HomeMy WebLinkAbout0050 FALMOUTH ROAD/RTE 28 - HAZMAT 4 x]
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Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper(Benjamin Moore)
.--------------------------------------------------------------------------------------------------------------------------------
50 Falmouth Rd., 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
Inspectional Services BARNSTABLE
TMe
Public Health Division RiRB:T BF•Q1639-20[�Nrt•M1Yaklls
W..mjs WlL-oSEAVII.L%•Y.TR B?PNST48tE
1639-2014 r
• = RAnrMBUE, 1 Thomas McKean,Director
hUm
' `� 200 Main Street Hyannis,MA 02601
r�
Office: 508-862-4644 Fax: 508-790-6304 '
v
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
c:
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 i T— d C�h
*A late charge of$10.00 will be assessed if payment is not received by July 1st. I
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 G LLONS)? YES NO.
• •-.�
4. FULL NAME OF APPLICANT: "q
5. NAME OF ESTABLISHMENT: W
Ae�
6. ADDRESS OF ESTABLISHMENT: 7 v "'I `~� C6
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: l
8. TELEPHONE NUMBER OF ESTABLISHMENT: Jr 0
9. EMAIL ADDRESS: s 'ce y t b a. t Y1 t C O'er
10. SOLEOWNER: AYES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRYSS�AND T�LFPH NE
4
CORPORATION NAME .•�1.•�w {7�
PRESIDENT
TREASURER •
CLERK r '
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE b
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
Number Fee
Number
THE COMMONWEALTH OF MASSACHUSETTS $150.00
1036
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper (Benjamin Moore)
SO Falmouth Rd., Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
----------- ----------I--------- - - - ------------------- - - --------------------------------- -- ------. ..------------------------ ---------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2020 unless sooner suspended or revoked.
PAUL J.CANNIFF, D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI, M.D.
07/01/2019 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
Town of Barnstable • a&AAA
Inspectional Services
Ft r Public Health Division B INSTABLE
Y I
9 BARNSTABLE,$ Thomas McKean, Director ``� �{
1639.
200 Main Street, Hyannis,MA 02601
r�
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS
GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS
JULY 1st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26 — 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 X V6T—r
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. 3 " O
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: yWIWJf1(��J�
5. NAME OF ESTABLISHMENT: 1w�j 1
6. ADDRESS OF ESTABLISHMENT: kA
1`760 YYl'fyts �7
?. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: / ,r
8. TELEPHONE NUMBER OF ESTABLISHMENT: ��� • �7J '" �`���
9. EMAIL ADDRESS: ecie V t & u, A.I"n t• p r'11
10. SOLEOWNER: O/YES_NO IF NO,NAME OF PARTNER:
11. FULL NAME, HOME ADDRESS,AND T EPIJONE # eFt��A �' t � n - ��, A �S
CORPORATION NAME 4r do 0 "` AXX 4�U�
PRESIDENT v mw ilisaw
TREASURER it
CLERK c f
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
*SIGNATURE OF APPLICANT DATE ?
Q:\Application Forms\Haz Mat App Revised 09-10-1 8.docx
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper (Benjamin Moore)
50 Falmouth Rd., 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
of Brnsxable
�Roewgu'Aatory ervices
'THE Richard V. Scali, Director 6%.%1"Al A
Public Health Division BARNSTABLE
• BA2NSiAELF.fR1iERVILLf.CDNR.XYMR115
t f MAFSRIHS Y.ILS•OS1Ert'liLLE•YTrS 9F:N514EF
CAB Thomas McKean, Director
MAS& y� 1639-2014
-- -- - -- -- -1639•- ♦0 -- - - —
-200 1Vlairi Street,Hga � -02G01----_ _----------_-..----
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth).
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 XV,S
*A late charge of$10.00 will be assessed if payment
Gis not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. e 0 I
2. IS THIS A PERMIT RENEWAL? ''" YES_NO. IF YES, SHIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF
GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: 4 f V` AA C; 14 V�b"
5. NAME OF ESTABLISHMENT: Al PXfi I L? (b
6. ADDRESS OF ESTABLISHMENT: 56 TAL-M.V I rD?�U
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: ;D $ , -)
9. EMAIL ADDRESS: iewe, lee i n t , Go r15
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME AD SS,AND TALEPHOIJEOF:
CORPORATION NAM 1-jM$qW r4tA-fr.0 fB 4 GO 'H u
PRESIDENT f �� Rprn a c 4ovo LN M u��D•- �R NS1- NVQ
TREASURER
CLERK << 5-03 376 - 04.4,
12. IF PREPARED BY OUTSIDE PARTY:
• NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE
Q kApplication Forms\HAZMAT APP 2017 REVISED.docx
,SUN 20 2017 Pm12:14
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper(Benjamin Moore)
50 Falmouth Rd., 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
J
1
t l� ® •
rowwnn., of Unstable
egulatoervlces
Richard V. Scali,Director
Public Health Division BARNSTABLE
• BPRYST.NIF• HIERNLLE•COTUR•HYuf:15
BA ffrABLE. r Thomas McKean, Director R Pti.�, i39`2Q 4N S1 P4cM5T4PF
`� �x
1639.�f 200 Main Street, Hyannis, MA 02601 �g ND
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
r�
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 13� V,5.
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. S
2. IS THIS A PERMIT RENEWAL? v YES_NO. IF YES, SKIP QUESTION 3.
i
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)? p DYES NO.
4. FULL NAME OF APPLICANT: W ` /lam �R' ' qewu
5. NAME OF ESTABLISHMENT: P-AAJ-
6. ADDRESS OF ESTABLISHMENT: (5 �L1AA00 A A n n!S AAA —e-W
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
S. TELEPHONE NUMBER OF ESTABLISHMENT: 'SD 7 7 P56
9. EMAIL ADDRESS: u,b,p�t,l r)1:. Gr> /yam
10. SOLEOWNER: /YES_NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME $ (
PRESIDENT flo
TREASURER
CLERK t t 1
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT C� w DATE
Q\Application Fonns\-IAZMAT APP 2017 REVISED.docx
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper (Benjamin Moore)
50 Falmouth Rd., 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
R
Town of Barnstable
• �j Regulatory Services
ti r
'".' Richard-V:'Scali, Director
` B" BMS Public Health Division Itma
s6g9. �0� Thomas McKean, Director 200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th).
s.
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 char a of$10.00 will be assessed if payment is not received by Jul 1st.
ASSESSORS MAP AND PARCEL NO. k. 'O DATE to -7
FULL NAME OF APPLICANT:
NAME OF ESTABLISHMENT:
ADDRESS OF ESTABLISHMENT: go
MAILING ADDRESS(IF DIFFERENT):
TELEPHONE NUMBER OF ESTABLISHMENT:
EMAIL ADDRESS: alftd*z 6w
SOLE OWNER: /YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME to lot 4
PRESIDENT
TREASURER
CLERK 1
IF PREPARED BY OUTSIDE PARTY:
SIGNAT L
/ICANT Name:
Company Address
Telephone#:
Email:
Q:\Application Forms\HAZZAPP Rev I6.docx Page 1 Iof2
ta rokti Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARMAN,.e.g' 200 Main Street• Hyannis, MA 02601
1639.
6. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: 44A64 s I 4wc„� „�I,a�1 Date:
Location/Mailing Address: _So F0„1m,�-{,, K I l:yav n,S ,,4&,l : Po Sox i I So
Contact Name/Phone: S+e ye►.. I�ulo�c, raQ Sob- 77 S-1 S6
Inventory Total Amount: tiSOOO 141 MSDS: 't&,e f License#: I036 �' 3>
Tier II : 0 —� Labelina: cep. \ Spill Plan: OK
Oil/Water Separator: Floor Drains: o Emergency Numbers:—
Storage Areas/7anks: c-1 v& 5 VA - ��\/z �'O< <<Ae"l * .e._
Emer enc /Containment u pment: 5 1, k,-r van. .5\k p—
Waste Generator ID: 1k Waste Product: 00VI .-
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS Iv o ►r�41v� cl�aµ'�C- �� , �o7 5 lwce--I4S} Y,ec,<-,
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous rdaterial 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/a.o lLxei t insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
— Paints, varnishes, stains, dyes Lye or caustic soda
�— Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
�— Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil&stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOM ENDATIONS:
c o✓` a,.n-L-r
Inspector: l
Facility Representative: �F -
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
°FINE*oyti Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-7s0-6304
• BARMA:19- 200 Main Street• Hyannis, MA 02601
t639
M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rF0 P /1 �,�q
Business Name: �ror5 au►k 04,11 ec- �2v� a �. Y 'too Date: /0 /
Location/Mailing Address: o 14%101V%V114,1 oxPIP p
Contact Name/Phone: +e-\t 'A- Ho l0 5 J-77s= 1 S"6
Invento Total A ount: N �� MSDS: 0911�I.cr-Sv pQ)re f License#: I 3 Ct�k 3
Tier II : O Labeling: re-tas l la b�1�� Spill Plan: �K
Oil/WaterSeparator: Floor Drains: O merclency Numbers: ye,5
Storage Areas/Tanks: RACLI\ Sal VA04
Emergency/Containment E i ment: 5 GZv a,I �.,b\ m ?� CCU kke,r
Waste Generator ID: 0 1 1A, Waste Product:
Date&Amount of Last Shipm nt/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS IV o AA-a o� e- O S r I^- I wv.*,410
NOTE: Under the provisions of Ch. 111, Section 31, of the eneral Laws of MA, hazardous materia use, ►ris,0ec�7at�.-
storage and disposal of 111 gallons or more requires a license from the Public Health Division. see;Zeo?
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/ .s,--es insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives (creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
�— Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOM ENDATIONS: o o6S
0 Arvck ,(, C,01 &00<5
Inspector:
Facility Representative: (e�:A I
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
\J
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS 100.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper(Benjamin Moore)
50 Falmouth Rd., 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
it • � � • ®.�
Town of Barnstable
Regulatory Services
Richard V. Sca1i,Director
Public Health Division
'°rEn► ° 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. 7 DATE
I
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT +�u
NAME OF ESTABLISHMENT �'C( �� `'' �� t W,
ADDRESS OF ESTABLISHMENT �1
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.
STATE OF INCORPORATION MA-
FULL
NAME ANDVOME
PRESIDENTpop
G 1. C tiJ t
TREASURER + + f i .
CLERK + •
• f SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP Rev2015.D0C
i
Town of Barnstable Office: 508-862-4644
Fav 508-790-6304
. Regulatory Services Department
* �, ; Public Health Division
MASS. Thomas A. McKean, CHO
b �a 200 Main Street, Hyannis, MA 02601
Payment Receipt
;Hazardous Materials Payment received: $100.00 (Check)-on 6/18/2015 Permit number: 1036
'Check number: 15627 Check amount: $100.00 Name on check: Hubbard Paint&Wallpaper
jBusiness: Hubbard Paint&Wallpaper(Benjamin Moore) Owner: STEVEN G
Address: 50 FALMOUTH ROAD/RTE 28, Hyannis
i
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
50 Falmouth Rd., 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
t�
FINE r°k Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
B""b��e.�, 200 Main Street• Hyannis, MA 02601
Fo39.
TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: ,) 64 � fa 1-4 0.-1l a < Date:
Location/Mailing Address: 50 v�.,-r-�1�. , gya VlA i 5 ��c 1 l SO
Contact Name/Phone: ON _ O9S --7'767- 1 S( A
Inventory Total mount: ti D I MSDS: License#: 1D31
Tier II : v Labeling: � o—
Spill Plan: �Oil/WaterSeparator: N FloorDrains: Emergency Numbers: Yes
Storage Areas/Tanks:
Emer enc /Containment ui ment: S i a
Waste Generator ID: Waste Product: Ct W
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS N° wow „� ����,qc.5 1 W ,N�Kkas 6,KC,'-(ast I kJ
NOTE: Under the provisions of Ch. 111, Section 31, of the General LaWs of MA, hazardous material use(12(b f i3)—
storage and disposal of 111 gallons or more requires a license from the Public Health Division. Set,
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 fpr engines&garages Pesticides:
Caulk/Grout/aolitmv4-s insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
�— Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil&stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: eqe
Inspect - L.O'�
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS
? Town of Barnstable
Regulatory Services
Richard V. Scali,Director
9 LA MASS.M$ Public Health Division
i639 ♦�
1639.• 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 r 3
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT V ,
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER: VYES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 2 bU
STATE OF INCORPORATION
FULL NAME AND H ME � SS
PRESIDENT � c ! l "YVW A4J O—V n'.
TREASURER 1,
CLERK t
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
Q\Application FormsU-IAZAPP.DOC
,t
R`}
1
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 02601
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
"a
Back to Maid Public Health Division Page
i
Q:\Application Forms\HAZAPP.DOC
Date:/Z/ 'I-
TOWN OF BARN STABLE,,,,-,,,C-eto,ti
TOXIC AND HAZARDOUS MATERIALS \ FORM
NAME OF BUSINESS:
BUSINESS LOCATION: So INVENTORY
MAILING ADDRESS: -Po 6o;< 11 ao Nyann,n s TOTAL AMOUNT:
TELEPHONE NUMBER: 5ot3 -77 s= ►5(.A XIMIla.r �0 '200cl
CONTACT PERSON: VV.Ao'Aa.y-k I hW,+t For/P r fttayt—
As
EMERGENCY CONTACT TELEPHONE NUMBER: MS'DS ON'SITE?
TYPE OF BUSINESS: .taa�,l(fla,ate .Sa,L - J,O�l�c�t,Qi�fa�a�eS
INFORMATION / RECOMMENDATIONS: o µ- , )e, dF1N`"ire Drl CD• r
ct:
i'GCona�c.e.v>�a91',a►1. �s � �,�(,e.�'p �- �as�s���� O��n.,�+ s�1�M,�'�r,�c�� �/�`5 �r^�'�
�T
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS ® ice :2,0Dj )n� - I,t+
The Board of Health and the Public Health Division have determined that the foil wing products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout 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
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
1 r�
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
SO Falmouth Rd., Hyannis,MA 02601
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
-
----------------------------------------------------------=--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------- -------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 6/30/2014 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
6/30/2013 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable
of Regulatory ,services
Thomas F. Geier,DirE�tnr
i Public Health DITision
Thomas McKean, Direct r
200 Main Strz~t, Hyannis,MA 02601 F= 50$-790-6304
O ca: 5084624644
Appficafion Fes: V OCAC
ASSESSORS m.,AND FAlICEL NO•
1 �/ DATE
APPLICATION FOR P-vRxSIT TO gTORF A-' /QR t D THAN
III G A.LLONS OF HA, U 1�ATERLkLS
=—L NA&SE OF APPLICANT
NAME OF ESTABL ISBM N7
ADDRESS OF EST-ABLIESIV5Y'T �� M
TELEPHONE .., o
SOLE OWYXR: V YES NO
LT APPLICANT IS A PARTN ' =NAya AND HONIM ADDRESS OF ALL
P ART.N�RS:
rn
I
IF APPLICANT IS A CORPORATION: FEDERAL IpEN=CATION N O
S'TAI'E OF INCORPORATION M
s ITI1L t�LAA-E+ AND HO D SS F',
PRESIDENT
CLERK
SI(34ATURE OF APTidCANT
RESTRICTIONS:
HONE ADDRESS i
EoNff TELEPHONE # i
Eazdoc}wp/q I
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
SO Falmouth Rd., 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.
6/30/2012 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
Town of Barnstable
pFTHE, Regulatory Services
Thomas F. Geiler,Director
r i
"BAMSUBLF. * Public Health Division
9� ,i639 `0�
59 5.11
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
111 GALLONS OF HAZARDOUS MATERIALS
51e-� ti t4.
0
FULL NAME OF APPLICANT �--k(Vit
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER: \X;S NO
r
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL"-
PARTNERS:
e�
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NA IE AND OME ADDRE OF:
PRESIDENT �q� � b PA
TREASURER
CLERK
i
i
SIGNATURE OF APPLICANT
i
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE# n'9 3- 6Y
Ham doc/wp/q
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
SO Falmouth Rd., Hyannis,MA 02601 T
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 6/30/2012 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
6/30/2011 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Fop
i
r
Town of Barnstab
�F11HEl Regulatory Services
Thomas F. Geiler, Director
[0
D'Ob
' �"'&%.LE. Public Health Division
i639'
iOlE Mai°i Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.00
12
ASSESSORS MAP AND PARCEL NO. �o 1051_DATE 70
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
� -_ 4-to
At�
FULL NAME OF APPLICANT F50,Ajz C) n W16-` ���P�� /�l (2-
NAME OF ESTABLISHMENTef�
ADDRESS OF ESTABLISHMENT 56 ` �OD
TELEPHONE NUMBER .' J
SOLE OWNER: ' 'YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS: == '
� C:)
Ln
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 7�,�7 0 ao a
STATE OF INCORPORATION r Ak
FULL NAME AND HOME DI $ 1 Q
PRESIDENT b - lZ 0�v►c1 �� ��r �S `L`` '- "'
TREASURER ran-C 02.(
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS��
HOME TELEPHONE it `5b(2 3-75 V x
Haz.doc./wp/q
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
50 Falmouth Rd., 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.CANNIFF,D.M.D. _
6/30/2009 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
Town ®f Barnstable
1 Barnstable
Regulatory Services Department bilkd
° M1 ftfticacft
Public Health Division
200 Main Street, Hyannis MA 02601
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. J DATE 1�Id
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
MORE THAN III GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT P�v 1' 0> ''J P*vi-r
• ADDRESS OF ESTABLISHMENT P �r4L.MBV'f
TELEPHONE NUMBER
SOLE OWNER: ✓YES NO t
/mil F.-ti
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALA Y
PARTNERS:
:.
sv �_
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Q&76v
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:PRESIDENT f I W, �����
EV N Q Nip L Z.
TREASURER ,jve
CLERK A
• SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
Q:\Hazmat\Haz Mat Application20D&DOC
t
•
MAIL-IN REQUESTS
Please mail the completed application form to the address below. Also include a copy of
your contingency plan (to handle hazardous waste spills, etc.) In addition,please include
the required fee of$100. Make check payable to: Town of Barnstable. Allow time for
in-house processing. Our mailing address is:
Town of Barnstable
Public Health Division
200 Main Street
Hyannis,MA 02601
FOR FAXED REQUESTS
Our fax number is (508) 790-6304. Please fax a completed application form. Also,
please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In
• addition, please mail the required fee of$100. Please make the check payable to: Town
of Barnstable. The check must be mailed to the address listed above. Allow time for in-
house processing.
For further assistance on any item above, call (508) 862-4644
Back to Main Public Health Division Page
•
QAHazmat\Haz Mat Application200&DOC
b
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $10o.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
SO Falmouth Rd., 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
r
L Town of Barnstable
Barnstable
UNWE Regulatory Services Department �
Y
Public Health Division
ec
tARNSI'ABLE.
"'AS& 200 Main Street Hyannis MA 02601 I �m
,e3q. �m � Y
prEo MA'S" 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. ✓ j b I I DATE 3 Q
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANTa N C9 t'r V 6 a
NAME OF ESTABLISHMENT 94 IA!&P
ADDRESS OF ESTABLISHMENT �� 0 / I�I "N
TELEPHONE NUMBER , 5
SOLE OWNER: J YES NO �?
w r-
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS F ALt
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.OR 2i 3
STATE OF INCORPORATION mt)
FULL NAME AND HOME ADDRESS OF: (�
PRESIDENT CfVV16-N ('V bk P Mft mJ9
TREASURER �2&rwP g a N^--
CLERK SAAM
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE# So '? 3 `7S 0 8k f.__
Q:\Hazmat\Haz Mat Application2008.DOC
I
Town of Barnstable
o I Regulatory Services Barn
Ft T
c Thomas F. Geiler,Director AMmericaCity
Public Health Division � ' I I ►
anxxsrasi.F.
9 Mass. Thomas Thomas McKean, Director 2���1639• A�� 200 Main Street
Ep Mp'l
Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
NOTICE
TO ALL BUSINESS OPERATORS
WITH HAZARDOUS MATERIALS
IN BARNSTABLE
The Town of Barnstable Town Council adopted, Chapter 108: Hazardous
Materials, a requirement for each business operator to obtain an annual permit
and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of
hazardous materials are stored, transported, utilized, and/or disposed of at a
particular site.
STEPS 1 - 2 - 3:
1. Please complete the attached application form.
2. Include a copy of your contingency plan
(to handle hazardous waste spills, etc.)
3. Submit the fee of$100.00 payable to the: Town of Barnstable.
MAIL all of the above to this office on or before June 30, 2008. A late
charge of$10.00 will be assessed if payment is not received by July 1, 2008.
Upon receipt of the fee and a completed application form, an inspection will be
performed by the Hazardous Materials Specialist to complete the Hazardous
Materials On-Site Inventory. A permit will be issued once the inspection is
completed and has passed.
Please feel free to view the above Code, Chapter 108: Hazardous Materials on the
Town Website, www.town.bamstable.ma.us , which is located under the E-Code
section if you should have any questions or concerns.
Number Fee
1036 THE COMMONWEALTH. OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
SO Falmouth Rd., 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 24, 2006 PAUL J. CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
t
Number Fee
1036 THE COMMONWEALTH OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Hubbard Paint& Wallpaper
50 Falmouth Rd., 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
Town of Barnstable I ;
.> Regulatory Services
26 Thomas F. Geiler,Director
B"R"An Public Health Division
y� t6g9.
1��'
IL639. 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 I d DATE '
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE
THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT '� 9 �(
NAME OF ESTABLISHMENT Lb)I;W P�IV-r 1, 0 (C. , N C' i
ADDRESS OF ESTABLISHMENT j��I'LMO 11t'�1 F'�!�
TELEPHONE NUMBER 1 5"
SOLE OWNER: YES NO a v
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS,4F ALL
PARTNERS:
v
N �
co
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NAME AND HOME ADD SS OF:
PRESIDENT epk jq6 �Pffim t" 4mm"tAp A' p 63le)
TREASURER
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE# 19A4 3 PK 0'