Loading...
HomeMy WebLinkAbout0574 BEARSE'S WAY - HAZMATr5�y �y�. w,� � I ' TOWN OF BA R N sTA B L ELsee"Orders' CE: CLASS: 1. Marine,Gas Stations,Repair ctory - 2. Printers BOARD OF HEALTH � � 3. Auto Body Shops f�v� ,,,� facto - 4. Manufacturers S. Retail Stores COMPANY Q_nA,� L-3Q 6. Fuel Suppliers ADDRESS Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbOveTanks Undergrouad Tanks IN UT IN IOUT IN OUT Lyallons Aze rest? Fuels: Gasoline, Jet Fuel (A) Wo o Vou � Diesel, Kerosene, #2 (B) Heavy Oils: 1 waste motor oil (C) �© new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: E DISPOSAL RECLAMATION RED, 1. Sanitary Sewage 2. Water Supply OTown Sewer O-Public site Private c r z frj�g, i 62 C� � O 3. Indoor Floor Drains: YES ( __-IQ6- / � C l e C> s O Holding tank: MDC 1, / o ,I_— 3e� 4` O Catch basin/Dry well On-site system 4. Outdoor Surface drains-.YES NC Holding, tank: MDC — O Catch basin/Dry well OOn-site system . ` d b S. Waste Transporters; o' �d � ;� r..0 `�` is Ved? Name. of Haulej:_ Test,n at i on i,awse� {a�ze.rYFS 1. e 2. e ers n s Interviewed Lnspector ate TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF O)XIC AND ZARDOUS MATERIALS - INSPECTION SHEET FIRM ADDRESS 7sY l y Zi 141? I r E Major type( /Of f materials: 1)' � �� ( � 3) 4) IF 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars e drums,barrels � aboveground tanks underground tanks / bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility for:# Remarks/Recommendations 1. Indoor a) separate, contained room b) stored in general work area i) inadequate .ventilation ii) floor drains r , iii) inadequate fire protection ' o 2. Outdoor `�V ~� a) uncovered, exposed to weather b) pervi;:us 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 2, hired hauler a) name of hauler b) address or disposal site Person(s) Interviewed s ector i Date - - - - Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH ..------------------------------------------------------------------------------------------------------------------------------- 574 Bearse's 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 rl Town of Barnstable Inspectional Services BARNSTABLE C� T • • t,Mls"s•WT-aMR�'�Rt:[OlM.BFaMMELE Public Health Division 1639-2014 BARNSTABLE, Thomas McKean,Director KAM s6 9. 200 Main Street, Hyannis,MA 02601 Eo r� C> N) Office: 508-862-4644 Fax: 508-790-630410 M APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALSn 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 1B *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. jq3=�_yq 2. IS THIS A PERMIT RENEWAL? L,,"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: In 1`�-10 .tdannk� j±f wa—,6 -L-ud, 6. ADDRESS OF ESTABLISHMENT: dZZ/ Piol,j, ,o 1, 42" k1li 5 t'r)/1-d 1-2400J 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: lug UI 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5D `7 Z 1)d Z)-3 9. EMAIL ADDRESS: /-"p ILPj ► i, .fw. 10. SOLEOWNER: YES ✓N-0 IF NO,NAME OF PARTNER: = YVI 141 0S 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME j PRESIDENT 7051 r r�n UPS TREASURER s CLERK • 12. IF PREPARED BY OUTSIDE PARTY: NAME: k.11-( Gf TELEPHONE#: D COMPANY ADp SS g/) �(�� c EMAIL: l b!(l��t'12.�,�2AV4 n� layCc SIGNATURE OF APPLICAN DATE �na64 Q:Wpplication Fonns\Haz Mat Appli Draft Jan20l9.docx Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S 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 �r ,7i at Town of Barnstable Inspectional Services BARNSTABLE p7HE T[L.� wvs*o�aeNi�s�'1+�"-c`wuCOss%u.•.a"-:ae • o� Public Health Division 3ARNMBLE. •` Thomas McKean, Director 9`l'ArE�s 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 DULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 I VST-- *A late charge of$10.00 will be assessed if payment is not received by July 1st. (a�� 1. ASSESSOR'S MAP AND PARCEL NO. -Uy7 2. IS THIS A PERMIT RENEWAL?_ZYES_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: 80. 16,0, 111 C�.n n l ,�/—j c �'.rzJ -lnt lr- 6. ADDRESS OF ESTABLISHMENT: ,�'7 lbet�5@ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 40 d D)1 �,�!� �,/�(4n,d,ma, dal�f�/ 8. TELEPHONE NUMBER OF ESTABLISHMENT: 56IF-771-19I&S 9. EMAIL ADDRESS: 10. SOLEOWNER: YES v"NO IF NO,NAME OF PARTNER: "-�P� 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: 5&R-5691 —J4cF CORPORATION NAME n i PRESIDENT J n . rhia 611V TREASURER CLERK 9 b-)a tPjf II)'S A YYiL /l 92fs 12. IF PREPARED BY OUTSIDE PAJRTY: NAME: Cc. I r TELEPHONE#:H/-86/p'' COMPANY ADDRESS9U & j el-1- EMAIL: P � 1 4atinr3 ) r" OQ&Ol N SIGNATURE OF APPLICANT DATE (p J I S Q:Wpplication Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S 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 7e • • • r i 10ewgu'AatoryB 5ervic ble ��� WASH Richard V. Scah, Director Public Health Division BARNSTABLE eaFnsTaelE•�nmut•cmtrtr•!nanms BAMSTABLE•D1 Thomas McKean, Director 163920 44� STneE iOjEp s 200 Main Street;Hyannis,'MA 02601-..--_ ---_ T 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 o 1/,S . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. Q�3"cwl 2. IS THIS A PERMIT RENEWAL? V1 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:o m0j,� A ac . 5. NAME OF ESTABLISHMENT:'b.,%.&�-1,.,nry-5 Q,,g- 6. ADDRESS OF ESTABLISHMENT: �� �5��`-1 t`�-lS �� Oaao1 , 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: ���� �� � �C �.;000 A 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50� `g1)1 -CAD03 9. EMAIL ADDRESS: _bo�\3 �,Cz Q 6-,�\ �_���� • CAt>w- 10. SOLEOWNER: YES11 NO IF NO,NAME OF PARTNER: q&,kx-"nSyo 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: �' -3 IS CORPORATION NAME �c�Cs�. �•t�n� s C��- vJ PRESIDENT Z--,wmtx.� C � TREASURER �tjt CLERK S c51 cs; a� l O 5 12. IF PREPARED BY OUT,kSIDE PARTY: Sln� NAME: s ACC a I„ It 5t) Lo TELEPHONE#: D- cd ` -3g J • COMPANY ADDRESS qO , EMAIL:6R15`�; �bC,.rtinI,, �►a 0 a\S)D 1 SIGNATURE OF APPLICANT o DATE (91X L l t QAApplication Fonns\HAZMAT APP 2017 REVISED.docx Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S 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 06/30/2018 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 �Ir Twn of Bnstable eg atory ervlces P Richard V. Scali, Director Public Health Division E*: LE•xru�as1AAWN I•E• Thomas McKean Director e.xsraaaMA38. , 'Y RFD MPS p�0 200 Main Street,Hyannis,MA 02601 Q C> Office: 508-862-4644 �a1'7'oZ0IU Fax: 508-790-6304 �. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZEr 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 �7 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,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 3-0,.mlaa, E 13g\% 5. NAME OF ESTABLISHMENT:t ol,\A rt� n(\; Cw- St3 (lL 6. ADDRESS OF ESTABLISHMENT: J'1 a Q'2c.<St S\*lc� �A dz ko-l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �'�� t�i���Ch�9 c'�1 \�� � �� ql�r�1 S S. TELEPHONE 1N'U?vMER OF ESTABLISHMENT: 9. EMAIL ADDRESS: )bf�\ 'S-�l CO CfJTYN 10. SOLEOWNER: YES X NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: c O-S-e% '39 b-0 CORPORATION NAME PRESIDENT TREASURER M 'SYI.t tv S P lv ;5 CLERK 12. IF PREARED BY OUTSIDE PARTY: , NAME MC\s:b c` N i 16 tl cO TELEP OT`E J:, • COMPANY ADDRESS Y1 sQygEMAIL n I S'ii CO e Im i Sk C�uto .G�'� SIGNATURE OF APPLICANT S DATE (D I< ,a I-] Q:1Applic:ation Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1094 THE COMMONWEALTH Of MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S 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. ---------------------------------------- 4 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 Town of Barnstable Barnstable Regulatory Services Department XNmedcaCft . Public Health Division r • rnxatsrne�.E. 9KAS& 200 Main Street, Hyannis MA 02601 639. 2007 Office: 508-862-4644 Thomas F.Geiler 1pirector FAX- 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 t ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT JAmA�5 ,�� f�.gL/c5ot� 71-, NAME OF ESTABLISHMENT &b3z �/j/i►.Jt,10�C✓l l uC�D . ADDRESS OF ESTABLISHMENT ./h 0 T Q� TELEPHONE NUMBER Vfoj- 77/ •-O(Jo3 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. STATE OF INCORPORATION n CWU,54_#3_ FULL NAME AND HOME ADDRE S OF: O10�`j PRESIDENT `/ ' �,E. 956 b. d/c. TREASURER u /-h. A .CLERK S1 NATUERESI NATURE OF APPLICANT, G : =6C5Y_ . RESTRICTIONS: HOME RES a S'J HOME TEL NE# &A3 -! JAinspection handouts\Haz Mat Application2008.DOC .. _ LoOYtight 2000 ADP,Ina. CHECK .` ISE FORD NISSAN HYUNDAI CONTROL NG. 52813 ISSUED BY: Lutzen,Christi .HYANNIS MA ozsoi PAGE 1C INVOICE INV0IGE PURCHASE bIS00UN7/ NET STOCK'NO.. DATE .._. ORDER NO COIVIMENTN i N AMOUNT ACCOUNT NO ::,:::AMOUNT: 062113 .APPLICATION FOR PERMIT TO STORE 1.00 . 00 HAZARDOJS TERIALS BALISE HYANNIS CAR WASH 52813 34*20203 -v,-100 . 00 T WN BARNSTBL 39*69M 100 . 00 ;. TOTAL 20203: 100 .00 .DETACH AT PERFORATION BEFORE DEPOSITING CHECK REMITTANCE ADVICE HECK BA " Date:_57—//s /13 TOWN OF BARNSTABLE C TOXIC AND HAZARDOUS MATERIALS R8G9T%&M0N FORM I{ NAME OF BUSINESS: kJ45L BUSINESS LOCATION: k k y, t 4m INVENTORY MAILINGADDRESS: TOTALAMOUNT: TELEPHONE NUMBER: SOB -7-1 t_ 0oo-3 CONTACT PERSON:`ooy �c P4r�os ' t EMERGENCY'CONTACT TELEPHONE NUMBER: (,17'7-t oD3,a MSDS ON SITE? <: TYPE OF BUSINESS: a14o,. . as r w a s lti Ye s I INFORMATION /RECOMMENDATIONS: ���� a l sp.l� <�1s�r�� /. 4-9 Fire District: IK�o Tor �tk;.. �� Co.«J�e55o! Toow K� CibSot�C..�ls a,4 5,{.� 1 �y4 r�nis j -' cl� vfl a.,sp,lls. 0614-K- eos4-1,,k cJ2o s Ma1e�,ai5 kcen�. i ewLrgegg s0 Waste Transportation: IJIA Last shipment of hazardous waste: Name of Hauler: Destination: f '€ Waste:Product: Licensed?Yes No ( F NOTE;:Under the provisions of, 111,Section 31,of the General Laws of MA,hazardous material use, .i storage•aod 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 I Maximum Y Antifreez0for gasoline or coolant systems) gs Miscellaneous Corrosive t ❑,NEW ❑•.USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) I Y ...Hydraulic fluid(including brake fluid) Refrigerants 1 :e Motor.0ils Pesticides ❑'NEW ❑USED (insecticides,herbicides,rodenticides) t } Photochemicals(Fixers) Gasoline,Jet fuel;Aviation gas Diesel'Fuel,kerosene,#2 heating oil ❑NEW ❑USED t 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 zp Miscellaneous Combustible l0 Car wash detergents Leather dyes I 2 SO Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's (;.t 10 Paints,varnishes,stains,dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) Any other products with"poison"labels I .j ❑NEW ❑USED (including chloroform,formaldehyde, y f Paint&varnish removers,deglossers hydrochloric acid,other acids) i; Miscellaneous.F.lammables Other products not listed which you feel Floor-&-furniture strippers may be toxic or hazardous(please list): I MetaLpolishes s. r+ r LaundrysoilA stain removers S (including.bleach) �L 11 - - fie�a.'C e l- N d y 4- Spot-.removers&cleaning fluids .i (dry cleaners) ( Other cleaning solvents Bug and tar removers 3 � Windshield wash WHITE.COPY-HEALTH DEPARTMENT i CANARY COPY-BUSINESS Apolicant's`Signature Staffs Initials �� °p IME Ao Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMA3&RLE. • 200 Main Street• Hyannis, MA 02601 �'OrFDMP�1, `0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cal- 04-3 Date: Q 2d Location/Mailing Address: 22s ar Contact Name/Phone: `'1'o�n -??f - ,o Invento Total A ount: 1ODD a0 MSDS: 7e5 h+dCk°'"U. "'� License#: Cq eA4-3 Tier II : IN Labeling: Jeol Spill Plan: Oil/Water Separator: Floor Drains: Emergency Numbers: e 5 Storage Areas/Tanks: -"S k\ S Amgc- coltv9 t., a <e. Conv,-, Emergency/Containment E ui ment: k < #--wk\ S o 0►1 �,�� Waste Generator ID: MQ o$-7710003 Waste Pr duct: w v� Date&Amount of Last Shipment/Frequency: u5 Ne., Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Iv o VN0,- 1J,C c&�'�`' '`� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws bf MA, hazardous'm erial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid �J Other cleaning solvents&spot removers Engine and radiator flushes P,�'(.e0 Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) �— Car wash detergents Printing ink �— Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes � Lye or caustic soda Lacquer thinners `/ Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: LtLL�hC.,�b�i'�C ova ���-L �5 ,A,o-� C�cew� ORDERS: 0 \10A . oK at f . INFORMATON/RECOMMENDATIONS: sir Go o a7 cc� ..c_. o ewe, o beg. a o ea ram. ,'°�� C� D� 1Q�2 ��Zo•�s "� e`er I-n�spector: DuJ S�\ko g�g Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS 10/04/2016 10:32 15088621628 READY CREDIT DEPT. PAGE 01/02 N Please print or type.(Form designer For use on alfte 12•pitch)typewtsr. Form Approved.OMB No,20`HO30 UNIFORM HAZARDOUS J)An;V�fb Nutt t 2.Fags of 3, ergancygas Phone 4.Manifest Tracking um her WASTE M MIFEST ' 5.Out toes Name end Majl ng Ad9ress Gerrerato's SReAddreas('rfdlfeDeM than maifmg etldress) �.r� q ' {• df y.S I ��^A•,}h;'.r t.�k`.5� .vr� (.�Y/C`✓S F ,t Generdfot•'s Phone: 8 yyrne b, U PAID p'Niumbef �ortar ICompanyMa ��'S :•,r* �.r -w°�+,.:� ,erg°�..ti..,,.,d ,r7 t'y�► 1 7.Tanspofter 2 Comlwy Name U.S.EPA ID NumSer 8.Do F1 Narr)e an 51�,gQd`e� ° U.S.EPA ID,Nurroet I���� r~•�l�� an��f`D4}J-sj�+"i+�r."J'�qf .',;1'� w� TM�ilia ' 1"i; ► PL"1�'4 +a`m t'}`c�"+a�3. `mot„ p� ^ -, S•7 -7 Fadfipa:Phone: Cop a✓,v� �; �`'� . 71 9a 9b.U.S.DOT Description(ndiding Proper ShIppirg Name,Hazard CkaSs,ID Number, 10.Cordalners 11.Total 11 Unit 13.Mute Codes HM (a�nddd Psding Grraup(d OOMMd f r �( }� .{ No. 7�pe Quarmry WtML •04 2 LJ t7 , 3, 4• MkTrWclona and Additional infCm�oon 15, GENERATORVOFFEROW 3 CRIt11MA7101i I hereby declare that the contents of this consignment are fully and accurstoly described above by the proper•shlpping name,and are efosslhed,packaged, marked and iabeled/pkaearded,end are in all resD03 in proper condition for transport according to eppticabio InWaUorial end national govemmental aEulefims.M export shl rnentand I am the Primary Exporter,i certify that the ocnmrde of this consignment mriferm to the terms of the aft 0ed EPAAckhoudedgment of Coltsent I cerify that the-waste minirnhzatlon statement identified in 40 GFR 262.27(s)(d I am a large quantity generamr)ot,(b)(if I am a"ll qn6 genre w),.6 but, e arsipfferofs Perodffyped Name . r' ttrre th ., Day Year 16.Intemational5tipments ❑Import to U.S. ❑Export from U.S. Port of entry/eAL Z Tronsporerslgrauae(for exports only): Date leaving U.S.: w 17,Ti2hSpoRerAckrawladgmentof Receipt ofMaW=15 r" Tran ,rime lflyped NameY�f # Signal 6 F M/ +jDay Year Z. d e C Transporter 2 PrmtediTyped Name Signature Month Day Year F- '8.Discrepanoy 18a.3iacrepancy Indication Spate C Qtrantlry ❑TY00 ❑Residue ❑Partial Rejection ❑FullR�ection Manifest Reference NurrOer 18b.Ntemate Feanty(or Generator) U.S.EPA ID Number u. facildy's Phane: wW 16C,Nl nature o',Ntem3ta Fedity(ar Cemrstor) (None Day War 2 19•rasardous UJaste Report Managemarit Molhotl Codes(I e.,codes for hazatdws waste troafrtlent,olsposal,end recycling systems) Wo 1. 7-1 y 20.Cesignated Facility Owner or Operabr.Wif,Catton of recelpi of hazardws materials coWod by the mardfeat axeept as toted in Item 15a PrIntedTiped Name srgnmturs Wnth Day Year EPA Form 8700-22(Rev.3-a5) Prevlous editions are obsolete, G ENERATIOR'$INITIAL COPY 10/04/2016 10:32 15098621628 READY CREDIT DEPT. PAGE 02/02 A = // Y DAILY WORKSHEET JOB NO- � 715 DAY&DATEiPrr�A STOUGHiON 781.347.177i nVIBQ�QEE�THL 781-341.6108 CONTACT PERSON SERVICES MAINE 207-872-SM P.a,NO. PHONE NO NEW WPSHIRE 603.749.49M PREVAILING WAGE _YES NO CLIENT 01 1 92W.-fC�.s� c�.•�J ���' �l BILLING ADDRESS, _ JOB LOCATION J .7' SQ /VO z eaa1_C fA r � �•t Depart From Shop Arrived Bade At Shop EQUIPMENT LABOR TI7e OTY TYPE FLEET Ik HPS. INITIALS NAME TITLE ARRIvE REG. OT DT PC A L cl9,30 safe cA� Pk•g I f - E OFF SITE/TRAVEL TIME MATERIAL Q fY. DESCRIPTION PA"Q PVC bvP e TOTAL 'LABOR HOURS DISPOSAL LIQUID MANIFEST NO. i SOLID �'��+ CAP� �a I MAN] T NO. OTHER JOB DESCRIPTION TRANSPORTATION SIC Trp e tp1f' ! �l �c 7 $ d •SUBCONTRACTOR r B. i V o, 'rmp W, 7"14 fe 6Bp+r�' 1 '� L +"R� d� JOB COMPLETED .YES rwsO T Fl" PO REMARKS A-4 j -s•`,- api7 vat '( .� A (>.-X ' I ID—d/.. C-culdk) C,,t D PP 47' 'irf•.c� Clgel" bu"P Wn,-,zv! CUSTOMER T-0 m MA�,�,"�s.�. � � �� REPRES@NTATIVE � .� CYN ENVIRONMENT REPRES ATIV DATE • Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BALISEHYANNIS CAR WASH 574 BEARSE'S 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. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health • Town of Barnstable Regulatory Services �. o r Richard V. Scah, Director '"� ��` Public Health Division WNSTABLE 36 Q• 0 BnkYS40lF•NaIERNLLF•[DNR•M'WYNS 3 � %10.5fOt6 KJt5.OSTERNLLE•W5T BMHSTIIBIE Thomas McKean, Director �� 1639-2014 (f' 377� 200 Main Street, Hyannis,MA 02601 b � •a Office: 508-862-4644 Fax: 508-790-630 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 lst—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ cc CATEGORY 3 PERMIT 500 or more Gallons: $150.00 . A late charge of$10.00 will be assessed if payment is not received b} July 1st. ASSESSORS MAP AND PARCEL NO. a Ck 3 D ��DATE /to , 020/J.0 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: (� I nl� MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: (-5-2) O 0 0� EMAIL ADDRESS: m1pr ��JO�.�S,Q��,��D. Ca►� SOLE OWNER: S_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TEL PHONE#OF: CORPORATION NAME kgd44 PRESIDENT fir. D �1A ►l1 f 0 TREASURER `Yl p�, r CLERK p IF PREPARED BY OUTSIDE PARTY: S NATU O P ICANT Name: Company Address Telephone#: Email: Q\Application Forms\I-IAZZAPP Revl6.docx Page 1 of 2 Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S WAY, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 1.11 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------- ------------------------------------------------------ - This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2016 unless sooner suspended or revoked. --------------------------------------- '� WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 574 Bearses Way ftyannis,MA 02601 Tony DeBarros ' General Manage, tel 508-771-0003 fax,'^.e_957-2947 A,U�-,@baliseauto.com balisehyanniscarwash.com v m E HranrNIS � L �p�M i n - a Town of Barnstable Regulatory Services Richard V. Scali,Director ` KAAL Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. oZ 3 ,Q)\A7 DATE U L APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ,�. 1\ S Q N W,r S NAME OF ESTABLISHMENT . ADDRESS OF ESTABLISHMENT S Z-tn S-2 S n1 5 TELEPHONE NUMBER O O 3 SOLE OwNER:�YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: i IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. LA - 'O -] b 5 STATE OF INCORPORATION G. C.•o,r (J FULL NAME AND HOME ADD SS OF: PRESIDENT TREASURER CLERK . SIGNATURE OF APPL , 6106�0'y fa . 1 � �I RESTRICTIONS: HOME ADDRESS 1 y % HOME TELEPHONE# C:\cache\Temporary lntemet Files\OLKWU AZAPP Rev2015DOC IKE*ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BP_RMASS. 200 Main Street• Hyannis, MA 02601 q, .aM ,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Et 639.N• 1440415 Business Name: SA-115e- c4r 45 k- Date: Location/Mailing Address: S a Contact Name/Phone: !'o -77 (- OOD Inventory Total Amount: n6'1 MSDS: e� License#: I O� Tier II : No Labeling: �� Spill Plan: o$ e� Oil/WaterSeparator: yt5 Floor Drains: e5 -OUx Emergency Numbers: Storage Areas/Tanks: , -'4o VKk5 �w C&Vvt p - 5a<roo VV-% /takes o OWS Emergency/Containment Equipment 5g4aL. k PJS k-4a,�ek0 —�v, �o CaSSo� rvo.�,n, Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid 100 Other cleaning solvents&spot removers �- Engine and radiator flushes Bug and tar removers t�tto +r-4 }ec�, ti k k t Hydraulic fluid (including brake fluid) �5 + �S Windshield wash 9laSscl�a�•� Motor oils '°R&`5c-°""'� VD Miscellaneous Corrosive Gasoline,jet fuel, aviation gas Cesspool cleaners too, 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 ��SS� Photochemicals(Fixers) Rustproofers x 2o -yo Photochemicals(Developer) j Car wash detergents 55 / o�3� Printing ink Car waxes and polishes 5�17 t Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Si r4y evx4-" -k Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons 0 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) ���d\s iy 1 Any other products with "poison labels" �\ lad (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: t�1 Cbyl v�9,,Lxcy 'Vlo+ ORDERS: OS evA-e<' v` G2 uty - O'k,c- wo �(-Sr J I I ORMATION/RECOMMENDATIONS: e was a otti \v-L-C e- c Q S o e f-, ray �D y OX ��t eS� t'1at ��'e��5 k�lS �- Inspector: ) Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 11/02/2015 11:12 STAPLES 0154 PAGE 01 t ► 6. Form roved.FMB No.i� p 2061., Please print or type.(Farm,des' ned for use on elite 02 ch)typaw tar.) 1 Ge�etamr 1D Hughey 2 Page 1 of 3.Amer Ras Pt one M deaf okmg Number "'� �( ' UNIFORM HAZARDOUS $! -f` t ; t93� 4f 4 9 JJ K TA WASTE MANIFEST 5.Genasto,'s Name and Malang Address it� eae d dif( t fhfit mellmg addresa) �r e IM tla ...ShP.'1"B �%I, ..,... Gong WaPhdrW. 0 E. r 0 s Us.EPA IO Number6.Transporter 1 Compbny Name Gyq oil 01440I3 U.s.9PAID Number 7.Trensporter2 Company Nerve 8•Designated Farality Name and Site Address U.S.EPA 0 Number Cyf)og 0,5JrpWW.)ri f Fad hea Phone: 7�1 3d 1"$;R 9a, 9b•U-s.DOTDEzcdiXon(Including Proper ehipplrtg Nam®,HR.Id C103s,ID Number, 10,Cordenem 11.TOW 12.Unk 13.Waste CodeS Fyy1 .andPaddngGt�lp(Ifany)) No. Type Quantity WMcd. a 1 XVt Sfto,Fs&gotvrlC 0"l fly '>{�is4?(6�C�rs taC?� ��rL+) rr blet�aYl�CS ge IT w 2•t; s'aH D�$L71S�'W-0 rb ex aj'i'rb(1"JaPof37 svg4 Niso3ti�"..) art i TT 4. 14.Spaded Hend6ng InsWclhn9 a�Addlticnal ,rtr�tiar M' r shi name, • ale das9idK padkaFed 15. GOERATQR-OFFEROR'S CERTEICA7ION:I hereby decbre that the cerrtw IS of this ovnSlgnmelrt arefutly end auxeatetyd�albed shove by the plops Aping . merked•ettd IaheNdlplaoarded,and We in 80 la pads m prupv Condition for hnsWaeoarding to applicable intematimal and Rationed governrrented regulitions.If export ehipM tN and I am thti Pdmsry Exporter,I certify-rat the of this.cOrlslgrrmetrt edn(onn to tha terms of the atCiudred EPAAdowwledgment of Consera, I owVj Brat the waste mlrrtma°on stA4etmt identlled In 46 OP,28227(a)(If I am a urge quantitf geneftdor)ot•0)(i am a small grant ty We, Dayeonsm W'S106smfs Nnted[lypsd Narn)s $Igneture'' N°nW -j 18.ntemational Sldprrards F�dtt Snln U.S. Port of eldfplca ❑Import to U.S. Trensporte7 signature(for ebpods only} Date Tearing U,S., 99 17.Tmnspotl*rAdmowledTnentafRede0ofM3W8d "� .' ►fig•, Day Yssr sgnahtre � r 1 Piin�(fypadAler//rle__ j i ' d Y P� fl r!I U 0,J _ Lr ,: cn TranSPwtar 2 PtYttedltyped Herne Slgnstura , onth Day' Year 18.Disrm3Paney, 18s_Dlwepency IndM'atron SPOW Quardla ❑TYPs ❑Reatdua ❑Partial R*dion ❑F)A F*4ewsn. Manlfast Refeam Number. U.B.EPA Ip Number 18b.Alten'.8ts FacUly(or G�ansfetor} PadGty's Phe me, Day ear i 1 Bc.5ignaMe of Alto nate FscvW Or Gane ator) 19.'ftarerd0U5,Nsate Repon Msnepffal Method Codes(i.e.,cWes for harardous waste htlatment,disposal,and reaydhg*tems) C 1. 2. 3. 4. i 20.Ddgnated Fadlly Darter of gperahmr Cart radon of rec6pt of hazardous malersts Coveted by the manlfestsocePt 25 rrOlad m Iham 18a F sped Name Sgnature MoldYr DdY Year EPA Fom 8700-22,(Rev.3-0 ) Previous editions artabsleto, GENERATOR'S 1NrML COPY IKE rogti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B ",„�LE. ' 200 Main Street• Hyannis, MA 02601 1659. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT ` Business Name: t�lkr'�s� aN is (I-ae- oae L Date: I y Location/Mailing Address: -7 r1%.e"s w 4 VIC M iS Contact Name/Phone:---J-oA c- <,ro 1- 0o0 3 ins w l.'aw�cr —InventoryTotal Amount: ^^- I 0 4, MSDS: eS License#: l�� Tier II : o Labelino: ok�'� Spill Plan: Oil/WaterSeparator: y,e5 Floor Drains: 2 7 OAD Emergency Numbers: Storage Areas/Tanks:C-a-, leg5o! cower)A&5 $�5'qAA -t-3a g.-1 aC Q1Ls4., . "a0T�1,5 L1e4v"-f3,e1't- Emergency/Containment Equipment: %k 5 4tS5or c0OVIA- Waste Generator ID: O cj71"1 (60C> Waste Product: 01 wa, e-c' 5Iv Date&Amount of Last Shipment/Frequency: (OD a,( -e I Z o I X Licensed Waste Hauler&Destination: M W ,Fr>o 2 3D3-77"7 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 �z Bug and tar removers Hydraulic fluid (including brake fluid) � Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: �_"��k ORDERS: I ORMATION/RECOMMENDATIONSdr: �O D Inspector:�• Facility Representative rzzlf WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I Number Fee 1094 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 . Town of Barnstable Board of Health This is to Certify that BALISE HYANNIS CAR WASH 574 BEARSE'S 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 l� Town of Barnstable FTHE Teti Regulatory Services Richard V. Scali, Director B" MASS. ' Public Health Division 9� M�. ,fig' °re039n. ° 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 UTILIZE MORE THAN 1.11 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 111 MtJ 6,94/M \, • NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT G!,6 Q � TELEPHONE NUMBER `5-as-77/ — aim 3 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. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT9se �,(Oc3 �GvcSf. naG�l � �R Ow�y TREASURER i� CLERK 0/U857 SIGNATURE OF APPLICANT, RESTRICTIONS: HOME ADD ,(d HOME TELEPHONE# ,172 - ' Q\Application FonnslI APP.DOC 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:\App9ication Forms\HAZAPP.DOC TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: �, Town of Barnstable TELEPHONE NUMBE _ - 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 qua ties 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 HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registere t� Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants ✓ Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, hes, stains, is 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) .3 (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. nters BOARD OF HEALTH satisfactory 3.Auto Body Shops ® unsatisfactory- 4.Manufacturers COMPANY � "'`l''l (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ' Bt5 �(;jgSS; 7.Miscellaneous UAN1TIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALove Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,J Diesel, Kerosene, #2 (B) Heavy Oils: V waste motor oil(C) new motor oil (C) tranAission/h draulic Synthetic Organics: degreaser d _ ;? 3 � 06 Miscellaneou . 3Z07 Gv�,4l. G�i�-ems DISPOSAURECLAMATION REMARKS: Q¢- 1. Sanitary Sewage 2.Water Supply hfv aw � `L3ie4�1 J� O Town Sewer Public /MOn-site OPrivate 3. Indoor Floor Drains YES P/NO f 'Holding tank:MDC 6 i O Catch basin/Dry well44 O On-site system 4. Outdoor Surface drains:YES �NO ORDERS: O Holding tank: MDC Catch basin/Dry well O On-site system 5. Waste Transporter 1 Name of Hauler Destination Waste Product � YES NO 1. - � 2. GZ rs n (s) Interviewed Inspector Date TOWN OF BARNSTABLE , LOCATION �,J�/�,Y &a4� SEWAGE # VILLAGE ASSESSOR'S MAP & LOT K"O*7 y �c INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUffiHERR AR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I _J Date: S /3 TOWN OF BARNSTABLE4 L� TOXIC AND HAZARDOUS MATERIALS RfR48TPJMON FORM NAME OF BUSINESS: A115'e, `Vyanr�,s BUSINESS LOCATION: S7y&f/a c's hj:�J , f�y4hn► s INVENTORY MAILING ADDRESS: 1go,,— TOTAL AMOUNT- TELEPHONE NUMBER: .So$ -7-1 .- 0003 ra.1 CONTACT PERSON: --Tov% o EMERGENCY CONTACT T LEPHONE NUMBER: 1,1'1 -72.1 oa38 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: /b vl--e- o /s ► Fire District: I►���?��oo,� eQ�a i.�- yL ['owe iDl�e 5��0( teorL. K4-e//� Q�Soli. v��1d G K 5.4-1 - 7- y�N�'1)5 +A ClAAW V,D QrW SOWS . ��{'41K- }'�IJDS�'L+4�a�OG�S Ma1GCt0.15 lice_. dos�"a,l� for�',+W.c.a��/ .0Ait- 70St eNccirSGxc./ aifl hoKe YLJn,bps. Waste Transportation: I J/A Last shipment of hazardous waste: 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 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) gs Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) 1 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 Za Miscellaneous Combustible r 210 Car wash detergents Leather dyes 2 SO Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's 16 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, If 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 s Laundry soil &stain removers (including bleach) "ov'� a 4' Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers s Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials �L