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HomeMy WebLinkAbout0062 CAMP STREET - HAZMAT 0 ST'.1fi'.Yy, .,� �'_ - f r a .tom• r ..4 ti: �: T > y,3 eY ( 4 r 1 c t y �-F�• _ t w. $ z r` §`r f � a rtor r r of S' b I _ •, +'•?F" t q '� §"'. r y` r n a `"',+a .? i .ice :�.}} r• •t,.? . t K,�: _4t s'. „}Z � 4 ) sTk)d aL; s< �i• �f t rnt > l r 7 Fr *9. S ;; y.r. r s A'- P �. '` I ip+. S ,:: '" " y�lfa;�, " r ; Z: ....s y'i _y{;7' e. ;F' +e et.'h yr' . ` S '.... - i r•t i y + v +7��` 4 sw r L-;yah'. `4 J's , tr♦ '.k c.R fir, ? • t�, 'r' i Y y - j� y y I ri t* � A� ��.»r.E � 9. L� 5'_,wt .��/{ ,...Tr r=�'3"'',+�'i` ¢r !' f'`'! t. i'„"� }i�, � y, "�:P' ,r�tw i' j 1 _ ,•' !a . r #'` - rS .�i - �. , �. 9.,r`A k � .s.ti�}� a,•. � ,r.S{w ;r c�+ r .;,�.��, j.. §' y i r t r 1 �x i' w .{'i `" a. ,4 •Y ;',� • i,- to •{ 4{ i f x s.:.�.� a3..r i Y- ? t s `'1 � ." `.* y Y` n•�'v ,i' °#' t'r �' ' ��.,.y s ,'..�r� ,r�.:�a 1, ty k, '� .5�', Y` t i !`,� e A"�!�`r^7♦� o � t .. / 4�? r 7k o a z sr �' i .s + »'„ti•< rr �` . s a w 1 'rr i1u s•. h 1f:*•• r'(r ;a,..a}'a *•+ ",r, ,'-lyy ` 14'»} Fr { rr1 Vr a 'aX§ wxr trh' ;, y 9^ti. {'fitt „IL' -.. +� ra "r '.�Yr �.i.• �'r r �`'x r Y4 x fx.,s,R� 'I§,� 'r•d'� _-'y_r#,e rR.ff, w ",�,,r1t e..1 ,.4 ♦ r.;, ro i.�•,r. 5 s -}',5 ! .x Z � - »A:! t x -d t •�?`., r ,�,'}::' s �t f� ` '!r »5 t.a' a, r :k Yd y�t 1 a .y� � i, s. �,.. ! it � 1 � "F i �«, iat .: ; ;. ;1 {..1 tom. � `� � ,4 s '�,{, t. 'a � ±, ,. §• . 1 .� C• '5 .y S -{.» , 1 4 "�°`.� r' fix.-fir R ,4• ,.+r a' r`�, r• ..,,,�. •'�, 9..'�^..'� ? "` r e t.,r.ay {' � ✓ a y +,ry�<. y'.�,.5� r s r Au ust 1"1 1986 ° a ,, t. �.� 1 x $ t" y1 o t b�� r �t * ? r•t �`a` K a ,`',s s 't is"!ra �•" � a� 9ya d,,.•w��.. F i ,z�5•. r � Jrj :toy�a� t �.tea.. fy! .y,: 4 � +t { Y tr t~� ..t-'' ^F p1�: rips 1C"•�' % ;: r,! `.� r "tt1 ^'i §' +yr)r 5 ae1 1 f•." as ,R L t r r+�" r, F y'{ .,,� + y r ht r y na t �',� sy;T� "+0. i� , ,� i s y� i �.t ty� • ,�. � ,�� . s�� r,r2 ' �`�.rr r 5 ;' r`r.�• . ,rN t a } T �;,Z t, .. ,5, ,. . rtrF.. St x`? �.-�K r t { �''• 'fi }' ;'F 4 "r',U r r* ,' , '.,..� Thomas A,,Vartone, MAD tr5� " �':. �- ,� ,; , �' �,r., ti �f, a+ ,-t - 4 !,� .gwi.. { .:�, v+ a•»a ? r ..t ?r L 1 �.'s x ,J. Ntdholas Vandemoer,"'M 1), r�•t t• » Bruce R Gord9•on M r'D. ,�) Y`b t A'qr f 1 ti Yk ♦i al , "Hyannis Eat; Nos'ef^a r na d iT.:ly rOF$t,t? ss socriation r.IxV61low Brick"Road #, �'••'°.•. 7 r ���i�01' ''r •`°� } ,Y K +•`u.ir -a • "r F y` ;, �. H annisbfA •t �7'• t.l "•F A r {, 4,+��+ »�-4�c•., »»°. ;n ,y� h.'+ I, a �"" r r to $ -tr 5� ;w Y .. l � i '1 r'�' r a'+ L T �a, .� � .].•,,, t .'+ ,y ��'• �i .v �. .y t Yam.t � Jr 'NO.TICE TO."A CMR, 30i HAZARDOUS',WASTE* 'EE ULATIOP�S ' �_'�'"ARTICLE:' 27, CONTROLIOF• TOXIC SAND'"H7�ZARDQUS lei'�ATER1Al;n�OF"`��THE--OWN- OFi`tt;� 3 BARNSTA-BLE'$.Y4:41 S, .r y? ,, y' r'""'r„!'a' s•s 'i''� 9 ' s� ;`" `+t ''r t w x.+� `S i''x q 's+ t r.�' 'S. 4 .,k. .r ,l r5rt: »t`=aL The;proPertp.'owned` by you listed:on;A'ssessors M No:° 327; Parcel 18y; at 62°Gamp,tStreet; f . Hyannis;-was hspected�by,Nancy;tLeitier, Flealth'slnspector for the Town of'Barnstable; the 'request 'of, the,Hyannis Fire Department"' 'The followvin ',violatio°ns tbf•f3I0 `CMR. 30 Haz rdous'.Waste Rey ulations a`� { Art.i 1 27 Z `� '` r g nd c e Controlof ,Topic and' Hatardous;:b+iaterial + theTownof'Banstable By laws, w r,f se d�eacq ' k !r} '? ` � ,` ky­ s,t .x+ .ry .:?- •?" »z S x _ � �?{'.v - a i � �td y k d ;s t_�' e s r � "•�> a .�' 9 �ar y ^� i ' ;. tr• ► _ Two ftfty five gallon•containers t y one`tslightly,,filled*with what appears `to be ran ;oilyt t, �t'- • xy.; _ G r g' - ,t, ...sy t'. { ,. �t.,t �.r. x ..R., t�. sunstance. ' one still,remains Cwo feet° below�,thel ground"sur'face r coiitain'ingViin;"dnknowri ` amountof"an unknown substance2 i {�^`. ia gxe ' ✓ �,�. \ i V.,r,' ,rarj'•§ `-r S4r D?7 t r`v,' a f+r .• r » r. d +.' � � x r ,, :i'x a [ i t r ' �•� +" �'..r .' - 4 a tt' r1� --'? � . , x` �e.0 4, "�' ha e'the zw .. Ay �r,.4 r A. ;. You-are.,directed, tor. v , o; :containers,-removed by a A lice�nsedhaza�rdous,waste transpp ter w thin ten-(10) days of, xeceip of;this.;notice:qf ffbe,Board of Ajealth,must?,r`eceive• t ` w. ? § _.., r"a X r t. ML ' r` •'i S Ji r �, w+ - § e t: s r-a copy Hof:. your­,receipt fr`o n the licensed transport;company We�are enclosing a,,list of } hazardous Waste.transpdrters licensed in•Massachusetts' '�• - � »r .t ;r 3 6,"'i-r � '* l'•e d 4 �'T t,4.ws }_ !t "��r k� _ r. 1 ! t..4 r, i.'•s t' y,. ? «` -� ♦ .§� -y r`+��J. a,l,""t''�� rr>u"'•:�+ � r ti�y'•,� :.oi1 `3..���• d, :�•,r��Y:' You may request�a.hearing,before the 'Boar of Health if written` petition;requestingasameL , x a y ram' a• a.. r{.,`X e t r. Tn c r � � ✓n r ; �z✓ � �is recetved-withintseven (7) days of receipt of this notice:. ►', � ti ? '• �� -'.4 •i` r 13* ", e+ t r .+'! i l F= , �•r Y'.x.- t sx ..,4 Nan tornpliance*tcould-result tint±a.f ine� if-up.to $500 �rwEach°days.failure'to' -comply with. an" `a f k- '�,ti:fr } � OIder Shall°,COnstiCute'a separate,violation �f# �fi',{,�E ,: � J ',rt a�C;•� ti °''�.,��� �•�'¢'��z '�:fT"�� � '•' �...9 s r -, s+L_ r 1 ,�Y., t sy " t l yrt,v t 'Yr t' r, •!- T �' F' .rt ',.{' { .�. ;3 r t . ++'•.` ER�O�RDER OF��,THE4BOARI7 OP"I EA1='pH �% �� ` r s �r .a� {# { 4 d 4 ! f`r t w�f• '`'S u§.� ,y44*�¢ '�` �' �>.aRxy •t � ty r �, �',r �!1,'s rr �r � �.f " s``r -' '�`y; � ft� i dr h r �'yy c� •� 4 - F a��• '�'„,, , 1.'i{ c"' r ".' , {, - tr'4.�•r.._ ':y r} a t �} r r'r , ry,.t 4 y�rI e. ' .i_,:+y �"� ? .»t t +-L' ( -, ap a ti 7 L rh -,,, y r h . `a{ TJohn M. 1Cellyt �Director of,Public Health' s �y 4 .'�a ♦ Y� I t +.�,L&S^ � � `r y e 4- ;:�E ti :e.•°s� t w �;,R r ."{ ! ;t.'f ♦ .a� +..fi �.'!' r{ 1 5 .'}!'C"F #.,kt �, r y .+5.. S 74:: ii z§ , .t dry e y..:'' r..tii. .. Y. r 5c. 4t .,€ s •.• � .A dry � ! •^�, *q `ems �`'. ,._� h .� +r -. r§}y � ,• \T t x-1 -%t .y. ;� .+t..,�S Yr. *s' z•=: JMK/mm:r '." t - �t*;-p5't } �' * Srh _a �'z.tt,. j r. r S ,S `'yS'#. c `tom r.,•+t.t + � . - -, � .,! `{ , k st n a ,� k . t�' �"' !, r r.'+• t ' .r ., ».,,p' tf 'y Y*f ♦ trot. V T5`'�; :f •'1. .J:. { ;, a d. ; t & SCy. ry � i�r 1 'Y^ ;3 .0 s c< �"..Kr• t�.'r,y °'N .i> y :z.; t w i 0 t`. i �# T rt s F' "P ,� � . r :,y, s -.k t 5 ��:,a:y alto-dr k• rr a � 9'r.i� • .Y t d� � t ,� a ....p .�` .rrra,,,ll•,s� 'i�` irz°.} I, e • r '�� � � r � F�'� .d' 4 ,1 ''. + *,�- c * ), t .+u•� .�?�t i '' 7.t• � t d '✓?' w F� }'�* :;*� ;»�:'� • + .sti, "� '�• .z .. 4 � q •, as � t,:v Y a sw �`'.; > N* �; , ,. `t1.` ,rq✓, ?• � � 5e t 'k : r �r `tom 1 � raa '�1+�. a : �� tr 1 ?+ 5•, , ° r r Q.. g ,# .'` q # i.- =d ,= s. y. 'r e, ".. sir, s..,�` " '4'J ► f x' 1 _:r +�* vtiy, l�r4t; t �e� f r {,tvi`,z•r ."'rs ,t. ' ti' i-1 'w Na: •'r rs. ,+±. t' _ •.• j «•� ++.` j.iy.. i.i ! ♦ r 'fr�,''r r t•,5.o �.'r ak i.��,. 2 +.'� s .+� `�, !'W, rt; k t y,e - aT t rs�'.1 •'�'c T �� ? •', � ..3` V:�1? +s, � a �y . er � � .f t ?• H KYr- � fr � x • µ• At{ yJ tip � 7` ;a ,t, ':g*+ " ,� > �,.;. # ,''�t i '•,'�� y`�'�a�s� t t " t � t . � dr � Y 8W 3 [r i ;� ...c. s .riy i �. '.s 4 Y r, � � 7 xr =,a•, :� ?a '' r, Jh'. •�, r k k k A. tY 1 3 y 7 r r . s+�i rQ r•,*{? s'rSJ «r A>�, •y- Y'Y_ + u ,y wT .... ,•. ti� 1 So ";a t � r }:. ;.'} r 5 4 / _ »I. b ... #.y Y .... 1 _'` A r'v.• R .5 t y`-. 41 I it M A� �44., jr •� - M w 7. .- I. P0 • A c ♦ MI q IwA Ms. 11. A Xx A, top W 1A A I ' 4, PI M T 1. 0 a *Q ."p a , a I errl, my-A nu.,bi i"O'If IV Po t,. N. 04 1 A a "A 0 1 W­ w1w I AX t " F.MY Vt "'b";;a tt, r1g. A 4k All, It, C._qj, gi o' ' -lopq� W, * �j� _4 ej'I P4 j MA 4 IMA MQQ1 A- 4 I Y A . . . 0 t - Q40 M lit, I VC "i!Aho In AOJIK CV' O�;t toil.41,qqf,�j" 71). lot, "If Jk - - I ♦ ' ' ..' ' VIA e", I,4t INV "Q;tA,' Ate 4 "-�if ,1 04 A�,6, It" q A.-T"A "44, v A A, tA�, 01 yK �T Mi� ?"M Y* -TWTC_'4*Tj W it ,t)P � L Y 4­ IF tv Q1 4i 111:V I'A Its,' t)"­ .44 t A?, 4.�"A' I,__�. , , &,,, I, " I 0ulM Z4 k iii R 14 1,4,r IN", C. At, 4%� IZ,I 4,Q 0m. =0 A.I t T )1.1 'A 44 J1, _, -IvJ 01, :P0 liv, WHO I; AV, 1 04 4 fQ W.%l Lyn a!�A 4FO Q, N, SY 1100 � I I " ­- 'I " WIN Mas Z, A� � _�I . sm. Af 4 'A't V,.,q "V A jS e X I 4W� ij NV Q- .np 71, top o7. 'o -10. AW , ­0'j,, ,,, . 11 ,�'r. , " 'T is II, I,. , . A.1 1 ,WAN I, QV' Mrs, 'jr aYS in PIT Oct P 91y2 998 121 RECQPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Z 0 Sent to Thomas A. Martone, M.D. �b s Street and No. v 00 o� r P.O.,State and ZIP Code O a c7 Postage $ to Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered 04 Return receipt showing to whom, m Date,and Address of Delivery d TOTAL Postage and Fees $ 1.67 ID U. cPostmark or Date co E mailed 8/11/86 j o U. IIL a , I STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST-CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) ' /I. Ifryou want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. ' Gi (no extratharge) 2 If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the I article, date,detach and retain the receipt,and mail the article. Il 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card, J Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix JJJ to back of article. Endorse front of article. RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. f 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. 1 I I i i SEINDF_Jzz Complete items 1,2,3 and 4. �O Put'Vour address in the"RETURN TO"space on the 3 reverse ie. Failure to do this will prevent this card from being relined to you.The return receipt fee will provide you the name of the person delivered to and the date of delivery. For additional fees the following services are Lc available.consult postmaster for fees and check box(es) .L for servicels)requested. 1.MN)thow to whom,date and address of delivery. 2. ❑ Restricted Delivery. v 3. Article Addressed to: Thomas A.Martone,M.D. J.Nicholas Vandemoer,MD. c/o Hyannis Ear,Nose & Throat Assoc. Yellow Brick. Rd.,HYANNIS,MA.02601 4. Type of Service: Article Number ❑ Registered ❑ Insured P 042 998 121 ®Certified ❑ COD ❑ Express Mail Always obtain signature of addressee or agent and DATE DELIVERED. N'S 5.. Signature—Addressee rC' xr� v µ� CA6. Signature F x 7. D m 2 S. Addressee t7]V's Address� CSfE Q fC X m n w UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS . uaa M AIL Print your name,address,and ZIP Code in the space below. • Complete items 1,2,3,and 4 on the reverse. PRIVATE P TY FOR • Attach to front of article H space permits, PENAL otherwise therse affix to back of article. USE, • Endorse article"Return Receipt Requested" adjacent to number. RETURN TO BOARD OF HEALTH - TOWN OF BARNSTABLE (Name of Sender) "lPfild Street,Apt,Suite,P:O.Box or R.D.No.) y tv ,end ZIP Code) `1 >s I ATTORNEYS AT LAW JACK J.FURMAN FURMAN BUILDING,255 MAIN STREET ROBERT T.CANNON HYANNIS,MASSACHUSETTS 02601 DIANE FURMAN ROSS TEL.(617)775-0277 August 15, 1986 Mr. John M. Kelly Director of Public Health Office of the Board of Health 367 Main Street Hyannis, Ma. 02601 RE: 62 Camp Street, Hyannis, Ma. Dear Mr. Kelly, This will confirm the message left with your office.on Wednesday, August 13, 1986 in reference to the property as above listed . This office represents Drs. Martone, Vandemoer and Gordon who are the owners of property at 62 Camp Street, Hyannis, Mass. which is the subject of yoa.gr letter dated August 11, 1986. Please be advised that I have been in contact with Zecco, Inc. in Northboro, Ma. and have scheduled an inspection of the site with Mr. Tony Zecco for Monday,August 18, 1986 at 10:00 a.m. will advise your office-of the status of the removal of materials subsequent to the scheduled inspection . Very truly yours, JACK J. FURMAN Q JJF/kkw enc aAl— w ov� ATTORNEYS AT LAW JACK J.FURMAN FURMAN BUILDING,255 MAIN STREET ROBERT T.CANNON HYANNIS,MASSACHUSETTS 02601 DIANE FURMAN ROSS TEL.(617)775-0277 September 5, 1986 Mr. John M. Kelly Director of Public Health Office of the Board of Health 367 Main Street Hyannis, Ma. 02601 RE: 62 Camp Street, Hyannis, Ma. Dear Mr. Kelly, Pursuant to your instructions in a letter dated August 11, 1986, please be advised that the two (2) fifty-five gallong containers located at: 62 .Camp St. Hyannis, Ma. have been removed. Enclosed for your records is the Uniform Hazardous Waste Manifest of Zecco, Inc. in regard to the removal and transport of these containers. 1 ,trust this matter may now be closed. Y urs veryft.r-ul JACK FURMAN ESQ. JJF/kkw cc: Drs. Vandemoer, Martone & Gordon o, E —COMMONWEALTH-OF MASSACHUSETTS ^ ) TENT OF ENVIRONMENTAL QUALITY ENGINEERING 14 �Y 8 DIOSION OF SOLID AND HAZARDOUS WASTE One Winter Street Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite(1 2-pitch)typewriter.) UNIFORM HAZARDOUS 1.Generator US EPA ID No. Manifest 2.Page 1 Information in the shaded areas WASTE MANIFEST Document No. q y of is not required b Federal law. 3.Generator's Name and Mailin Address Q' © 01� rr A.State Manifest Document Number 3 1 ' - JW It '�1t9�V _.__:_ _ _-- _ MA CO22891 D ` A1,WIij cS�- 14Y.AvA. s � KA-6',- B.State Gen.ID n O' 4.Generator's Phone( ) • — ru 5.Transporter 1 Company Name 6. US EPA ID Number C.StaterTrans.tD- rU zeciluyl Inc. MA0105292: 4495 _ �; 7.Transporter 2 Company Name 8. US EPA ID Number . ransporter's Phone( L-t N , E. tate Trans.ID 00 9.Designated Facility Name and SiteAddress 10. US EPA ID Number 00 Zecco Inc F.Transporter's Phone( I n0 N ¢ i " G.State Facility's ID Not Required 345 VPSt Main stme H.Facility's Phone( > '� �5 7 v 0 ..12.Containers 13. 14. w l; W 00 0 11.US DOT Description(Including Proper Shipping Name,Hazard Class,and ID Number) •�4 Total Unit Waste No. No. Type Quantity WtNol 4,4 N /V���• U 0 P rn c G b. Z °n E m y N . . LLI aD E n cr R c. oA T •_ 0 3 Z R d. F-I a� r— rn tv co J.Additional Descriptions for Materials Listed Above(include physical state and hazard code.) K.Handling Codes for Wastes Listed Above - O a. a a. C. t7 b. d. b. d. E 15.Special Handling Instructions and Additional Information 0 ; Q 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 according to applicable international and national, 99 v C government regulations,and all applicable State laws/regulations.Unless I am a small quantity generator who has been exempted by statute or regulation from Q the duty to make a waste minimization certification under Section 3002(b)of RCRA,I also certify that I have a program in place to reduce the volume and toxici- tyof waste generated to the degree I have determined to be economical)g g y practicable and I have selected the method of treatment,storage,or disposal currently. i E avilable to me which minimizes the present and future threat to human health and the environment. CD Date C ! Printed/TypedName Si nat a onth Day Yea --AOMA UT 1-.Transporter- 1 Acknowledgement of Receipt of Materials - e �T C N Printed e a Signature Month Day Ye r O 18.Transporter nowledgemer t of Rec ipt of Materials Date R ? Printed/Typed Name Signature Month Day Year E R 19.Discrepancy Indication Space s F .. A C I - L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Date Y Printed/Typed Name Signatura4 Month Day Year Form A proved o.2 00-0404. xpires 7-31-86 EPA Form 8700-22(Rev.4-85 Previous edition is obsolete) COPY 3: GENERATOR-MAILED BY TSDF .. INSTRUCTIONS FOR CbMf?CET1IJG"fH�E.INIFORM H6,ZARDOUS WASTE MANIFEST • 'item G:STATE FACILITY"S ID-No entry is required by Massachusetts; *Item H:FACILITYPHQNE�-Enter atelephonenurFtberwiih area!code for the TSDF designated to,fective.thevyaste listed onthemanifest. IMPORTANT::READ ALL INSTRUCTIONS BEFORFvGAYNPLEXJHIS FIO.RM. Item 11:US DOT DESCRIPTION-Allof the following'rtwstbe entered:The correct US DOT(Department of Transportation)name for the State arid fkid!6ral regulations require Generators,trrfris orter9 Er(aTreatment,Storage,and Disposal Facilities ITSOf'sl to use this form and, waste as identified in 49CF,Rparts 171 177lusuaNy found in column 2 of section 171 101).the assigned DOT Hazard Class(usually in col- if necessary,the Continuation Sheet for ntergtate r rttrasta' shipments,.of hazardous:wastes_ - urnn 3rand the 4 digit UNiNA ID number(column 3A).(e.g.:Waste Sulphuric Aaid,spent,corrosive material,LIN1832 RQ).US DOT requires ii y - the word"waste"before or in the shipping name for all hazardous waste: The MA�ritariifest contains 8 copies.ALL COPIES MUtSTBELEGIBLE�111egible manifests submitted to the State will be returned to the generator _ - ..-• .for proper'completion.)This form is deal ned f0,usetafia 12 i t7tlita)typewriter.A fi m balk q nt en may also be used if you press down Item 12:CONTAINERS INO PE)-Enter ttte number of containers for each wasteandthe appropriate abbreviations from Table I(below) W p P g p' Y I P l P Y Y P for the t HARD.Each of the 8 copies must.be filed with the appropriate party as it is corr(pleted.Copy distribution is as follows: type of containerused: r COPY 1:. DESTINATION)STATE-Mailed by TSDF:tffe original stays with theahipmgnt from generation to completion by the TSDF. "1 TABLE I-CONTAINER TYPE* I ' When the manifest is completed,the,Srsor ltust mail this copy to thestate wherethe facility is located. DM=Metal drums,barrelstkegs OW Wooden drums,barrels,il(egs DF=Fiberboard or plastic drums,barrels, !' I" - TP=Tanks,portable g.. TT=Cargo-tanks(tank truck_s)' 4'1h kegs i COPY 2: GENERATOR STATE---Mailed by T$�DF�,V�hen the TSDF has completediis sectiort of the manifest,he mails this copy to the DT=Dump track *•� CY=Cylinders TC=Tank cars ,.State whets the waste was yenera / if - CIW=Wooden boxes,cartons,cases CF=Fiber or plastic boxes;cartons,cases CM rMetal boxes,cartons,cases(incl. COPY 3: GENERATOR COMPLETED COPY-Mailefl by TSDF:When the TSDFhas completed his section of the manifest,he mails this rolls) I copy back tothe Generator of the waetelvyho must retain.it on-site for his records. t* - • F• _ (,,, C3A=.Burlap,cloth=paper/plastic bags '� Item 13:TOTAL QUANTIYY Enter the total quantity of waste described on each k ne. t,,, COPY 4.TSDF COPY:When the TSDF has complq d'his secon of the manifest,he keeps this copy for his records. _ ! " I Item 14:UNIT.(Wt./Vol.)-'Enter the appropriate abbreviation from Table llibelow)for the unit of measure used In determining the total,quantity COPY�fTRANSPORTER.1:-When the_transportetf complg{'ed his section of the:manifest and transferred the waste to the TSDF,he _.G _ of waste described on eacFi line.Db not use fractions. d+ ` ?keeps this copy for his records.. a w - , to •-* • _ TABLE 11-UNITS OF MEASURE • %;.N(5TU If a continuing transporter is used,`he generaioris responsible fogsupplying him with a legible photo-copy of the - �. " i P-=Pounds } 1 �",. - G=Gallons Niouids only) L Liters(liquids only) + �N manifest,which must contain signatures'where regIHIIf4d. T,=Tons(20iJ01bs.) Y-Cubic Yards K=Kilograms .i CCPY 6: DESTINATION STATE-m led by Gene'kr.When`the Ggherator has completed his section of the manifest and transferred M-Metric Tons(1000 kg I5'j N rCubic Meters F• his waste to the transporter;he mailsthi4 cogy-to;theSti to where the designated facility(TSDF)is located. ., i ;L - - *item I:WAS -TE-NO. Enter the�4,digitEPA hazardous waste number as it appears:in 40 CFR Part 261,tuopgrts C and D.If a non-RCRA COPY 7:' GENERATOR STATE-Mailed by GenerlItor:Whenthe generator hakcompleted his section of the manifest and transferred ' State-regulated Wa'stestream is being manifested,enterthe State waste code here.If both the Destination and-Generator States have assigned his waste to the transporter,`he,mail this copytL the-State where the.waste:was generated. codes use the Destination State code.If there is no EPA/State code,enter"none"., y" COPY$; GENEF�.ATOR:When the Generator 3c�hplet8d h��ection of tfie manifest and transferred his waste.to thetr. ansporter,he *Item J,,ADDITIONAL DESCRIPTIONS FOR MATERIALS LISTED ABOVE-Enter desert ption of analysis for any waste whi h does not have r.keeps this copy for his records. , �f r` a U.S.DOT shipping name.or has an.N.O.S:designation,Enter constituent percentage*,chemical n 0't physical state's'IS=Solid,L'�Liquid, r - G=Gas,St=Sludge)and EPA.Haza0 Codes(Ignitable(1),Corrosive(C),Reactive'IR),EP Toxicity I ;ri uta Hazardous IHI,.Toxic IT1.Enter �' - 1 •' - ' the specific gravity if othe,<-than'1,q.Any additional desired waste descr{ption�rlay also be entereA{te e. - - µ,,.T '� t GE'NER_ATOR SECTIOI , > t..,fi+t` r "`" Item15:.SPECIALHANDLING�INSTRUCTIONSANDADDITIONALI`'JFORMATION-Usetpigspaco"taitlicatespecialtranspoR'ation;veAt- ,�µ Item L•GENERATOR'St1S EPA ID NC.f-MAtiNIFE�#IOCUMtENT.plf2.-Enter the ffS EPA generetor's 12 digit identification number.Then ment,storage or disposal or Bill of Lading information.If an aiterhate facility(TSDF)is designated,rtdt�Aflare.For international shipments, enter a pnique_5 digit number you assign to this,mahifest.UsVf`aenallq',increasing numbers leg.00001,00002,etc.,)is.recommended. t Generators must enter the point of departure(City and State)from the USthrough which the wastertY Ravel.before entering a foreign coun- t4 item 2:PAGE of .-Enter the total numlJer of�agas used b corngletL this manifest''Le.,the first form plus the number.of Continua- try.This space may also be used for emergency response telephone numbers,end other inf4rmati i6 itsienerator wishes to include about �• tionSheets,ifan Any EPA appr etl oved co minuon' '♦'ltafm be:0 clpbutdistributionandcom letionmustmeetMassachusettsmanifest the shipment,.includingplecarding,^ requireirerits. *Item t +y ii •itemK:HANDLING CODES-TSDF'Compietes this section-See"Designated Facility Sqctio/"�gIbbtTowl; "Item Ai STATE MANIFEST DOCUMENT -..,f;vumber prepiirjfed6y MA except on the Ctontinuation Sheets_Enter this number in Item Item 16:GENERATOR'S GERTIFICATJON-The Generator must read,sign(by hand)and-date tfi4`ertificatlon(with date.of Lrarlsfer'to L on each Continuation Sheet attached'.to.or partof ai`-manifest. .�; t • transporter).If a mode other than h`i+way is Used,the word"highway"should be linedou'tand tt 4r 4'ibpriatemode(rail,water or air)in- �+, serted In the space below.I dhuther mode in addition to the highwoy mode is used,enter ttto approWtigt mode(eg."and rail")in the-spare .Item 3:GENERATOR'S NAME AND MAILING ADDRESS Entef.,ttte ilprne(as notified to EPA)and mailing address of the Generator.This t t - „ ) address should be the.location that will managtl the returned mn�ast fx3res.m -. -• .. �. below: nt Item 4:GENERATOR'S PHONE,NUMBER-Enter,a telephone number with area:code where an authorized agent of the Generator can,be reach- ,r•, TRANSPORTER SECTION ad in art emergency. :'A Item 17:TRANSPORTER t ACKNOWLEDGEMENT-Print or t+e the name of a ersonacce'+. . 1 f� yp th p g the waste on behalf:of the first `Item B:STATE GEN ID-The State Generator IDris the street address of the Qenerator's pick-up location.If the mailing address andthe street Transporter.That person must acknowledge acceptance of the waste described on th?manifest by sign ng an d'entering the date of receipt. address are the same,enter"same"i4this block L-^'" t Item 18:TRANSPORTER 21ACKNOWLEDGEMENT-1 if applicable,follow the instructions 1'60hem 17 for Transporter 2. ' r ] item 5-ARANSPORTER I COMPANY NAME Enter thelcolrip, name(as notified to EPA(of the first tretjsporter who will the t: - waste., ri - 1 If°,'t i _ ` + { ' DESIGNATED FACILITY(TSDF)SEC TIJ1� <•.� y - Item K:HANDLING CODES:TSDF SHOULD COMPLETE:-Enter the ultimate handling method utilized at the designated facility for each waste Item 6.U,S,EPA ID NUMBER-Enter the.US EPA 12 digit ideritific3tion number of the first transporter identified in Item 5., p ++�I.� listed in Item 11.Only the foliowinprbcess codes ma*be used: 'Item C STATE+TRAN ID-Enter the State of reg6fation and A license plate number of the waste-carrying portion of.thq vehicle being ' f r. vI J^'\A • - "FABLE III PROCESS CODES ^•t - - - used totrtiake the pick-up. - a _ y( r tf l l f I " _'`4 STORAGE: So11C0nte1 w a S021T ki elf• S031Wpte PN.1 p SO4 uri4ca lmpeurM,nanil• 50510tt.er-Specilyl •Item D:.TRA'NSPORTER,S PHONE-Enter a telep oneAumber.with`area code where an authorized agent of the transporter can be reached.. `+ - , TREATMENT'Reier,040cFRPert265,Appe 1,•t44102. +1 r DISPOSAL: OJ911npctlon wetll L DeOL.rJi:11• x 0611Len4 Applwafonl IOce.'n Diapweli , 06315uAece lmp.1 Item 7:t RANSPQRTER 2!COMPANY NAME If aPcepte,enter the company name(as notified•to EPA(of the secondtra sporter who will I DY4 fbtMrSpentyl transport the waste.If more than two transporters ivilbbe ilsad,�{se a Continuation Sheet and list the transporters in thetbrder they will be , � %•t .< ' transport g the waste: t c }`•�i + „ Item 19:DISCREPANCYINDICATIOI SPACE Tf a agthorizedrepresentatibe of ihedeslgnated fadfRy's owner or operator must dote in Item 8:f7,S EPA ID NUMBER-If appCicable,.enter 4 e US PA 1. PJi it identificatiorrnumber of the transporter in Item 7t +: this space any significant discrepancy between the waste described on the m1mifest and the waste aatually.receivad at the facility.Any re- transporting - jected materials should be listed here,along with anihdicationof the disppsiti8nof the fejectedmaterals.Any applicable DiscrepancgorEx- eltemf STATE TRAN ID-If applicable,en er the e•1 pp � �e�oriAtranaparter's Stale of registration and license plate number ft}�`��ie waste carry- caption reporting requirements must.also be comp{ede+'yit}t;Federal and state lregulations map.'vary-. � ing portion of the vehicle being used tomaka'the pick-up. - "'3 Y ' ' ,,I ' g .•:y p'. T - i 1 r�J'`. Item 20:FACILITY OWNER OR OPEFI,fLTOR CERTIFICAtTIOM-{Print or type the name of the persotl accepting the waste on behalf of the owner 'Item FT.TRANSPORTER'S PHONE-Af applicable,a ter the second trans porter's telephone number with area code where agent or operator of the designated TSDFy'That person mustacknowledgel acceptance ofthe waste described on the manifest by signing Iby hand) of the trart�p'ortsrcan be reached. TM I,J and entering the date of receipt,Tijeeignature of t1ke authorized TSDF agent indicates acceptance of(except forItems specified in Item 19) - i, ^•'4^••-«y "4 J w t "' and agreement with statements on t its manifest. ltem 9'6ESIGNATED FACILITY NAME AND SITE 40ORES$� Enter ti a company name(as notified to EPA)of the TSDF designated to receive - the waste listed on this manifest..The.address must be the sita`address,which may differ from mailing address. NOTE:FOR INTERSTATE SHIPMENT YOU MAiY BE REQUIRED TO COMPLY WITH THE MANIFESTING REQUIREMENTS OF BOTH THE . DESTINATION AND GENERATOR STATESREGARDING THE COMPLETION OF SPECIFIC INFORMATION INCLUDED IN LETTERED ITE.A Item 1 D:US EPA ID.NUMBER.—Enter.the US_EPA 12 digit identification number of the.designated.TSDF listed in item 9.