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Home My WebLink About0045 FALMOUTH ROAD/RTE 28 - HAZMAT Qbodl ym J S MI E A DR No. 53LOR UPC 12543 smead.com • Made in USA Past t=N TM PRooucr tNE SFI OF TW SFlPRAM CERTIFIED SOURCttJG WMM1N.SFmROGRAM.aRG � 1 °FTHe rop Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMASS. 200 Main Street• Hyannis, MA 02601 i639 `00 n. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rf0 MP'� Business Name: v Date: ox0 Location/Mailing Address: Contact Name/Phone: FOE "711 •— W 11 Inventory Total Amount: �JrOd CMSDS: -V Cafe- License#: �J� g Tier II : 140 Labelina: Aa mill Plan: QVA Oil/WaterSeparator: Floor Drains: 10 Emergency Numbers: v Storage Areas/Tanks: 0 'W "a 41 Emergency/Containment Equipment: I Aru P11 Waste Generator ID: Waste Product: 01 �0(0� Date&Amount of Last Shipment/Frequency: On Licensed Waste Hauler&Destination: Other Waste Disposal Methods: L—L1ST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage2nd disposal of 111 gallons or more requires a license from the Public Health Division. JAntifreeze Dry cleaning fluids E]) utomatic transmission fluid Other cleaning solvents&spot removers -,Engine and radiator flushes ug 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 i/ Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rust roofers Photochemicals(Developer) P ( p ) 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: 0 ` Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I � INVOICE Page ,of 2 .nc.<:....,,,..:a Citiii' Din Oil CoTpora tan i =2 ngv.atc., Billing Account# Service Account# Invoice# Invoice Date j °r`'e"6.'A0-°-' CA64674 CA64674 84521666 10I16120 DON'S No:08-153 427 FED DNO . Billing Address Service Address Branch Location Terms CAPE TIRE SERVICE CAPE TIRE SERVICE CYN OIL-SVC STOUGHTON Net 30 Days 45 FALMOUTH ROAD 45 FALHOUTH ROAD HYANNIS MA 02601 HYANNIS MA 02601 For Questions Call: Service Date 781-341-5108 10/14120 _._.__... _......... - ......_------------ PO Number Department# Department Tax Status/# QUANTITY PART# TERM SERIAL/PROFILE# UNIT PRICE UOM SALES TAX TOTAL 1 10256 8 $25.0000 EA $0.00 $25.00 OIL SERVICEiSTOP FEE NON-PREOUAL CRANKCASE 300 66636 8 $0.9500 GA $0.00 $285.00 USED OIL REC`ICLE AUTOMOTIVE OIL PO Number Department# Department Tax Status/# 16 QUANTITY PART# TERM SERIAL/PROFILE# UNIT PRICE UOM SALES TAX TOTAL 1 100065. 224 $20.0000 EA $0.00 $20.00 . E-talanifest Fee a SUBTOTAL $330.00 TOTAL TAX $0.00 CURRENT AMOUNT DUE $330.00 USD Interest:^,iii be ciiaigec at a rate of 1.5%per;1looth for all past due amounts. . _...-_. --------- - Billing Account# Service Account# Invoice# Invoice Date CA64674 CA64674 8452166610116I20 Cyn Oil Corporation. _......... I PLEASE RETURN THIS `y ��,..... 42 Longwater Dr. PORTION 1NITH Current Amount Due it Date Due I� Total Amount Due Norwell.MA 02061 PAYMENT.MAKE ANY ADDRESS CORRECTIONS $330.00 11/15/20 BELOW. $330.00 00084521666000CA64674000000330008 0000001 CAPE TIRE SERVICE Cyn Environmental Services 45 FALMOUTH.ROAD PO Box 734867 HYANNIS MA 02601 Dallas, TX 75373-4867 6 001890 000000 0001 0002 �oa�►�row Town of Barnstable Office:508-862-4644 ,�Y o Public Health Division Fax:508-790-6304 � BARNSTABLE MASS. 200 Main Street• Hyannis, MA 02601 039. � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: oervkce Date: V lY l�o Location/Mailing Addr ss: ys a vim . o f 7.48 Contact Name/Phone: 50e6--1-1 k - %t t I Inventory Total Amount: A- 00 a\ MSDS: -'v �oG��r�Pa�� License#: 3% c`"- 5A Tier II : PV I la Labelino: 0 Spill Plan: o o->� Oil/WaterSeparator: �O Floor Drains: ZS Emergency Numbers:% Storage Areas/Tanks: o o 4.I kffa o,I owl s :9-5'S �, -1 Jos Emergency/Containment Equipment: 5 1 3-SS a l 1t� ,�floors k� Waste Generator ID: ODD l Waste Product: DI r'� �l-kcrs, awfi `reeee_ Date&Amount of Last Shipment/Frequency: 4 b )i b Zoo 1A4 a x/ ►tip, Licensed Waste Hauler&Destination: d, / 64o244'." MA Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Iva 'm� G I� thV�2 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws f MA, hazardous mfiterial 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 JMiscellaneous 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 VPaint&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: WSk�- b� vkc�� CObv�e- ow-A- k e.rA VAkdJk C,o Wk a.k,n o o 00 -ems- ORDERS: ot V I M&%1AA- k AAAA IV< a c tr -r ova 6►-�,e.. INFORMAT N/RE O MENDATION �( Co� eL %/lJ�vt> ��5 -e- \JYL oo inspector:" kke-, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 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 MILLED,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Q Director of Public Health f� �t t ® Town of Barnstable �t r Regulatory Services Richard V. Scali, Director MAS& Public Health Division BARNSTABLE �rn u-WM""awnms �pAp'�A Thomas McKean,Director 1639--72[0�14 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-630. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 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 Y'& • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE CO FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: C "�N ,iKCJ— L�jL ADDRESS OF ESTABLISHMENT: ry)0 -"---'P)d !±IJ MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: -7 EMAIL ADDRESS: SOLE OWNER: Y YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME OkPt�Tir2e PRESIDENT F'�GAt,(o� TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SI AT �APP T Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev I6.docx Page 1 of 2 4� J\ Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 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. Scali,Director MASS. ' Public Health Division Thomas McKean,Director ems; 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4644 Fax: 508-790-6304 : Application Fee: $100.0.0 ASSESSORS MAP AND PARCEL NO. �` �,LJ DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C A PE ! ► P-z S& 'u L-^ , NAME OF ESTABLISHMENT • ADDRESS OF ESTABLISHMENT CIS TELEPHONE NUMBER SOLE OWNER:_X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.Llq � a (p STATE OF INCORPORATION h(1 A FULL NAME AND HOME ADDRESS OF- �/ PRESIDENT��11 1 )��j( TREASURER CLERK 4 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS PS (6(A - HOME TELEPHONE# C)Z(D v) so - 3 a(!�- oy� C:\cache\Temporary Intemet Fi1es\0LKD3UiAZAPP Rev2015.DOC Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 ® ; snaysr BM Public Health Division MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ,Hazardous Materials Payment received: $100.00 (Check) on 6/12/2015 Permit number: 358 Check number: 025917 Check amount: $100.00 Name on check: Cape Tire Service INC I Business: Cape Tire Service, Inc. Owner: WINTHROP V,7R& NANCY K TRS Address: 45 FALMOUTH ROAD/RTE 28, Hyannis i iy • IKE*ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASSBLE, 200 Main Street• Hyannis, MA 02601 � t6 9. 0 p 3 � l a EDMP� TOXIC AND HAZARDO US MATERIALS INSPECTION REPORT Business Name: C4, I `«- Seri%ce_S Date: / iY ts- Location/Mailin Address: �a. v►�n a,✓I h r S O 2'�&8 Contact Name/Phone: v. Go H.S0VL- Ssfi. 1�• Inventory Total Amount: � � MSDS: S License#: 2 5g Cap Tier II : N o Labeling: GO (100ka4 Spill Plan: Oil/WaterSeparator: MIA Floor Drains: t,�o Emergency Numbers: e S Storage Areas/Tanks: 0 A prrfo!o,\ -5ti. 22<wa5kt_o,I ,A h"fA Emergency/Containment Equipment: &QC. 1v_ ,,cr�,ec� Waste Generator ID: MV0000 I q 1116 of Waste Product: 0' e_<5 , a,v Date&Amount of Last Shipment/Frequency: ;Z<O Je-1 L- /X/Mo Licensed Waste Hauler&Destination: U � rrl. (9, ( }o o w Other Waste Disposal Methods: Rw} ce2r,2 4o lr_- u5 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 '. - a1 �t�w` Dry cleaning fluids �— Automatic transmission fluid 9 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:V Road salts grease, lubricants, gear oil 5'Stx.r� 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: 4tk c00k01•1-k by oo,s ORDERS: J 2 ola oors At At' 0 y 1 at" 60s4vtase. INFOOATION/R ItCQMMENDATIONS: o1.c,-dvt, < �64&40 OA. l { C3A, ---�1 VV" Inspector: I�a1.1,C -- Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F� ►oy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B'"MA `E SS. 200 Main Street• Hyannis, MA 02601 �16 59. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4i e li-e,c%ji c- Date: Location/Mailing Addr ss: 6kA-L-_ Ox X48 Contact Name/Phone: —5o� Inventory Total Amount: ^- .Sb Ak MSDS: GS License#: 3 58 Tier II : o Labeling: OK- Spill Plan: 746 Oil/WaterSeparator: Floor Drains: IV Emergency Numbers: Storage Areas/Tanks: w o,l krk (uy,c i'Co be Emergency/Containment Equipment: & s JC°<otr Waste Generator ID: _��tJD00o014115 Waste roduct: Date&Amount of Last Shipment/Frequency: -ko\o- t a. Licensed Waste Hauler&Destination: v- Q. t Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS N0 "^`�}a,f C�a�.r�.S ►v� o�y Siy��L l�S� �ac �>ti NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous ma i�erial 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) 7— 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 ZBattery 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: �T0.�yYl�t� �r��Os�Sd um� L)C,4ty. aV�cIQ<eZ-E-e_ Q<• OR ERS: 10 A A JA Loi4A6= o o °o , INFORMATION/ ECOMMENDATIONS: o �ra Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS p.1 ra. �,euo-ess�e flmIAE VA t-tst -3A4=0265 1771 Ylaspragtoo�., N° sm 2�.1 9. Una,NAAa .' EPA MO..MAD-082M777 IC:AIr%.MA-4O7NN OMS VT CT NW 2a:Ar 375.ME•HUVT-840 Chi INTO. £deceived from Date Addrew .:QU�NR' y . DE9CAI ojw 1T OR+FO$ b40UIVT- �. 81�CY(�pG s 5 4 p.2 ._� 'lease print or We.(Fern designed for use an el to 12-pitch)typewritu) Farm Approved.OPAB Na.20504039 UNIFORM HAZARDOUS F.Gcer,1orlDNunftr 2.Page 1 of 3,Emergency Response Phone 4.NFanifest Tracking Number V ASTE MANIFEST 1-800-899-1038 '' r i '"'1,? q 7 G B F S.Generator's Name and MAP Generates S4e Address(if different itim malting address) t ne -' 6.Transporter 1 Company Name U.S.EPA 10 Number CYN OIL CORPORATION MAD082303777 '.Transpomr2 Cornpany Name' U.S.EPA ID Number 8.Designated FaaLty Name mud Site Address U.S.EPA fD Number CYN OIL.CORPORATION, 1771 WASHINGTON STREET,STOUGHTON, MA 02072 Fac s Phone: 781.341-5108 MAD 0 8 2 3 0 3 7 7 7 9a, So.U.S.DUrDesrxFptlon(hrduding Proper Shlpping Name,Hazard Class,IDNumber, 11containers t1.Total 12.Undl 13.tPfasfeCodes Jim aP1d pa�gsimp(dar4) No. Type Quo* WtNol. 1, STATE REGULATED OIL WASTE _..__. / MA98 t W 2 j 1 3. 4. t4.Special HandfingtubuctionsandAdddiord Momiadm 24 HOUR EMERGENCY SPILL RESPONSE 808-899-1038 D.O.T. EMERGENCY GUIDE#128 PASSED DEXSIL ,5. GENEPATOMOF )ROWS;CER7[=TiON:i hereby dedare thatthe center's of ttds oonsignmert are Uy and accurately described above k yr hs proper shipping name,and are classified,packaged marked and labeledlplacarded,well are in all respects in proper oondtion for bansport according to ao cable intemafimal and natonal governmental peg dafions_If end shipmerd and I am the Primary Exporter,I certify That the contents of ft oohs grimem ccntwm tothe terms of the attached EPAAdtnrnNedgment of Consent I ce fy that the waste mi imizafAn statement identified in 40 CPR 28227(a)Of I am a large quantify generator)or(b)(y I am a snhafl quarter ganertdoor)is tore. GerreratclsfOflerofsPrrdedlTypedhamte Signature Month Day Year -� '6. pnational5hrymeras �- ❑Import to U.S. ❑Expmtfm Pert of erlMewl: a Transporter signature(,or exports only) Data leaving U.S.: '7.Transporter erdofReceiptofMatenals Transparter yped f Signaure - ~`- -- - uanth -DEY yew- Q 'ran erg Nlarne SiOwAre Mongh Day IF r 18.Discrepancy 18a.Discrepancy Indiccalian Spaos ❑f}uanliy ❑Type ❑Residue ❑Patel M'edjon ❑Full lisjecties �. Manifest Rsfamice Number. 18b.:Aft noFacifty rGeneralar), : U.S.)PAID Number: . V .. - .. paoiCdyrsPhp,a,:`: _ - - y�j .1tla:Signature•aiMtartntaFardily.(oFG,Goeralwj. .: _ - :.., 'Month- Icy : War. - Z W11 Hazaclnus Was(e Report agertent Method Cddes(W.,mdes.fsr hazardous waste treatment,dsposal,and recping systems) 4. 20.Designated Fady e .Ce cation of reoelipyd herardous 'apdals cohered by the pt as rdjh in item I& Prl:ded/fypedName S tore Month Day Year i i- For T00-22( .3t5j 'io ions j DESIGNATED FACILtTYTO GENERATOR Date:/2/ /b / 13 TOWN OF BARNSTABLE -- ns ,oK., TOXIC AND HAZARDOUS MATERIALS REStSTRAMN FORM NAME OF BUSINESS: Ca -L BUSINESS LOCATION: q 51 1�-til N a nrl S INVENTORY MAILING ADDRESS: fo 80>C ;ZLf 8 , H)t an n, 5 TOTAL AMOUNT: TELEPHONE NUMBER: 5-0f5-7-7 1 - III ( CONTACT PERSON: D, EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: a.y+o r��a�.r ar•�- �a�,•.,�-�v�annc� �� I�� a - �j NFORMATION / RECOMMENDATIONS: 9)4b✓G q#ttfree,.I.,x6te, Fir District: y� 1 400<S Z�/�a�Cc SXie Q �r�wig •t�� ar� beor� I e ' as?oors I�(J:� c¢9� a r►,� 5 go�1x-n,��QS ovt,�Qc�►t.s-1-o pr�•/ew�'�r+DS r9t��lls f�o�t. r�.�.ln�v�, door yJ C/ea►c✓,p f I C4 w (100l 4ot4&ae rvtor'k�e4en 5) Ca <il ccwf a,-t ars v kpvl Yto+ ,✓I v �)Ma1,��-gars �11 �►+ �.¢.�nt.,c of�� Cot,1��•t,a-c5 a��lal�e-I Waste TfaAspartatiefi: :M14\V10D000y/66'- Last shipment of hazardous waste: /� /3 Name of Hauler: CV►1. 6), Destination: C�JT, MA Waste Product: Iaks+e fl,l/ l4«s i-anf, �,ree&— Licensed No M4908?-363777 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 110 An 'freeze (for ga oline or coolant systems) Miscellaneous Corrosive LZNEW Sr USED 5 Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils --// Pesticides I�NEWN0 LTUSED (insecticides, herbicides, rodenticides) z�t'.�6�`Ifiets Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas 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 )S 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 Laundry soil &stain removers _ (including bleach) Z 00r Jam, Spot removers&cleaning fluids 1 (dry cleaners) b-5 how )v%S 14— 1&-CA ,b2 Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. .----------------------------••----.....------------.....------............---------------......------------------......•--..---- 45 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 Town of Barnstable as Z& Inspectional Services BARNSTABLE nw�sr.e:e�n:�elru:"°Y�;' Public Health Divisionw ]fi]9.7011 1� 'u co BAANBPABL6. I Thomas McKean,Director A t6 9' s`� 200 Main Street, Hyannis,MA 02601 . CEO Mf►� Office: 508-862-4644 Fax: 508-790-6304 ' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 1 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 Pd CATEGORY 3 PERMIT 500 or more Gallons: $150.00 1 *A late charge of$10 00 will be assessed if payment is not received by July 1st. p a_SAr0 j 1. ASSESSOR'S MAP AND PARCEL NO. 3Sg 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 0ORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? v YES NO. 4. FULL NAME OF APPLICANT: &)Joiu� E . VVa1 LOl U jr. 5. NAME OF ESTABLISHMENT: T Y? 2.rvju Ill C 6. ADDRESS OF ESTABLISHMENT: 45 ��11rr®Uith Pd ' ha 0611 i hq Pr 01 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: nTo e V 1 a. (,Dry) 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME C� -TingScf\j1 Inc . PRESIDENT KcV_X_X= F. WKkA r u.P TY. 15 t t r 10 1fk bLP,,W�l 1 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE CA -J I W 2-O Q:1Application Forms\Haz Mat App Revised 09-10-18.docxr/0—�7/-45 I Ail Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 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 �i F Town of Barnstable Inspectional Services BARNSTABLE OF SHE WNsa9:e•alre0.9 F•cPum 1— ® Public Health Division °�r°:• a`° YE :57s-1n:a 377� : a BAR,N ^BLE. • Thomas McKean, Director 1639 °r a 200 Main Street Hyannis,MA 02601 =° fo Mo+ � Y , Office: 508-862-4644 Fax: 508-790''6304 a.:. :r: APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE n` HAZARDOUS MATERIALS Q13� 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—JUNE30th). 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 g vsnPc( cm1 4� *A late charge of$10.00 will be assessed if payment is not received by July 1st. 35 1. ASSESSOR'S MAP AND PARCEL NO. I "O 5 3 2. IS THIS A PERMIT RENEWAL? vlYEs-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: Ca,0-0 7% Je_.ry 1 C� , V) 5. NAME OF ESTABLISHMENT: ea4Pt, ! IY�I Ce I h C 6. ADDRESS OF ESTABLISHMENT: '7 kd 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 67 D 49' 7 7 1 ~ 1 11 o 9. EMAIL ADDRESS: I 10. SOLEOWNER: r YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATIONNAME PRESIDENT p myaym,& 1 TREASURER Is CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Jt- oZO Q �Application Forms�EIaz Mat App Revised 09-1 - .docx Q: i Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 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 Vwofor Barnstable eg atory ervices Richard V. Scali, Director Public Health Division BARNSTABLE srae •urrEnnue.cmun.xranwa ' M Thomas McKean Director DH M1�10�-2014 7HAfi3. � 7 1639-2014 --200 Main-Street-Hyarihis;-MA-02601--- -- - - ----- ------ Office: 508-862-4644 c="60 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 X VS *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: L N�?2,-T% 5. NAME OF ESTABLISHMENT: h 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER O^^F ESTABLISHM �ENT: r / / 9. EMAIL ADDRESS: 2 LEem,`t1,r2J ,c n 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME AD RESS,AND TELEPHONE#OF: CORPORATION NAME 'T"a_e_,6!/1 ut� T�L PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME. .. .. ._. .. TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application FormsUiAZMAT APP 2017 REVISED.docx Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, Hyannis,MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- ---------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Ll Director of Public Health "how of Unstable Kegi%atoervices t►+� Richard V. Scah,Director � r� Public Health Division BARNTABLE y BA0.tl5Aptf..1"iFA4"LLE[OTUR.NYa.t:15 • BAMSTABLE,LAS& ]y]p9$, Thomas McKean)Director F0.5SY�'°��79""` 7 163g9y5�577Z034 i63q �� iOlpp�.�e 200 Main Street, Hyannis,MA 02601 Office: 508-862-464 aory4 Fax: ( -790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE i a HAZARDOUS MATERIALS 01 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 ,R1 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: 5. NAME OF ESTABLISHMENT: iaP2 i 6. ADDRESS OF ESTABLISHMENT: LI mU y pl �'� CC rl�Yl 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: �50W- -7 '7 9. EMAIL ADDRESS: '.-e02,�7(�� 10. SOLEOWNER:.�_YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT )p 0"'}- TREASURER � CLERK tepL OnhccDLA I 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: . COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC N DATE �/ Q:\Application Forms\HAZMAT APP 2017 REV c Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 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 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 y r Town of Barnstable °ptHE Tpk� Regulatory Services Richard V. Scali, Director H" MASS. ' Public Health Division qj i639. �0 A�Ep MA'S Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Ap a ion ee. 100.00 r ASSESSORS MAP AND PARCEL O. DA E J/ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT We-,(-tle:i f 1�-- NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT o S TELEPHONE NUMBERC� l / 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 l �° 0,-A g STATE OF INCORPORATION FULL NAME AND. O E ADD S OF: PRESIDENT ��CL�(�PV-�1, TREASURER l ( t lie CLERK syclykiURE O PLICANT RESTRICTIONS: HOME ADDRESS G C HOME TELEPHONE'��C4 Q:\Application FormsUiAZAPP.DOC a MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow 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 0260.1. FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. 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 Back to Main Public Health Division Page I Q;\Application.Fonns\HAZAPP.DOC 6 y 1' Q SPILL CONTINGENCY PLAN Emergency Coordinator, Name: 'PO VJ 0"U Ct,C_e_.r Address: Daytime Phone: SOY-j-7 ( - ) I / Evening Phone: sc'F - 3 a6 a y� Fire Department: (7 Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 x Waste Hauler: Name: 1 Phone: Building diagram indicating hazardous material/waste storage area, location 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 from reaching a catch basin, sewer system or the ground. Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMASA.MCKEAN,R.S.,CHO Director of Public Health r t- ,' •_E 'own of Barnstable of Regulatory Services Thomas F. Geiier,Director } } ae� .11 Public Health Division •y MAR4. A nna�a Thomas McKean, Director 200 Plain Streit, Hyannis, CIA 02601 Of= 508-8624644 Fax: 50&790-6304 Application Fes: $100.00 ASSESSORS IYiAP AND PARCEL,NO, DATE APPLICATION FOR PERAIT TO STORE AND/OR UTIL= MORE THAN 111 GALLONS OF Hd� QUS MATERIALS FULL NAME OF APPLICANT /90 dE/1T w��Li¢cE J/{ NANNI E OF ESTAB7 IS v= ADDRESS OF ESTABLISIBIEN7 TELEPHONE NUN= 6F09) 771" /1// SOLE OWNER: v YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAA1E AND HOMT,ADDRESS OF ALL PARTNERS: f IF APPLICANT IS A_ CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION �sS FULL NAME AND cv AD RESS F: PRESIDENT � C�- TREASURER CLERK 5 SIGNATURE OF APYIJCANt f RESTRICTIONS:, HOB ADDRESS HOMI TELEPHONE# ; F 4 . MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the reTlilcd fee amount. Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, M 025d1 FOR FA=D REQUESTS- Our fax number is (308) 790-6304. Please fax a completed application form.. In addition, you must Mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. For farther assistance on any item above, call (508) 862-4544 A i II i i i i i i " I i i i Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, 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 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable 0—FTHE Tp� Regulatory Services Thomas F. Geiler, Director BARNSPABLE, 9e NIA . Public Health Division v i639. ArFDMAyA 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 CNPe --r1—CZC 5g2\f(C ADDRESS OF ESTABLISHMENT —4RLm t' TELEPHONE NUMBER 1 ` 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 A HVME rD, SC°� lL PRESIDENT TREASURER CLERK t t t SIGNATURE OF APPLICAN RESTRICTIONS: HOME ADDRESS C ec`'r r, D HOME TELEPHONE # Haz.doc/wp/q L � ® CONTINGENCY PLAN 1. 3 FOOT CONCRETE WALL AROUND WASTE OIL TANK. 2. ABSORBANT GRANULES FOR ALL LIQUID SPILLS W/SPILL CONTAINER 3. MSDS BOOKLETS READLY AVAILABLE 4. EVACUATION ROUTES POSTED THRU OUT BUILDING 5. 6 FIRE EXTINGUISHER THRU OUT BUILDING • �J • Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This.is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, 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 6/30/2010 unless sooner suspended or revoked. ------------------------ WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CAN.NIFF, D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Barnstable �YT Regulatory Services Department o Me MaicaCft ® �> AS Public Health Division r ` 200 Main Street, Hyannis MA 02601 lfn l�A 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT r-- NAME OF ESTABLISHMENT 1 I I k P— Q4 ADDRESS OF ESTABLISHMENTQ 'jr lj,� TELEPHONE NUMBER Jr'Off- 1 - SOLE OWNER:_YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS . F ALI PARTNERS: CTt p• w IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION m I�SS FULL NAME AND HOME ADDRESS OF: PRESIDENT y F Q Qa Zco O TREASURER CLERK e_YlL1L C.Cy'1w� l 2!�_d'1 y p ate 0J-QA L X?f • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS IS 60,A LX 12& QlLA40 HOME TELEPHONE # 7 3a 04 Kok Q:\Hazmat\Haz Mat Application2008.DOC Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. uVI� 45 Falmouth Road, 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 June 30, 2009 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i Town of Barnstable Barnstable VE r° Regulatory Services Department o, ;efiea i Public Health Division HAMSrABM 9cb 039. � 200 Main Street, Hyannis MA 02601 ABED MAC A 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT CP)OE()P-( suvt ce' NAME OF ESTABLISHMENT • 1 ADDRESS OF ESTABLISHMENT 45 T�Jln u'lh )ecl TELEPHONE NUMBER S- -7 7 1- ' r` SOLE OWNER: Y( YES NO N rn IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.oqa STATE OF INCORPORATION FULL NAME AND HOMF,ADDRESS OF: PRESIDENT 12t UO,Ila Q- &I lot M jan/-);y TREASURER 1' , )) CLERK 16 A v (, (� NATURE OF APPLICANT 11 RESTRICTIONS: HOME ADDRESS P J2 It i '►S HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC I � CAPE TIRE SERVICE INC. 020489 NCHECK UMBER 2728---..TOW-,- _OF__Q tRJ1STABLt CASH t iCCT 10001 , REG l ETEFZ o Q 50 ice.::_:._ TERR INV # DATE CODE AMOUNT TERR INV 4 DATE LODE AMOUNT TERR INV # DATE CODE AMOUNT ACCOUNT NUMBER: HAZ MAT PERMIT °733 063iII,16 06/30 560L06 160.()V' TOTAL 100.00 r— ''f Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, 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 June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 15, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services _ ;:j•:�; •,. Thomas F. Geiler,Director led Public Health Division 01 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax:.508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE ,[ La(o APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT_4 IQ ba'f `C{G°y ', . CNAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER �� ) - /. .�• �.. `:1. CD i}•:<<s;,a Chi - -SOLE OWNER: YES NO -_ 22 IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 04'a a STATE OF INCORPORATION MO-6t) FULL NAME AND HOME ADDRESS OF: � �qq � PRESIDENi��iC�bPX'f (e . �f�JQ IQ _,d TREASURER CLERK SIGNATURE OfAPPUISAT RESTRICTIONS: HOME ADDRESS -7 HOME TELEPHONE# 02S �Is:..a�c'wpry MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). 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. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). 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 furdaer assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page 1II Number Fee 358 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Tire Service, Inc. 45 Falmouth Road, 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 June 31, 2008 unless sooner suspended or revoked. ------------------------------------ WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health CAPE TIRE SERVICE INC. 018992 CHECK NUMBER 9729 TOWN OF BARNSTABLE CASH ACCT 10003 REGISTER: �04e28 TERR INV # CLUE OTY AMOUNT TERR INV # CODE OTY AMOUNT TERR INV # CODE OTY AMOUNT ACCOUNT NUMBER: PERMIT TO STORE HAZMAT 9728 PERMIT 50800 1 100.00 # TOTAL # 100.00 f r ® PRINTED ON RECYCLED PAPER PRINTED „ INK �J SOY INK Town of Barnstable Regulatory Services Thomas F. Geiler,Director $" ' "B Public Health Division 030'- 61 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 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 C-AVt I QL- T-Y1C, NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 14S ®l3t"1 1 c3 .TELEPHONE NUMBER SCY-9-1-1 l ` 111 ° - SOLE OWNER: X YES NO ��.�{{ M IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS O�JALL sy PARTNERS: a) r- ,..a ri IF APPLICANT IS A.CORPORATION: FEDERAL IDENTIFICATION NO. 04 g c STATE OF INCORPORATION m A.&S FULL NAME AND H ME ADDRESS OF: l PRESIDENT w4 (� - U % n r S �o TREASURER tl CLERK SIGNATURE OF CANT RESTRICTIONS: HOME ADDRESS �- HOME TELEPHONE# )WN OF BARNSTABL� .;. cOrfpUlaNCE: CLASS: 1,. farine,Gas Stations,Repai.r Q satisfactory • 2. `Printers BOARD. OF HEALTH 3. Auto Body Shops (� unsatisfactory- 4. Manufacturers �MPANY i'► 1l�i�n � �J�� . (see"Orders") S. Retail Stores a 6. Fuel Suppliers DRESS 1 2 ; Class: •,,,� 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) JOR MATERIALS Ca::e lots Drums ,AboveTanks Undetgiound Tanks IN UT I .,r N e e 1 Fuels: Gasoline, Jet Fuel (A) p� Diesel, Kerosene, 12 (B) Leavy Oils: F ,- } ^. waste motor oil (C) ,r <� CJ new motor oil (C) �- � �- transmission/hydra lu is f ` y � J synthetic .Organics: ti M Z degreasers ' E 1 c n iscellaneous: ? I LA 9�� - POSAL REC J1'I lUN. REM US: . Sanitary Sewage 2, Wate ;Supp'I Town Sewer` Q�'RUblic 611-site 10., Private Indoor Floor Drains: YES NO O Holding tank: MDC .r s a Catch-,basin/Dry well 0 On-site system UfiIlM: Outdoor Surface drains:YES NO ® Holding. tank: MDC - O Catch basin/Dry well kt QOn-site system Waste Transporter Licensed? Name of HaulerDen 3 na fiFS n_ , l C 142 CT QAA r/ .r ~' al . erson s), Interviewe ` Inspector Date A 0 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:� Board of Health MAILING ADDRESS: � ��'�� l Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES >� NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered lease put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants _X Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene,#2 heating oil Pesticides (insecticides, herbicides, Otherpetroleum products: grease, lubricants rodenticides) 1/ Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine V_ Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business r TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH Satisfactory 2.Printers 3.Auto Body Shops �p unsatisfactory- 4.Manufacturers COMPANYL." r `,rJ _� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS j ,��y�.��v � � Class: 7.Miscellaneous nRY QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATES Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) i Diesel, Kerosene, #2 (B) Heavy Oils: ZING, waste motor oil (C)j new motor oil (C) transtfi raulic �- �✓ Synthetic Organics: degreas reams Miscellaneous: Y g - - � DISPOSALIR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply To •/r "�° ��"'a '` Town Sewer ublic ., O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC r 'P O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product i 2. rs n (s) ntervie d I Spector Date FO'W N OF BA.RN'STABLE UUMPLIAALZ. a, ., satisfactory 2. Printers BOARD OF HEALTH 3. Auto Body Shops - fry '~. unsatisfactory- 4. Manufacturers (see"Orders") S. Retail Stores COMPANY + � 6. Fuel Suppliers ADDRESS Class.: _� 7. Miscellaneous (� � �� •�m QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoor: MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks IN IOUT IN IOUT IN UT # 6 g.-llonse rest Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: + U waste motor oil (C) ' new motor oil (C) transmission/hydraulic t Synthetic Organics: degreasers Miscellaneous: ILL: iL DISPOSAL RECLAMATION RE RKS: (, 1. Sanitary Sewage , 2. Water uppl OTown Sewer bli ` On-site O Priva e 3. In oor Floor Drains: YES NO O Holding tank: MDC OCatch basin/Dry well ____.__--- .__. .•___.-,._._-_,_,_.__ __.___ — On-site system 4. Outdoor Surface drains:YES NO/ O Hold.ing tank: MDC fJ O Catch basin/Dry well OOn-site system ` r S. Waste Transporter V Licensed? Name of Hauler_ 1 u 23 el e s n(sf Ifit.6-fviewed Inspector Date L TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: � � Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: ,/� ✓/// P.O. Box 534 CONTACT PERSON: ,��g✓� �� fc`-ram Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua tities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry j weight? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored Please put a check beside each product that you store: ��ntifreeze (for gasoline or coolant systems) Drain cleaners i' Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners ,.,Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants esel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine ar wash detergents Lye or caustic soda Car waxes and polish es es Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business y -s TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 3. Body Shops C O unsatisfactory- 4.Manufacturers COMPANY c� (see"Orders") 5.Retail Stores er 6.Fuel Suppliers ADDRESS O ��4* 0 l,p"j G? Class: 7.Miscellaneous �y14*1111,V QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) five new.motor oil (C) I transmission/hydraulic S nthetic Organics: Qdegreaser aC,4-6 yl ---rp �4 W-Z- 0, Miscellaneous: f 9 DISPOSAVRECLAMATION REMARKS:" 1. Sanitary Sewage 2. W ter Supply d`a'�!/r �' �' �' ,� O Town Sewer Publics rV44_1n,.e On-site OPrivate 3. Indoor Floor Drains YES_j/_NO f6l S O Holding tank: MDC ' O Catch basin/Dry well O On-site system v ` 4. Outdoor Surface drains:YES Y NO ORD RS: O Holding tank:MDC $Lv X`Catch basin/Dry well c'k _ ¢ O On-site system ' 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2 �✓ P_e`r_s_on_(_s'f Interviewed Ins .ector Date l