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Home My WebLink About0087 ENTERPRISE ROAD - HAZMAT h Corn' �qiql oq ti IRE ropy Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA-S. ,g' 200 Main Street• Hyannis, MA 02601 .a M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD P'� Business Name: I & Date: -lit Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: MSDS: Ws License#: Tier II : NO Labelin : Spill Plan: IVA Oil/WaterSeparator: Al Floor Drains: A V Emergency Numbers: Storage AreaslTanks: y vl h Emergency/Containment Equipment: Waste Generator ID: Was a Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage 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) V Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: salts Rd sa* 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 V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: P 7 )%91 33 Inspector: Coi�lac� QIjOd+r McS Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F�HE roy Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • MASS. 200 Main Street• Hyannis, MA 02601 " 163 9. A,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 P'� Business Name: Ste,,Nn , o 1 s g100L �� Date: � 3 f Location/Mailing Address: is Contact Name/Phone: Q.e sit %ti t. M Lst, e_ t"o( D)(� ��sc 4.- 921e5 gaH -o�Cs'te� In entory Total Amount: �- 00.r SDS: yt�, License#: II 9 1 Ca`F' 4 Tier II : G S �-� Labeling: z'4%1- Spill Plan: o Oil/WaterSeparator: A Floor Drains: Emergency Numbers: Storage Areas/Tanks: 6kor-e-fA k 1 $alp Emer enc !Containment E ui ment: V%a'� �� ovt,s k-C- Waste Generator ID: 41114 Waste Product: AIIA Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 44.A*"-4s C-n-h k-1 1 t h Pn1yZ�-�b� 1 Antifreeze Dry cleaning fluids $. 4 I Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) +< A`c'1 t.0e Asphalt&roofing tar -11- Swimming pool chlorine IPo 0 kp V- +17- Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" �ko�k '�' (including chloroform, formaldehyde, t a�o� fi4- I hydrochloric acid, other acids) �y� Ov 5k,c.t�B Ib�C�p �v��1 Gl,to�,,..c gs'tw A-,-g t 32X2tb 6t4 VIOLATANS:_ ORDERS: o o wo-�' S�'otte C'.�1, ns,"A- co vi-4-,t i K-!ne) o 1go 5 . INFORMATION/RECOM ENDATIONS. C• G o^C o,n o w� c cr a Sv a-� 1\,Lo �GlSv1, j'�'Dre- 387 �J u+� aw Ell t5 1/ri -5� ;� O�Inspector: L2we Ili o" (v+V fc 11 d4VV!u- 1 1 i l P,�'►0 tit S �f2 Facility Representative: ' WHITE COPY-HEALTH DEPARTMEINT/CANARY COPY-BUSINESS `oF►"e rok Town of Barnstable Office:508-862-4644 ~'^ Public Health Division Fax:508-790-6304 e" R,1; '$ 200 Main Street• Hyannis, MA 02601 1639. MO% TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT TFD Business Name: 151.0 1 V.--0."1 r0644, Date: 6 Location/Mailing Address: Se tw ,Jc gvqh Contact Name/Phone: Inventory Total Amount. OL 0.00010 SIDS: Xb o 4�H,- awl, License#: l 1 C�+'2 Labelin : ka.\ S q mill Plan: d o � Oil/WaterSeparator: Floor Drains: o Emergency Numbers: t` Storage AreaslTanks: ° b -a! Emer enc /Containment ui ment: 0<10 5, o .c-1 Waste Generator ID: A Waste Product: Date&Amount of Last Sh ment/Fre uenc Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS O W`�`� c�a, IvL t vkQAMA-v-<y 5 NOTE: Under the provisions of Ch. 111, Section 31, of the General Law of MA, hazardous material use, I KS,�IkCW, . storage and disposal of 111 gallons or more requires a license from the Public Health Division. Set 1NVCV��y 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: N6,17k Ae,145 A i 1 0 1W I FORMATION/RECO MENDATIONS:-101 o Inspector: Facili epresentative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i oF�"E r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE 200 Main Street• Hyannis, MA 02601 MASS. JA Fora+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT r Business Name: 'K4-0A1 P0& Q s,a►ti Date: S 27 7 6 Location/Mai ling_Address: E r (-1 4vl✓I i Contact Name/Phone: 45+�6Je_ vk n .S'o - i t,K Inventont Total Amount: '`''y MSDS: e-,5 License#:_� Tier II :`I e-j- GCS\oC�K!.--.�' "'`AZ,Labelina: ��-k d Spill Plan: 0 05� Oil/WaterSeparator: N A �� Floor Drains: 0 mergency Numbers: StorageAreas/Tanks: \ �� o\�t� � Acek 5 Ss Ce.�a,I 54,N Emer enc)/Containment E ui ment: 5e, Waste Generator ID: W IN Waste Product: Date&Amount of Last Shipm nt/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 5 n 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 ��,QQQ� �5 1�lot Gasoline,jet fuel, aviation gas Cesspool cleaners A-t Diesel fuel, kerosene, #2 heating oil Disinfectants 1` �1A a Miscellaneous petroleum products: Road salts o�tAq poI grease, lubricants, gear oil Refrigerants 1�*Lk'1� l �I�'''�4�� Degreasers for engines&garages Pesticides: �� ( Caulk/Grout insecticides, herbicides, rodenticides LilaG� Battery acid (electrolyte)/batteries Photochemicals(Fixers) I Rustproofers Photochemicals(Developer) Car wash detergents Printing ink k,L�tp�� Car waxes and polishes G� p 1 W sote)(6 ,�r`�\C"" �tW4 Asphalt&roofing tar � o Swimming pool chlorine �{p o� Lac �5. Paints, varnishes, stains, dyes /��` X,.x , ust, Lacquer thinners �j� `— Miscellaneous Combustible �ol�jS��sot� Paint&varnish removers, deglossers 1 eather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's bmt� p Metal polishes Other chlorinated hydrocarbons Ck1c1 v"1&u 1 Laundry soil &stain removers (including carbon tetrachloride) ��LeA A y� (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, �. hydrochloric acid, other acids) c�6d opl� VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: aoI t!v"-, &,P v e'VU<-i ov` - GZv�g c- Q l .tic av, av�. spec o . dQ�Q*r - , Facility Representa ve. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °FIKErok, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508a90-6304 • RARMASSBLE.g• 200 Main Street• Hyannis, MA 02601 MPy&`0 ,TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 115✓ �^^ po��s s Date: �6 �6 1 Location/Mailing Address: -T 6 e-,-bf.k R �►'� 3 M.,I ku rczs s Contact Name/Phone: -H 5-- ,'Z 3Z a w n Inventory Total Amount: I�� alb°�5 MSDS: Yeg License#: g ) �-°�,� �/n�� Tier II :�o V.�t.get,q%t "Al�,v. Labeling: OK Spill Plan:``'o be- o5�a Oil/WaterSeparator: Floor Drains: Emer enc Numbers: Y05 Storage Areas/Tanks: Skoca OW4 ep<(-4-tL/ Emergency/Containment EqMoment: �otbQ-v�' ko�n.g, e. Waste Generator ID: N)Ps Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ..II LIST OF TOXIC AND HAZARDOUS MATERIALS lV o MA of ��a 5 t v, iw.-he_n-\(7fl S'iy,GZ ��k' I kl) 61 — NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous aterial use, Cg1a 3� storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners 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 V 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/ ECOMMENDATIONS: ask 4•r��5 av� 3 -t-L 5 4 , -L r, Inspector: L 1 Facility Represent WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 8/ 8 / 13 TOWN OF BARNSTABLE - ,,-- TOXIC AND HAZARDOUS MATERIALS R _. FORM NAME OF BUSINESS 6ty/1,i r Poo ) 4,4 S k bes I Itti BUSINES6 LOCATION: vj4,--r r � Rd , ao✓lr s INVENTORY ,.MAILING ADDRESS: 4 vim— TOTAL AMOUNT- TELEPHONE NUMBER: SD3 --77 / D Gv2 3�z1� CONTACT PERSON: �S f..e y e— EMERGENCY CONTACT TELEPHONE NUMBER: M DS ON SITE? TYPE OF BUSINESS: S01 n,*A, po o / 15„4,ritl C-p— INFORMATION / RECOMMENDAT NS: %fa Js v u- fi Fire District: ft�,c','KAA- DGV'do a J &)6+5b,I( cv n ^, a n,§) k a.llcow p I 14y a h n,s e.vw o�ee.S .Axo d�i,elZ C-c,ppr�,►+q Waste Transportation: A)IA Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No 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) 1 ' Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW I ❑ 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 lob+3m b Swimming pool chlorine , n1alX 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 E�mX► Laundry soil &stain removers 11 (including bleach) JU►Sc g'+'t��j ),�el4, 44 I�S��TS74 ' Spot removers&cleaning fluids ' (dry cleaners) 4cea+ -5, 4 ljee-c i, Q& e. 6 - .7- Other cleaning solvents ' Bug and tar removerso►� - Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials °F1Her°k Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMASSBLE.g` 200 Main Street• Hyannis, MA 02601 t639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MP'� Business Name: ;54„/mm"Ir Q 1 I�Ak JeMb Date: Location/Mailing Address: (HqWnKJ Contact Name/Phone: Sbg-775 AM Inventory Total Amou t: ` u 6L 4, ?414 MSDS: License#: Tier II : 0 Labeling: " 5 Spill Plan: Oil/WaterSeparator: WA Floor Drains: 77fit Emergency Numbers: .5 Storage AreaslTanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: A Licensed Waste Hauler&Destination: l� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Read salts FC,,,J ScJfS 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 x 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: L. yC ` ' Inspector,: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87A ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ------------ -------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health z c4 . Town of Barnstable Im Inspectional Services BARNSTABLE Public Health Division W N&w�21=10«+I1► 1699-2914 BANWAIN4 1 Thomas McKean,,Director MAM * 200 Main Street, Hyannis,MA 02601 a , Officer 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 I st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 � �O CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Z Ol�i *A late charge of$10.00 will be assessed if payment is not received by July 1st. o2A>, 2021 1. ASSESSOR'S MAP AND PARCEL NO. C" �3 r 2. IS THIS A PERMIT RENEWAL? YES—NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER B SINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIAL TORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: , M-Sgalq 5. NAME OF ESTABLISHMENT: Su&,w`m, Pnnlh4,4�a leo;*, 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT.FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: B r a 10. SOLEOWNER: YES NO IF O,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK ` 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT 'f /DATE C:\Users\trippv\Desktop\Renewal Applications for 2020 Save for VST Quick Lookup\Haz Mat App R ised -10-18.doex 4} MAIL-IN REQUESTS i Please mail the completed application form to the address below. In addition, please include the required fee. `Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: • • • .` 1. . r A 1 ..- Town of Barnstable ` ' Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS ' Our fax number is (508) 790-6304.- Please fax a completed application form. In addition, please mail the required fee-amount. Please make the check payable to:Town of Barnstable. The check must be mailed to the address listed above. Allow,up to four days for in-house processing. For further assistance on any item above,call (508) 862-4644' ti C:1Usersltrippv\Desktop%Renewa1 Applications for 2020 Save for VST Quick Lookup\Haz Mat App Revised 09-10-18.doex Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN .-------------------------------------------------------------------------------------------------------------------------------- 87A ENTERPRISE ROAD, HYANNIS, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health C`i i TOwn of Barnstable Inspectional Services BARNSTABLE Public Health Division ,�� .� °il ;�;�. 1679.2010 .ntuverene: s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:- 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL.PERMIT(RUNS JULY 1st-DUNE 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: $150.00 S *A late charge of S10 DO will be assessed if payment is not received by July Ist. a � 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES—NO'. IF YES,SKIP QUESTION 3. 77- 1 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIAL TORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. <711 4. FULL NAME OF APPLICANT; A�. i =' 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: " , .-) m Lim 10. SOLEOWNER: YESMNO EF- O,NAME OF PARTNER: A 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER. CLERK 12 IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS _ ENTAIL: *SIGNATURE OF APPLICANT z'✓ /DATE C:WsersCtrippv\Desktop\Renewal Applications for 2020 Save for VST Quick Lookup\Haz Mat AppR 10-1$:docx Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87A ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i a 5Vwor of B4rnsxable eg atory Services Richard V. Scah,Director oFt"e'� Public Health Division BARNSTABLEz 1 MARNMBLF, 1 Thomas McKean Director MA fig, ) 1639-2014 ._3 94iPlFo �s`e� 200 Main Street, Hyannis,MA 02601 C �A Office: 508-862-4644 Fax: 508-790-630A: APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE N� 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 ,z V.S. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1:ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL YES_NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.- 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: S 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: o 9. EMAIL ADDRESS: . �OO ISO �Gdz� 'Co 10. SOLEOWNEi YES NO IF 4,"OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE r 1 Q:\Application FormsU4AZP✓IAT APP 2017 REVI A= Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87A ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Aug 04 17,01:47p Pool and Spa Design 5087781230 p.1 TRcowl of B agnstable f eg tort' ervtces Richard V. Scah,Director Public Health Division B_ARNSDOLE, I " Thomas McKean,Ditectot 200 Main Street,Hyannis,i.11A 02601 a Office: 508-862-4644 Fix: 503490 630 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE IL4ZARD0 S MATERIALS r IN ACCORDANCE Vi UR THE TOWN OF BARNSTABLE GENERAL ORDNANTCE,CHAPTER�I`08, HAZARDOUS-MATERIALS,ALL BUSINESSES THAT HANDLE OR,STORE H.4ZARDpUS MATERLALS GREATER THAN HOUSEHOLD QUAI-TTITIES ARE REQUIRED'I0 OBTAL'�T AN ANNUAL PEMf[I'(RUNS JULY I st-RUNE 3Oth). APPLICATION FEES CATEGORY 1 PERMT 26-110 Gallons: $50.00 Ci CATEGORY 2 PERMIT I I i -499 Gallows: $125.00 x CATEGORY 3 PERMI.T 500 or more Gallons. SI50.00 s *A late cha a of S10.00 will be assessed if Dayment is not received by July 1st. L ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENERTAL�YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT A'PLICATIONS,INDICATE WHETHER BUSINESS Ii4S ZONINGIBUILING APPROVAL FOR HAZARDOUS MATERLi-LS STORAGEMSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAD'IE OF ESTABLISBAIE•NT: %_1`c v b. ADDRESS OF ESTABLISHMENT: �• 41� J �� 7. MAILING ADDRESS(IFDIEFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: - 9. E-MAIL ADDRESS: l t C - b bo iti-- 10. SOLEOWI&R\ YES NO IF NO,N OF PARTNER . 11. FELL NA.WIE,1110NIF•ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12.,IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS , EMAIL• SIGNATURE OF APLL DATE ,f Q:'AP'hc-a6on:orms\HAZ 4ATAPP017REVls dog 4 f nn($ -',c w of Banstable � P eguuatory Services Richard V. Scali, Director Public Health Division *ipzo; LE, * •rrcnnrus,� Thomas McKean, DirectorPS?x5R0f.,fo3 `� 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-63h APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTEP,408, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS l� 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 — 'vl- . CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL�YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: ►Y`fl�Mi ' 6. ADDRESS OF ESTABLISHMENT: (:�5 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: / 8. TELEPHONE NUMBER OF ESTABLISHMENT:150t5 . d 9. EMAIL ADDRESS: ` `c f_l.;'r ,Lam 10. SOLEOWNEk YES NO IF NO,NIME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\I-IAZMAT APP 2017 REVISED.docx Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87A ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------- ------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ------------------------------------ -- \ WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 06/30/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health t► Town of Barnstable �t *ati Regulatory Services Richard V. Scah, Director " Public Health Division Am 16f9 �0 WSW Thomas McKean, Director 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 JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by 1st. ASSESSORS MAP AND PARCEL NO. DATE (O FULL NAME OF APPLICANT: _ NAME OF ESTABLISHMENT. -4�mL ,c ADDRESS OF ESTABLISHMENT: �L 6 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT:L( �� EMAIL ADDRESS k V`f\ rn I �(U ILJ SOLE OWNER: X YES NO ,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: SI N TURE OF A PLICANT Name: ` Company Address Telephone#: Email: Q:\Application Fonns\IAZZAPP Revl6.docx Page 1 of 2 f ppHE`T Town of Barnstable Office: 508-862-4644 iRegulatory Services Department Fax: 508-790-6304 • . eaRtts�nSM Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $125.00 (Check) on 5/27/2016 Permit number: 1181 I !Check number: 6726 Check amount: $125.00 Name on check: Swimming Pool &Spa Design j Business: SWIMMING POOL AND SPA DESIGN Owner: RAYMOND A&LINDA A TRS Address: 87 ENTERPRISE ROAD, Hyannis i i Note: Category II --- - • Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87A ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable °F11HE row Regulatory Services ti Richard V. Scali, Director '" KAS&` Public Health Division i0rfo nnA+' Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 X ASSESSORS MAP AND PARCEL NO. �7 J �/� DATE / APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT1�t � NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 4 • TELEPHONE NUMBER L ` ;?u, CJ -O SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# J:�HAZAPP.DOC I p IKE t Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 • BAtNSTABL Public Health Division Mass: ' Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $110.00 (Check) on 8/5/2015• 'Check number: 5919 Check amount: $110.00 Name on check: Swimming Pool &Spa Design ;Business: Swimming Pool &Spa Owner: RAYMOND A& LINDA A TRS TRICCA j lAddress: 87 ENTERPRISE ROAD, Hyannis • i L Number Fee 1181 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that SWIMMING POOL AND SPA DESIGN 87 ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 Town of Barnstable Barnstable- Regulatory Services Department 1 Public Health Division + IIAMSPABM •I 9 MASS. 39 i639. 200 Main Street, Hyannis MA 02601 10m a � 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANTI:�)A-cue NAME OF ESTABLISHMENT ' ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER ~ JI SOLE OWNER:,YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: ` Q C :.� w� TI IF APPLICAN -IS_A-CORPORATION: FEDERAL IDENTIFICATION NO STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK 'IGNATURf OF APPLICANT RESTRICTIONS: HOME ADDRESS I �D Ivl�c��5 11Ar?,ryl c�c? k'VWW HOME TELEPHONE# -1 tj B di a J:\inspection handouts\Haz Mat Application2008.DOC IDEM Guidance Indiana Department of Environmental Management Office of Land Quality 100 North Senate Indianapolis, IN 46204 OLQ PH: (317)232-8941 HAZARDOUS WASTE CONTINGENCY PLANS Contingency Plan Preparation Guidance Federal and State hazardous waste regulations(40 CFR 265 Subpart D--Contingency Plan and Emergency Procedures(40 CFR 265.50 through 265.56),referenced by 3291AC 3.1-10-1),require that large quantity hazardous waste generators(by reference in 40 CFR 262.34)and treatment, storage and disposal facilities(TSD's)must have, and be prepared to implement,a Contingency Plan which is designed to minimize hazards to human health or the environment from fires,explosions,or any unplanned sudden or non-sudden release of hazardous waste or hazardous waste constituents to air, soil, or surface water. The following discussion provides guidance on key elements of the contingency plan. Also attached is a suggested outline for a contingency plan and a model plan. This guidance applies to generators and to facilities under interim status. Site-specific requirements for permitted facilities will be developed during the Part B permitting process. The plant-specific Contingency Plan will,of course,be organized and worded as is best suited to the facility. The Plan, and all parts, should be specific regarding what to do,who to notify, and in the case of off-plant assistance,what those groups will and will not do during the emergency. Although the contingency plan provides a plan of action during and following an emergency situation, training is necessary and required to ensure that the correct actions are taken during an emergency. In addition to the training given to all personnel,the emergency coordinators should receive specialized training for this role. A crew of employees should also be specially trained to assist the emergency coordinator in dealing with an emergency. Contingency Plan Implementation The contingency plan is a document which sets out an organized,planned,and coordinated course of action to be followed in case of a fire,explosion, or release of hazardous waste or its hazardous constituents which could threaten human health or the environment. The plan need not address all product spills but must address spills of materials which are hazardous wastes. The contingency plan must be implemented for an on-site,as well as an off-site release that could threaten human health and the environment,even if the emergency coordinator does not believe that the wastes will leave the site. The contingency plan was designed to deal with threats to facility personnel,as well as with threats to people outside the facility. The preamble to Subpart D of the federal regulations notes that the Agency did not intend to require implementation for releases of"insignificant amounts"of hazardous waste, such as very small spills or a leaking valve. OSHWM General ID#0021-02-HW October 1996 r At a minimum, the plan must map out general strategies to deal with both sudden and non-sudden events. Such strategies must involve outlining a series of steps to be taken in response to an incident and should include decision points where outside assistance may be required and the circumstances under which evacuation of the facility is advisable. The following criteria should be used in the contingency plan implementation decision process: 1. The contingency plan must be implemented if an imminent or actual incident could threaten the environment or human health. a. Spills The spill could result in release of flammable liquids or vapors creating a fire or gas explosion hazard. The spill could cause the release of toxic liquids or fumes. The spill can be contained on-site but the potential exists for groundwater pollution due to aquifer contamination. The spill cannot be contained on-site resulting in off-site soil contamination and/or ground or surface water pollution. b. Fires The fire could cause the release of toxic fumes. If the fire spreads,it could ignite materials at other locations at the site or cause heat-induced explosions. The fire could spread to off-site areas. Use of water or water and chemical fire suppressant could result in contaminated run-off. c. Explosions An imminent danger exists that an explosion could occur,resulting in a safety hazard due to flying fragments or shock waves. An imminent danger exists that an explosion could ignite other hazardous waste at the facility. An imminent danger exists that an explosion could result in release of toxic material. An explosion has occurred. Emergency Coordinators The facility must select at least one(1)employee who is either on the facility premises during normal operational periods or is available to respond to an emergency by reaching the facility within a short period of time. This employee must be designated the primary emergency coordinator. The emergency coordinator is responsible for coordinating all emergency response measures, and being thoroughly familiar with: OSHWM General ID#0021-02-HW October 1996 -- The facility's contingency plan; -- All operations and activities at the facility; -- The location and characteristics of waste handled; -- The location of all records within the facility;and. -- The physical layout of the facility. The selected emergency coordinator must have the authority to expend funds and recruit employees to implement the Contingency Plan. The owner/operator should also select alternate emergency coordinators if for some reason the designated emergency coordinator may be unavailable. Emergency Response Procedures for Spills, Fires, and Explosions The appropriate level of response to a particular incident is largely a matter of professional judgement. However, the full range of response methods to be employed in a variety of potential situations can been anticipated and,thus, should be outlined as emergency procedures. The level of detail appropriate for these response procedures is dependent upon a number of factors including: -- The type of waste handled. -- The potential for fires,explosions,or releases. -- The immediate health and safety effect of the incident upon personnel. -- The potential hazard to the outside environment. The contingency plan must contain elements which address emergency procedures to be undertaken: -- Immediately upon discovery of an emergency. -- During emergency control phase. -- Immediately following attainment of control. Immediately upon discovery of an imminent or actual emergency,the first duty of the emergency coordinator is to warn the operating personnel, since they are likely to be the first group exposed to danger. Secondly, appropriate State or local emergency response agencies should be called if their assistance is needed to cope with the emergency. In the event of a release,fire,or explosion,the emergency coordinator must identify the character, exact source, amount, and extent of any released material. He also must assess possible hazards to the environment and human health. The identification of the discharged material may be accomplished through observation,review of manifests, and,if necessary,by chemical analysis, although response should not be delayed until the analysis is complete. If the release,fire,or explosion could threaten the environment or human health outside the facility,the emergency coordinator must immediately notify the appropriate local authorities and notify either the on- OSHW 4 General ID#0021-02-HW October 1996 scene U.S. Environmental Protection Agency(EPA)coordinator for that geographical area,or the National Response Center at AC 800/424-8802, and the Indiana Department of Environmental Management(IDEM),Office of Emergency Response at AC 317/233-SPEL(7745). During the emergency control phase, the emergency coordinator must take all reasonable steps necessary to ensure that explosions and releases do not occur,recur, or spread to other hazardous waste at the facility. These steps include,where applicable, stopping operations. The emergency coordinator must monitor for leaks,pressure buildup,gas generation,or ruptures in valves,pipes,or other equipment, wherever appropriate. Details should be provided to emergency personnel concerning the types of on-site emergency equipment to be used and the need for personnel protection equipment. Immediately after an emergency,the emergency coordinator must provide for treating, storing,or disposing of recovered waste,contaminated soil or surface water,or any other material. The recovered material must be handled as a hazardous waste unless it is a characteristic hazardous waste only,which is analyzed and determined not to be hazardous. The emergency coordinator must ensure that in the affected areas of the facility,no waste that may be incompatible with the released material is treated, stored, or disposed of until cleanup procedures are completed. All emergency equipment must be cleaned and made fit for its intended use before operations are resumed. Emergency Equipment 40 CFR 265.52(e),referenced by 329 IAC 3.1-10-1 of the State hazardous waste regulations,specifies that the plan include a list of all emergency equipment at the facility. In addition,the location of this equipment is to be noted and a physical description of each item on the list is to be provided along with a brief outline of the equipments' capabilities. Emergency equipment will vary from facility to facility,but must include the following as required by the regulation,unless none of the hazards posed by waste handled at the facility could require the equipment's use: -- An internal communication or alarm system capable of providing emergency instructions. -- A device capable of summoning external assistance(telephone or two-way radio). -- Portable fire extinguishers,fire control equipment,spill control equipment, and decontamination equipment. This list will be used by facility personnel during an emergency. The format for the list should,therefore, allow identification of any needed equipment and its location in the easiest possible manner. It is suggested that a plot plan showing the locations of the equipment also be included in the Plan. Evacuation Plan The Contingency Plan must include an evacuation plan for facility personnel where there is a possibility that evacuation could be necessary. Where no possibility exists that facility evacuation could ever be necessary,this plan element may be omitted. Situations which would warrant partial or complete evacuation are as follows: -- Explosions resulting in airborne debris including container fragments and hazardous waste. -- Spills or chemical reactions resulting in toxic fumes. OSHWM General ID#0021-02-HW October 1996 1 -- Fire when it cannot be contained and is spreading to other parts of the facility,or when fire could generate toxic fumes. -- All incidents where necessary protective equipment is not available to emergency response personnel. The evacuation plan must ensure the safe egress of facility personnel. The evacuation plan must indicate a recognizable signal to start evacuation,evacuation routes,and alternate evacuation routes (in case primary exit routes are blocked by releases of hazardous waste or fires). Required Reports Within fifteen(15) days after an incident requiring implementation of the contingency plan,the owner or operator must submit a written report on the incident to the EPA Regional Administrator,and the Commissioner of the Indiana Department of Environmental Management,which includes: -- Name, address, and telephone number of owner/operator. -- Name, address,and telephone number of the facility. -- Date, time,and type of incident. -- Name and quantity of materials involved. -- An assessment of actual or potential hazards to human health or the environment. -- Estimated quantity and disposition of recovered material that resulted from the incident. Before operations are resumed in the affected areas of the facility,the owner/operator must notify the Regional Administrator and appropriate State.and local authorities that the facility is in compliance with follow-up procedures to an emergency prior to resuming operations in the affected areas. Amendment of the Contingency Plan The contingency plan must be reviewed,and immediately amended,whenever the following situations apply: applicable regulations are revised;the plan fails in an emergency;the facility changes in its design, construction,operation,maintenance,or other circumstances in a way that materially increases the potential for fires,explosions,or releases; the list of emergency coordinators changes;or the list to emergency equipment changes. For More Information Contact the Compliance Branch, Office of Land Quality at 317-234-6923, or the IDEM toll-free number 1-800/451-6027. OSHWM General ID#0021-02-HW October 1996 Suggested Outline Contingency Plan 1. Facility Identification and General Information a. Name of Facility b. Address of Facility c. Name,Title,Home Address, and Telephone Number(office and home)of Primary Emergency Coordinator d. Type of Facility e. Site Plan f. Description of Generator,TSDF Activities 2. Emergency Coordinator a. Primary Coordinator b. Alternate Coordinators c. Duties and Authority to Commit Resources 3. Implementation of the Contingency Plan a. Spills b. Fires c. Explosions 4. Emergency Response Procedures for Spills,Fires,and Explosions a. Immediately upon discovery of an emergency(Notification) b. During the emergency control phase(Control and Containment) c. Following attainment of control(Follow-up) 5. Emergency Equipment a. Emergency Equipment Inventory b. Location of Emergency Equipment(Facility Diagram) c. Equipment Capabilities d. Emergency Equipment Available from Other Sources 6. Coordination Agreements and Telephone Numbers a. Police b. Fire c. Hospital d. Other Emergency Response Units e. Spill Contractors OSHWM General ID#0021-02-HW October 1996 i 7. Evaluation Plan a. When to Evacuate b. Signals to Begin Evacuation c. Primary Evacuation Routes d. Alternate Evacuation Routes 8. Required Reports a. Incident Report b. Notification of Compliance Before Resuming Operations 9. Amendment of Contingency Plan a. Revised Regulations b. Facility Change c. Emergency Coordinator Change d. Emergency Equipment Change OSHWM General 1D#0021-02-HW October 1996 Contingency Plan* Perfect Craft Manufacturing Company 1988 Diamond Boulevard Nature Valley, Indiana 46100 IND000123456 *This model contingency plan is for guidance purposes only. OSHWM General ID#0021-02-HW October 1996 1. Facility Identification and General Information Name: Perfect Craft Manufacturing Company x Location: 1988 Diamond Boulevard,Nature Valley,Indiana 46100 Operator: Mr.Dan Dearthy 123 Tobacco Road Nature Valley,Indiana 46100 Telephone: AC 317/555-5000(office) AC 317/555-8217 (home) Emergency Coordinators: Mr.Fred Gordon 456 Contingency Lane Nature Valley,Indiana Telephone: AC 317/555-0000(office) AC 317/555-8127 (home) Beeper Number 4516 Mr.John Davis 789 Evacuation Route Nature Valley,Indiana Telephone: AC 317/555-5000(office) AC 317/555-2188 (home) Beeper Number 4515 Type of Facility ' Large quantity generator of hazardous waste with interim status for the on-site storage of hazardous waste in tanks and containers. Container storage capacity=4,125 gallons Tank storage capacity 10,000 gallons Facility Site Plan See Figure,I on next page. OSHWM General UM021-02-14W October 1996 Lost Creek Container Storage Area Storm Water Retention Pond 5,000 gallo n 10,000 gallon W WrP Storage Tank 00 Storage Tank Maintenance Shop Plant Vistor Parking 0 O Ir w Engineering and Plant Offices a Administration Building Parking Fence Guard House Diamond Blvd. Site Plan Perfect Craft Mfg. Co. OSHWM General ID#0021-02-HW October 1996 Description of Generator and TSD Activities Manufacturer of custom fiberglass boats and custom metal boat trailers. Processes include the hand lay-up of fiberglass hulls;the building and finishing of teakwood decks;metal fabricating; Y P g g g , g, phosphating and painting; and cyanide,chromium electroplating of small parts. Hazardous wastes are generated from various processes in the plant. Fiberglass Operations: Waste Acetone(F003) Waste Acetone still bottoms (F003) Wood Finishing: Waste Toluene(F005) Metal Finishing(Painting): Waste Toluene(F005) Electroplating: Sludge from treatment of rinse waters(F006) Spent cyanide plating bath solutions(F007) Bottom sludge from cyanide plating bath solutions(17008) Perfect Craft Manufacturing Company has interim status for the storage of waste acetone(liquid and still bottoms)and cyanide plating baths and bottom sludges in 55-gallon containers. Wastewater treatment sludge is also stored on the pad in 20 cu/yd roll-off containers. Waste toluene is stored in a 10,000- allon aboveground tank located just northeast of the main plant. Waste mineral spirits are stored in a 5,000-gallon aboveground tank located next to the 10,000 gallon tank. 2. Emergency Coordinators Principle: Mr.Fred Gordon Contingence Lane Nature Valley,Indiana Telephone: AC 317/555-5000(office) AC 317/555-8372(home) Beeper Number 4516 OSHWM General ID#0021-02-HW October 1996 I Alternate: Mr.John Davis 789 Evacuation Route Nature Valley,Indiana Telephone: AC 317/555-5000(office) AC 317/555-2188 (home) Beeper Number 4515 The emergency coordinator serves as chief of the emergency crew,which is on each operating shift. These personnel have received intensive additional emergency training above regular plant emergency training. One of the emergency coordinators is always "on call",i.e.,can be reached by telephone,pager, or a "beeper". Mr.Dan Dearthy,President and facility operator,has given authority to the above mentioned emergency coordinators to expend funds and recruit trained employees in the event an incident requires implementation of the Contingency Plan. Both selected emergency coordinators are senior management personnel and are responsible for hazardous waste management at the site. The emergency coordinators are throughly familiar with all aspects of the contingency plan,all operations and activities at the facility,the location and characteristics of waste handled,the location of all records within the facility, and the facility layout. 3. Implementation of the Contingency Plan The Contingency Plan will be implemented if an incident might threaten human health or the environment. The emergency coordinator has full authority to make this decision. Implementation of the contingency plan is not limited to incidents at the regulated storage units,but includes incidents at all hazardous waste generation and accumulation points throughout the plant. Furthermore,the contingency plan must be implemented whenever an incident might involve hazardous waste anywhere on the plant property. Depending upon the degree of seriousness,the following potential emergencies might call for the implementation of the contingency plan: -- Spills A spill of waste acetone or waste toluene from containers or tanks which can be contained on-site but the potential exists for groundwater pollution due to aquifer contamination. A spill of any on-site generated or stored hazardous waste from containers or tanks which cannot be contained on-site resulting in off-site soil contamination and/or ground or surface water pollution. OSHWM General ID#0021-02-HW October 1996 -- Fires A fire which could cause the release of toxic fumes from hazardous waste. If the fire spreads,it could ignite materials at other locations at the site or cause heat-induced explosions. A fire which could spread to off-site areas. Use of water or water and chemical fire suppressant could result in contaminated run-off. -- Explosions An imminent danger exists that an explosion involving hazardous waste could occur,resulting in a safety hazard due to flying fragments or shock waves. An imminent danger exists that an explosion could ignite other hazardous waste at the facility.. An imminent danger exists that an explosion involving hazardous waste could result in the release of toxic material. An explosion has occurred. 4. Emergency Response Procedures for Spills,Fires,and Explosions Immediately Upon Discovery of an Emergency An employee discovering a spill,fire,or an imminent danger of explosion involving hazardous waste that is not easily controllable with equipment and materials at hand must contact the emergency coordinator. The emergency coordinator will immediately respond to the call and assess the situation. If the emergency can be controlled without evacuating the plant,emergency crew members will be contacted to respond to the incident. If the emergency coordinator determines that the incident requires evacuation of the plant,he will immediately activate the internal alarm. (NOTE: All Perfect Craft Manufacturing Company employees are instructed to activate the internal alarm system,if the incident is an obvious immediate threat to fellow employees or the environment.) All employees hearing the alarm must close down their equipment and proceed to the administration building to await further instructions. Members of the emergency crew will proceed to the plant engineering office to await further instructions from the emergency coordinator. The emergency coordinator.will concurrently assess the situation by identifying the character,exact source,amount and extent of any released material. He will also make an assessment of possible threats to human health and the environment. If the incident could threaten the environment or human health outside the Perfect Craft Manufacturing Company property,the emergency coordinator will contact the Nature Valley Fire Department,the Nature Valley Police Department, and Pity Hospital if injuries have occurred from the incident. OSHWM General ID#0021-02-HW October 1996 The emergency coordinator will call the National Response Center,telephone AC 800/424-8802, and report the incident. The report will include the following: -- Name and telephone number of the reporter. -- Name and address of this facility. -- Time and type of incident -- Identification and quantity of materials involved. -- The possible hazards to the environment and human health outside the facility. In addition,the emergency coordinator will contact the Indiana Department of Environmental Management(IDEM), Office of Emergency Response at AC 317/233-SPIL(7745). A designated member of the emergency crew will conduct a roll call for all employees who reported to the administration building and engineering office. During the Emergency Control Phase The emergency coordinator will take all necessary measures to contain the hazard within the facility property, and to prevent its spread to other nearby properties,with the assistance of the emergency crew and emergency personnel assigned by the various parties contacted. Emergency crew members are instructed to carry respirators or'self-contained breathing apparatus (SCBA)'s and wear boots,gloves,and safety glasses prior to responding to an emergency. In case of a spill of flammable or toxic solvent waste,absorbent material will be placed on the spill by the emergency crew. If the spill is from a leaking or damaged container,it will immediately be over packed. In case of a spill of waste toluene from the tank,the emergency crew will dike around the tank with absorbent material. If the spillage is due to the tank being ruptured,an outside spill contractor will be contacted immediately to empty the tank. (See Figure 2 for more detailed instructions). In case of a spill or release of waste cyanide,the alarm will sound an intermittent bell. In such a situation,the emergency crew is instructed to evacuate the area and join all other employees at the administration building. The Nature Valley Fire Department will immediately be requested to respond. In case of a fire or explosion,emergency crew personnel are instructed that if the fire cannot be readily controlled with available equipment,the area must be immediately evacuated. (See Figure 3 for more detailed instructions). i OSHWM General UM021-02-HW October 1996 Following Attainment of Control Following containment znd control of the emergency,the emergency coordinator,along with the emergency crew,will provide for collection,treatment, and disposal of the waste and contaminated soil,water, or other materials by the emergency crew or outside contractor, as appropriate. The emergency coordinator will ensure that all emergency equipment is restored to full operational status by the emergency crew. The emergency coordinator will investigate the cause of the emergency and will take steps to prevent a recurrence of such or similar incidents. The emergency coordinator will make sure that cleanup and restoration have progressed at least to the point of not jeopardizing she health and safety of the employees,and that EPA staff and local authorities have been notified before permitting resumption of the operations affected by the emergency. 5. Emergency Equipment Internal Communication/Alarm System The main plant building is equipped with ten(10)wall-mounted switches tied into an electric bell alarm system. Ten (10)switches are located in production areas, adjacent to each of ten(10)work stations, and one each at the container storage pad and tank storage area. The switches are red and clearly marked for rapid identification. OSHWM General ID#0021-02-HW October 1996 Figure 2 Emergency Response Procedures Tank and Container Spills 1. Determine source of spill and stop all flows to the tank. 2. Identify the waste material spilled and determine the hazards involved in terms of potential for fire, hazardous gas release, corrosion,explosion,and water pollution. 3. Evacuate all endangered or unnecessary personnel. In case of the release of toxic or flammable gases, determine if off-site evacuation is advisable. Remove nearby wastes that may be incompatible with the spilled material. 4. All spill response personnel are to wear protective.equipment,including respirators and/or SCBA's, and are to stay upwind of the spill to the extent that is possible. 5. Contain the spill to the smallest area possible. Examples of equipment available for spill containment are absorbent and spark proof shovels. 6. After the spill is contained,treat the spill with neutralizing agents to lessen risks of fire, corrosion, explosion, or other hazards. Apply non-reactive sorbent materials. 7. Decontaminate area affected b spill b removal of spilled and sorbent materials and contaminated Y r Y )' soil. 8. Clean up,restore,or replace spill response equipment and return it to its original location. OSHWM General ID#0021-02-HW October 1996 i + ARUMM aEOKMHZR Y 0 Ff�CAI S IBIS + * -AAA 1"m 0 I",n WF SWTA SWTak "`+ 0 0 MMMEft — * x + Rai -0 x x c Cn m 0 D PW9 OSHWM General ID#0021-02-HW October 1996 Figure 3 Emergency Response Procedures Tank and Drum Storage Fire 1. Determine what is on fire by location, drum label, inventory, log, or other means. 2. Determine if persons are endangered by the fire or if the fire could spread to other wastes. 3. Evacuate all endangered persons. In case of release of toxic gases or where there is potential for explosion, determine if off-site evacuation is advisable. 4. Define the limits of the fire. Estimate the potential dangers due to location with respect to other wastes in the immediate vicinity. Call the local fire department if they may be needed. 5. Fire fighting personnel are to wear full protective clothing and breathing apparatus as is appropriate. 6. Firefighting should be done at a maximum allowable distance staying upwind and from a protected location,if possible. 7. All fires shall be dealt with using fog protection (i.e., water spray). Small fires such as a single barrel fire can be approached with portable extinguishers, dirt, or sand to extinguish flames by smothering. 8. All large fires will require fog line protection with approaches made behind heavy equipment(e.g., front end loader)to smother fire and protect personnel. 9. Extra caution is to be taken with containerized material fires for signs of rupture or explosion due to heat releasing hot liquids, flammable vapors, or poisonous gases. 10. After fire,clean up affected areas. Run-off from water used in firefighting should be treated as a hazardous waste and disposed of properly. 11. Clean up all fire fighting equipment and return it to its original location in a state of readiness. OSHWM General ID#0021-02-HW October 1996 �e 1",n 0 Wlm Wi' SWTak 0 SjqyMik ► RA ► i cn C) D m aRadCB�s m 0 OSHWM General ID#0021-02-HW October 1996 I - Outside telephones are located throughout the main plant, maintenance shop,engineering offices administration building, and drum pad. The telephone numbers of the emergency coordinators,the Nature Valley Fire Department,and the Nature Valley Police Department are displayed prominently near all the telephones. The telephones have internal intercom capabilities. Fire Control Equipment To provide rapid response to fires,wall-mounted,hand-held fire extinguishers are centrally located at each of eight(8)areas within the main plant,maintenance shops,and drum storage pad. Because the primary danger of fire is from flammable liquids,carbon dioxide extinguishers are used. An automatic sprinkler system runs throughout the main plant. The sprinkler system is of the foam-water type. Capabilities: Response to small fires. Spill Control Equipment Each working area within the plant and the drum storage pad is equipped with a supply of spill absorbing materials,shovels,and an emergency shower and eye fountain to wash off personal spills. The maintenance shop contains a large supply of absorbent material, shovels,over pack drums, and brooms for spill control. Capabilities: Response,containment,and cleanup of spills throughout the facility. Personal Protective Equipment The maintenance shop also contains a large supply of coveralls,boots and gloves for emergency crew members. Also,each emergency crew member is assigned and test fitted in a full face respirator with appropriate cartridges. Capabilities: To provide emergency crew members with protection when responding to emergency spills. First Aid The administration building houses a fully stocked first aid station. Capabilities: To provide first aid for minor injuries which occur during normal situations or during emergencies. OSHWM General ID#0021-02-HW October 1996 Scott Air Packs Self-contained breathing apparatus (SCBA)are located at the wastewater treatment area,maintenance shop, and administration building. SCBAs are to be used by trained personnel only in extreme emergencies. Capabilities: For the use of emergency crew members in extreme emergencies for rescue operations. Arrangements have been made with acme Trucking to provide a 10,000-gallon tanker to pump the waste toluene tank if needed. Figure 4 provides a facility plot plan showing the location of the above-mentioned emergency equipment. 6. Coordination Agreements and Telephone Numbers Nature Valley Police Department(AC 317/265-7890) The NVPD has received a copy of the contingency Plan along with a layout of the facility. In a letter to the NVPD,Perfect Craft Manufacturing Company identified types of hazardous waste handled, places where workers are normally working,entrances,and evacuation routes. The NVPD personnel have received a special briefing on the hazards of cyanide waste spills and have worked out community evacuation routes and procedures. Nature Valley Fire Department(AC 3171265-3456) The NVFD has received a copy of the contingency plan. The fire department has visited the site and has a observed site access routes,the locations of high risk areas,and have inspected fire protection capabilities including the sprinkler system. These inspections are conducted twice per year. In addition the fire department has conducted training exercises for the emergency crew using ignitable materials. The NVPD personnel have received a special briefing on handling of cyanide waste spills. Pity Hospital (AC 317/265-5678) Hospital personnel have received a special briefing on the health hazards of toxic solvent waste and cyanide waste and on treatment for exposure to these wastes. Also,the hospital has a Contingency plan calling for decontamination of victims. I OSHWM General ID#0021-02-HW October 1996 Acme Trucking,Inc. (AC 317/265-8810) A contractual agreement(copy attached)has been reached with Acme Trucking,a licensed hazardous waste transporter,to provide a 10,000-gallon tanker any time within one(1)hour's notice in case the waste naphtha or waste toluene tanks required emptying. 7. Evacuation Plan Facility personnel will be evacuated if the emergency coordinator decides that their personnel safety is in danger. If evacuation is necessary,the facility alarm system will be activated,resulting in a continuous bell ring. Facility personnel are instructed to immediately shut down all equipment and proceed to the nearest exit and assemble at the rear of the administration building. If the nearest exit is blocked,personnel must use the next nearest available exit. A diagram of available exit routes is located at each work station(see Figure 5 on next page). Emergency crew members must report to the engineering office to await further instructions from the emergency coordinator. Each employee must immediately report to his/her supervisor upon reaching the administration building.. If the alarm signal changes to an intermittent ring,emergency crew members are instructed to immediately join all other employees behind the administration building. 8. Required Reports Within fifteen(15)days of any incident requiring implementation of this contingency plan,the emergency coordinator will file a report with the EPA regional administrator and the Assistant Commissioner of the Office of Solid and Hazardous Waste Management(OSHWM). The report will include the following information: -- Name, address,and telephone number of owner/operator. -- Name,address,and telephone number of the facility. -- Date,time,and type of incident -- Name and quantity of material involved. -- An assessment of actual or potential hazards to human health and the environment. -- Estimated quantity and disposition of recovered material that resulted from the incident. The operator will note in the operating record the time,date,and details of any incident that requires implementation of the contingency plan. 9. Amendment of Contingency Plan OSHWM General ID#0021-02-HW October 1996 Perfect Craft Manufacturing Company will review,and amend,this contingency plan whenever the following situation apply: applicable regulations are revised;the plan fails in an emergency;the faculty changes in its design,construction, operation,maintenance,or other circumstances in a way that materially increases the potential for fires,explosions,or releases;the list of emergency coordinators changes; or the list of emergency equipment changes. OSHWM General ID#0021-02-HW October 1996 Town of Barnstable Barnstable Regulatory Services Department HRARNGU AFAmedeaCity Public Health Division 200 Main Street Hyannis MA 02601 639• y m � 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 / [/V 3 Thomas A.McKean,CHO 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 NAME OF ESTABLISHMENT cy \ M;'1N3 ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER t) �� SOLE OWNER:�r YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDR�8 OF ALO o PARTNERS: a C w tV � IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# J:linspection handouts\Haz Mat Application200830C MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow time for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy o-your contingency plan (to handle hazardous waste spills, etc.) In addition, please mail the required fee of$100. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow time for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page J:Vnspection handouts\Haz Mat Appliation2008LOC