HomeMy WebLinkAbout0617 BEARSE'S WAY - HAZMAT 7
Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $15o.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 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
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05/24/2018 15:13 5087906325 BARNSTABLE WPCD PAGE 02/03
7 Rble
egpatto� emc s
Richard V. ScA Director
�. Public Health Division BAMMLE
aMAIM
r Thomas McKean,Director M^L w
f�9 � L639-2Dfi
a 200 Main Street;Hym is,MA 02601
Office., 50&-862-4644 Pax. 508-790-6304
APPLICATION'FOR PERMIT TO STORE,AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WnH TI3E TOWN OF BA.RNSTABLF 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 J n Y 1 st—TUNE 3 0th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $50.00 ❑
CATEGORY 2 PERMT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERWT 500 or more Gallons: $150.00 X Vs
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
I. ASSESSOR'S KA,P AND PARCEL NO.
2. IS T$iSS A PERMT RENEWAL? L-'/YES`NO. IF"'YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
• ZONING/BUILDING APPROVAL,FOR H47ARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: _ Airjl-e'..0.i I1L
5. NAME OF EST'ABLISHMENTi-Te�_.)e'ti j\E [`'t l t.: 1 LA v,1 1 S1Crt�
6. ADDRESS OF ESTABLISE31ENT:
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHIVWNT:
9. EMAIL ADDRESS:
10. SOLEOWNER: 'YES I"-NO IF NO,NAME OF PARTNER
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLEICK
12. IF PREPARED B'Y OUTSIDE PARTY:
• NANX: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICAN'� DATE j ;2-1�1X
Q:1Apptication Foms1HAeMA.T APP 2017 Pll%ME"doCx
TOWN,'OF BARNSTABLE �.
INVOICE INVOICE NET INVOICE PURCHASE
CE DESCRIPTION ORDER# '
DATE� NUMBER aMOUNT.,� .
5/15/2018 432470 HOLD/HEALTH/HAZMAT293-001 $150.00 18009956 647600-673010
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VENDOR,# VENDOR NAME _ CHECK AMOUNT CHECK DATE CHECK NUMBER
4595 TOWN OF BARNSTABLE $150.00 06/14/2018 � 977778
REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON.
IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION.
Town of Barnstable
Finance Department
230 South Street
Hyannis,MA 02601
Tel:508-862-4654
Fax:508-862-4717
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Office: 508-862-4644
Fax:508-790-6304
Regulatory Services Department
• g Public Health Division
HARK Ast
Thomas A. McKean,CHO
059.
FOMp��" 200 Main Street, Hyannis, MA 02601
Payment Receipt
'Hazardous Materials Payment received: $150.00 (Check) on 6/28/2018 Permit number: 322
Check number: 977778 Check amount: $150.00 Name on check: Town of Barnstable
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IBusiness: Town of Barnstable-Water Pollution Control Ii
;Address: 617 Bearses Way, Hyannis i
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Note: Category III Permit 2018-2019
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Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 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
DO_NALD A.GUADAGNOLI, M.D.
07/01/2019 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN, R.S.,CHO
Director of Public Health
J
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Town Of Barnstable
Inspectional Seances BAMSS ABLE
0 o wn�wnf•olrcaa: Y�t e=ovs%'.:• i
Public Health Division ]01<
snxxernarE. = Thomas McKean,Director
MAM CD
p tbj� a� 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 14OUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS
DULY 1st—JUNE30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: 350.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $i 50.00r
*A late charge of$10.00 will be assessed if payment is not received by July Ist. 1 bd a�
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? v YES _NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,
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:
Fr . qy6
S. TELEPHONE NUMBER OF ESTABLISHMENT: d T'
9. EMAIL ADDRESS F" tF -- ` `�
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: TELEPHONE#:
NAME:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE
Q:Wpplication FormslHaz Mat App Rcviscd 09-10-18.docx
T'ow�nor1 BARNs'i'i4BL= , p
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`tNN®10E4 INUOIC � � NE INUOtCE �Ia URCHA E� $
DATE: LNUMBER t}ICE ESCRIF ^IONS f OUT ORDER#
7/16/2019 481884 WPCD/HOLD 293-001 HEALTH HAZ/M $150.00 20000248 647600-673010
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VENDOR#i s _, �ENDOR NAME CHECKAM:QIJNTCHECK DaAT GHEC}�NUMBER,,
4595 TOWN OF BARNSTABLE $150.00 08/01/2019 1002126
REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON. r
IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION.
Town of Barnstable
Finance Department
230 South Street
Hyannis, MA 02601 /
Tel:508-862-4654
Fax:508-862-4717
l
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07/lS/2019 09:17 5087906325 BARNSTABLE WPCD PAGE 01/03
Y. r
Date: 7511 q
FAX
Number of pages including cover sheet:
`)Co: From:
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Attu: 0`J
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TOWN
Water NNW Control D' .
earses Way
Plione: Phone: �lygnnb,MA 02601
Fax hone: Sa'7 0. ' 103()"1 Fax uhone:
CC:
REMARKS: ❑ Urgent ® For your review ® Reply ASAP ❑ Please comment
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Thank you.
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Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 Bearses Way, Hyannis,MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
4� ---------------------------- ------------------------------------------------------------ ------------------------------------
------------- ----------------------------------------------------------- ------------------------ -------------------------------
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
r
r 06"M/2017 14:29 5087906325 BARNSTABLE WPCD PAGE 02/02
• � cPchK� 9 �l
u of B nstable
eg atory-Semees
�a r Richard V. ScA Director
Public Health Dxvxsion
BAMSTABLB z
W.MM-a.�
Tbomas McKean,Director "MIPM-5-CMIX 03
o •` 200&Wz Street,Hyannis,UA 02601 Ca
Office; 50"62-4644 p?�8 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE !�?
-- HAZARDOUS MATERIALS 63
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, C1iAPTER 108,
HAZARDOUS NIATERLALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
M,A,TERLALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUALTERMIT(RUNS J[JLY 1st-DUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 C
CATEGORY 2 PERriIIT 111 --499 Callow: $125.00 ❑
CATEGORY 3 PERMIT 500 ox more Gallons: $150.00
*A,late charge of$10.00 will be assessed if17ayment is not received by J&1st
1. ASSESSOR'S MAP AND PARCEL NO. 2'32)T 00 1
2. IS TWS A PERNIIT RENEWAL? . V/WS NO. IF YES SIB QUESTION 3.
3. FOR ALL NEW PItJRNIU APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR H&ZARDOUS MATERIALS STORAGW.USE OF
• GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: I�C c.y_I JC
5. NAME OF ESTABLI,SHMNI': a i tL � c") 1 y.
6. ADDRESS OF ESTABLISHMENT:
N u I fi jft Add'-3 62.Fa 1 rn b u-NhrRocL cp
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: _--- �[►�e��
8. TELEPHONE NUMBER OF EST,A,BL S NT; 1� 7kL&335
9. EMAIL ADDRESS: aMrt°0, bX&0-4", btdt 6�' MA...us
10. SOLEOWNER: YES NOW 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#:
C012MPANY ADDRESS — EMAIL;
• SIGNATURE OF APPLICA DATE
Q-'tApphcstimi FoTwWAZMAT APP 2017 REVISE docx
06�;1�3(2017 14:29 5087906325 BARNSTABLE WPCD PAGE 01/02
FAX Date:
Number of pages incluci4ag cover steet: ,
To: prom: - - ��--- --
Attu• _ Kristine berry
Phone: Phone: ° V U,33
ry
Fay hone Fax phone:
CC:
REMARKS: ❑ Urgent ® Far yeur review ® Reply ASAP 'lease Comment
Thank you.
1Krristnnee Perry
1
TOWN 67VBARNSTABLE
INVOICE INVOICE` NET INVOICE PURCHASE r
INVOICE DESCRIPTION,,
DATE NUMBERAMOUNT ORDER# _
6/9/2017 391039 HOLD HEALTH 293- 01/A. BOULE \\ $150.00 17010421 647600-673010
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VENDOR# VENDOR NAME, CHECK AMOUNT CHECK DATE CHECK NUMBER-
_ . �. .
\4595 TOWN OF BARNSTABLE $150.00 06/29/2017 957134
REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT-'OF ITEMS SHOWN HEREON.
IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION.
Town of Barnstable
Finance Department 1
230 South Street
Hyannis,MA 02601
Tel:508-862-4654
Fax:508-862-4717
A \
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Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 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 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
i own of tsarnstawe
Regulatory Services
yP e� Richard V. Sea]!,Director
snaNsrnsi s.
KAM
Public Health Division
'°ram a Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee:$100.0.0
ASSESSORS MAP AND PARCEL NO. 3 001 DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
III GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT 141 )j'C
1111 tl�evre
NAME OF ESTABLISHMENT -✓ l�S -
ADDRESS OF ESTABLISHMENT (0/1 Begf5e'S ^05k u/
S
TELEPHONE NUM 3ER s� y 7 96
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. 7'OI
STATE OF INCORPORATIONf1 S�
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
! SIGNATURE OF APPLICANT
• RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
C:\cache\Temporary Intemet Fi1es\0LKD3\IIAZAPP Rev2015.D0C
4{V%T Town of Barnstable Office: 508-862-4644
Fax: 508-790-6304
0 Regulatory Services Department
• BM,, 8 Public Health Division
Mom• Thomas A.McKean,CHO
� 1639.
.61 200 Main Street, Hyannis, MA 02601
Payment Receipt
Hazardous Materials Payment received: $100.00 (Check) on 7/6/2015
I
Check number: 914584 Check amount: $100.00 Name on check: Town of Barnstable
'Business: Barnstable Water Pollution Control
I
;Address: 617 Bearses Way, Hyannis
I
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p•
Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 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
06/25/2013 14:14 MAX 508 790 6325 WATER POLLUTION CONTROL IM002
P-ab-bc He-.a_ltl h Divisic f
02 501
07ffcr: �J3-SGZ F 50&990-63
CATION FOR p��� T' �S`IL'�E r���1.OR MOSE ' N
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DDFaSS OF EST.kEILSMYaM
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AT2I-JC-�'T IS A CORPOR.Aa7ON; (�-
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Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00
Town of Barnstable
Board of Health
This is to Certify that Town:of Barnstable. Water Pollution Control
617 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 6/30/2011 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER, M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
6/30/2010 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN, R.S.,CHO
Director of Public Health
r
E Town of Barnstable
�oF�He rOwti Regulatory Services
° Thomas F. Geiler, Director
BA NWA
MASS. LE,a• )Public Health Division
1639
9-
�ooArFpm 6 lb
1,E Thomas McKean, Director
200 Main Street, Hyannis, IOTA 02601
Office: 508-862-4644 Fax: 508-790-6 304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO.ja ® DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
I II GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT TOWN OF
r Water Pollution Control Div.
NAME OF ESTABLISHMENT 617 Bearses Way
Rpois,MA 02601
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER: YES NO
IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
b
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.doc-up!q
I
Hazardous Waste Collection Page 1 of 1
6,Q i 614 <ya•'
All
I• Q 4 �
Duly 6th 2010 Home > Departments > Public Works > Solid Waste Division
E-Mail Town Hall Isearch Websit,.
SOLID WASTE DIVISION Supervisor: Glenn Santos
Telephone: 508-420-2258
45 Flint Street, Marstons Mills, MA 02648 Fax: 508-428-9139
Created: 6/9/201010:40:17AM Office Hours: Sun thru Sat 7:30 to 3:30
Updated:61912010 1 0:40:17 AM
HAZARDOUS WASTE COLLECTION
Saturday July 24, 2010
9:00 - 12:00
Hazardous Waste Collection for Barnstable Residents only
Proof of Residency is Required
Collection is at the Barnstable Transfer Station
8
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Town Hall-367 Main Street- Hyannis,MA-02601
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http://www.t.awn.bamstable.ma.us/PublicWorks/SolidWaste/PressReleases/hazcollectiori.asp 7/6/2010
Number Fee
322 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 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 6/30/2010 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER, M.D.,CHAIRMAN
PAUL J.CANNIFF, D.M.D.
6/30/2009 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
Illy
c
�lUN. 18. 2009 10:47AM BARNSTABLE_ADMINISTRATIVE N0. 4132 P. 1
• TO : HEALTH
Town of Barnstable
Regulatory Services
• ,�' q„ Thomas F.Geiier,Director
a M Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Fax: 508-790.6304
Office: 508-962-46U
Application Fee:$100.00
ASSESSORS MAP AND PARCEL NO. DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE
THAN III GALLONS OF HA7.ARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT W wG' � Li
• G Q
TELEPHONE NUMBER
SOLE OWNER: V YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. w r
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
• SIGNATM OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
" Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
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. jq 3 �Q DATE
APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN.
111.GALLONS.OF.HAZARDOUS MATERIALS
FULL NAME OF APPLICANT 20 114,
NAME OF ESTABLISHMENT UUAY- � 14/l i, 6 R 4ev ( )LZ
1
ADDRESS OF ESTABLISHMENT l
TELEPHONE NUMBER
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:
PRESIDENT
TREASURER
CLERK—
SIGNATUfE OF PLICANT
RESTRICTIONS: HOME ADDRESS
;20? HOME TELEPHONE#
Ha7-doc/wp/q
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ar
Number Fee
506 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable Water Pollution Control
617 Bearses Way, 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, 2005 unless sooner suspended or revoked.
----------------------------------------
SUSAN G.RASK,R.S.
WAYNE MILLER,M.D.,CHAIRMAN
October 4, 2004 SUMNER KAUFMAN,M.S.P.H.
THOMAS A MCKEAN,R.S.,CHO
Director of Public Health
z
Number Fee
506 THE COMMONWEALTH OF MASSACHUSETTS $1oo.0o
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable Water Pollution Control
617 Bearses Way, 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, 2005 unless sooner suspended or revoked.
----------------------------------------
SUSAN G.RASK,R.S.
WAYNE MILLER,M.D.,CHAIRMAN
October 4, 2004 SUMNER KAUFMAN,M.S.P.H.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Date: � / 28/ O�
TOWN OF BARNSTABLE
TOXIC AND � "HAZARDOUS MATERIALS ON-SITE INVENTORY
w NAME OF BUSINESS: �2 1?4:1�'071-7
BUSINESS LOCATION: Cn 1-7 j ' (it16L" J4�4 a~U.� INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: 5-88 s -7CM — 632 5— 3 G3.AUns
CONTACT PERSON: ±EW/` O:;z 4e3 SAP WiS�
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS:ludAld n-�`/�u.�4�t
I FORMATION/RECOMMENDATIONS: �-5�4m-e- e-Xe-f- &rhmcrbke*ire District:
'z_e /Vo s
-- &62�*
of e_
hAcla'Yta�k' wi -I'u'K 3
W to Transportation: Last shipmen of hazardous.waste:
Name of Hauler: Destination:
Waste Product: &t�t Licensed? Yes No
__NOU: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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) Misc. Corrosive
5Yo&NEW USED Cesspool cleaners
Automatic transmission fluid 70 Disinfectants
Engine and radiator flushes Road Salts (Halite)
f Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
j NEW .� d U ED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
14 Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. 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# d �� chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
L/ Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
v Paint &varnish removers, deglossers (including chloroform, formaldehyde,
/g Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
&k F'� Xt� 2;&>0 �c�A
Laundry soil & stain removers �i� '.�d ZLt au-1
(including bleach)
Spot removers & cleaning fluids
(dry cleaners) 5 Olt,/
Other cleaning solvents �X/°�,c: 1 a.
Bug and tar removersF�,�;r,
da:-t Windshield wash .sv
WHITE COPY-HEALTH DEPARTMENT/C RY Y-BUSINESS
Number Fee
506 THE COMMONWEALTH OF MASSACHUSETTS $Ioo.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable- Water Pollution Control
617 Bearses Way, Hyannis,MA 02601
Is Hereby Granted a License
FOR: STORING OR HANDLING Ill 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, 2009 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
07/01/08 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
s
Town of Barnstable
' Barnstable
,THE Regulatory Services Department
Public Health Division
i AM
9 Mrs 200 Main Street, Hyannis MA 02601
$�fFClJIA'�A m
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 -7 / J)C5�
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT >C1Y1/Y� ��L.V `> ��.� r Y�l ��I Vim► l..C �
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER: YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATI
ON: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
Q:\Hazmat\Haz Mat Application2008.DOC
,
O N OFBARNSTABLE ., g s .„
'° �w .' r: .-s,.r..t .,-z
"��;�INVOICE „. INVOICE oa... � Y NET PURCHASE ANIZAT ORGION
INVOICE
�. , x :;,. x y3 s INVOICE DESCRIPTION* `y y �� .m- � ,
vDATE .;• NUMBER � �f � a.: h x AMOUNTIORDER#� NUMBER
�. z
5/31/2008 293-001 WPCD-HAZARDOUS MAT APP $100.00 28012988 647600-673010
I I
a � I
.VENDOR#x �� VENDOL2NAINE' rCHEC AMOUNTY Ha
K.a y� .eC ,EC,KdATECHECKNUMBER
3,
4595 TOWN OF BARNSTABLE $100.00 06/30/2008 742734
REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON.
IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION.
Town of Barnstable
Finance Department
230 South Street
Hyannis,MA 02601
Tel:508-862-4653
Fax:508-790-6224
•
Number
Fee
506 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable Water Pollution Control
617 Bearses Way, 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, 2008 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
SUMNER KAUFMAN,M.S.P.H.
T/1J2OO7 PAUL J. CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
„TOhW,NO�BA�tNSAB�
All
INVOICE aINVOICE , .Y' lN1/OICE DESCRIPT ION n, ��3 TINVQICEPl11RCHASE ORGANIZATION
5/31/2007 053107WPCD WATER POLLUTION/293-001 $100.00 27012369 647600-673010 a
I
I
IMP
VENDOR# 3 VEND012 NAME ` j CHECKAMOUNT CHECK DA E CHECK NUMBER]
4595 TOWN OF BARNSTABLE $100.00 06/14/2007 711053
I
REMITTANCE ADVICE-ATTACHED IS OUR CHECK IN FULL SETTLEMENT OF ITEMS SHOWN HEREON.
IF NOT CORRECT,PLEASE RETURN WITH EXPLANATION.
Town of Barnstable
Finance Department
230 South Street
Hyannis, MA 02601
Tel:508-862-4653
Fax:508-790-6224
rt Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
' NSTAB , Public Health Division
s6g9, ,0�
639 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. '; O I DATE C.�
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE
THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT 0U)/) 0-F 16a.r05 hk
NAME OF ESTABLISHMENT k)bz er poll
ADDRESS OF ESTABLISHMENT �% 86alnos Wa — �Iyd ol)rs ,1)/19
TELEPHONE NUMBER �" Rd' (OAS
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:
PRESIDENT .
TREASURER
CLERK
T��Zz 01 ——DI//-",
SIG ATURE O APP ICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE #
f
i
Number Fee
506 THE COMMONWEALTH OF. MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Town of Barnstable Water Pollution Control
617 Bearses Way, 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.
June 5, 2006 PAUL J. CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
v Director of Public Health
't
f
TOWN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
NER AND INSTALLER INFORMATION
ADDRESS: G1 17 f'iT c' �°.% MAP NO. PARCEL NO. Q C�
OWNER NAME: 'X VILL4GE:��
INSTALLATION DATE: , BY:
`� `S\ Jam, � 1, • ; II
~' / /' � '� f%f CERT.
ADDRESS: ,
�~4TANK FORMATION
L CAT I t+ OF TANK: '''` "�� 1! � l4x``/l l/w///lr
CAPACIT� TYPE AGE l ✓ / FUEL/CHEMICAL ? Z(J�'/f '
TESTING CERT I F I CAT I ONa L,]--PASS--•C] AIL DATE
LEAK DETECTION ] CG INN/A TYPE/BRAND
ZO�E OF CONTRIBU ION C)o YES C ] NO DATErTO BE REMOVED
FIRE DEPT. PERMIT IS5 ED C .7 (YESk C 7 NO DATE
LUNSERVATION C CHECK IF�-N/A DATE I f
e. HORD OF HEALTH TAG N 31 7 C I[ ] .DATE ?—
Alrq
o1w
Z Mf
7
PLEASE PROVID A SKET H SHOWING HE TANK LOCATION ON THE BACK OF THIS CARD
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