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0017 ELM AVENUE - HAZMAT
Nc n 5 { o z1HE l°wti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAg .9 200 Main Street• Hyannis, MA 02601 �p'FOMP�a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: r-c "011- Rq',t Dated 13 ;t 0 Location/Mailing Address: L-' Contact Name/Phone: " 7#16 -0W29' 0 0 Inventory Total Amount: MSDS: Yt License#: T 3 Tier II : YL� D,rye. I Labeling: 8!Xepfi aT Spill Plan: Y�= Oil/WaterSeparator: V S Floor Drains: yLJ Emergency Numbers: Y&S Storage AreasfFanks: /.,)- ) %-AUK fv-ei i- 4co>A—T Se"O; t3 vS 6 Emergency/Containment Equipment: �I TV, 13 Waste Generator ID: 114 C 3 0 Q 0Q(o 977 Waste Product:4141; FVN'b/P-,t 0 GE 1%�-i� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Lo8y�p a � Other Waste Disposal Methods: S�e�— 5 . d `3 -r-6 V=i� LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze 7,5, 0,me G@h�r�t3 �rrvlc t/ 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 I-"- Motor oils '.Z-3,1�6 F6 j'$ 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) �G Car wash detergents y3v I,�S QA Printing ink Car waxes and polishes C. P,51 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: A90vvC7 IIN�FO�RMATION/RECOMMENDATIONS: tk�, a - LV 14 u��� r34 1; �, .i��.0 ►�..z►-, � Cloorvr` m�,y Inspector: J Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------- -------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and `Q, and expires 06/30/2017 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �6 3 Town of Barnstable WE r� Regulatory Services Richard V. Scali, Director &ARNST"MPublic Health Division BA�NSTABLE �}163q 10� nARM S M�RW..iiemwNs"r'e n AU 1639-2014 r Thomas McKean,Director �o 200 Main Street, Hyannis,MA 02601 �V s Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ 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. ASSESSORS MAP AND PARCEL NO. DATE . Cv _0(? -.2 01 (c, n- FULL NAME OF APPLICANT: el V PM U 7T4 `t rj-�P,,t kio,J .S-rgEFT �m4LjV `-t7 NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: I'7 ��J1 14yE �ff-yleAf 1-9 f4-�1- MAILING ADDRESS (I F'DIFFERENT): ,,I� //UI US l91 44-c 91YR-14-- /" C)070-e / da. 3 fbO TELEPHONE NUMBER OF ESTABLISHMENT: 5b8 7`,7 6 -033 V EMAIL ADDRESS: 1 V l-(l�-! ©N L (:P CO rI SOLE OWNER: p,- YES_NO IF NO,NAME OF PARTNER: FULL NAME, ADDRESS,AND TELEPHONE#OF: CORPORATIO NAME �� NOv- i¢ -t� ?)tZo�.C7JA .5r4C&'lT . /4 PRESIDENT C36ULG6 S J-,l c oAj l AA fl,- AQ, l4/K tz1J TREASURER v 8- '7V(, 0 3 7cP CLERK IF PREPARED BY OUTSIDE PARTY: S NATU#OF APPLICANT Name: to Company Address Telephone#: Email: Q:\Application Forms\HA7ZAPP Revl6.docx Page 1 of 1� .� �� � , �' t ` ��;�, �.. �,� �,�a; > :� �_... p '- '�� M. � ., .. � °ft►�rok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ` BA N�LE. ' 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: PIV YW&A gC'oc o,.LSf e Co . Date: Location/Mailing Address: I"7 Owt Aye— , 0 qoyi i S Contact Name/Phone: e I l 5o -78 Invento Total Amount: MSDS: Ve.S '+`,4 51>S License#: (o Tier II VC5 - ct4st-I Labeling: eor(#C40zk1*-vz0 SDS Spill Plan:. &S Oil/WaterSeparator: Yes Floor Drains: e S Emergency Numbers: Storage Areas[Tanks: VL K k,t,5.1 Q Sr+ byl lL wAbe�Q ,K s�-wl lore 19 9 Q, Emergency/Containment Equipment: 5. 11 >,k4 a o �v OK Waste Generator ID: MA G D L ? Minot- Product: mo5 5144 1�� ►_o1 sobxs Date&Amount of Last Shi ment/Fre uenc : 3 3 I to o, soli X s atiJ S - w►t Licensed Waste Hauler&Destination: wlti os 1 a �Nv+t.H► ,. .-� Pcg�.r,Qcce �T Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS o Ion -s w ory SMC 1- 1a5�' 1vtsf4e{.aVL 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. (tee v/ Antifreeze 300 AS-( Dry cleaning fluids 1%l��7— Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) v/ Windshield wash %2D AVr Motor oils 9-c 3Sa,As-( 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) y Car wash detergents ISO 10", A'' 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: 14 v N,kww,4,15 1 Z-o As-r ORDERS: INFORMATION/RECOMMENDATIONS: o ASS". 3 0\.,6 0 -e- Inspecto ."� Facility Representati WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMASS .. 9! 200 Main Street• Hyannis, MA 02601 1639.�ArFOMP+�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: PNmo0vt Da e: . 30 / Location/Mailing Address- 1-7 rlvpL Ave- , ay'rJ15 ,L +r,a) �irle_ ►titov` - Contact Name/Phone: i o c�l - OZ� o SW-7 6-D 78 a;O aVf MSo.r I Cad(12 Inventory Total Amount: I-1$00 a4 MSDS: a License#: U Tier II Zgc-l� Labeling: (moo Spill Plan: ks Oil/WaterSeparator: Ye-5 Floor Drains: ye5- ©INS Emergency Numbers: A5 Storage Areas/Tanks: I2 D00 coki, Emergency/Containment Equipment: `J t S °0N15 t Waste Generator ID: AAAt,3000 Wast'e Product: v toil 5011AZe7 Date&Amount of Last Shi ment/Fre uenc 23 ?00 lb w or Q fr,0KC?AX Licensed Waste Hauler&Destination: r o�-f'1,1a �'t1�� o aV �� 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. �fJ w'- 00 Antifreeze 300 4l [vbL,��( Dry cleaning fluids S� 1' al b�+i,GcFs k--c of 5 �— Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes 9 Bug and tar removers Hydraulic fluid (including brake fluid) 120 Windshield wash 120 AST 100 Motor oils 2X�jS�Daq,l A5-TS 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) `I o0 Car wash detergents W 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, �v A� hydrochloric acid, other acids) VIOLATIONS: QJ &"'(.a15 19.0 A-o-r ORDERS: INFORMATION/RECOMMENDATIONS: o is9vG or Ceeo rti,e av �o�s a- Inspector: V Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS I °FT"E•ok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE. ` 200 Main Street• Hyannis, MA 02601 i639• �0 "rFor�n+" TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 336a ov,. -jbz Q4 Co. ate: 7 16 1� Location/Mailing Address: Iwt ve. livLv4y1,s c V�q o� Contact Name/Phone: o a ovum O -7 -o 'f� -775- Z 1011►.+ MJV' Qoe Inventory Total Amount: ^- ,)LOD &I MSDS: qCS License#: 6q t O Tier II : �S5- ��a1,L 1 r 4lgSou�ba}�s) Labeling: &vacs Spill Plan: , Oil/Water Se Separator: p leh Floor Drains: Yr_5-7 o u.>S Emergency Numbers: " Storage Areas/Tanks: sw&t g 1&IU44-vt Emergency/Containment Equipment: Cu k� o 005 1 5 q,11V,�', -V'\k ,b000" 'A Waste Generator ID: MR��rnS1 �r37°13 Waste Product: o% 01� 7 Date&Amount of Last Shipment/Frequency: 5117-01 14 Doo lb 2,12Tr I So Licensed Waste Hauler&Destination: vw,roV-' V1k v\ e. _ Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Dv�� V%kA- ov' �7oMA, C NOTE: Under the provisions of Ch. 111, Section 31, of the General Law hazardous mVerial use, storage/and disposal of 111 gallons or more requires a license from the Public Health Division. J Antifreeze Sao P�4i ma`s �,eAt Dry cleaning fluids �— Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers �— Hydraulic fluid (including brake fluid) V Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants �— Miscellaneous petroleum products: _V 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" 144 ! (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ��V• �-�-'-wn.Lai 6 ORDERS: INFORMATION/RECOMMENDATIONS: l vl.1- Inspector: V F.�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 7/ // 113 TOWN OF BARNSTABLE s G 034- TOXIC AND HAZARDOUS MATERIALS N FORM NAME OF BUSINESS: T ,6-o a CO. BUSINESS LOCATION: --7 et-'rt , INVENTORY MAILING ADDRESS: dA , Plimaiff', 23 a TOTAL AMOUNT: TELEPHONE NUMBER: .sbS —7y.b -0379 A- l Sbb CONTACT PERSON: Al EMERGENCY CONTACT TELEPHONE NUMBER:-5-,0'b-775--62SY6 MSDS ON SITE? TYPE OF BUSINESS: Dv5 ✓vtaim-4,CvtAvLW— &S INFORMATION / RECOMMENDATIONS: �411 Fire District: «��K- on-3 t, ©� w a✓ es(a�-a,r wl^�Zk- -s — 8 �Q,!• 13 IS Q. a 1n1� a �mr�.etu.'ror Waste T Alf-5bb7-78cf767 Last shipment of hazardous waste: 3 27 t 3 Name of Hauler: �(Z.R�K Goo. Destination: N°� "� E,n,/�ca►,.�cxv�tat Pcav, ,� Waste Product: 01uwa,+4� A I✓��,.2� Licensed a No If NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes �,�D�,I Road salts (Halite) I p Hydraulic fluid (including brake fluid) Refrigerants 10S' Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes �S Laundry soil &stain removers (including bleach) Js Spot removers&cleaning fluids (dry cleaners) 01 e,I,9-a K.1, Other cleaning solvents Bug and tar removers / vA,-t' CGL-M te"a,15 S Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials MASSACHUSETTS FIRE INCIDENT REPORT 10 FDID# ````i``` ``s` ``` '' DEPARTMENT Revise Form < 01 9 2 2 Hyannis Fire Department Report 9 If Date Alarm riva In ervice Incid 00596 Fire 006/26/96 Day Wednesday 08:38 08:41 09:16 FO)&D F77......:;:; ACTION TAKEN .:;:;:: MUTUAL AID LEAK >>4 1 �` Remove Hazard PERTY USE (OCCUPANCY) ":::: IGNITION FACTOR Parkin Area NO FIRE OJ_FUncovered DDRESS ZIP CODE CENSUS TRACT D 17 ELMAVL02601 40 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. P&B BUS STATION 508 775-5524 F, 12 OWNER NAME (LAST, FIRST, MI) ADDRESS JTELEPHONE MONTEIRO, DANA P.O.BOX 474 E. FALMOUTH 508 457-7623 G 13 METHOD OF ALARM CO. DIST. PERSONNEL ENG RESP. AERIALS RESP. ::.::. 3 © RESP. ........... 0 SHIFT HAZ MAT PRESENT? TANK. RESP. .......... JOTHER RESP. LA j BARNSTABLE POLICE No. SUBSTANCE 0 0 1 SPEC. EQUIP. USED? O 20 FIREINJURIES VATAT.TTTP SERVICE O '< O OTHER O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LASS 0 10 TOTAL INS. 1 0 CLAIM PD 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX j. AREA OF ;;EQUIP INVOLVED IN IGN. ORIGIN X X. FORM OF HEAT IGNITION : :. MATERIAL FORM TYPE © IGNITED METHOD OF r= LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE ® EXTINGUISHMENT ..... EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE N COop Material generating FORM TYPE ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date KNOWLTON, RICHARD A. LIEUTENANT 6/2 6/9 6 • Comments for this incident have been printed on an additional comments page. Comments for Incident: 96 000596 Exposure: 00 Date: 6/26/96 WL"RECEIVED A CALL FROM THE BARNSTABLE POLICE REPORTING A CAR LEAKING GAS AT THE P&B BUS STATION ELM STREET, I RESPONDED ON 822 WITH FF MCCORMACK AND FF HENNESSY DRIVING. ARRIVED ON LOCATION SIDE 1 AND FOUND A GOLD LINCOLN MARK VII, MASS. REG. 128-XOO, VIN#ILNBM92E8JY851441,LEAKING GAS FROM WHERE THE FILL PIPE CONNECTS TO THE TANK.THE OWNER OF THE CAR, DANA MONTEIRO,WAS LOCATED IN BOSTON AND HE ADVISED US THAT THE CAR HAS 3/4THS A TANK OF GAS. 811 ON LOCATION AND REQUESTED ONE DUTY WRECKER.CAPEWAY TOWING ARRIVED AND GAINED ACCESS TO THE CAR. THE CAR WAS TOWED TO CAPEWAY TOWING'S LOT.THE GASOLINE WAS SOAKED UP USING ABSORBANT PADS. I ADVISED ANN MONTEIRO OF THE SAFETY CONCERNS WITH LEAVING THE CAR IN THE BUS STATION PARKING LOT. 822 SECURED AT 0916 IN SERVICE. RICHARD A. KNOWLTON �► I ;2J MA.SSACHUSETTS FIRE INCIDENT REPORT tA to ... .>`...... <`'DEPARTMENT Revised '`':01 9 2 2 Hyannis Fire De artment Report Form ....................... If Date Alarm rival In Service # 000405 Fire 004/30/96 Day Tuesday � 09.09 09.14 10.55 ION FOUND :............ :: ACTION TAKEN IMUTUAL AID B ood Intent Call Not Class >6 9 Investi ation Only ' IXED PROPERTY USE (OCCUPANCY) » IGNITION FACTOR CCBus Passenger Terminal 1 7 3 NODE OCORRECT ADDRESS ZIP CODE CENSUS TRACT D 17 ELM AV. 02601 40 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. P&B BUS CO. 508 775-5524 12 ME OWNER NA (LAST, FIRST, MI) ADDRESS TELEPHONE F G 13 METHOD OF ALARM CO. DIST. PERSONNEL ENG RESP. ........... AERIALS RESP. q RESP. � 0 SHIFT HAZ MAT PRESENT? TANK. RESP. OTHER RESP. D J. 0 1 Direct Report (Verbal No. ALARM SUBSTANCE 0 0 1 SPEC. EQUIP. USED? FIRE O 20 OTHER SERVICE �0 O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. CLAIM PD 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION K COMPLEX AREA OF << EQUIP INVOLVED IN IGN. O ORIGIN FORM OF HEAT IGNITION MATERIAL FORM TYPE © ? IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE O E r. op 17777=1 Material generating FORM TYP ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date HARALD BRUNELLE iEPUTY CHIE 4/3 0/9 6 Comments for this incident have been printed on an additional comments page. Corr ments for Incident: 96 000405 Exposure: 00 Date: 4130196 twPATRON OF THE P&B BUS CO CALLED THE BPD AND STATED SHE THOUGHT THERE MAY BE A GAS LEAK INSIDE THE TERMINAL BLD ON ELM AV. *HE STATED SHE COULD SMELL GAS INSIDE THE BLD. OFFICER FORCITE INVESTIGATED AND FOUND THE SAME HE THEN REPORTED THIS TO US. WE RESPONDED WITH E-822 AND DEPUTY BRUNELLE,UPON ARIVAL WE FOUND AN OBVIOUS ODER IN THE TERMINAL AREA,WE REQUESTED THE GAS CO TO THE SCENE,WHEN THE SERVICE MAN ARMED HE FOUND A SMALL LEAK IN A HEATING UNIT OF THE GARAGE AREA THIS HOWEVER WAS NOT A LARGE ENOUGH LEAK TO BE THE CAUSE OF THE ODER IN THE LOBY AREA. THIS UNIT WAS SHUT DOWN BY GAS CO.MANAGER WAS NOTIFIED TO HAVE THIS UNIT REPAIRED ASAP. WE ALSO INVESTIGATED THE CRAWL SPACE UNDER THE BLD AND QUESTIONED POS BACK UP OF ODER FROM SEWER DRAINS BOH WAS NOTIFIED AND DONA MORANDY RESP TO THE SCENE,WE ALSO REQUESTED THE SEWER DEPT TO CHECK SAME. WE ALSO REQUESTED THE PLUMBING INSPECTOR TO THE SCENE TO CHECK POSIBLE DRAIN PIPE PROBLEM.UPON ARIVAL OF THE PLUMB INSP WE DETERMINED THE ODER WAS BEING CAUSED BY THE FLOOR DRAINS IN THE REST ROOMS DO TO EVAPERATION OF TRAP WATER IN THE DRAIN PIPES ALLOWING SEWER GASES TO BACK UP INTO THE BLD. OUR METERS ALL SHOWED NO EXCESSIVE READINGS OF CO,OR OTHER GASES. NO ONE WAS REPORTED TO BE ILL FROM THIS INCIDENT.WE ADDED WATER TO THE DRAINS AND SUGESTED TO THE MANAGER THAT THIS BE DONE REGULARLY TO PREVENT THE SAME THING FROM HAPPENING AGAIN. APPARATUS CLEARED THE SCENE 10:55 i Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable AkAl it .1,A Inspectional Services BARNSI_ABLE eu NMs -ar MU-COWU---S m,�Ils W�s-G�Mac-Mg"�E Public Health Division 1639-2014 BARNSTABM Thomas McKean, Director '-,-,20&,Maui Street;Hyannis,:MA 02601-- -iq6"34- Fax. 8- -6 - 6 offil 8 6 44 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st-JUNE 30th). APPLICATION FEES . CATEGORY I PERMIT 26- 11OGallons: $ 50.00 El CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 11 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 g(VST-p I *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? / YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS - ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)?_YES NO. 4. FULL NAME OF APPLICANT:. P1.w A4 p L77-1 g Z gockZ-U Sl- R�. J. 5. NAME OF ESTABLISHMENT: P&5ekfaLiT BiZode7ok- (2o 6. ADDRESS OF ESTABLISHMENT: 17 4F-4,-f R K6 14-cfOWN1 i A4A o.1 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: z2> 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5DR - ?q(*. 037,P 9. EMAIL ADDRESS: 6- S c i4m r Q '?' -)3 10. SOLEOWNER:.YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,ORMADDRESS,AND TELEPHONE#OF: CORPORATION NAME P-LY NOVI;Y 4 Ath Pj2 o c-k-ra--j sn Lrs-r- 1?4-a-s-ine PRESIDENT-J'p,YA/ TREASURER Ck&4tK— /A1 �US-M14C. PAAh R pt-qofour � 1-1,1 0.a.3&6 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE QAApplication Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires ' 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health t Town of Barnstable � Inspectional Services BABSTABLE WPSMna IUS 0— •c;M Public Health Division "°SrGw°'°5:5 ��4' h snlr,E, Thomas McKean, Director 2 • NUSPI 9`bAtE1 3i a � 200 Main Street, Hyannis,MA 02601 CL'? Office: 508-862-4644 Fax: 508-790-6304' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' �a HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ �_ �� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 x`r.-r *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1444 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 ILIOUSEHQLD QUANTITIES 25 GALL )? YES NO. \ • 'l-��,,s�tc,� ' i4rv►4-��t Nlc-ttou9-S 1 �`� 4. FULL NAME OF APPLICANT: oco 9t` t -7 (V 5. NAME OF ESTABLISHMENT: ' 6. ADDRESS OF ESTABLISHMENT: I 1 ELM 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 6D� 3a- CQO 9. EMAIL ADDRESS: —WP (4 01-f e- P-b., CogA 10. SOLEOWNER: YES_kNO IF NO,NAME OF PARTNER: !� 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 'y WlW* `,- 13 PRESIDENT Dv2.V V TREASURER ( 00 CLERK g — CD 49W'UJk 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\iIaz Mat App Revised 09 10-18.docx q t9V(��- Q `'�7�/ Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Myannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------- ----------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ------------- -------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2018 JUNICHI SAWAYANAGI Q THOMAS A.MCKEAN, R.S.,CHO `+ Director of Public Health At {a i THE FOLLOWING IS/ARE THE BEST I IMAGES FROM POOR QUALITY ORIGINALS) Im A DATA 1 Vwofor Brnstable eg atory Services Richard V. Scah,Director OFTHE fn a Public Health Division BARNSTABLE awxr»sTABLe. = """sT"a 7 $ Thomas McKean,Director 1639-2034 1659. 59. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 t1 V.S .-p m *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM 8. TELEPHONE NUMBER OF ESTABLISHMENT 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME O 11. FULL NAME,HOME ADDRESS,AND TELEPH CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT. `"r ` L DATE Q:\Application FormMAZMAT APP 2017 REVISED.docx of Brnsxable �/l�0 �� 11�8 Voengatory Services t"e Richard V. Scali,Director ' of � Public Health Division BARNSTABLE ' � . • Thomas McKeanMAS& ,Director ""�°�""�i°;°o;" � 200 Main Stteet, Hyannis,MA 02601 C Office: 508-862-4644 Fax: 508-790-6304 -c < -E_ i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ,Arti rya-� HAZARDOUS MATERIALS - , IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 1 l O Gallons: $ 50.00 ❑ - CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 �z V,S .7 n►"� *A lateeccharge of$10.00 will be assessed if payment is not received by July 1st. 1 1. ASSESSOR'S MAP AND PARCEL NO. .2. IS THIS A PERMIT RENEWAL?_�_YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: '?4 yNo-07-p N 1O12cc.le7 O S f/Zccgc7/CAicw" 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 14VC /�`, i9IVAj N �✓� �� � U l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �' iN t�US%i2/maci�2Gz �,� 8. TELEPHONE NUMBER OF ESTABLISHMENT: SU8 74((® 0 ,37e 9. EMAIL ADDRESS: t o.,v 6 "6 . Co M 10. SOLEOWNER: -'YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,REM ADDRESS,AND TELEPHONE#OF: CORPORATION NAME %ycocle--ro/J T C:)M/'i ` PRESIDENT &60o LGC Q NDuS721q �!A�/c /,� TREASURER / LV nvu7--( O2?&a CLERK Sys 7 6 b 3 7,e 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OFAPPLIC ANT DATE Q\Application FormsUiAZMAT APP 2017 REVISED.docx Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN O DONALD A.GUADAGNOLI,M.D. ' 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r �:•� . aQ �/coo c.G�/G�1 o q � - ow1� of Unstable Regulatoervices THE r Richard V. Scah,Director J Public Health Division BABSTABLE t MRN5Tfsiw-.5 tE•Sx�ER.ILLEdoIDIT•HY4eNIS �• =Amu'¢ABLE, • Thomas McKean, Director vu5'u'svLLs 6 9niU 4°sreax;laut 6 � 200 Main Street, Hyannis,MA 02601 ��g Office: 508-862-4644aol�l Fax: 508-790-6304 0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS K5 IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑�{, CATEGORY 3 PERMIT 500 or more Gallons: $150.00 E� ✓S' *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: 1�<y fro jr ( 4 20 c�T,J R w y_ Co . 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: l 7 6L f't V67 1S /-1/1' 0-16 6 2 /.J 2>U S7/Z/19--Q Pr9 ic-Ac &-P 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: y ATo 07 S. TELEPHONE NUMBER OF ESTABLISHMENT: 7c/6 -O 3, '7P 9. EMAIL ADDRESS: /� A-(i L i o NE j,3 (26 17 10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 7C y t-t o c.rly /U c-k-ioAJ s7;EG cs7 PRESIDENT (3-EoK G-F S R aI Z c)Un/ 1 10 g-to A-,4 TREASURER `' 13-ZJ d- -73o2- 6,0 /y CLERK H 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF DATE 7- 3 -� o i 7 Q:\Application Forms\H T 2017 SED.docx f C r .Md • • Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.GANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services Richard V. Scan,Director MASS Public Health Division f-m Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 "r Office: 508-862-4644 -"'Fax: 508-790-6304 Do Application Fee: $100.0.0 ASSESSORS MAP AND PARCEL NO. 0(L/ / DATE J APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANTScn`ff 'j NAME OF ESTABLISEMIENT r%1-�Yticr774 5'— '8 a--oCk Tr4 • HA),-/N(s o° , I1VSUlT21Ac P421- VA) P4'-1 HocT� /-"g 66 ADDRESS OF ESTABLISHMENT PN y 1,e a _-/�1�C��i A v� i�v�,v1 s --j-W oa&o TELEPHONE NUMBER '74 —0 37? SOLE OwNER:ZYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION N0._6`/ 17 3.3'1 70 STATE OF INCORPORATION FULL NAME AND �� ADDRESS OF: /� PRESIDENT l�onGE S tiZ�o�/I TREASURER 1p�/z. X--� CLERK err J'1/4- 0 6 }SI`N 'OF' L ANT RESTRICTIONS: HONKADDRESS r3 /Vi us?Izi fic P/9�zh Z—y f-io c)Ti-r �-7,6 HMM TELEPHONE# 5-b 73 6 02366 CA=he\Temporary Internet Files\0=3\1AWP Rev2015.DOC 2015 JUN 25 AM 9: 05 Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department sAMRN.. as a Public Health Division MAsa. Thomas A.McKean,CHO � °5 &`$ 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 7/1/2015 Permit number: 641 (Check number: 103770 Check amount: $100.00 Name on check: Plymouth &Brockton St. Ry. Co. ;Business: Plymouth & Brockton Street Railway Co. _ !Address: 17 ELM AVENUE, Hyannis { Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/15/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health .r Town of Barnstable Regulatory Services Richard 'V, Scab Director ELARNIMBLM ' Public Health. Division rab � Thomas McKean, Director 200 Main Street, Hymuds, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO, DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT f 4t'Hozr NAME OF ESTABLISE MENT ADDRESS OF ESTABLISHMENT 17 &&M 5✓6 My d,y"j TELEPHONE NUMBER J` (��"� ('- (53 7 F 6 A-4nass � SOLE OWNER: YES "NO f N�us7', r ��k RG IF APPLICANT IS A PARTNERSHIP,FULL NAME AND DORM ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO, D 4l f 7 3 3 4/7 o STATE OF INCORPORATION _ - FULL NAME AND ADDRESS OF: / PRESIDE+NT G dre G 5 ANZ<Ic�n11 h" f ry�.v�fn rr9c i�rt,�k. X'b Rio j off TREAS'MR G Va' 3 fP a CLERK ILI SIGNATURE APPLICANT i'D 41.Wa - - 5a#49 /4?14mff-JY RESTRICTIONS: HOME ADDRESS_ HOME TELEPHONE#� QAApplication h m UL4WP.DOC b01Ee 39dd 1NIVW Ed T609ZCL805 6V:ZZ VTOZ16Tf90 I •i. Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Plymouth & Brockton Street Railway Co. 17 Elm Avenue, Mailing: 8 Industrial Park Road, Plymouth, MA 02360, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f 1 Town of Barm-table are Rem atory Services } °-� Thous F. Gefler,Director MASS. Pubhe Health Division n Thous McKean,Director 200 Main Sted, Hyannis,MA 02601 Ofrca: 5084E -464 Fes: 50S-790-6304 AppflCa#ion Fen: $100,Oa ASSESSORS ASAP AND PARCEL NO, DATE APPLICATION FOR PERIIT TO STORE AND/OR. UTU= MORE THAN III GALLOINS OF HAZARDOUS MATERIALS III�L NA Ya OF APPLICANT Eel 1--A OF ZSTA3LL9IEyf ENT ADDRESS OF ESTABLIESIS ,NT us i, ���,ry�H �i� oz 3 6 o &I-ti A te° • /�/.auM 1 M TELEPHONE N 031B R SOLE OWNER.✓ YES NO ©, o w OF APPLICANT IS A PARTN=S=,FULL NAlYLF, AND HOMI ADDRESS OF ALL PARTNE2Z5: 4n. v i N w �'• =H APPI3CA N-T IS A CORPORATION: FEDERAL IDENTIFICATION NO, d / 7 33 q 70 STATE OF INCORPORATION -W=NAME AND ADDRESS OF: n PRESIDENT C7,!�oyLC r C 19AJZcJO�V 1 S' J"iD')� //¢��/�L`C (G) / Lt�Hb"cT7N �iA 02 j to U 7--- ,TREASURER1�lll� � K 1 S fl SI�ti A OF AP�i,I RESTRICTIONS: HOME ADDRESS �-b �0110mjj' Mfl 01340 HOB TELHPHONE �2zdac/wp/q i 2013 JUN 25 AM ID: 42 r r� J i T Town of Barnstable OFTHE r, ,� Regulatory Services z a Thomas F. Geiler, Director MASS. Public Health Division dUN 19 2Qw i639• Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized,and/or disposed of at a particular site. STEPS 1 — 2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous ` was ` �spills, etc LAYV 0 fJ � LE , TCE 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2013. A late charge of$10.00 will be assessed if payment is not received by July 5, 2013. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us which is located under the E-Code section if you should have any questions or concerns. Q:1Hazmat\Haz Mat Permit Letter.DOC ! . J r 2013 JUN 25 AM 10 42 A a Number Fee 641 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Plymouth &.Brockton Street Railway Co. 17E1m Avenue, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------I------------------------------------------------------------ ------------------------------------------------------------------------------- ----------------- --------------------- This,license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health �w • � Town Of Barnstable Barnstable Regulatory Services Department AB Public Health Division BAIMST9 1 M 200� a' �34, � m ,Street,Hyannis MA 02601 p 1 TfD MA't A - 2007 a Office: 508-862-4644 Thomas F.Geiler,Director . FAX: 508-790-6304 Thomas A.McKean,CHO Application Fes: $100.00 OASSESSORS MAP AND PARCEL NO. DATE �p- /�"0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS h FULL NAME OF APPLICANT ?L H wrrs� lf- '8IZ.o Utr.'0 o y NAME OF ESTABLISHMENT Q ADDRESS OF ESTABLISHMENT/7 �L H A✓€ /-�y,¢,yN r I H 0..7 6 a l TELEPHONE NUMBER 15 OF 730? - 6 03 SOLE OWNER: � YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL �I PARTNERS: t v v IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.Q /73,E`r 7Q STATE OF INCORPORATION l-114- S S FULL NAME AND IOW" ADDRESS OF: PRESIDENT_G.EazGE .S'R•VZuoAl1" �-/„�UST2/,g c pi7.tk `Z 4?/70L)W�1.� o- h) TREASURER u CLERK 4 • SIGNATURE OF APPLICANT. QFFicc� W 6 C RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# QAFlazmaM-faz Mat Application2008.DOC • � � 24 • TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL TORAGE SYSTEMS 7 -7® NAME ADDRESS /�!V VILLAGE S LOCATION OF TANKS: CAPACITY: J OF FUEL AGE: TYPE: OHEMICAL (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. I J 7/ 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: 9 � r TESTING CERTIFICATION SUBMITTED: (,p--7,,CA PASSED I DID NOT PASS it Pe� a � �--�� ``� ��� �(�� 1 =TI yannisPikton Bus Lines � .. ..w...+..=r-..s.w..-.►«�+ewr�r+�ii++ FF w.Y':�e-..,+.i� S AO ' - q -. •• of a<t>•Net Addr�eeO aa0 tpsatG) CNY. _ b IL-_TANK TQ TEST; l6.�. WACIIYq !Pod �� - _ - P�k Tank MemdoptW _ _ .T '�N"PIP Position WIWI: OW94oubt alto To Sapta�T $M SOCAI -'BETE ININ I ACIM., - 4 ` tat. 11 wow sotton, fra-,gyp. inventor, -- >Eta. : ciaoona . Fgrtrp.,RTICX BEFdRE AND AFTER MACM COMPARTME"T.DtfOP � # OR EACH METERED OEUVW QUANTITY _ $ - - leo0ttetfofuitank(trpbaMl j s TWADwnrtp It. SPECIAL CONDMONO-AND PROCEDURES TO TEST.THIS:TANK �V - �-� � : ' : e• •- 8 .aniuulsaetlons wvflcabia.catsek btdow;attd raeard poosdueitn lop(2'6). - _ __-- ,� - _ r[] r in Fant. .p H�+t miter tabN G►.tant.> ordw,~ - 'une(.)bap _0 Vapor soowry.Ya«n. -, .:..[] stw 1 - ❑- - - a8..-TANK,MEASUREMQIRS FOR .21;,TEMPEI)ATURENOLUME FACTOR(a)•TO TEST THIS TANK —`- - It►vattotYTop--'F , Gnter_-'F �Dottom_'F On Truck •F i — Astrmbls tirbirp foi 4 L. - 22._ readmy iftei ebtadation �� •c .' - Y4•for 3'1 .., a23. '3O _ - pits prr•F In range of egmcW dwW _ Togf tub6tp to ssgrobls (APpmxbnkte) .,.,. a {{ s ;. total ful quantity ank cosffwAant of expansion for change m Oft n e top to,gr.d.'......... or in ua "F _ �aiintl hoe on Teat-Elbow rr.or eiori M• Z5. t + �—� fa - volume thenge per' (24) Digits per'F In teat Volume dmnge per dlplt. --- *` -- Range(25) Compute to 3 decimal plaoe� (a) •N FM piprr estenits above grade.we top of fig. -- # Ear cEoll 30 3i MUME r WOWARE s- - - 34 . tE unlaE r f ATION CORD TO R(e)........ EACH READING,* s !YI RED A01'GAL USE FACTO 21� . 28. a. z ?�. f...t 32. - . hodoat In . ho+oa 35. 36. 37. Tera>are-_ ' i.eere biji :' Record"Us Or etdnp Op ; � _aafaeMs Ways computation Adl.ateuat_- _ (p� RatM 6redoa4 Replaced(-) Tearmd Hiyber+ (r)r(a) vehm Kiln_ _ Tjm/ eed rtdbaiAa ttKt (Use isg 111101100104 heel to Senor low i- �ea�+ E�s�(+t bowt {tE bG) leepth of Una N wndett.). No .`d t1Rfd Gobrs After hsdeat Reading Rpdiay -Ramrod Reeding Reading Rsrew edto (+) do ` —-- - MIWAIMUR, W. ' �i'11��F7l�l�l�JR�aa�\�J�LII�t \P�I� em s.. MI mIma�' i � S• . L-12 t 10 nA 0 !� Usim, mi mWalAw • _ mom` ► � • - f� WOr -t�i Aiw7m, :� ice' _ mil Ke 0 WER Ia"m ►r :i ►:�1 WE, - : yam N' „ -v : i -W! 1110, 2mu�_ a• pro VWro ®' i®M IMF -- TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �a Mail To: NAME OF BUSINESS: Board Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: ' 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 quantit' s totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES _1� NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please Indicate If the materials are stored at a site other than your mailing address: ADDRESS: , TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when store Please put a check bes de each product that you store: /" Antifreeze (for gasoline or coolant systems) Drain cleaners V 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, ens,#2-berg-o Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE , OMRUANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS L Class: 7.Miscellaneous �s QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATE S Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, ) Heavy Oils: waste motor oil (C) new motor oil (C) r transmission/hc , . Synthetic Organics: degreasers Miscellaneous: R C Y DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply Town Sewer /,MPublic � O On-site OPrivate 3. Indoor Floor Drains YES I/ NO O Holding tank: MDC__,4,,j'4 O Catch basin/Dry well eFn�arzriYc 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Pers (s) nterviewed Inspector Date