Division Fax:508-790-6304 BARMASS. 9` 200 Main Street• Hyannis, MA 02601 1639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ►fit 4 N.W-d-v c��n,.A C9 �� s `� fc.J Date: Location/Mailing Address: 7ic, 34ea.r dL11 o: o Contact Name/Phone: o..� -18"IC21PAvV4 ,dog- 7�-601,11, 94 ce., ,r,e4<, ,,ii Inventory Total Amount: ^ _� MSDS: °�'`�� esS License#: I t OCb Tier II : o Labeling: OK Spill Plan: Ye,5 Oil/Water Separator: Floor Drains: 00 _ Emergency Numbers: 2 s Storage Areas/Tanks: 3- $S a {.rM S &,e w agk-e,0, t Emergency/Containment Equipment: Waste Generator ID: Waste Product: O t Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: L-Ak (,�GQ b v sv aka ova — t v`ok c. otiJ LIST OF TOXIC AND HAZARDOUS MATERIALS N D VH aA a-< C1 W-y-'s w ivtv�Z-4v<Jaterial p tkGe Vm- IKg +�-YL- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous use, 1 storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids v/ Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers .l Hydraulic fluid (including brake fluid) �— Windshield wash Motor oils +wct',- 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: g-cot s ow O etS -e, r-ec, 6 ) ,ek- apt re, r ViA-w11- a ('ece�v�� 3� wire,. Luc �� 1a+es os�1 w� �,�n es o 46✓e. INFORMATION/RECOMMENDA IONS: & v e, 6164 s coVq o .QwA Inspector: L`� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IB�oy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ` BARMA9-%. 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: le- i a Ca s a k `T r Date: / ► i Location/Mailin Addre s: "1 's a hn►s a 1 -�o a aCP,c' Contact Name/Phone: D000 Q 610<gtcw 1'-1-.S S-foo6(o Ta rake- �cazrvQ k� bk C�G`f�2 Inventory Total Amount: N 21 MSDS: 6- �Av License#: Tier II : I o Labeling: Or'- Spill Plan: Y,e5 Oil/Water Se Separator: 1 ( Floor Drains: o p P Emergency N e enc 9 Y Numbers: Storage Areas/Tanks: 3- C,s1� c.ov�. eoWA-1-s Emergency/Containment Equipment: Waste Generator ID: Waste Product: 01 Date&amount of Last Shi ment/Fre uenc : N 2,3 I S'D a Licensed Waste Hauler&Destination: I 5 G�4--ar ARC a-A 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 I Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers — Hydraulic fluid (including brake fluid)3 41 (, Windshield wash (o 20$ Motor oils 504- ISo Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants �- Miscellaneous petroleum products:S Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries I 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: NO lei-XL5 b< v^ .�Yt �vu9--• Inspector: l� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °Ft Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 200 Main Street• Hyannis, MA 02601 1639. � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �. « Date: 2-4I Location./Mailin Address: ' i(mk,k 73b kc ' Contact Name/Phone: Inventory Total Amount: 'JCL MSDS: LS- o►ti 4a CWR, License#: Tier II : l Labeling: Y- o t Spill Plan: Oil/WaterSeparator: Floor Drains: Q 0 Emergency Numbers: y25 Storage Areas/Tanks: 3`SS 4>0-1 ot.<'N's kF� Emergency/Containment Equipment: t Waste Generator ID: o -1560(,Je Waste Product: JLk� e ot� Date&Amount of Last Shi ment/Fre uenc : I I 1<1I I$'O ( n- I X Iq t- Licensed Waste Hauler&Destination: hak c,A \) --7KKAv �fL ( t��ot7\tCti Other Waste Disposal Methods: to elzan� 1 61aQ MA O c�S� ,A,11 a� k(1ee.tti. LIST OF TOXIC AND HAZARDOUS MATERIALS S��c��e-5-k- kvky�, NOTE: Under the provisions of Ch. 111, Section 31, of the General L ws of MA, hazard us material use, storage and disposal of 111 gallons or more requires license from the Publl�ic� Health Divisic�'- ✓l� \otti", DDQS�S G�4A1�-2.( Ito �StV\t.AU 't � W4'S�- ©t` 6rSN1S �11�o'E' c 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) V 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: V k�. o+` "5 0,0� k L�c , L cex A)e r 60,1) Po A-4 , DERS: A, '\ , v t\ C 5 : k ` 'l5 ..e-O, ( o e- Yo gk -- cn a s rI o, 1v1- i INFORMPTION/RE OMMENDATIONS: vA 4 k 5 T C© t1,¢ cvvu a,•we no , Inspector: s Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: � l�l TOWN OF BARNSTABLE- g T'G^...— TOXIC AND HAZARDOUS MATERIALS \ N FORM NAME OF BUSINESS: Alf g kwt.cA cs` op/af Cae •,Ak-5 f-e- BUSINESS LOCATION: INVENTORY MAILING ADDRESS: O .Bark' arks TOTAL AMOUNT: TELEPHONE NUMBER: ,5-0 9 — 77 CONTACT PERSON: EMERGENCY CONTACT TE-LEPHOWE NUMBER: a(-,5 MSDS ON SITE? TYPE OF BUSINESS: 4"40 r-eQ-q ,.",, /1ja-0 INFORMATION / RECOMMENDATIONS: Obi<,� � r�o� sf �a ,reQo�s Fire District: of VL A ,s sare eor DI L-a10-. M61>S If er&okyices . 1P Sfe,Me�r�+t��r s�,J1 p1ron� s. Waste Transportation: '1X"9000081z..0,<- Last shipment of hazardous waste: /s i 3 Name of Hauler: Destination: J�44y <1zeH Cn4tfgfo K, VQ. Waste Product: 04-0,-- s e4e4.e-e Licensed?So No of �S>oaq SoZg4Z (co.»bvs} Ali 1�Rw NOTE: Under the provisions Ch. 111, Section 3 , of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires 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 Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive NEW/b 0 USED 2- Cesspool cleaners 3 Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides L�1 NEW 9(- a USED v f to SS a d (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 2 lubricants, gear oil ❑ NEW ❑ USED p 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 (including bleach) Spot removers&cleaning fluids (dry cleaners) 4c) �v<vk-- %4. SPet IJ-Lr Other cleaning solvents Bug and tar removers oMp)t�5. CyK. o, A,4�25 1 , A-e.r Windshield wash A0 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials I TOWN OF BARNSTABLE BAR—w2 4, Ordinance or Regulation WARNING . NOTICE Name of Offender/Manager bdk-�lrj Address of Offender j MV/MB Reg.# Village/State/Zip �..� ! t / Business Na-me r �!r€ -- i Ytt y ,vtcylTl�r f� am/rpm on ►f 20 a 1 Business Address 7.3n oonr-qp`rt 1je, V Signature LoF Enforcing Officer **M(,�va1l .. Village/State/Zip PV4Vtv1+5 , RA 0,2(,r)► r } t��1 Location of Offense -774, �Ft4a� /Jn�! � l7�" . ,.- Enforcing Dept/Division Offense ►"". ,Iv(, nU. a,,�_ il�� ruS ✓? - r�ca �e �� P � kr�� r,-aG►�r �_ Facts W!4 r- � 1,i� e 4 CLplo r I(A-L A_,<4 nom�94) 7 This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ! - Address of Offender MV/MB Reg.# Village/State/Zip Business Name ,;.a 44' _ 2. am/pm,,, one ,,",' 20 1 s Business Address` Signature/.of-' Enforcing Officer Village/State/Zip f�tfrrlF`' r � Location of Offense -7-,., f': s t Al-e _ SS )}} Enforcing Dept/Division Offense f' C�` i t. rA F ? St' r 7 3" ? x_ Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER "CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ;TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM f NAME OF FIRM: CZ "&,/ ;Z ClIel- MAILING ADDRESS: q) TELEPHONE NUMBER: '7 '7/— '9 5 CONTACT PERSON: Does your firm store any of the toxic or-hazardous materials- 13.st"ed==bEl=aw; either for sale or for your own use, in quantities totalling, at anytime, more than 50 gallons liquid volume or 25 pounds dry weight? YES t,� 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: f, ADDRESS: 2 2 �ft TELEPHONE: 'J��--C ;?/p 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 'I Diesel fuel, Kerosene, #2 heating oil Other petroleum products: grease, (creosote) Swimming Pool chlorine lubricants Lye or caustic soda . Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproof ers Car wash detergents outdoors) 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 Paint brush cleaners "Poison" labels (including chloroform, formaldehyde, ' Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners) R E C E I V E ® list•v:< Other cleaning solvents HEALTH DEPT, Bugand tar removers TOWN OF BARN STABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants MAY 2 7 -1981 Road Salt (Halite) - -- -----_.-- ----------- - - _ GUMI'L1FUVl:C: .� [:LAJJ:yt. 1 JWtj1 OF BARNSTABLE 2. Printers O satisfactory 3. . Auto Body Shops OAR D OF HEALTH 0 unsatisfactory- 4. Manufacturers (see"Orders") S. Retail Stores COMPANY 0�'9- 6. Fuel Suppliers ADDRESS��� Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor: 1AJOR MATERIALS Case lots Drums AboveTanks Underground Tanks IN OUT I 0U IN # a e s Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) AAI Heavy Oils: waste motor oil (C) new motor oil (C) , transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL RECLAMATION REW RKS: 1. Sanitary Sewage 2. Water Supply OTown Sewer Public OOn-site Q Private 3. Indoor Floor Drains: YES NO O Holding tank: MDC O Catch basin/Dry well -- On-site system 4. Outdoor Surface drains:YES NC ' O Holding tank: MDC OCatch basin/Dry well — -------- — -- - OOn-site system Licensed? S. Waste Transporter flame of Hauler_ Dectina i nn Waste Product NO 12 23 81 Person s) InterviLeweJ Inspector ate ' n ` BRANCH OFFICE BRANCH OFFICE TAUNTON,MA 02780 ATTLEBORO,MA 02703 HAYWARD,EOYNTON &WILLIAMS INC. FREEMAN ENGINEERING CO. 7 BROADWAY 178 NORTH MAIN STREET 617-822-9870 617.226-1302 HAYWARD-BOYNTON & WILLIAMS INC. 140 SCHOOL STREET- BROCKTON, MA 02402-617.586.0628 �AN� SLq REGISTERED LAND SURVEYORS& PROFESSIONAL ENGINEERS Continuous Service Since 1880 W .i r xv A °"fs -Qew"\��`` May 10, 1986 S�ONAL ENG EXHIBIT A SITE ASSESSMENT REPORT Cape and Islands Tire Co. , Inc. 730 Bearse's Way Hyannis, Mass. 02601 Attn: Mr. Gilbert C. Wood Subject: 730 Bearse's Way, Hyannis, Mass. I Gentlemen: i I As requested, this office has conducted a visual inspection of the above premises on April 10, 1986 , and found the following: The premises contain two buildings on about 0.6 acres of land situated on the east side of Bearse's Way. are by the Cabe and islands VTireyCo , Inc. , an Automotive Tire Sales and Install- ation Dealership. It is understood that no underground stor- age of gasoline or oil exists on the site. The exterior of the site is almost entirely paved. An area of about 100 square feet has been contaminated by oil, which, it is understood was caused by a previous owner depositing used automotive oil filters on the ground. It is recommended that the contaminated soil be excavated, disposed of properly, and the soil replaced with clean gravel. PROPERTY SURVEYS • SUBDIVISIONS CONSULTING CIVIL,SANITARY&ENVIRONMENTAL ENGINEERING i ' F `Y L\+ Cape and Islands Tire Company, Inc. -2- May 10, 1986 Nothing else was observed on the premises which would indicate the presence of hazardous waste. The inspection conducted by this office was a visual ground surface inspec= tion with no chemical or bacteriological testing performed. No opinion is rendered concerning past activities on the premises which may have become obscure by time. If you have any questions, please do not hesitate to call. Very truly yours, filbert A. Registered Professional Civil Engineer . OF ALB A. ZF PEARSON, JR. �=+ CIVIL y l\ No. 22618 �(EGISTE''�O, `�, Il _ K TOWN OF BARNSTABLE BOAR ® OF HEALTH CO/VTR L OF TO_UC AND HAZARDOUS MATERIALS - INSPECTION SHEET l ` FIRM .�G�,- .) '�f l�f ADDRESS Major types of materials: 1) ��iG�- 2) 3) 4) 5) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility v/or # Remarks/Recommenc :<.ions 1. Indoor �- a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system ' 3. Separate holding tank . C. Off-site disposal 1. hauled by own firm 'z �� 2, hired hauler a) name of hauler b) address or disposal site PersoLn(s) Interviewed _ _ ,/ _ _ Inspector Z' ( / Date�`- - - -�- - - - — — — — 6 so 81 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: ® 451�joiq 0"V-s �At✓ Town of Barnstable TELEPHONE NUMBER: 7 74�r^ "46� 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 totallin , 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 HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored i lease put a chec7bes"ide'e'each pro uct that you store: Antifreeze+ for 9 Y )gasoline or coolants stems Drain cleaners ( Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants V Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants ✓ Duel, kerosene, #21-heafifl� 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, vaP;+shes; s;-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):h(dry cleaners) 1 -TZ1 c. L,0(� � Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business I � , MICHELIN TIRE i CAPE & ISLANDS TIRE CO., INC. ! 730 BEARSES WAY GREG ILL HYANNIS,MA. 02601 SALES MANAGER 775-6066 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 Mass: 1 7.Miscellaneous QVA ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Pienl, Kerosene -)' 4A V Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic t90 Synthetic Organics: degreasers . A) 1 ti Miscellaneous,: Vj e Z'11 r q DISPOSAL&EcLAmATION REMARKS: 1. Sanitary Sewage 2. Water Supply z . O Town Sewer AT?ublic 4rOn-site OPrivate 3. Indoor Floor Drai YES NO Holding tank. D O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES /� NO DERS: O Holding tank:MDC Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1 YES INO 2. I/e'rsoiff fritervi—ewed— Inspector Date