Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0088 ENTERPRISE ROAD - HAZMAT
NCAfjrjl'S � Ic)C, trw►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM SS. 200 Main Street• Hyannis, MA 02601 1639. prfOMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ;,•,tL ✓� . Date:01�a Location/Mailing Address: S ' Contact Name/Phone: 0 7'J d fy Inventory Total Amount: MSDS: US License#: I� Tier II : Labelin Spill Plan: Oil/WaterSeparator:_ , Floor Drains: Emergency Numbers: Storage Areas/Tanks: SL e Qia\l Emer enc /Containment E ui m t: 5 Al � Waste Generator ID: A Waste Product: -ra i$ a Date&Amount of Last Shipment/Frequency: aoal Licensed Waste Hauler&Destination: i Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 00 4' Inspector: f Facility Representativ .' WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS r 0p1ME TO Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA MASS' 200 Main Street• Hyannis, MA 02601 ,bM A,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MAy Business Name: I S Date: EJO M Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: MSDS: LAO License#: _ Tier II Do Labeling: Spill Plan: Q10T Oil/Water Separator: A ; Vlopr Drain : no Emergency Numbers: Storage AreaslTanks: Emergency/Containment Equipment: tifja Cbeq Waste Generator ID: f�14®��i'j, Waste Product: IN N Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: ` l ✓ Other Waste Disposal Methods:_ rwg, LIST OF TOXIC AND HAZARDOUS MATERIALS h® n jfur NOTE: Under the provisions of Ch. 111, Section 31, ofNfttal"Lawls"TMA,hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Aqm�' Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FIKE►orti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 eARMA.'Lq- . 200 Main Street• Hyannis, MA 02601 prFCMA'� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I C h(XIG # 16A Date: 9 C Cq to Location/Mailing Address: r-, 9-549 Contact Name/Phone: Inventory Total Amount: ,�itl MSDS: � �11hP, License#: 1I.17 Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment E ui men : p N [aste Generator ID: 6*67 Waste Product: rh!WfihfflM H LARWL ra v08 Date&Amount of Last Shi ment/Fre uenc : 3 �aD qp(censed Waste Hauler&Destinatio ther Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes e or caustic soda Lacquer thinners ri/ Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes v'miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 5011 elm q o` w Inspector: Facility Representative: Y4.t4, WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS van we, c�e ' �cTle. pf THE Kok, Town of Barnstable S Office:018--862-6'44 Public Health Division Fax:508-790-6304 • BA MASSBLE.g• 200 Main Street• Hyannis, MA 02601 �PfFDMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: i C fie Date: C171 201q Location/Mailing Address: 2 eA P11 466' M n fb UK 61 �5 Contact Name/Phone: -IU'61 Inventory Total Amount: � SDS: Ohll h& + j n License#: colt Tier II : tj o Labeling: CfAco Spill Plan: Q Oil/Water Separator: IVA Floor Drains: A t C) Emergency Numbers: e Storage Areas/Tanks: A-�AQ— i Emergency/Containment Equipment: Waste Generator ID: \/ 7 1 Waste Product: r Date&Amount of Last Shipment/Frequency: bA ' Licensed Waste Hauler&Destination:* i "U V S -� Dr V Other Waste Disposal Methods: A 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 *a 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) phalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes 0o`{ ' Lye or caustic soda ✓Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables 3p4-60 Fertilizers Floor&furniture strippers /t PCB's Metal polishes bP2- Other chlorinated hydrocarbons Laundry soil &stain removers Pd° (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMM NDATIONS: bUG iC � fimf Inspector: r& Facility Representativ Cm WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °F THE TOk'I Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7 BAaMA83BLEy, 200 Main Street• Hyannis, MA 02601 �A t6M MP p�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED '� An f� Business Name: V"` 'r_�a��S A e�5 C r^g+-�> Date: 7 A 1 Location/Mailing Address: goo ket c'II,.(- et►1.11 S Contact Name/Phone: SO - -17$- 03 %'7 - Inventory Total Amount: ti 1`�(� q(J SDS: B�^��'"'�-t CA Iv- License#: 1117 t2- Tier II : Labeling: co Spill Plan: Oil/WaterSeparator: Floor Drains: o Emergency Numbers: ©K Storage Areas/Tanks: 3 fie.a. v� ahl' G�b 1a�4a- �+ti 1ab�-1 h�►�S - ®o Emergency/Containment Equipment: o-r }s "W S }e- Waste Generator ID: -7 Wa to Product: VKk6c �e-�v=Kb awv� Date&Amount of Last Shipment/Frequency: t l '1 2.v 1'7 O —J* IXC , ,C Licensed Waste Hauler&Destination: 1e btu c_ 1: 4v s Other Waste Disposal Methods: -5 —.4Y4I1,-_ LIST OF TOXIC AND HAZARDOUS MATERIALS Iv 0 V4A 1°'( e,"Wy-t IA5+ tKS 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 oK S }�J mt,►1��os.���v Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for eppines&g ages Pesticides: Caulk/Grout` bc� 51V-eVCeSixS 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: &fir ov5 e., `�G2a/15c� ��S -ex, ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 091405 Michaels 01:08:08 p.m. 10-23-2017 1 /2 FAX k AV DATE: 10/23/2017 PAGES: g 7— FROM: Michael Krenek,Safety Manager Michaels Stores,Inc. 8000 Bent Branch Drive Irving,TX 75063 972-373-3394 ph.krenekpemichaels.com TO: Town of Barnstable • Public Health Division 200 Main Street Hyannis,MA 02601 Fax: 508-790-6304 RE: Application for Permit to Store and/or Utilize Hazardous Materials Michaels Stores,Inc.#1052 88 Enterprise Dr. Hyannis,MA 02601 • °FINE)°k Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARM..Rq E�` 200 Main Street• Hyannis, MA 02601 �ArEDMA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: &4s 9 (If4; S Date: Location/Mailing Address: 6c4zr&�-w- IAA_ , FIV th A 15 Contact Name/Phone: rt, S Did- -7-7 -031 mv� Invento Total.Amount: '�^'' 11 SDS: `�� �41� �'^�'b' °�^�t`'�- License* Tier II : b Labeling: O Spill Plan: e- Oil/WaterSeparator: 1A Floor Drains: fJo Emergency Numbers: es Storage Areas/Tanks: _yjf"5 e, r-k-eAw a cis 4 oC wktAYi Emergency/Containment Equipment: ,lI ,• ' CIA % Z Waste Generator ID: 019-7-70 0 Waste Product: tS L Date&Amount of Last Shipment/Frequency: X 1 V< I tt k -tA7k5 4 o 110 ,s ,��s •�-c� Licensed Waste Hauler&Destination: 0- -e e<� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS , D om\ ��&V r +v' IN qe%t NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more 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 `o K-S r te- I a k Ao<«cl s of Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: o\X, A ,(-,a 5 Se_. is -� YLO W1 V— V' - a D a c� �I 4 0 L5 -LJ 45{p .Z01-7) I I Inspector: / Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE rokl Town of Barnstable Office:508-862-4644 - °� Public Health Division Fax:508-790-6304 &`RM�LE. ' 200 Main Street• Hyannis, MA 02601 1639. �0'fOnu+"�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: /'�'c.�a-e-1'5 Av4 e -6s tQ4 S 4a<�e- Date: Location/Mailing Address: Ovsv.vi= s Contact Name/Phone: 5--C> - T 9 1`7 Inventory Total Amount: N 1 g�� MSDS. 3" C41I - License#: I I I-1 � A Z Tier II : 00 Labeling: Spill Plan: $ Oil/WaterSeparator: N. Floor Drai s: o Emergency Numbers: Y�s Storage Areas/Tanks: &ae,&' C` �' 1 a�xl e � tea.-►�, b�w- ro���� .6eam"A g --Q.- c. 's 1.e-b Emergency/Containment Equipment: 51 P 6 Waste Generator ID: /`IVsDA -77a 3t-7 Waste Product: (M tgc_ T'4-4vc-*-SJ� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: - I"c. 6Kv' h s --7 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 V 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 f ( insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine �— Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: ._ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p IKE*opt Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMA% ,� 200 Main Street• Hyannis, MA 02601 �A t639. MAC p�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT TFD Business Name: r►'I I GkQ-4 S A r+4 S cr gV4 S S+ re— Date: Location/Mailing Address: IR.Q /-&4 Jrl 15 Contact Name/Phone: o - 7 - a3 �-- l SOG a� e 3 wl CAI Cyy InventoryTotal Amount: MSDS: S- License#: �1 1-7 Tier II : o Labeling: 60e1- Spill Plan: Ye s Oil/WaterSeparator: N A Floor Drains: C Emergency Numbers: e s Storage Areas/Tanks: s+D O 1 yk"+f- 0.v a• �b\.cam Emergency/Containment Equipment: 000,*(- is a �� S t'�� �� G�1e� a5k��- h Waste Generator ID: �l , 7 Waste Product: KSL nn+1c CeCV5.-J, 'k,m/ Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NV AA-a�0e LNk t,y-5 '`~' I--J4-,kA0,< L-e- \a��� ow 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 Z Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils 7— 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/aoQCkx",v.,e9�,Cf-y,.-5 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: INFO MATT N/RECOMMENDATIONS: No C-C a.N`•M-ev. n .ov` 1 Inspector: LacJ�1�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p IKE►p Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • enRM�`E.� 200 Main Street• Hyannis, MA 02601 039. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: i el q er'S Cca.RS o.« Date: t $ Location/Mailing Address: f {cr a✓�✓I I Contact Name/Phone: , o -"�?S -03 t-1 �� �� `�"�•ow� Sovl� MSDS LicInve to Total Amount: "ISO a1 ^ ense Tier II : o Labelina: G'oo� _ Spill Plan: es Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: & Qco,AJtA %5 Az * 5koce6e tvl GC, xSpo l o` �@ow�a�►�cC Emergency/Containment Equipment: `J �(� ►v� a -Col .( h -tIP 1111R'- Waste Generator ID: '7?�O3 l Waste Produc : Al txe mise �ccz Date&Amount of Last Shi ment/Fre uenc : 1 i I 5 5120h Z Licensed Waste Hauler&Destination: l, Ooo Ito ► 7 Other Waste Disposal Methods: Al LIST OF TOXIC AND HAZARDOUS MATERIALS (vvV+e v��-rj -5tKL 2 14-5�- \K-3 ftll VIL NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, kg413 . 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& arages Pesticides: Caulk/Grout/c..Lvt5vj�Ls�c.-S%V_5 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:IQ—,(V �A 16 4!r*<4 - ORDERS: twty-) oC2,. INFORMATION/RECOMMENDATIONS: N v o � i5'1v2 of Inspector: 1 , 0NN L Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOWN OF BAR Date: /2/ �/ 13 NSTABLE� yayt-, TOXIC AND HAZARDOUS MATERIALS R FORM NAME OF BUSINESS: /v 66.e-s BUSINESS LOCATION: gS �„i-}�r,�r,�� 1� I�yan,1 , 6 INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: mob - -77a tol /7 ^' /$D ell-D CONTACT PERSON: ,,-}-,,�, AjAy, 5 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ar'S A)o - k)§C- )-&cv INFORMATION / RECOMMENDATIONS: '� i h°"`'`"� /►� s�'ah`���w {��.aR.,� �s Flre District: a,�e{, S �►t, Q 1 ,a a 2� 11a i A-e— h vl►5 e , b aVa. A,b L-P- k 14 s -) s e., CVa.1 a.b " - «e vvt W-Iz vzeo, Go ,e-5 OK -j, e- Waste D$�1 S 031`7 Last shipment of hazardous waste: I y i3 alb) Name of Hauler: _e-ld ,a, Destination: *4 ,c e-le- ,'M Waste Product: CL6115, ex14afn, Licensed es No T/lJ�oppl I o i�-j 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 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 ❑ 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 (acEl,es,.ae��res�.� � 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 l 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 a,.'�o5;I s Other products not listed which you feel Z Floor&furniture strippers/tJAK may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 ..------------------------------------------------------------------------------------------------------------------------------- 88 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 Town of Barnstable Inspectional Services BAB STABLE • " Public Health Division ��>>p�100, R1-f.-MSTMu,k,; O„ vA45TON;rvIIL•AST[0.VILL_•'M;TO-![ 1fi39-3019 BARNMASrSABBLE• ` Thomas McKean, Director 9Qp i639• �� '°reoMata 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 Is F `Gh 03 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El �� L-}pI-N-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? X 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: Michaels Stores, Inc. 5. NAME OF ESTABLISHMENT: Michaels Store 91052 6. ADDRESS OF ESTABLISHMENT: 88 Enterprise Rd, Hyannis, MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8000 Bent Branch Dr, Irving, TX 75063 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-778-0317 9. EMAIL ADDRESS: draperr@michaels.com 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Michaels Stores, Inc. PRESIDENT Ashley Buchanan TREASURER Jennifer Robinson CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT /tom= DATE 11/20/2020 • C:\Users\draperr\AppData\Local\Microsoft\Windows\INetCache\COntent.Outlook\IROCIHFG\Haz Mat App Revised 09-10-18.docx I Tripp,Vanessa From: Ryan Draper <DRAPERR@michaels.com> 0-ent: Friday, November 20, 2020 2:02 PM To: Tripp,Vanessa Cc: LicensesandPermits; Sherri Torres Subject: RE:Town of Barnstable - Hazardous Materials Renewal Attachments: Haz Mat App Revised 09-10-18.pdf Follow Up Flag: Follow up Flag Status: Completed Hi Vanessa Please find attached the application you need. Sherri Can you please help take care of the outstanding$10 Ryan Draper, CSHO Director—Compliance The Michaels Companies Made byyou- 8000 Bent Branch Dr,Irving,TX 75063 (0)972-409-5786 1 (M)817-791-1411 • draperr@michaels.com F Connect with Us: Facebook Instagram(Twitter I Pinterest YouTube(Join Our Team From:Tripp,Vanessa <vanessa.tripp@town.barnstable.ma.us> Sent: Friday, November 20, 202010:33 AM To: LicensesandPermits<licensesandpermits@michaels.com> Subject:Town of Barnstable- Hazardous Materials Renewal ❑ External Email ❑ Good Morning, Thank you for submitting your payment in the amount of$125.00 for Michael's Store#1055,located at 88 Enterprise Road, Hyannis, MA 02601.A$10.00 late has been assessed.There is balance due of$10.00.Your current permit expired on June 30, 2020.We did not receive the application,with the payment submitted. Please complete •the renewal application,attached above,and return to me by email or mail to 200 Main Street, Hyannis, MA 02601. 1 Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 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 06/30/2020 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 f W , Town of Barnstable Inspectional Services BARN TABLE FTHE Tn.� wvs"icceu�.�a`-"c'x O Public Health Division =539-=0=4 C.: YBAPNSrABLE, ' Thomas McKean, Director r 1639. v 3r s`0 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 � \D�ti 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑, CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 -�g VS i CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. b3 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES, SKIP 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: ,f�l cvw-& 6. ADDRESS OF ESTABLISHMENT: gg ErAf-V*pC i5& Kd • �- dhnl S , MA , OZ(41 'Dal TV 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �,t�.I/�u� (o1951o(vyt. (a�,inS,tS� ltmi�S5?,c.l 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 1 l am&5 aA4 DOC,Y"(w MdUJ5•ewl 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME /V1,lGY1a l S S+0VXoS L✓ L- PRESIDENT TREASURER A4AcheA tS CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT/�k DATE Q:\Application Forms\Haz Mat App Revised 09-10-18.docx MICHAELS STORES, INC. OFFICER LIST Officers Position Held Phone.# Navin Rao VP-Asst. General Counsel 972-409-7490 8000 Bent Branch Dr. Asst. Secretary & COO Irving, TX 75063 Michael J. Veitenheimer SVP General Counsel 972-409-1655 8000 Bent Branch Dr. & Secretary Irving, TX 75063 Rebecca Shaffer Vice President Tax 972-831-4185 8000 Bent Branch Dr Irving, TX 75063 THE MICHAELS COMPANIES 8000 Bent Branch Drive Irving, 9-175063 972 4G91300 o ensu=e Michels St es, Inc. payments for our Business License Permits Device Y e ice Registration, etc. be recei ed by the due dates, please mail your renewals and correspondence to the below address: Michaels Stores, Inc. Store# Attn: Licenses and Permits PO Box 619566 DFW, TX 75261-9566 Sh uld you use the physical address,o 8000 Bent Branch Dr.; Irving,TX 75063;please add th Attn,xLic_ensesTan Peerrmits." Do not send correspondence to the store location as it only delays payment or return mail. All payments come from our corporate office. Please, mail all licenses and permits to the above corporate address for proper distribution to our stores If you have any questions or need additional information,please contact me at licLnstiandperaiirs(iiiicliaels.col,i or 972-409-1507. Kind Regards, %�CZ�2A Janatha McCullough Sales Tax Manager iaronbrothers I PatCatads. I I I l��ice C ARTISTREE' r Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 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 T_ ;.; —gz �' O r;.sue.: �_, Director of Public Health �=. ti•. TRowrl�of Bnstable egu atory Services Richard V. Scah, Director oF.ME r Public Health Division BARNSTABLE M ` eaaic,^,uu•�ertEnriL.e.crnurz-nritisu BABNSTABM ~ Thomas McKean Director """'� '""''°'ff"{{"AA�U-MST°" = y nu99. 16�lU�4 059. 200 Main Street, Hyannis,MA 02601 ,, Office: 508-862-4644 Fax: 508-790-6304 ,X; APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ri X, HAZARDOUS MATERIALS C, IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,`�;5 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 + $10 Late Fee= $135.00 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 1. ASSESSOR'S MAP AND PARCEL NO: . 293-019 2. IS THIS A PERMIT RENEWAL? X 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: Ryan D. Draper 5. NAME OF ESTABLISHMENT: Michaels Store#1052 6. ADDRESS OF ESTABLISHMENT: 88 Enterprise Road, Hyannis,MA 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8000 Bent Branch Dr.,Irving TX 75063 8. TELEPHONE NUMBER OF ESTABLISHMENT: (508) 778-0317 9. EMAILADDRESS• 1pinvoices@michaels.com 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Michaels Stores, Inc. PRESIDENT Chuck Rubin TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • l SIGNATURE OF APPLICANT. ���� DATE 07/12/2018 C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx li y i+ J MAIL-IN REQUESTS 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: 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 d C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 ENTERPRISE ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. _ 07/01/2017 JUNICHI SAWAYANAGI 6 THOMAS A.MCKEAN,R.S.,CHO Director of Public Health d� lei cQche*baoog1q(P8 ` ow� of B stable I regulatory Services t�r� Richard V. Scali,Director • %"' rr Public Health Division BARNSTABLE ` `" MASS. e, Thomas McKean,Director INNS gN E•GEx E0.NLLE•fA UR•N Ax15 HgNSNN.Y MILLS-951FRVLLIE•WE$f BpgP5Ig6!,E MASS. 1639-2014 fuv s� 200 Main Street,Hyannis,MA 02601 �Dg Office: 508-862 4644 Fax: 508-700.6304 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 I. ASSESSOR'S MAP AND PARCEL NO. �q q 2. IS THIS A PERMIT RENEWAL? >/ YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONLNGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: M 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: $ he r s 1� l�vahn;' m� �Z601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: fy 8. TELEPHONE NUMBER OF ESTABLISHMENT: U g- —7 17 - 031,1 9. . EMAIL ADDRESS: 10. SOLEOWNER: V'--YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,APD T�jLEPHONE#OF: CORPORATION NAME N��`ca fS Spa yes PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN ATE p Z 3 • Q:1Application Forms\IIAZMAT APP 2017 REVISED. ocx N TOWN OF BARNSTABLE � `�''� ., Ordinance or Regul BAR-W ation 56� w WARNING NOTICE Name of. Offender/Manager ►�J'►lbh f ram! oftOffender ( Village/State/.Zip MV/MB Reg.# N Business Name_ �1!�, 4�it 1 r4.- s ,ram '. s ,2 I am/ •on g I�, 20� . Business Address--�� �'2� Signature o Enforcing Officer VillagelState/ZiP a✓l✓l, 5 Location of Offense Offense �X 'ram p Enforcing Dept/Division _Facts - - I ►1� _Q.G C o eQ �'t- S ' '�-4 s e6a C'o VA This will serve only as a warnin S II is the 'oal of g- At this time no legal action has been taken. g Town agencies to achieve volunta Ordinances, Rules and Regulations. own attempts to Education efforts .a d warning ry comp nnot notices ce Of Tare P gain voluntary compliance. Subsequent violations will result re appropriate legal action by the Town.. WHITE-OFFENDER CANARY ORD:/REG_-PROG. PINK-ENFORCING OFFICER GOLD ENFORCING DEPT S � C s 972409121,05 Michaels 01:08:20 p.m. 10-23-2017 2/2 'Rovgv of Bqynstable �i�Q 10/� e atory Services Richard V. Scali,Director Public Health Division BARNSTABLE omas McKean,Director ages. Th ie En ►tee 200 Main Street,Hyannis,MA 02601 23 Office: 508-862-46" F= 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERIVIIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125,00 CATEGORY 3 PERNIIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. I. ASSESSOR'S MAP AND PARCEL NO. Zq p q 2. .IS THIS A PERMIT RENEWAL? V YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGMUILDING APPROVAL FOR HAZARDOUS MATERL4,LS STORAGE[USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: M'tjkQ spa r" hr 5. NAME OF ESTABLISHMENT: , ; UL e.�S 037 Z 6. ADDRESS OF ESTABLISHMENT: r s µ m R Z 60i 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHIVIBNT: _ S U g- `7`I k- 0 3 1-1 9. . EMAIL ADDRESS: 10. SOLEOWNER: AYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND ULEPHONE#OF: CORPORATION NAME Nl i a.r, PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: . SIGNATURE OF APPLIC Q:1Appilmdon FOmIS AZMAT APP 2D17 REVISED, ocx Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 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 �r 6-,iun-2015 18:45 SpanDSP Fax Header 5887780380 p.2 ,;i Town of Barnstable Regwatoly Sem-ces Richard V. Sc 94 Director { Public Ifealt ` �' �T�,,S10n . 5639. lobs ThOBM McKeU,Director 200 IV�i�1 S"• y I�y�i�rliS, 0260�. Office: 508-8b�-46�i4 Fex;: 508-190-6304 APPDcation Fee:$100m A SMORS Map AND PARCEL No. � �l 7/ DATA APPLICATION FOR PERMIT TO STORE AND/OR U-TMU, E MORE THAN 1I�LON3 OF HAZAR OI S MATERIALS M-L NANM OP APPLICANT NAME OF ESTAMzS NT L L Z G -#7 l D • A MS OF ESTABZ;m'T 2t S= �p, TELEPHONE NU?VWR SOLE OWNER:—'i:'ES ✓NO IF APPLICANT IS A PA RTNERSAW,FULL NAM AND HOME ADDRESS OF ALL EARTNMS: ( t FiJ7 A O 63 W APPLICANT IS A CORPOFAITON: FEDERAL XDENTMCA71ON No STATE OF LNCORPORATION KAS nLL NAMM AND ROM AD DIMSS 0�: TREASURER C—f=0 TE C;Y CLEF �N SXGNATM- Off'ApFLIC ANT RESTMC170NS: HONM AnDMS 110M TELEPHONE7m CAM:hmkx=pemyh&mttFUM'k0LXD3v AW11Rvm15,p00 02/26/15 09: 31 AM - Michaels Stores - via VSI-FAX Page 1 of 3 #k1912581 ®_ • ' s Where Creativity Happens- -Fax To: Public Health DF;fton From., Ryan Draper 1 Fax 508-790-6304 Pages: Phone: 508-8624644 late: 2/20/2015 Re: Michaels Store#1052 CC: O Urgent O For Revlew ❑Please Comment O Please Reply ❑Please Recycle •Comments: 0 Attached is a completed Hazardous Material Storage Permit Application. Please note that we are having the check cut now and we should have sent shortly. For future renewal notices in regards to this application, I would request that it be sent directly to my attention so that I can ensure c ompfance. Thanks for your assistance this morning. Best Regards, Ryan Draper Safety Manager 972-409-5786 t I6: AID: . a;i::E1J. Michaels Stores, Inc. 8000 Bent Brand Dr. Irving,TX 75063 • r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department • nsrnt Public Health Division MASS. Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 �o Payment Receipt Hazardous Materials Payment received: 1$ 00.00 (Check) on 6/30/2015 ;Check number: 030091132'7 Check amount: $100.00 Name on check: Michaels Stores Procurement +iCompany Inc. i I 1 Business: Michael's Store #1052 Owner: PRIME 132 LLC Address: 88 ENTERPRISE ROAD, Hyannis • Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to'Certify that MICHAELS STORE# 1052 88 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. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health t� ZY un-2016 12:43 SpanDSP Fax Header 5087780380 PA To of Bamstable • �"�' RegoI Iatory Services Rich V. Scaii,Director 1 Public ifealth Division B S1 LE Thom s Mclean,Director ^�""""�° '•I i69!-bAa Office: 508-8G2-4C�q4 200 Main S ect,Hyannis,MA 0.2601 fJ Fax 508-790-6304 APPL1CA,TIQ1V 'uOR R T To STOP AND/OR tTMIZL HAZARDOUS MATE S IN ACCORDANCE.WITH THE TOWN OF BARNSTAJ3LE GENERAL ORDINANCE HAZARDOUS MATERIALS,ALL EUSII MssES THAT HANDLE oR STORE CRAFTER 108, MATERIALS GREATER THAN HOUSEY-TOLD QUANTITIES ARE REQUIRED j TO OBTAIN AN ANNUAL PEFIVIIT(RUNS JUL1' l st_YUNE 30th). APPLICATION FEES CATEGORY 1-PEST 26— 110 Gallons: $ 50.00 p CATEGORY 2 PERMIT 1.110 499 Gallons: $125.00 4 ws - CATEGORY 3 PERMIT 500 or move Gallons: $150.00 p A late cl�a a of Q,Op will be assessed if ingyment is not received b 121 lst_ • ASSESSORS MAP AND PARCEL NO. DATE CP ZI (P FULL NAME OF APPLICANT: � NAME OF ESTABNT: ` ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DuTERENT): TELEPHONE NUMBER OF ESTABLISHMENT- ?? 3 EMAM ADDRESS: N SOLE OWNER:—YES—NO IF N07 NAME OF PARTNER: FML NAMME HOME ADDRESS AND TELEPHONE#OF. CORPORATION NAME , � PRESIDENT •Q � TREASURER .` CLERK IFPREPARED]BY OUTSIDE PARTY: • SIGNtA�TURE OF APPLICANT IF Company Address Telephone #: Email: Q:Apphea6on Forms\HAZZAPP Rev 16.docx Page l oft f - c r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department s Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/20/2016 Permit number: 1117 'Check number: 0300915021 Check amount: $125.00 Name on check: Michaels Stores Procurement !Company Inc. `Business: MICHAELS STORE # 1052 j ,Address: 88 ENTERPRISE ROAD, Hyannis 1 • Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 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 28'.s'eb- 15 16:54 SpanDSP Fax Header 5087781380 p.2 'down of Barnstable 04 Regulatory Services Richard V. Scali,Director , ►MASS,AMASS,,S z Public Health Division 9 a a Thomas.McKean,DiA-e'etor 200 Main Street, Hyannis. MA 0260.1 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. _--- DATE APPLICATION FOR PERMIT TO STORE ANWOR UTILIZE MORE THAN Ill GALLONS OF.ELkZARDOUS MATERIALS r FULL NAMM OF APPLICANT1 V ��,� �► ��� _ NAME OF ESTABLISEME.NI' / I G RA�L S-T 02 I �� TELEPHONE.NUMER 50'� 1-)17.Q 3__�9 SOLE OWNVR: ✓ YES NO IF APPLICANT IS A,PARTNERSHIP,FULL N_A M AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPaRATIONN: UDE-RAL WE iTYFTCATION NO.75- 191-f 36Dq STATE OF INCORPORATION XA S . FULi:.NAME A�'A HOW ADDRESS OF: PRESIDENT TREASURER CLERK SXGNAT URE OF APPLICANT RESTRICTIONS: HOME TTOME TELEP.RONE-# I'XffA?A.0P,XC Number Fee 1117 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that MICHAELS STORE# 1052 88 ENTERPRISE ROAD, HYANNIS,MA 02601 C� 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 J 13.Dry-2013 15:55 SpanDSP Fax Header 5087780380 p.2 Town of Barnstable Barnstable Regulatory Services Department . I: Public Health Division 1 � KAM 200 Main Street Hyannis Mrs 02601 2007 Office: 508-862-464 3 Thomas F,Geiier,Director FAX 508-�r 90-6304 Tharnas A.McKean.CHQ ,Application Fee: $100.00 ASSESSORS 1VIAP,AND PARCEL NCO. DATE APPLICATION FOR FERMIT TO STORE AMOR UTILIZE MORE THAN I11 GALLONS OF HAZARDOUS MATERIALS PULL NAME OF APPLICANT n)�a l�ctZ - S NA IME OF ESTABLIS M .ENT/V) i G HHAEL 5 ST o11�6 ADDRESS OF ESTABLISHMENT X 4 &Jtj�G i ( LS6 S TELEPHONE NUMBER o --7 79 - b31 "-1 SOLE OWNER: /YIC4 S NO IF APPLICANT IS,APARTNERSW.,FULL NAME AND RO11![E ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION. FEDERAL IDENTIFICATION NO. M N STATE OF INCORPORATIlON7 x�S FULL NAME'AIND WWI ADDRESS OF: PRESIDE N T TREASURER _-- C.LFJI.K �NX'rU E F APPLICANT RESTRICTIONS: ROM AwftsS k)CC1,MF WF.LEPHONE# hUnspeetion hnndoatsViaz Mot ApplicadonM8..DOC IF 12/16/2013 11:10 9724095791 RISK MGMT PAGE 01/15 x wler+e Creativity Ha�eru' T& Regulatory Services Department Fronr. Ryan Draper Fwa 508-790-6304 Pages: 15 Phone: 508-862-4644 Date* 12/16/2013 Rye: Hazardous Material Permit App CQ O 4lrgent X For Rw lew ❑Please Comment 0 Please Reply ❑Plea**Recycle •Cammenft Attached is an application for a Hazardous Materials Permit for Michaels Store #1052 located in Hyannis,MA. Personal information on our executive personnel cannot be made available due to privwy, In lieu of the personal information, I have attached a credit sheet that lists their names and the physical mailing address of our corporate office. Also attached is a copy of our SOP and training for Hazardous Material Disposal and cleanup. We have an additional contingency plan through 3E for larger spills, though this has never been needed due to the nature of our products. All Hazardous Materials in our inventory are for consumer level and we do not typically store anything in single quantities over 1 gallon. We will have the$100.00 fee sent in the mail. If you have any questions,please feel free to reach out to me. Best Regards, Ryan Draper Safety Manager Michaels Stores, Inc. 972-409-5786 draoerr2michaels.com I 12/16/2013 11:10 9724095791 RISK MGMT PAGE 02/15 13-Dec-2813 MSS Span= Fax Header 50877B83M p.2 Town of BarnstablL'- Bamstable Regulatory Services Department Public Health DiVigiffll � 1e4m 200 Main Stet,Rrwds MA 02601 2007 aM -a6a-�aa F, FAX sa P904B% Thomm X MC1CW.CFO Aopflmtim Fee: $100.00 A33ESSORS 1M",AND PARCEL NO. APF MC TIQN, OR PERNft 1O STORE AMLOR UT'ILIU MORE_TIM 1I1 O I&NS OF HAZARDOUS RUm MnZ.%?AM OF APPLICAnL I ;k?E'R-- L. AlAx4CK . ry NAM OF JES'I'AE.ISMnNT IVJI G H T \ d� ADDRESS OF ESTABLMIL Zt f (S • r '�`�+ Ni_u_1 SOLE 0WNM..•r YW p JY A.PPLIW-r IS A k't1i<RTIW v nML NAM AM DOME ADDRESS,DP'ALL PAS:A r IA ly'APMCAM IS A CORPOt AUDN: YEIDERAL MINM.CATM NO.,-7 -119 STATE OF UWORPC RATIONI� _ FULL NAMWAND ROM ADDRESS OF: �eR�sm��r TREAIR CURK �M,&^?"PUCANT RTSTRICTI ROM,A► O RESS 1�0) TTLONE# 7_IinmptctienhmtdGtl���tot+lppl�an2ROR.i�OC . 12/16/2013 11:10 9724095791 RISK MGIVIT PAGE 03/15 MICHAEL.S STORES, INC CREDIT SHEET WWYSICAL ADDRESS: MAILING ADDRESS 8000 Bent Branch Drive P.O. Box 619566 Irving,TX 75063 DFW,Texas 75261-9566 CORPORATE INFORMATION: Offlce of the CEO: Chuck Rubin Office of the CFO: Chuck Sonsteby HISTORY: Organized as a Delaware corporation in 1983 as the successor to a Colorado corporation which commenced operations in 1962. Name changed to Michaels Stores, Inc.in February 1984. Engaged in operating retail arts and crafts stones under the name"Michaels"and frame shops under the name°Aaron Brothers;' As of March 13,2013,the Company owns and operates 1,106 Michaels stores in 49 states and Canada,and 123 Aaron Brothers stores. BANK REFERENCE FEDERAL TAX_I)[L NLUMBER;. Banc of America Securities Texas 75-1943604 Bank of America Merrill Lynch Mail Stop; MA5-100.0909 100 Federal Street 9 h Floor Boston, MA 02110 Attention: Betsy Aatto Phone: (617)434.4113 Account #54275854 TRADE REFERENICr�S 1. The Chicago Tribune 2. Los Angeles limes 435 N. Michigan, Roam 300 Times Mirror Square Chicago, IL 60611 Los Angeles.CA 90053 Jim Gallagher(312)222-3634 Phone (213) 237-2160 Fax (213) 2%%7-7878 Merchandise 1. Crayola 2. Macpherson':, 1100 Church Lane 1351 Ocean Ave Easton,Pennsylvania 18044-0431 Emeryville,CA 94608 Phone: (610)253-6271 (510)428-9011 S. Larson-Juhl 4. Wilton Industiies 3900 Steve Reynolds Blvd. 2240 W 75'Street Norcross,GA 30093 Woodridge, IL, 60517 (800)833-0216 (800)772-7111 Trade 1, Conway Truckload 2. Swift Transportation Inc. Greg Sutton—Billing&Credit Renee Krug,Revenue Mgr. (800)641.4747 800-800-2200 Greg Sutton—Billing&Credit 2200 S. 75n,Avenue 4701 E.32'"Street Phoenix,AZ 55043 Joplin, MO 64840 12/16/2013 11:10 9724095791 RISK MGMT PAGE 04/15 Hazardous Waste Management Standard Operating Policy Effective:October 21,2013 `• Version:1.0 Less Prevention Overview of Policy Purpose: To safely and correctly disposal of Universal and Hazardous Waste. Responsibility: All Associates Frequency: As Needed t�raper�4taste'Disp�sal Universal and/or Hazardous Waste must never be discarded in a trash receptacle, compactor, open top dumpster and/or placed down the drain. UnlvrenLill Vlfaslte rd 'MM6l ai'rrtp1 • Batteries • Rammables • CRT and/or LEWD Monitors • Aerosols • VCRs • Solvents • Printers • Corrosives • Fluorescent Lamps (see below) • Toxic Materials • Ali Associate are responsible for properly disposing of all Universal Waste and/or Hazardous Waste. • All products classified as hazardous materials must be clearanced out or sold As.-Is immediately. • If a product deemed a hazardous material or universal waste is damaged beyond repair or otherwise unsuitable for selling,the product must be discarded using the StrongPak disposal method. • Report all improper disposals to the third party confidential hotline at 1-800-241-5689. • Burnt fluorescent lamps are to be discarded through the Facilities Department. o Contact Republic Services at 1-877-379-0628, stro'noak, . • The Store must have a designated Hazardous Waste storage area. • StrongPak posters must be placed in a visible location next to the Hazardous Waste storage area. • The shelving must contain: o Training guide o Waste labels o Plastic totes n $pill kits CONRIDENTIAL.FOR INTERNAL USE ONLY. Pale 1 of 2 9 MiCMAIA Stares,Inc_09/2013 Suparsades SOP:232 Hazardous Waste Management 12/16/2013 11:10 9724095791 RISK MGMT PAGE 05115 Hazardous Waste Management Standard Operating Policy Effective:October21,2013 Version:1.0 1p5s Prevention o Approved re-sealable waste accumulation bags Waste Labels • The site information must be completed on each label and placed on each plastic tote. • The Accumulation Date must be entered on the date that the first waste was placed into the container. Accumulation Bags • One waste item is permitted per bag. o Multiple items of the same chemical can be placed in a single bag. • NEVER mix unlike items. o When in doubt, use separate bags for each item. • Double-Bag and add absorbent to waste that is leaking. shippiirig:wMie • A StrongPak technician will pick up all Hazardous waste on a six month rotation If a single container becomes full, DO NOT call for a pick-up. o Use one of the empty containers and re-label as needed. o If you do not have any empty containers, contact the Loss Prevention Department_ • The StrongPak Technician will sign the shipper's certification statement of the Uniform Hazardous Waste Manifest, as the offerer of each shipment for purposes of the EPA. lii'iN#OOi(�i11�l1t� The Support Specialist is responsible for filing copies of all completed Uniform Hazardous Waste Manifests in the Cash Office. • Maintain the record for a rolling three years and then place in the shred bin. Inspections from the regulators of Hazardous Waste can be either scheduled or unannounced. Always escort the inspector while they are in the Store and offer any assistance. e Notify the District Manager(DM)and the Loss Prevention Safety Manager immediately upon the inspector's departure. CONFIDENTIAL,FOR INTERNAL U66 ONLY, Page 2 of 2 Wiehaels Stores,Inc.09/2013 Supersedes SOP:232 Na"rdons Waste Managem®nt 12/16/2013 11: 10 9724095791 RISK MGMT PAGE 06/15 • The StrongPakTm Guide to • Potentially Hazardous Material Management Guia do SuongPrtk'"Sabre el Manejo de 1&eeriales I�atentcialmente Peligrosos Where Creativity Happens- Hazardous Waste in the Trash or down the train! iNo ponga el desecho peligroso en 1;)- basura o poor el desague! a i S II'1P'ka,, Iti Not Sure? Consult the Michaels'Hazardous Waste Program,the StrongPak Hazardous Waste Program Poster, the Potentially Hazardous Material Management Poster and this Reference Guide for more information �Inseguro? Consulte el Michaels' Hazardouse Programa de Gestion de Rcsiduos, el Afiche de StrongPak y esta Guia de Consulta Para mas informaci6n • ;� 5�ericyncle• ®200-2011 Staricycle,Inc.All rights reserved.Ver.Michaels 2011 RVatSUSMAIABILITY StrongPak 12/16/2013 11: 10 9724095791 RISK MGMT PAGE 07/15 Cuh dtSfft01%k"SJ+tc d Mancjn do Mnccrialm Potentdnlmente Pcl-g{rmq The StrongPakTm Guide to Potentially Hazardous Material Management Do Not Return to DC No vu"a DC If an item is in any of these 6 conditions, it must NOT be returned to the DC. (See your program training for more information.) Si un articttlo se enctientm en alguna de estas seis condiciones,no debe ser devuelto a la:DC. (Consultle el progmma de capacitaci&pare mAs infiormaci&L) Leaking About to Leak Parlially Full Fagas A panto de fuga panciabliente compiem. is . w . � e n ■. L @. Missing/Broken Cap Missing Nozzle Crushed/Damaged p'alta/tapats rotas Falta boquilla ,A,plaw.do/dafiad.os 02W64111 Stericycle,Inc.All rigfitsresented. '.# ftkW 2 Ver,Michaels 2011 EqsvftS1(It11 1 1 1RETURN 1 DC 12/16/2013 11:10 9724095791 RISK MGMT PAGE 08/15 Gutade Scranp7ak^Sohn at Maneln de Mnaerlalea Paremdalmenm Petlsmm& The StrongPakTM Guide to Potentially Hazardous Material Managament Hazardous Waste Area Setup Coa igurad6u del area dir'esiduos peligxosos Spill ;� :.:;� Spill Kit tsmchc Absorbent ::,; y_M ir;��-,mot do dcrramc Alawrbenrc de dcrr•.ime This Guide Posters 1 curA Afichcv _ ,,.. F Tote Label Filled In do In cnnrerlcdor a 1wrio"B . Totes ���•� •--- and ou,ra.;,rw Supplies `MEOW Con rrnedory A suministros ••^ —•'- Spill Supplies SLIMilliSrn18 de derrame9 DO NOT BLOCK ACCESS TO THE HAZARDOUS WASTE AREA—AISLE SPACE MUST REMAIN CLEAR. TOTE LABEL(S) DUST BE VISIBLE. CONTAINERS MUST BE EASILY INSPECTED FOR LEAKS AND DAMAGE. NO BLOQUFAR EL A.RF,A.DE D>rSECMO5 PELICROSOS-EL PASILLO DEBE DE MAN'T'IENERSE Si N OES'MUCCIONLS. LAS'ETIQUETAS DE LOS CAJAS DEBEN DE ESTAR CLARAMENTE VISIBLE. LOS CAJAS DEBERAN DE ESTAR DEBIDAMENTE INSPECCIONAD.AS POR,POSIBLES DA'OS 0 ESCAPES. tl�2OW-2011 Sta6oyee,Inc.All rights reserved. d-10 Sb°'G'4w 3 ver.Michaels 2011 ► • IJS WASTEAREA SETUP 12/16/2013 11:10 9724095791 RISK MGMT PAGE 09/15 Gulw de SvenFPalc"Sobre e`Minele de A wAslu Amni/a1ITMM pllirftVM The 5trorVaFm Guide to Potentially Hazardous Material Management Retail Hazardous Materials: Examples Vents al par Menor de Mmeriales Peligrosos:Ejemplas Aerosol and Flammable Types of Products • Oils Hwxsrdaus 1Nwew r Aemele, Varnish FWwables and combmaa Stains . - ""."" Paint Thinners Oil Based Paints +' ' • Products Containing .,.� � .__.._..._.. -. Petroleum Distillates '��'� Model Paints u.,W_...— ;: • Butane Lighters �a1tEY'i A1O1•lTmw.delO�DQIRVEgI•D6 • Spray Paint r; • Spray Glue Keywords Flammable Combustible Ethanol or ethyl alcohol Acetone Danger Harmful or fatal if swallowed Methanol or methyl alcohol Toluene Conows under pressure Petroleums distillates Xylene Store under 120°F Alcohol IPA or isopropyl alcohol Do not puncture,freete or incinerate Oxidizer Liquids Types of Products Hluardoue • Epoxies Waste • Hardeners(MEK)Peroxide ax • Peroxides X> Keywords , .,,_..._._._..._.__..._-........ Causes Burns as Danger Reactive Sodium hypochlorim ®.ee�,ohwnMWbMlbtlCBlegdlYUl6 Methyl Ethyl Ketone Harmful or fatal if Hydrogen peroxide -- Avoid contact with skin or eyes swallowed Oxiidkrer May cause severe irritation or damage Bleach Poison to eyes and skin Chlorine 4 02a3s-2011 Stedeycle,Inc.All rights reserved. i'� •' aauK61�t1r V�,Michaels20 1i Pa EiZARDO MATERIALS 12/16/2013 11:10 9724095791 RISK MGMT PAGE 10/15 Gulp He hm,ngPik'%)htc cl Mmtie do Mateialex Nwntanlmenre Pellgmw The StrongPWM Guide to Potentially Hazardous Material Management Retail Hazardous Materials: Examples Veata al por Menor de Materiales Peligrosos:Blemplos Corrosive Acids Types of Products Etching Cream Convafim ac1d1r x�.a w1 fir Keywords Danger ° Corrosive Causes burns Avoid contact with skin or eyes With bleach Sodium hypochlorite Ammonia - . Sodium hydroxide Ammonium hydroxide Ham%l or fatal if swallowed Corrosive Base - Types of Products Ha�rdaue'Wesoa • Antiquing Kits Centrsiae Sam fPNz12-q • • Metal Cleaners and Polishes + "'""' °'� y .._._..._...— - — - Keywords L, Danger ,� .. q.i Corrosive •. .: Avoid contact with skirl or eyes Sodium hypochlorite With bleach nmcanneusm,n�e,ttamm,ta,vneaAatoc. .� .., Sodium hydroxide Causes burns - _._....----_____-- Ammonia Ammonium hydroxide ... Harmful or fatal if swallowed 5 �2=-2011 Stericycle,Inc.All 6ahts reserved. SLLSOAI�IIAgtt�llf Ver.Michaels 2011 , IZARDOUS MATERIALS 12/16/2013 11:10 9724095791 RISK MGMT PAGE 11/15 Guiade SsranPPelc'Sabre ei Mgntj,+dr.mmc, I-Fm ntckdrnmtc Pdigmsm The 5trongPakT"'Guide to Potentially Hazardous Material Management Retail Hazardous Materials: Examples Yenta A per Menor de Matetxales Peingrosos:Ejemplos State Regulated[Toxic Types of Products Hm"d°"` Waem Wood polish m • ww /1 s"It, a Acrylic Paints ST a raxlos • Glues �n•a: Uw J"" • Water Based Cleaners a..�W • Soaps and Detergents ! __ • Any Product not Assigned to ''n� a Hazard ouse Waste Storage Keywords ns edM11111 em do+Y4eg4 Surfactant Foaming Harmful it swaffowed May cause eye irritation Keep out of reach of children Avoid contact with skin Universal Waste Don't Forget! Types of Products Includes Batteries was� Compact Fluorescent Lights -- • Fluorescent Lamps y Household Batteries _ Small Bectronio Devices ��-� �• W.. Rechargeable Batteries High Intensity Bulbs T �7 Nnawda aeon. �i. i 7 ree•a+n++up.+r NI� Keywords On Yaaoi TAT Y 011•arNWWlYCOTA TWS Fluorescent .. .•° ,';<11m 07aWe1®fYN1OM®Rm11Y01Y®. i Battery Electronic Rechargeable Digital LCD or LED Touch Screen Flat Screen Touch Pad 02006-2011 Stericycre,Inc.AII rights reserved. Ver.Michaels 2011 U1 Y 12/16/2013 11:10 9724095791 RISK MGMT PAGE 12/15 Dik eleSunngNk'&,hm el WimeV,dr M„ ilc;Ki". tcixlmrntc Migr,o p The StrongPakrm Guide to Potentially Hazardous Material Management Bagging and Handling Embolsade y Manejo '1";`�.,:i,.��;.,.j:•' ''%%"tiYi�;~�"%F*:4tp,4,��7};,�rS'S:ro;S'?i'.' x.:+i'�i'+,e � .k':'i:,i;'p�,'ks., 'Q�. "`.k':`x,,g'S•,�,�i�f;�,y'ati:A?;15,"a�_r'I•lq�; .. .• r�I i;. Sri' ,'.fir,+�Hl,• .. ":•." ......'••�r u1 'p9' $rrt One Item []e r B a � ,�'s� '� '' •,�° s aft' ,!�!���;-�;, - ' . Un Ardculo " de Desechu ' por Bolsa .��e'er .`i'•'� ^a� "�,',.y3q:;� 'r'i..: d�'.fh'o`r�i�•Y'auti•:We! •;•� ,l '+ol�.ra. -�+YrwWrj"'�-^„�,�.YAh'I6•i�'•�1:•'+v'�o^°W�•'luiiin.r.,b�..i✓ •.•^M4,•�rww�•�rwtnvwue•�.ew.� Bags must be completely sealed Bolsas debut estat completanteiate waados .d. �.:, .',`,:...` ,fit+'t�ti ��!��^'�~;��•f•.,�(� Always ': ;. p 's'•d?r'4',,i'.�'9:..K r1,�fnt q"ir,� ..j.1„, .t..�;. _ Double-Bag & Absorb ' ,',.rp V A. p;•j':e r4a..1Rp t y{'h �•� F''•.',i'j4•rrr;�,�r� rr h1`,3'� 7���''� `' i Leakers !fie'.'9P'� '�R '1'r'�i 9'•r.•��nrr+�'„�;.:5 !-. !'3•,.�-;�'' i F�::;r:,..,,..nor,'_' ,.y, .r•.h.b�;'a :.�,L'r. F'� ''�''•� d •',e-�1. .!'d M... "•d doble bolsa `''a��£ .�s�'�:r'r :,kip�'�r;'"'sa4��p�''. CS 0 absorbe cuando y; y.�""ate. yy +V$' iijr- p(9r 9":r• re1fl:, hay escap f11tra�Cl�IIeS �rSl1��,� aa!y�+"!l��v)hIY'F �N9��ai',� 1'de liquidas (L"M-2011 Staricycle,Inc.All rights reserved, Ver.Michaels 2011 , HANDLING 12/16/2013 11:10 9724095791 RISK MGMT PAGE 13/15 CTlfadcSthmBPak-StbscdrvlangadcMatcrinlest'ntentdnlnmsePelipmstm The StrongPakrm Guide toPotentiallyllaYartIOUS Material Management Hazardous Spill Cleanup .[ Liapieza de Detrames •P.,"c�(ljis "JI +'+'—m..w.'2yM•rr,+ww;wry.,�•'. !.v'-!.IiN:y^•-...;.<`'•: Call the StrongPak NQTUNE(1-977-5442-5923) Always use Gloves. Add Absorbent. if you need assistance. Usar gnatites, ACiada.Ab!orbente, "�iif�;.'•:.. ;,err«•y.r ,,,,��qqs:i•? T:�•(:':.'..�• 31'L •'Ki51e :i,��7t''+i.lt:e :,l,Y�' • +�.T :lo,r .i4 d"fFh�*P .)j�•15` F 'iu 4 � "Ib M f�,�}} •. rR ME AR� .•( 1 Ib ,� �qf."F'`i':':'.:'.:...:•"'•''ice•:"'F�'. i yr .:�t;:,:. a.�5v.t �.' ,, . , '+r'a•1`••�a:i: ' Bag Item and Absorbent Double-Bag and Add Gloves Coloquc cl art[cv.lo y absorbcotc cn la bola, Coloque en otrabolsay aisada.l.os guantes �,':{?r�•-rc::�.tiy!�"y!��{,,. Ti`"sy'� :'.G °?' i!'i�''` .li. Write Name of Item on the Bag Add Bagged Item to StirongPak Box F,scdba cl oombrc cic]artic,dv cn In ltoka Coloque el artieulo cmbolsado cn.1 t caja StrongM $ 0 2W8.20115taricycla,Inc.All rights reserved, st�rt5USTAlAoABILRII Vey NliGhacls 2011 a s 1 1 r,S SPILL CLEANUP 12/16/2013 11:10 9724095791 RISK MGMT PAGE 14/15 CuG do SttangPak"Sobm cl Mancgo do Mr,=Wex Poeenodalmenre Pal(rasoc The StrongPakTM Guide to Potentially Hazordoas Material Management Remember: Documents and Logs Keep all logs and documents for three years from the date it was signed. Recuer& Documentos y Regiistros Mantaticr todos Jos rcostros y documcntos por tres anos a partir de Ia fecha de su firma, Manifests (Must be keptfor at °r ''"''�:��^� o M leastthree years.) 7�� �� ,s wi rv�I:.r'r`�i..ir`-M I � b�•-r•.-w.j 1r19t117[ESrd9 ''y•._—�.--.—•— ��.-•..H ..J.�-•i-,.L--� 1 (Flay clue tenor fur : I -.• _4 to rncnos tics afRos.) -a ,�.1,. Me a r.,:.�- ,Rau, +w i .. LOR Forms �PMR6 pMnt�MInG4YNA enlftnGtgY (Must he kept for ate°� leasrtnreeyears.) _ =�;�_��_���•�M,�� e•�si%"�w�:.�n..�,�ao.�iv"ems�.s.-e+nrtrnrar�rrr..a.r�.- a..um.s • Fosnnas LDR (Hay que terser par la me1109 U.05 axiom.) . ............... -..."-..," rummrmei d1tYi�.: vw�f�rY.��,xY.wen-len'i aeM.¢ori+1wti'-.a�. P 11.r61®11ML W.1A1111R9Nl.�LIMOOIDOAOp.w�fmlWIEOO.M �iyew.�•�iir,vr��:��o-.�.v.•m~"asris q�� auestions? Call 877-542-5923 iPregmtm?idame 877-542-5923 t92W6 2011 Srericycle,Inc,All rights reserved- �', gii1�""` Ver,Michaels 2p11 � r Slfoalgl�h IIVIENTS AND LDGS 12/16/2013 11:10 9724095791 RISK MGMT PAGE 15/15 Gnfa do S"ngl'.&_Sobrc cl Manclo do Mai b1ft Pftlr h.iMrenrr Pelfgmam The StrongPak7M Guide to Potentially Hazardous Material Management To order supplies and for other assistance Please contact the StrongPak HOTLINE at 877-542-5923 (voice) 866-781 -1166 (fax) Supplies available include: • 9" x 12" Self-Sealing + Totes Bags • Literature, Posters and • 13" x 18"` Self-Sealing Container Labels; Bags • Spill Absorbent • 18" x 24" Self-Sealing Bags 9 Spill Kit StrongPak bags must be used in this program and may not be used for any other purpose. 70 ©2CM-2011 Stedevele,Inc.All rights reserved. 0.0 '' + Ver.Michaels 2011 k ZRING SUPPLIES - ,. .v- ,.+....nw...r .+. ..,�r.v.,,N"^.rr "'y S�'yrYti�Mv ';vv _ N.^P/" _ ''w'+' v`s',rrn•+i +.-w v TOWN OF BARNSTA.BLE BAR-W 4932 / Ordinance or Regulation k WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name M� 1 d �s 44- a 1 ,,A C-4 /I amp/pm, on 41 3 20 1 Business Address T Signature of 'Enforcing Officer Village/State/Zip 4%14(d?Yl►� . VA A Location of Offense i Enforcing Dept/Division x Of f e n s e X 'i.ce; 1 L r,.,p w'c ( . f � � Facts W t '�`. V 'f��l'���� >�� l ,�� Es� 103- �n Ally. 1+' C,',qy "��AY ILjr l N,,f 11+( l / This will serve only as a warning. At this time no legal" action has been taken. It is the goal of Town agencies -to' achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance,._ Subsequent. violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. .PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 4932 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 1 Address of Offender MV/MB Reg.# Village/State/Zip Business Name A.,I , 2. 17 am/pm, on 20 t r r, Business Address 1 _, ' Signature of Enforcing Officer t : L Village/State/Zip Location of Offense f rr Enforcing Dept/Division � 4 Offense It 1 ! t , '! - 1 �A , , �, �� ., .,,• Facts 'j\+ ► '.t .� E; � r 10,4- f 1 4, 4V r•f This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR—W 9, 22 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager A41A5V%q >4>Mt"1!Z.J . ! Address of Offender MV/MB Reg.# Village/State/Zip Business Name h4t e-� -t ny 6 d"<-,. �4 ;, 15' am/ , on ��,s !!P?, 20 1'7 Business Address , v4-e, r Signature `of' Enforcing Officer Village/State/Zip \b_ ✓1 yi 1 4 IW O 1)2 G,o ! � of h �/ Location of Offense .e_ i, r_1 A r4 ,r-s D'fa E Enforcing Dept/Division Offense '� .s �t �'ya . lh , feLF RtJ �iGCVLst Facts ► ►\' L t e <r,knV J4_ t,+rr '"' .-�w - t " -< �n A. -4, C:7►"'t T �..�FAT�A,K\_ [5 L�a e4 e This will serve "only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 771 r Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager Address of Offender MV/MB Reg.# Village/State/Zip 11 Business Name `` i t .4 ;. am/p`m on aE 20 1"7 Business Address r . rMk _. , � . '''i �' / 1'' Z' -'-K Signature of Enforcing- Officer Village/State/Zip l IN/ Location of Offense . Enforcing Dept/Division Of fense 6>, ,; �i �< " �,. t ! ` ,- ,� � t - ti . _ . a l< L-1; Facts This will serve only as a warning. At this Ttime no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. SENDER: COMPLETE-THIS • .MPLETE THIS SECTION. ,DELIVERY,,, ■ Complete items 1,2,and 3. A. Signature_ ■ Print yorri name and address on the reverse ve� ❑Agent so that we can return the card to you. ❑Addressee M Attach this card to the back of the mailpiece, B. R ceived by(Printed Name) C. Date of Delivery or on the front if space permits. D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No I1 ATTN:ANTHONY DOMENICHELLI MICHAELS STORE j 88 ENTERPRISE ROAD " HYANNIS, MA 02601 3. Service Type ❑Priority Mail Express® II I II�III IIII III I II II II I I I ❑Adult Signature ❑Registered Mallm 111111 al1111111111 ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1797 71 ❑Certified Mail® Delivery Certified Mail Restricted Delivery Psilgriature stum Receipt for ❑Collect on Delivery erchandise nr;nfl—t_An Delivery Restricted Delivery ConfirmationTm I I 7 015 17 3'0 I1 b 01 4'9 9'D 4 0 8 7 �' ❑Signature Confirmation f aril Restricted Delivery Restricted Delivery �PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ii USPS TRACKING# k -- 9590 9402 1933 6123 1797 71 United States •Sender:Please print your name,address,and ZIP+4®in this box* Postal Service (, 1 \ Town of Barnstable, health Division 2.00 Main Street j Hyannis,MA 02601 I 1�111ryy1�.I�1��llh"III13'11'1it -fill 11t111'll'tl l'}Llf"�!'I Rff C L Q' Certified Mail Fee `. Extra Services&Fees(check box,add tee as appropriate) '[I Return Receipt(hardcopy) $ lii;v4 r-a Q, ❑Return Receipt(electronic) $ - t `Postmark 1-3 []Certified Mail Restricted Delivery $ r OV Here A 1-3 ❑Aduft Signature Required $ ❑Adult Signature Restricted Delivery$ , Postage - zi $ � Total Postage and ATTN:ANTHONY DOMENICHELLI IS Ln Sent To MICHAELS STORE 88 ENTERPRISE ROAD o Sireet ani%Apt.No HYA N N I S, MA 02601 jl State,Zip+4' Certified Mail service provides the following benefits: o A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate o Electronic verification of delivery or attempted return receipt for no additional fee,present this q delivery. USPS®-postmarked Certified Mail receipt to they ■A record of delivery(including the recipients retail associate.* * L 3 signature)that is retained by the Postal Service- Restricted delivery service,which provides t-_ for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent I-)Important Reminders: Adult signature service,which requires the 11 ■You may purchase Certified Mail service with signee to be at least 21 years of age(not u First-Class Mail®,First-Class Package Service®, available at retail). _ or Priority Mail®service. Adult signature restricted delivery service,which u Certified Mail service is rota011able for requires the signee to be at least21 years of age international mail. and provides delivery to the addressee specified 1 ■Insurance coverage is notavallable for purchase by name,or to the addressee's authorized agent; with Certified Mail service.However,the purchase (not available at retail). Z, of Certified Mail service does not change the a To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on"r? ■For an additional fee;and with a proper this Certifted Mail receipt,please present your ^. endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for F— the following services: postmarking.If you don't need a postmarkion this Return receipt service,which provides a record Certified Mail receipt,detach the barooded portion; of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply IZ" You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.^_I electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTAM:Save this receipt for your records. Ps Forth 3800,April 2015(Reverse)PSN 7530-02-000-9047 NAME OF OFFENDER BAR 7 8 7 3 4 1 C..� .�� I TOWN OF ADDRESS OFOFFEND�R BARNSTABLE CITY,STATE,ZIP CODE f pfr lW►qy, MV/MB REGISTRATION NUMBER OFFENSE • HARNS7'ARI.E. + A J n A[ +�Lf MASS. !o {.�'��'K. { • l/ '/�,M Q.. 'e7 "�!i ^ r � 7I��' H fr .l d f6�9• ♦ y ,�g n,, y y o ��IFD MK+� HOW.�l 4 t I`G - �.F J YM4'T�� 1 `5 d•J i 1'� VALLJ TIME AND DATE OF VIOLATION LOCATION OF VIOLATION LLI NOTICE OF /2- (A.M.,/ P.M))ON 20 I I eI {bG I VIOLATION SIGNATURE OF_ CING Q/` ONd ENFORCING DEPT. BADGE NO. w rn l , I l eer r44, o OF TOWN I H REBY ACKNOWLEDGE RECEIPT OF CITATION XUJI ORDINANCE Unable to obtain signature of offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS E ,r�oa � Date mailed '"? w OR YOU HAVE THE FOLLOWING LTERNA°fIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION 1 You ma elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holida excepted, Q ( ) Y P Y Y PP 9 P 9 Y 9 P w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P. Box 2430, a Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. �2)1 If you desire to contest this matter in a noncriminal proceeding,yyou maYy do so by making written request to DISTRICT COURT DEPARTMENT,FIRST ARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS TABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature