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0306 FALMOUTH ROAD/RTE 28 - HAZMAT
z o r 7 cs� Number Fee loss THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts Store #8830 ................................................................................................................................. 306 Falmouth Road, Hyannis, MA ................................................................................................................................................................... .... Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. .................................................................................................................................................................... Restrictions: .............................................•...................................................................................................................... This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r Town of BarnstableIMA Inspectional Services BARNSTABLE Public Health Division ` ��`"" 1639-1014 BABNBTARM 2 Thomas McKean Director [ S rEo 9.A` 200 Main Street,Hyannis,MA 02601 '? Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE rti 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 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 [2 �d *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. P-� " 2. IS THIS A PERMIT RENEWAL? V YES^NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS P ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 'J ', 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: �� t�SL�'Ic�� �I('A 1 �L IM�t& C� 2 tui 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: ,t ) (7�Lz7 8. TELEPHONE NUMBER OF ESTABLISHMENT: Q I 9. EMAIL ADDRESS: 10. SOLEOWNER:*YES NO IF NO,NAME OF PARTNER: FOV0' 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# CORPORATION NAME 0 t.Ap�� Q,�tP 1' PRESIDENT '( TREASURER CLERK Q� Etc 0 12. IF PREPARED BY OUTSIDE PARTY: O� • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT6 �v DATE 06/09/2020 Q\Application Formfflaz Mat Appli Draft.Jan2019,doex Effective 10/03/18 Advance Stores Company, Incorporated Virginia - 6/17/1929 Directors Tammy M. Finley Thomas R. Greco Jeffrey W. Shepherc Officers Thomas R. Greco President and Chief Executive Officer Michael T. Broderick Executive Vice President Robert B. Cushing Executive Vice President Sridhar R. Donthi Executive Vice President, Chief Technology Officer Tammy M. Finley Executive Vice President, General Counsel and Corporate Secretary Natalie S. Schechtman Executive Vice President, Human Resources Jeffrey W. Shepherd Executive Vice President and Chief Financial Officer Reuben E. Slone Executive Vice President Andrew E Page Senior Vice President, Controller& CAO Maria R. Ayres Senior Vice President Allison M. Bubar Senior Vice President Michael C. Creedon Senior Vice President Yogesh A. Jashnani Senior Vice President David L. McCartney Senior Vice President Rachel E. Geiersbach Vice President and Assistant Corporate Secretary • ORUTOPRRT I WORLDPAC-- I (33 sr AUTO PARTS Nre AH..ioN. . Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts Store #8830 306 Falmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r t s Town of Barnstable Inspectional Services ' °'�'��` ' QFI rQwy BARNSTABLE Public Health Divisi *>`aYE•CF :4VIltA•CO'Vi1•M?fltF Q� y.c;•;:a:s::as;ar:i':::._.,e:-s*ea¢;t;!ssc y BARNSATrABLE, ' Thomas McKean, Ditec', 9�01pp ,tn�0� 200 Main Street, Hyannis, MA 11 5 2019 Office: 508-862-4644 TAX ACCOUNTit Fax: 508-790-6 304 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$10.00 will be assessed if payment is not received by July 1st. y 1. ASSESSOR'S MAP AND PARCEL NO. ;�ga --61(39 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: W-614,ufll, 1"l. 5. NAME OF ESTABLISHMENT: N1/a ytAk &A,6 gem 6. ADDRESS OF ESTABLISHMENT: 3:01, 0.�vYto w-�. mod..' it yGt,ft" Vk 00110b 7. MAILING ADDRESS IF DIFFERENT FROM ABOVE: -PPA vt Lq- 8. TELEPHONE NUMBER OF ESTABLISHMENT: .fib$. rl�Z$-o1b3 9. EMAIL ADDRESS: 4.VUM16 AeAe Art&xcI @ady"ce..-a.Lc-Eo cam 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME, HOME ADDRESS, AND TELEPHONE # F: CORPORATION NAME abYwv�cRa�e-S Cemt�arW cod�ara� PRESIDENT a s TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATUR:E OF APPLICANT DATE 09 ou big Q:\Application Forms\Haz Mat App Revised 10-18. )cx Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts Store #8830 306 Falmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------------- ---------------- ------------------------------ -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 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 1 i RECEIVED.41 � Tow of B nsxable MAY 14 2018 RegulatoryVrvices 91 Richard V. Scali, Director �NiN� Public Health Division BARNSTABLE t BANNSTAEtf•CLi1TERVILLf•CDNR•NY0.R115 snnxsr'aaM Thomas McKean, Director NMSONSNILS•osrRvae•wsRRRNsret MAS& 1639-2014 °1 . ArEo�a` ----- -- - - -- --200 Main"Street Hpanriis,MA 02601_- - -- ---------- � 6" Office: 508-862-4644 Fax: 508-790-6304 0") 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 V. S . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: W G Vl l l h' V Y -7 4�C693D 5. NAME OF ESTABLISHMENT: H U y ( Nto �ay'r`'j "50 6. ADDRESS OF ESTABLISHMENT: PJQ S /W A ag 1 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: �� ( ( �i�[1� janbrf, T- r 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: iilmps DY►@ 4 Va r1f e ' auin,,to M 10. SOLEOWNER: YES NO IF NO,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 Q: DATE �Application Forms\IIAZMAT APP 2017 REVISE o w Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts Store#8830 306 Falmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------------------- --------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ---------------------------- --------------------------------- �{ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health J ez 33930 - ® �w of B nstable eguatorylervlces 10 Richard V. Scali, Director Public Health Division BARNSTABLE BARNSrABM Thomas McKean, Director '�eo6ra+s`� 200 Main Street,Hyannis, MA 02601 _j Office: 508-862-4644 /"' ��`00 Fax: 508-790-6304x APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALSi 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 l 11 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. FY-2 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: ADVANCE STORES COMPANY INC 5. NAME OF ESTABLISHMENT: ADVANCE AUTO PARTS #8830 6. ADDRESS OF ESTABLISHMENT: 306 FALMOUTH RD 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: PO BOX 2710 ROANOKE,VA 24001 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-0103 9. EMAIL ADDRESS: JLOUIS@GENFITAX.COM 10. SOLEOWNER: YES X NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ADVANCE STORES COMPANY INC PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE C:\Users\Decollik\AppData\Local\Microsoft\Window) emporary I net Files\Content.0utlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx ./ . i Effective 10/31/1.6 Advance Stores Company, Incorporated Virginia - 6/17/1929 Directors Tammy M. Finley Thomas R. Greco Thomas B. Okray Officers Thomas R. Greco President and Chief Executive Officer Robert B. Cushing Executive Vice President Tammy M. Finley Executive Vice President, General Counsel and Corporate Secretary Thomas B. Okray Executive Vice President and Chief Financial Officer Charles E, Tyson Executive Vice President • Ashish Bharara Senior Vice President William H. Carter Senior Vice President Jaynes T. Durkin Senior Vice President Todd A. Greener Senior Vice President David L. McCartney Senior Vice President Michael J. Pack Senior Vice President James A. Paisley Senior Vice President, Chief Information Officer Natalie S. Schechtman Senior Vice President, Human Resources Walter L. Scott Senior Vice President Robert A. Wheeler Senior Vice President Rachel E. Geiersbach Assistant Secretary may. 4 Town of Barnstable Regulatory Services Thomas F.Geiler,Director MAIM � Public Health Division 1 1� e+ ' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax 508-790-6304 Appiication Fee: $100.00 a. ASSESSORS MAP AND PARCEL NO. r'y � DATE May 2,2013 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Advance Auto Parts#8830 - ' NAME OF ESTABLISHMENT Advance Auto Parts#8830 ' li ADDRESS OF ESTABLISHMENT 306 Falmouth Raad Hyannis, MA 02601 �.., TELEPHONE NUMBER (508)775-0103 O SOLE OWNER: X YES NO ; IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS IFALL PARTNERS: — - FZ Mailing Address: 5008 Airport Road r Roanoke,VA 24012 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 540118110 STATE OF INCORPORATION Virginia PULL NAME AND HOME ADDRESS OF: PRESIDENT j t dvr TREASURE CLERK_ — � _. SIG OF APPLICANT , RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts Store #8830 306 Falmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 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 Town of Barnstable �t Regulatory Services • °� Richard V. Scah, Director " `" MASS � ' Public Health Division BARNS . 1639 �u,smaAOu sos EaN�ut� n �fD MA'S► 39-2014 M� Thomas McKean,Director 16 � 200 Main Street, Hyannis,MA 02601 - -Office: 508 862 4644 Fax: 508-790-6304 � w 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 Y,s • A late charge of$10.00 will be assessed if payment is not received by July lst. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: A c y&vn c.e.. 444-VO P0-1f_11-s # S 8 3O NAME OF ESTABLISHMENT: Al j an c e- A-k A-o {tea r $g 36 ADDRESSOFESTABLISHMENT: 3OU 9t./vwa,. t, F�A, Ay&oyiis ; IJA4 o2,&o/ MAILING ADDRESS(IF DIFFERENT): po !�,og Z710 RoA,,Oke, qA 24001- Z' o TELEPHONE NUMBER OF ESTABLISHMENT: Z.'o e� 7-75-- &03 EMAIL ADDRESS: 1V1 C.a • -�aw+� � c�dV car.Ge. -a�-� �. SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address /V,e-e-k .6. o,.,,�s o� Telephone#: /uq✓, €�v r(O�n rr en l q �./5 Email: Q:\Applicarion Forms\1AZZAPP Rev I6.docx Page 1 of 2 r BIKE►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. ` + MASS. 200 Main Street• Hyannis, MA 02601 �prED MP+&`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: V2vtaeL v1�o k-r-+ Date: Location/Mailing Address: 30 b `fL n A, S Contact Name/Phone: - -T p 01-ry ovGtC- I �$3© Pavl -718/-77/- -7 Inventory Total Amount. z�bbb�a I MSDS: �P '; -A 61W4 4lae-,o License#: 1a$8) Tierll : 2-' 1� v � c�c3 Labelina: oive, Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: `Ie S Storage Are Emergency/Containment Equipment: w +1 l eA 1tA4, a &x a Ae— Waste Generator ID: Waste Product: o. Date&Amount of Last Shipment/Frequency: 2 t 17 A, - I-x Licensed Waste Hauler&Destination: Other Waste Disposal Methods: \aa.kkex i ro<Le, grn, P4c� t041�4 ko Ger Qn<ak'C— LIST OF TOXIC AND HAZARDOUS MATERIALS`�wve4-fy PCbv,40Q by �'o�,PptA�C��w 2©13. �0 vA Q- --,rC,6K cS 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. J 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-r WAA�er Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners VDiesel 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) yCar 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: 5 &Av o kc2L%t - sAw 19 -� <( v. M, 2 5. og'k �., ot�c. rZGe%v i Inspecto ` Facility Representati e: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p IME►ohti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMS SS.A 200 Main Street• Hyannis, MA 02601 t639. 0 A�fO MA+p` TOXIC AND HAZARDOUSMATERIALS INSPECTION REPORT /'Business Name: b ✓lee- Av+-a A,,r4S Date: Location/Mailing Address: 30 to red✓Koj4-k. KW , / yc�v►rl i s Contact Name/Phone: Li Sot- oyi,vt 6-a$-775- oto3 �. �0ao a1 6 Inventory Total Amount: MSDS: Ovt hw.,, e. License#: I 0 06 Tier II : 4,0 Labeling: G906 Spill Plan: < ] eta S� Oil/WaterSeparator:_ Floor Drains: 0 Emergency Numbers: e_S - o sQQ°� Storage Areas/Tanks: 740 jkk o%k qf. rAeAyt41 1u1 & coceS k&cLa ow k e � Emergency/Containment Eq pment: �Q !A t� L1 Waste Generator ID: Waste Product: Gtl"-3fe- o,/, 4-0ecy Bores Date&Amount of Last Shipment/ re uenc : 5 4 X v' Licensed Waste Hauler&Destination: 4- -e- k ezv-- Other Waste Disposal Methods: a�': Got' 5 ah, 4G +e> ai1ce_ o--a g(-e 05C . LIST OF TOXIC AND HAZARDOUS MATERIALS _ l vt v, K4w' y�('Ov� Q� GorPof�-�e. ;mac. or3. NOTE: Under the provisions of Ch. 111, Section 31, of the Ger�(eral 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: ��"�s� wa��e, w�avt��eS�S vv+ a J4,k4:12 ORDERS: a &t-v i q �afS O a `i?- Mavii t 5 `I'a V-e INFORMATIO /RECOMMENDATIONS: ,11- 1 eat �2 0+K1k C n 5 ot�• •-.� )( lej-os-' 'In)&5+t vvtkv1%�c4+ `I-o I L4vtl I-e- Inspector: I . L AJ�1•G��e� t<eeyl- - Facility Representativ WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS 4 �\ Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts 306 Falmouth 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 Regulatory Services Richard V. Sc*Director WAM Public Health Division jDl w E'D Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax:, 508-790-6304 Application Fee:61 a r ASSESSORS MAP AND PARCEL NO. FY-2 DATE 6-1.6-15 APPLICATION FOR PERAUT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADVANCE AUTO PARTS #'8830 ADDRESS OF ESTABLISMV,NT '306 FALMOUTH RD E TELEPHONE NUMBER 508-775-0103 5 SOLE OVt NER: YES X NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: j IF APPLICANT IS A CORPORATION: FEDERAL.IDENTIFICATION NO. 54-01 1 81 1 0 STATE OF INCORPORATION VA FULL N`A.ME AND HOME ADDRESS OF: PRESIDENT .... ... . . . TREASURER CLERK SIG ARE OFAPPLICANT RESTRICTIONS: HOME ADDRESS_ PO BOX 2710 ROANOKE, VA 24001 HOME TELEPHONE# 540-362-4911 C;lcachelT=porary Internet FileAOUDWHAZ.APP Rev2015.DOC f °Ft►�ro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. • 200 Main Street• Hyannis, MA 02601 . :a� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: UJmzt - -A,4o R4+,e, I Date: (, 2S/ Location/Mailing Address: 30to T a o aNyl1 s +0 cof Contact Name/Phone: beo� o>%"-,� 08-~71 - 9103 Inventory Total Amount: 'ODD 9 . I MSDS: 0VJ%%V---Q �"" 10 -accegg License#: ? Tier ll : 0$6� e. 1� �D Labeling: G-boX Spill Plan: i-5--A �,P,05 - Oil/Water Separator: t3l A Floor Drains: Emergency Numbers: A5 Storage Areas/Tanks: Zoo qci -Je,' '- o\ h � Emergency,/Containment Equipment: t,11 \4A 3 Waste Generator ID: Ab Oa Waste -duct: oa54,--odlo4`ier.i Lo�QS Date&Amount of Last Shipment/Frequency: 2 2y 3 , -4 l Licensed Waste Hauler&Destination: 1 0 O 2 Other Waste Disposal Methods: '' LIST OF TOXIC AND HAZARDOUS MATERIALS f)D wka� or e�Ik -g {�^ "`v�Kko�� S��c�Ian +�s �'�e . NOTE: Under the provisions of Ch. 111, Section 31, of the Lneral 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: )--`�K5t.4,vi.r.Q-9 �o e fL a•�- S�ote ORDERS' 0sA-e-Q-q V'-N V ,-, S,p,1\ ,bkaan., o.( oug—g oJS MA-vo-C'�a., S INFORMATION/RECOMMENDATIONS: VO,I 7- Inspector" 1 , �►K-��� Facility Representativ . WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS l Date: /cJ l l S l l3 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS R1EG4STRATtQN FORM NAME OF BUSINESS: A o+o -+ &45 BUSINESS LOCATION: 3D(v a ✓�� 4vw\i-5 INVENTORY MAILING ADDRESS: 14 KLA— a G ► IG. fQ1,�c�Ja shy o Lo TOTAL AMOUNT- TELEPHONE NUMBER: -5'60 - I-Pr_ m03 CONTACT PERSON: 1-15e�- Poo Ii o4 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?n TYPE OF BUSINESS: 11 ,>+,D e,r+s ra,, 1 , oAs o c I-v �o� loaf��e<y ow e,6md jf,<, - INFORMATION / RECOMMENDATIONS: Ajcz ..6 /1 cQv►�aye� �,/( Vire`0 1s0. ��5g re D strict: o6 qsiA el 0 1 a 6eA L o lke-e a W4.-,4�e 44 ya mi n is �/v�avt��es� owSl-�.e,�rC�- I2as� Svears. ��s lA�ll abso.r�o�-,��-s �1 IJ& wastes k� Waste Transportation: Safe} kev�Lot Last shipment of hazardous waste: rr(avti�'e.s4!5 a Name of Hauler: AAAa''"e- �� C�°�t}E ��s Destination: 0$4_-s 1t4P--. Waste Product: o► ( +- 6i4-6-e5 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. ,S�,re. Goa► l t- ,rtueh,�ecr et 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 Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes �f�G�. G��Ife_ — ��S-Fr���-Mana`u.rSSzs�3101 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 Advance Auto Parts Hazardous Materials Package Summary Sheet Aerosols Level 20.01 gallons 160.1 Ibs Level 3.19 gallons = 25.52 Ibs Level 63.24 gallons = 505.94 Ibs, TOTAL 86.44 gallons 691.56 Ibs Flammable Gas- Hazard Class 2.1 TOTAL 0.62 gallons TOTAL 1.13 cu. Feet Non-Flammable Gas-Hazard Class 2.2 TOTAL 25.71 gallons TOTAL 46.76 cu. Feet Flammable Liquids-Hazard Class 3 IA 0 gallons IB 19.86 gallons Ic 13.39 gallons TOTAL 33.25 gallons Combustible Liquids-Hazard Class 3 II 17.62 gallons IIIA 32.09 gallons IIIB 1,573.17 gallons TOTAL 1,622.88 gallons 013GANIG;>';. Organic Peroxide - Hazard Class 5.2 PEROXIDE TOTAL 0.55 gallons Corrosives-Hazard Class 8 e . Sulfuric Acid within 172.62 gallons automotive batteries Remaining Products 23.3 gallons TOTAL 195.92 gallons f NTINGENCY.PLAN Emergency Coordinator, Name: 3n JC,,,A�,-t- _ z�+- _ �� 'r24., w•�a Address: ,Zoo ,3. Daytime Phone: -g-r?..�s3 ati��g EveWng Phone: i-s-i-7-7s 3 - -72,3 3 Fire Deppartment: H Glnr i 5 �r� u i 4w.e..-E- L6oc3 �7$ 13o C� DEP 24 Hour Spill Hot Line: $8-304- 33 Waste Hauler; Name:: P5 c Phone: !-87-7 - 5' 7? - 9 I Building diagram indieatg hazardous mate al/waste storage;axea, location � I' of absorbent scavenger-materials, fire extinguishers, fire alarms (if present),. and evacuation route (if applicable). Actions to be taken to control a spill or-release and preventing it froze reaching a cateb basin, sewer system or the ground. 0-b S 6,d -� �eo v%I0_. O 6 �nGv L�iIIF,n'r.'IIIL'�;tlllifllrill��: �k. 7 - � •'T6.:aLv`'.IOr•:V�I�_jai 4y, I Ii— �r����r ��0 �•I OF 01 MM%WC AT TILE w PARTS ' Irnau urnau u i u L��*-�r. 1IMANA CLEAR SPACE or III,ON lop of 1�6n!IILa,9uRn411IITill�l r}II�` PARTS CATALOG SHELVES EPC WORKSTATION PARTS UPROIT BRACES LS:,�'I�L'L C'�•.;,�'IJ:IIII�A�lll�� � � L•f u f'G,ff■:,tip—.f. 60'GONDOLA millim!! TALL WING PAN REGULAR MNG PANEL �wa� Y�A'■�. fs ►,YS,uf-�- r f.:0.. Mm -moo.-,0 .. ■ W.;, �' ■ UM �■■f-tf r, ., f♦ ■ 1 1' 1 1•I ,r ■ 1� 1 Auto P�rri�s � 4 �/ BB.nNGH+718% CSG 13 Michael Degrasse 10/23/12 12:35 PAGE 1 Safety-Kleen Systems, Inc . 2600 N Central Expy, Suite 400 Richardson, TX 75080 800-669-5740 - -0808 REFERENCE NBR. CUSTOMER# 10037 �ADVANC2 AUTO # 1130 59108585 Al2-43 SST 601-2761 SRVC DATE: 10/23/12 SRVC WEEK: 2012:34 ��� PHONE 508-775-0103. BILL TO CUSTOMER# BILL TO ADDRESS: 0009526741 ADVANCE AUTO Po Box 2710 ATTN ACCTS PAYABLE Roanoke VA 24001-2710 PHONE 540-342-3356 PURCHASE ORDER# TAX EXEMPTION NBR PRODUCT/SERVICES SERVICE/ TOTAL PRODUCT OTY UN T PRICE TAX CHARGE 66668 DO-IT-YOURSELF OIL SERVIC 152.000 0.0000 0.00 0.00 SERVICE TERM 12 WEEK HALOGEN / CHLOR-D-TECT TEST R LT PASS: PPM < 1000 # CONTS: 1 TSDF: 7422 MANIFEST#: 003358883SKS FORM CD: US SK SHIP# 208431564 CNT#: 120930710282 QTY: 152 WT/VOL G PROFILE: 0150105 SKDOT 3298 ----------------------------------------- TOTAL SERVICE/PRODUCTS 0.0000 0.00 0.00 TOTAL CHARGE 0.00 CREDITS 0.00 --------------- TOTAL DUE 0.00 UNPAID BALANCE THIS RECEIPT 0.00 Used oil in drums or non-auto generators classified as high risk. cation form is required for all customers (initial sign-up and when status changes) . GENERATOR STATUS CESQG: Vehicle Customer certifies that (i) the above-named materials are properly classified, packaged, marked and labeled, and are in proper condition . for transportation according to the applicable regulations of the Department of Transportation and (ii) no material change has occurred either in the characteristics of the waste/material or in the process generating the waste/material. Customer agrees to pay the above charges and to be bound by the terms and conditions (1) set forth in (a) the General Terms and Conditions provided separately to Customer or (b) any SK agreement signed by Customer and SK, and (2) incorporated herein by reference. Unless otherwise indicated in the payment received section, SK is authorized to charge Customer's account for this transaction. Customer certifies that the individual signing this Service Acknowledgement is duly authorized to sign and bind Customer. The following provision is applicable to Safety-Kleen's ' parts cleaner and paint gun cleaner services: Customer agrees that it will not introduce any substance into the solvent or aqueous cleaning solution, including without limitation any hazardous waste or hazardous waste constituent, except to the extent such introduction is incidental to the normal use of the machine. Customer further agrees that it will not clean parts/paint guns that have been contaminated with or otherwise introduce polychlorinated biphenyls (PCB's), herbicides, pesticides, dioxins or listed hazardous waste into the solvent or aqueous cleaning solution. Safety-Kleen has the capacity and is permitted to accept, store, and/or reclaim the spent parts washer solvent; paint thinners, solvents and paints generated by customer; or dry cleaning filter cartridges, powder, and still residues containing perchloroethylene, petroleum naphtha, or triflurotrichloroethane dry cleaning solvents. Safety-Kleen and customer agree that this agreement is intended to satisfy the requirements of 40 CFR 262.20(e). IN THE EVENT OF AN EMERGENCY CALL 24 HR EMERGENCY # 1-800-468-1760 (Safety-Kleen Contract # 94138) x CUSTOMER / GENERATOR: x� TRANSPORTER: Michael Degrasse LAST PAGE THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , - m / �C(�� IL DATA TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip Business Name am/pm, on 20_ Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense tll�U ' Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W �~ Ordinance or Regulation WARNING NOTICE Name of 'Offender/Manager �' ;✓ .� Address of Offender / MV/MB Reg.# Village/State/Zip Business Name 1 1 -7 X/ Business Address la �E V, '' Signature of Enforcing Officer 1 Village/State/Zip Location of Offense �J {/ Enforcing Dept/Division Offense Facts 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. JCOIVNDRi� s p town 01 Barnstable rWnl �TiO�P�'!®: ioo. vv �o�fUa� • io 8�3 Regulatory Services ;,IFK DATE- fKCK MSt;: Thomas F.Geiler,Director EP Public Health Division y '-�� R���� Thomas McKean,Director 200 Main Street, HYannis,MA 02601 Office: 506-$6274644 Fax: $08-79M304 APPMANon Fie:5'1 .co ASSESSORS MAP AND PARCEL NO. DATE APPLICATION.FOR PERMT.TO.STORE.AND/OR UTMIZE MORE.TMAN, All GALLONS OF RAZARDOUS MATERIALS FULL NA.M Off'APPLICANT 7:bo,r,i e-/ b�h' 7v-e- cs= NAME OF ESTABLISHMENT L)a A 'e /Q.f 'v S 3 o ADDRESS OF ES'TAUTASIIZ UNT a �- TELEPHONE NUMBER 6-0 F) --71 S-d 10 3 r, SOLE OWNER:—WS_,00 r IF AFPLICA NT IS A PARTNERSHM,FULL NAME AND ROME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL XDENtMCATION NO. SS�D FULL NAME AND ROME ADDRESS OF: �'ZtFSIDEN�' �� Pt-t za..,- S-k A ll k c TREASURER =, CLERK SIGNXnn OF APPLICANT RESTRICTIONS: DOME ADDRESS HO&M TELEPHONE#F I Town of Barnstable OF THE TOk� Regulatory Services Thomas F. Geiler, Director " B" MA&S.`E ' Public Health Division v� 1639. ' den►�'�" Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax:' 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE Jam`« j—1 � APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT `/AMr� ,G ,gtidl� T2, NAME OF ESTABLISHMEN c%,CL- i6e"6L-If ADDRESS OF ESTABLISHMENT ��L� y� /y��rr� j �/ X Ord/ TELEPHONE NUMBER SOLE OWNER: YES_ZNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL;-'; PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.�p STATE OF INCORPORATION 14r) FULL NAME AND HOME ADDRESS OF: PRESIDENT ` .9j./d,, /�i -/fie 64 /A) 6PRJ06PUR�) A4 TREASURER /ZZ m� OIG�i CLERK �� _ SIGN TURE O LICAN RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q Town of Barnstable C °FtHEI°�� Regulatory Services Thomas F. Geiler, Director lARNSrABLE• ` Public Health Division 9� i63. ,fig °rfc 39. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.. SATE 0(0130 J 1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN - 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT J se2tNAME OF ESTABLISHMENT I ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNERZ�ES NO Q IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF:"AIL — PARTNERS: o u cD .- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.1 d 00 1` l STATE OF INCORPORATION ( ► FULL NAME HO . O PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q cel Town of Barnstable 100, 00 pF11HE Regulatory Services Thomas F. Geder,Director AR NAS&LE. - -Public Health Division 1659.QED MA'S Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME.OF APPLICANT� LLA C NAME OF ESTABLISHMENT C4ZVC ADDRESS OF ESTABLISHMENTR8 Wq TELEPHONE NUMBER SOLE OWNER: �<YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OFCD A PARTNERS: M N IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO._CY OOd a7 a a STATE OF INCORPORATION FULL NAME AND HONE DRESS OF: PRESIDENT U � U, TREASURER n OUP,, CLERK SIGNATURE F APPLI ANT RESTRICTIONS: HOME ADDRESS 15 G kU G�—� HOME TELEPHONE# d Haz.doc/wp/q —Poc 10 C). O O Town of Barnstable "�� ZzDgq Regulatory Services Thomas F. Geiler,Director MASS. ' Public Health Division 039.iOTEc '' Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.347- 060 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �Y-4(qri �De� NAME OF ESTABLISHMENT (�ra wejlS J&W h m 6 w e l; _--_ Q�L a Gal ADDRESS OF ESTABLISHMENT o�`T TELEPHONE NUMBER cc' V OLE-OWNER AYES NO a F'APRLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL L5ARTNERS: .:! IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK IGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 00�l� a r �, cS, �l Iwo� O d 66 yC HOME TELEPHONE# . Haz.doc/wp/q Town of Barnstable L C d (0IZ01 ,Z1 / pFIME r, Regulatory Services p. 00 i Thomas F. Geiler,Director " MAS&&AMSTABLE, ' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE -�u'Aji' 0 1;261 j APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT s rE V z N C, L y1V o NAME OF ESTABLISHMENT T-1V 0C-j°Eit,"D rA17- l-7V7V /Z Ee�l�' ADDRESS OF ESTABLISHMENT 'S n!y� M62y )CD,. ��`( ywl -�Po -11)/ TELEPHONE NUMBER ,5®Fl- '-7t7 l SOLE OWNER:--XYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: :a o IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION IN) FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF AP ICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# xaz.aoc/wp/q Town of Barnstable ( C THE Regulatory Services I too o d Thomas F. Geiler, Director_ '"R'''nA. Public Health Divisi SS.MA on y �Ar�59. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 50&862-4644 Fax: 508-790-63 04 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. ;KOP 7 d�A DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 36 TELEPHONE NUMBER 5T - 7-71- SOLE OWNER: YES NO - i \.Jt 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 $&ATUft OF APALICANT j RESTRICTIONS: HOME ADDRESS �e/� / A�' HOME TELEPHONE# %P�� Haz.doc/wp/q l d C0,1 z2 I ( CO/?JZ) Town of Barnstable f 100. 00 pUTNE Tp Regulatory Services GN C�4 Thomas F. Geiler,Director r s Public Health Division 1639• iOTEn nnr►+°i Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 3 —�� DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS AA FULL NAME OF APPLICANT 1v`/Ouv,�� NAME OF ESTABLISHMENTAMA- ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER 40 SOLE OWNER: ' YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF�ZL Q N —J� PARTNERS: 4 ..sue 1, w M IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT Cam Gv`% r �l CLERK A CANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q co Town of.BarnstabreSI DO 00 G�VCN ��1He rq Regulatory Services Thomas F. Geiler, Director '"R'ASS.STABLE, " Public Health Division � ,fig' �fD - A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE U-1 N co E-APft1CATI0N FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN r 111 GALLONS OF HAZARDOUS MATERIALS 1 .-..n it '.N• IRFUtti NAMX QF APPLICANT 00��e. �UtO�m NAME OF ESTABLISHMENT AN, a "�'`\`+.� -7,*.�c ADDRESS OF ESTABLISHMENT 3 \ CAA TELEPHONE NUMBER SCOg %Aj�,N �0a.b SOLE OWNER: J YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. CA-SA 9�,O;.f6 STATE OF INCORPORATION '1`` FULL NAME AND HOME ADDRESS OF: \ �^ PRESIDENT -001A 1;\ moose TREASURER it '+ CLERK 1 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS qj, G0 UCH HOME TELEPHONE# Haz.doc/wp/q Town of Barns able Regulatory Services l00 Cab ti Thomas F. Geiler,Director 9 11,&M& Public Health Division 16g9, �4 �fD MAy 1, Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLWATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN `,'' 111 GALLONS OF HAZARDOUS MATERIALS F .L NAME OF WPPLICANT --2j G -fa N� QF ESTAB SHl�IDNT �"�''��'� � o A )RW OF ESbL�iBLISMVIENT -9 y-9 TELEPHONE NUMBER 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. d 5/3 X3 S e-,0 STATE OF INCORPORATION -1�1--9 FULL NAME AND HOME ADDRESS OF: PRESIDENT 4So:j,= C�I-j TREASURER CLERK G�JC-�P SIGNAYUkk OF APPLICANT RESTRICTIONS: HOME ADDRESS -SL9 s HOME TELEPHONE# Haz.doc/wp/q =j., Town of Barnstable b b b cock [ON � E lti Regulatory Services Thomas F. Geiler,Director B"R ASS.�• ' Public Health Division � QED 39. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 I 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 APPLICANT NAME OF ESTABLISHMENT � � 1� �15' ANC ADDRESS OF ESTABLISHMENT 0,40 3�9 /s b« 'j,, #'YIWNt"S , M4 TELEPHONE NUMBER 771 4 7Y V SOLE OWNER: YES_)(NO _u--IF A"LICA- T IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL 7AIRTNERS: c 1 C." IF. PLICA g,IS A CORPORATION: FEDERAL IDENTIFICATION NO. Oy -ZP'3/7F7 STATE OF INCORPORATION WI►� FULL NAME AND HOME ADDRESS OF: c4 3 AU,vtL TV— n st y Zcllnl77f WX 01I6'/ TREASURER CLERK S NATURE OF APPLICANT RESTRICTIONS: HOME AD RESS -9AtE AS A- �E HOME TELEPHONE# SGf- Haz.doc/wp/q Town of Barnstable h��� �� too. 06 �IHE I Regulatory Services °s Thomas F. Geiler,Director 'AR"'Sr"B`E KAn ' Public Health Division q 1 9 i6 . �pTFO A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT P1 1 I'5 Au+) ADDRESS OF ESTABLISHMENT � � i ��—�[x Va c 1 I TELEPHONE NUMBER co =.-3 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL HOME ADDRESS OF: P r u,� c� LA -vt-eaQa rJt TREASURER CLERK / SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS z HOME TELEPHONE# E Haz.doc/wp/q 117 Town of Barnstable j THE Ip� Regulatory Services Thomas F. Geiler,Director_ J " '" 'ASS * Public Health Division 16 9. �0$ Fa MaY' Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 3Z� Z:T(--1 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �I,�GZ2 Ah -(dmS-�� NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 0/ . TELEPHONE NUMBER SOLE OWNER: YES NO - _ C IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: co IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 6 / /f STATE OF INCORPORATION (M A . FULL NAME AND HO ADD OF: PRESIDENT LC P3 t,�CLP� TREASURER 0. CLERK a Z &GNATURE OF IC RESTRICTIONS: HOME ADDRESS UZ 'Sh (/t , d, HOME TELEPHONE# tea(2 q3`?3 � Haz.doc/wp/q Town of Barnstable f �°F1HE Tp�� Regulatory Services , Thomas F. Geiler, Director �L U '"R" `�`� ' Public Health Division <,' f �. $ i639• �0 prf039. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATEy..f APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT - , j NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENTT TELEPHONE NUMBER �'C.( `-t!} 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 EEO SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q f Town of Barns able a �SHEl°L Regulatory Services Gm" 02)166) Thomas F. Geiler, Director_ $"RMASS."A Public Health Division 1659.A'En Say' Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 ° Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. a '7J a3 `l DATE 611 g6ll � APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Pcy Sfrtu r�S L�rnc c..t.�]S ADDRESS OF ESTABLISHMENT ?e)6 Pf�c��e r� 's �� ,T/1/5 '914 ©a�o� TELEPHONE NUMBER a.O SOLE OWNER: V YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: a IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0 rn STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q 1 -- - �LV11 1J:J31 rae �Ua IMU CJZS YYhihk( YULLU IUN UUN RUL l¢IUUG W/ f Town of Barnstable i Regulatory Services J Thomas F. Geiler, Director YAM"�� ' Public Health Division 1619. 6ti Thomas McKean,Director 200 Main Street, Hyazuis,MA 02601 01�-ice: 508-862-4644 Fax_ 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. Rq3--Do DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF'APPLICANT PO 4.0- J� �a�l1� I 4 , NA OF ESTASLiNT _ {�.�C� r po 1!fir rir� �.o n �O I , ADDRESS OF ESTASLISEWENT / beo-r4 i k—L/ TELEPHONE NY7MBER _._ lS -' D 33 SOLE OWNER: '.YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HO MIE ADDRESS OF ALL PARTNERS: IF APPLICANT IS A,CORPORATION: FEDERAL IDENTIFICATION NO. a Li STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGN 'URE OF APPLICANT RESTRICTIONS: HOME ADDRESS _ HOME TELEPHONE# xaLd�n,��y. Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts 306 Falmouth Road/Mailing: 5008 Airport Rd, Roanoke, VA 24012, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2013 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 5/13/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health i.r Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax 508-790 6304 Al'plicatlon Fes: $100.00 ASSESSORS MAP AND PARCEL NO. DATE May 2, 2013 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 1.11 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Advance Auto Parts#8830 NAME OF ESTABLISHMENT Advance Auto Parts#8830 ADDRESS OF ESTABLISHMENT 306 Falmouth Road Hyannis, MA 02601 TELEPHONE NUMBER (508)775-0103 7-, ram; o SOLE OWNER: X YES NO r �� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS .OF ALL PARTNERS: f' 77 y Mailing Address: 5008 Airport Road 0 Roanoke,VA 24012 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 540118110 STATE OF INCORPORATION Virginia FULL NAME AND HOME ADDRESS OF: + PRESIDENT ,,i oyr ryt Ll tc �OCJ� 1�t11�r�(�'t� CI 6a, D I a t(0l TREASURER CLERK_ SIGN.SIGNAtftE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Number Fee 1088 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Advance Auto Parts 306 Falmouth Road, Hyannis, VA 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 revolted. ---------------------------------------- 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 i!' r _.� Town of Barnstable y Reg ulator Services °p THE Tp� Richard V. Scali,Director 9'MA� g Public Health Division lop • 1639 �� °lfo 39 Thomas McKean, Director Ck-F j)TB i�/30/iY 200 Main Street, Hyannis, MA 02601 Office:. 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT /� ` q�p NAME OF ESTABLISHMENT )M��C U Av -0 �a(h U O�J+� ADDRESS OF ESTABLISHMENT LP DJ WI t,4- TELEPHONE NUMBER' 115- O L 6 Q SOLE OWNER:_t- YES NO 4 max. IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OFF :L r Q PARTNERS: 3a. o i3 22 t V LV IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION �I R FULL NAME AND HOME ADDRESS OF: PRESIDENT .QQ TREASURER- CLERK ATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# 540' h'L' V Q:\Application Forms AZAPP.DOC