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0068 CAMP STREET UNIT 1 - HAZMAT
--- y�c,/a�n d�s Number Fee 1340 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Hyannis Family Medical Care 68 Camp Street Unit #1, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN _DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BAMSTABLE OFSNE� enawslne.F•care:l:v=-:wn•.su+.r Public Health Division aY5lCti qi Sit,39-LLE-+,'.TBUL SE 1579-301a t s JY C • &ARN "LE. r Thomas McKean, Director cri MAW 039. N ATFp A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ; �.n 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 NLY 1 st-NNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 <L Vs i CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ F4 Cbi �1 II '-1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. 3a I 103q C/U 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 0/1 5. NAME OF ESTABLISHMENT: 'S rC4 Mi I\/ /vim I-CA ) (,A Ye 6. ADDRESS OF ESTABLISHMENT: Cp g (12 ►M,o S-t1 Uf . 001 I I 1 , NV A P"d, W kil 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: '7 11'--Lt 13"30 9. EMAIL ADDRESS: S f"AC4. &V 10. SOLEOWNER: /YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME V Q hv1 iS kAt`(AI CATC PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT'-2 DATE �/ a Q\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1340 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Hyannis Family Medical Care 68 Camp Street Unit V, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ---------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health rf ,` TRowri of Barnstable eg atory ervices Richard V. Scali, Director �SME hy, Public Health Division B STABLE Y enRtlsraelE.[imE1MZSE.miUR•4YlJ.MIs BAENSTABLE. : Thomas McKean, Director 16;"o;� --200 Main-S-redt Hyannis;1\ 02601--- - --- --- ---- 311� o Mo+ Office: 508-862-4644 Fax: 508-790-630 � APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE �D HAZARDOUS MATERIALS ct4 1rsZ ' 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 1/s CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD ?UANTITIES (25 GALLONS)? YES NO. I" P A-k: 4. FULL NAME OF APPLICANT: ffi o y1 y►k c Fa M I v Kept ru I CDC Ye— 5. NAME OF ESTABLISHMENT: Ri A n►1 us FGt�'►'►r i� 01) (A rt 6. ADDRESS OF ESTABLISHMENT: (Qpj l a►yl4 StrtL+ UV114 � , lTdgYly►� f , M/� Qa�Of 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 3 3 q — K-- 1310 9. EMAIL ADDRESS: s to r,\j . , C�ti� R H r" R C iOc _ P a on 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ny A h n�f _ fit wt ).� ",CA) C9l r-C, PRESIDENT 1 m-& I u tu l TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT . t/ DATEf Q:\Application Forms\HAZMAT APP 2017 REVISED.do �a Number Fee 1340 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health s� O This is to Certify that Hyannis Family Medical Care 68 Camp Street Unit#1, Hyannis, MA y� Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Tow of hnstable Regaatoervices r .• . 1. . Richard V. Scali,Director Public Health Division BARNSTABLE • r � anaxsrnB .arrrnhuB.cmun.xraai is L l BARNSTABLE, * Thomas McKean, Director WSW* iOMRVI0 4WESI B0.9x5TAG � MASS. 3g95-72�0{ 039• 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Q �al// Fas: 508-790-6304 � APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE t`1 Ph HAZARDOUS MATERIALS n 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 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 'r. L . CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3 a g/184 hol4 3 A 81011 2. IS THIS A PERMIT RENEWAL? YES VINO. 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: -f'Q ut Ayi"I 5. NAME OF ESTABLISHMENT: HV Y%A M i M Q 4 I (90 (Are. 6. .ADDRESS OF ESTABLISHMENT: 68 CA MO S-Vttf, UN_l� A)f A h vh h 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 33 q _ Li-10 1320 0 9.. EMAIL ADDRESS: SSA C V GI llt►1d T vh C►a G P 0 w1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME H ( n n is Fu vA I I\, kaij pt COY , PRESIDENT .br. V i w\ -1 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 1.6111b . Q:\Application Forms\HAZMAT APP 2017 REVISED.do �^ +u�-Q u+ fl2K w u K IKEToh4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA�BLE p 200 Main Street• Hyannis, MA 02601 �pfFDMA+�`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 7 / Business Name: %Oyl' E(:�iCOA colf Date: 6 I Location/Mailing Address: Contact Name/Phone: 771yJ 470 -137o Inventory Total Amount: �1 SDS: eS ' License#: 1��6 Tier II : Nb Labeling: O Spill Plan: Oil/WaterSeparator: 0 Floor Drains: 0 Emer enc Numbers: Storage Areas/Tanks: a� ft'. Emergency/Containment Equipment: Q(1 Si Waste Generator ID: NON 177 A %31) #'Waste Product: VC 1 Ge` i�C, rlG+06I, P'W4C Date&Amount of Last Shipment/Frequency: ac'� Licensed Waste Hauler&Destination: C,lP(A-n OLrborS g ny-y Ca.15r) C)Atu� wg,StP Moovv Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash 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" Pro PaA 0 t (including chloroform, formaldehyde, 1 hydrochloric acid, other acids) VIOLATIONS: --_ CA( ( � ORDERS: INFORMATION/RECOMMENDATIONS: Q FeCOt•+'1t CA� Q ;01 f rA3� , RME Inspector. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS r IME roy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 RARM SS. e` 200 Main Street• Hyannis, MA 02601 t6S9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MPS Business Name: Q,vti V1 t 5 Fa,hit , I y Ap-�- C4f-e— Date: Location/Mailing Ad ress: h 8 2, A, Contact Name/Phone: a,vL• InventoryTotal Amount: A-��'4 16..1 SDS: Y-6 License# Ire-A+ � Tier II : Labeling: b1C, Spill Plan: -to o -V Oil/WaterSeparator: 0A _ Floor Drains: Emergency Numbers: +` Storage Areas/Tanks: ►- I_ Oahk c kt-�wA- Emer enc /Containment ui ment: A'n Waste Generator ID: Waste Product:%�tik-ec.�c�tow.ks.le�+SoD,zoQzv\+-'1 Date&Amount of Last Shipment/Frequency: 2A 15,jO Licensed Waste Hauler&Destination: Other Waste Disposal Methods: C+'V-,NA n.a�i Ot{ LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION RECOMMENDATIONS: lr4L- C�, c.� man?` a M0.k Sao<u�r�-oy-s t-t w t 1-ov\,,�h \1Jt.\C, l Ir�V4*0k►wwk.At2,W4, h ca.kor.��<�I c 4 CI�Q�n �-��c�vSS Inspectorr:: o� 5 +l �a�b� 6� / S 1 i1k �k�FacilityRepresentative: ( aVloi +e �fmf- �I�, } 11ITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Please print or type.(Form designed for use on elite.(!2-pitch)typewriter) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS' 1.G�evneratoyr�ID Nu13 Rmb�e}r y 2.Page 1 of 3}Emergency Response Phhone 4.Manifest Tracking Number WASTE MANIFEST _' F ram; (�. # FLE 5 Generator's Name and Mailinr99ddress Generator's Site Address(if different than mailing address) }i�f'9F@fll4 3t1 to s.�4d,"�tr4a r ai a:34s. Generator's Phone(7741 0-3 10 6.Transporter.]Company Name U.S.EPA ID Number Hatb03$ I Ni i 11 Q ,` }r `w" 4 tp 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number "��a:sr Rtir m�tT?4x;a#.a ecA 4z *Fns r 141C Facility's Phone: mc-C,j��-i-gi ,V, ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HIM and Packing Group(if any)) 13.Waste Codes H No. Type Quantity Wt.Nol. 11012 'fA.AGFTiC ACID�E 9l.R6T�ON tk,��d3 1 V Z 2,v w 1 t CD t 3. ! I t 4 14.Special Handling Instructions and Additional Information i r 15. GENERATOR'SIOFFEROR'S 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's{/Oyfferor's Printed/Typed Name ! ignature e Monthay ear 16•'InternationolShipments] ❑ + ✓ �? e- F- Import to.U.S. ❑Export from U.S. Port ofentry/exit s Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transpoyiert^ me p d Name Signature f Month ay Year Z Transporter 2Prihted/Typed=Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space- ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q �- Facilit's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z r� 9.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 7 T 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered.by the manifest except as noted in Item 18a Printed/Tvped Name Signature Month Day Year EPA For i 87D0 �v, 05 ,Fd v4i°us end i p4 s9ar&e;,obsole obsolete, ,�.y111 DESIGNATED FACILITY TO GENERATOR Page 1 of 2 Lavelle, Timothy From: Tim Lavelle [timlavelle@outlook.com] Sent: Wednesday, August 09, 2017 4:13 PM To: Lavelle, Timothy Subject: FW: Hyannis Family Medical Care From:Stacy Duffany [mailto:stacy.duffany@hfmcpc.com] Sent: Wednesday, August 9, 2017 1:19 PM To:timlavelle@outlook:com Subject: Fwd: Hyannis Family Medical Care Good Afternoon Mr. LaVelle: Last year, we had our liquid waste analyzed. I wanted to forward some documentation concerning that analysis. I thought this may help you to determine the best recommendations for the storage of the liquid waste. Thank you again, Stacy Duffany ----------Forwarded message ---------- From: Stacy Duffany <stacy.duffany(a,hfmcpc.com> Date: Wed, Aug 9, 2017 at 11:16 AM Subject: Hyannis Family Medical Care To: wrex2hyannisfire.org, timlavellegoutlook.com Cc: Pina Patel <pina.patel@hfmcpc.com>, Jennifer Huggins <jennifer.hugginskhfmcpc.com> Good Morning Captain Rex and Mr. LaVelle: My name is Stacy Duffany. I am the laboratory supervisor for Hyannis Family Medical Care (HFMC). It was a pleasure to meet Captain Rex in person this morning: The Captain indicated that I may be meeting Mr. LaVelle in the near future as well. After a precursory review of the Haz Mat Fees Announcement Document, it would appear that HFMC needs to apply for a Hazardous Materials permit. I calculated that we have approximately 24 gallons of solvents and approximately 10 gallons of solvent waste. I would think that we need a Category 1 Permit, but I would defer to Mr. LaVelle for his professional opinion. The Captain indicated that he would be in touch regarding any specific permitting that would be required for two liquid nitrogen dewars we have on site. It is common practice to have these dewars located indoors in an analytical setting. Upon an inquiry to another analytical laboratory that does this, they have a permit for the possession of the dewars. By all means, please let us know what is required of us at your earliest convenience and we will meet those requirements. 8/10/2017 Page 2 of 2 I am in the office most days Monday - Friday 7:00am - 3:00pm. My contact information is below. My mobile number is the best telephone number to reach me any time. Per the request of the Captain, please find a chemical inventory list attached. Thank you very much for all your help in guiding us through this process. We look forward to acquiring the correct permits for our work here. Best regards, Stacy Duffany Stacy Duffany Laboratory Supervisor 1lya.nnis .Fam.ily Medical. Care 68 Camp Street; Unit I Hvannis, MA 02601 Main: (774) 470 - 1370, ext. 46 Fax: (508) 484 - 1777 Mobile: (508) 320 - 0864 Email: stacy.duffany(f.�hfmcpc.com Stacy Duffany Laboratory Supervisor l4va.nnis Family Medical. Care 68 Camp Street, Unit 1 Hyannis, MA 02601 Main: (774) 470 - 1370, ext. 46 Fax: (508) 484 - 1777 Mobile: (508) 320 - 0864 Email: stacy.duffany(&hfmcpc.com 8/10/2017 Dear WASTE MATERIAL PROFILE SHEET ,gHag�� Clean Harbors Profile No. CH1397897 A.GENERAL INFORMATION GENERATOR NAME: Hyannis Family Medical Care GENERATOR EPA ID WREGISTRATION# MP5084841777 GENERATOR CODE(Assigned by Clean Harbors) HY13758 CITY Hyannis STATE/PROVINCE MA ZIP/POSTAL CODE 02601 ADDRESS 105 Park Street PHONE: (774)470-1370 CUSTOMER CODE(Assigned by Clean Harbors) ME30677 CUSTOMER NAME: Med Waste Disposal ADDRESS 406 North Street CITY Duxbury STATE/PROVINCE MA ZIP/POSTAL CODE 02332 B.WASTE DESCRIPTION WASTE DESCRIPTION: Fixer Waste PROCESS GENERATING WASTE: spent lab waste IS THIS WASTE CONTAINED IN SMALL PACKAGING CONTAINED WITHIN A LARGER SHIPPING CONTAINER? No C.PHYSICAL PROPERTIES(at 25C or 77F) PHYSICAL STATE NUMBER OF PHASES/LAYERS VISCOSITY(If liquid present) COLOR SOLID WITHOUT FREE LIQUID 7 1 2 3 TOP 0.00 0 1-100(e.g.Water) POWDER clear MONOLITHIC SOLID %BY VOLUME(Approx.) MIDDLE 0.00 101-500(e.g.Motor Oil) LIQUID WITH NO SOLIDS BOTTOM 0.00 501-10,000(e.g.Molasses) LIQUID/SOLID MIXTURE >10,000 •FREE LIQUID ODOR •SETTLED SOLID NONE BOILING POINT OF(°C) MELTING POINT OF(°C) TOTAL ORGANIC •TOTAL SUSPENDED SOLID —95(-35) CARBON SLUDGE MILD <140(<60) <=10� STRONG 95-100(35-38) GAS/AEROSOL 101-129(38-54) 140-200(60-93) O 1-9% Describe: ❑ >200(>93) >=10% FLASH POINT OF(°C) pH SPECIFIC GRAVITY ASH BTU/LB(MJ/kg) <73(<23) <=2 <0.8(e.g.Gasoline) >20 <2,000(<4.6) < 0.1 73-100(23-38) 2.1-6.9 0.8-1.0(e.g.Ethanol) 0.1-1.0 � Unknown .21 2,000-5,000(4.6-11.6) ❑ 101-140(38-60) 7(Neutral) 0 1.0(e.g.Water) 1.1-5.0 5,000-10,000(11.6-23.2) 141-200(60-93) 7.1-12.4 1.0-1.2(e.g.Antifreeze) 5.1-20.0 >10,000(>23.2) i.� >200(>93) >=12.5 >1.2(e.g.Methylene Chloride) Actual: D.COMPOSITION (List the complete composition of the waste,include any inert components and/or debris.Ranges for individual components are acceptable.If a trade name is used, CHEMICAL MIN MAX UOM ACETIC ACID 1.0000000 -- 15.0000000 % WATER 85.0000000 -- 99.0000000 % DOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS(EX.,METAL PLATE OR PIPING>1/4"THICK OR YES NO >12"LONG,METAL REINFORCED HOSE>12"LONG,METAL WIRE>12"LONG,METAL VALVES,PIPE FITTINGS,CONCRETE REINFORCING BAR OR PIECES OF CONCRETE>3")? If yes,describe,including dimensions: DOES THIS WASTE CONTAIN ANY METALS IN POWDERED OR OTHER FINELY DIVIDED FORM? YES 0 NO DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING;ANIMAL WASTES,HUMAN BLOOD,BLOOD PRODUCTS,BODY YES Q NO FLUIDS,MICROBIOLOGICAL WASTE,PATHOLOGICAL WASTE,HUMAN OR ANIMAL DERIVED SERUMS OR PROTEINS OR ANY OTHER POTENTIALLY INFECTIOUS MATERIAL? I acknowledge that this waste material is neither infectious nor does it contain any,organism known to be a threat to human health. This certification is based on my knowledge of the material. Select the answer below that applies: The waste was never exposed to potentially infectious material. YES NO Chemical disinfection or some other form of sterilization has been applied to the waste. YES NO I ACKNOWLEDGE THAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS. " YES NO I ACKNOWLEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETTED. YES NO SPECIFY THE SOURCE CODE ASSOCIATED WITH THE G22 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE. W113 WASTE. 1 Report Printed On:Friday,March 10,2017 IWINWEB/Profile\Waste Profile.rdl Pape 1 of 3 � l Cteanftr�r Clean Harbors Profile No. CH1397897 E.CONSTITUENTS Are these values based on testing or knowledge? Knowledge Q Testing If constituent concentrations are based on analytical testing,analysis must be provided. Please attach document(s)using the link on the Submit tab. . Please indicate which constituents below apply. Concentrations must be entered when applicable to assist in accurate review and expedited approval of your waste profile.Please note that the total regulated metals and other constituents sections require answers. RCRA REGULATED METALS REGULATORY TCLP TOTAL UOM NOT APPLICABLE LEVEL(mg/1) mg/l D004 ARSENIC 5.0 FYI. .. DO05 BARIUM 100.0 J D006 CADMIUM 1.0 J DO07 CHROMIUM 5.0 ❑ DO08 LEAD 5.0 L`'t DO09 MERCURY 0.2 DO 10 SELENIUM 1.0 . -----•- D011 SILVER 5.0 ------------------------- - VOLATILE COMPOUNDS OTHER CONSTITUENTS MAX UOM NOT D018 BENZENE 0.5 APPLICABLE ...................................................... BROMINE ❑ D019 q CARBON TETRACHLORIDE 0.5 � D021 CHLOROBENZENE 100.0 CHLORINE IJ FLUORINE D022 CHLOROFORM 6.0 D028 1,2-DICHLOROETHANE 0.5 IODINE -•----------•----•--------------- ----- SULFUR D029 1,1-DICHLOROETHYLENE 0.7 . J -----••--•---•----• •--•----•- POTASSIUM D035 METHYL ETHYL KETONE 200.0 D039 TETRACHLOROETHYLENE 0.7 SODIUM J - - - D040 TRICHLOROETHYLENE 0.5 AMMONIA ❑ _ J D043 VINYL CHLORIDE 0.2 CYANIDE AM ENABLE .................................................... ______ ------------------------------------- COMPOUNDS CYANIDE REACTIVE- SEMI-VOLATILE _ _ J D023 o-CRESOL 200.0 CYANIDE TOTAL _ - •- ---•------•--•--•. SULFIDE REACTIVE D024 m-CRESOL 200.0 J 0025 p-CRESOL 200.0 HOCs PCBs D026 CRESOL(TOTAL) 200.0 - NONE Q NONE D027 1,4-DICHLOROBENZENE 7.5 <1000 PPM <50 PPM D030 2,4-DINITROTOLUENE 0.13 >=1000 PPM >=50 PPM ---•-------------------------------------------------- D032 HEXACHLOROBENZENE 0.13 - -•••-- IF PCBS ARE PRESENT,IS THE D033 HEXACHLOROBUTADIENE 0.5 WASTE REGULATED BY TSCA 40 ...................................................... CFR761? D034 HEXACHLOROETHANE 3.0 D036 NITROBENZENE 2.0 YES ❑J NO --- ---------------------•--------------------------•- D037 PENTACHLOROPHENOL 100.0 0038 PYRIDINE 5.0 . -•------------------•----------- D041 2,4,5-TRICHLOROPHENOL 400.0 D042 2,4,6-TRICHLOROPHENOL 2.0 ------------------------------------------------------- PESTICIDES AND HERBICIDES D012 ENDRIN 0.02 ------------------------------------------------------ D013 LINDANE 0.4 D014 METHOXYCHLOR 10.0 - -------------------- - 6015 TOXAPHENE 0.5 D016 2,4-D 10.0 ------------------------------ --------------- D017 , 2,4,5-TP(SILVEX) 1.0 D02C CHLORDANE 0.03 •-----•-------------•--- --------------------- D031 HEPTACHLOR(AND ITS EPDXIDE) 0.008 ADDITIONAL HAZARDS DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT,WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED? YES 0 NO (If yes,explain) CHOOSE ALL THAT APPLY DEA REGULATED SUBSTANCES EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL Q NONE OF THE ABOVE Report Printed On:Friday,March 10,2017 /WINWEB/Profile\Waste Profile.rdl Pape 2 of 3 Clean Harbors Profile No. CH 1397897 tleanHaE� F.REGULATORY STATUS YES FV01 NO USEPA HAZARDOUS WASTE? ❑� YES NO DO ANY STATE WASTE CODES APPLY? MA99 Texas Waste Code YES Q NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY? YES Q NO IS THIS WASTE PROHIBITED FROM LAND DISPOSAL WITHOUT FURTHER TREATMENT PER 40 CFR PART 268? LDR CATEGORY: Not subject to LDR VARIANCE INFO: YES Q NO IS THIS A UNIVERSAL WASTE? YES Q NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR(CESQG)? YES NO IS THIS MATERIAL GOING TO BE MANAGED AS A RCRA EXEMPT COMMERCIAL PRODUCT,WHICH IS FUEL(40 CFR 261.2(C)(2)(II))? YES Q NO DOES TREATMENT OF THIS WASTE GENERATE A F006 OR F019 SLUDGE? YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIBITION FOUND AT 40 CFR 268.3(C)? YES Q NO DOES THIS WASTE CONTAIN VOC'S IN CONCENTRATIONS>=500 PPM? YES NO DOES THE WASTE CONTAIN GREATER THAN 20%OF ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE>=.3KPA(.044 PSIA)? YES NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE>77 KPA(11.2 PSIA)? YES FY-1] NO IS THIS CERCLA REGULATED(SUPERFUND)WASTE? Y-S F-,�O NO IS THE WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES? Hazardous Organic NESHAP(HON)rule(subpart G) Pharmaceuticals production(subpart GGG) YES NO IF THIS IS A US EPA HAZARDOUS WASTE,DOES THIS WASTE STREAM CONTAIN BENZENE? YES NO Does the waste stream come from a facility with one of the SIC codes listed under benzene NESHAP or is this waste regulated under the benzene NESHAP rules because the original source of the waste is from a chemical manufacturing,coke by-product recovery,or petroleum refinery process? YES NO Is the generating source off this waste stream a facility with Total Annual Benzene(TAB)>10 Mg/year? What is the TAB quantity for your facility? t -1 Megagram/year(1 Mg=2,200 Ibs) The basis for this determination is:Knowledge of the Waste Or Test Data Knowledge Testing Describe the knowledge G.DOTITDG INFORMATION DOT/TDG PROPER SHIPPING NAME: UN2790,ACETIC ACID SOLUTION,8,PG III H. TRANSPORTATION REQUIREMENTS ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY YEARLY OTHER CONTAINERIZED BULK LIQUID BULK SOLID 11-22 CONTAINERS/SHIPMENT GALLONS/SHIPMENT: 0 Min-0 Max GAL. SHIPMENT LOW TON YARD STORAGE CAPACITY: 2 CONTAINER TYPE: TONSIYARDS/SHIPMENT: 0 Min-0 Maz PORTABLE TOTE TANK BOXICARTONICASE CUBIC YARD BOX F%,�o DRUM OTHER: 16 DRUM SIZE: I.SPECIAL REQUEST COMMENTS OR REQUESTS: GENERATOR'S CERTIFICATION I certify that I am authorized to execute this document as an authorized agent.I hereby certify that all information submitted in this and attached documents is correct to the best of my knowledge.)also certify that any samples submitted are representative of the actual waste.lf Clean Harbors discovers a discrepancy during the approval process,Generator grants Clean Harbors the authority to amend the profile,as Clean Harbors deems necessary,to reflect the discrepancy. AUTHORIZED SIGNATURE NAME(PRINT) TITLE DATE Report Printed On:Friday,March 10,2017 /WINWEB/Profile\Waste Profile.rdl Pape 3 of 3 CHEMICAL INVENTORY Chemical Name Common Name Manufacturer Product Number MSDS Note Columnl 6-Acetylmorphine(6MAM) Cerilliant A-009 Yes 6-Acetylmorphine(6MAM)-d3 Cerilliant A-010 Yes 6AM Reagent Kit Carolina Liquid Chemistries BL-425 Yes 7-Aminoclonazepam Cerilliant A-916 Yes AcetonitHle Fisher A996 4 Yes Acid Wash Solution CO2 Acid Reagent Carolina Liquid Chemistries 100262 Yes Alcohol Prep Pads Henry Schein 112-6131 Yes Alkaline Wash Solution Wash Concentrate Carolina Liquid Chemistries 100263 Yes Aloe Guard Health Link Yes alpha-OH Alprazolam Cerilliant A-907 Yes Alprazolam Cerilliant A-903 Yes Ammonium Acetate Avantor Performance Materials 0599-08 Yes Ammonium Formate Acros Organics 401152500 Yes Amphetamine Cerilliant A-007 Yes Amphetamine-d5 Cerilliant A-013 Yes Amphetamines Reagent Carolina Liquid Chemistries BL-412 Yes Barbiturates Reagent Carolina Liquid Chemistries BL-417 Yes See Amphetamines Reagent Benzodiazepine Reagent Carolina Liquid Chemistries BL-418 Yes See Amphetamines Reagent Benzoylecgonine Cerilliant B-004 Yes Benzoylecgonine-d3 Cerilliant B-008 KYYesibeta-Glucuronidase Campbell Science DR2100 Buprenorphine Cerilliant B-044 Buprenorphine Reagent Carolina Liquid Chemistries BL-424 Butabital-d5 Cerilliant B-030 Cannabinoid ReagentCarolina Liquid Chemistries BL-410A See Amphetamines Reagent Carisoprodol Cerilliant C-077 Clonazepam Cerilliant C-907 Yes Cocaine.Metabolite Reagent Carolina Liquid Chemistries BL-413 Yes ISee Amphetamines Reagent Codeine Cerilliant C-006 Yes Codeine-d6 Cerilliant C-041 Yes Diazepam Cerilliant D-907 Yes Ecstasy Reagent Carolina Liquid Chemistries BL-423 Yes EDDP Cerilliant E-022 Yes Ethanol Reagent Carolina Liquid Chemistries BL-421 Yes ISee Amphetamines Reagent Ethyl Alcohol Assay Calibrator#2(100 mg/dL),5mL Lin-Zhi International,Inc 0223 Yes Ethyl Glucuronide Cerilliant E-015 Yes Ethyl Glucuronide-d5 Cerilliant E-063 Yes Ethyl Sulfate Cerilliant E-064 Yes Ethyl Sulfate-d5 Cerilliant E-066 Yes Fentanyl Cerilliant F-013 Yes Fentanyl-d5 Cerilliant F-001 Yes 100000 ng/mL Formic Acid Fisher A117-50 Yes Hydrocodone lCerilliant H-003 Yes Hydrocodone-d6 lCerilliant H-048 Yes Updated 8/10/2017 1 of 3 CHEMICAL INVENTORY Chemical Name Common Name Manufacturer Product Number MSDS Note Columnl Hydrogen Peroxide 30% BDH VWR Analytical BDH7742 Yes Hydromorphone Cerilliant H-004 Yes Hydromorphone-d6 Cerilliant H-050 Yes Isopropyl Alcohol 2-Propanol Fisher A461-4 Yes Isopropyl Rubbing Alcohol USP 70% Henry Schein 112-7067 Yes Isopropyl Alcohol 99% Ward's Science 470301-464 Yes Lorazepam Cerilliant L-901 Yes MDMA Cerilliant M-013 Yes Methadone Cerilliant M-007 Yes Methadone Reagent Carolina Liquid Chemistries BL-415 Yes See Amphetamines Reagent Methadone-d3 Cerilliant M-021 IYes Methamphetamine Cerilliant M-009 Yes Methamphetamine-d5 Cerilliant M-023 Yes Methanol Fisher A456-4 Yes Morphine Cerilliant M-005 Yes Morphine-d3 Cerilliant M-006 Yes Norbuprenorphine Cerilliant N-059 Yes Norbuprenorphine Cutoff Calibrator(10 ng/mQ,5mL Lin-Zhi International,Inc 0275 Yes See Ethyl Alcohol Assay Calibrator#2 Norbuprenorphine Intermediate Calibrator#1(20 ng/mL),5mL Lin-Zhi International,Inc 0277 Yes ISee Ethyl Alcohol Assay Calibrator#2 Norbuprenorphine Intermediate Calibrator#2(40 ng/mL),5mL Lin-Zhi International,Inc 0278 Yes See Ethyl Alcohol Assay Calibrator#2 Norbuprenorphine Low Calibrator(5 ng/mL),5mL Lin-Zhi International,Inc 0273 Yes See Ethyl Alcohol Assay Calibrator#2 Nordiazepam Cerilliant N-905 Yes Nordiazepam-d5 Cerilliant N-911 Yes Norfentanyl Cerilliant N-031 Yes Norhydrocodone Cerilliant N-053 Yes Noroxycodone Cerilliant N-011 Yes Opiate Reagent Carolina Liquid Chemistries BL-411A Yes See Amphetamines Reagent Opiates Cutoff Calibrator(Morphine 300 ng/mL),5mL Lin-Zhi International,Inc 0023 Yes See Ethyl Alcohol Assay Calibrator#2 Opiates High Calibrator(Morphine 1000 ng/mL),5mL Lin-Zhi International,Inc 0025 Yes See Ethyl Alcohol Assay Calibrator#2 Opiates Intermediate Calibrator(Morphine 600 ng/mL),5mL Lin-Zhi International,Inc 0024 Yes See Ethyl Alcohol Assay Calibrator#2 Opiates Low Calibrator(Morphine 150 ng/mL),5mL Lin-Zhi International,Inc 0022 Yes See Ethyl Alcohol Assay Calibrator#2 Oxazepam Cerilliant 0-902 Yes Oxycodone Cerilliant 0-002 Yes Oxycodone Cutoff Calibrator#1(100 ng/mL),5mL Lin-Zhi International,Inc 0243b Yes See Ethyl Alcohol Assay Calibrator#2 Oxycodone Cutoff Calibrator#2(300 ng/mL),5mL Lin-Zhi International,Inc 0246b Yes See Ethyl Alcohol Assay Calibrator#2 Oxycodone High Calibrator(800 ng/mL),5mL Lin-Zhi International,Inc 0249b Yes See Ethyl Alcohol Assay Calibrator#2 Oxycodone Intermediate Calibrator(500 ng/mL),5mL Lin-Zhi International,Inc 0248b Yes See Ethyl Alcohol Assay Calibrator#2 Oxycodone Reagent Carolina Liquid Chemistries BL-419B Yes ISee Ecstasy Reagent Oxymorphone Cerilliant 0-004 Yes Phencyclidine(PCP) Cerilliant P-007 Yes Phencyclidine(PCP)-d5 Cerilliant P-006 Yes Phencyclidine Reagent Carolina Liquid Chemistries BL-414 Yes See Amphetamines Reagent Phenobarbital Cerilliant P-008 Yes Propoxyphene Reagent ICarolina Liquid Chemistries BL-416 Yes See Amphetamines Reagent Updated 8/10/2017 2 of 3 a CHEMICAL INVENTORY Chemical Name Common Name Manufacturer Product Number MSDS Note Columnl Purell GOJO 2156 Yes Sodium Acetate Trihydrate EMD Millipore SX0255-1 Yes Surine DTI Dyna-Tek 720 Yes _ Temazepam Cerilliant T-907 Yes THC-COON Cerilliant T-019 Yes THC-COOH-d3 Cerilliant T-008 IYes Tramadol Cerilliant T-027 IYes Water Fisher W6-4 lYes Updated 8/10/2017 3 of 3 r - •ti eurofins (X Final Report Spectrum Analytical ❑ Re-Issued Report ❑ Revised Report Report Date: 27-Feb-17 16:46 Laboratory Report New England Disposal Technologies,Inc Project: United Medi-Sutton,MA 83 Gilmore Drive Sutton,MA 01590 Project#: 20-18962 Attn:Marty Gaffney Laboratory ID Client Sample ID Matrix Date Sampled Date Received SC31788-01 Aqueous Waste Waste Water 17-Feb-17 12:00 21-1`647 16:55 I attest that the information contained within the report has been reviewed for accuracy and checked against the quality control requirements for each method. These results relate only to the sample(s)as received. All applicable NELAC requirements have been met. Massachusetts#M-MA 13 8/MA I I 10 Authorized by: Connecticut#PH-0777 Florida#E87936a� J Maine#MA138 ff New Hampshire#2972/2538 New Jersey#MA011 New Ycrk#11393 June O'Connor Pennsylvania#68-04426/68-02924E Laboratory Director Rhode Island#LA000348 USDA#P330-15-00375 Vermont#VT-11393 Eurofins Spectrum Analytical holds primary certification in the State of Massachusetts for the analytes as indicated with an X in the "Cert."column within this report. Please note that the State of Massachusetts does not offer certification for all analytes. Please refer to our website for specific certification holdings in each state. Please note that this report contains 15 pages of analytical data plus Chain of Custody document(s). When the Laboratory Report is indicated as revised,this report supersedes any previously dated reports for the laboratory ID(s)referenced above. Where this report identifies subcontracted analyses,copies of the subcontractor's test report are available upon request. This report may not be reproduced,except in full,without written approval from Eurofins Spectrum Analytical,Inc. Eurofins Spectrum Analytical,Inc.is a NELAC accredited laboratory organization and meets NELAC testing standards. Use of the NELAC logo however dces not insure that Eurofins Spectrum Analytical,Inc.is currently accredited for the specific method or analyte indicated Please refer to our Qualio1veb page at www.spectrum-ana.'ytical.com for a full listing of our current certifications and fields of accreditation.States in which Eurofins Spectrum Analytical,Inc.holds NELAC certification are New York,New Hampshire,New Jersey,Pennsylvania and Florida.All analytical work for Volatile Organic and Air analysis are transferred to and conducted at our 830 Silver Street location(PA-68-04426). Please contact the Laboratory or Technical Director at 800-789-9115 with any questions regarding the data contained in this laboratory report. Eurofins Spectrum Analytical,Inc. 830 Silver Street T 1 413-789-9018 Agawam,MA 01001 F 1 413-789-4076 www.EurofinsuS.com/Spectrum Page 1 of 15 f CASE NARRATIVE: Data has been reported to the RDL. This report excludes estimated concentrations detected below the RDL and above the MDL (J-Flag). All non-detects and all results below the reporting limit are reported as"<"(less than)the reporting limit in this report. The samples were received 1.2 degrees Celsius,please refer to the Chain of Custody for details specific to temperature upon receipt. An infrared thermometer with a tolerance of+/-1.0 degrees Celsius was used immediately upon receipt of the samples. If a Matrix Spike(MS),Matrix Spike Duplicate(MSD)or Duplicate(DUP)was not requested on the Chain of Custody,method criteria may have been fulfilled with a source sample not of this Sample Delivery Group. Analyses for Total Hardness,pH,and Total Residual Chlorine fall under the state of Pennsylvania code Chapter 252.6 accreditation by rule. See below for any non-conformances and issues relating to quality control samples and/or sample analysis/matrix. SW846 8260C Calibration: 1702010 Analyte quantified by quadratic equation type calibration. 1,1,1,2-Tetrachloroethane 1,1-Dichloropropene 1,2-Dibromo-3-chloropropane 4-Isopropyltoluene Bromoform Carbon tetrachloride D ibromochl oromethane Naphthalene n-Butylbenzene trans-1,3-Dichloropropene This affected the following samples: 1703383-BLKI 1703383-BSI 1703383-BSD1 Aqueous Waste S702276-ICV 1 S702622-CCV 1 Samples: S702622-CCV 1 Analyze percent difference is outside individual acceptance criteria(20),but within overall method allowances. Bromodichloromethane(21.9%) Carbon disulfide(-27.8%) Chloromethane(-24.3%) Analyte percent drift is outside individual acceptance criteria(20),but within overall method allowances. Dichlorodifluoromethane(Freonl2)(-38.0%) This lahoratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 2 of 15 SW846 8260C Samples: S702622-CCV 1 This affected the following samples: 1703383-BLKI 1703383-BSI 1703383-BSD I Aqueous Waste SC31788-01 Aqueous Waste Elevated Reporting Limits due to the presence of high levels of non-target analytes;sample may not meet client requested reporting limit for this reason. The Reporting Limit for this analyte has been raised to account for interference from coeluting organic compounds present in the sample. Acetone This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 * *Reportable Detection Limit Page 3 of 15 Sample Acceptance Check Form Client: New England Disposal Technologies,Inc Project: United Medi-Sutton,MA/20-18962 Work Order: SC31788 Sample(s)received on: 2/21/2017 The following outlines the condition of samples for the attached Chain of Custody upon receipt. Yes No N/A Were custody seals present? ❑ ❑ ❑ Were custody seals intact? ❑ ❑ n Were samples received at a temperature of<6°C? ❑ ❑ ❑ Were samples refrigerated upon t-ansfer to laboratory representative? ❑ ❑ ❑ Were sample containers received intact? El ❑ ❑ Were samples properly labeled(labels affixed to sample containers and include sample ID,site ✓❑ ❑ ❑ location,and/or project number aad the collection date)? Were samples accompanied by a Chain of Custody document? 0 ❑ ❑ Does Chain of Custody documen_include proper,full,and complete documentation,which shall ✓❑ ❑ ❑ include sample ID,site location,and/or project number,date and time of collection,collector's name, preservation type,sample matrix and any special remarks concerning the sample? Did sample container labels agree with Chain of Custody document? ✓❑ ❑ ❑ Were samples received within method-specific holding times? ✓❑ ❑ ❑ This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 4 of 15 Summary of Hits Lab ID: Client ID: Parameter Result Flag Reporting Limit Units Analytical Method No hits detected. Please note that because there are no reporting limits associated with hazardous waste characterizations or micro analyses, this summary does not include hits from these analyses if included in this work order. This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 5 of 15 r Sample Identification Client Project# Matrix Collection Date/Time Received Aqueous Waste 20-18962 Waste Water 17-Feb-17 12:00 21-Feb-17 SC31788-01 CAS No. Analyte(s) Result Flag Units *RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert Volatile Organic Compounds Volatile Organic Compounds by SW846 8260 Roy Prepared by method SW846 5030 Water MS 76-13-1 1,1,2-Trichlorotrifluoroetha <50000 D Ng/I 50000 44600 50000 SW8468260C 23-Feb-17 24-Feb-17 GMA 1703383 ne(Freon 113) 67.64-1 Acetone <950000 R03,D Ng/I 950000 172000 50000 " 107-13-1 Acrylonitrile <25000 D Ng/I 25000 23300 50000 " 7143-2 Benzene <50000 D Ng/I 50000 14200 50000 108-86-1 Bromobenzene <50000 D Ng/I 50000 10400 50000 74-97-5 Bromochloromethane <50000 D Ng/I 50000 26400 50000 75-27-4 Bromodichloromethane <25000 D Ng/I 25000 13400 50000. 75-25-2 Bromoform <50000 D pg/I 50000 18200 50000 74-83-9 Bromomethane <100003 D pg/l 100000 44800 50000 78-93-3 2-Butanone(MEK) <100000 D Ng/I 100000 59800 50000 104-51-8 n-Butylbenzene <50000 D Ng/I 50000 14100 50000 135-98-8 sec-Butylbenzene <50000 D Ng/I 50000 16800 50000 96-06.8 tert-Butylbenzene <50000 D Ng/I 50000 15000 50000 75-15-0 Carbon disulfide <100000 D pg/I 100000 20600 50000 56-23-5 Carbon tetrachloride <50000 D Ng/I 50000 30000 50000 108-90-7 Chlorobenzene <50000 D pg/I 50000 10800 50000 75-00-3 ChWoethane <100000 D Ng/I 100000 29400 50000 " 67-66-3 Chloroform <50000 D - Ng/I 50000 20400 50000 74.87-3 Chlo.omethane <100000 D Ng/I 100000 20200 50000 95-49-8 2-Chlorotoluene <50000 D Ng/I 50000 15800 50000 10643-4 4-Chlorotoluene <50000 D Ng/l 50000 12900 50000 96-12-8 1,2-Dibromo-3-chloroprop <100000 D pg/I 100000 43200 50000 " ane 124-18-1 Dibromochloromethane <25000 D Ng/I 25000 11200 50000 " 106-93-4 1,2-Dibromoethane(EDB) <25000 D Ng/I 25000 13400 50000 74-95-3 Dibromomethane <50000 D Pg/I 50000 9450 50000 95-50-1 1,2-Dichlorobenzene <50000 D Ng/I 50000 12400 50000 541-73-1 1,3-Dichlorobenzene <50000 D Ng/I 50000 10300 50000 106-46-7 1,4-Dichlorobenzene <50000 D Ng/I 50000 12300 50000 75-71-8 Dichlorodifluoromethane <100000 D Ng/I 100000 41600 50000 (Freonl2) 75-34-3 1,1-Dichloroethane <50000 D Ng/I 50000 16200 50000 107.06-2 1,2-Dichloroethane <50000 D Ng/I 50000 14400 50000 75-35-4 1,1-Dichloroethene <50000 D Ng/I 50000 34600 50000 156-59-2 cis-1.2-Dichloroethene <50000 D Ng/I 50000 12800 50000 156-60-5 trans-1,2-Dichloroethene <50000 D Ng/I 50000 15800 50000 78-87-5 1,2-Dichloropropane <50000 D Ng/I 50000 15400 50000 142-28-9 1,3-Dichloropropane <50000 D pg/I 50000 11200 50000 594-20-7 2,2-D'ichloropropane <50000 D Ng/I 50000 33400 50000 563-58-6 1,1-D,ichloropropene <50000 D Ng/I 50000 24100 50000 10061-01-5 cis-1,3-Dichloropropene <25000 D Ng/I 25000 13600 50000 10061-02-6 trans-1,3-Dichloropropene <25000 D Ng/l 25000 24600 50000 100-41-4 Ethylbenzene <50000 D pg/I 50000 15200 50000 87-68-3 Hexachlorobutadiene <25000 D Ng/I 25000 21600 50000 591-78-6 2-Hexanone(MBK) <100000 D Ng/I 100000 61000 50000 This laboratory report is not valid without an authorized signature on the cover page. I 27-Feb-17 16:46 *Reportable Detection Limit Page 6 of 15 Sample Identification Client Project# Matrix Collection Date/Time Received Aqueous Waste 20-18962 Waste Water 17-Feb-17 12:00 21-Feb-17 SC31788-01 CAS No. Analyte(s) Result Flag Units *RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert Volatile Organic Compounds Volatile Organic Compounds by SW846 8260 R05 98-82.8 Isopropylbenzene <50000 D Ng/I 50000 18000 50000 SW846 8260C 23-Feb-17 24-Feb-17 GMA 1703383 99-87.6 4-Isopropyltoluene <50000 D Ng/I 50000 20600 50000 1634-04-4 Methyl tent-butyl ether <50000 D Ng/I •50000 13900 50000 " 108-10-1 4-Methyl-2-pentanone <100000 D Ng/I 100000 43600 50000 (MIBK) 75-09-2 Methylene chloride <100000 D Ng/I 100000 39400 50000 91-20-3 Naphthalene <50000 D Ng/I 50000 17300 50000 103-65-1 n-Propylbenzene <50000 D Ng/I 50000 15800 50000 100-42-5 Styrene <50000 D Ng/I 50000 .20100 50000 630-20-6 1,1,1,2-Tetrachloroethane <50000 D Ng/I 50000 29400 50000 79-34-5 1,1,2,2-Tetrachloroethane <25000 D Ng/I 25000 15500 50000 127-18-4 Tetrachloroethene <50000 D Ng/I 50000 28500 50000 108-88-3 Toluene <50000 D Ng/I 50000 14200 50000 87-61-6 1,2,3-Trichlorobenzene <50000 D Ng/I 50000 24600 50000 120-82-1 1,2,4-Trichlorobenzene <50000 D Ng/I 50000 22500 50000 - < 000 D /I 50000 13900 50000 108-70 3 1,3,o-Trichlorobenzene 50 Ng 71-55-6 M,1-Trichloroethane <50000 D Ng/I 50000 24200 50000 79-00-5 1,1,2-Trichloroethane <50000 D Ng/l 50000 18200 50000 79-01-6 Trichloroethene <50000 D N9/I 50000 19000 50000 " 75-694 Trichlorofluoromethane <50000 D Ng/I 50000 30600 50000 (Freon 11) 96-18-4 1,2,3-Trichloropropane <50000 D Ng/I 50000 12800 50000 95-63-6 1,2,4-Trimethylbenzene <50000 D Ng/I 50000 13400 50000 " 108-67-8 1,3,5-Trimethylbenzene <50000 D Ng/I 50000 12900 50000 75-01-4 Vinyl chloride <50000 D Ng/I 50000 25600 50000 179601-23-1 m,p-Xylene <100000 D Ng/I 100000 19000 50000 95-47-6 o-Xylene <50000 D Ng/I 50000 23500 50000 109-99-9 Tetrahydrofuran <100000 D Ng/I 100000 53000 50000 60-29-7 Ethyl ether <5000C D Ng/I 50000 21500 50000 " 994-05-8 Tert-amyl methyl ether <5000C D Ng/I 50000 24700 50000 637-92-3 Ethyl tert-butyl ether <50000 D pg/I 50000 12000 50000 108-20-3 Di-isopropyl ether. <50000 D Ng/I 50000 11800 50000 75-65-0 Tert-Butanol/butyl alcohol <500000 D Ng/I 500000 299000 50006 123-91-1 1,4-Dioxane <1000000 D Ng/I 1000000 634000 50000 110-57-6 trans-l,4-Dichloro-2-buten <250000 D Ng/I 250000 156000 50000 e 64-17-5 Ethanol <10000000 D Ng/I 10000000 1180000 50000 Surrogate recoveries: 460-00-4 4-Bromofluorobenzene 105 70-130 2037-26-5 Toluene-0 103 70-130 17060-07-0 1,2-Dichloroethane-d4 110 70-130 1868-53-7 Dibromofluoromethane 104 70-130 General Chemistry Parameters Flashpoint Did Not °F 1 SW846 1010A 27-Feb-17 27-Feb-17 VK 1703582 Flash But Caught Fire This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 7 of 15 Sample Identification Client Proiect# Matrix Collection Date/Time Received Aqueous Waste 20-18962 Waste Water 17-Feb-17 12:00 21-Feb-17 SC31788-01 CAS No. Analyte(s) Result Flag Units *RDL MDL Dilution Method Ref. Prepared Analyzed Analyst Batch Cert General Chemistry Parameters ph 4.12 pH Units 1 ASTM D 22-Feb-17 22-Feb-17 BD 1703363 X 1293-99B 19:40 19:45 This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 8 of 15 Volatile Organic Compounds-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units "RDL Level Result %REC Limits RPD Limit Batch 1703383-SW846 5030 Water MS Blank f1703383-BLK11 Prepared&Analyzed:23-Feb-17 1,1,2-Trichlorotrifluoroethane(Freon 113 <1.00 Ng/I 1.00 Acetone <10.0 Ng/I 10.0 Acrylonitrile <0.50 Ng/I 0.50 Benzene <1.00 ug/I 1.00 Bromobenzene <1.00 Ng/I 1.00 Bromochloromethane <1.00 Ng/I 1.00 Bromodichloromethane <0.50 Ng/I 0.50 Bromoform <1.00 Ng/I 1.00 Bromomethane <2.00 ug/I 2.00 2-Butanone(MEK) <2.00 Ng/I 2.00 n-Butylbenzene <1.00 Ng/I 1.00 sec-Butylbenzene <1.00 Ng/I 1.00 tert-Butylbenzene <1.00 Ng/I 1.00 Carbon disulfide <2.00 Ng/I 2.00 Carbon tetrachloride <1.00 Ng/I 1.00 Chlorobenzene <1.00 Ng/I 1.00 Chloroethane <2.00 Ng/I 2.00 Chloroform <1.00 Ng/I 1.00 Chloromethane <2.00 Ng/I 2.00 2-Chlorotoluene <1.00 Ng/I 1.00 4-Chlorotoluene <1.00 Ng/I 1.00 1,2-Dibromo-3-chloropropane <2.00 Ng/I 2.00 Dibromochloromethane <0.50 Ng/I 0.50 1,2-Dibromoethane(EDB) <0.50 Ng/I 0.50 Dibromomethane <1.00 Ng/I 1.00 1,2-Dichlorobenzene <1.00 Ng/I 1.00 1,3-Dichlorobenzene <1.00 pg/I 1.00 1,4-Dichlorobenzene <1.00 Ng/I 1.00 Dichlorodifluoromethane(Freon12) <2.00 pg/I 2.00 1,1-Dichloroethane <1.00 Ng/I 1.00 1,2-Dichloroethane <1.00 Ng/I 1.00 1,1-Dichloroethene <1.00 Ng/I 1.00 cis-1,2-Dichloroethene <1.00 Ng/I 1.00 trans-1,2-Dichloroethene <1.00 Ng/I 1.00 1,2-Dichloropropane <1.00 Ng/I 1.00 1,3-Dichloropropane <1.00 Ng/I 1.00 2,2-Dichloropropane <1.00 Ng/I 1.00 1,1-Dichloropropene <1.00 Ng/I 1.00 cis-1,3-Dichloropropene <0.50 Ng/I 0.50 trans-1,3-Dichloropropene <0.50 Ng/I 0.50 Ethylbenzene <1.00 Ng/I 1.00 Hexachlorobutadiene <0.50 Ng/I 0.50 2-Hezanone(MBK) <2.00 Ng/I 2.00 Isopropy'Ibenzene <1.00 Ng/I 1.00 4-Isopropyltoluene <1.00 Ng/I, 1.00 Methyl tert-butyl ether <1.00 Ng/I 1.00 4-Methyl-2-pentanone(MIBK) <2.00 Ng/I 2.00 Methylene chloride <2.00 Ng/I 2.00 Naphthalene <1.00 Ng/I 1.00 n-Propylbenzene <1.00 Ng/I 1.00 Styrene <1.00 Ng/I 1.00 1,1,1,2-Tetrachloroethane <1.00 Ng/I 1.00 This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 •Reportable Detection Limit Page 9 of 15 Volatile Organic Compounds-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units *RDL Level Result %REC Limits RPD Limit Batch 1703383-SW846 5030 Water MS Blank(1703383-BLK11 Prepared&Analyzed:23-Feb-17 1,1,2,2-Tetrachloroethane <0.50 Ng/I 0.50 Tetrachloroethene <1.00 Ng/I 1.00 Toluene <1.00 Ng/I 1.00 1,2,3-Trichlorobenzene <1.00 Ng/I 1.00 1,2,4-Trichlorobenzene <1.00 Ng/I 1.00 1,3,5-Trichlorobenzene <1.00 Ng/I 1.00 1,1,1-Trichloroethane <1.00 Ng/I 1.00 1,1,2-Trichloroethane <1.00 Ng/l 1.00 Trichlorcethene <1.00 Ng/I 1.00 Trichlorcfluoromethane(Freon 11) <1.00 pg/I 1.00 1,2,3-Trichloropropane <1.00 Ng/l 1.00 1,2,4-Trimethylbenzene <1.00 Ng/I 1.00 1,3,5-Trimethylbenzene <1.00 pg/I 1.00 Vinyl chloride <1.00 Ng/I 1.00 m,p-Xylene <2.00 Ng/I 2.00 o-Xylene <1.00 ug/I 1.00 Tetrahydrofuran <2.00 pg/I 2.00 Ethyl ether <1.00 Ng/I 1.00 Tert-amyl methyl ether <1.00 pg/I 1.00 Ethyl ter:-butyl ether <1.00 Ng/I 1.00 Di-isopropyl ether <1.00 Ng/I 1.00 Tert-Butanol/butyl alcohol <10.0 Ng/I 10.0 1,4-Dioxane <20.0 Ng/I 20.0 trans-1,4-Dichloro-2-butene <5.00 Ng/I 5.00 Ethanol <200 pg/I 200 Surrogate:4-Bromofluorobenzene 52.2 Ng/I 50.0 104 70-130 Surrogate:Toluene-d8 52.5 Ng/I 50.0' 105 70-130 Surrogate:l,2-Dichloroethane-d4 53.6 Ng/I 50.0 107 70-130 Surrogate:Dibromofluoromethane 51.9 pg/l 50.0 104 70-130 LCS(1703383-BS1) Prepared&Analyzed:23-Feb-17 1,1,2-Tri:Norotrifluoroethane(Freon 113) 21.9 Ng/I 20.0 109 70-130 Acetone 19.6 Ng/I 20.0 98 70-130 Acrylonitrile 16.9 Ng/I 20.0 84 70-130 Benzene 20.3 Ng/I 20.0 102 70-130 Bromobenzene 20.9 ug/I 20.0 104 70-130 Bromochloromethane 20.1 Ng/I 20.0 101 70-130 Bromodichloromethane 23.3 (ag/I 20.0 116 70-130 Bromoform 20.4 Ng/I 20.0 102 70-130 Bromomethane 18.0 Ng/I 20.0 90 70-130 2-Butanone(MEK) 19.2 pg/I 20.0 96 70-130 n-Butylbenzene 18.7 Ng/I 20.0 94 70-130 sec-Buty'lbenzene 21.5 Ng/I 20.0 108 70-130 tert-Buty�benzene 21.3 pg/I 20.0 107 70-130 Carbon disulfide 15.1 Ng/I 20.0 76 70-130 Carbon tetrachloride 23.1 Ng/I 20.0 115 70-130 Chlorobenzene 19.8 Ng/I 20.0 99 70-130 Chloroethane 18.1 Ng/I 20.0 91 70-130 Chloroform 21.1 pg/I 20.0 105 70-130 Chloromethane 15.7 Ng/I 20.0 79 70-130 2-Chlorotoluene 20.6 Ng/I 20.0 103 70-130 4-Chlorotoluene 20.8 Ng/I 20.0 104 70-130 This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit . Page 10 of 15 Volatile Organic Compounds-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units *RDL Level Result %REC Limits RPD Limit Batch 1703383-SW846 5030 Water MS LCS(1703383-BS71 Prepared&Analyzed:23-Feb-17 1,2-Dibromo-3-chloropropane 16.9 Ng/I 20.0 84 70-130 Dibromochloromethane 22.0 Ng/I 20.0 110 70-130 1,2-Dibromoethane(EDB) 21.9 Ng/I 20.0 109 70-130 Dibromomethane 21.7 Ng/I 20.0 109 70-130 1,2-Dichlorobenzene 19.3 ug/I 20.0 97 70-130 1,3-Dichlorobenzene 20.7 Ng/I 20.0 103 70-130 1,4-Dichlorobenzene 18.9 Ng/I 20.0 95 70-130 Dichlorodifluoromethane(Freon12) 16.7 Ng/I 20.0 79 70-130 1,1-Dichloroethane 20.7 Ng/I 20.0 104 70-130 1,2-Dichloroethane 22.6 Ng/I 20.0 113 70-130 1,1-Dichloroethene 19.6 Ng/I 20.0 97 70-130 cis-1,2-Dichloroethene 20.8 ug/I 20.0 104 70-130 trans-1,2-Dichloroethene 20.0 pg/I 20.0 100 70-130 1,2-Dichloropropane , 21.0 Ng/I 20.0 105 70-130 1,3-Dichlpropropane 21.8 Ng/I 20.0 109 70-130 2,2-Dichlcropropane 19.9 Ng/I 20.0 99 70-130 1,1-Dichlcropropene 20.4 Ng/I 20.0 102 70-130 cis-1,3-Dichloropropene 20.1 Ng/I 20.0 101 70-130 trans-1,3-Dichloropropene 19.0 Ng/I 20.0 95 70-130 Ethylbenzene 20.6 Ng/I 20.0 103 70-130 Hexachlorobutadiene 21.6 Ng/I 20.0 108 70-130 2-Hexanone(MBK) 20.1 Ng/I 20.0 101 70-130 Isopropylbenzene 21.0 Ng/I 20.0 105 70-130 4-Isopropyltoluene 18.8 Ng/I 20.0 94 70-130 Methyl tert-butyl ether 21.8 Ng/I 20.0 109 70-130 4-Methyl-2-pentanone(MIBK) 21.6 Ng/I 20.0 108 70-130 Methylene chloride 18.9 Ng/I 20.0 94 70-130 Naphthalene 17.0 pg/I 20.0 85 70-130 n-Propylbenzene 19.6 Ng/I 20.0 98 70-130 Styrene 20.9 pg/I 20.0 104 70-130 1,1,1,2-Tetrachloroethane 20.2 Ng/I 20.0 101 70-130 1,1,2,2-Tetrachloroethane 19.2 Ng/I 20.0 96 70-130 Tetrachloroethene 20.6 pg/I 20.0 103 70-130 Toluene 21.7 Ng/I 20.0 108 70-130 1,2,3-Trichlorobenzene 19.5 Ng/I 20.0 98 70-130 1,2,4-Trichlorobenzene 19.6 Ng/I 20.0 98 70-130 1,3,5-Trichlorobenzene 20.7 Ng/I 20.0 103 70-130 1,1,1-Trichloroethane 20.6 Ng/I 20.0 103 70-130 1,1,2-Trichloroethane 20.9 Ng/I 20.0 105 70-130 Trichloroethene 21.1 Ng/I 20.0 106 70-130 Trichlorofluoromethane(Freon 11) 19.8 Ng/I 20.0 99 70-130 1,2,3-Trichloropropane 19.6 Ng/I 20.0 98 70-130 1,2,4-Trimethylbenzene 21.3 Ng/I 20.0 106 70-130 1,3,5-Trimethylbenzene 21.3 Ng/I 20.0 106 70-130 Vinyl chloride 18.2 Ng/I 20.0 91 70-130 m,p-Xylene 20.6 Ng/I 20.0 103 70-130 o-Xylene 20.1 Ng/I 20.0 101 70-130 Tetrahydrofuran 17.2 Ng/I 20.0 86 70-130 Ethyl ether 18.1 Ng/I 20.0 90 70-130 Tert-amyl methyl ether 20.1 Ng/I 20.0 100 70-130 Ethyl tent-butyl ether 21.6 Ng/I 20.0 108 70-130 Di-isopropyl ether 20.2 Ng/I 20.0 101 70-130 This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 1 I of 15 Volatile Organic Compounds-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units *RDL Level Result %REC Limits RPD Limit Batch 1703383-SW846 5030 Water MS LCS(1703383-BSM) Prepared&Analyzed:23-Feb-17 Tert-Butanol/butyl alcohol 182 Ng/I 200 91 70-130 1,4-Dioxane 209 Ng/I 200 104 70-130 trans-1,4-Dichloro-2-butene 16.6 Ng/I 20.0 78 70-130 Ethanol 320 Ng/I 400 80 70-130 Surrogate:4-Bromofluorobenzene 50.5 Ng/I 50.0 101 70-130 Surrogate:Toluene-0 51.8 Yg/I 50.0 104 70-130 Surrogate:l,2-Dichloroethane-d4 52.2 Ng/I 50.0 104 70-130 Surrogate:Dibromofluoromethane 51.1 Ng/I 50.0 102 70-130 LCS Dup 11703383-BSD7) Prepared&Analyzed:23-Feb-17 1,1,2-Trichlorotri0uoroethane(Freon 113) 20.6 Ng/I 20.0 103 70-130 6 20 Acetone 20.8 Ng/I 20.0 104 70-130• 6 20 Acrylonitrile 17.5 Ng/I 20.0 88 70-130 4 20 Benzene 20.4 pg/I 20.0 102 70-130 0.4 20 Bromobenzene 20.3 Ngll 20.0 102 70-1'30 3 20 Bromochloromethane 20.1 Ng/I 20.0 101 70-130 0 20 Bromodichloromethane 23.4 Ng/I 20.0 117 70-130 0.8 20 Bromoform 20.8 Ng/I 20.0 104 70-130 2 20 Bromomethane 19.2 pg/I 20.0 96 70-130 6 20 2-Butanone(MEIQ 21.1 Ng/I 20.0 105 70-130 9 20 n-Butylbenzene 19.4 Ng/I 20.0 97 70-130 4 20 sec-Butylbenzene 21.1 Ng/I 20.0 105 70-130 2 20 tert-Butylbenzene 21.6 Ng/I 20.0 108 70-130 1 20 Carbon disulfide 16.0 Ng/I 20.0 80 70-130 6 20 Carbon tetrachloride 23.0 Ng/I 20.0 115 70-130 0.5 20 Chlorobenzene 19.8 Ng/I 20.0 99 70-130 0.2 20 Chloroethane 17.3 Ng/I 20.0 87 70-130 4 20 Chloroform 21.8 Ng/I 20.0 109 70-130 3 20 Chloromethane 16.1 pg/I 20.0 80 70-130 2 20 2-Chlorotoluene 20.6 Ng/I 20.0 103 70-130 0.4 20 4-Chlorotoluene 20.3 Ng/I 20.0 101 70-130 2 20 1,2-Dibromo-3-chloropropane 20.3 Ng/I 20.0 102 70-130 19 20 Dibromochloromethane 23.4 Ng/I 20.0 117 70-130 6 20 1,2-Dibromoethane(EDB) 23.0 Ng/I 20.0 115 70-130 5 20 Dibromomethane 21.4 Ng/I 20.0 107 70-130 1 20 1,2-Dichlorobenzene 20.2 Ng/I 20.0 101 70-130 4 20 1,3-Dichlorobenzene 20.3 Hg/I 20.0 102 70-130 2 20 1,4-Dichlorobenzene 20.0 Ng/I 20.0 100 70-130 6 20 Dichlorodi0uoromethane(Freon12) 16.1 Ng/I 20.0 76 70-130 4 20 1,1-Dichloroethane 21.1 Hg/l 20.0 105 70-130 2 20 1,2-Dichloroethane 23.1 ug/I 20.0 116 70-130 2 20 1,1-Dichlo,roethene 19.2 Ng/I 20.0 96 70-130 1 20 cis-1,2-Dichloroethene 21.2 Ng/l 20.0 106 70-130 2 20 trans-1,2-Dichloroethene 20.8 Ng/I 20.0 104 70-130 4 20 1,2-Dichloropropane 20.5 Hg/I 20.0 102 70-130 2 20 1,3-Dichloropropane 22.5 Ng/l 20.0 113 70-130 3 20 2,2-Dichloropropane 19.9 Ng/I 20.0 99 70-130 0.2 20 1,1-Dichlo.ropropene 20.0 Ng/I 20.0 100 70-130 2 20 cis-1,3-Dichloropropene 20.7 Ng/I 20.0 104 70-130 3 20 trans-1,3-Dichloropropene 19.8 Ng/I 20.0 99 70-130 4 20 Ethylbenzene 20.7 Ng/I 20.0 104 70-130 0.5 20 Hexachlorobutadiene 22.7 Ng/I 20.0 113 70-130 5 20 This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 12 of 15 Volatile Organic Compounds-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units *RDL Level Result %REC Limits RPD Limit Batch 1703383-SW846 5030 Water MS LCS Duo(1703383-BSD1) Prepared&Analyzed:23-Feb-17 2-Hexanane(MBK) 22.2 pg/I 20.0 ill 70-130 10 20 Isopropylbenzene 20.9 Ng/I 20.0 105 70-130 0.4 20 4-Isoproayltoluene 19.2 Ng/I 20.0 96 70-130 2 20 Methyl tert-butyl ether 21.9 Ng/I 20.0 109 70-130 0.6 20 4-Methyl-2-pentanone(MIBK) 21.7 Ng/I 20.0 109 70-130 0.3 20 Methylere chloride 19.9 pg/I 20.0 99 70-130 5 20 Naphthalene 19.6 pg/I 20.0 98 70-130 14 20 n-Propylbenzene 19.9 Ng/I 20.0 100 70-130 2 20 Styrene 20.3 Ng/I 20.0 102 70-130 3 20 1,1,1,2-Tetrachloroethane 19.9 Ng/I 20.0 100 70-130 1 20 1,1,2,2-Tetrachloroethane 18.7 Ng/I 20.0 93 70-130 3 20 Tetrachloroethene 21.7 Ng/I 20.0 108 70-130 5 20 Toluene 21.6 pg/I 20.0 108 70-130 0.09 20 .,2,3-Trichlorobenzene 21.3 Ng/I 20.0 106 70-130 9 20 1,2,4-Trichlorobenzene 22.0 Ng/I 20.0 110 70-130 12 20 1,3.5-Trichlorobenzene 21.6 pg/l 20.0 108 70-130 4 20 . 1,1,1-Trichloroethane 21.2 Ng/I 20.0 106 70-130 3 20 1,1,2-Trichloroethane 21.6 Ng/I 20.0 108 70-130 3 20 Trichloroethene 21.8 pg/I 20.0 109 70-130 3 20 Trichlorofluoromethane(Freon 11) 20.6 Ng/I 20.0 103 70-130 4 20 1,2,3-Triciloropropane 19.6 Ng/I 20.0 98 70-130 0.5 20 1,2,4-Tri methyl benzene 20.9 Ng/I 20.0 105 70-130 2 20 1,3,5-Trirriethylbenzene 21.4 Ng/I 20.0 107 70-130 0.4 20 Vinvl chloride 18.8, Ng/I 20.0 94 70-130 3 20 m,p-Xylere 19.4 Ng/I 20.0 97 70-130 6 20 o-Xylene 19.6 Ng/I 20.0 98 70-130 3 20 Tetrahydrofuran 18.2 Ng/I 20.0 91 70-130 6 20 Ethvl ether 18.5 Ng/I 20.0 93 70-130 2 20 Tert-amyl methyl ether 20.6 Ng/I 20.0 103 70-130 2 20 Ethyl tert-butyl ether 21.2 Ng/I 20.0 106 70-130 2 20 Di-isopropyl ether 21.2 Ng/I 20.0 106 70-130 5 20 Tert-Butanol/butyl alcohol 197 Ng/I 200 98 70-130 8 20 1,4=Dioxane 209 pg/I 200 104 70-130 0.1 20 trans-1,4-Dichloro-2-butene 16.6 pg/I 20.0 77 70-130 0.6 20 Ethanol 364 Ng/I 400 91 70-130 13 20 Surrogate:4-Bromofluorobenzene 49.8 Ng/I 50.0 100 70-130 Surrogate:Toluene-d8 52.5 Ng/I 50.0 105 70-130 Surrogate:1,2-Dichloroethane-d4 52.8 Ng/I 50.0 106 70-130 Surrogate:Dibromofluoromethane 52.6 Ng/I 50.0 105 70-130 This lahoratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16 46 *Reportable Detection Limit Page 13 of 15 General Chemistry Parameters-Quality Control Spike Source %REC RPD Analyte(s) Result Flag Units *RDL Level Result %REC Limits RPD Limit Batch 1703363-General Preparation Duplicate(1703363-DUP1) Source:SC31788-01 Prepared&Analyzed:22-Feb-17 pH 4.12 pH Units 4.12 0 5 Reference(1703363-SRM1) Prepared&Analyzed:22-Feb-17 pH 6.00 pH Units 6.00 100 97.5-102. 5 Reference(1703363-SRM2) Prepared&Analyzed:22-Feb-17 pH 6.02 pH Units 6.00 100 97.5-102. 5 Batch 1703582-General Preparation Duplicate(1703582-DUP1) Source:SC31788-01 Prepared&Analyzed:27-Feb-17 Flashpoint t Flash But Caug T lash But Ca 20 Reference(1703582-SRM11 Prepared&Analyzed:27-Feb-17 Flashpcint 81 T 81.0 100 95-105 i This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 14 of 15 I Notes and Definitions D Data reported from a dilution R03 The Reporting Limit for this analyte has been raised to account for interference from coeluting organic compounds present in the sample. R05 Elevated Reporting Limits due to the presence of high levels of non-target analytes;sample may not meet client requested reporting limit for this reason. dry Sample results reported on a dry weight basis NR Not Reported RPD Relative Percent Difference pH The method for pH does not stipulate a specific holding time other than to state that the samples should be analyzed as soon as possible. For aqueous samples the 40 CFR 136 specifies a holding time of 15 minutes from sampling to analysis. Therefore all aqueous pH samples not analyzed in the field are considered out of hold time at the time of sample receipt. All soil samples are analyzed as soon as possible after sample receipt. I Laboratory Control Sample(LCS): A known matrix spiked with compound(s)representative of the target analytes,which is used to document laboratory performance. Matrix Duplicate: An intra-laboratory split sample which is used to document the precision of a method in a given sample matrix. Matrix Spike: An aliquot of a sample spiked with a known'concentration of target analyte(s). The spiking occurs prior to sample preparation and analysis. A matrix spike is used to document the bias of a method in a given sample matrix. Method Blank: An analyte-free matrix to which all reagents are added in the same volumes or proportions as used in sample processing. The method blank should be carried through the complete sample preparation and analytical procedure. The method blank is used to document contamination resulting from the analytical process. Method Detection Limit(MDL): The minimum concentration of a substance that can be measured and reported with 99%confidence that the analyte concentration is greater than zero and is determined from analysis of a sample in a given matrix type containing the analyte. Reportable Detection Limit(RDL): The lowest concentration that can be reliably achieved within specified limits of precision and . accuracy during routine laboratory operating conditions. For many analytes the RDL analyte concentration is selected as the lowest non-zero standard in the calibration curve. While the RDL is approximately 5 to 10 times the MDL,the RDL for each sample takes into account the sample volume/weight,extract/digestate volume,cleanup procedures and,if applicable,dry weight correction. Sample RDLs are highly matrix-dependent. Surrogate: An organic compound which is similar to the target analyte(s)in chemical composition and behavior in the analytical process,but which is not normally found in environmental samples. These compounds are spiked into all blanks,standards,and samples prior to analysis. Percent recoveries are calculated for each surrogate. Continuing,Calibration Verification: The calibration relationship established during the initial calibration must be verified at periodic intervals. Concentrations,intervals,and criteria are method specific. I This laboratory report is not valid without an authorized signature on the cover page. 27-Feb-17 16:46 *Reportable Detection Limit Page 15 of 15 Special Handling: N ❑ Standard TAT-7 to 10 business days e:urofins CHAIN Off' CUSTODY RECORD l tshTAT-Date.Necded: ?_ ? +� /� Spectrum AC18�YtICaI All fAfs subject KIabosatory<apSrot•al ;Page. of Mill 24 hr nonfication:needed.'for rustic; Sarnples disposed after 60 days tplesc otherwise instructed, .Report To;: {� �•✓_. / ''9.% /��""' l f�6° �eice T"o:. Project No: "�.�. �. .. I G -./ — Site Names �.;�'I✓" �% l'f Wit/ r°'t"��'�" (f f�` j j _ p' Location: ✓�V '�� Tel cph nie T: 3, q L. — + /�/ C2 Sanipler(s): Protect Mgt: /--t- / ,—� er I <.)N'o.: Quote F=Field Filtered I_NaS'201 2=HCI 3 lI>SOa 4=44NO, 5-Na011 6=Ascorbic Acid �/ - List Preservative Code belntV: QAIQC:Reporting Ntotes: 7=CF1301-t VNIaIISO 9=Deionized Water 10-11,P0, It= I t 12= . n "adxlitiorial c,harges,riray aPPP1Y Il 97 DW Dinkins Water GW=Groundwater SW Surface Abater 4't W-Waste Water Containers Analysis ,:nl ucretM lzePnn7 ❑Ycs CT.DPH r' Repon? ❑.is R O=Oil SO=Soil SL=Sludge A-=fridoor:'AmbieutAir S(.'=Soil Gas `1 ( d stndard ❑Nogc �! ❑pQA; 11 = az= x_,: `mac r: r ` eta - El ASP lib El ASP B* v c k \ — ❑Nz Reduced' ❑NJ Fulls R \ G=Grab C=Co'np ite v ❑TierIP ❑TierN Lab.CDc Sample ID: Date: Time: tJ 'State speciticrcpcn:ting stand.uds; 13 t �o Relinquished by: Received by: Dater Time Temp'C ❑ EDD.format: r, � tc..a, .:i�__. �� � � ❑ E-mail to: A �� ` cot radar f � r Co t d� Condition upon receipt:. 'Cus ody Sealsi ❑Present ❑ [rttaoE ❑' Broken ❑ Ambient ❑Iced Refrigerated ❑DI VOA Frozen, .❑Coil.lasFrozen Sample shipping address:11 Almgren Drive •Agawam,MA 01001 •413-789-9018•www,.EurofinsUS.com/Spectrum Rev.Sep 2015 TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNI*N. G NOTICE Name of Offender/Manager r � Address of Offender MV/MB Reg.# Village/State/Zip Business Name +qoylhls 5m ' !\1 t el e- O br( rf2^' am/tpm, on 16It8 2017 - " Business Address , t,F►�, �", lJu>`+� f 7f I �r%'fi�. �--~ M Signature of" Enforcing Officer Village/State/Zip V10 1 5 , 0 ? coo 1 Location of Offense 141rivtt F',n Yv4r f ! Enforcing Dept/Division Offense V ►°�� +'''^ '�i� - G Cy1iT�� �fLt M r Facts A,i46Y I Lice q5e- - 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 OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name 4" >z t� ' 1 }} , �" JJ� � am/pm, on l`` a 2017 a F �'fy iF - Business Address ;` Signature of Enforcing Officer Village/State/Zip pfq 1 ,t Location Of Offense. +rkI1 _e � ,,trV ?" r( Enforcing Dept/Division Offense T E! f C o p cr ' Facts f s , .;, �, _" v ; } . � ; �I _ei , , ✓��, f I ; , r+ ti� %'`- �.t ���.:+�'! 4 +pc„ ,� R.✓,gip' � d x H„ „t'' ' �:.,.r � 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 OFFICER GOLD-ENFORCING DEPT. • - I „ti.t <t..w '.a fir. 'ax Ill :<Y u7 Q 0 e:� -�-E p^ Certified Mail Fee Gc Er $ .�j p' � Extra Services&Fees(check box,add fee as appropriate)';,'• ///��� '} V_ � ❑Return Receipt(hardeopy) $ f /�Y^/ �r117 0 ❑ReturnRecelpt(electronic) $ I �)�Vr Postmlalrk! 0 []Certified Mail Restricted Delivery $ 1 HeYe C ❑Adult Signature Required $ ❑Adult Signature Restricted Delivery$ �,._ O Postage rn $ a Total Postage ATTN: STACY DUFFANY $ HYANNIS FAMILY MEDICAL CARE V7 Sent To ►a 68 CAMP STREET, UNIT 1 o sireeiendApr' HYANNIS, MA 02601 pity State,ZIF Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A.unique identifier for your maiipiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. " signature)that is retained by the Postal Service— Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders. -Adult signature service,which requires the ."� •You may purchase Certified Mail service with signee to be at least 21 years of age(not __ First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service..i Adult signature restricted delivery service,which" is Certified Mail service is notavailable for requires the signee to be at least 21 years of age intemational mail. ` .r and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent: with Certified Mail service.However,the purchase (not available at retail). f of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on;,= •For an additional fee,and with a proper this Certified Mail receipt,please present your _ endorsement on the maiipiece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record.. Certified Mail receipt,detach the barcoded portion_, of delivery(including the recipient's signature). of this label,affix it to the maiipiece,apply You can request a hardeopy return receipt or an appropriate postage,and deposit the maiipiece. electronic version.For a hardeopy return receipt, complete PS Form 3811,DomesSc Return Receipt•attach PS Form 3811 to your maiipiece; IMPORTANT:Save this receipt for your records. PS Forth 3800,April 2015(Reverse)PSN 7530-02-000-9047 • • • • ■ Complete items 1,2,and 3. A. Si ature e Print your name and address on the reverse X :3 Agent so that we can return the card to you. ❑Addressee ® Attach this card to the back of the mailpiece, B. Received&JOrinted Name) C. Date of Delivery or on the front if space permits. D. Is delivery address different from item 1? ❑Yes I If YES,enter delivery address below: ❑No ATTN: STACY DUFFANY- I I i HYANNIS FAMILY MEDICAL CJARE ! I 68 CAMP STREET, UNIT 1 C HYANNIS, MA 02601 -- -- lI l Ill�I l�l Ill l II Il II I I I I'll I III I l I Ia l VI 3. Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered Mal" 0 Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1797 64 a fled Mall Restricted Delivery 'Re u Reoelpt for ❑Collect on Delivery Merchandise 2. Article Number(transfer from service labe4 O Collectnn.Delivery Restricted Delivery ❑Signature Cc flrmationTM 1 i 4 1 ; pl ❑Signature Confirmation 7 015 17 3 0 0 0 01 4 9 9 0 5 213 it Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt 1 _ USPS TRACKING# First-Class Mail I555 Postage a•.F.ges Paid USPS I Permit No.G-10 I 9590 9402 M`U23 1797 64 I United States •Sender:Please print your name,address, and ZIP+4®in this box" Postal Service "Town of Barnstable ! o .F Health Division I 200 Main Street Hyannis,MA 02601 �,I1�1�1„llnl�il�llrllllli��laltl�;��liil�h°hnlliilllll:�r�ll� t TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: k'AV-41 Board of Health MAILING ADDRESS: � R � � �� Town of Barnstable � TELEPHONE NUMBER: � � 6a�-. 'T ! 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 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' . 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 _V/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) J' Other cleaning solvents /,vim �� A%,, 46,11.�In 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 satisfactory 2.Printers BOARD OF HEALTH �' 3.Auto Body Shops N,F O unsatisfactory- 4.Manufacturers COMPANffZeWtMA U XIZAVAIAl (see"Orders") 5.Retail Stores `/ 6.Fuel Suppliers ADDRESS 6T Gdt� 5 /T��S Class: 1 7•Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lot, Drums IN OUT I IN I OUTI IN OUT #&gallons 777 Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) wast new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 4r1. Sanitary Sewage V 2.Water Supply �� ' V O©4© G 2-27 (�Town Sewer 1 'Public O On-site /OPrivate f3. Indoor-.Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system jJ4. Outdoor Surface drains:YES NO V 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 1 605 c-®v , L��E �OC�CC� r/ 2• S �G fl� Co� l Ctti. iv �e� vtr ✓ on ( 'Interviewed Inspector /Date