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0027 BODICK ROAD - HAZMAT
T- _t `l &off Icy Nahrll'S n i Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 NST+ BARMASS .. o! 200 Main Street• Hyannis, MA 02601 039.�pfOMA�a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: /�1IA i^ Qa �IA� Date: Location/Mailing Address: oG Contact Name/Phone: ry l�l �(., License#: U �Inventory Total Amount: C� MSDS: Tier II : d Labelina: Spill Plan: U Oil/Water Separator: IJIA Floor Drains: Emergency Numbers: Storage AreaslTanks: 1.i SO q41hind 1 Emergency/Containment E ui ment: Waste Generatc V 0=13IL6 Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 1.1 LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) windshield wash — V Motor oils z/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 ye or caustic soda Lacquer thinners Miscellaneous Combustible V 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: � 14a 0171 Inspector- Facility Representative: ` WHITE:COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1251 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. .-------------------------------------------------------------------------------------------------------------------------------- 27A Bodick Road, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 26 - 110 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 BARNS "ABLE ' "'" SR°"2014 Public Health Division � !639-2014 � U Thomas McKean, Director en 39. 200 Main Street, Hyannis,MA 02601 !�; r..a Office: 508-862-4644 Fax: 508-790-6304 �W 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 1 CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 LI vsT" ,(G�1 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ ` CATEGORY 3 PERMIT 500 or more Gallons: $150.00 _ ❑ --- *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. —144—O-lR 2. IS THIS A PERMIT RENEWAL? 9/ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4.. FULL NAME OF APPLICANT: /11/b-�A��A d77VF M�/N�.vl/0 , 5. NAME OF ESTABLISHMENT: IV 11 (24h-- Aarp47,0,We— AaYIAldA11WE-4Ao6, /Ar- - 6. ADDRESS OF ESTABLISHMENT: le K AoA� 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: —1-09 /n/ /C7 8$ 9. EMAIL ADDRESS: �A 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 01J>-z iD PRESIDENT A. eA7-r11-3 TREASURER ,&k'f�yoJ e,17zx-3 CLERK Wj /Il. 047VAD 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE .�� Q:Wpplication Fonns\fiaz Mat Appli Draft Jan20l9.docx L Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Truck & Auto ......•••••••••••••••••••-•••••••••••••...••••••••••••••••••....••••••••....•••••••...•••••••••--••.............................. 27 Bodick Road, D, 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 BARNS' LE Public Health Division "i °2014� " ` 1639-2Q34 4.. �gTABL Thomas McKean, Director ��Ig ; ' cMASK i6 .+"`� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 D. 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 -rd�CATEGORY 2 PERMIT 111 499 Gallons: $125.00Rev" 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:. &AJAL.D 6 psi)eq 5. NAME OF ESTABLISHMENT: � \ ► KUG� t"' 6. ADDRESS OF ESTABLISHMENT: 27 D 11yi61- 1P 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: '�U 0 2 7 g y 9. EMAIL ADDRESS: , 10. SOLEOWNER: N YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT S A A C TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: J SIGNATURE OF APPLICANT DATE / 2 b Q:Wpplication Fonns\Haz Mat Appli Draft Jan2019.docx 1 tNE*ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 9B^"M.RS 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MPy \\ ii Business Name: +G e &APIrlouve Date: 7/AV b9 Location/Mailing_Address:_ VA AO&K 96 1. PA rxn6W Contact Name/Phone: Inventory Total Amount: -�SDS: vi" License#: W1 Tier II : Labelina: Spill Plan: U Oil/WaterSeparator: 0 Floor Drains: Emergency Numbers: Storage Areas/Tanks: WGIS�o C 6 Emergency/Containment E ui ent: Chi c Waste Generator ID: tN.A 0(5M4 Waste Product: c i Date&Amount of Last Shipment/Frequency: bullo S 0 Licensed Waste Hauler&Destination: Other Waste Disposal Methods: o LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: S 1 Inspector: .. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS i °FZHE.rok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTwBLE. 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT fE0 MP'� Business Name: kk Ackiu tits Date: y 26 17 Location/MailingAddress: o � — Opt 4 R„h 1 S Contact Name/Phone: DaLi. 5'09- 'z1 1 - I 88 Invento ryT Total Amount: SDS: License#: Tier II : V ��5� t✓°"-�' t Labeling: Spill Plan: OK Oil/WaterSeparator: Floor Drains: Emergency Numbers: O kZ S Storage Areas/Tanks: 1- 20 60 &A-6 I� -�5 ow ��t-c, �S a l oQtvw�. wa kr; o•k Emer enc /Containment Equipment: Waste Generator ID: A OID a t Waste Product: Ws ( oi/6rafr-liy Date&Amount of Last Shipment/Frequency: 2 Zo t'1 bLelyr o►ti w-tra� Licensed Waste Hauler&Destination: Q 21.w awrfiar. ✓l'r Other Waste Disposal Methods: o s I is aK 4t`t A G&A- •S , ,Kee- as LIST OF TOXIC AND HAZARDOUS MATERIALS Iv o "`^ ~1~ `A?"OL,`^'�L AV-, I VN%J-"1%-V0 b 1 1-54( 1w 1a^ NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous ma1rial use, storage.and disposal of 111 gallons or more requires a license from the Public Health Division. / Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils ,wti5k•- 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 V Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: d 05V-0 of ac9� -,ov-5 .4 "We- Inspector: Facility Representative: X. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS c. II E Tok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMAg5;- ` 200 Main Street• Hyannis, MA 02601 059. 0. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: %A m',ve- Date: Location/Mailin Addres : 2 JA j&,61 e-k ayrl► g Contact Name/Phone: ay ov. Sob - 77f - 14$9 -Inventory Total Amount: n" MSDS: ,,Ma License#.�QA Tier II : 01A Labeling: Vo4 Spill Plan: D Oil/WaterSeparato : Floor Drains: A I- Emergency Numbers: Storage Areas/Tanks: - e. % I 2 til s x.c-<-s Emergency/Containment E ui ment: T ®vL 15,4-el Waste Generator ID: meo 12 Waste Product: 01 vac..! Date&Amount of Last Shi ment/Fre uenc : ti IL- e, Sill � e--eav►ef Licensed Waste Hauler&Destination: G 0.�s o l Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash T Motor oils T!S 0 0.0. Miscellaneous Corrosives Gasoline,jet f'U 1, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants �j0 Degreasers for engines&garages 0 S Pesticides: Caulk/Grout \ z insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries.6 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: NFORM ION/RE OMMENDATIO S: Inspector: ' v 1 Facility Representative: I WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t IIHME � Town of Barnstable Office:508-862-4644 Public Health Division Fax!508-790-6304 • enaA-%rB M 200 Main Street• Hyannis, MA 02601 1639.ate. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MAC. /� Business Name: J'n/�l� - bt Z A1A1 T1n 0vE- Date: I I Location/Mailing Address: 2.-7 A 80,11ak R;- , \LJuNA16 Contact Name/Phone: "Dk.4 L ak o y. S"D o--1-7 1 - I J A 22 Inventory Total Amount: MSDS: W'(l ��}a"^ License#: _ Tier II : 00 Labeling: 0K. Spill Plan: Oil/WaterSeparator: NJIA Floor Drains: tJ o Emergency Numbers: oK Storage Areas/Tanks: t_ wUc'S (Kikk + o• Emergency/Containment Equipment: Waste Generator ID: MA4 00 Waste Product: %pa<kS Gl�ctv�a,f Date&Amount of Last Shipment/Frequency: 4 I D j,%,J CLr c. .eaV-.,! Licensed Waste Hauler&Destination: aFe kWkeeM Other Waste Disposal Methods: �Ja�-tL o�1 fi �v�5��ltr� o A.Q. LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts \L grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: - 9-0 ate kikl, GI-e D ,MI o G S/ , Skoet I t 4, % 0 VA41 AA L i x\�� 1DJ Cv, 1ati�i�t 0►�-��aHS�S��— �1n��� - ��G� Inspector:----T ��a,n•�sky� + �e�e, v��, �•ck ,/v�g➢S oK 5,��. G?-�,0 � �,p Facility Representative: � WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1251 - THE COMMONWEALTH OF MASSACHUSETTS $50.0o Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. 27A Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 . " INE Inspectional Services BARN TABLE FTn.. MRNTnPLE�'T'c:\:1•CO'U!i•HrgRrcl_ C Public Health Division s,�w"13-39-2014r.„ «E "4 =�BARNSTABLE, Thomas McKean, Director `bArFO ;�a`0 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 , �r 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 MY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 5) d 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. 1. ASSESSOR'S MAP AND PARCEL NO. 0 19 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: -'2>AV A . gFQ-70/3 5. NAME OF ESTABLISHMENT: 17;lb-d,4,A- ' AaTD/Moj/✓e- 6. ADDRESS OF ESTABLISHMENT: A019.D IV4 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: ✓)�A 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 9/b- Dcmo o77✓6 /CIA dN/W,%-: S-1VOP>/j C PRESIDENT �,->Av/> W. /y7CyJ oP/,2A 8&)Ay V5XAA 16 /;jA 016o/ 6Ze W.6-,6191 TREASURER /6,eS4YA) IV.PA7'DA 30,0/4ATEg oAy//YA,--NI-5 ^A OaGol _09 99 -Z jq CLERK aL YA - �'AiZ�30,P/A4T"uIAYHyAAbV1 /1j� D��o/ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT ' DATEi9'� Ae/ Q:\Application Fonns\Haz Mat App Revised 09-10-18. ocx 0 &&zfflXR I. Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Truck&Auto 27 D Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------ -------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable /y.Q♦�µjR]� �l9�ILLY.YN��OI�O.UIW 11 Inspectional Services BARNSTABLE ,�Ft►�rod Public Health Division �nG.:;aY , « .s.P 9B^ AT B�•$ Thomas McKean, Director .=""o"Or y' 1639.+>`0 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-6.504 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS f eta IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, C! HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY l st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26 — 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125,00 VS`i C( h CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ / `0 *A late charge of$10.00 will be assessed if payment is not received by July 1. ASSESSOR'S MAP AND PARCEL NO. ��b / 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: 1z 12 C 6. ADDRESS OF ESTABLISHMENT: 2� /J�✓,�/�' �t' 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: -�-- 10. SOLEOWNER: �YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME, HOME ADDRESS,AND TELEPHONE # OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • *SIGNATURE OF APPLICANT DATE leg 119 Q:\Application Forms\Hat Mat App Revised 09 10 I8.docx Number Fee 1251 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. 27A Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 AN . • ,Poe CAK-* r Voengatorytervlcesof B nsxable IKE Richard V. Scali,Director ' Public Health Division BARNSTABLE �. WNSfMIE•MMMVIUE- iT.N M9S i 11AMsTABLE. 1 Thomas McKean, Director ""�°�"I 0MR o.W41MAS& iOrE1 639. A 200 Main Street, Hyannis,MA 0260.1 575 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 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 x VIS , 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. 1. ASSESSOR'S MAP AND PARCEL NO. .344-0-19 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: --A AV I D R• EA-rC)/3 5. NAME OF ESTABLISHMENT: M 1 D-CAPS Aw*rp 0JV6, MAMWE- -SHOP,IW-- 6. ADDRESS OF ESTABLISHMENT: d47A Ab., NYA10 Nl.S 4 IrMA 02(go l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: -509-77/- 1223 9. EMAIL ADDRESS: -IV/A 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Alb-dAar--AwVM07'rvE, 1nAW1AF-sSW,ixk7-- PRESIDENT --:]>A Vl-)tl R • "Tom TREASURER l aQR4-wN M . EA7 CLERK "4p-,-yo In - &vTa� 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT0J DATE Q:\Application FormsUiAZMAT APP 2017 REVISED.docx Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Truck &Auto 27 D Bodick Road, 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 liC+ i4 • • • AI �1111,t of B nsxable Voengatory Services Richard V. Scali,Director , �'THE BLE �5 � o Public Health Division �,� f1,�T•HYAt^,15 . r :*: : 3T MUSTMa Thomas McKean,Director MAM ' ' J&� 'pry&Nab p� 200 Main Street, Hyannis,MA 02601 [ 4p J Office: 508-862-4644 Fax: 508-790-6304 "M �e APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 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: � ����' 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 2--7 0 OP ; �� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 9 n S. TELEPHONE NUMBER OF ESTABLISHMENT: d IEI�11 -/7 7 8 9. EMAIL ADDRESS: 10. SOLEOWNER:I(A 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 APPLICANT4 DATE l ' Q\Application FormsUiAZMAT APP 2017 REVIS0Tdocx I - pF1NE�Oh, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' BA"NSTA6L6. 200 Main Street• Hyannis, MA 02601 1659. MASS. g. A'fOMP��,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: J � Cac.�,c- a,�.„�- ,R v'}o Date: 11 Location/Mailing Address: &Ae,k eR F� a.n+► s Contact Name/Phone: I_.,A.r�Ikr.�l4st �wu� cl� .� SoQs-'�"l�-`�,Z►Z o�ru.<- IRow e<r�/ InventoryTotal Amount: "n �� SDS: License#: y OO Ce,4-2 Tier II : u Labeling: OkC Spill Plan: Oil/WaterSeparator: NIA Floor Drains: b Emergency Numbers: Storage Areas/Tanks: 2115'4wl wags- �� 'awu- o.�.S, Emergency/Containment Equipment: { o -e— Waste Generator ID: Waste Product: rat 1 Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: o Q�c.�v�pS ova NJ L.A,`l LIST OF TOXIC AND HAZARDOUS MATERIALS I o YKs.` NOTE: Under the provisions of Ch. 111, Section 31, of the Geheral�Laws 6f MA, haz� ardo�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 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers -�✓ Hydraulic fluid (including brake fluid) Windshield wash Motor oils + w r^s+k-(, Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners �— Miscellaneous Combustible Paint&varnish,removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 'J��`f. O ' j) CzCo< S o �5 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS _ e I , `oFvHKE 1pk� Town of Barnstable Office:508-862-4644 0 Public Health Division Fax:508-790-6304 BARMST�A�BLE, 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A , C —Wel 7 ok-o Date: 11 I (o Location/Mailing Address: '7b V-fyi n r S Contact Name/Phone: Lan- 7-78 9212 ewvt.t Inventory Total Amount: �0 MSDS: Oti,Mtiw SIw A . License#: LJ Tier II : ; Labeling: Spill Plan: OK Oil/WaterSeparator: 101A Floor Drains: Emergency Numbers: d K Storage Areas/Tanks: 2�S�q�i 1 to•D. IDS l EmergencyiContainment Equipment: 5 .- c OA 5 t+e, Waste Generator ID: Waste Product: Ot Date&Amount of Last Shipment/Frequency: A0 4A g oi2 +<-aOvt4eVS Licensed Waste Hauler&Destination: kf, o o! v< < o .-`ta Other Waste Disposal Methods: k o p, r 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 1 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers (1 Hydraulic fluid (including brake fluid)to Y 1 o Windshield wash ► n Motor oils :3 k �1 S 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 ) k S 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.k 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, nn nn hydrochloric acid, other acids) VIOLATIONS: O Qev t —©i 1 SkvsCe— 2©I1- ORDERS: 4'moo C 5 -e 01 C y, INFORMATION/RECOMMEND IONS: o i Inspector'__ c Facility Representati WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °U IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' "M�`E" ' 200 Main Street• Hyannis, MA 02601 1DlEt 639. � TOXIC ANDHAZARDOUS MATERIALS INSPECTION REPORT Business Name: gtwk Ay+a Date: 4 11 1 JI Location/Mailing Address: Q77 b BooQ, - Contact Name/Phone: a rr El t, c�. "O - 7 - ?�12 oww�.r_ o,� err' Inventory Total Amount: ^-300 q MSDS: l25 License#: Oct Tier II : tQ1 o Labeling: Ok<, Spill Plan: �5 Oil/WaterSeparator: Floor Drains: o Emergency Numbers: Storage Areas/Tanks: 2 T o,4 I&Wa Emer enc /Containment Equipment: S 4 c 0 A-e- Waste Generator ID: 091 2- Waste Product: O, Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destinatio : Other Waste Disposal Methods: \-CkvA� 0 •.11 ac. �.} .� f�� cl < LIST OF TOXIC AND HAZARDOUS MATERIALS IVY wla\off c.�ncv.�t g�o �v�vo-cy �j�hL��aSk tks ,o� NOTE: Under the provisions of Ch. 111, Section 31, of the(general Laws of MA, hazardo s material use, S/r f i 3. storage and disposal of 111 gallons or more requires a license from the Public Health Division. 41 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: ORDERS: INFORMATION/RECOMMENDATIONS: 5 % e- < ,>,e, -1 + Q. e � �� o o O l QJ�K�,�ceiA �! a Inspector--T M + Av�A1e, / �tI-Owot4ry Coot#-Pl.%A. lr5. Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS L (�,C f-`/ Date: 8/ 1 113 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Qvtlk AO+O BUSINESS LOCATION: 27,'t> .60,djz_� , Ryanvi,S INVENTORY MAILING ADDRESS: 6,tmA _ TOTAL AMOUNT: TELEPHONE NUMBER: SOS -775- z. l1-- CONTACT PERSON: -ery o t Lr t, �tc��14a e EMERGENCY CONTACT TELEP146NE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: t)+& rre a.f,e-- NO &VFORMATION / RECOMMENDATIONS: cave 5t�o�� Fire District: Iac�5 � of +4 Vt t) Q r2 C..e v 1{ O v to 14 11ti- A A 4 a4_r 0 t)_- &L4A A 15 enoo- 5 he-r-4 a I►�+•o►— ex��rR Z 0 arrc,Dvt o!.e, *_yLe g_S 3' e.ed S ►t ,r� a+ti-r fos-f ,P►t s ii2, Waste T ' O� : ,MVr P- 78 j;Z 1 z- Last shipment of hazardous waste: y 4 I Z Name of Hauler: G�.ea►v "arbors Destination: AWAV 6 IA1,5f4, , 14 Waste Product: was+_e_ o Licensed? a No dj&L 06(,488oD5 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 (P Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive &'NEW I MUSED ,�' Cesspool cleaners y Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides a,'78 U NEW 3 ®'USED Z-*' (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's J 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 l5� Laundry soil &stain removers (including bleach)Spot removers removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers -Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1251 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. 27A Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 r Number Fee 1251 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. 27A Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 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 OZ. v S70 C�j 1 ado ' ow of Unstable � eg atory ervices Richard V. Scali, Director ��t4IME Public Health Division BABLEB4NHSi4i•HY4F;:15MAgS:D`:51 E4.Yit40:ELE• Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 -•J Office: 508-862-4644 Fax: 508-790-6304 X APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE Fos 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 V S- CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. .g IN o79 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 40&44 y.J n9.94-rvI3 5. NAME OF ESTABLISHMENT: /rflb-cApg AarnmorlyF MAC/nib s*eA, Me-- 6. ADDRESS OF ESTABLISHMENT: aJ4 JoviRi< ,fib /✓yAN_N�$ mA o ®% 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: -TZS V/ /S'es. 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME A&-vv1na77✓A m.yc lwe .sHoA,l ve PRESIDENT .'>Ay 1.1- /1. 7-MA TREASURER A6 R F-4-V,-j /11• Fay 7y j CLERK Ao,9&1V, 1 ram 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE I� Q:\Application Forms\HAZMAT APP 2017 REVISFID.Idocx Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Truck &Auto 27 D Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health . o of Unstable 11��,,egwwi%a oerva ces Richard V. Scali,Director j ,�, SK t Imo dfL��. .A. • Public Health Division BARN%A g y Thomas McKean,Director mares uc 1639>ZO q Urt•n'+eras t BARNBTABLE, • wssrwa wu3.Osr aru111e•vlslea'.nsrao:E ArE 3,ts 200 Main Street, Hyannis,MA 02601 w� Office: 508-862-4644 Fax: 5 790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS rr IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: .$ 50.00 , CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 [ I/•.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? iu/-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 h.1 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: L3G4> IC V 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: 08 --78 J Z 1 Z- 9. EMAIL ADDRESS:: 10. SOLEOWNER: V YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER —_-'=.` CLERK -----`- 12. IF PREPARED BY OUTSIDE PARTY: NAME: ; -- TELEPHONE#: COMPANY ADDRESS -- ' EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISE Aocx Number Fee 1251 THE COMMONWEALTH OF-MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Mid-Cape Automotive Machine Shop, Inc. 27A Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 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 t Town of Barnstable ��►�1�,,ti Regulatory Services Richard V. Scah, Director E& � BARNSTABLE Public Health Division 039. •� arxnsae •m ne rtue.mnm•wuixs ♦ .uvsrois Kws•osreavue•rrs 6wxsrne� `t a 1639-2019 Thomas McKean, Director Gh� �77g 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 ]�L 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 1st. ASSESSORS MAP AND PARCEL NO. 344-0-j9 -oc>A DATE 4 aOaST 2, Zo I t. FULL NAME OF APPLICANT: 4oQ2A-y� /r1• eA•r&O NAME OF ESTABLISHMENT: 41-6-eA�£ AcyvmowVg r�C ADDRESS OF ESTABLISHMENT: e74 :Bo>let Al 4YAA))U1.5 mA 9a6o/ MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: ,Spy 1711/ /9199 EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME wj-eAp� , a—mvvanve 47A"1A36 -alwA,iNc PRESIDENT 4. P,o 7VIO TREASURER 1-o,eaYa7 /4 - 647oIO CLERK l0,e y.J .m eArVAD IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: W92�0=�- e Company Address Telephone#: Email: Q'Application Fornis\HAZZAPP Rev16.docx Page 1 of Number fee 9 400 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable o Board of Health r This is to Certify that JR Truck & Auto 2 7 D Bodick Road, 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 i Town of Barnstable �'THE ti Regulatory Services Richard V. Scah,Director inaxsrni�.e. Public Health Division BAMSTABLE j9. p10� wru�""s"Mljus �'u-ww-m Lf F ^ Thomas McKean,Director 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-630S �D 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 [ V' CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ , • A late charge of$10.00 will be assessed if paMent is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE ( All FULL NAME OF APPLICANT: /2 0A)4LbC ZZ7 a-Tr-- NAME OF ESTABLISHMENT: . ADDRESS OF ESTABLISHMENT: 1z 4.-2 >a21 ' 1 c MAILING ADDRESS (IF DIFFERENT): I TELEPHONE NUMBER OF ESTABLISHMENT: '!5G3 :z l EMAIL ADDRESS: SOLE OWNER: JZVES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,,AND TELEPHONE#OF: CORPORATION NAME_ PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: = SIGN=UOA CANT Name: Company Address Telephone#: Email: Q:\Application FormsViAZZAPP Rev I6.doex Page 1 of T Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department Public Health Division Thomas A.McKean,CHO a 96 4ti 200 Main Street, Hyannis, MA 02601 Payment Receipt :Hazardous Materials Payment received: $125.00 (Check) on 6/9/2016 Permit number: 400� :Check number: 5927752165 Check amount: $125.00 Name on check: Cumberland Farms 'Business: ]R Truck&Auto Owner: DAVID R TR ;Address: 27 BODICK ROAD, Hyannis 'Note: 27 D 1 • Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that JR Truck & Auto 27 D Bodick Road, 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 Hea►th - - Town of Barnstable Regulatory Services ti • Richard V. Scab,Director gip' Public Health Division ° Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 i-T= 508-710-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. ✓ vZ q DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT -Z_- TELEPHONE NUMB �� !2 ,z lo-Z" �— SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: �r IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. / STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SI ATT OF APPLIC RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\ca=Temporary Internet Files\0=3RA-WP Rev2015.D0C Town of Barnstable Office: 508-862-4644 � Fax:a Regulatory Services Department 508-790-6304 • W%ANnABLK Public Health Division MAC. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 6/9/2015 Permit number: 400 7 ICheck number: 75-53 Check amount: 1$ 00.00 Name on check: Ronald Perry 1Business: IR Truck&Auto Owner: DAVID R TR !Address: 27D BODICK ROAD, Hyannis ; INote: Money Order • Number Fee 400 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that JR Truck & Auto 2 7 D Bodick Road, 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 : n r k Town of Barnstable °pTHE r Regulatory Services 1" Richard V. Scali,Director { BARNST'. Public Health'Division 9 Mom. r 1639. �m iOlFa nnn'�° 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 111 GALLONS OF HAZARDOUS MATERIALS FULL N AME OF APPLICANT f.O�A C..� ,1 NAME OF ESTABLISHMENT -Tra.)C/< t /+0 ro ADDRESS OF ESTABLISHMENT 2--7 I014� TELEPHONE NUMMER J'S—Q e `7-7_ SOLE OWNER:-,,"S NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS 6-F5ALL PARTNERS: - IF APPLICANT IS A CORPORATION:. FEDERAL IDENTIFICATION NO.. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: 1 r p PRESIDENT /Z c�1lJ L� 3 P lZl' c/ f /u -1 CS- y-� TREASURER CLERK i SIGNATURE OF APPLICANT RESTRICTIONS: HOME.ADDRESS HOME TELEPHONE# Q:1App1icztion FormMAZAPP.DOC 1 1 „„- COMPLETE CYLINDER HEAD-RECLAMATION SERVICE - k --.....r' Mid-Cape Automotive. Machine Shop 27A BODICK ROAO HYANNIS. MA'02601 DAVID,EATON 771-1988 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:44)4 c#14 -�-,,� c14ira c as o Board of Health MAILING ADDRESS: 17 a BOO Isis J?® ° Town of Barnstable TELEPHONE NUMBER: roFr - 7 z f i 9 5Z-P P.O. Box 534 CONTACT PERSON: 10 1",q 7 N 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 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: 'M 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 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, varnishes, stains, 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): (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 satisfactory 2.Printers BOARD OF HEALTH 0 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores u 6.Fuel Suppliers ADDRESS r-/f Class: 7.Miscellaneous 1' A'�__�QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil(C) new motor oil(C) / transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: b "le � r 66 Lr DISPOSAIJ.RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Public It On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_k/ NO ORDERS: O Holding tank:MDC c .fit 'J� ze a Catch basin/Dry well ��� O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product Alz YES I""' L.2 P Person (s) Interviewed ns ector 46a�ez uv UA' INS I A 13 L � IPIYli1f1I1C� Tnsr a _ 130ARD 0 F HEALTH , ksatisractory '• 2• printers 3. �uto . rodyy Shops j; �, 0unsatisfactory- 4. ' Flanufactlrrers COMM, _i�{ �, (see"Orders") S. neta�.1 Stones ADDRESS. All//,d, tJ � 6. Fuel Supf•llers Classs y. Misr iinneous �[ � ' ( '�'•' ' QUANTIT1E5 AND STOINCB (IN�indovrs• OU1'=vu Case lots Drums tdoc IUh10lt FtA7CRIALS AbdveTanks Undetground 'Tanks Fu e1s.: . =-- i� �L 1lL QLL 6 Re tons iasoli:�e, Jet Fuel (A) Diesel, Kerosene, 12 (p) e — Jleavy Oilst was-te 'motor aril C _ new motor al (C) transmission/hydraulic - Synthetic Organicst _ degreaSeis -U_4�7 f� ,y \tit 7 •v tlisceilanevuss i , l'U� 0EJt°TIU . sanitary Sewage 2. Water SupplytiU'11K5t QTown Sewer �( )'� Pub1iC r' Win-r i�e /� Q privet Indoor tivor Drainst YES NO / t Q Holding tank t• MUC {{JJ ja{Q Q Catch basin/Dry well , On-site system nut ..___..�_....,...... . _._._•....:._..... _..__.�.— Outdoor Surface drains tl"E5 Ntt rj iiuldln` tanks Mix f Q Catch basin/Dry well On-site system `---- Waste Transporter '---� --•----.�_ _ R dame of Ile»tar Llcerisedf r #" •..DPS.t,itlgl-lnn - 1llnste prn rrt ,r ersori s) nte'sv ewe �' .�1� vi.''� ( .•"�- ,, - ... �: nspectgr ate TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: � 96Z * Board of Health MAILING ADDRESS: l Town of Barnstable TELEPHONE NUMBER: 771- 1� ,oO 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 toV1191 at any time, more than 50 gallonsliquid 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 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 t� 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, varnishes, stains, 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): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business i. � r . TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops 'lass: 4.Manufacturers COMPANY / (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS : 7 jSSS• 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MAT L LS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) AZ D Diesel, Kerosene, #2 (B) Heavy Oils: � waste motor o' new motor oil (C) transmission/hydraulic Synthetic Organics: egreasers �'� q-Ir Miscellaneous: ✓I . I�,s DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public . AOn-site OPriv ate eY 3. Indoor Floor Drains YES NO 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES - NO ORDERS: O Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product 1. ////�y�•� YES NO 2. 0, Persons Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �s �� Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: � a C Town of Barnstable TELEPHONE NUMBER: 7 P.O. Box 534 CONTACT PERSON: c f 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 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 registered ry weight. 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, varnishes, stains, 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): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business 'r G.:+rtt ��7ciy�,,.,�.....;�:s�Tr+e"�-•"'�^►h,,i+�.�•;h•-�.i•=,iGii.�^,•i`;yA•iAi&�r�^'y�.��'i&'a'7 .,,r�e-:...r^.-+'rMy;;-•-'tm"1.:+��.n^n,:sXy�,=s^^"7.•er'�f'�=dk-�s=T"*'i. ..t.,a4rr+..,:'-fit.1�' TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair O satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops- 0 unsatisfactory- 4.Manufacturers COMPANY`:�"•,/� a �, 00 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS - 726- Ir "'lFw Blass: 7•Miscellaneous ` , •- '`,� , " � ' - QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS ,. _ , Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) /2 new motor oil(C) t4 transmission/hydraulic Synthetic Organics: V degreasers Miscellaneous: } C4-W4 7-- i F DISPOSALlRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply .. -•rr�r�% 1 7 O Town Sewer �*,Public �Q'On-site OPrivate 3. Indoor Floor Drains YES NO '' O Holding tank:MDC • C O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC 411_04Z O Catch basin/Dry well r ` O On-site system v 5.Waste Transporter Name of Hauler Destination Waste Product •d YES NO 2. Person-(s) Interviewed • Inspector. j {' /Date t , TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: /070 Town of Barnstable TELEPHONE NUMBER: '7 ;7 /-- d O� ;� P.O. Box 534 CONTACT PERSON: 'yi ,e-� '��i�f 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 totalli g, 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 i1106189411111 Please put a check beside each product that you store: Voop 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, varnishes, stains, 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): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Co - H - py Health Department/ Canary Copy Business { TOWN OF BARNSTABLE COMPHANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops _ -�--' O unsatisfactory- 4.Manufacturers COMPANY �S fitT � (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 'Z7 'F dLooJ'�1r' Class: 7.Miscellaneous �lo6�QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATER S 1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils.: wst`motor oil (C) new motor oil (C) f Y transmiss on/hydraulic ke Synthetic Organics: degreaser Miscellaneous: 1 4 DISPOSALIRECLAMATION RE MARK S: . 1. Sanitary Sewage 2. Water Supply n Town Sewer Public 01,apd �/ _g;Z-3- On-site OPrivate . 3. Indoor Floor Drains YES NO 0 Holding tank: MDC ` 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO OR ERS: 0 Holding tank: MDC t `� 0 Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES INU erson s erviewed Inspector Date OWN OF BARNSTAB`_ COMPLIANCE: L Marine,Gas Stations,Repai.r QsatisfactoryPrinters BOARD . OF HEALTH Auto Body Shops unsatisfactary-�� turers Retai.lcStores :OMPANY -• -��. �' (see Orders ) Fuel SupFliers %DDRESS .,, Class: Miscellaneous yr 0- , M; QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) 4AJOR MATERIALS Case lots Drums AboveTanks Undetgrouad Tanks IN UT IN IOUTI OUT N G xl e s Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) t , new motor oil (C) transmission/hydraulic Synthetic Organics: ti degreasers Miscellaneous: DISPOSAL RECLAMATION REW RKSr: , 1. Sanitary Sewage 2. Water Supply" Q Town Sewer "" Public ,,. � r,��.�-s -site O Private �. ew. 3. •I oor Floor Drains: YES Nl� Q Holding tank: MDC _ O Catch basin/Dry well QOn-site system 4. Outdoor Surface drains:Y ES N41 C ry O Hvl'dinl;• tank: MDC �• Q Catch basin/Dry well On-site system S. Watt Transporter Licensed? r Destination - ' NaSts' Product ' 1 7.\ u ei Persons fife-evi ew Inspector Uat'e