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0055 BODICK ROAD - HAZMAT
3 OW -� i S M E A No. 10339 smaad.com • Mad®in USA► `�.CpNBJ� Number Fee 332 THE COMMONWEALTH,OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health ,This is to Certify that Scudder Taylor Oil - -------- ------------- -- SS Bodick Road-PO Box 1210, 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 Town of Barnstable Barnstable of T Regulatory Services Department • � A�Amcricat�7y Public Health Division ] 200 Main Street,Hyannis MA 02601 Alf�1�YA 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. b Z DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Ckkk ltr ( .�l GY \ 1 • ADDRESS OF ESTABLISHMENT Q( �C� Q� an8 0 02(061 TELEPHONE NUMBER 0 7 T6—0 q 7 q SOLE OWNER: "/YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADD RES OF ALL PARTNERS: ; ---i : ; �,a x IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 03 IS` STATE OF INCORPORATION FULL NAME'A D H JME DDRESS O ZO r '� PRESIDENT V t� 02,3 a TREASURER CLERK • SIGNATURE O CAPPLICANT. i RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # 0�j - S Q:\HazmatlHaz Mat Application2003.DOC l Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS. ' 200 Main Street• Hyannis, MA 02601 9 g. �plEOMP�a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: k Eon% Q i& a- Date: 611,11 Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: <gyp® MSDS: �� ` hq License#: Mq Tier II : Labeling: Spill Plan: Oil/Water Separator:_ Floor Drains: Emergency Numbers: J Storage Areas/Tanks: Emergency/Containment E u' ment: Waste Generator ID: Waste Product: C', i4 Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage a771 posal of 111 gallons or more requires a license from the Public Health Division. ntifreeze D cleanin fluids rY 9 � Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers J-lydraulic 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 ye 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: I 6 i' PS 61044,11 �'b —ff dt QQ A � ORDERS: Pop INFORMATION/RECOMMENDATIONS: Inspector, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS �pf,ME rok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. 200 Main Street• Hyannis, MA 02601 MASS. a "rFOMP�" TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: b * -P Date: Location/Mailing Address: ® a G Contact Name/Phone: IL. _&W0�,A b^m S+a" 77'0�- b SFr ' Inventory Total Amount: 700---,L6'b�5q, SDS: `��S License#: Tier II : Labeling:W;11 0 06 �3A-P Spill Plan: 4FJ- Oil/WaterSeparator: I/ 1-1A. Floor Drains: Va Emergency Numbers: z� StorageAreas/Tanks: / ,�?sA,Sr t�Qe{x 2a� 3-d7�SIds Lisa �r��-r�°�yr't` Emergency/Containment Equipment: Waste Generator ID:�I/'�SG��7 *�€p' Waste Product: C3 r Irv -t' r�F Date&Amount of Last Shipment/Frequency: �cr�w�r� 6%1 Licensed Waste Hauler&Destination: Pai����-f I , ]� � y1Z::V , Other Waste Disposal Methods: dY� 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 Ar-`'VOAe Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushesug and tar removers Hydraulic fluid (including brake fluid) Windshield wash —� Motor oils 4- ,\/QS C 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, dyesye 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" w4Jfe 01 1 6 1910 (including chloroform, formaldehyde, hydrochloric acid, other acids)VIOLATIONS: h7 e �,r�;`w, ►n�p� f be Cy `� Ctw� 'y t qLI I �5;1� ORDERS: X)8cLj' INFORMATION/RECOMMENDATIONS: Yl✓cspA—, Inspector: C Facility Representative WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°FTHe rotiti Town of Barnstable Office:508-862-4644 • °� Public Health Division Fax:Sos-Aso-ssoa • BARNSTABLE. ' 9 MASS 200 Main Street• Hyannis, MA 02601 039. �ArFOMR TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: vk*A%5 k 2 Olds .J�t p Date: CS Location/Mailing Ad ress: c \c- 4 v\•5 Contact Name/Phone e Inventory Total Amount: �'�D&qkl SDS: °�`'��"`� k<<ess License#: Tier II : . Labelina: -)('69e. b Spill Plan: ` S Oil/WaterSeparator: Floor Drains: 0, Emergency Numbers: yPg Storage Areas/Tanks: W•�� ��«�eola, 2�54a�.�JGI elk A5—\, o1k&.0a<s vv4Ae b , b Emergency/Containment Equipment: .R.; ve«\ab1�h �v�, J %,) Waste Generator ID: t��I rl'1 b Waste Product: o% 0.rca- Date&Amount of Last Shipment/Frequency: �� ��I o Q&-I "- IA Licensed Waste Hauler&Destination: e'Of't"', Other Waste Disposal Methods:LIST OF TOXIC AND HAZARDOUS MATERIALS A o 0ka\V--/ e-VX,�C1,' AV, 1v� y 14,4 1j4 ,,w, NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws bf MA, hazardous maferial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze +w 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.),,wa5kv 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: 011 1 v 4 19W.0 Lm� p WA e, ORDERS: ( 'CJwlS Veil Cotti -IvA 'S . lJ \ l -44 4 &AL5 2•C&1\ ,>Cu5ke- oAAo cJ o i c� INFORMATION/R OMMENDATIONS: c, r C,1 k cow a1V't"C5. C,-( 1 r• 54E / Inspector: A- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I►�*opt Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • B"RM�`E ' 200 Main Street• Hyannis, MA 02601 Fo►a�°�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ttyrtK n, s i6rwkt e:14 V't*ev4-ter Date: Location/Mailing Add ess: %v or5k,G 14 &nx 15 Contact Name/Phone: E 0< So -7757-�588 r3 Invento Total Amount: 7. bD 9a. MSDS: &N' (I"'`'a«e--.g License#: 1���QX ► Tier II : a Labeling: AW al�.eau a�C `�" Spill Plan: Oil/WaterSeparator: Floor Drains: 6 Emergency Numbers: Storage Areas/Tanks: xjt< - nc.w k v ,-, v �-Ikus -w te- G, 1 -t o So�c l P3 Emer enc /Containment ui ment: 5 uaQ�e<< aK ,�'i rt� Waste Generator ID: &I ko 6�!V -okP sae «SS Waste Product: o 1 , aleIrt o. -01 Date&Amount of Last Shipment/Fr quency: %c.4_v 5 f_-'Ito wl AA^\,S o wvt✓ Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. k D_ Antifreeze X k-�S Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid)S 3 Windshield wash ►+t t Motor oils %14Ho ,,44bo was}-e, 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 ti�V Refrigerants y Degreasers for engines&garages I- Pesticides: Caulk/Grout insecticides, herbicides, rodenticides 3rV Battery acid (electrolyte)/batteries �kte 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 3 1 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/ ECOMMENDATIONS: i ar 3 ct a,< ev k�c,AA s I xc.e-w Jul oS ,M, 'S • BJ/ , G 4 RU�►/� G`�^�7'2�1�C��O J� \$ ��L �t �— (9'Siz nspect i La j � w l'im,tMabS bc.�°�OLAY �aaw&4-k i'50050,1 . �,a�ility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS � CLV�14A4.0-A hocy eovkat�.,e1s J11,g . Number Fee 149 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Brake &Auto Repair 55 D Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------;---------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. 9 ---------------------------------------- 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 HUG-12-2016 09:39 Frorr,:BPRNST HER.TH To 508—L--C,19562 P.1 Town of Barnstable N, RegW.atory Services MOL til Richard V. Scali,Director BARNSDRE Public Health Division 63 200 Main Suect, llyarniis, MA 026(.)- Vp 11h.umas McKcau, Director Offim 508 662 16.11 Fax: A,PPJ-,ICA'I'tON FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS I CORT)ANCE WITH THE TOWN Oi:l BA RNSTABLE GENE.N AC I F1A 1,,0 R D IWANC E.,C HA!?"f'l:(Z I r181 ALL BUSINE '�',F S S THAT HANDLE OR STORF.14AZARDi.)US' MA'.1'EMALS GREATER.TH' "�'-L'AHOMFJ-101,1)QUAN VHIES ART; Rr-,Q(.IIRED '1'0 OBTAR4 AN 1st—JUNT 101hY AI.PL[.CA'ri.0N FEES CATFCi'r0RV I PERMIT 26 - 1110 Glu'llons: S 50.00 11 F-1 CATF(''ORY2 PERMIT 1 il --499 Gallous. $11215,00 C "1 ATEGORY 3 PERMIT 500 or aigiv Gallons: 'NP 50,0(..) x A late be assess-"j ifimyqlcrit il,not rece:Ved bN-Juh 1st. ASSTSSO,R-S,',.Nl,-,A,P,.AND,.-P.A,lt('-fE.L 1NO. DATE NANNIE OF A F F, ADDRESS Or ESTABLISHMENT: Cq (.61 "MAILING ADDRESS (IF DIFFERE,N'l.-)l-- TETIFTBONP,"NITN IM OF USTABLIS11M.EiN Y: S 0 L F 0 WNM'R! 1141"ES—NO IF NO,NA-M.E 0FPARTX'F.R, FULL NAME,TIOME ADDRESS,AND T ELEPHONY,li OF- C ORPORATf ON NAND 1�t4,Ltiq, PRESIDENT TRYASITRFR CLY',RK IF M E,IIARFD-BY'OITTSII)E''P.kR'FY-;14 OF, TPL I CA Name.- Company Addi- 'Email- --------- Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB N.o.2050-.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page I of 3. 4.Manifest Tracking Number Emergency n 0 1 JJK re�Phone WASTE MANIFEST A j 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) Generator's Phone: A. 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number B.Des I nated Facility Name and Site Address U.S.EPA ID Number 1,0-K.1c 111 IRN 62.Acfyt� Facility's Phone 4S.-3-1 ?27 0 0 0 12 J 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10..Containers 11.Total 12.Unit '13.Waste Codes HM and Packing Group(ff any)) No. Type Quantity Wtivol. 1Z LLJ Z 2. LLJ O 3. 4. --------------- .................. 14.Sjcial Handling Instructions and Additional Information 15. GENERATOR'S1OFFEROFVS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by.the proper shipping name,and are,classified,packaged marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am,the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26127(a)(if I am a large quantity,generator)or(b)ffl I am a small quantity generator)is true. Generatoes/Offem,'s Printedrryped Name Signature Month Day Year -j 16,International Shipments Import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter I Printed/Typed Name Signature Month Daiy Year 0 rr U) ;'7 Z Transporter 2 Printedirryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy indication Space El Quantity 1:1 Type El Residue El Partial Rejection Dull Re.jection Manifest Reference Number. 18b,Alternate Facilitfij(or Generator) U.S.EPA ID Number u- Facility's Phone: 0 LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 0 rn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 14A 1 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in lte[Wl 8a Nntedfryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY IRE T°�h Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA�BLE.g` 200 Main Street• Hyannis, MA 02601 �ArFDMA+A`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 9.14VIAls, ra <- a o Q+ l Date: Location/Mailing A dress: 41Z a S G 1U 14yar%A'1S Contact Name/Phone: 6�t ©reyL,6 -oA J So - 588 CAS Invento Total Amount: ^"�� �� MSDS: License#: Tier II : 00, Labeling: Spill Plan: c5 Oil/WaterSeparator: Floor Drains: o Emergency Numbers: e- Storage Areas/Tanks: t Emergency/Containment Equip ent: 4 4%kz fi 1K-��- ' cv&K waS Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: No C)KV s 4 iK G %DOU Licensed Waste Hauler&Destination: O her Waste Disposal Methods: + 1 �S (pv�VJ-A v- 5 pC�G(,�n�,�21 ov` -JA--0, � k, + V �t��idvo po�C b y& �s3 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. SS Antifreeze Dry cleaning fluids t 0 Automatic transmission fluid t 10 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers �— Hydraulic fluid (including brake fluid) t5 Windshield wash t, %v1• Motor oilsclil5a 1064y,.4-ISv,6W Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants \V Miscellaneous petroleum products:jo Road salts grease, lubricants, gear oil Refrigerants t� Degreasers for engines&ga�a�g y 4t y� 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 4e<-sc- laaLa-Je� Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: G, g 1;7o{ yA r,'L' P- %5 y6a- INFORMATION/RECOMMENDATIONS: oLh W k e ak ,eat,b—4- -e— P y Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FnE ro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMS�LE. • 200 Main Street• Hyannis, MA 02601 ,b,q TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT r6c 1Api1 a Business Name: av►h%s W6e- aWj- o-4a RR E..-C Date: 2 6 IS Location/Mailing Ad ress: OeAc I'I 4AA16 Contact Name/Phone: Inventory Total mount: 11 o0 4 MSDS: %v^VtCAA- MleSS License#: y Tier II : Labeling:-k'o bey Spill Plan: 4-z, ol>+ Oil/WaterSeparator: No Floor Drains: rJ o Emergency Numbers: Storage Areas/Tanks: - 51 4':00 W A6 1 te., o,( a1 D ovw5 �dr o,l ci oA Emergency/Containment Equipment: o,& , A& Waste Generator ID: I`Ah °1 g `6 2`I f Waste Product: Date&Amount of Last Shipment/Frequency: %o 1 %'A %S-Z �l Licensed Waste Hauler&Destination: Sck4* 4Ask0v. i ,�iaS Zso`f b 54,6 -KWe-) Other Waste Disposal Methods: �Oac.n Oc,sA o M-6ince,V A-,aA2,< a4N <ee-6e.-- Gjoba.\ LIST OF TOXIC AND HAZARDOUS MATERIALS NO VAC\w( r�� i v� �rV �rx �� 'l� IVt� t101— NOTE: Under the provisions of Ch. 111, Section 31, of the G neral Law of MA, hazardous rr�aterial use, 1 a Ift,6storage and disposal of 111 gallons or more requires a license from the Public Health Division. � 7 Antifreeze A- 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 A- Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts J grease, lubricants, gear oil Refrigerants Degreasers for engines&gara es Pesticides: L7 wus as Caulk/Grout , insecticides, herbicides, rodenticides Battery acid (electrolyte)/batterie� 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 V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes VMiscellaneous 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: IN ORMATI N/RECOMMENDATIONS: 2 & O� WS e-� L v ay- a s A' iK V2W (-0—Inspector: 71 4Q,-,J �cility Representative: i WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS 2�Igll�- Date: 3/ 3 //I TOWN OF BARNSTABLE Gt,a%&— TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 8g4,1/lis &,`.t Qy;Q A-+p Q.eQa�{ BUSINESS LOCATION: q2- rQf�, -}ya��,s INVENTORY MAILING ADDRESS: ,IaoL - TOTAL AMOUNT: TELEPHONE NUMBER: S-05 -7'75- b s S 8 /o �9�jjdn5 CONTACT PERSON: �i,� Dr►rycsfo,ti,'� EMERGENCY CONTACT TELEPHONE NUMBER. MSDS ON SITE? TYPE OF BUSINESS: o+e &t4 +tLen4KeP— INFORMATION / RECOMMENDATIONS: ot:+ � ��.ve10T FirefDstrictl� p f ,I a►`Rrt l7artt, J x1;tr 3� e wwe ,I, .cf'a4 4 A S A •fri vt 16 t�rtoQ�0,l16 — �l +�. �Q s�.tv�,�cdQ�bso�be+�l'g�a�p/,�.��c{-fcal��onc�►�,kg tcs ncceSse�yJ 0 Mar S 6& 6 f Go e,K,c� l� 4' t� •tf 5 et a K ►ufs o /Cm i rs�xecc� � �� MQn,�rs�s oily Waste T j)1+gi���/gr�1Z� Last shipment of hazardous waste: 4va11 nr A6ol Name of Hauler: 6& 4'0eeK- Destination: Cra+t$tvvL, R;r- Waste Product: moo►/ ;leers, 4d,-Crceac,Da-s Licensed es No igiI So y2 ua IG 011 l�r,.e,Q,It 1 ee keatt e la"t� 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 re uires 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 An 'freeze (for ga oline or coolant systems) Miscellaneous Corrosive NEW yS 6 USED SS Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils / fti 5 r Pesticides 20 ► NEW 7� O USED KVV f"� -9I (insecticides, herbicides, rodenticides) t4s q-lwf Photochemicals(Fixers) Gasoline, Jet fuel,Aviation gas Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) zS lubricants, gear oil ❑ NEW ❑ USED 13, Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine 10 Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible (f<ros016) Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes f Laundry soil &stain removers (including bleach) above,., A160, Spot removers&cleaning fluids I �( (dry cleaners) I,JcbAv_ Mklnl4s- 5 4ie- -'o✓t. 617LQ� Other cleaning solvents Bug and tar removers J1 4 I Ie&6 - eArrS . I Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials i L y -y�y c� - 03/07/2014 08:35 5087909562 _ HYANNIS BRAKE PAGE 01 Form Approved.OMB No.2M-0M Please pri or tope.IFofm dell tied for use on elite 02-pitch)typewriter.) 1 3.emergency R�pcnse i �nii�tTracMn9 Abe` ln� C i,Generator ID Number "', 2.Page of (�lip 7 0 V S K V UNIFORM HAZARDOUS r0'i 'if !;`."Y V V WASTE MANIFEST - Generator s Site Address(il dif ferent than Meiling address) 6.(�NwoCs Nmnt�ro M 1, •Address Generators P43na: J.S.EPA'0 Number S.T Ocltyr 11 Cotgpanp Nerve U.S EPA ID Number 7,Transporter 2 Comparry Name 8.Desgnated FacdltY Name and SiteAddresa .7"' U.S.EPA ID Number Facility's Phone: Elo.ContaNV11.Total 12.Unit Ia.Waste Codes 9a, 9b.U.S.DCT Da6cription(including P oxr Shipping Name,Hazard Class;ID,4umber Nc. Quantity WWd. I-M and Packing Group(H any)) i 2' UJI 3 � 4. 9 14.Special Handiirg instvirons and Additarrad Int)..motion !,;! ;;'� +� . i. - 0 6 •')4'- . . . r, •a� .. . l I r'� ' ' di; fr :'�.`ri 1;..'rr`.e x'. y,. `tt,f�.. {1tC_iJl 16. GENERATOR°SWFFEROR'S CERTIFICATION:I hereby declare that he contents O'this cons gnrwt a'e fully and accurately described above by the proper shpping name,and are da Wfled,packaged. marked and labaltddpawded,and are in all respells in proper OW100111 for misport ar iding to appl cabie international and national governmental regulatlons.H export stupmenl and I am the Primary Exporter.I certify that ft convents of this consignment ep'iform to the terns of the attached EPA Acknowledgment of Consent. I oW4 that the waste mindnizaticn statement identifed in 40 CFR 262.27(s)(d 1 arr a large quantity generator)or(b)(it[am a s7a1 qti*generator)is true, fleneratcr'510fteror s Nnte&Typad Name Signature Month Day Year J 16•Intemaional Shipments' 1. ❑imp,to U.S. Ezpor.from U.S. Port of array a dt Transporter signatirs ffar exports only) Date leaving U.& w 17.Tren rAcknoatedgmantofRecs'ptofinetedals Tran r 1 Printe,130e,A ame Signatur� M" Gay year ronapo ter 2 Printed yped Name Sigralure Month Day Year 18,Discrepancy '69.Discrepancy Ind;cmtion Spece Qu�rtity C Type Residue Part al Rejection ❑Full Rejection Manifest Reference Number: '6b.Alternate Facility(of Generator) U.S.EPA ID Number U U, Facility's Phone: t6.Sgnature of Attemara Fsality(or Ganeratlxl Nonth Day vow d N19.HaWdouS Waste Report Management Method Codes(i.e.,codes for tszardoua waets treatment,dlgppael,and recyoling systems) LU 2. 3. 4. Fla rated Fedfity owreror operator Certiratatwn of receipt of hazardous materials covered by the manifest except as noW in hem 18a yped Name Signature Month bay Year EPA Fgrm S?GO 22(Rev.3 16) Previous editions are obsolete. QaENF RATDR S INNITIAL.C1:PY 03/07/2014 08:35 5087909562 HYANNIS BRAKE PAGE 02 J-tlil0 . Form Approved,OMB No 2050-0039 Pleas 4. Number e print or type.(Form desi ned for use on elite 12-pitch?typewriter) 2 e of 3.Emergency Reap msa txFiorre w Attest Track UNIFORM HAZARI]CUB 1 Generator ID Number e f101957665 WASTE MANIFEST 17t ��� P+ G ;� than mail IN address) s C;neratora Name and Meiling Address �AC�s U.S.EFA ID Number S.-rangpprter 1 Company Name �l�f FTY�#iL1� N 9'YS)r:N8, INC. U.S.EPA ID Number 7.Transporter 2 Company Name U.9.EPA ID Number 8.Designated Facility Name and Site Wass SWETY••'E'�L.FF_'fd 8'rSTE:I'4S, INC. 000675 167 MILL STREET CRANST DN li5D S460' k:: 9a. 9 90,J•S.DOT DsxVi on(ltldudir Proper Shipping Nm,Hazard Class,ID Number, 10.Contahte'S 11.TDtal 12.Un4 Q.Waste Codes KM and Packing Group('d any)) No. Type Quantify WtNo. x 1wA=:TF CnP!Bus?!3LE LIQUID N.0-a. � (pE.TRrJL,EUM h;A(aHTHI?) NAIZA3 DCsIII i Lea �: W.��7t. Ct3MS.)a T ISLE L I f,U I D N 0 5. r'�/' DM f FF TR 0L.F.010 NPF'HTHA) NPIM3 ICI 3. X WASTE C.01151-18T I SLE LIQUID Edo g-S. y✓� LIPS IS ... a�_......... t Aral' APF i6-4W dk 1/ N � fCVO•�7eP � 14.Special Har00ng Instructions andA&manel Inforrnation t)t~ :lispl t�iS 1'�:NG# �D ;)EEIt l 1 1f 71;_6 g+6,- 15. G R I tires I L r n C he proper shopiPg name,and are dessiflod,P0.8ged, marked and tabsledrpla;oarded,and are in all rwitacts In p'DDer condition for transport according to applicable International and nafionel governmental regulations.If export shipment and I am the Primary Exporler,I ced1V mat the conterrta of this consignment rmnfonn to the terms of the atiedied EPAAcknoWedgment of Consent. certify that the Heats min m®tioh Statement identified n 40 CFR 2o2.27ta)(if I am a large quantity gerierator)or(b)(ill am a V.Wd qusn*generator)Is true. era 9101ferorl;Printed/iyoedName Signatpre Month Day Ye -j WnbknatloihTSMments r— ❑Import tc U.S. ❑Fort from U.S. Port of entrylexit: , '9 Transporter signature(for exports only): Date Issuing U.S.: W 17,Transporter Acknowledgment of F(Welpt of fn=dale Transco iAt IN ti Signature f ✓ Moat Day Y r Tr rl ted7 yped Name Signature M Day Yaar 18.D screpsnoy 188.Dist'epancymoication Space ❑ Duantity ❑Type ❑Residue ❑Partial Rejection ❑Full 110. ion Manifest Referaoce Number 18b.Alternate Facility(or C,ensretor) U.S.EPA ID Number _J U Facilitya Phone: w 18c Signature of Aft mate Facility for Generator) Day Year Q 1 g,Hazard"Waste Report Management Method Codes(.e„code8 for il*WCOU3 weals trestrtreit,disaosal,and mcirdin9 sYsierns) t, 2. 20.Designated Facility ONner or Operator:Cartification of receipt of hazardous maierials covered by the manifest except a oted in Item 1 Be Printed yped Name Month Dap Year I r r EPA Form8700-22(Re'v.3-05) Previou5 editions arsobsolete. DESIGNATED FACILITY TO GENERATOR I�Ol it410704 00008101 3) 0QM@71 4) 03/07/2014 08:35 5087909562 HYANNIS BRACE PAGE 03 , Form Reproved.OMB No.2050-0039 Please print or type.(FDrm deoi ned for use on elite(12-prttr))typewrlier.j 1,Generator ID Number 2.Page 1 cf 3.EmerWcy Rsspanse Phons 14,Manif851 Treckin Number �+�( UNIFORM HAZARDOUS i � 01 r SKS WASTE MANIFEST �" 5.Gerreratoies Name and Meiling Address s ite Aran maitng address) ,Gererefcvs Phone:' Y.. 6.Transpolar 1 Conlpar'y fame U.S.EPA ID Number U.S.EPA ID Number 7.Transpolar 2 Company Name T.-Designated Facility Hams and$Re Address U.S.EPA 10 NUrrbar FacR' sPhone go. 9b.U.S.DOT Destri*(indiding Proper Shipp ng N 3me,htW4 Ciess,ID Number, 10.Containers it.Total 12.Unit 13.Vlaste Codes HM and PaAirg Group(Fany)) No. Type Q6antity 1VtNol. r Qix 1. .,f+,,, .r:• , c _ li.'i,r =1 r,S, i' _ i:'r:; ,r v 2. WC7 r.i; ,r. i'. :•, i.' ',i• r?, :•j, '•t' ,...,.. -:..'1'.'d,.r..{,1.'4�i.1�'��., �( �'t;i.�'. Ar ;+'l yet sJf'.r!`t�i• f•.!:i` ty1. 3. ,F, F;is if .. t._I 1r,1''. }'r l?fi•i•'('gl�: �').. .. r ( ���. 14.Spedal Handling Instructions and Additional Information 75, G NE T tTOR'$ ERfTIrIC herebpded4te 2YAra" nlettts rAn6fgn rtepl'ar hl "a ECCUrt#ely sraib�d' 9/!he D shippirg name,am are classified,packaged, marked and labeedlplacarded,and are in all resaeds in Doper oorifton fortraWr!aczodng to applImble intemational and national govemmernel regulations.f export shipWl and I am the Primary Exporter,I Certify that tha cordents of this Consignment ecMarm tote temw of the attached EPA Acknowedgment of Consent. I car*that the waste minimization statement Nentihred in 4o CPR 262.2i(o)(d I arr a larpe quantity generdtot)or(b)(if I am a small quantity generator)15 true. Cenerator'01'farots Prutled/Typed Name Signature Month Day Year j IsAnt"Wrial Sh pmen9 ❑Impoft to U.S. ❑E>tport tram U.S. Port 01 enryfe>ak k Tr'ansperlar ttignatrre(for ex"only) pate leaving U.S.: W 17•TratrsponerA*npwlecgmEmtof Receipt ofMaterials Tramporlar 1 Printad'ryped Nacre w.... S grrahtre Mat>ift. Day Year a CAN 4 Transpo 2 Print•, ad Name SIc}tieture Month Day fear F- 18.DlmIxtrcy rr'�It 1sa.DismVancy Indiallon Space ❑ Quantity ❑Type l_J Residue ❑Pelbl Re.t. ❑Fug Rdecilon Manifest Reference Numbef: 191).Aternate FadlRy,;or Generator) U.S.EPA ID Number _J ty IQL Fgdline$Phone: 13c.Sgnature ofAltamete Facility(or Generator! Montn Day Year 19•Honedovs waste Report Management Method Codes tix..odes for hazarcous waste heatrent,eisposal,and recycling systems) FA c 1 2. 3. 4. 20.Designated Fact ty Owrer or Operator.Certification of receipt of hazardous materats covered by the manifest amaot as need in Ram I& Printedfryped Narre Signature Month Day year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIQI.COPY 03/07/2014 08:35 5087909562 HYANNIS BRAKE PAGE 04 Please print or ype.(Form designed for use on elite(12-pit0)typwititer.) Form Approved,OMB No.205M39 UNIFORM 4uRd414 1.Generator ID Number 2.Page 1 of 3.Emergency Rasp=Phone A.flariff"t Tracking Nuft," `KS MIADSE�18W241�� S WASTE MANIFEST 5. eneratoes Name and Mailing Addres3• e' its AmimssTf Mni than nailing addras=) HYANN1 a BRAKE 4h FSEARSE RORI+ HYg1vN.i5 MIA 0��1 Generators Phone: dj r . S.Transporter 1 Company Na'ne y y r+S INC. U.S.EPA ID Number y t'(��y y� 7 9PFF.TY—KLEEN 9YS EMS, 1NC r XROO"5Kr9s30 7.Transporter 2 Company Name J.S.EPA IC Number $.Deslgnated Facility Name and Site Adcreas V.S.EPA ID Number SR�' TYWKLEEfV SYST':-.1M5, INC.- >1 �5 167 MIIt_L STREET CRANSTiJN RI 02995, R i DW*802842 FarAltysPho�e: �F�;.' i'�rj.—IdP,Q�B oa Ob.U.S.DOT Description(including Pnoer SNI)PNhg Name,Haza d Coss,In Number, 10.C011allhera 11.otal 12,Unit 13.Waste Codes HM and Peokng Group(i:artiy)) No. Type QJarhtit,' Wt.Nol. 1. � IDRATNEI) LASED OIL FILTERS DM P MR'. 9 Rein i rNO L15DOT OR USEPA Ri~GkJ RTUI rL W 3. i 4• P , I 14,Special Handling'Inslnrclions and Addltloral Information 5K "f Rf.N#l i 10b I k.3468 the proper shipping name,and are c1milled,packaged: ria k rd arid labeWp acarded,and are in all respacls!n proper condition for transpon according to aptaicable ntemational and national govemmenlal regulatlm If Export shipment and I am the Primary Exporter,I cedfy that the contents of this consignment conform to the terms o'the attached EPAAcknovrledgment of Consent. I certify that:he waste minimization statement iderided in 40 CFR 26227(a)(if I am a large quantity generator)cr(b)(if I am a sme9 quan1t generator)Is toe. GeneratorsJOfferors Printed/Typed Name Signature Month Day Year f v f -y Lz F 16.6 t.rnali0na Shipments ❑I.,rw to U.S. ❑Export from U.S. Port of entry,'exit: Tron9porter signature(far exports only): Data leaving U.S.: 1 .-rensporter Acknowledgmen:of Receipt of Materials t-eTrarNp 1 Pdmoo R pK Pvame Signs Month Day Year F C 4 otter ri Name stuns ',Day Year 1S.DISGeparcy (r �1 16a.Disaeprncy Indication Space ❑ Quantity ❑Type U Residue ❑Penis Rejection ❑Fug Rejection WOW R6Wwce Number; H 16b,Aite'nate Facility(orGenemtw) U,S•EPA ID Number V Fac:HtVs Phone yLj 1 So.Sigrature of Alternate FaAty(a Generator) Month Day Year d 19.Hazardous Waste Resort Management Method Codes(i e.,soda far haza•dous vyaste treatment,die aadracycling systems) C 1, 2. 3. 4. �: 20. eshgnated'Facil ty Owner or Opereto':Certi5catJon of receipt of hazardous materials covered by the fast ey4t as noW in tern 1 Ba Rypap!tame Sig tuQa Mpntrh Day Year lal EPA Flirm 8 GO-22(Rev.3-05) Pre tioL-s editipns re obsolete. ;"; DES! FED FACILITYTO GENEFIAT6R 1) f�lt4i�, ci 31 4) f ff Ll 03/07/2014 08:35 5087909562 HYANNIS BRAKE PAGE 05 Please print or type.(Form designed fiv use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UMFORM HA7 Do 1 1.Gene,stor ID Number 2.Pexp I of 3.Emergency Response Phcna 4,Manifest Tradlung Number 4 -717 10 Sno ARDJ VC WASTE IIIANIFES I U 1 q 5.Generator's Nam and Mailing Adete" dftt then mailirg ad rem) Gerteretor's Phone: r:'"wiul— 6.Transporter 1 Company 1. U.S.EPA C Number RIZ11? KA.I, ::1;�-- :-. IN( 7.Tran5poMr 2 Company Nara U.S.EPA ID Nurnbar 9.DesonatEd Facility Name and Sae AddleSS U.S.EPA C NLrnber C I'soililYsPhore: ga gb.U S.DOT I)BstApW(including Proper Shipping Nam,Hazard Clem,ID Number. 10 Contairters 11,Tola 12,Uno 13.We$*codes Al and Packing Group(If enV)) N r, Type QW-1ttY ftljol. q1 r T P. ,J44J: *- 2. LU 4. 14.Special Handling1ranctions and Addition Information Sk rR;.:,R*j r or t'. it, -511 'M51&it I WORhly he proper �Stripping name,and a,e classified,packaged, 'nafkft Wdlabeled1placardoe,and are in all raspe:b n prcparcondKian for transport a=rdingtc apploalble iritematQnol and ne+ionglgoverrmenfalregUallons.If export shipment and I am the Prinra-y 2-xpoqer,loer*that ft contents ofthis consignment conform tothe terms of-.1heaftachad EPAA*noWedgmentof Consent. cer*that the waste rninhizaloo staterrenlidenfified in40 C--R 202.27(a)(if I am large quantily generator)or (ill prnasmell quantity generator)Is true. GaneretVS/OffErar's Printedrtyped Name Signpwe Mont.) Day year -416, nwN)onalEhip-nants ElImport to U.S. Expos from J S. Port of anhy;e)dt: Tfamp:)Ker Signature(for exports only)' Date leaving U.S.: 99 17.Transporter AclwMedgmenl of RKept of Materials M Transpo)r 1 Pfted/Typed Name natu f Month Day Year CL 2 PrrvfddfW q5me tore = Month Day Year tY 18.Discrepancy 18a.Disorepercy n0=b:)n Spacc ❑ a-mify Type ❑Residue ❑Partial Rejadion ❑Full Rejection Manifest Reference Nurnber. f- 18b,Aternate Faclily(or Generatori U$.EPA.lo Number IL Facility's Pho.le: LQLJ 18c.Signsiur3 ofAftemte Pocili'y(or Generetor) Month Day Year Z i 0h 79.HazardousReport Management NeJmd COON(i.e.,Oases 10f hazardous waste tfeatnient disposal.and rscr.hng systems) L in • 3. 4. 20.Des4nat8cl Facility Owner or Operator:C44tificafjon of receipt 3f hazardous materials covered by the manifest except as noled in Item 169 NntedFy*Nerne S gnaturs Month Day Year EPA Form 370(r22(Rev.3-05) Previous editions are wsolele. GENERATOR'S INITIAL COPY Piano,I exar,75024 www.SEd"-aeen.cOM FOR SERVICE C+41t BRANCH MANAGER DOC.Exp. ""�"""' CUSTOMER NO. SEFMCEWBEK TEARITDHY SAL,OVER 60 DAYS 5 F41 CDDE OU'S NCE W 1 f �r y� iFt� m HYANNI� RIRARF _ O GTIAw ITurER SVC.P/C PROD.PA m SB wEnr N N CKI 4 stir? :HEARSE ROAD • `LOC AXE N xA H YANN J S M 02-6 i 1 m SERVICE D TE ISALES REP NO. CUSTOMER P.O.NUMBER CUSTOMER PHONE# TAX CODE DATE Ei]PTIPROD ORDERED ERVI O.M.S.TAX PRODUCT TA}( Ln SERVICFI � ' REA4ARK& SAES TOTAL WASTE SOLVENTJURUMS SERY1Gt CHANGE CA'TNE OFT )� � Llt7lW. CHARGE CC 0CFMCETEIM uxHrre PROMO NUMBR UNITPRIGE TAX CHARGE MIN. PIrTr MUL SKDOT TERM week 1N. .Y,n;a OODE N0. RELEASE 8 GIV 1 - Lm 00 7 [i LO rA& E- 3 3 P E - c ] E 1 2 �. GHECK (3I)fID PDoR wi BECAISINPI1113 YFS Ho WCHNER'IPBRYGMMDTO YEti T07AL-SERVICEIPRODUCTS 10. I 0. 0 P!. APPA�AAtATE MACHBEcamunu [] ❑ aroLwIlLE !❑I ❑ LOCAL aMEXO-9ncarel ❑ ❑ Z= B CLFAIWNESS Fusa�� lJ ❑ Nat oTOanWNE ❑ ❑ W-C USEPA TRANSPORTER 1 ID-NO. USEPA TRANSPORTER 2 ID 1J0, GENER4TOFi i1SEPJ0.JC!N0 _ t�NE 3TAi��J�:� I Q*A4.4FNRY ❑ ❑ LL 165PAa ❑ ❑ aFtdsaLYtnraTETa �� Dr UP)LLYDTSHAuum AOCOPTAIIal CRITEFM _ Z a 12.DO AINERS 19. TOTAL 14.LMT I ERT Y THAY MY TITTAI W LO 11.US SCRI I N (INCLUY}INGPROPERSHIPPItJGNAME,H R A N TYPE vrtaK O°T" E" WASTEsrnEabSnaEwTt"N F THE FOLLOYMIG J W DRAINED USED OIL FILTERS P 1476 OQO 9 o OUDH �RH Fam 22o um.TO 280D Ld.4.A8HONiH UJ7i4LS N W GRrATER nUN22000 19SMONrN I NITIALS 0 D- SIGNATED FACILITY NAME AND ADDRESS r / �i �t INC. I CERnPYTHAT NO RW7EPoN cHAr+c3E MI]UCOUfIFM USA EPA lD NO. z l SAf E F Y—Kt-EEN SYSTEMS,STEMS L NCESA IN THE CHAA4C1PAt9T1C9 OF THE WASTE f MATERws OR W THE PROCESS GEHE>TATING THE STATE ID NO. W - e WASTE MATEAL4L9. CASH TOTAL RECEIVED APFt AYA1 TPN i AGREE TO PAY IW ABOW CHARGES AND TG RE BOUND BY THE TERMS AND TOTAL CHARGE V S.TJAI]RAYIS SET FORTH ABOVE AND ON THE REVERSE SIDE OF THIS OOO.AAENT. (FROM ABOVE) CHECK NUMEIER Q 1nOAY'S S�VM- PLEASE PLEASE CHARGE W ACCOLIMF FOR TN9 TAAMSA=PON UPPE3 OIHLH%4ISE BiDICArED IN THE PAYM9CT RECENED SECTAONL nIC INDNd]U4L 9HON440 THIS WASTE MIN. W E]FKV M-0)XFAS HILL ESSAGE UOCAIMFM IS ILI1 V AUrRMI2E0 TO SW AND ONO QISTOYpT TO RS reMS. (FROMABOVE) INN010E61 AMVUN15 INYUIC:EHI` AMOUNTS -DPI.tnA�.rynrM,o.....,,.nAnaAe+aaropnpayerrm,rvq®oa.m.,,.e.�, ,WA me soh �� vm.r smww amao�oneTm�oentaw.�..�wwm turr.,sc�eri� TOTAL DUE y[, (il PREVIOUS MANIF S Q>X m CREDIT DO NOT YARITF IN THE AREA BcLOVV a B Pr6TtOjwomerNemeCJtE •�; CS)DIT CARD N0. AMEX EXP.DATE _ O"I VISA ~j :1` ,` 2)0 39149 S0 MQ By: OUS70MER I&ERENCE EFOERGENCYCALL 6shames Authorized Repeel W&e INFOHWTION THIS AGREEMENT CONTINUES ON THE REVERSE SIDE 03/0 7/2014 08:35 5087909562 HYANNIS BRAKE PAGE 07 Form APPI'Md.OMB No-2064-DG32 Please print or rmcles', net elite ilo Response Phone Pleaw P 2.Paq��' ancy C,ewaiwr ID Number 57 UNIFORM HAZARDOUS 00 KS WASTE MANIFESTGenoratcr mailing ad MP P,Q, n cles, n t=2.P2 or Generator ID Addle, Generato(SPhons 110 Number T X R W0&jQ19Z0 C)Number 7.Tronsportat-2 company Name 010151-1 U.S.EPA ID Number 8.Designated Facility M87-,nd-SgAdd. RT 029V �Lamlll's Phone:: pe7 Sholyng Name,Hazard Class,1D Number, I0.CmIlairlem 11.Total 12,Unit 13,Waste codes 9a. 9b L.S.DOT Desdptiori(Including Pro No. Type 0"tity, Wt.Nol. hM an.1 Pwk-nq Group(r any)) _MP73t RO 5 1 ii TO 1,7-RPIT-D 131-77 1. w `N' T 1JrC3QT UP tJ 17SF'Pf' �EWLPTED"' 10 w V-1 LU 3. 4. 14._Special Handfirl,Instructions and Additional hrformation IF TM 7MI 1,11 J'6 4 Aj Tj T r q I N L I V 5slJ EN_ (I P R I E R S AS NE C I�q'j y 115. GENERA-rOR'Si6i�FEAOR'aCEREFICATWNt I hereby ded8re That The contents 0'this oonsJV",rt are fully and accurstatyclascrite,11 above by 1110 prow shipping name,and are JwlfI4 packaged, marked and lalaelediplacarded,and are it al respedS in proper wMita for transport according to appk4le imarnatzgelaM nalonal governmental regulations.If export shipment and I am the Nmsry ExporW.I oatiy that the contents of this consignment conform to the terms of the afteched EPA AMoWedgmerd of Omni, I cenif/that the wasteminimizefiDn itatemeni ideniffi9d In 40 CFR 202.27(a)(i:I am a large quantity gerierAor)or(1b)Iff I am 3 Ma QW* Generartcrs,!Offemrs PrinWyp.ec Nave Mont Day year r7_ 0". .. " 16.International ShIpments, Import to U.S. El Export from U.S. PDA e entlylexit Trarig'DrI61 signature(to,exports only): Date leaving U.S.: U.1 17.T erAtkeKwedgment af Receipt of majeries .1e a 11 Tral r I PhAled me slyna� Mont Day Year pp , . .. &A Z OrranspW 2 PrinledTyW Nome ignatire Month Dky Year I1,Discrepancy lea.DWeaancy Inoication Space 0 Quanthy DTYP' 0 Re3icue 11 Partial Re actlon El Fdl Rejection �711 WOW Reference Number: 18b.Afternate Fac lity r Generator) U.S.EPA IC NUm%r YFecilitys Phone: 0 16C.$ignaiture of Aftivate FaClIlly(or Generator; Month Day Year Z 19.Hazardous Waste Report Management Method Cotes(i.e,.Code$for h8Xaj0Ws waste treatmert,cUWoaal,and recycling systems) 2. 4. 20.DesVoled raollity Owner orOoerator.Certification of receipt rdcus materials covered by the mqnjfwiexcWS.tded in 1 18a Prinlisd!Typsd Name 'ri I i Slonstury Z'.' MD* pay-, Y40j, 7 jKfff 87 Previomed"nSafla!0060106- DESIGNATED FACILIVY TO GENERATOR 10� IME*o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 (` a^e.sq e.� 200 Main Street• Hyannis, MA 02601 �ArFO MP+a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: U i &-S C re-e` -1 Dater Location/Mailing Address: S >'3na,�Lt, )41 9� ✓rr 4-da6o Contact Name/Phone: �� cam•- V'�a���o�� So�'' ° ' 7 9L-3 O Inventory Total Amount: , sero License t /-?a Tier II : 1V'0 Labeling: Spill Plan: VP S '� Oil/WaterSeparator: „r1 -1 nyvle Floor Drains: Iva Emergence Numbers: YP j � Storage Areas[Tanks: !2 1�C WcsJc. / "a y 6 N--was D 1 Emergency/Containment Equipment: 1 -- Pe+ r- • 's Waste Generator ID: M A In 9- 1 g 1i 0 Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination:-(21 ear" w,-ho,rs Other Waste Disposal Methods: C «,r kf a i I b u e,!2! A4, F�r-�P j I/ 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. v 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 b� 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, 1- ,4i feu' )—©0 hydrochloric acid, other acids) VIOLATIONS: ORDERS: IF INFORMATION/RECOMMENDATIONS 4 Inspector: Al Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F� ►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 C98ARM��e.� 200 Main Street• Hyannis, MA 02601 $, 079• TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'�s Business Name: iW il^PC Date: 6I I A Location/Mailing Address: 15300�� M � ; � M Contact Name/Phone: Aad3r j2LOO) �- lee Inventory Total Amount: � So: o h License#: 19al j Tier II : Labelinci: c Spill Plan: 0 C Oil/WaterSeparator: 4k4JAnk FIgor Drains: < mer enc Numbers: U i Storage Areas/Tanks: c"kli oil wafiP, oil e• Emergency/Containment Equipment. dry Ly PL1 VC %/ Waste Generator ID: a0 4 Waste Product: Oil i '?-� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: wa4e hl l bud i i 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 an disposal of 111 gallons or more requires a license frgm the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid 9,0 Other cleaning solvents&spot removers Engine and radiator flushes ug and tar removers ,kiydraulic fluid (including brake fluid) Windshield wash gLO 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 �G Miscellaneous Combustible o Paint&varnish removers, deglossers Leather dyes V 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 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t INE rokti Town of Barnstable Office:508-862-4644 CBLE. Public Health Division Fax:508-790-6304 3ARNATSASg` 200 Main Street• Hyannis, MA 02601 1639-plED MP+�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 1eSe� �rteGA Date: 6 7 7 Location/Mailing Addres : c-k VU y4i4j4 Contact Name/Phone: 00, Inventory Total Amount: ^� �00 a� SDS: let License#: ��Z-3 cz,+3 Tier II : ��� Labeling: qvPvt Spill Plan: &9 Oil.WaterSeparator: �j'�g1ti� arkw\C- Floor Drains: o Emergency Numbers: Y25 Storage Areas/Tanks: 1N ) a\AAw 0•\ 'L'�o 9 WkAkY_ o.\ 1% a\ tvvtiC-, - aC a�� ,e 17��jr Emergency/Containment Equipment: ow, d.& <4 <awt-, Waste Generator ID: C106 I�o Waste roduct: D d , Date&Amount of Last Shipment/Frequency: t Ae-Q5 v Licensed Waste Hauler&Destination: Other Waste Disposal Methods: %Qw*e- of\ .5 LjJl\^A.4 ovA. SAR-� LIST OF TOXIC AND HAZARDOUS MATERIALS n D ►�na)�l t!,t%snG \w\vtv�. V*-,e- 5,�•c.e. a 5k �ti„S s�,` NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous terial 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 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 J Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (e9ectrolyte)/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" E� (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: No S a L Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS I °rnF Tom Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. . • 200 Main Street• Hyannis, MA 02601 t639. � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Z <e c-k Date: Z Location/Mailin Address: c. Contact Name/Phone: C�ZL- 41 11d►w Inventory Total Amount: --A- ,POISDS: W Qck� ova k License#: Tier II :, 1 0-4&V oyt.of,f-t - 40,c�Labeling: qob Spill Plan: S PSG t Oil/WaterSeparator: fiGky�, et l gFloor Drains: Ko Emergency Numbers: t '� Storage Areas/Tanks: 0 S t 2 c�5k c_c� \ 1 �� GJ�wk�rWWe k ows�ttc.. Emergency/Containment Equipment: a,l�-5 <a NA- C �/�f a� Waste Generator ID: NV\, o C44 6 -0 - < Waste Product: Date&Amount of Last Shipment/Frequency: o ,S o5&1 C<v,,.A-kA, g, er eL�, o Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 00 Antifreeze S�.k SSwk �k3 Dry cleaning fluids L{ Automatic transmission fluid Other cleaning solvents&spot removers l Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 0 Windshield wash '30,YX o Motor oils `l k 7.40 + 2So wkSaw Miscellaneous Corrosives Gasoline,jet fuel, aviation gas <,rr- Cesspool cleaners Diesel fuel, kerosene, #2 heating oil S Disinfectants '1►, Miscellaneous petroleum products: Road salts grease, lubricants, gear oil 1 \ VA:� '- Refrigerants "J Degreasers for engines&garages\,< Pesticides: . Caulk/Grout 3 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 LJ 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" \1p V)E,F \ko (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/ ECOMMENDATIONS: OW, V .r YA/ "kA .!-% • Inspector:✓1 I,4�1-2 ` Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1223 THE COMMONWEALTH OF MASSACHUSETTS $150.00 ' Town of Barnstable Board of Health s This is to Certify that Diesel Direct SS Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 06/30/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable • �tHE� Regulatory Services ti Richard V. Scali, Director s " � Public Health Division BA�NSTABLE W 1639 �0 �roiu ruiR"�r�.tiEwn'"ars."'nxrnat �.: '°�Eo►�r`+" Thomas McKean, Director i`��g° K 200 Main Street, Hyannis,MA 02601 : Office: 508-862-4644 Fax: 508-79Q-6304 �. t. 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 - El 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 Jul 1st. ASSESSORS MAP AND PARCEL NO. DATE b �� I FULL NAME OF APPLICANT: �1�C2G� (U)'tjiam Mc `Va o\rO. NAME OF ESTABLISHMENT: -b\e St 1 -b!(-e-C�� ADDRESS OF ESTABLISHMENT: SS B6 GIC fA._�uinis . 01 MAILING ADDRESS (IF DIFFERENT):I q M ay b 9, 1 k j�1�)n�I)7 Z TELEPHONE NUMBER OF ESTABLISHMENT: 888-900 - 7787 EMAIL ADDRESS: a CO I o. (P re.c� `, CO ryl SOLE OWNER: A YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS_,AND TELEPHONE_ #_.OF CORPORATION NAME f e C-+ PRESIDENT ►,)iljic.w-t Mc fyc..rn �ArCA. - 31 W14mf r Lj , P4la sS ws m0k NSA 411.771.3113 TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Q Q Company Address : Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page I of 2 •►�r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 200 Main Street• Hyannis, MA 02601 Fo►'9. , TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Scv ! 1 a, (a 1, Date: 9 Location/Mailing Address: .S a►1-4 1 S eta, o IPO Box t odvnymis, o1 C..k Contact Name/Phone: _ o-�t. , c. o _ . a <a�SL rob-7-7 l- Sol 1 V If Inventory Total Amount: O MSDS: ye-2 License#: 331- Tier II : _ 00 ` Labelina: 6yV- 61 Spill Plan: y t- Oil/WaterSeparator: Floor Drains: tv M Emergency Numbers: Ye's L Storage Areas/Tanks: 2 v�\ ATA - j o,1 ANoAAe,9 Emergency/Containment Equipment: ovk,5 Waste Generator ID: �' Waste Product: \ o,1 Date&Amount of Last Shipment/Frequency: 6 12- I4 '116-eick Licensed Waste Hauler&Destination: vQ U 0� 303�-1 Other Waste Disposal Methods: o% ,,II 5 q LIST OF TOXIC AND HAZARDOUS MATERIALS N o twcL u( Ana S ��- �v��1�ld�bry tKIQ ��5� 1�5 te�- NOTE: Under the provisions of Ch. 111, Section 31, of the eneral La s of MA, hazardous'material use, ;L0%3- 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 JDiesel fuel, kerosene, #2 heating oil Disinfectants ✓ Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants �L 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/RECOMMENDATONS: Q- Sb al a vkk— e. Inspector - Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOWN OF BARNSTABLE Date: j�L,n5 et%oV%- TOXIC AND HAZARDOUS MATERIALS REqG1ST9AT1QN FORM NAME OF BUSINESS: ,Jcvd&s 10-r 61 BUSINESS LOCATION: ,S� -Bjl cle- PIX , 14 ya hn,5 INVENTORY MAILING ADDRESS: f0 80x I Z I 0 Z gl,(n✓t l3 ( I7/7N,: Carol Co TOTAL AMOUNT: TELEPHONE NUMBER: pAce.- Sob--776-o`f71, 44r4S 12le --77t-5a71 1600 q4 40K's CONTACT PERSON: � Mcgr1161 EMERGENCY CONTACT TELEPHONE NUMBER: <aok cz// 781 -831-3647 MSDS ON SITE? TYPE OF BUSINESS: 9)il 14,der JGL-1e,-- 4 cnanct Ir y$s INFORMATION / RECOMMENDA IONS: 1/ecy �IeR,�- �� Ks�ll-Dfdjknf�t� Fire District: �c►�+ +1l clean et',a, I&, -e- ovi- , +110»r//s 5 Sill 401,tvt oA- -qyV le rook 4 t � Waste T : M�,So877�oy7� Last shipment of hazardous waste: / 6 ! -l7sy¢1 Name f S ri. r a e o Hale • lei C w � 1 Destination: l��hlanr,QE„d-�ov►�Qeace;, Waste Produ/ca t�or �v ��QS ar-i'S c Licensed es No M �4, c by �olva-1 .�ll�lr.+wc kaP*f 0,K NOTE: Undef the p ovisionf of Ch. 11 Section 31,yof 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. ,i u LIST OF TOXIC AND HAZARDOUS MATERIALS �, �,o g�n� �ws .ef�»c, D 'e- y The Board of Health and the Public Health Division have etermine ha -?e fol owing pro ucts exhibit toxic or hazardous characteristics and must be registered regardless of volume. �t/.'o-1i&*r-16,0# facie no Obs rved / Maximum Observed / Maximum Antiff eze (for gasoline or coolant systems) Miscellaneous Corrosive &NEW YLLISED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils I I a- � Pesticides ld NEW ;W4 USED�f' ° ° ,�l (insecticides, herbicides, rodenticides) Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas 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 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) 4,9 lMp6-�(-, 4n Spot removers&cleaning fluids /n� I LL (dry cleaners) oI do 24T-a,tk,Xylr,r4 t,-X0/rth - 114bL/, T�f Other cleaning solvents I I I" //.. Bug and tar removers 16 C,kA .has ylu.Gg I7� CS 6j etrvte�1/�,rr�t, Windshield wash l4 co�C gvwlval1 #01AvA 44K ru p a t"e, /S 0 '_ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �PP , nt's Si r ature�r St 's Initi N C�ylgfpt�F fa 1�PG.prA,K I 02/28/2014 13:15 FAX 5087718077 SCUDDER TAYLOR OIL �16001 c I'SCUDDER-TAYLOR OIL l Cape Cod's Leading Oil Dealer Singe 1864 Associated Companies: • Fawcett Oil • South Shore Fuel t To: rh From: Fax: Pages: Phone: Date: Re: CC: ❑Urgent 0 For Review ❑Please Comment ❑Please Reply 0 Please Recycle • Comments: THIS MESSAGE IS INTENDED FOR THE USE OF THE PERSON TO WHOM IT IS ADDRESSED. IT MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. If you are not the intended recipient,your use of this message for any purpose is strictly prohibited. If you have received this c ommunicaticn in error, please delete the message and notify the sender so that we may correct our records. Fuel Cil • Heating Equipment e Air Conditioning a Excellent Service 478 SOUTH SS., PO BOX 1210, HYANNIS, MA 02601-2001 e 508-775-0474 a 1-800-698-0474 . FAX 508-771-8077 cri inncD TAvi no rnne r 02/28/2014 13:15 FAX 5087718077 SCUDDER TAYLOR OIL 1a 002 I Global Remediation Services Inc. TAIL10. InvoiceI .. �. 700 Richmond Street East Taunton, MA 02718 -V` DATE INVOICE# (508) 828-1005 'W.IIV 7/27/2011 9616 700 Richmond Street,East Taunton,MA 02718 BILL TO Scudder&Taylor OR Co. Don McBride PO Box 1210 Hyannis,MA 02601 I I P.O. NO. TERMS DUE DATE REP Net 30 8/26/2011 HA ITEM DESCRIPTION QTY RATE AMOUNT Friday,July 22,2011 MDC TRAP CLEANING Field Service Labor, materials &equipment to vactor out 1 2,935.00 2,935.00 and clean MDC trap/holding tank system Disposal Disposal of oil/water(min. disposal 1 450.00 450.00 charge) Disposal Disposal of sludge/solids(min disposal 2 345.00 690.00 charge) Trans Transportation to licensed disposal facility 1 400.00 400.00 miscellaneous Fuel&Energy Surcharge(5%) 4,475 0.05 223.75 Total $4,698.75 Please Make Checks Payable to Global Rernediation Services Inc. 02i28/2014 13:16 FA% 5087718077 SCUDDER TAYLOR OIL ^_ Z 003 _ ~ . Please pritrt or type._(Forrm.deslgned for use on elRe(12•pft)qpwter,) Form Approved.OMB No..2050�0039 UNI F.0k i1;H/tZARI)OU$ 1."o-ratcr ID.Number 2.Page 1 of 9.°me gency Response.Phase 4. !feat jrae.qg Nurtifiei WASTE iIIimFEST ��MM5� 1 !- -IM12 JJ K 5,Generator s Name and Melling Address GereMWO:.$I%Address(if ditMt then malling adiess) �iw OH Ge rato -7 �l�!� 'Is PhoneWO7 6.Transporter 1 Nnpary tame . . A'ID Nri or' 7..Treosporter 2 Cbmoany Name U:S,EPA ID Number 4� 8.Designated Fadgtyr Name ard She Address U.S.EPA ID Number mrtit Ctp. M- -MO. ftiftIghten.MA 0.2072 LSA FEICMI is Pttbne:., 9a 9h,U.S.DOT Dam iptton Qnduding Prcper Shlppfng Name,i{ez=Class,ID INumber, 10:Cur taioers.... and Packing Group(f any)). ::.11..To�l .. 12:Ur!h• . 1&Waste Codes (Lraotfly W1d r�. �. Type � � . 1. �T��, Ptets�t;iifri t�l�,`'���+C31� .`. ,> . .. • • ... z: 2. LAS +. s ! 3. [7 4. 14.S pa!Hapfing Imhud qns andAddildonal hdarmatlon -r 15. GIeN;RATOfj'.SfOFFERoR;s CERrFICATtON; I hereby declare that the contents of ft cdrQnmept are M4,and aocuretelydeecribed above by the proper,:shippkrg name,and are classified;packaged; ma&.d and iaboAplacaudec,and am In all respad6 in proper wnd tlon fortransport eccdrdfng.to applicable International and national governmental reguleticna.If axporl shipment and I aro the Prim Exporter,I certify 6tafthe contents of this consignment conform to the teRna of the attached EPA Acknowledgment of Cansant. I certify that the:waste rrg" ; statement identified to 40 CFR 262.27(a)(ff I am a large quantty genara�or(b)(d l am a s radl quantity generator) true s Prurted?yped Name lure Month . Y rba; - PVFWe y F 16,hrtemotfonal ands . ❑Inport to U S. ❑Expodhrn U.S. Port of why/exh: TransWersignatttv.(for.aXpdkS cuily);- Date moving U.S;: 17.Trump.orterAdmotgWilma '-,cf.Receiptoffu99dals _ �.Traosport�r' Prin yped Name Signature Month y a r � . . z Trans 2 Pfmt�Type N Sfgrra Morrlh Day Year w;. 18.Discrepancy 19a Discrepancy Indlad;on Space ^� ❑cm-tity ❑Typ.. ❑Residue ❑PartialRe0on . ❑Fug Rejection Menffest Ruferanca Number. 18b.Alteniate Facility(or Generator) U.S.EPA ID Number Fadity`s Phone: W.1&Signature cfAltemate FacflBy(or Generator) Month Day Year z 19.Hazardous Waste•Report Managemert Melhod Codes(Le.;codas for hazardous.waste treatment,disposal,and recycflng systems) Lu Lu 2• 20.Designated-Facility Owner orOper :Cartifcotton of receipt of hazardous materials covered by the rrmtdfest except as net m Ftn drfype erne f; Skfi ahlre EPA Farm 8700-22(Rev.3 05)Previous editions are obsolete. TRi4NSPORTER'S COPY 02/28/2014 13:16 FAX 5087718077 SCUDDER TAYLOR OIL 16004 Job# `. WORKSHEET P.O.# ; Day&Qaie�I 1Si• -1� T&M ❑ RATE ❑ Contact Person j/ / �b/• S'a� 7 �� Contract ❑ RATE ❑ Telephone _�.,c Client --ST `� : Start Time Billing Address A io/ �'�; On-Site Time 7. Ending Time Attn: GLOBAL r �- Job Location ��;�c�-r.�i�f/i.l� S� ,rlr�•t.�-� LAB.OR ';.': ; EQUIPMENT Name Title ST OT DT Qty. Type Fleet# #of hours Day Rate Pro•ect Mana er H.D. pickup/Box Supervisor / Vactor <- ,11,nt(,1/1 j Foreman Dump Truck ` -,J Field Technician Roil-off Truck 4'U d ` Field Technician Vacuum Truck Equip.Operator Backh,oe Equip.Operator r Truck Driver U Excavator Truck Drive � Bobcat w/ Compressor/Generator DISPOSAL Rolloff Can Destin ion CSE Equipment Truck4ot - Amount Manifest# r t :� Ldz i1v L�-- JOB r S RI . _ _. ._.. i — MAT IAL . Q pescri tion Q Descri Lion i, n .i f S •,. i Level C❑ Level B❑ ANALYSIS Q T e Destination K. - JOB COMPt_ETED, - Signature: = Date: ' zz /1 Customer: (Company'Name),.-.,r SUBCOPM4TRACTORS By. .�/s� "�I I- me Cbrzpany Description (Print Name) _ (Title) Data: • d ;,gNVIRONMENTAU CONSTRUCTION/ TRANSPORTATION i 02/28/2014 13:17 FAX 5087718077 SCUDDER TAYLOR OIL 1?1005 } Please pdnftr SypS f&mdasigned for use on elite(12-pitcdl)typewriter.) _ Form Approved.OMB No.205NO39 UNIFORh9 HUMMUS I,.Generator ID Number 2.Page 1 of 3.Emergency Response Prime 4.Manliest Traddng Numtrar WASTE MANIFEST MAVOOO M 017-304-1012 0 0 8128641 JJ K I• 5.Generator's Name and Mailirg Address Generator's SiteAddress(ifdi6erent then mailing address) St rider&'T'wilor CHI Company Po Box 1210 Hy55 °klURw°��1-2059 Generator's Phone: 5W77&-0474003`MA 02001-1210 6.Transporter 1 Company Nam U.S.EPA ID Number t3WW Ret' abon Set-vim l ne. MAC300012 M 7.Trarxparter 2 Company Name U.S.EPA ID Number 8.Designated Fadlgy Name and Site Address U.S.EPA ID Number __.... _ �,norm Cornpli✓once Corp. AMD062179Bp0 441R Canton St. 781-297-3J30 Shn4j nn, MA 02072 USA FadlItys Phone: ga. 9b.U.S.DOT Description(InclAng Proper Shipping Name,Hazard cress,ID Number, 10.Conte is 11.TOW 12.Unit HM and Pac;&g Gmup(f any)) No. Type Quantity WLNd. 13.Waste Cady 1 1' NA.1270. Piet*Ieun Oil. 3,P(.11l 7T D woqq t Z 2. UJI 3. f " 4. 4 t 4 %Soeoial Handing lnstrudionsandAdditional Information 1.Profile 04445CLH-oiMalar(L) ERO: 128 � 15. MERATORWFfERORS CERTIFICATION:I hereby declare that the contents of fib oonsiprrnent are fuly and acxxaately described above by the Proper shipping name,,and are ssi8ed,oad®ged, marked and labelddfplacarded,and are in all respects in prspercondition for transport according to eppilcable Intamadonal and national govammanlel regulations.If export Shpment and I am the Primary Exporter,I certify that the contents of fife consignment contrm to the limo of the attached EPAAcknowledgment of Consent. ,. 1 certify that the waste rrdnimizpn statement Identified in 40 CFR 26227(a)lfl I am a large quantity generator)or(b)(81 am a small quendty generator)Is he. Go ratoes/ ror's PdnWyoed Name, Signature MonthNlv Y —t 16.IntBmabonal Shiamants E'~ Import to U.S. ❑Exporl from U.S. Pod of entryfexit Transporter signature(far exports only): Date leaving U.S.: �. 17.TransporterAdowadedgment of Receipt of Materials T Pri yped Name Signature Mo � Yes r ZZ Trans M Fu 2 ftt 9 dryW N Signat Month Day Year H 16.Discrepancy I ea.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue Partial Re cllat Elje ❑fuQ Rejection Manifest Reference Number: 18b.Alternate Facdiy(or Gereator) U.S.EPA ID Number J Faaditys Phone: up 18c.9ghatun3 afAttemate Facllry or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1, f . F ,r 2. 3. 4. 1113s 20.Designated Facility Owner or Opera rtfication o;receipt of hazardous matarids covered by the manliest except a3 nda m 18 P' yped Name r .. Signature r hto Year EPA Form 8700-22(Rev.3-05) Precous editions are obsolete. DESIGNATED FACILITY TO GENERATOR 02/28/2014 13:17 FAX 5087718077 SCUDDER TAYLOR OIL IM 006 14 as. TRAD E S E �.tiITEf) I\I)t>>IRI;1I �ff;�ii f.i � 1.W' Awnvwftw t 47 GRACEY AVENUE MERIDEN,Cr 06451 TOLL FREE(888)276-0887 INFQ UNITEDINDUSTRIAISERVICES.COM Re: Manifest received at Environmental Compliance Corporation Stoughton, MA To Whom This May Concern: Enclosed is a completed copy of a Unif, rm H zardous Waste Manifest or a Pion-Hazardous Waste Manifest regarding waste received at our facility on Z This copy,together with the copy of the manifest you retained when the waste was initially shipped,must be retained in your files as proof that the waste was transported and received by an authorized,designated facility. Our storage and treatment methods are as folkwvs: • H111 Stabilization • H135 Water Treatment • H061 Fuel Blending s `All products of our fuel blending process are burned for energy recovery. Thank you for choosing a United Facility for your treatment and recycling needs. For additional information,please visit our website at www.unitedindustrialservices.com. To schedule a tour of our facility,please call(888)2764=6 or e-mail us at csb@ united industrialservices.com . Very truly yours, Al William C.Morris ' WCM/c1m www.tradebe.com or www.unitedindustrialservices.com r 02/28/2014 13:18 FAX 5087718077 SCUDDER TAYLOR OIL (a007 0 M. vr; United 0/1 Recovery TRADE B E'" Ij)NI'"TI:L)iNDUS"l'Rihl,SERVICES Page 1 of 1-8072211066 441 R Canton Street Stoughton,MA 02072 (781)297-3530 Analytical Laboratory Report client/Generator ID-Name: Global Remediation Svcs Inc Sample 0: S072MI060 Driver: Global Remediation Svcs Inc Truck: Global Remediation Svcs Inc Sample Identification: E04 Sample Type: Truck Semple Date Collected: 7/22/2011 Target: INTERNAL Time Collected: 11:30 AAA Proftletl:: 4445CLH Matrix: Solid,Liquid Sampled By: KS Composite/Grab: COMPOSITE Condition: Intact Number of Containers: 1 Condition Comment: Manifest 1l: 008128641 JJK Temperature: Job ID: J0720110051 Rcvd within Holding time:Unknown Special Handling: Visual Inspection Memo: Receiving Plant; 441 R Canton Street Stoughton,MA 02072 Analytical Information _Parameter-----'- - --Analytical Method Flags Result Unit Date Reference pH SW-846%288080 — _ -- 7.43 su --- 7/22/2011 Flash Point SW-846%2B1020A >200 QF 7/22/2011 %'Oil ASTM%2BD1796-97 1 % 7/22/2011 %Water ASTM%28D1796-97 68 % 7/22/2011 %Sediment ASTM%2BD1796-97 31 % 7/202011 %Rag ASTM%2901796 97 Pii4 7/22/2011 Glycol Test REFRACTOMETER NA 7/2212011 Total Halogens SW-846+EPA+9076 <1 X0 ppm 7/22/2011 BTUsIL'B SW-846+EPA+9076 NA 7/22/2011 Silver SW446CH3.3EPA7000B •ND<0.30 ppm 7/22/2011 Copper SW-846CH3.3EPA7000B 0.87 ppm 7122/2011 Lead SW-846CH3.3EPA700013 2.21 ppm 7122=11 Iron SW-846CH3.3EPA70006 36.52 ppm 7/22/2011 Cobalt SW-846CH3.3EPA7000121 ND<0.30 ppm 712212011 Nickel SW-846CH3.3EPA7000B 0.68 ppm 7122/2011 Cadmium SW-846CH3.3EPA7000B NO<0.30 ppm 7/2212011 Zinc SW-846CH3.3EPA7000B 2.45 ppm 7/2212011 Chromium SW-846CH3.3EPA7000B 0,77 ppm 71=011 PCBs,Total SW4146%288082 ND<2 ppm 712212011 Sample Treatment ECC TREATABILITY TEST NA 7122/2011 Specific Gravity GRAVIMETRIC 1,110 g/ml 7/22/2011 Phenols CHEMETS NA 7122/2011 Authorized for Release: Town of Barnstable y% 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 To: SCUDDER,FREDERIC F 2ND& Date Tuesday,February 20,2007 SCUDDER,RICHAF:D M&ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE: Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 0 Tag NO: 00485 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent I 7 p4��aka ram, i Barnstable &NRNSTABLF- MASS. Town of Barnstable FD� Regulatory Services Department 2007 Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Date: April 1, 2009 TO: RF &RM LLC 22 Channel Point Road Hyannis, MA 02601 O PIW RE: Underground Storage Tank at: 55 Bodick Road Hyannis, MA Map Parcel: 344080002 Tank NO: 10 Tag NO: 00485 Our records indicate that your underground fuel (or chemical) storage tank is over 20 years old, and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60) days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90) days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A. McKean, RS, CHO Health Agent °t1Me r°k� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARN STABLE, 200 Main Street• Hyannis, MA 02601 �prFOMA+p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT / Business Name: �� i r Date: �b Location/Mailing Address: ..Contact Name/Phone: Inventory Total Amount:w MSDS: License#: Tier II : 'v _ Labelina: Spill Plan: Oil/Water Separator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: 2 Emergency/Containment Equipment: a F ® � [Date aste Generator ID: a Waste Product: &Amount of Last Shipment/Frequgncy:censed Waste Hauler&Destination: her Waste Disposal Methods: , Cia wgy &44 .0- �f.C® Z71 LIST OF TOXIC AND HAZARDOUS MATERIALS f)© 44K, jn t�frdous NOTE: Under the provisions of Ch. 111, Section 31, of the Genera Laws of MA, 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 ydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners y/Diesel fuel, kerosene, #2 heating oil Disinfectants V 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: © !P 6 Inspe o.: y, .I. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1223 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Diesel Direct .---............................................................................................................................. 55 Bodick Road, Hyannis, MA ..---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 0Wf. O Bam s �b ;r Om U.00OA DIM No main s E�ices Sn�l'=8�7,2;4fY,44 k���t 5�d.�a7�CS����Q�t PSI T 4N' O PEIIMIT TO TOiIE N - A �iRDt� �i A`CE� 3AN���� T�`�C}yl�f�F��1R1�tSTABY;F<�iEN �A'L CJ�?I�l1��CC ;C�'I.APTEIt.108;. r HXi ARD 5U5 tVIe4T TA1 S,t�1 it BU N SS Tr A ""T AI�bL b : `XC�1 12 1YTJt LI+ ;MATEFUAW- GtE�TER RAN:T � TEH©IUD-Qi�AidTI 'TS ► it �i[JTREiS fi(3BTA,N A�1.��i�7Ut��PEIt�IT{�C7N5' J.�'LX lst—J�IN�;3Oth�; PPI. ICATIG'F v— CATEGORY 1 PERMIT 6 11t af6h U0 ❑ Osa AT�O�dItY 2ERMIT r 49' OA�I'EO�ER�' 3 'ERMTT 50�o 1 s � xnrea oI-lo' t • . It ar tQ:rzcll e,; sses ed xt. t: s x�c� rscd biui 1st„ . 1 AS E SC1�t}S M. STD-PA�CEL'NO na.. 1 � r � 1 n. ... :. ...µ..: .: .........�... F ALL NE` LT A;PFLICATIOitS,INY3I+�ATF 'YIT UESS RAS 'ERIALsTf4Ei d u GREtX' ' 'it ROLrSEHC3LD QU +T1S{xZ GAI? oo S k FULL:N'�►1 E'OF AI'PI�I..CAI�1T., ;r eft 41, S 1V � TA3I.ISH1VIElT �;;._ 4-q 4it1! ;n 7� 1VIAIL G IN Mg, 8 TEL kT30t3E NUi!'1BER OYE,STI-WAIaLo IS Y .. E'MA,IL;�.ADIIII $S yy : t r a?: r" : `k 4, ut' .,i 1.b, LEt7VNE1 wYS N O XF NO�, tME`:iF PxYII ' 1ER:. 11 I.L N , Ol r�DI3TtG5S,AND T LE TO CCY ORATIflNY NAMI� 1 r I?I�tESYI)ENT; �f✓�!54��^" fix✓ ... h 3 ����"' ,Y a p�• _... ..,...... .... ........ .. .... ..r., ^. ... .. y Y p R Tp1 E`yam M . /$NAMI: TEL : O. N. #. � Y .. E . " S14G E OF A ?' LICA TlT: A l L � Q ;pptictcnrFcnrnslE#aztvtacrtsptiT7ra `rar, eox: r �1 • Town of Barnstable Inspectional Services BARNSTABLE �TNE Tpy,_ ncrxsrete-czhnLt.cmur•nrcn.ts Public Health Division M SWSM'15.6SEAYLt_•lF B?ANS &E 3639/-//332014 �U (= BARNSTABLY. = Thomas McKean, Director `� 200 Main Street' Hyannis, MA 02601'°TfD Mpl� Office: 508-862-4644 Fax: 508-7906;304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $1.25.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 kvsr d ' *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? v 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 (25GALLONS)? YES NO. 1 4. FULL NAME OF APPLICANT: �it J e-I N"(��J }I r c 1 +�~n G 5. NAME OF ESTABLISHMENT: D)'e-,E)t1 ))m I)) C 6. ADDRESS OF ESTABLISHMENT: 5,`J,5 P-nA I 1'C0 C1d�I CAA n 13 MA 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: qq tpf je_, 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: fidC41m o f AWpSU P bi Q(V e4, Crj 10. SOLEOWNER/ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME pi t.L O it ez,+ Tn4, PRESIDENT Q1U,1(4 MC A TREASURER_= P1( _ 'L'P.A:Y�APA CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx r Town of Barnstable Inspectional Services BARN STABLE tr+e r Public Health Division -S-S <<'v,r,ST-3115 M0.�SICAiS M:ILS•J�iFRVILL-YftSI IfANMi14&k 1639-2014 r Thomas McKean, Director 57 039. `� 200 Main Street, Hyannis,MA 02601 i Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ n 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.' ► LQ % 15 � 1. ASSESSOR'S MAP AND PARCEL NO. Hey % 2. IS THIS A PERMIT RENEWAL? tAYES—NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 144&VNt q, 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: §-gn f3 b-01Cr all 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: �-Os -2 7)- 1 Ste& ;J 9. EMAIL ADDRESS: (=G IZ v"�S 7�i�! �J !��!(3A�Cc C c�v✓�C�►-S 1 I� l Z ^tC I 10. SOLEOWNER: -- YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME L4UA gnli r l�cc�•c; s` ram!5y S�o (i�o�ci�►2� �0�-7��' (pS'�8 PRESIDENT S � TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT DATE C:\Users\trippv\Desktop\Renewal Applications for 2020 Save for VST Quick Lookup\Haz Mat App Revised 09-10-18.docx Number Fee 1223 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Diesel Direct SS Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHD Director of Public Health Town of Barnstable Inspectional Services BARNSTABIME Public Health Division BMWgrABLE.Mass. Thomas McKean, Director ' �. w , prfv �a`0 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304_' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 9 VAT *A late charize of$10.00 will be assessed if payment is not received by July 1st. oeti JL, 1. ASSESSOR'S MAP AND PARCEL NO. 3qq— 0 00.; 2. IS THIS A PERMIT RENEWAL? V/ 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: Dl'e!�LL Q j I cC :4) L 5. NAME OF ESTABLISHMENT: Tj�)G 6. ADDRESS OF ESTABLISHMENT: �JUUt1� P-OAJ 4VA AJS MA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: U�� q oo :]q�' 9. EMAIL ADDRESS: Ock,in s P 9PLQ f c�,-./ L DItS&L 1)1(4c;� , Lom 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME pie&-L npect fAC: PRESIDENT tQ114.1eyrti M40AMAkA TREASURER 9PILA O'Lu r CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: j TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE I QAApplication Forms\Haz Mat App Revised 09-1 A-18.docx it Number Fee 1223 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Diesel Direct SS Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------- --- ------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health CPO TRoewr of BUnsxable g atory Services �"T ►per Richard V. Scali, Director WE Public Health Division BARNSTABLE BMWgrABLS.A Thomas McKean, Director M�M� lyA$,Q 0 1639-2014 -- 3�g 2 Main Stxeet�..Hyannis,-MA 02601 -- -...__------------_.___-- Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ,K V, - *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Pfyc-4 IAJ Z 5. NAME OF ESTABLISHMENT: D) &tl, y/ly Caf 1NC 6. ADDRESS OF ESTABLISHMENT: P-)o 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: `? f mA Pk• S I 1 MA �- az01Z S. TELEPHONE NUMBER OF ESTABLISHMENT: DS - 90 I'M{�9. EMAIL ADDRESS: s �l-Q (yam Li � a 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME O 1 re. C4 IN L PRESIDENT w 1 C WmAVA TREASURER A CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT / DATE J' l� Q:1Application FormsViAZMAT APP 2017 REVISE cx Number Fee 1223 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Diesel Direct SS Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------- ---------------- -- - - ------ -------- ------------------------------------------------------------------- --- -------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health v f _ �� �/coo c.�►� 1�� o Of B�nstable egulatory Services. a T Richard V.Scali,Director "' .a Public Health Division BAMSTABLE i i M�LSTYi,'S 46ii.Mit�ia lld•JfWLTt6f lay Thomas McKean,Director ,, . 200 Main Street,Hpariuis,MA.Q2601 Office: 50M62-46.44 Fax: 508-790-6304 X 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-..00L E3 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 C7 V *A late char-ge_of$10.00 will be assessed if payment is not received.by duly 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/BUELDING APPROVAL FOR HAZARDOUS MATERIALS,STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: G 6. ADDRESS OF ESTABLISHMENT: (y)AQ1e S+Wj '�40P�' NJ MA 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: fl 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS � t4J � ` � � t.+ �r C`CA , 10. S0LEOWNER-; X YES No IFNO NAME OF PARTNER:;; I L FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME bi-e..z _ l ` ' -0 M 12. PRESIDENT_ i3 i L(. M G N A fn are,, TREASURER CLERK_- sy--,l 6t o l be i 12. IF PREPARED BY OUTSIDE PARTY:. NAME: TELEPHONE#: COMPANY ADDRESS EMAIL:. pp• .SIGNATURE OF APPLICANT - ' "� DATE b S- .f Q\Appiication FormsWAZMAT APP 2017 REVISED.docx Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $100.00 o Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS Bodick Road-PO Box 1210, 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 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 r Town of Barnstable Barnstable Regulatory Services Department � • �I'ABLE,o� ;eriea C V DARNS Public Health DivisionMASS. � p� 1639. `0� 200 Main Street, Hyannis MA 02601 prED MA'l 2007 Office: 508-862-4644 Thomas Fg eile C-I�irector FAX: 508-790-6304 Thomas A?McK ,CHO C . � N) . E�7 Application Fee: $100.00 G' c ASSESSORS MAP AND PARCEL NO. DATE � m APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C6 91rilt-u Inc. NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT SS .60dt JC ax cz/U � �` (AA G TELEPHONE NUMBER �0 � �-6�Zy U2(ad/ SOLE OWNER: YES V NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 073/Ob.J I STATE OF INCORPORATION MA FULL NAME AND HOME ADDRESS OF: PRESIDENT jg FAtA)(ajt 12,o C,=Cen� S� Dc"JV,,lr /Y)l- 62-332- TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS J2,Q tJ Ci U*1 M1. HOME TELEPHONE# /- - / / Q:\Hazmat\Haz Mat Applicati=2008.DOC Emergency Response Contingency Plan Kingston Oil Company Fawcett Oil Company Scudder Taylor Oil Company Joyce Tucker Response Environmental 1-508-795-0100 Direct Line 1-800-273-8260 Braley&Wellington Ins 1-508-754-7255 Cell Phone 1-603-502-1974 Acadia 1-800-691-4966 Fawcett Oil Companies Oil Release Call List The following individuals are to be contacted in case of a reportable oil release or spill. A reportable release is ten gallons or greater or any release which threatens a water supply or a storm drain. Based on the severity of the release we may only have two hours in which to report the spill to the DEP so please contact the proper person ASAP. Please make call in the order listed. Fawcett Oil Kingston Oil Scudder Taylor Oil Rich Aranella Ben Fawcett Donald McBride Cell: 617-892-3232 Cell: 781-831-3522 Cell: 781-831-3562 Direct Connect: 72 Direct Connect: 3 Direct Connect: 39 Home: 781-648-7055 Home: 781-934-2922 Home: 508-420-0356 Rob Fawcett Chris Ranney Dustin Calkins Cell: 617-892-3256 Cell: 774-836-5355 Cell: 802-274-6839 Direct Connect: 50 Direct Connect: 32 Home: 781-934-8347 Home: 508-888-7257 Home: 508-394-1293 Ben Fawcett Rob Fawcett Rob Fawcett Cell: 781-831-3522 Cell: 617-892-3256 Cell: 617-892-3256 Direct Connect: 3 Direct Connect: 50 Direct Connect: 50 Home: 781-934-2922 Home: 781-934-8347 Home: 781-934-8347 Red Fawcett Red Fawcett Red Fawcett Cell: 781-831-3509 Cell: 781-831-3509 Cell: 781-831-3509 Direct Connect: 1 Direct Connect: 1 Direct Connect: 1 Home: 781-934-5291 Home: 781-934-5291 Home: 781-934-5291 j r 1. Qualified Individual Information This section defines the qualified individual for the daily operations of Scudder Taylor Oil Company. If more than one person is listed, each individual indicated in this section shall have full authority to implement the response plan. For each qualified individual; the name, position, home and work addresses, emergency phone number,and specific response training experience is listed. This section defines the lines.of authority and accountability for environmental compliance. The Qualified Individuals are: (Donald McBride 40 Gorham Lane Centerville, MA 02632 Work Phone: 508-775-0474 Home Phone: 508-420-0356 Cell Phone: 774-836-5359 Rob Fawcett 10 Heron Way Duxbury, MA 02332 Work Phone: (781) 585-1920 Home Phone: (617) 242-9850 Cell Phone: .(617) 892-3256 i 1. Emergency Notification Phone List This section identifies and prioritizes the names and phone numbers of the Fawcett Oil Companies and personnel that need to be notified immediately in the event of an emergency. This section includes all the appropriate phone numbers to ensure that, in case of a discharge, any employee could immediately notify the appropriate parties. The Emergency Notification List is: Fawcett Oil: Office: (617)547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Chris Ranney Home Phone: (508)888-7257 Cell Phone: (774)836-5355 Scudder Taylor Oil: Office: (508)775-0474 Donald McBride Home Phone: (508),420-0356 Cell Phone: (774) 836-5362 Dustin Calkins Home Phone: (508) 394-1293 Cell Phone: (802) 274-6839 f 1. Spill Response Notification Form A Spill Response Notification Form to provide a checklist of information that shall be provided, as applicable to the Massachusetts Department of Environmental Protection, National Response Center(NRC) and other personnel, is as follows. Response Environmental (866) 577-5274 i 2. Response Equipment List and Location—Contractor Support This section provides a description of the Fawcett Companies list of Emergency Response equipment and location of the response equipment. When appropriate,the amount of oil that emergency response equipment can handle and any limitations is described. This section also provides a description of Fawcett Oil Companies' support emergency response vendors and location of their response equipment. The Response Equipment List and Location—Contractor Support is: Fawcett Oil: 1 Tyler Court,Cambridge, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental,Inc. Randolph, MA National Environmental.Services Needham, MA Kingston Oil: 82 Main Street, Kingston, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA Scudder Taylor Oil: 55 Bodick Road, Hyannis, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA 3. Facility Response Team This section provides a list of the Fawcett Companies' response personnel, including those employed by the Fawcett Oil Companies and those under contract to the facility for response activities,the.amount of time needed for personnel to respond,their responsibility in the case of an emergency, and their level of response training. Three different forms will be created for this section. The Emergency Response Personnel List shall be composed of all personnel employed by the Fawcett Oil Companies'whose duties involve responding to emergencies. The second form is a list of Emergency Response Contractors(both primary and secondary) retained by Scudder and Taylor Oil. The third form is the Response Team List,which shall be composed of both emergency response personnel (referenced by job title/position)and emergency response contractors, included in one of the two lists described above,that will respond immediately upon discovery of an oil discharge (i.e., the first people to respond). Emergency Response Personnel List Fawcett Oil: Office: (617)547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617) 892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781) 831-3509 Chris Ranney Home Phone: (508) 888-7257 Cell: (774) 836-5355 Scudder Taylor Oil: Office: (508)775-0474 Donald McBride Home Phone: (508)420-0356 Cell Phone: (774) 836-5362 Dustin Calkins Home Phone: (508) 394-1293 Cell Phone: (802) 274-6839 Emergency Response Contractors Fawcett Oil: 1 Tyler Court, Cambridge MA Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) I Kingston Oil: 82 Main Street, Kingston MA Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) Scudder Taylor Oil Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Envirosafe Sandwich, MA (Vacuum truck, labor,disposal) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) Response Team Fawcett Oil: 1. Rich Aranella Oil Manager Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 2. .Rob Fawcett Manager Home Phone: (617) 242-9850 Cell Phone: (617) 892-3256 3. Response Environmental Spill Manager Spill Reporting: (866) 577-5274 Office Phone: (508) 759-0110 Glenn Goral, LSP Jeffery Curtis, LSP Matt Geiger Stefanie Wood Alan Desrosiers Paul Renouf Kingston Oil• 1. Chris Ranney Service Manager Home Phone: (508)888-7257 Cell: (774)836-5355 2. Rob Fawcett Manager Home Phone: (617)242-9850 Cell Phone: (617) 892-3256 3. Red Fawcett Manager Home Phone: (781) 934-3514 Cell Phone: (781)831-3509 4. Response Environmental Spill Manager Spill Reporting: (866) 577-5274 Office Phone: (508)759-0110 Glenn Goral, LSP Jeffery Curtis, LSP Matt Geiger Stefanie Wood Alan Desrosiers Paul Renouf Scudder Taylor Oil: 5. Donald McBride Oil Manager Home Phone: (508)420-0356 Cell Phone: (774)836-5362 6. Dustin Calkins Service Manager Home Phone: (508)394-1293 Cell Phone: (802) 274-6839 7. Response Environmental Spill Manager Spill Reporting: (866)577-5274 Office Phone: (508)759-0110 Glenn Goral, LSP Jeffery Curtis, LSP Matt Geiger Stefanie Wood Alan Desrosiers Paul Renouf 6. Immediate Actions In this section,a description of the Fawcett Oil Companies'worst case release, as well as a small and medium release,will be detailed as appropriate. A multi-level planning approach will be defined because the response actions to a release (i.e., necessary response equipment, products, and personnel) are dependent on the magnitude of the release. Planning for lesser releases is necessary because the nature of the response may be qualitatively different depending on the quantity of the release. To address multi-level planning requirements,this section will consider types of specific release scenarios that may contribute to a small or medium release. The scenarios shall account for the normal oil delivery operations that take place. Once the discharge scenarios have been identified,the section will further identify and describe implementation of the response actions. Worst Case Scenario Release: Tank Accident with Entire Cargo Release 5,000 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact -Provisions should be made in vehicle for emergency personnel(fire,police)notification to company in the event of driver incapacity • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Full Contingency of Response Team List and Spill Trailer for emergency containment while contractor en route. • Implement Contractor Notification for Full Contingent of Personnel and Equipment for containment assistance and remediation. Medium Case Scenario Release: Residential Tank Rupture 270 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Available Response Team List and Spill Trailer for emergency containment while contractor en route • Implement Contractor Notification for Personnel and Equipment for containment assistance and remediation. Small Case Scenario Release: Vent overfill 1-20 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Qualified Individual or designee for inspection A. Implement available Response Team List and Spill Trailer for containment and remediation B. Implement Contractor Notification for Personnel and Equipment for containment and remediation. Co.,Robert Fawcett & Son General Liability Claim Form OIL RELEASE ACCIDENT REPORT hover 10 gallons or if near Wet,Landsl Date &Time of Spill Estimated Amount Spilled Location: Name Address City State Zip Code PhoneNumber 1. Notified AIG/PIER HOT LINE (first) Yes No Emergency Claims Number 1-877-743-7669 Person Contacted at PIER PhoneNumber 2. Notified Local Fire Department Yes No Person Contacted 3. Notified Response Environmental, Inc. Yes No Phone # 508-795-0110 (Glen Goral) 4. Notified State D.E.P. Yes No 1-888-304-1133 Statewide Person Contacted M 5. Notified Braley&Wellington Ins. Agency Yes No Sandy Blanchard,Cathy D'Elia,Parker Wellington Phone: 508-754-7255 Fax: 508-797-3507 Person Contacted PLEASE INCLUDE STATEMENT OF SPILL ON OPPOSITE SIDE OF THIS FORM Robert Fawcett & Son ., Automobile Claim Form OIL RELEASE ACCIDENT REPORT (over 10 R-allons or if near Wet Landsl VP Date&Time of Spill Estimated Amount Spilled Location: Name Address City State Zip Code Phone Number l. Notified Local Fire Department Yes No Person Contacted 3. Notified Response Environmental, Inc. Yes No Phone 4 866-577-5274 (Glen Goral) 4. Notified State D.E.P. Yes No 1-888-304-1133 Statewide Person Contacted 5. Notified Braley&Wellington Ins. Agency Yes No Sandy Blanchard,Cathy D'Elia,Parker Wellington Phone: 508-754-7255 Fax: 508-797-3507 PersonContacted PLEASE INCLUDE STATEMENT OF SPILL ON OPPOSITE SIDE OF THIS FORM Number Fee 1178 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that TOWN TAXI OF CAPE COD SS 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,O.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health rw F� 4 Town of Barnstable e u t Wt • �� d S ` & Public Health Division ° Thomas McKean,Director Fw. r� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �r- Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. J 2- DATE G�l� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT (�Cl�>/� �� 1AX1 NAME OF ESTABLISHMENT �Z �t OU-77, • ADDRESS OF ESTABLISHMENT G'l /�VE 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. ® gcJm t STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGN OF PLICANT RESTRICTIONS: HOME ADDRESS D IZl - HOME TELEPHONE# C:\cache\Temporary Internet Fi1es\0LKD3\HAZAPP Rev2015.DOC - o Town of Barnstable Office: 508-8624644 Fax: 508-790-6304 O, Regulatory- Services Department • � sn Public Health Division M.nss> Thomas A. McKean,CHO fl 3 ` 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $100.00 (Check) on 6/12/2015 i Check number: 3107 Check amount: $100.00 Name on check: Town Taxi of Cape Cod, INC. I Business: Peter Cutler Owner: 63 CIT LLC !Address: 63 CIT AVENUE, Hyannis i i • Q\ Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS 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 Health r.. { f - Town of Barnstable °FINE , Regulatory Services Richard V. Scali,Director Y 8 AJ MAIM Public Health Division 039. �IEDMA'�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. 3g06 0 0 0-2 DATE /C APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS rI FULL NAME OF APPLICANT0- 0- if C . NAME OF ESTABLISHMENT b8a I (6f ON I . ADDRESS OF ESTABLISHMENT eJ�'jc- MA OZ:too J TELEPHONE NUMBER bog "-7 7,5 U y 7 y SOLE OWNER: y 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 �P FULL NAME HOME ADDRESS OF: PRESIDENT i�` �2.(� Cl�5C�Pi>�'S�-- �JXbO NIA TREASURE �- a "'. v M n CLERK J1� fj` • SIGNATTM;E F&P / RESTRICTIONS: HOME ADDRESS 7 (IV vrc MR HOME TELEPHONE# - ,3/-3 -1-V 7 C:\c-ache\Temporary Intemet Fi1es\0LKD3\HAZAPP ReQ015.DOC x akW 711 Town of Barnstable office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department suu+ina Public Health Division v • „ Thomas A. McKean, CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015� � ,Check number: 4308 Check amount: $100.00 Name on check: Scudder&Taylor Oil jBusiness: Scudder Taylor Oil Owner: R F & R M LLP !Address: 55 BODICK ROAD, Hyannis i • • Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS 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 3 i Town of Barnstable °FTNe TOh• Regulatory Services ti Richard V. Scali, Director BMMMMAS& ' Public Health Division prFD 39. 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 NOW ft U 02, DATE -� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Cy ADDRESS OF ESTABLISHMENTLQj02,661 TELEPHONE NUMBER Og 72S -b q?y SOLE OWNER: /YES NO 1F APPLICANT IS A PARTNERSHIP,FULL NAME"AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. IO l.S� STATE OF INCORPORATION �A I . i FULL NAME HMO DRESS OF: PRESIDENT 1 rat TREASURER T v CLERK 2-0 ce4j- SI,G AT PPL�GAN RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# -7 Q:1Appiication FormMAZAPP.DOC Emergency Response Contingency Plan Kingston Oil Company Fawcett Oil Company Scudder Taylor Oil Company Joyce Tucker Response Environmental 1-508-795-0100 Direct Line 1-800-273-8260 Energi 1-888-252-4650 Cell Phone 1-603-502-1974 Acadia 1-800-691-4966 1. Qualified Individual Information This section defines the qualified individual for the daily operations of Scudder Taylor Oil Company. If more than one person is listed, each individual indicated in this section shall have full authority to implement the response plan. For each qualified individual;the name, position, home and work addresses, emergency phone number,and specific response training experience is listed. This section defines the lines of authority and accountability for environmental compliance. The Qualified Individuals are: Donald McBride 40 Gorham Lane Centerville, MA 02632 Work Phone: 508-775-0474 Home Phone: 508-420-0356 Cell Phone: 774-836-5359 Rob Fawcett 10 Heron Way Duxbury, MA 02332 Work Phone: (781) 585-1920 Home Phone: (617) 242-9850 Cell Phone: (617) 892-3256 I 1. Emergency Notification Phone List This section identifies and prioritizes the names and phone numbers of the Fawcett Oil Companies and personnel that need to be notified immediately in the event of an emergency. This section includes all the appropriate phone numbers to ensure that, in case of a discharge, any employee could immediately notify the appropriate parties. The Emergency Notification List is: Fawcett Oil: Office: (617).547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617) 892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Chris Ranney Home Phone: (508)888-7257 Cell Phone: (774) 836-5355 Scudder Taylor Oil: Office: (508)775-0474 Donald McBride Home Phone: (508)420-0356 Cell Phone: (774)836-5362 Carole Cook Cell Phone: (781)831-3547 1. Spill Response Notification Form A Spill Response Notification Form to provide a checklist of information that shall be provided, as applicable to the Massachusetts Department of Environmental Protection, National Response Center(NRC) and other personnel, is as follows. ENERGI (888) 252-4650 2. Response Equipment List and Location—Contractor Support This section provides a description of the Fawcett Companies list of Emergency Response equipment and location of the response equipment. When appropriate,the amount of oil that emergency response equipment can handle and any limitations is described. This section also provides a description of Fawcett Oil Companies' support emergency response vendors and location of their response equipment. The Response Equipment List and Location—Contractor Support is: Fawcett Oil: 1 Tyler Court,Cambridge, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA Kingston Oil: 82 Main Street, Kingston, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA Scudder Taylor Oil: 55 Bodick Road, Hyannis, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Energi Insurance Services Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA 3. Facility Response Team This section provides a list of the Fawcett Companies' response personnel, including those employed by the Fawcett Oil Companies and those under contract to the facility for response activities,the amount of time needed for personnel to respond,their responsibility in the case of an emergency, and their level of response training. Three different forms will be created for this section. The Emergency Response Personnel List shall be composed of all personnel employed by the Fawcett Oil Companies'whose duties involve responding to emergencies. The second form is a list of Emergency Response Contractors(both primary and secondary) retained by Scudder and Taylor Oil. The third form is the Response Team List,which shall be composed of both emergency response personnel (referenced by job title/position)and emergency response contractors, included in one of the two lists described above,that will respond immediately upon discovery of an oil discharge(i.e.,the first people to respond). Emergency Response Personnel List Fawcett Oil: Office: (617)547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617)242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Chris Ranney Home Phone: (508)888-7257 Cell: (774)836-5355 Scudder Taylor Oil: Office: (508)775-0474 Donald McBride Home Phone: (508)420-0356 Cell Phone: (774)836-5362 Carole Cook Cell Phone: (781)831-3547 Emergency Response Contractors Fawcett Oil: 1 Tyler Court, Cambridge MA Energi, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) Kingston Oil: 82 Main Street, Kingston MA Energil, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor,disposal) National Environmental Services Needham, MA (Vacuum truck, labor,disposal) Scudder Taylor Oil Energi, Inc. Worcester, MA (LSP,Spill Management.Assessment) Envirosafe Sandwich, MA (Vacuum truck, labor,disposal) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor,disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) Response Team Fawcett Oil: 1. Rich Aranella Oil Manager Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 2. Rob Fawcett Manager Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 3. Energi Inc. Spill Reporting: (888)252-4650 Office Phone: (978) 531-1822 Casey Bryne Paul Nestor Kingston Oil: 1. Chris Ranney Service Manager Home Phone: (508)888-7257 Cell: (774)836-5355 2. Rob Fawcett Manager Home Phone: (617)242-9850 Cell Phone: (617)892-3256 3. Red Fawcett Manager Home Phone: (781)934-3514 Cell Phone: (781)831-3509 4. Energi Inc. Spill Reporting: (888) 252-4650 Office Phone: (978) 531-1822 Casey Bryne Paul Nestor Scudder Taylor Oil: 5. Donald McBride Oil Manager Home Phone: (508)420-0356 Cell Phone: (774)836-5362 6. Dustin Calkins Service Manager Home Phone: (508) 394-1293 Cell Phone: (802) 274-6839 7. Energi Inc. Spill Reporting: (888) 252-4650 Office Phone: (978) 531-1822 Casey Bryne Paul Nestor 6. Immediate Actions In this section, a description of the Fawcett Oil Companies'worst case release,as well as a small and medium release,will be detailed as appropriate. A multi-level planning approach will be defined because the response actions to a release (i.e., necessary response equipment, products,and personnel) are dependent on the magnitude of the release. Planning for lesser releases is necessary because the nature of the response may be qualitatively different depending on the quantity of the release. To address multi-level planning requirements,this section will consider types of specific release scenarios that may contribute to a small or medium release. The scenarios shall account for the normal oil delivery operations that take place. Once the discharge scenarios have been identified,the section will further identify and describe implementation of the response actions. Worst Case Scenario Release: Tank Accident with Entire Cargo Release 5,000 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency g y Phone List Contact -Provisions should be made in vehicle for emergency personnel(fire,police)notification to company in the event of driver incapacity • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Full Contingency of Response Team List and Spill Trailer for emergency containment while contractor en route. • Implement Contractor Notification for Full Contingent of Personnel and Equipment for containment assistance and remediation. Medium Case Scenario Release: Residential Tank Rupture 270 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Available Response Team List and Spill Trailer for emergency containment while contractor en route • Implement Contractor Notification for Personnel and Equipment for containment assistance and remediation. Small Case Scenario Release: Vent overfill 1-20 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Qualified Individual or designee for inspection A. Implement available Response Team List and Spill Trailer for containment and remediation B. Implement Contractor Notification for Personnel and Equipment for containment and remediation. Number Fee 1178 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that TOWN TAXI OF CAPE COD SS 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 II r�. O Town of Barnstable Regulatory Services Richard V. Scali, Director sARNSTABLB. ' MASS. Public Health Division9. 9 i63 ,0� also Thomas McKean, Director .200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.,3v DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 1A)G NAME OF ESTABLISHMENT S C,U 7 4151 - ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER ZS Ss�� SOLE OWNER: '✓YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 6!�( .�3?37,2- STATE OF INCORPORATION FULL NAME AIA HOME ADDRESS OF: � % ` PRESIDENT CJ'R /!� / a�� rVX�04)77Y/'Oil% 4=2 TREASURER CLERK SI�GNAT PPLYCANT RESTRICTIONS: HOME ADDRESS /0 HOME TELEPHONE# 60$— Q\Application FonnSUHAZAPP.DOC SPILL CONTINGENCY PLAN Emergency Coordinator, Name: Address: Z�007?V Daytime Phone: 69—7 r7S� a Evening Phone: Fire Department: "08 —7q5—� � l�� � r✓ /yl� G� Barnstable Public Health Division: 508--862-4644 - DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: �5A �Ar.I G'1��4W ,6D) Phone: Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable), Aj eve-AkloiD Poor- Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. SFlL-L- To T5G- 060FAIQG7P Uy USIN6y' � l Number Fee 237 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that TOWN TAXI OF CAPE COD SS BODICK ROAD, 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 t l Town of Barnstable �fTX RegulatorY sSemc-cS Thomas F. Geiier,Dired-or a � Public Health. DIii0j, M 1675�9- Thomas McKB2n3 Director 200 gain St-ee, Hyannis, MA 02601 F= 508-790-6304 OEcz: 508402-4644 Appiicz6on Fee: $100.00 ! ASSESSORS jgAP A�I-DAR PCEL NO,. Qt d ATE a 0[3 _ itPLI PATIO. FOR PER E TO STORE AND/OR UIUJYME MORE TH"-N 111 G_�LQNS OF UA�,�RDOUS MATERIALS F 1=NAi�IE OF APPLICANT NAB w OF ESTAB��T D oks ADDRESL� OF EST_ABLLSHI��N'I' o��cK ��� � v w TELEPHONE NUJ Yn R SOLE OWNER: VYES NO N m IF APPLICANT IS A PAI3TNF'�5� ETA AND HOlySE ADDRESS 0F ALL v y PARTNERS: N rao ry r�r+ �'APPLICANT I5 A C oRP10RATION: FEDERAL mETIICATIONNo. STATE O_INCORPORATION FIJI�NA_ AND H ADD SS�079; /��yKOUT i�lPRESIDES T TREASURER � < 81 A F A21'LIC .NT HOB ADDRESS P FS=CTIOIINS: How TELEPgON3 Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS Bodick Road-PO Box 1210, Hyannis,MA 0260-1 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 t e Tow of Bamstable of Regulatory Services °- Thomas F. GeBer,Diredu Public Hem Di-Osion A , Thous McKean,Director 200 Maim Strut, Hyannis, MA 02601 OfEca: 508462-4644 F= 50&790-6304 Applica#icn Fea: $10G.00 ASSESSORS MAP AND PARCEL NO. 3 HgOO '000 LDATE APPL CATION FOR PEP= TO STORE AND/OR UTT= MORE =kN III GALLONS OF HAZARDOUS MATERIALS CNAME OF APPLICANT i -NA_� Off'ESTABLLS 'T S ` I U it ADDRESS OFESTABTLISEN LI n NLS QZ7 ,b1 I TEz1EPH ONE SOME OWNIR: YES PTO -9 APPLICANT IS A PARTNER=,FULL INAM+ AND HOMI ADDRESS OF ALL PARTNERS: I I i I IFH APPLICANT IS A CORPORATION: FEDERAL IDE=CATION NO. I STATE OF+t CORPORATION M� '=N-A-I HO ADDRESS OF; PAESIDEINT CA-4 TREASURE-P, - 176-0.a C.e C'�ER7 r_-c_ WU20L0tWL9wLCZ Inc RFST2WEONS: HOSE ADDRESS `Ud 1� � AA HONR TELEPHONE', Fazdadwp/q i Emergency g y Response Contingency Plan Fawcett Energy Partners, Inc. Cape Cod Oil Services Inc. DBA's Fawcett Oil South Shore Fuel Scudder Taylor Oil f Oil Release Call list Fawcett Energy Partners, Inc. Cape Cod Oil Services Inc. D BA's Fawcett Oil South Shore Fuel Scudder Taylor Oil The following individuals are to be contacted in case of a reportable oil release or spill. A reportable release is ten gallons or greater or any release which threatens a water supply or a storm drain. Based on the severity of the release we may only have two hours in which to report the spill to the DEP so please contact the proper person ASAP. Please make calls in the order listed. Cell Home Chris Ranney 774-836-5355 508-888-7257 Ben Fawcett 781-831-3522 781-934-2922 Rob Fawcett 617-892-3256 781-934-8347 Red Fawcett 781-831-3509 781-934-5291 1. Qualified Individual Information This section defines the qualified individual for the daily operations of Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and all the DBA's listed. If more than one person is listed, each individual indicated in this section shall have full authority to implement the response plan. For each qualified individual;the name and emergency phone number is listed.These individual are experienced to respond to any spill. This section defines the lines of authority and accountability for environmental compliance. The Qualified Individuals are: Chris Ranney Home Phone: (508) 888-7257 Cell Phone: (774)836-5355 ----- ---- - - Ben Fawcett Home Phone: (781)934-2922 Cell Phone: (781)831-3522 Rob Fawcett Home Phone: (617)242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781) 831-3509 2. Emergency Notification Phone List This section identifies and prioritizes the names and phone numbers of the Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed and personnel that need to be notified immediately in the event of an emergency. This section includes all the appropriate phone numbers to ensure that, in case of a discharge, any employee could immediately notify the appropriate parties. The Emergency Notification List is: Chris Ranney Home Phone: (508)888-7257 Cell Phone: (774)836-5355 Ben Fawcett Home Phone: (781)934-2922 Cell Phone: (781)831-3522 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Fawcett Oil: Office: (617)547-2360 South Shore Fuel: Office: (781)585-1920 Scudder Taylor Oil: Office:(508)775-0474 3.Response Equipment List and Location—Contractor Support This section provides a list of the Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed, Emergency Response equipment and location of the response equipment. When appropriate,the amount of oil that emergency response equipment can handle and any limitations is described. This section also provides a description of Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed support emergency response vendors and location of their response equipment. The Response Equipment List and Location—Contractor Support is: Fawcett Oil: 1 Tyler Court,Cambridge, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA South Shore Fuel:82 Main Street, Kingston, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA Scudder Taylor Oil: 478 South St, Hyannis, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham, MA 4. Facility Response Team This section provides a list of the Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed response personnel, including those employed by Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed and those under contract to the facility for response activities,the amount of time needed for personnel to respond,their responsibility in the case of an emergency, and their level of response training. Three different forms will be created for this section. The Emergency Response Personnel List shall be composed of all personnel employed by the Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. whose duties involve responding to emergencies. The second form is a list of Emergency Response Contractors(both primary and secondary) retained by Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. The third form is the Response Team List, which shall be composed of both emergency response personnel and emergency response contractors, included in one of the two lists described above,that will respond immediately upon discovery of an oil discharge(i.e.,the first people to respond). Emergency Response Personnel: Cell Home Chris Ranney 774-836-5355 508-888-7257 Ben Fawcett 781-831-3522 781-934-2922 Rob Fawcett 617-892-3256 781-934-8347 Red Fawcett 781-831-3509 781-934-5291 Fawcett Oil: Office: (617)547-2360 South Shore Fuel: Office: (781)585-1920 Scudder Taylor Oil: Office:(508)775-0474 5. Emergency Response Contractors: ( Call Energi at 888-252-4650 FRIST) Fawcett Oil: 1 Tyler Court,Cambridge MA TMC Environmental Franklin, MA (LSP,Spill Management. Assessment Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor,disposal) South Shore Fuel: 82 Main Street, Kingston MA (Call Energi at 888-252-4650 FRIST) TMC Environmental Franklin, MA (LSP,Spill Management.Assessment Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) Scudder Taylor Oil 478 South St, Hyannis, MA 02601 (Call Energi at 888-252-4650 FRIST) TMC Environmental Franklin, MA (LSP,Spill Management.Assessment Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) i Response Team: 1. Chris Ranney Home Phone: (508)888-7257 Cell Phone: (774)836-5355 2. Donald McBride Home Phone: (508)420-0356 Cell Phone: (774)836-5362 3. Dan Goodridge Home Home Phone: (781) 275-8416 Cell Phone: (781)389-0207 4. Spill Manager Call Energi at 888-252-4650 FRIST TMC Environmental 800-223-8865 6. Spill Response Notification Form A Spill Response Notification Form to provide a checklist of information that shall be provided, as applicable to the Massachusetts Department of Environmental Protection, National Response Center (NRC)and other personnel, is as follows. 7. Immediate Actions In this section,a description of the Fawcett Energy Partners, Inc., Cape Cod Oil Services Inc. and the all the DBA's listed worst case release,as well as a small and medium release,will be detailed as appropriate. A multi-level planning approach will be defined because the response actions to a release (i.e., necessary response equipment, products,and personnel)are dependent on the magnitude of the release. Planning for lesser releases is necessary because the nature of the response may be qualitatively different depending on the quantity of the release. To address multi-level planning requirements,this section will consider types of specific release scenarios that may contribute to a small or medium release. The scenarios shall account for the normal oil delivery operations that take place. Once the discharge scenarios have been identified,the section will further identify and describe implementation of the response actions. f Worst Case Scenario Release: Tank Accident with Entire Cargo Release 5,000 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact -Provisions should be made in vehicle for emergency personnel(fire,police)notification to company in the event of driver incapacity • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Full Contingency of Response Team List and Spill Trailer for emergency containment while contractor en route. • Implement Contractor Notification for Full Contingent of Personnel and Equipment for containment assistance and remediation. Medium Case Scenario Release: Residential Tank Rupture 270 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Available Response Team List and Spill Trailer for emergency containment while contractor en route • Implement Contractor Notification for Personnel and Equipment for containment assistance and remediation. Small Case Scenario Release: Vent overfill 1-20 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release if required, Notification to Federal Regulatory if Water Affected • Implement Qualified Individual or designee for inspection A. Implement available Response Team List and Spill Trailer for containment and remediation B. Implement Contractor Notification for Personnel and Equipment for containment and remediation. Fawcett Energy Partners, Inc. Cape Cod Oil Services Inc. DBA's Fawcett Oil South Shore Fuel Scudder Taylor Oil Spill Response Notification Form (Over 10 gallons or if near Wet Lands) :- Date &Time of Spill Estimated Amount Location: Name Address City State Zip Code Phone Number 1. Notified Local Fire Department Yes No Person Contacted 2. Notified State D.E.P. Yes No 1-888-304-1133 Statewide Person Contacted 3. Notified energi Insurance Service, Inc. Yes No Phone: 888-252-4650 ( Call Energi, before calling any Contractor ) Person Contacted Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS Bodick Road-PO Box 1210, 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 -� .,ti....�.�.�,.......a.......- Director of Public Health— , t F Town of Barnstable �oFIHE Tp Regulatory Services Thomas F. Geiler, Director • BARNSTABLE, a PublicMASS. ublic Health Division vao i639 pTFoMAya' 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 I 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 ( �� U 2(o®) • G TELEPHONE NUM ER 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. 0 J� STATE OF INCORPORATION ` FULL NAME ND O E ADDRES OF: PRESIDENT jjWW1 12-04 Sf, 0 Z333Z TREASURER CLERK • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # - Haz.docA%P'q Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil 55 Bodick Road-PO Box 1210, 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. 7/20/2007 PAUL J. CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 0 Town of Barnstable Regulatory Services Thomas F. Geiler,Director 41 NB , Public Health Division q g s 6 , � Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE TILAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ctl Pf- COD (5 /C. JC--XV/(-€ / 6 Al c- NAME OF ESTABLISHMENT O A SC'cl0,DE-2 Tt YLOtL O /C ADDRESS OF ESTABLISHMENT JCS 6 0DIC/T R.A, A d,, PDX Ax/O� /�yANA/i S TELEPHONE NUMBER -sU 77 J-" 0 7 SOLE OWNER: YES INO 1 u� g� `7 IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D 0 STATE OF INCORPORATION , FULL NAME AND HOME ADDRESS OF: PRESIDENT ./?009EV R- FAVC-rt., /ao CXE-5ce1v sr ., D✓Xp✓nY Mt O�33 TREASURER 11 C l CLERK U P SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS A+0 S-7- Dul- t" HOME TELEPHONE # 7$/ Y ' d' i� 7 t Em ncy Response Contingency Plan Kingston Oil Company Fawcett Oil Company Scudder Taylor Oil Company I r 1. Qualified Individual Information This section defines the qualified individual for the daily operations of Kingston Oil Company. If more than one person is listed, each individual indicated in this section shall have full authorit to t, a response plan. For each qualified individual the nameposition, "s �' , home 'dlw emergency.phone number, and specific response training experience is liste s, 'n'defines the lines of authority and accountability for environmental compliance. The Qualified Individual is: Tom Walsh 46 Murray Ann Terrace Centerville, MA Work alone 11508-775-0474 8) 771-3.684 ,.. Il E� e11�P &1) 831-3547 j;; 1 i gIIII11 I'1fppnIlll t ; , I3 �_ i i GIs i 2. InJ y . � ration Phone List This se ti'on i '' and prioritizes the names and phone numbers of Kingston Oil Company and personnel that r need to be notified immediately in the event of an emergency. This section includes all the appropriate phone numbers for Kingston Oil Company to ensure that, in case.of a Il discharge, any employee could immediately notify the appropriate parties. The Emergency Notification Phone List is: Fawcett Oil: Office: (617) 547-2360 e Burns Home Phone: (978) 988-3861 Cell Phone: (617) 892-3261 2] Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617) 892-3282 3] Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617) 892-3256 Kingst n Oil: .. Office: (781-585-1920) Ailamain Home Phone: (508)477-7071 Cell Phone: (781) 831-3529 21 Diana Caprio Home Phone: (781) 585-8401 Cell Phone: (781) 831-3526 3] Red Fawcett Home Phone: (781) 934-5291 Cell Phone: (781) 831-3509 4] Carl Gardiner Home Phone: (508) 824-3514 Cell Phone: (781) 831-3539 5' om Smalley Home Phone: (508) 378-0464 Cell Phone: (781) 831-3541 Scudder Taylor Oil: Office: (508) 775-0474 I] Tom Walsh Home Phone: (508) 771-3684 Cell Phone: (781) 831-3547 2] Don McBride Home Phone: (508)420-0356 �II z Cell Phone: (774) 836-5362 3�., Ranney Home Phone: (508) 888-7257 Cell Phone: (774) 836-5355 4 3. Spill Response Notification Form A Spill Response Notification Form to provide a checklist of information that shall be provided, as applicable to the Massachusetts Department of Environmental Protection, National Response Center C) and other response personnel, is as follows. WI i li E�iRI,.; .r- •. fie tnsuranoe Packeye 1a0IDreaf Dealers ACCCIDENTAL RELEASE OF PRODUCT FIRST REPORT-INCOMING CALL Date of incident / / Day Time Employee name Department Where did rele qcc;ri at customer residence ❑ i9 Type of product Hid fuel/dieseUkerosene❑ gasoline ❑ Propane IF RELEASE OCCURRED AT CUSTOMER LOCATION: Customer name Address City/state Telephone no. Where on the property did the spill occur: basement❑ exterior ❑ Other ❑ describe,,', :Ill i{i h; Vd Approximately ow mit p , :uct was spilled: Has homeowner been notified: ❑ yes ❑ no Has product been contained? ❑yes ❑ no Has fire department, DEP or other authorities been contacted ❑yes ❑ no #2 FUEL-REL AS NT #2 FUEL-EXTERIOR RELEASE ' 'i�' �I� YES;_ NO YES NO Immediate acces ,to'bi ;. ''e' " Has the flow of the release been terminated? Is tank in finished area? Has product flowed off the homeowner's Are there any floor openings or drains? premises? Any sump pumps in area? Did product come out vent pipe? Did the tank rupture? Did product spray from hose? Any storage iterr.s near.tank? Has product splashed/sprayed onto house? An bushes or shrubs contaminated? Y Any water sources within sight of spill? Grade of land is such that product will flow: ❑toward house ❑ Away from house f . IF RELEASED OCCURRED ON ROUTE/ROAD: Has the vehicle een mi:volved in an accident with another vehicle ? El Yes No Has there been a rollover? ❑Yes ❑No Product released involved: ❑ Punctured or split cargo tank❑ Hose or nozzle Where is the vehicle: ❑ In the roadway ❑ On embankment ❑ Off roadway ❑ Other Location and landmarks: Wrecker needed ❑Yes ❑ o Have police or fir(ed�e eyed at the scene: ❑Yes ❑No Any injuries? R Yes '' `No Is there any way to easily stop the flow of the leaking product? ❑Yes ❑No Any storm drains or water sources in the immediate vicinity: ❑ Yes ❑No Have mats been placed over storm drains? ❑Yes ❑No Have spill materials and equipment been used to damn, dike or divert the product to a safer area? ❑ Yes ❑No Ili 1 Please give brief des TCAW'accident/incident as described by driver: iJ CALL SPLASH 24 HOUR SPILL RESPONSE NUMBER: 1-866-577-5274 NOTIFICATIONS If quantity is=>10 gallons, or any amount to water [catch basin included], or quantity unknown ■ MA-DEP 888-304-1133 If surface water affected ■ Natio al Res onse Center 800-424-8802 I I 4. ,i "'' ent List and Location—Contractor Support This se tion pr LI' es a description of Kingston Oil Company's list of emergency response equipment and location of the response equipment. When appropriate, the amount of oil that emergency response equipment can handle and any limitations is described. This section also provides a description of Kingston Oil Company's support emergency response vendors and location of their response equipment. The Response Equipment List and Location—Contractor Support is: Fawcett OR: 1 Tyler Court Cambridge,MA er se Trailer:275 gallon double wall fuel oil tank Y Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes,Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester,MA Fleet Environmental, Inc. Randolph,MA National Environmental Services Needham, MA Kingston Oil:Kingston,MA Emergency Response Trailer:275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment ontainmept of 1-100 gallon release of fuel ontractor Support: Response Environmental, Inc. Worcester,MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham,MA Scudder Taylor: 55 Bodick Road Hyannis,MA Emergency Response Trailer:275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels,Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Response Environmental, Inc. Worcester, MA EnviroSafe Sandwich, MA Fleet Environmental, Inc. Randolph, MA National Environmental Services Needham,MA J B�� 'iill I! ! I 5. Facility Response Team This section provides a list of Kingston Oil Company's response personnel, including those employed by Kingston Oil Company and those under contract to the facility for response activities, the amount of time needed for personnel to respond, their responsibility in the case of "'` vel of response training. Three different forms will be created for this an eme,gen�C ' �,i � p g• section The esponse Personnel List shall be composed of all personnel employed by Km ston rl ompany whose duties involve responding to emergencies. The second form is a list of the Emergency Response Contractors (both primary and secondary) retained by Kingston Oil Company. The third form is the Response Team List, which shall be composed of both emergency response personnel (referenced by job title/position) and emergency response contractors, included in one of the two lists described above, that will respond immediately upon discovery of an oil discharge(i.e.,the first people to respond). Emergency Response Personnel List ' umame Home Phone: (508)477-7071 Cell Phone: (781) 831-3529 Smalley Home Phone: (508) 378-0464 Cell Phone: (781) 831-3541 31 Carl Gardiner Home Phone: (508) 824-3514 Cell Phone: (781) 831-3539 4] Red Fawcett Home Phone: (781) 934-5291 Cell Phone: (781) 831-3509 Emergency le Contractors FawcettQ�il� I a , Cambgid e MA s, €�I s;,:,E,,;: g Respon a En l,`Inc. Worcester, MA [LSP, Spill Management. Assessment] Fleet Environmental, Inc. Randolph, MA [vacuum truck, labor, disposal] National Environmental Services Needham, MA [vacuum truck, labor, disposal] Kingston Oil: Kingston, MA Response Environmental, Inc. Worcester, MA [LSP, Spill Management. Assessment] Fleet Environmental, Inc. Randolph, MA [vacuum truck, labor, disposal] National Environmental Services Needham, MA [vacuum truck, labor, disposal] Scuddet ;8f � odick Road Hyannis, MA Respo a En Yi1c. Worcester,MA [LSP, Spill Management. Assessment Enviros fe Sandwich, MA [vacuum truck, labor, disposal] Fleet Environmental, Inc. Randolph, MA [vacuum truck, labor, disposal] National Environmental Services Needham, MA [vacuum truck, labor, disposal] f Re spo se! a s'< '' su �: Dumaine Service Manager Home Phone: (508) 477-7071 Cell Phone: (781) 831-3529 2] Tom Smalley Oil Delivery Home Phone: (508) 378-0464 Cell Phone: (781) 831-3541 3] Carl Gardiner Oil Delivery Home Phone: (508) 824-3514 �I Cell Phone: (781) 831-3539 cett. Owner ' Home Phone: (781) 934-5291 Cell Phone: (781) 831-3509 5] Response Environmental Spill Manager Spill Reporting: (866) 577-5274 Office Phone: (508) 795-0110 Glenn Goral, LSP Jeffery Curtis, LSP Matt Geiger Stefanie Wood p Alan Desrosiers Paul Renouf i 1.3 r 6. Immediate Actions In this section, a description of Kingston Oil Company's worst case release, as well as a small and medium release, will be detailed as appropriate. A multi-level planning approach will be defined be�ja nse actions to a release (i.e., necessary response equipment, products, and p onh �sl� i dent:on-the magnitude of the release. Planning for lesser releases is necess l ec `nature of the response may be qualitatively different depending on the quantity of the release. To address multi-level planning requirements, this section will consider types of specific release scenarios that may contribute to a small or medium release. The scenarios shall account for the normal oil delivery operations that take place. Once the discharge scenarios have been identified, the section will further identify and describe implementation of the response actions. Worst Case Scenario Release: Tank Accident with Entire Cargo Release i JI, 1i, 5,000 gallons of Fuel Oil Respon 'e lOn�t • ".i� fication from Driver to Emergency Phone List Contact -Provisions should be made in vehicle for emergency personnel[fire,police]notification to company in the event of driver incapacity • Notification to State Regulatory of release,Notification to Federal Regulatory if Water Affected • Implement Full Contingent of Response Team List and Spill Trailer for emergency containment while contractor on route. • Implement Contractor Notification for Full Contingent of Personnel and Equipment for n si tance and remediation. Mediu Cas' .,., io Release: Residential Tank Rupture 270 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release,Notification to Federal Regulatory if Water Affected • Implement Available Response Team List and Spill Trailer for emergency containment while contractor on route. • m ctor Notification for Personnel and Equipment for containment si$ r ediation. Small Case Scenario Release: Vent overfill 1-20 gallons of Fuel Oil- Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release,Notification to Federal Regulatory if Water Affected % • Implement Qualified Individual or designee for inspection CII1 v.Table Response Team List and Spill Trailer for containment and l d 1 �'I h V B] Implement Contractor Notification for Personnel and Equipment for containment and remediation. n Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil SS Bodick Road, 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 August 18, 2004 SUMNER KAUFMAN,M.S.P.H. THOMAS A MCKEAN,R.S.,CHO Director of Public Health To)vn.,-of Barnstable Regulatory Services ti Thomas F. Geiler,Director , .S Public Health Division e o y Masse ,g;. r�krnpY" 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 $-P-a y APPLICATION.FOR PERMIT.TO STORE AND/OR UTILIZE MORE THAN 111.GALLONS.OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT / 1fd MIi S F• al+(-SH 'e C E,✓ER/}C Mi t✓/}G, E& NAME OF ESTABLISHMENT (A!°,F.- COO OIL .56�C VIC f- 'VC ADDRESS OF ESTABLISHMENT 600/Lr xo' TELEPHONE NUMBER 50 SOLE OWNER: YES V NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3w /,S / STATE OF INCORPORATION I-1A FULL NAME AND HOME ADDRESS OF: PRESIDENT /(00rC LI /L F`�c,��%-�, �� G!�i;,S� NI ,�%a ��Xdc�23� TREASURER j/N Me— CLERK S M� SIGNATURE OF APPLICANT r� RESTRICTIONS: HOME ADDRESS /6 M'j 1f-AA1P /'9' HOME TELEPHONE# () 6 Haz.doc/wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan(to handle hazardous waste spills, etc). In addition,please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc)._ In addition, please mail the required fee amount of'$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above.. Allow up to four days for in-house processing. For further assistance on any item above call 508 862-4644 . I Number Fee 332 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Scudder Taylor Oil �- - SS Bodick Road-PO Box 1210, 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 6/30/2012 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable C L I q-7-7 DIME, Regulatory Services Thomas F. Geiler,Director ` MAS& ' Public Health Division 9Q i�A�S�S' g' QED +" 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. 3y 9 0%0 =1 DATE { APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT6x\ i'lL- NAME OF ESTABLISHMENT — (k- . ADDRESS OF ESTABLISHMENT n h 02ko TELEPHONE NUMBER SOLE OWNER:XYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALI4 , PARTNERS: v ' `0 rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME HOME ADDRESS OF: 1 n PRESIDENT l`• F&mo� I� �aAf S l. -b y�U Y ) llq A TREASURER CLERK G AT�F,,QF f�QIC�1 (n� RESTRICTIONS: HOME ADDRESS �lw/�- �- �1 It HOME TELEPHONE# Haz.doc./wp/q I� f Emergency Response Contingency Plan Kingston Oil Company Fawcett Oil Company Scudder Taylor Oil Company o a coo i 1. Qualified Individual Information This section defines the qualified individual for the daily operations of Scudder Taylor Oil Company. If more than one person is listed, each individual indicated in this section shall have full authority to implement the response plan. For each qualified individual;the name, position, home and work addresses,emergency phone number, and specific response training experience is listed. This section defines the lines of authority and accountability for environmental compliance. The Qualified Individuals are: Donald McBride 40 Gorham Lane Crterville, MA 02632 Work Phone: 508-775-0474 Home Phone: 508-420-0356 Cell Phone: 774-836-5359 Rob Fawcett 10 Heron Way Duxbury, MA 02332 Work Phone: (781) 585-1920 Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 l� 1. Emergency Notification Phone List This section identifies and prioritizes the names and phone numbers of the Fawcett Oil Companies and personnel that need to be notified immediately in the event of an emergency. This section includes all the appropriate phone numbers to ensure that, in case of a discharge,any employee could immediately rfotify the appropriate parties. The Emergency Notification List is: Dick Robbie Home Phone: (508)432-2385 Cell Phone: (781)831-0963 Fawcett Oil: Office: (617)547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617) 892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617) 892-3256 fled Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Chris Ranney Home Phone: (508)888-7257 Cell Phone: (774)836-5355 Scudder Taylor Oil: Office:(508)775-0474 Donald McBride Home Phone: (508)420-0356 Cell Phone: (774)836-5362 1. Spill Response Notification Form A Spill Response Notification Form to provide a checklist of information that shall be provided, as applicable to the-Massachusetts Department of Environmental Protection, National Response Center(NRC)and other personnel, is as follows. i 2. Response Equipment List and Location—Contractor Support This section provides a description of the Fawcett Companies list of Emergency Response equipment and location of the response equipment. When appropriate,the amount of oil that emergency response equipment can handle and any limitations is described. This section also provides a description of Fawcett Oil Companies'support emergency response vendors and location of their response equipment. The Response Equipment List and Location—Contractor Support is: Fawcett Oil: 1 Tyler Court,Cambridge,MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Kingston Oil: 82 Main Street, Kingston, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms 0 Personnel Protection Equipment Unit is capable of containment of 1-100 gallon release of fuel Contractor Support: Scudder Taylor Oil: 55 Bodick Road, Hyannis, MA Emergency Response Trailer: 275 gallon double wall fuel oil tank Transfer pump and hoses Absorbent Pads Absorbent Booms Clay Absorbents Shovels, Rakes, Brooms Personnel Protection Equipment Unit is capable of.containment of 1-100 gallon release of fuel Contractor Support: Facility Response Team This section provides a list of the Fawcett Companies' response personnel, including those employed by the Fawcett Oil Companies and those under contract to the facility for response activities,the amount of time needed for personnel to respond,their responsibility in the case M . of an emergency, and their level of response training. Three different forms will be created for this section. The Emergency Response Personnel List shall be composed of all personnel employed by the Fawcett Oil Companies'whose duties involve responding to emergencies. The second form is a list of Emergency Response Contractors (both primary and secondary) retained by Scudder and Taylor Oil. The third form is the Response Team List,which shall be composed of both emergency response personnel (referenced by job title/position) and emergency response contractors, included in one of the two lists described above,that will respond immediately upon discovery of an oil discharge (i.e.,the first people to respond). Emergency Response Personnel List Fawcett Oil: Office: (617)547-2360 Rich Arenella Home Phone: (781) 648-7055 Cell Phone: (617)892-3282 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Kingston Oil: Office: (781)585-1920 Rob Fawcett Home Phone: (617) 242-9850 Cell Phone: (617)892-3256 Red Fawcett Home Phone: (781)934-3514 Cell Phone: (781)831-3509 Chris Ranney Home Phone: (508)888-7257 Cell: (774)836-5355 Scudder Taylor Oil: Office:(508)775-0474 Donald McBride Home Phone: (508)420-0356 Cell Phone: (774)836-5362 Richard Robbie Home Phone: (508)432-2385 Cell Phone: (781)831-0963 Emergency Response Contractors Fawcett Oil: 1 Tyler Court,Cambridge MA Response Environmental, Inc. Worcester, MA (LSP,Spill Management. Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) Kingston Oil: 82 Main Street, Kingston MA Response Environmental, Inc. Worcester, MA (LSP,Spill Management. Assessment) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor, disposal) National Environmental Services Needham, MA (Vacuum truck, labor, disposal) F Scudder Taylor Oil Response Environmental, Inc. Worcester, MA (LSP,Spill Management.Assessment) Envirosafe Sandwich, MA (Vacuum truck, labor,disposal) Fleet Environmental, Inc. Randolph, MA (Vacuum truck, labor,disposal) National Environmental Services Needham, MA (Vacuum truck, labor,disposal) Response Team Fawcett Oil: 0 1. Rich Aranella Manager Kingston Oil: 1. Chris Ranney Svc Manager Scudder Taylor Oil: 1. Donald McBride Oil Manager Home Phone: (508)420-0356 Cell Phone: (774)836-5362 2. Richard Robbie Risk Manager Home Phone: (508)432-2385 Cell Phone: (781)831-0963 3. Response Environmental Spill Manager Spill Reporting: (866)577-5274 Office Phone: (508)759-0110 Glenn Goral, LSP Jeffery Curtis, LSP Matt Geiger Stefanie Wood Alan Desrosiers Paul Renouf 6. immediate Actions In this section,a description of the Fawcett Oil Companies'worst case release, as well as a small and medium release,will be detailed as appropriate. A multi-level planning approach will be defined because the response actions to a release (i.e., necessary response equipment, products,and personnel) are dependent on the magnitude of the release. Planning for lesser releases is necessary because the nature of the response may be qualitatively different depending on the quantity of the release. To n Adress multi-level planning requirements,this section will consider types of specific release scenarios that may contribute to a small or medium release. The scenarios shall account for the normal oil delivery operations that take place. Once the discharge scenarios have been identified,the section will further identify and describe implementation of the response actions. Worst Case Scenario Release: Tank Accident with Entire Cargo Release 5,000 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact -Provisions should be made in vehicle for emergency personnel(fire,police)notification to company in the event of driver incapacity • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Full Contingency of Response Team List and Spill Trailer for emergency containment while contractor en route. • Implement Contractor Notification for Full Contingent of Personnel and Equipment for containment assistance and remediation. Medium Case Scenario Release: Residential Tank Rupture 270 gallons of Fuel Oil. Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Available Response Team List and Spill Trailer for emergency containment while contractor en route • Implement Contractor Notification for Personnel and Equipment for containment assistance and remediation. Small Case Scenario Release: Vent overfill 1-20 gallons of Fuel Oil Response Criteria: • Immediate Notification from Driver to Emergency Phone List Contact • Notification to State Regulatory of release, Notification to Federal Regulatory if Water Affected • Implement Qualified Individual or designee for inspection A. Implement available Response Team List and Spill Trailer for containment and remediation B. Implement Contractor Notification for Personnel and Equipment for containment and remediation. Number Fee 237 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that TOWN TAXI OF CAPE COD SS BODICK ROAD, HYANNIS,MA 02601 T 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 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health LL 1�„ �.: Town of Barnstable �'THE Regulatory Services LIN V Thomas F. Geiler,Director '"R"AS&LE, Public Health Division •i639 `fig' 'QED 39 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. jJ4�08000C;-DATE ' / ` APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �� e �U 7-G52e— � n NAME OF ESTABLISHMENT 0 p r e a ADDRESS OF ESTABLISHMENT v'' S / a�;L(� /2� I7VCchV11 S MA 0�Gc) TELEPHONE NUMBER ,� c . SOLE OWNER: YES NO r CD IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF L PARTNERS: cry raa rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 6! STATE OF INCORPORATION FULL NAME ANIDHOME ADDRESS OF: PRESIDENT' fC-r� 0 / O Z 6 7,S— TREASURER CLERK SIUNNAT S—/,— APPLICANT l� {T/��RESTRICTIONS: HOME ADDRESS111XW0V7t1 �O�— HOME TELEPHONE# �,�oS—36a Sad Haz.doc/wp/q Number Fee 149 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Brake &Auto Repair SS D Bodick Road, 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 Tow of B nsxable bD 5 y —' egu'atory Services � s� Richard V. Scali, Director a5" of t"e rq,�, Public Health Division BARN LE • BAFNSTA2lE•fEiffflINLLE•�NIR•MIFf3i15 BARNSTABLE. = Thomas McKean, Director N""S°N'""gib„°o<4���Nn� y Mnas $ CM -- - - -375- --- - ATFo�a 200 Main Street;Hyarirus;Iv1A 02G01--"_ ""_- --- - -_-� _ M Office: 508-862-4644 Fax: 508-790-6304 ' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 10 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). N q(f X L 0 APPLICATION FEES i,J rt w"") CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ���- 5 CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 V S S°&E Jo,i -"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? I 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: C✓owvtQ!3 -01�o,i ar 5. NAME OF ESTABLISHMENT: 14-0/ )145 R411q-- �YTlC 6. ADDRESS OF ESTABLISHMENTS 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5 0 S-' 7 7 5-- 5' $ 8' 9. EMAIL ADDRESS: 6D OiZ,,+►S>0,V e 14-t J?-A.Ile- , Op"4CA-ST 11 . 10. SOLEOWNER: L14ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 14-1/rNxu 3 i3x4ice 5i\.l L• PRESIDENT 6 0 w4-b 0►� - �/ TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT 7-4� 4 DATE A,// � Q:\Application FormsViAZIVIAT APP 2017 REVISED.docx Number Fee 149 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Brake& Auto Repair SS D Bodick Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- --------------- ------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health N w of Unstable 1 aatoerices / �� /0/a�g t►� Richard V. Scah,Director � r Public Health Division BABSTABIE • ♦ BAueLSTRBIEiExitavue.COIJR.Mnrrl`. " EAMSTABLB. Thomas McKean,Director wRS 0.15w 51639-2014MASS Srennh5r4!1 Fe 8. 200 Main Street, Hyannis,MA 02601 ��� Office: 508-862-4644 pj 'p?V` v 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 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0,1r' *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? t/ YES NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. , 4. FULL NAME OF APPLICANT: ("' ruw✓1n 5. NAME OF ESTABLISHMENT: ��d ��S 15�"��C�j Lfi(C 6. ADDRESS OF ESTABLISHMENT: S'� O )2- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: Co k— 2?3-' Li�&-&' 9. EMAIL ADDRESS: GRwlS PbM CQ0'1( -S-` 10. SOLEOWNER: L4'ES_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 QAApplication Forms\HAZMAT APP 2017 REVISED.docx TOWN OF BARNSTABLE BAR-WE' 3400 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager , . Address of Offender c. ,,� �/r ��'�,�'�'�"` . ► rx ,� ..� MV/MB Reg.# Village/State/Zip -`s. , . , + t ,"j,� �c. Business Name .�r� t + - �rt.� � I ram/ ; on s` r 20 Business Address Signature bf_ Enforcing Officer Village/State/Zip ;i- u,04"A'4 Location of Offense !, , j t.*A,A j,2A:r_�V10 Enforcing kD.ept/Divis. 'on Offense TPA Facts .� "' !�t A. t/ S VP,4. 6-- 'l v h*zi s This will serve only as a warning. At this time n6 "legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices - are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. kb.;.,='..'��a�.�•.�''�'`�`r..ise��=,�'""^�`t``ti�,f .'.-_ - __�. "�!ez�-r-+ TSB- ::r° G"'�"�t�'.'�L.:,- __._ TOWN OF BARNSTABLE Ordinance or Regulation BAR -W 66060 WARNING NOTICE Name of Offender/Manager LAW 0'l or Cm 1 �-r L� _Address of Offender 37 \Jk:+0)0d IQ MV/MB Reg. # Village/State/Zip /A1arsAon� ei:11516U1 05,6gq Business Name HILkum"S gfck e € flr Au o 11tPA4r am/pm on ��3 20 � Business Address 5 d�►c / fow? I Ft` Signature of Enforcing Officer Village/State/Zip kurknY)►S/,M0J oacoI j�� j� V ,,1 ` Location of Offense � ((Hots I~f-Ae'. ai f� ALAo RzO,( He(AA Enforcing Dept/Division Offense y,'n1e .'0f) o� +Own CO�e- M-6 ( Liceow CAn1 rUAlkngelicq Mao) Facts i1105� W ref . i5 r;cr� <5u� aullons yC �t grr-kouS groat, t p Ufl irai;,irt,- eP c 4 1A I -fee axe U�'lfL This will serve only as a warning.-At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to _ gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFER GOLD- ENFORCING DEPT. TOWN Of BARNSTABLE �30�0 Ordinance or Regulation BAR. -W WARNING NOTICE Name of Offender/Manager Or -1 Address of Offender 37 w4imo_( tic MV/MB Reg._# p4ar5A(K16 04151jAcA1� ..0'1(q.Village/State/Zip s q i V \I r 6 j Business Name- ftht'#1+ Ire Gt� ` � c,t e am/ on1 1Ct 20 Business Address 55 1) vrC � �rFr `f' Sigrature of Enforcing Officer Vlllage/State/Zlp HoArmIsIlk,10,1 W Location of Offense AUk(,nol,� Rta � af� A Rtoc r enit'h ' EnforcingDept/Division -Offense y%4(jj&j;uj) t) 4 Gvio co& 0;1--b ( Li C+?J0' t'�Ctc� r014;nQQ1Q 0161) Facts W51 , Ow0er iS %(;0A <50c) cu1 m 670rc(Als rro4er Als «mo w+ Pl(,ir v Ilice1f-)+c1(0VbP ` &PROACc'),4ee , 4 lul lak fee Acde Ao. SUl)k t 4v f;vyS .This will serve only as a warning:. At.this.time no legal action has been taken. It is the goal of Town agencies to achieve voluntary-compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance.. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD- ENFORCING DEPT. TOWN OF BARNSTABLE t Ordinance or Regulation BAR -W 'I059 WARNING NOTICE � n Name of Offender/Manager !JW��� orris"'1 -gyp on �!n Address of Offender 37 A , /AurSNOAS Pi 5 ) 02(49 MV/MB Reg. # Village/State/Zip Business Name_ mr Brak aff Auk) am/pp, on 05/4( 20AI Business Address � #J ��Erfi► UUO ii►!� �r Sidnature of Enforcing Officer Village/State/Zip �Q1�fiiS J,{'1G� -r)9,601 .Location of Offense 1-4cw1l.ts At-(A cml1 Re PhY" ' Enforcing Dept/Division Offense V"Olalim 0 iown CyC�e OF`6 01'cense 'an� CM4100e plan) Facts ���R� �t r,. >1P�r �� �tJr '� r� r►�r, (+�� 4 t... )� I(}r, 1�r !t(P► w a sir [M} itUSal�i1 -k 11� A4f feE �*LA " ,sirs "rEl 17, 1flf'S This will serveionl as a warning.NAt this time no); ai action has been taken.P�lt is the goal of Towri agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts;to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. - 0 WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFER GOLD'ENFORCING DEPT. TOWN OF BARNSTABLE �5� Ordinance or Regulation BAR -W WARNING NOTICE Name of Offender/Manager W �� Of M JOI) R Address of Offender 37 Apu( A , /Nckt sloos MV/MB Reg. # I!, Village/State/Zip Business Name kx is �( e cN& AiAo kt,Paij am/pm; _on 05/A( 20,.t Business Address D NAA Got ;f V Signature of Enforcing Officer Village/State/Zip na601 Location of Offense knn#'5 a AA, Re atr { Enforcing Dept/Division Offense V;OldUn O� iWn (0(� 109- t 11'(enk At'#� C!1#'�104t" djUrll Facts r1n1fr'fN4 {f- �101 1r�AIC �1n I air: K ,` `` ^yam �3 yy�^ y`,, ` t /'\' .�. ."} Vkr'}i- i�"^\��aj. i vG..r- • r..._ { f 1_,+ E1iX tlt .els,� et}��i lid_ 1t3►�MltAtk itt}� � ( t.A,t� .FJt?� ' " l �Hl ' t�C tlrtt .Y1► �.� Ae�t isj{ This will serve only as.a warning.At this time no'legal action has been taken. It is the goal_of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal.action by the Town: . } WHITE-OFFENDER. CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD-ENFORCING DEPT. r 4 03/14/2006 15:41 5087786448 HYANNIS FIRE PAGE 01 HYANNIS FIRE DEPARTMENT yYANIVIS 95 HIGH SCHOOL RD. EXT. HYANNIS, MA.02601 QD� HEM It4L 11 �*' - - HAROLD S. BRUNELLE, CHIEF ITUDERTAWARCREs80f Fly E 0001TIDe �E°E'"' " FIRE PREVENTION BUREAU BUSINESS PHONE:(508)775-1300 FACSIMILE PHONE:(508)778 6448 LT. DONALD H. CHASE,JR., CFI LT. ERIC F.HUBLER,CFI FIRE PREVENTION OFFICER FIRE PREVENTION OFFICER FACSIMILE TRANSMITTAL SHEET THIS FAX IS GOING TO: HIS FAX IS BEING SENT BY: y .... �.....�. =r.....�...... . . SUBJECT OF THIS FAX: ... ..... .�fr.............. ........ ...................... ..... .. _................. DATE: FAX NUMBER: NUMBS OF PAGES: . ................... ................. INCLUDE .OVER) NOTES: ............................................................................................ 7 ........... ...........�.s....... ........................ .......... . ....... . ... ,.r,�. . .. .. �,�� .... .................................................. . . .... ... .. ...L22 ---ecr. ..... 4��;4 1-1-ek .... ........................................................................... ... ... 03/14/2006 15:41 5087786448 HYANNIS FIRE PAGE 02 a , Tank Data Tank Removed From: Gallons_ ( No. and Street ) Previous Contents y xlls • ( City or Town ) , Diameter V Length�� Date Received 1-1029 Fire Dept. Permit #_ Serial # (if available) tt Tank T.D. # (Form FP-290)` Owner/Operator to, mail revised copy of Notification .IForm(FP-290, or Fp- 290R) to: UST Compliance, Office of the State Fire jMarshal, 1010 Commonwealth Avenue, Boston, Ma. 02215. RECEIPT OF DISPOSAL OF UNDERGROUND STTY�E gTORAGE TANK NAME AND ADDRESS _� S G_ GRAN C O. WET ' OF 2 g-Wot rnTT ST APPROVED TANK YARD A 01*7 A4HOVED TANK YARD NO, 8` - Tank Yard Ledger 502 Chin 3.03(4) Number: 07 0 / I certify under penalty of law I have personally exanined the w,derq,�vi,�rd s 6-tor tank delivered to this •appzwed tank yard» by f�,, corporation or partnership a4« LciVd/ and accepted.same in c onfo=ance with Massarh=tts Fiz+e Prevention Plegulation 5 52 CMR 3.00 Provisions for Approving i� Steel Storage Tank dismantling yards. id perW-r issued by LOCAL Head of Fire DePar nt FDID/ L�Ic Yard.this 1-to transport of f appr0V%1d 0.tank Yard oar or owners authorized represenatative: SI(�1A7U1� TT1TE �19~Z / flP1TE SICN® 7hiS ■i of disposal must be returned to the local head of the fire department FDID1 ( ! 4 t to Oz CMR :00: (rAtH TAM MM MwE A FWiPr or DISpOSALI I FORM F-P, 291 rev. 11/95) (CNf7i) IfLeA ACHUSEM SUM FIR£ MRR.SK LDS C*FIC I z � 03/14/2006 15:41 5087786448 HYANNIS FIRE PAGE 03 • Make application to local Fire Department. Fire Departmen' gins orlginal application and issues dt- '-:ate as Permit. 1 r. . 1) , t��vlJdlJP,6 fin• y Y TION and PERMIT Fee: �� .. AP:P L#�CA� . for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: _ ank Owner Name(please print) — X narure ao(rND ove�^ Address zi Crry guro Sus•t Advanced Environmental Co. or Individual —___—_......_. •-•--..—••.- ari„ > . O :Hox 472 ,.1 Atlantic Ave . Address _ —•-•- — - - South Denn s ,:"MA Sig[raturr3 i applyi g for it) Signature (if applying for permit) IFCI Certified Other O IFCI Certified :7 LSP# /�� th r • 14,0 rvss �'rr I'anK Capacity(gallons) 50 Substance Last Stored _.--- Tunic Dimensions(diameter x length) i�em�rks: i Advanced' EnyirontnentalStateLic.#_ MV5083856100 �=:nr transporting waste srdou;waste manifest# E.P.A. :pprovcd tank disposal yard J .G.Grants Qo . Tank yard# 03501 i ,yp,e of inert gas TJef Tank yard address Readyi> > e,: MA —_— --_ .,;'.y or Town .r11V1-/.I Permit# :)ate+of Josue Date of expiration ------ - Di Safe Toll Free Tel. Number-500-322 4844 1 sale approval number: g Sinar,,re/Title of Officer granting permitFIRE PRFVFWfftMRiAUlMkNf ran,oval(s)send Form FP-280R signed by Local Fire Dept. to UST Regulatory Compliance Unit, Or r j� EXT n 1310. Boston, MA 02108-1618. HYANNIS, MA 02601 03/14/2006 15:41 5087786448 HYANNIS FIRE PAGE 04 TOWN OF BARNSTABLE �- UNDER( ?ID FUEL AND CHEMICAL STORAGE TEMS _y ASSESSORS MAP NO• / PARCEL NO. f'�, ADDRESS, O� VILLAGE_ - en NAME: . P u. t.a 1... N CONTACT PERSON f>S7W)Jti4 "'O U V-l.S Po�j _ PHONE NUMBER S P CAPACITY: TYPE OF FUEL. AGE: TYPEE:: LEAK LOCATION OF TI(NKS:. OR CHEMICAL*, DETECTION v � L �►���.�SS SYSTEM' DATE OF PURCHASE OF. EACH: 1. �._ 2• 3._ 4. 5. DATE OF• FIRE'DEPARTMENT PERMIT: PASSED DID NOT PASS TESTING CERTIFICATION SUBMITTED: - PLEAS$ .PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE SACK OF THIS CARD. ±1I Y f , �1`g Al " v ii 1'I, �I,N Y ,iti!1• FidaplParcet ,344080002 Ii+lapf�arcel� 344080002 � �' � � k ; v 7an �b�r l � 3d r= 00485 �1 ed 02/01/1980 §e N �t� Rafe ' R E 4 z � 7 2 M � f� � 4<F $ � g�Y a`,kJ �• Y .aa. �� � �� S �b��� � �4 � � 1 s•. WIN g y 500 g z dot a! albs Waste Oil existing 3/15/06 i 5 HE a aR& 4q F.,,%do c Rpt D�i'►'1 la� IWO s Gy oc - �1 `r w a �a 1Parcel 1' 334 4080002 ���`� T arksa ble w Md�Sllarc��1 �� 344080002 € I z Tank Ntir 00 T N r00000 ls �led 09/28/1990� t W�,tgmP Tie$t t�if ttvn bate$ �1 �� a Stafu o ��Removaiift�at s?t@ des —'" � n eI1lOVa �y �•u„�id`� s '�srY'�h� a -. ��lrldllG . ��5�" '" .� �•�a'' F` � a rj*"f'� k 330 44 �Y r 3 Acfc{itlppai[7 tails Existing AST i i r EN � intl apf 'cef 344080002 � �T a BrRstatb�� � � �prcel 344080002 7,an �01a N 00486 � xad 01/01/1982 ocati BM Best Notr icafron tei, 02/14/1997° VI / 9 04/04/1997� x �� 3 uei Storage flea§bl B � � i Caf ©diGgeEea# ruc sttibn 1. a t etib � �" k Sbr� �In#o iR tl iarta pet�iis Removed _g"I a mmgm ; i Rnd Maiarcel," ,344080002 � 7nofBarnsa to s �fi r �" ,� � � � � Heaith➢epartrnent a�thrstem g� � 344080002 �' g ankNbF02 � � bF00480 t�ns�aiipd� 01/01/1975 caf4 BAll . fRerrovat�NNvf>fi�tion[�af� �} �f, est b 03/27/1995`PP �� 1 Sforeel f�� FO Fuebt 5IDrage apacltf 3gf iOn5Fl1Ct1011 � i.@a yBteCtOtTY � 'rd� 1 �e10 Addiio aj[� ail�� No leaks RAWv z ��`���FindxMa �Paree�it f 344080002 a �� � �£ Tn n�n�:Ba � Health�epartmntHeaitM�S stemz sm�t , , i ', ' Ma IParcelY�� 344080002 � ��� _ �fiank b�r �03� ag�iC . 00481 .� �stailed� 01/01/1975�L�bcation �B �� � ^BtnO�l tificatiOi�DHy i � t ��,�-0-3/-2 r 12/01/1991 � �mnva au ,at ,.d s Y rs ariante,, B�� Fie�Stp, ed'��FO � �" E�ueiSt@rah easnn � C p�acity �pn trt�ct p �� W� � eak�etection�� � ���tModic Detect�an t�Stora{gegg an infn% 020000 f� �d ''a•Y� �� :�^^-^^ ��.., �... :� .. •�''• ..,.n�.6;4,._�A.,a,.: �, ,�i.,,�'.Y�a`?-.ad�t <4� �1__ j����s�/Fe����� Atlditinnal�e�ails No leaks I PTO �,l Y..rs. w.�.r,,.. .��, -`.�".��_.�.�. `�1:« ... .,. .:����w„�.""��«& a .au�am ..ss:�2���:�::a �•i= ,.,.... � - f l " owhofB rnsta leb +Fi;nd learcel 344080002x� �� � '.,_ P��� lF Af '�� _r f g jt � R Y � ���r�4 €`� mac`.F Y'S,SS�.'a�' 1 ��,g+9' xm.B�✓'^-� � ankVbr 04 00483 � --- ------ � a Ta staked 01/01/1975� Looa�or� B � M, tR s Capae�# o stri�et[on eak D�tet�ort ' � CdthodicDete tion d3torage�ank IniYo 006000� ditiOna�De#aids No leaks gv I i e ' .!k < R'1 F �ptP 1 344080002 Tanl%Nbr jUb T,aglp �00484 i C Stsde 01/01/1975 Locti�n B f �� Td t NotitEcati R oyalNNotificatign atel � P 03/27/1995'xa ` �RAmf hm%i- qe,,�Reason� x �� apty Cons coon eaDeteet�on Cathgd� etec Mif'�itinai Detajils No leaks I ��€nd�Map/PareeYX 344080002 � �? Df B "n table h �� H�ea tDe artmten HTil ealthste r x e WA r �Y as` MaptParcel 344080002� Nbr 06� 7a� r 00482AN � lilts led 01/01/1975 Lopata B �{ 03/27/1995 is . a v t �ps rME e�{nava�f `' 12/01/1991 � 4�¢ e �£e� ��� ��� �z�a �'�✓n � � � .. �'�'fit,�� � �' � ': f j'�igw a � �7 ,CAL�Bf � �� �, Gip c t ��Ca �t>ruct�a�ii � � �� �iC>pet�cct�anF �G�thot�iQ�ete twn �� rrr� ddtionaiD moils` No Leaks WE KI a r e ! q Nil IS Nil �.. d `„ a e-'�� �� � ��� � �b^� ��' ,�•¢$ � '" x��z=: � __ ��, a;§'�5f� a`L '�t'�S': owl o B rnstable � aplNarcel�344080002 r� �IIa�IParcel 344080002 � Tantc�Nr 07 01337 3 cak A 07/11/1997����1§o �i�n �WN Retno�al IJotiflcMOP,, "WA I z3. � � i*t� Stor FOe1�StorageF7eassin�� C4 14 d Cbrstructi n ��LakCfetect� ii Gthc�`diaf)e ect'o S#arnklnfo 000330 SS l 1 � 11 n Addi�onal Detatfs . Existin'N all n i i'a` a l S y ray ' Flom ' �•. 'Tiownof Barnstable Intl Map/Parcel 344080002 � Health Department Health System MAW c � xa �r��; '� g r eddv r z � #s➢� � ,.f�, .�� J � �.:,a a .�, 4jE r z a Ma /Parcek' 344080002 p w W Tank Nbr 08 Il wag Nbr� 00000 "'`a�lnstalied ���� Location � �: ��, f TestNatifieat on©ate': :t status ' " � Date�Q 1�RemovalfNatlficatlon Dafe ��—ram� '�� ���r�� ' fl .......... � D Abandon r �N Removal t: '� �' 09/01/1987 ' a q r7a - Fuel StdreOAG � FuelSiorage Reason , 1 G < SAM .ga y' Capacty i 1 Constr ciion Leak Detection Cathodic Detection Storage Tank Info 10000 �� � l '''q� :: dam'. S4 µy w. .:..... .59(r. .(., '•s$rr .,,,..£ ':' ,` {j {y Adi�itlonalDetails � Removed Add Change ' f arnstt1ble Y Ind Ma tParcel- 344080 002 Department HMthsSystern r ° ai �' L �y .�. �' KI MapiParcel: 344080002 y � Tank�Nbr �I TagNbr 00485 tailed 02/01/19801ocatign! ' , ' TestNotificat on Date Status Date Rern"ovals otiflcatian Date E Test gk f �� Abandon' � pq, Rern�aval Y ' �� Nana ee t ��- Fuel Stored FO Fuel StorageReason x £� ,.,,. '- '� �,. �y „camp < f f CapaGety Construction X Leak D tection Y Ca..... Detea c� Adcf�tional Details Waste Oil existing 3/15/06 4 `F R.M. R. c � .,,....». ....L.........,.,ate. <" <, ., :. y;-,..�.......,...�.- ......,......�,;.._„ ORA 4q firr,do c r0a rm� � �zdr T G� � y �� bodlloc load, t=i d IVfa I arcel� 344080002 �� Tonof r s�ta6lp $ A r '��'� F€alfti®e artmert� eatthsSystem z Map/Parcel 344080002 Malt r r 'TanCc N6r 00 � �Nbr 00000 �staileMA ti 09/28/1990 L atlor� ZO 3 � ^"� ��"�� R. , 101 r ''.0 my. F u Stored F j Fue Sto7ge Reason" p ;'a✓y� r l f tC < :.1�acrt COI1StTUCtIOn .�^ ,�,: %ea: :�f7eteCflOn: ""' �"�'t Ci tOC�IC` e e Tp, 33 t .�i °k `-.: firm; ,,�. j 2x trot a1D�eta ' Existing AST i 1 '�MaptRarcei � `344080002 �� a r L s �"' °, 3g `'`^' a �Tanlc a 01 Ta Nbr� 00486 �� stalle 01/01/1982�Location� B i � > g r ka �f2emaval Not�ficafion Rafe � � a ' 03/05/1986' �� MA" 9 04/04/1997� Fwef Stored x Fwel Storage > Capa,c C nstruetion �f:ea c�etect�o �a# �o Petec ro �� �Stor. r►knfo 000500 Fk �tlditfonaf petaftsk Removed q r OF `. ,+ '��.� '.fi"`"'�.�-�a��✓�3"u'°,�.,, .a`:.,.�L��=� ,!s:�.�w'% 3{.a`�r',��'>,-� ��i3'" w�'.�,�,�„*?:>izU: r � ..spa.�a,z.,;�e; .,r.�>�a �z�,,� �,��,�'#�,� ��as' 4 x S 3'1�a"�a`�'c`�`�� ft� 1. �' �Sy �L� x� ✓' �; �L� `��� r 't S� MaplParcei 344080002 �' ' a �> 00480 nst�ailed� 01/01/1975 ca io Tait r 02 �9 Nk} � �Q ��f��Test Not►icabon$Date ' ' ',� �� "� ��`� � s ``�.�' �` � � r } mW 12/01/1991 x 1la i nce Y�. . ,4�s�� r'y' -�:v r ¢Xa' r�f � r�is f' G°a achy l;Oi15t[ t10I1LeAK-etectixoit"�`� a Cfat iofiiC"fie ecfion zStoE g�van E#c� 020000 ,�drtnait3ei[ '�: No leaks ���Change���i0�p C Town of f3arhstable �s Find-Map/Parce�4�344080002 01 rCe1� , 3344080002 Tank Nb 03 Ta�Nb�r 00481 4 nstailetl 01/0111975 Loca' on B Removal,Notlticatiowa ` 03/27/1995 trzr � �Rra f e- @St ` ' a F d a tk, 12/01/1991 , `}O"�r:N3 ��rY' rx f p FuStgor FOB Fuei St—orageas n a� paC,: onstruCtrOn 'g a aLea#c Detectro' Edt QCGc7etect�Qn 0` �g A(#dit#onahDefai#s��� No leaks a Aad mult L i f � .>... ..« u ��' .�.o...ca _..✓ ..;.a».:: ` c,.. _nz.....�;... ,_;b,,..'. .. ���indTVapiPar 344080002 � awn of Bari eta Te � � � �.. s � Ft a h�Department eafth System , ' MaplParcel J 344080002 # � s � Remo�iaf�ot�ficat�onf7a�e ��ti.. � �` g, � � 03/27/1995� § 12/01/1991 ��" FlStora e�Resan B F FueiStored G � � 9 pa�cgty�ontr rctgon �ak Deter Cat ad► Deection :�St ro age dank fob 006000 N 1�Od§itgonaoBetaiFsj No leaks ' - p 3� � ouvn of Barttsta le 344080002 ,� a�/Parcel , 344080002 TanYt�Fbr�051 ag Nbr 00484 � nstaled01/01/1975o�a� o B ( atitEcaftron==D ���`� � RemovaFNot�ficafon Elate I 03/27/1995 �sajaar,','XREW ggrw..-red "%' ,a ya..�3��''v` 'r•. ,-� Test MOO Cons tro� � LeaDetect�onat�r i°et�#ion, �. M A Atltltti,nat L7etails K No leaks ��' s'.ti�� "��-r a*-.� � ���Fs � ��..✓�pia cry��'� � �. `"� , r �n •t �k a i�e ${F[nd Ma lFareef 344080002 fNapl,Parcef � 344080002 TacrNr 06 �Ta`�Nbr 00482 �fnsafled� 01/01/1975� Loe tort B ��. 4``�✓'' '3Y g Test atif[catiorfbate , StatusDat `� Rem644 Na �y ;est �1 03/27/1995 � h U X �F � 12/01/1991 s e .F� FUefSt�orageR�eason tl" t rs � C pacrtyCo ct[on "� Leahfletectl6n� Ca od[Gd ectccrr �� Star�ag Tk'fnfo 010000 Add[tiona�Def �' No Leaks r add � � � aag� r pYH"rcj l,'M R"^ s� f .3cp&g�° t�,.i 4+'°" F Map/P�rce[i 344080002n©�Sarnstabl ind e �� F ' > HeannRueparfinent> > ��� �, W. fp a AapFParce! 344080002 Tan4�N bG 107 j„ 9 NbJ 01337 b' a n led " 07/11/1997' r --- t �� ,�Remouaf�Natlf catlon�Date� � ��� ,t ` � � " 5 u v' � ban ow F12W." e�nQYal�' SO �1 _., � � � Yall Cie l �y+ 3 Y Fue� or� FO FuetorageReason r �� " Gp tea 'er �''tsvzo�d1y et t o 3 Add�onal�Deta�ls ��EwsUng AST s W� FmdFMap"/Parcel 344080002 Town of Barnstable, Health Department i3Olth System VI / F ryy+ ! MaplParcel 344080002 " Tank Nbr 08 Tag Nbr `00000 ; '\Installed j Locati B Iw Test Notifi atidn Date` — k z f „Status � a� eK As � R'e�m al.ot`ification Date'� �' �est� �3 . IMIA and�on y WK Ab ��� v WIRE « qN 09/01/1987 Remdvlal rya 40 22 g Aga r Leh tea' . Fuel Stored' G ��� FueStorage Reason r r � achy G stru coon kak Det@Ctiort �Chodic Detec#10 Storage ,4dditional[3etails � Removed AN, S, a s.l ` Town'of Barnstable 9 Find MaplParcel 344080002 r A ��� Health"'Deartrr►ent Healtff System Axw � a Map/Parcel ;344080002 01,��arik IVbr / agNbr 00485 , a Installs 02/01/1980 A. ocationB �F , POP:- IV, t poi ,iv�� Test Da Notfication te�� t, 5 � Date Remoeal Notification Date a TF gft afiddh fi Removal '�f i iR Fuel Stored FO Fuel StorageReason � � a�Capacity�Const chop IL""C�Cletect�on CatFiodic etectioii �Sto5age Tanko Additional Details Waste Oil existing 3/15/06 R' � Adtl Change z od 5� h ` c ;a Apia Find Map/Parcef�� 344080002 h gTawn cif Barnstable . Health Department Health System � # k Map/Parcel: 344080002 k 4"Tank Nbr 00T!Tag N6rt 00000 Installed 09/28/1990 Location A ? z ah �TestNotrficat�onpDafe StatusD,atewe No RemovaloNofific t n D to a � y � s P Vest: < 2404 v r � Abandon i. i, € 1 i � 'ApRemovals I ! yVariancemu el Stored, FO i #��uellStorage lKeason � � �� Ml Rapacity Co,nstruction y �LiE metectionln Cathodic De action Storage Tank Additional Details - Existing AST P� a �, i ,... ..+....F..f....;::A.uw. ..... ,__:a ,✓vxi,,....o- .,.,,.$!a ✓ .........i..i .. w.nwe.a.,u:.....x. i n , � Find MaplParcel 344080002 Town ofarnstable , h 1r Health Department Health System Xi awl�a� IVlaplParcei �344080002 � ���� � Tark Nbr 0 TagNbr: 00486Instailed; 01/01/1982 LocationB w r i yT Test;Notificaton Date 02/14/1997s! ° Status : bate i RemovalrNotification Dar, w TV" sf P, 1=� 03/05/1986 � PITS; " s AbandonA nag r 3 ' 04/04/1997� A� �k rrq*v ri ,ay8r1r1Ce ar, 41 K k•. qp fir, < ,Fuel Storetl D I iiige,gendh .laI, his r%W. , r &Capacity Constructiion I:e De ak Detection, Cathodic te tion „_ antonal Details Removed 3 , _ .. i t Find MapiParcel 344080002 k Town of Barnstable HealtDepa�tment Health System ' v Ni ;�MaplParcel4�344080002 � � �� � ° � W � IV "I Tank Nb�� 0� fag`Nb7 ,0 0 Installed 01/01/1975 L cat n � AM S TestN'otrfication�Date I;r 'a I e R movaI""' cation Dates i r"A psi Test' 1 _ 5 e r r /4bandorl ir6� � c .. Removal 2/01/1991110 1 1 " A dOr Stored FO Euel Storag Reason B� _ Capacity t ionsstruction b IT Leak Detection � E�athodic®etect�on Storage Tank Info# 020000 Y �' x r '. .�... s�y Additional De#ails No leaks q Change x � . la f I y• 4 1 Find@Map/Parcel 344080002 o u51, Town ofBarnstable rr a Health pepartment Flealth Systems f , 4-40 i Map/Pargte, 344080002low-vo 9 Tank Nbr 03 �Tag°Nb E 00481 ®tub tailed 01/01/1975 v Location- ' B 0.wip VIA a� ,Test nae �r x Statuses >v , < � "'AR, Re moval Not�ificat oh Date'& AM Test . 1 M 03/27/1995' � ' z a /Xban-don- �G' R mOval. 12/01/1991! �,� ,M. -fir „` j ` -�` II �0 t „ FuelSto red FO B w .�/ r+a, r x + a Capac�ti r Construct1on Leak�Detect�on $,Cathodic Detection Sto ageTankl fob 020000 r ".' , 1 ir, � Ad�ditionai�Qetails No leaks a ' , i Find MapiParcet344080002 Town oFBarnstaW a x � c'' "� �Q HealthDepartment Health System �$ a VA Ma arcel f IA A two a Off- fte <' /P p 344080002 77 TaNbr 04 �7ag Nbr 00483 Installed ? 01/01/1975 Locatiori B41, ,' �3 # Test NotificatwngDate. i p , �� �i, Status Date � Remo�ral NotfficatinDate � Te str 1 03/27/1995 ` 6 # ° ilk andon _� Rerrioria�� 12/01/1991011 C7. r ¢ Variance"'' F s I^p t t _ r FuelStored, FuelStorage Reason , 1 Capacity Go'nstructron LeakDetectonfiathodc Detection ; Storage Tan(iInfo 006000 .. ..,. .... r " 1144 Mi lttonai details ' No leaks � , ,Add Changes Y :.u. .t,uu:.�.�.,,,.wz, .0 ,,, ..,w.,_, a...u...ax,.. .�,;,,• a...a�,t». ,, : i x ` `Town willarnstable t �_ ��Fmd'Map/Parcel 344080002 M ,� k �He th Dep h yste � � s al artment Healt S m s r �. yy Y 10 ��iVlapfParceC 344080002 Z. Tank Nbr: 05 A;.- 00484 Installe 01/01/1975 Location B ' 'Test Notfication Date' Status Date Rernova&Nobfi ti n Date Tea 1QWr � 03/27/1995 momp 10 Abantlon_ �h � 9 ! 09/01/1990 s m—ww� 3 - 9 fM Y �YNK�5 ` Y perME Fu-1pStored FO , Fuei Storage Reason B��r `�� � $,���Cap city Construction, �` � I:eakDetection FCat �d c De#action 7 Storage Talk Info 001000 Additeo al De#ails No leaks ` r ; /M' fe Find lVlaplParcel 344080002 JFRI` f, arnstable , Health Department Health System � b y f �' a RAap/Par" cel 344080002 ,. f } TankNbr O6 g br 00482 1 stalled w 01/01/1975Location-�a l r7 SOW 4 TesMotification Data Status t Lei 7 r .. a Y a ! 3te� - k� Removal�Notification®ate '� e A r � " Ale Aban �r r ar � RerMoval 12/0111991(m s Yar�ance y' d FuelStored FO ` k Fuel"St rage Reason B r CapacityCflnstruct�an LeakDetdction Cathodic"Detection Storage'Tank info E 010000 r r 'i44 a. �i40 iditional,Detaifs � No Leaks ., er a �. 4- Town of Barnstable Find Map/Parcel 344080002 o � s ✓ Health-Department Healtfi System 'e .0 ; 7r -a C '�� a p� . 41 mul"I .r ✓fie �g � c 4 1 r A Map/Parcel34408000240 Ta[k Fbr 07 Tag I�br �� dM t� � Ins�taile�� 07/11/1997 Locate n 1"` �Now � . Test�Not�frcation®ate �� Status'A,�1611p to Remova}Notification`Dater � v Test r d � �' xU A' -Y� �—sIto WITMAI Abandon I frig% RemOva v � .., _ y .— �lanancen A, � # ®rJ y �a OWN a � c � Fuet Stored FG ` ul StorageReason ON ;.p. / Ff a ` wF � Fix , �Capecity Construction Leak Detection Cathodic Detection i Storage Tank info 000330 SS E g 5-- r' �AdditionahQetail Jf'istingASTTJus a � a e � zYa 4 M'd Mange I ,� i x y➢ ' may : FindMpa 344080002r 5 f m4 ro tabl Health Deparm Hea fh Syte s WE v Sirs °sue' y �y /Map/Parcel 344080002 � Tank Nbr Tag Nbr77 00000 Installed�: �� ' Location B ` rr H, TaestNot�ficat�onDate �— , Sll tatus Datoa ROW emovakotificationy Testdog n� emo�al 09198T c�1 /dill ij n a 00 -, { FuelStored x TG Fuei Storage Reason Capac+tygnrstructron� �� Leak Detections Cathodic Detection a / StorageyT nk Info 10000 r /i Additional tads 3 Removed t A � , ���� %� � �' (is � � ) f" Town of Barnstable jig # � Regulatory Services Thomas F. Geiler. Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 C' Fax: 8-790-6304 To: SCUDDER,FREDERIC F 2ND& Date Thursday,January 05,2006 SCUDDER,RICHARD M&ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE:Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 02 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent r Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Scudder-Taylor Oil Fax: 508-771-8077 — Corp Name: Mailing Address ......... Location: 55 Bodick Road,Hyannis Street: P.O.Box 1210 __.._....._. _.. .............. mappar: City: Hyannis Contact: ;Tom Walsh,General Manager State: Ma Telephone: 508-775-0474 Zip: 02601j Emergency: Person Interviewed: Don McBride,Plant Maintenance Business Contact Letter Date: 9/21/2005 Category: ;Fuel Inventory.Site Visit Date: 10/19/2005 Type: ;Gas/Service Station Follow Up/Inspection Date: _. public water ❑ indoor floor drains ❑ outdoor surface drains P/1 license required ❑ private water ❑ indoor holding tank mdc outdoor holding tank mdc W currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - - on-site sewage El indoor on-site syste ❑ date: _ _outdoor onsite system 6/30/2006- - I REMARKS: Bulding is heating by fuel oil.Above fuel tank-330 gallons, compliance: 275 gallons,and 300 gallons. Underground fuel tank-4000 Satisfactory gallons. EPA#MAR00015159 MSDS available.. Speed!Dry used for small clean ups. Rages kept in metal cont.u1st.Spill kits in each trucks. Haz. Mat.Training annually.Battery's recicled with Interstate. Used tires removed by Cape &Island. 6/29/04 Onsite inventory. Staff has annual hazmat WI training. Has MSDS,manifests,contingency plan onsite. Has proper ' A �A_ o ' septic installed last year for truck washing. Has containment for water runoff. Shop is clean,organized and in good shape. Shop manager is r�A very knowledgeable about his storage and proper handling. Advances ►/1�/j r (/� Liquid Recyc.Takes solvent. Unifirst takes shop rags,uniforms,and �V w� fender covers. ORDERS: label HW drums"Toxic and Hazardous Waste",obtain Hazmat Permit for 04-05. 10/19/05 alp-Facility is very clean and organized.ORDER: Label waste antifreeze drum with "waste/used antifreeze"RECOMMEND: keep parts cleaner lid closed when not in use. ✓"' -�� - Ce701 � ► o-Yn. S a� r Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals gty's 111 gals or more " "description ' ,,tir h".. ,unit ofnesure waste oil 285igallons antifreeze for gasoline or coolants stems( g y ) -It 61'gallons Misc.Flammable i 57 gallons ......_............,_..__.........._..__..______.._.._._....._._........_..._.____.._._._,__.._..........._.._................._.....,___,......._.._,_..a.__.._,__.....__......._....... _._.____......__,.._.__._._.._.._......_..._._.._......__...._... misc.petroleum products:grease,lubricants 49 gallons ............................m.._....................__._._._._...._...._.................._.._..__.-__.____.. Acetylene ? 9 gallons automatic transmission fluid 4 gallons hydraulic fluids(including break fluid _._._ i _ 1'`��"'__,_...____..... _.._. y (' g ) gallons motor oil 300 gallons waste antifreeze j 85 gallons other cleaning solvents 30 gallons ...._.__._...___._.._______T._.__._......___.____..._.._.................__._..._..__._..__.__....___._................._.....__.._.._------- _........_......._ _..__.....__.............. ...... Misc.Combustible 30 gallons _....__------...__.......___....__._...__.__.....__-__.._.......__..........__.__._...._.__......__._.__.. . Waste solvent j 30 gallons __.__....___......_.._......_................,....._......_............_...._.._._.........__....___.................._-_._................._..._._..............._......_............_..._...... __ 0 Waste Transporter Cyn Oil Fire District: Hyannis ....._.. _ . ....:. .......... ......._..... Last HW Shipment Date: 8/12/2005 Waste Hauler Licensed: Yes II Town of Barnstable Regulatory Services g Y Thomas F. Geiler. Director r Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: SCUDDER,FREDERIC F 2ND& Date Thursday,January 05,2006 SCUDDER,RICHARD M&ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE:Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 05 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent i Town of Barnstable `0y Ttt Regulatory Services Thomas F. Geiler.Director r Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: SCUDDER,FREDERIC F 2ND& Date Thursday,January 05,2006 SCUDDlk,RICHARD M&ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE: Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 06 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old, and has not been removed as required by section 326-3:subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent f Town of Barnstable Regulatory Services �I RALH NThomas F. Geiler. Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: SCUDDER,FREDERIC F 2ND& Date Thursday,January 05,2006 SCUDDER,RICHARD M&.ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE:Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 04 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding . fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, lease furnish this office evidence in the form of a permit from our local p p Y Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent TOWN OF BARN STABLE Health Division — 200 Main Street - Hyannis, MA 02601 �fNE rp� FAXDate: March 14, 2006 + BARNSfABLE, i Mass. Number of pages including cover sheet: 1 9 i639. ♦0� �ArfD MA'S A To: Diane From: Alisha Parker Town of Barnstable Health Division _� � Gfza_E d OUS M Cl-�hpp/liS '=Sh n'&JI - , Mail to: 200 Main Street Phone: 508-775-1300 Hyannis,MA 02601 Fax phone: 508-778-6448 Phone: 1-508-862-4645 CC: Fax phone: 1-508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP P ease comment Good Morning Diane, I was hoping to gather some information from you on UST an AST in Hyannis. I am trying to update our records and was hoping that you could fax me copies of the Tank removal applications if any. The following properties are: 55 Bodick Road m/p 344-080-002 5 tanks total underground, 1 tank aboveground 1200 Phinney's Lane m/p 274-031 3 tanks total underground 141 Spring St. m/p 328-062 1 tank total underground Since Joan has retired, I have taken over the UST and AST removal information to input into our database. If there is an easier way to contact you, via e-mail for example, please let me know. I appreciate your assistance that you have given so far and thank you in advance for assisting me in the future. i Feel free to contact me at any time. My email address is: , alisha.parker(a)_town.barnstable.ma.us i Town of Barnstable 't i O," Regulatory Services Thomas F. Geiler.Director � � Public Health Division " °Ef3 SAE +j� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: SCUDDER,FREDERIC F 2ND& Date Thursday,January 05, 2006 SCUDDER,RICHARD M&ROBERT M 22 CHANNEL POINT RD HYANNIS MA 02601 RE:Underground Storage Tank at: 55 BODICK ROAD Map Parcel: 344080002 Tank NO: 03 Tag NO: 00000 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3:subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent TOWN OF BARNSTABLE V� UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS ASSESSORS MAP NO. L PARCEL NO. o ADDRESS: �B-ov>k c_y, VILLAGE: NAME; . *3:70 c- _ CONTACT PERSON TJ�� S W L-t-\ �N PHONE NUMBER -T LOCATION ,OF TANKS CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION S `QC a c �ZD • �o o �eQSSS SYSTEM DATE OF PURCHASE OF. EACH: 1. -1— 2. 3. 4. 5. _ DATE OF FIRE DEPARTMENT PERMIT: ( �� $z_ TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. `KID . TZN8TTwwpp �urnerE? one tank 0M ONWEALTH OF MASSACHUSETTS FIRE DISTRICT OF HYANNIS,{MASS. FIRE DEPARTMENT FIRE PREVENTION DIVISION PRMIT FOR .,STORAGE OF FUEL OIL =; In accordance with provisiona of.Chapter 148, aenbial -Laws,'and amendments thereto an d 'Regulations made under authority thereof ei t;.Name `Scudder & +I'� � Namett r t � .5ame # (owner or occupant) ' s ai ' (Installer) r Address '. �_ �a. .$S� Address},Hy ani'iis < r ST OBURNER . 1 ;F1bredasSTypeofTank - .....a .. .:w: Y' Manufacturer ABC _ �... .._ __.: Capacity 5Q�. gale.(or) Size.. P � Model No. or Size "_...9.3.�.C.1 _.M Location t ....u ae g _round s� ; �� k >R FarrenkbpfE Type .g11I1..:._. ass. pproval No.".�Q8.9 a f �. fi �t,R u `'Permit issued pares .� of DepArt ent) H ii Pee_........._....:.......c.'r�y�B d::.q.:._.,.:..:_ ,...._......»... `�:s This Permit MusfIk Conspicuously osted on remises r►� •y, "-•'!. j :",'r,' - .=?-r 1j'-,. !.e:' r_ -{'y e.A �,�r�v)+ � p. ...•�' � r rr I r f �.�....:.:�•.1.... V��n.M.w•v.Y.�.r.I4�.p....r.:.�...:tW.�l:1�.�wrw�ra.�a.r.rw.....w..a:........a•..rwi�r.•�HwtiMwrlr..r+..+.w.wNIM.. y��.....-.....•. �.sn.wrV..wiww•.r...'..v.�i�Mw..�'wM aft lwr�-.r......�...�+..w.�w...w....wwr►.�+•. s• .. w...�.w....�... w...�.....�r.� TOWN OF BARNSTABLE i UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME U�k��' T W ADDRESS VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL ®� o' C-20 3 s� �� �� 7 so 02� 6.) y, no Alpo Z"/--) 7 fT: (Give same information for any additional<tanlcs on reverse side of card) DATE OF PURCHASE OF EACH: 1. &2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS ` Y „ . • r y ` ` r tee... �a, . 9_ ° �?• ti ~#x+e4{i,,r�iv X .,,.y t - C _ " �P , ' .r.arar.i�:Jy1 ��1- Se _ a{ :fi �w. dT�- � a• r '.'� i' • _ r ; - K §/,..a,, { L_�f �y. _, ,.� ;. •ai T`_�A A - 'r*.{ti .` Manager . rTuckex" -T41wri d,Il Co.Inc. x ,• Iyanough Rd. �t �Hyann :s Ma. i� d sE, i'g' .�� ` t r'. ¢ ''� r a � S� s ♦� c -,•5^ .�'^-# {;"•�� _ sS i " .. .. �.,, ae w ,'. 3 `. z '.4 •-t; .may" .`..- .K e ,� :Cyanough- Rcaad. 'Rte.. ,28, Hyannis r =tea a J. 1 e a n -t, a f. _ '�' _ i1 �•.k� ; Nss. { � •.d .e r `�. a - - ! t � � `;� `t Ate. � J �A � a k 3 Y♦•:j � a¢ _. r } v ;:- ♦ '+�„ 't• kS � '� i ems. '�f T:`A: 5 - a% � > i �,' - r t parr� �� tt *'{�._�. s. �„ � �.,r. r'� '. ~ i` � .. .Y" .. i- .., s •' .m +^ 40 LOCATION Tucker Town, Inc- s/s Iys.z ough Rd. Rte. 28 -� Iyanough Fed. Hyannis Hyannis BOOK , PAGE DATE GRANTED �1OUNT STORED 20,000 gals. gasoline 77/15Q June '� 1, 965 30,000 gals. fuel oil DOE_WD 1977 March l 1, 1977 VAR � "` �' AR PETERSHAM OIL COMPANY, PETERSHAM, MASSACHUSETTS 01366 3V / Q 90 b-¢ dv dc*44 IrW � 9 � `Zvo,.wlh p Ale. A. y T V OC 4 . AA41,T V CV^PWAA�/ S i• FAA. -3370et. &01i •,;�--_._. _ - ESQ j 1F tt/ 5 t 4 _ - 00 a 3So6 k� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Z2a,114 25-046Al `71 Board of Health MAILING ADDRESS: ' 6 Town of Barnstable TELEPHONE NUMBER: �2 ��5'} P.O. Box 534 CONTACT PERSON: %Z� �- t� s� fl 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 L-," 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 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 __�o-.w „am ,,,.,+.,' dyes Fertilizers (if stored outdoors) Paint 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): ry cleaners) ke Other cleaning solvents _ Bug and tar removers Household cleansers, oven cleaners White Copy Health Department/ Canary Copy-Business a TOWN OF BARNSTABLE ACOMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ��p O unsatisfactory- 4.Manufacturers COMPANY �f7.4r�� '� /W..eeel& � (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous ANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drurns Above Tanks Underground 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 G� 6V Miscellaneous: I� e . Gv ze, v 14 �i DIS SAI✓RECLAMATIO REMARKS: 1. Sanitary Sewage 2. Water Supply _V �' `AL 0 Town Sewer OPublic e1 /zr. .0(On-site O Private 3. Indoor Floor Drains YES VNO 0 Holding tank: MDC_L O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES 1�A0 1. 2. oe Person (s nterviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ___"___ NAME OF BUSINESS: /V4 /u�/ Mail To:wt Board f oa d o Health MAILING ADDRESS: ®°4 �- '�� 1��.e.�r.�`• S Town of Barnstable TELEPHONE NUMBER: 7 -5-7�& 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 tot (ling, 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 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 o's/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, 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 COMPLrANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops O/ unsatisfactory- 4. an COMPANY 1/4, d (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER S 1oveUnderground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste m or oil (C) a� new motor oil (C) ' J transmission/hydraulic 2 [/ Synthetic Organics: degreasers 69 • �Z�ti�/ems ,Miscellaneous: d- DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.eNVater Supply O Town Sewer Wublic 4-On-site O Private 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1• � �� YES NO i 2. leg Person (s) Interviewed Inspector 7 Date 1 TOAIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail.To: NAME-OF BUSINESS: VM3,4 � Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: `7 2, e P.O. Box 534 CONTACT PERSON: '` '/� ,¢G� Hyannis, MA 02601 M r CP4-n /Rl f ` Does your firm store any of the toxic or.hazardous materials listed below, either for sale or for your own use, in qua tities totalling,=at.any time,-more than 50 gallons liquid volume or 25 pounds dry weight? YES 4,1 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,foI lowing,products exhibit toxic or hazardous characteristics and must be registered when stored ' Please,put a check,beside each.product that.you store: L/ 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 I/ Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, V 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 y 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 OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD O HEALTH satisfactory 3.2.Auto Body Shops r � Q unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ,Jr Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATE S Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTJ IN OUT #&gallons Age Test Fuels: A� �z Gasoline,Jet Fuel (A) Diee e�o Heavy Oils: waste motor oil (C) � new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: lie, DISPOSALlREC ION REMARKS: ` OP6 G2��;Q• 1. Sanitary Sewage 2. Water Supply - O Town Sewer Public 'L (Von-site OPrivate 3. Indoor Floor Drains YES NO Holding tank:MDC f , O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2• Person (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS. e Board of Health MAILING ADDRESS: Q. rO Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON:--T-1`�,OS'c,,4o)n D . Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua 'ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: �, � TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: ,V Antifreeze (for gasoline or coolant systems) 4' ' Drain cleaners -r-= Automatic transmission fluid Toilet cleaners -�=- Engine and radiator flushes - Cesspool cleaners Hydraulic fluid (including brake fluid) —Disinfectants V Motor oils/waste oils - Road Salt (Halite) -- _ Gasoline, Jet fuel Refrigerants lz'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 2.Printers O satisfactory BOARD OF HEALTH 3.Auto Body Shops ' unsatisfactory- 4.Manufacturers {� �/ O (see"Orders") 5.Retail Stores COMPANY, a3�uc� -ice 6.Fuel Suppliers ADDRESS . �� �t� Class: 7.Miscellaneous �"�'40ANTITIE5 AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT I#&gallons Age Test Fuels: Ga , Dieg'el'Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic . Synthetic Organics: a� degreasers Miscellaneous: DISPOSALIR.ECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply ol>a` O Town Sewer `Public XOn-site O Private 3. Indoor Floor Drains YES NO11 O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES VNO ORDERS: Q Holding tank; MDC ,VCatch basin/Fk�Ie - O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product •d 2. Pe/—son (s)interviewed el Inspector Date r.zs. - .•.t ,,,.,,,,,,,,, y,•,.w Sava:n`tfiMirtrxir•' wwye `yeY�'4�a°-•iy:+:..r.«..w.'».....•;rr--y�,'•....+.•"^v..,k,..+vw.N;i.,,,w..n•.M.w,,,.wc,•.. w..s�--+.I` i„a'�±.w�-�.. �p.; �� .. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q satisfactory 2.Printers -BOARD OF HEALTH 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMP 4 c ., , -,-- o'er' (see"Orders") S.Retail Stores ANn 6.Fuel Suppliers ADDRESS *'" t C185S: � 7.Miscellaneous ' QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS i Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age- Test Fuels: rr Gasoline;Jet-Fue1T(A)' Diesel, Kerosene, #2 (B) Heavy Oils: waste motor.oil (C) new motor oil(C) ;tF transmission/hydraulic Synthetic Organics: degreasers i Miscellaneous: • f DISPOSALIRECLAMATION REMARKS: 4 1. Sanitary Sewage 2.Water Supply 40,4 to-,? O Town Sewer ;OPublic =���,4 rF�e,f,.ar�fit r ,Q On-site OPrivate ( 3. Indoor Floor Drains YES NO _1 O Holding tank:MDC ` 0 Catch basin/Dry well O On-site system 4:Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC -- - ---�� - �. ,O Catch basin/Dry-w-ell O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product •d r 2. ` Person(s)Interviewed 6 Inspector (J. 'Date11 " ti, TnYTr Ahin LIA7ADnn11c uecrnn .. ^^••• ^- �� 4 Sc �A4L�'SZ �1L �m ✓'" NAME E OF FIRM: ��z�t.' 'a'A''`Xi�• � �� MAILING ADDRESS: 70o TELEPHONE NUMBER 11 2 75- 0q-74 CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES lr 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: onca TELEPHONE: 439 rr►C • a o�A �2 �1) —� LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: —Z Antifreeze (for gasline or coolant systems ) Refrigerants g is Automatic transmission fluid Pesticides (insecticides , Engine and Radiator flushes herbicides,rodenticides ) Hydraulic fluid (including brake fluid) Photochemicals' Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel,. Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors ) Car wash detergents PCB' s Car waxes and polishes Asphalt & rnnf i ng tar _ t--^"' chlorinated hydro- carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric- acid, other Metal polishes acids ) Laundry soil & stain removers Other products not listed (including bleach ) RE C E IV EDL Spot removers & cleaning fluid�EALTH DEPT. which you feel may toxic or hazardous (please p (dry cleaners ) TOWN OF BARNSTABLE lease list) : Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners Drain. cleaners J�N 1 2 1981 Toilet cleaners Cesspool cleaners _-:eisinfectants Road Salt (Halite) 1 'a of TOWN OF BARNSTABLE BOARD OF HEALTH CONT OL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM n 'l ADDRESS (�..Q,��� •'� �►-� Major types of materials: 1) —1116 All 2) 3) 31 A d WrQV_JhL - .5) 6) Adpne M I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/Recommen(..I, ions 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains gyp. iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit B. On-site disposal vv���e �A d ks 1. Town sewer \ 2. Regular septic system ^h 00 3. Separate holding tank S J , J C. Off-site disposal CAL SP �t 1. hauled by own firm 2. hired hauler O K a) name of hauler b) address or disposal site 's 4 Persop(s) Interviewed, Inspector Date 6 30 81 COMPLIANCE: ,+ ; i CLASS': Y.,,Marine,das Stations,Repair TOWN OF BARNSTABL � Printers B A R D OF HEALTH satisfactory 3:. Auto Body Shops satisfactory- 4. Manufacturers (see"Orders") 5. Retail Stores COMPANY r 6. Fuel Suppliers ju ADDRESS ��.,�,, ,.I f Class: 7. Miscellaneous MINWANNNEBW _ QU 'ITIES AND STORAGE (IN=indoors; OUT=outdoors) _t . -•Case lots Drums AboveTanks Underground Tanks MAJOR MATERIALS---�-- IN IOUT IN IOUT IN OUT N gallons-Age rest? Fuels: Gasoline, Jet Fuel (A) 'Diese ,�Kerosene, (B) A0 Heavy Oils: waste motor oil C) c , new motor oil. . (C) ansm s o ydraulic r Y ✓- r 77 Synthe .c Organi - degreasers4 - 1 y i i Miscellaneous: . e DISPOSAL RECLAMATION ,- � REW.RKS: � 1. Sanitary Sewage 2. Water Supply OTown Sewer Public 0 On-site O Private �- 3. ,Indoor Floor Drains: Y NO Holding tank: 'MD O Catch basin/Dry well On-site system 1 j ✓� 4. Outdoor Surface drains:YES NO a #i O Holding tank: MDC Catch basin/Dry well On-site system S. Waste Transporter ` " -°' Licensed. ' . me of Uauler- f2esti nati on WaSte� ProdLct ' /1 :12 23 ei. . Viers n s) IrA.erviewed tl"i-ice ° Inspector Date- - TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: re',Board of Health MAILING ADDRESS: �'�- f&a�gxm5 4, A Town of Barnstable 1 TELEPHONE NUMBER: Z��'�� ,��-�.� P.O. Box 534 ' Hyannis, MA 02601 CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registere 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 YqL,or oils/waste oils Road Salt (Halite) Gasoline—Jet4ual, 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 Y Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tet achloride) 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) 1/ Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business i TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops �QAAV- 5 7w«_, O unsatisfactory- 4.Manufacturers COMPANY��°v,�l 4 6 Fuel ��'. f-�a-z=�' (see Orders ) ., Stores .Fuel Suppliers ADDRESS fE e!A W,i ,y Class: 7.Miscellaneous HY 1t-AA%,(QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: � waste motor oil (C) new motor oil (C) v tran'smissio id lic Synthetic Organics: degreasers z Miscellaneous: 4/1 D SPOSAUR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer &ublic O 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 NO Y ORDERS: �c O Holding tank:MDC I- Gj O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Destination Waste Product YES N0 1• ` r 2. Person(s) Interviewed Inspector Da TOWN OF ' RARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,REpai.r I O satisfactory 2: Printers BOAR© OF -HEA TH 3. Auto Body Shops �� toc Ounsatisfactory4. Manufacturers COMPANY �. 1, a (see Orders") S. Retail Stores 6. Fuel Suppliers. ADDRESS �-� �L ( ass: 7. Miscellaneous Q UANTITIES AND STORAGE (IN=indoors; OUT-outdoors) MAJOR MATERIALS Case lots 1*7'Drums AboveTanks Undetground Tanks IN 10DUT IN IOUT I IN IOUT #' 6 aellons ee Fuels: Gasoline, Jet Fuel (A) „ter (0 N' �Diesel, Kerosene, #2 (B) ` Heavy Oils: T+..�. waste motor oil (C� t Uc new motor oil (C) L transmission/hydraulic ITS— Synthetic Organi7N, degreasers /nn, d Miscellaneous DISPOSAL/RECLAMATION REM ►RKS: 1. Sanitary Sewage 2. Water Supply. _---- ��----- - O Town;Sewer O Public O On-site O Priva a O �PD�L_,�!�� 3. Indoor Floor Drains: Y S NO p^ � � ?./ n Q Holding tank: MDC IVv1 L O Catch basin/Dry well On-site system 4. Outdoor Surface drains:YES NO ft�i O Holding tank: MDC Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? (1, stinatina .fa-r re Product YES NO MA, Ile erson s Intervi e ., �. i� ei ) Inspector Date i 191 . F DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING € s DIVISION OF SOLID AND HAZARDOUS WASTE r® One Winter Street Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite III 2- itch)t P typewriter.) UNIFORM HAZARDOUS 1 G ne, or US EPA No. ( �� .f Manifest 2.Peg 1 Information in the shaded areas WASTE MANIFEST l % A /`�— DocumenvNo�. `'` � - of is not required by Federal law. 3.Generator's Name and Mailing Address A State Manifest Document Number MA` C47800'S / B:,State Gen'10 4.Generator's Phone(�.7 ) •' � , � t �,J,• ; i 4 5.Transporter 1 Company Name r f r 6• US EPA ID Number CYN OIL CORPORATION , • ate Trans is _ MADO82303777f _ 7.Transporter 2 Company Name 8. US EPA ID Number D.Transporter Phone'I; 6,17 i" 344.0265 C —E.-St- ....... Trans.ID C N 9.Designated Facility Name and Site Address 10. US EPA ID Number h _ L oho CYN OIL CORPORATION I I' I I =:1 II I 151 I I 00 1771 WASHINGTON STREET F.Transporter s Phone;( ) r ,itSTOUGHTON, MA 02072 MLA D 0 8 2 3 0 3 7 7 7 G.state Feairity s ID .Not'Requlred`1 z H.Faculty's Phone( 617. ) 344 0265 (j 1 1.US OOT Description(Including Proper Shipping 12.Containers 13• 14 4 9 P ppin Name,Hazard Class,and/D Number/ 11 tT Total Unit Waste No. a No. Type Quantity Wt/Vol 5 ` WASTE PETROLEUM OILS N.O.S. COMBUSTIBLE LIQUID NA,1270 01011 T c b. T � } � G M Q 1 to E! rr ra R a) c 4 H A Z c ~S D is T c 0 2 R d m Z Z H J AddiUonal D�scriptions for Materials Liste Above linclude-physical state and hazard code./ rri K. Handling Codes for.Wastes Listed Above a• cu R f b d E 15.Special Handling Instructions and Additional Information16 tv E W 'a =' Z y 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway m O according to applicable international and national government regulations. V If I �C am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to beeconomically practicable a) and that I have selected the practicable method of treatment,storage;or disposal currently available to me which minimizes the present and future threat to human health and the environ- ment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that C' is available to me and that 1 can afford. E N Printed/Typed Name_R•,.. , Date Signature p Month: pay.. Year - R T 17.Transporter 1 Acknowledgement of Receipt of Materials VA _ Printed/Typed Name t % r s Sig Date nature Month D Yea P ,• 0 18.Transporter 2 Acknowledgement of Receipt of Materials T Printed/TypedName Date E Signature Month Day Year R F 19.Discrepancy Indication Space A C E 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except noted in Item 19. T Date y Printed/Typed Name GERALD E. MCCARTHY signature Month Day Year 8700-22(Rev. 9-86)Previous editions are obsolete. Form Approved OMB No.205010039.Expires 9-30-88 EPA Form COPY>6: DESTINATION STATE—MAILED BY GENERATOR g ENT OF ENVIRONMENTAL QUALITY ENGINEERING ' --_ DIVISION OF SOLID AND HAZARDOUS WASTE One Winter Street �''• �'`� Bostorl., Massachusetts 02108 V(A S7/ Please print o ype.(Farm designed for use on elite 0 2-pitch)typewriter.) 09`! (FORM HAZARDOUS 1.Generator US EPA ID No. Manifest 2.Page 1 Informatio in the shaded areas WASTE MANIFEST i' Document No., of. is not required by Federal law. 3.Generator's Na-ne and Mailing Address A.State Manifest Document.Number MA C454162 3 z'> B.State Gen.ID Y z n 4.Generator's Phone 1 5.Transporter 1 Company Name t1 J 6• US EPA ID Number C State Trans ID CYN OIL CORPORATION [MIA LD 10 18121310 13171717 ,$ + L^ 7. Transporter 2 Company Name r 8• US EPA ID Number D.Transporter's Phone 1 617 ") 344=0965 tate Trans.ID I' Cy 9.Designated Facility Name and Site Address 10. US EPA ID Number r' ru a0o CYN OIL CORPORATION 0D 1771 WASHINGTON STREET F.Transporter's Phone G..State Facility's ID :,; Not Required 0 STOUGHTON, MA 02072 MAD 0 8 2 3 0 3 7 7 7 H.Facility's Phone( 617 I 344 0265 { 12.Containers 13. 14. Vp 11.US DOTDescriFtion(Including Proper Name,HazardC/ss,and/DNumber/ Total 0' Unit Waste No. a. No. Type Quantity Wt/vol C WASTE PETROLEUM OILS N.O.S. COMBUSTIBLE LIQUID NA 1270 c b 001 TT. GcD M040"1 to E rr1 O N Z a E f�1 (D R c. CC A a (o T C p O o R d. Z rn a� -C a J.Additional Descriptions for Materials�isted Above/include physical state and hazard code.) Z K.Handling Codes for Wastes Listed Above Z C. tD to -C b. y d E 115.Special Handling Ir:structions and Additional Information d. Z E Z = a O' 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are lully and accurately described above by � N O proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transpon by highway XI O according to applicable international and national government regulations. U If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable C and that I have selected:fie practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ. N men4 OR,if I am a small quantit y y generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that 1 N can afford. NPrinted/TypedName Date Signature Month Day Year.O l =. r y a 17.Transporter 1 Acknowli dgement of Receipt of Materials t\ U A Printed/TypedNa_ \ Date N Signature Month Day. Ye \� C P ra R18. Transporter 2 Acknowledgement of Receipt of Materials T Printed/TypedName Date E Signature R Month Day Year 19.Discrepancy Indicaticn Space F A j C I L 20.Facility Owner or,Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. - l T Date y Printed?ypedName Signature .j GERALD E. MCCARTHY ` Month Day Year Form Approved OMB No.205010039.Expires 9-30.88 I I I I I I EPA Form 8700-22(Rev.9-86)Previous editions are obsolete. COPY>8: GENERATOR-RETAINED BY GENERATOR COMMONWEALTH OF MASSACHUSETTS 0'- Is DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING DIVISION OF SOLID AND HAZARDOUS WASTE PF One Winter Street • P.O. Box HWM • Boston, Massachusetts 02108 • Please print or type.(Form designed for use on elite(12-pitch)typewriter.) UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. WASTE MANIFEST "`s'a':;'':'<, 6 "' r . r•. 2• Page 1 Information in the shaded areas 1 / " '`! ' 1 I is not required by FederaEaaw. of 3. Generator's:Name and Mailing Address A. State Manifest Document Number B: State Gen.ID 4 Generator's Phone(,� ' 'r^r 1 :Y`z SAME D !�:. n 5. Transporter 1 Company Name6. US EP ID umber C. State Trans.ID U: ru 7. Transporter 2 Company Name 8. US EPA ID Number D. Trans orter's Phone `) ,'r t - }a,.,E. � E. State Trans.ID Q`n OD 9. Designated Facility Name and Site Address 10. US EPA ID Number r N _ _ `i f J r,r,G F. Transporter's Phone( ) G. State Facility's ID NOT REQUIRED o 0 H ,'r i, t^;:y :.)" c..`.A, ADOW46'606 H. Facili 's Phone t r-.* 7 � tY 3 f}} f t E✓4t 12. Containers 18. 14. . 1•` 11. US DOT Description(Including Proper Shipping Name,Hazard Class and ID Number V No. Type Total Unit Waste No.- C a. r a: Quantity Wt/vol T. N �• i YY c 511 r\r n � :�..� I - 1 •..3 tat, i r U .1 r 15 G' N Ci r• �. �.;. i.! T Y )f .�rl 1 Y C E O N b. E r*i R Z A M t11 T c. D O 0 —� iv R Z d. I N �1 L M (d D U 1...1 J.Additional Descriptions for Materials Listed Above(Include physical state and hazard code.) K.Handling Codes for Wastes Listed Above Z M n1 a C. !.1 t7 a. c. co O -C b• d. b. d_ 15.Special Handling Instructions and Additional Information M OL l r' D O 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment,ere fully and accurately described above by p Vproper shipping name and are classified,pecked,marked,and labeled,and are in all respects in proper condition for transport by highway - �] C according to applicWe international and national government regulations. (1) If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable 0) and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ. E0- ment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I can afford. (t) O Printed/Typed A'ame Signature Date rfv Month Day Year v Tr18. Transporter 1 Acknowledgement of Receipt of Materials ~ Date C NP rinted/Typed Name :Signature Month Day Year g / aportef 2 Acknowledgement of Receipt of Materials Date E Printed?yped Name Signature Month Day Year 19.Discrepancy Indication Space F A C 20.Facility Owner or Operator,Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. I T Date YL_ I Printed/Typed Name Signature Month Day 'Year Form Approved OMB No.2050-0039.Expires 9-30.88 EPA Form 8700-22(Rev.9-861Previous editions are obsolete. I COPY>8 : GENERATOR—RETAINED BY GENERATOR ,? MASS Or 13ARNS�IA C L - ; E' GOMpL1ANCgt MASSt , Marine.Gas Stations,RE pair t �, . F. DA r 0 a isfactory ;, •, 2. 'printers .' F �) : ? . . �' f' 3 �uto Pody Shops aatisfact 4 'Ffanufacturers uno - • !FIpANY. " i' . ' (see"Ord rs'1) S• p• Retail Stores } 6. Fuel Suppliers , JURESS Claws 7. Miscelialievus r {r---- # � P�s li>r�?'�.t;7 j 1.k1+ "`�;v t�,# zG t..l� '1 J d r� '� h,� � � 1 It .. � 1 + rA .. . rti> � . it QUANTITIES AND S10RAGH (INsindoarsZ UUl'moutdoors, s t °" `''' '' Abdve�'anks Undetgcound Tanks JOR FN16RIA ,. Gase lots ` .,� Drums '.; ,1 ., } Fuej't Gasoline; Jet Fuel (A) a w t �{ 4�>•7Ry*a: �6 ;a^-*rr� r gr y i • ( / , i�F :•,T Pll aty { F.k. y,.� . Diesel, Kerosene, ,A� B .;. `%.�R� } x i Leavyoil dj- .waste mdtor all new motor-'-Oil . :�C� ;: i 4 {F i 1 f. '?'A�Y�'Y-''� F t'� ..i. i.•.l�J.,•• •1 f �.� .t # i���•� ' 154 transmission/h ';� A .. §fr s'L 3, "''`, tti 1 f+ ,,q'}r•}v ( U^i •-: �",. ` s ;ynthetle ,Organics 14i'4`: F • _; 1 1 LeL- 4. x3,F i•iy ,� ' M t•-:!' � �, 4t y yr{i r y Pq1 ' Ir pWjY jfF@ n+1! Yx cif h'"9� r F �i "'` }-• , xa ', f s Ml t• ' A 1 v" a;: t s,tt�'',•.flr1Y .. r° Fxi�S.. z,A,,�� �?g INIFIALWERVATIOIJ SanItary;,SeHage x ' '? 2. Water u ./ <x""�� r' hl Sewer { � d�t''.,'..r?`,'•t;'*, -, ,,t $ ..Vzf' YES, '' " NpUu bli'-c. s:: bQ #%M private IndoorjlooDrainss 2R„' , �.. lloldingtanks;iMUC. Catch basin/UryY well- 0 On•site system Outdoor Surface drains:YES �N(t a �f��r C) 11vidin`-,tanks MUC' h " � � 'Rk ' 9 y -,•j r. .,. i !. r_ , fir �t6S1,�,. a'�'�f=��t` �.� j !'�:u'.•;w'� 1 f 4 -Y ra><. . " Y` 03Catch basin/Dry well g � #xFf$* V, Aa .0 On-aite aystem' `s ,`t ,�`#��' } � {F"•' ; '' '1 i,' �x�".' rqs YT�NS .,.,^ +s� t ai��G y , 1 r t{a ��•...•.Haste Trans Trans �'(1 � tom. • zt '��` �` r 't ' r t f -*r. #.�. i,t ._4-'t.. r. yq �' �� it . • L!ceased? nA 0 .; ,. ,�,: > ..,,��:x.�. XI •t *=F,� ;.'1; ,r �R_ ,&�: �rt,; 3rY 'Y.,aM -,� v - •r. cr / 4 t rirtv �r ,a ����w w• •w >-.t° .a.�k .r t¢,ib�` r,'.'G#tr te.� -r ..{�' k +.s)�� , f TOWN -OF BARNSTABLE r•.. BOARD OF HEALTH ONTROL (M TOXIC � 0 MA ERIALS - INSPECTION SHEET FIRM fJ�l-��iLU�� lyre. AD ZA Major types of materials: 1) 2) 31) 4) S) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal lass_ paper plastic cans,bottles,jars drums,barrels r aboveground tanks fJ / un4ierground tanks �-' bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility 1 ✓or # Remarks/Recommen(,dons Indoor a) separate, contained room b) stored in general work area v i) "inadequate ventilation ii) -floor -drains_ iii).zinadequate_-fire-- Protection- 2., Outdoor_ a) uncovered, exposed to-;weather b) pervious=surface/cat.ch._basins.,&_ r IIL "Disposal= 1, A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system _ 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site r► Perso=Ite 7dT 1X44) '' Ins ecto — — — — — — — — - - p �r —/p - - - - - -- - - - Date ( � / 6 30 81 - - - - - - - - - - - - -