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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: Mail To:. '� Board of Health
MAILING ADDRESS: Q' 5 Town of Barnstable
TELEPHONE NUMBER: 7�� � ; P.O. Box 534
CONTACT PERSON: 4
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 when stored
ease 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
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
_1,,��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
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
/Asphalt & roofing tar Leather dyes
,/ Paints,w 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
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY S' ,o & (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS - Class: 7.Miscellaneous
UANTITIES AND STORAGE (IN= indoors;OUT-outdoors)
MAJOR MATER S Case lots Drums Above Tanks Underground Tanks
IN OUT I IN OUTI IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic `I/
Synthetic Organics:
degreasers aye
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. ter Supply
own Sewer Public
0 On-site QPrivate
r
3. Indoor Floor Drains YES f/ NO
O Holding tank:MDC ��
Q Catch basin/Dry well
�N
O On-site system ! � �
4. Outdoor Surface drains:YES NO �/ ORDE S:
Q Holding tank:MDC '
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2. �
Person (s) Intervie d Inspector Date `
TOWN ' OF QARNsTAa�E . COHPLIANCE: CLASS; 1. Marine,Gas Stations,REpalr
' Q satisfactory 2. Printers
(� Q OF -,[AL'1'H. 3. (luto Body Shops
/ �`��'�- Q unsatisfactory- 4. tanufacturers
� ��•�Cj;���� /�jt<� (see"Orders") S. Retail Stores
COMPANY M 6. Fuel Suppliers
ADDRESS ® �I- � r?� f� �j(j' Class: 7. Miscellaneous
vrr� QUANTITIES AND STORAGE (IN-ludoors; OUTwoutdoor.
MAJOR MATERIALS-
Drums AboveTanks Undetgroi:od Tanks
MIL M 4liZ 1ti N' B ag l lone [sit
Fuels:
• Gasoline, Jet Fuel (A)
Dlesel, .Kerosene, 12 (B)
ueavy-ol•ls
f4
'waste motor oil C) 1
transmission/hydraulic
Synthetl.c Organics:
degreasers
Miscel'taneous e
DISPOSAL/RECLAMATION MUMS:
1. Sanitary Sewage 2. Water Supply NOW
/
Town Sewer \Public /11L1�� �V��l Ili%C.11J' lVifW A119 Z_m1r—, _k
/
O on-site Private n C //... C �1�1V' �,
3. Indoor Floor Drains: YES NO
Holding tank: MDC ( cU ���� ��
O Catch basin/Dry well
OOn-site system
4. Outdoor Surface drains:YES NO
r
Q ffoldinL tank: MDCV j
Catch basin/Dry well
OOn-site system
S. Waste Transporter Licensed?
Alm"f_llaulpm 12cst`I nat i gin Waste Product_ _YES_ O
14- i
r
L2_ E
u 23 et erson' s Interviewed Inspector f_. 'Date
FOVVN OF BARNS lA r�irvvuu. �,..�..., t`Tv -
- � '.O sa'ti.sfactmry r � 2. •Prn e s
,- -'3. •.Auto Body Shops
BOAR?,.: OF HEALTH unsatisfactory- •4. 'Manufacturers
,. „ „ 5• Retail Stores
COMPANY (��• �� (see Orders )
.� - F qVb4 I �; :• v..- ' �6. Fuel Suppliers
ADDRESS - C_ U _ Class: P 7. Miscellaneous
T-1,40
QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors)
Case lots Drums AbOveTanks UndetgTouad Tanks
1•1AJOR MATERIALS �. IN UT IN 0 IN OUT fr z 1 e rest?
Fuels:
Gasoline, Jet Fuel (A) '
•Diesel, Kerosene, #2 (B) .
,,Heavy Oils:
waste motor oil (C) '
new motor oil. (C)
` transmission/hydraulic �.
Synthetic Organics:
degreasers
t '
Miscellaneous: /
DISPOSAL RECLAMATION Y�REW,RKS:
1. San'tary Sewage 2. Water_ Supply
Town Sewer Public
O On-site Private
3. Indoor Floor Drains: YES\f NO
Holding tank: MDC
!Catch basin/Dry well
On-site system i
,'`� ll✓'1 'A �
4. Outdoor Surface drains:YES NC
Q,Holdin,g• tank: MDC "la,
OCatch basin/D`ry well ---
OOn-site system
S. Waste Transporter i ✓� f ;. i.censed?
Name of Hauler- �stination Waste Pro NO
12 23 81 / sons In .ef e e -Inspector Date
CleanHarbo!3
ENVIRONMENTAL SERVICES COMPANIES
94 THORNTON DRIVE
P:O. BOX 2068
HYANNIS, MA 02601
(617)778-2341
M.D.C. TRAP INSPECTION FOR CLEANING
Speedy Muffler
102 Falmouth Road
Hyannis, MA 02601
To Whom It May Concern:
On December 1, 1987 the M.D.C. trap located at the above address
was inspected visually by Clean Harbors of Hyannis. The following
condition was found:
rM.D.C. trap in " good " condition
M.D.C. trap in " fair " condition; pumping
and cleaning suggested in the near future.
M.D.C. trap in an 11 unsatisfactoty " condition;
pumping and cleaning is recomended.
INSPECTOR:
DATE: f/
KINGSTON,MA NATICK,MA SOUTH BOSTON,MA SOUTH PORTLAND,ME ALBANY,NY PROVIDENCE,RI HOOKSETT,NH FARMINGTON,CT
(617)585.5111 (617)655-8863 (617)269-5830 (207)799.8111 (518)434-0149 (401)461.1300 (603)644-3633 (203)674-0361
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service
102 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
�d
Town Of Barnstable
Barnstable
INE
Regulatory Services Department
Public Health Division
.200 Main Street,Hyannis MA 02601
TFfl �° 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. ,, -LIO 3 DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
MORE THAN III GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT � �'�%� 1966�5�'��
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER: YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS;OF ALL�
PARTNERS: '�►• � �
Yf�1
co
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Q �
STATE OF INCORPORATION
FULL NAME AND HOV D S OF:
.. PRESIDENT.T �
TREASURER
CLERK
• SIGNATURE O PPLICAN.T.
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE#
Q:\Hazmat\Haz Mat Application2008-DOC
i
•
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 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
i
Town of Barnstable TABLE
In
spectional ectional Services BARNS
Public Health Division
. wwSTAB�e�= Thomas McKean,DirectorMAM
1619.
off. 200 Main Street, Hyannis,MA 02601 4 1
�:.
Office: 508-862-4644 Fax: SQ8-790 63Q4'
APPLICATION_FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS
GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS
JULY I st—DUNE 30th).
APPLICATION FEES
50.00
CATEGORY 1 PERMIT 26—110 Gallons: $1200 Cl
'CATEGORY 2 PERMIT 11_L� 499,Gallons:
CATEGORY 3 PERMIT 500 or more Gallons: $150,00
,k *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? O�YES _NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONINGIBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEJUSE OF
i GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
• 4. FULL NAME OF APPLICANT: t01'1t'�7 � � v Pj � EriC'
l f�
5. NAME OF ESTABLISHMENT: GY��t7
I 6. ADDRESS OF ESTABLISHMENT: O .�CT
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: ._1
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: S<
1 1.0. SOLEOWNER: YES VNO IF NO,NAME OF PARTNER:
~s
I L FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME t rD .Q.v,C-
PRESIDENT 1
TREASURER
I CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: l I 1 TELEPHONE#: -:_'t�— e 3
a :�; ;ss.s.;.COMPAN ADDRESS r EMAIL: Y'CtWt U
SIGNATURE OF APPLICANT DATE Lp 1!
Q:\Application Forms\Haz Mat Appli Draft Ian2019.docx
t
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 Falmouth Rd, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
------------------------------------------------------------------------------------------------------------- ---------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2020 unless sooner suspended or revoked.
-------------------------- ----------
PAUL J.CANNIFF, D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI, M.D.
07/01/2019 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
TpC O'B "Is able
Regulatory
emCCS , ti
Richard`'.Scal ,Director
NIABLE
Public.Health . ,
`s susrtsre E Thorrias McKean,DirectorNAM
o a '•4$ 200 Man SrrM,`Fl}annis,NMA 02001
x:
r� : 5()x-7 C,6304
(N)tcc 5+)8-862-4044 I.-A
APPLICATION FOR PERMIT TO STORE RAND/OR UTILIZE
HA?..AR:DOUS;VIATE tALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER I08,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE,OR STORE HAZARDOUS
MATERIALS G EATI R p AN IJOUSEROL-D QuAN I`1TIES ARE RI:QOIRI:D TO OBTAIN AN
ANNUAL.PERIMIT'(RUNS-DULY Is(—JUNE 30th).
APPLICATION FEES
CATEC',ORI' l;PER1tIlT 2h I1Q Gallon: S 50.00 1�
CATEGORY 2 PH,RN11`I' 111 —4y9 Gaiions: i25.(
CATEGORY 3 PERMIT 500 or more,Gallons: $1500) ✓
e char f :I w i be Bess ,d if m is n r �v d J 1
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT REIKEN SAL? K YES NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NNNV PERMIT APPLICATIONS, INDICATE ti' HETHER'BUSIN.ESS HAS
Z.01VI 4G/BUILDING APPROVAL'FOR HAZARDOUS MATERIALS'STORAGEIUSE OF
GRFA'I.,El2`I'HAs lIi(?tiSFH(7LD QtTANT1'I'IFS(2ri GALLONS)" X YES NO.
• 4. FULL NANIE OFf APPLICANT: Monro Muffler & Brake, Inc.
5. 'NAMI OF IaSTA[iI:ISIIiviCNT: Monro Muffler & Brake #422
. ADDRESS of ESTAa�LI.�I�i�1 I: 102 Falmouth Road, Hyannis, MA 02601
7. M;AILfNG ADDRESS(IF.nli:Pl,'RENT:FRO`M`ABOVE' PO Box 8000,Monsey,NY 10952
8. 'rFLE.PHO'ttlE'NU'NIB P.OF :S'rABI,IS'H,r'f N—I;: (508)771-7702
9. EMAIL ADDRESS: renewals@businesslicenses.com
10. SOI:EOWNER: X YE9iN0 iF'NO,NAME OF PARTNER:
R: --
11. .F1;LL NAME,IIOAI.E ADDRESS ANI)TELLPHONE#OF:
CORPORATION NAME Monro Muffler&Brake, Inc.
PRESIDENT'John W VanHeel
TREASURER
CLERK
12, IF PREPARED BY OtiTSIDE PARTY: #, (845)35S 8390 x 223
NANTE: Danielle Whitman TELEPHONE
COMPANY ADDRESF"+►Q$p 10MAH,: renewa1s0businesslicensescam
SIGNATURE OFAPPLICANT E (t? /3
C.•i•ser5t)ece+lhr,ApnUakxLl ncati�ticrossliti� to owo, ens �1n nef dea;Ci ic�ne.O 4X)L,eU7X4Q 4*)rI'_',AI?+Ss1'1"Al't�2��fi^it ti"S,S3 U.dw..
lown of •nstable
Inspectional Services BARNSTABLE
• OpTF1E ma M-ST.e:E-CW 1%U-mm•M. 1- ,+ -
'�, Public Health Division wP3iCN3giS 3679-Z39-20014 8wffitE
BARNMBLE. s Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
29.�q
Office: 508-862-4644 -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: XV61
*A late charge of$10 00 will be assessed if payment is not rec ive v July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? V- 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 NA OF APPLICANT: 4 ��7w 4�
ME �
5. NAME OF ESTABLISHMENT: MWOT ew CNA
6. ADDRESS OF ESTABLISHMENT:
7. MAILING ADDRESS (IF DIFFERENT FROM ABO
S. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: �a.•C�M� 4� �� 0 •��
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEEILUNE#OF:
CORPORATI AME
PRESIDENT
TREASURER ' v`
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMP DRESS EMAIL:
DIG1�TA OF APPLICAN6 D E Zq `n
MAY (3V]paQ&n \Haz Mat App Revised 09-10- .docx
L By
+I
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 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
� �lSdc�tK-#
VowgiBof BInstableeatory ervices
Richard V. Scali,Director
Public Health Division BAMSTABLE
BARO►ST� Thomas `�•� o as McKean,c ean,Director �163_2024�"�`
.619. 200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 j( 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 PERMrr RENEWAL?_\/ YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMrr APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? ✓ YES NO.
4. FULL NAME OF APPLICANT: �C9�Y1 6tqoxwV
5. NAME OF ESTABLISHMENT: SSCAtA W 4Z7�
6. ADDRESS OF ESTABLISHMENT: RO;SA d21j0%
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: ZbO V�0 ��Wy I' ►'+�
S. TELEPHONE NUMBER OF ESTABLISHMENT: (,9-
9. EMAIL ADDRESS: ' M- A%0.1�.11��It
10. SOLEOWNER: YES NO IF NO,NAME,OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATIO NAME =4 C
PRESIDENT ( r
TREASURER u
CLERK O6A-U-
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE
Q:\Application FormsVIAZMAT APP 2017 REVISED.docx
Number Fee
193
THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 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
Director of Public Health
To of B nstable
Renato ervices
t►+e r Richard V. Scali,Director
Public Health Division BABSTABI
..� "RNS:APIF.� TFAutLL£-C=ff•HT-.IS Z'
HFIIS:WS AILS�C51E.VIlIF•V!_SI P4�NSi46'.k
�g'ABLE, = Thomas McKean,Director 1639.2014 t
Ar f 3,c 6. 200 Main Street, Hyannis,MA 02601. Dg
Office: 508-862-4644v Ql b/l Fax: 508-790-6304 n�
X
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' 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? 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: ��fy
5. NAME OF ESTABLISHMENT:
6. ADDRESS OF ESTABLISHMENT: � � �4\1 aM(S- m-A
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:" �� &h+( Lw
S. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: TO V 1 amoy Cabnax);C fn
10. SOLEOWNER: .i YES_NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TE PH E#OF:-
CORPORATION NAME Motif u �64 Lw c-
PRESIDENT SDl1 ti U t Z�q-V
TREASURER D' pMI�Y oS)w
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICAN AJ DATE
Q:\Application FormsWAZMAT APP 2017 REVISED.docx
From:5856470947 Page:-1/1 Date: 3/30/20161:47:30 PM
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CHECK AOLINT AMOUNT
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CHECK NUMBER
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OF REQUEST
SUNLESS Bp D Y NOTED, CHECK V1lII_L BE MAILED,
ITEMS PAPER•CLIPPED MUST GO WITH CHECK.
ITEMS STAPLED TO RF_QUES T R�M&IN WITH REQUEST-
This fax was received by GFI FAXmaker fax server. For more information,visit: http://www.gfi.com
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS 100.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 Falmouth Rd., Hyannis, NY
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
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Town of Barnstable
Regulatory Services
� Richard V. ScaIi,Director
MASL Public Health Division
` Thomas McKean,Director
200 Main Street, Hyannis,MA 02601 �✓
Office: 508-862-4644 � Fax: 508-790-6304
Application Fee:$100.00 I
ASSESSORS MAP AND PARCEL NO. ! ' �/� DATE v
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
Ill GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT / '�nt1► ���"Cl� Jerx
NAME OF ESTABLISHMENT M o,j,fh M uf-P 1t, 2 2.
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TELEPHONE NUMBER - 7" I 7� Q Z
SOLE OwNER:IK YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 16-0o *3t6 L?
STATE OF INCORPORATION /V`P A'
FULL NAME AND HOME ADDRESS OF: /J
PRESIDENT Sod►. J.,. �'�I 2�J ���le�ar Pc�— ./�.�� i�o��}�fr� Y !�t 6 I S�
TREASURER
CLERK
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ITEMS STAPLED TO REQUEST REMAIN WITH REQUEST.
IKE r Town of Barnstable Office: 508-862-4644
. � Regulatory Services Department Fax: 508-790-6304
BARN�nHL
Public Health Division
Thomas A. McKean,CHO
200 Main Street, Hyannis, MA 02601
Payment Receipt
'Hazardous Materials Payment received: $100.00 (Check) on 6/18/2015 Permit number: 193
Check number: 1717617 Check amount: $100.00 Name on check: Monro Muffler/Brake
i
Business: Monro Muffler/Brake Service STORE #422
,Address: 102 FALMOUTH ROAD/RTE 28, Hyannis
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Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 Falmouth Rd., Hyannis, NY — —
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
Town of Barnstable
°FTNe rqw Regulatory Services
ti
Richard V. Scali, Director
.� M►.�. g Public Health Division
•i639 ��
ArEo 39 Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. DATE G1 1 ,
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT C�P O \Qj✓ � � L
NAME OF ESTABLISHMENT ly-4'0f 0 ►'�� y z
ADDRESS OF ESTABLISHMENT Lc* Pd. rrxxct-V--t jLCJ
TELEPHONE NUMBER ' L��
SOLE OWNER: YES J NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. t G01s3a61 2�
STATE OF INCORPORATION � C 2L
FULL NAME AND HOME ADDRES OF: 1 n
PRESIDENT 3"01�,►J VAN3 KCe-.
TREASURER 1b1 S'
CLERK
SIGNATURE OF(�APPLICANT
RESTRICTIONS: HOME ADDRESSIOZ5
HOME TELEPHONE #S�v S�`�`�i 4 - 3 1
Q: Application FonnsU-IAZAPP.DOC
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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 -olan (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
Q\Application Forms\HAZAPP.DOC
I
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service
102 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
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MONRO MUFFLER Brake and Service
Monro Muffler and BJ's Locations
SHOP MAINTENANCE and SPILL PLAN
State of Massachusetts Locations
This policy has been developed and implemented to meet the requirements of the State of
Massachusetts regarding spills of oil and/or hazardous materials, and to outline the
responsibilities and expectations of Monro Muffler employees in meeting the various
environmental requirements and issues that could be encountered.
In order to comply with these regulations, protect the environment, and ensure the ability
of Monro Muffler Brake and Service and its subsidiary companies, and it's employees to
have a safe and healthy work environment, the steps and procedures outlined in this
manual shall be strictly complied with. To accomplish this goal, each employee will
receive training on this plan, have access to the plan, and sign the verification that they
have been provided the necessary instruction and will abide by the outlined procedures.
Training will be provided upon hire with refresher training to be conducted on a yearly
basis.
In addition, a copy of this plan shall be posted in the Vehicle Repair
area in a place that is accessible by all employees at any time of the day.
The primary concept of this plan will be to establish those practices and procedures that
Monro Muffler will require of each of it's employees and locations. It has been
demonstrated that the best Environmental Practices are those that are employed to avoid
spills and/or incidents. To accomplish this result, the required policies for dealing with
various items and issues will be addressed below.
GENERAL FACILITY MAINTENANCE
Market Manager(Emergency Coordinator)
It will be the responsibility of the Market Manager to inspect each facility under his/her
control to ensure that all necessary steps and procedures are being complied with. Any
issues identified, will be addressed immediately to bring the store into compliance with
these policies and procedures. Should the Market Manager have any questions or need
further assistance, he/she shall contact Tom Giannone, Director of Facilities, at 585-647-
6400, extension 378, for guidance.
1
a
Market Manager will act as Emergency Coordinator for all sites under his/her control, to
coordinate emergency response measures. Should the Market Manager be alerted to an
incident, they will immediately notify Thomas Giannone and travel to the store to oversee
all containment and cleanup activities.
The Market Manger will ensure that all required notifications are made to the local fire
and police agencies, local governments, health departments, and the MA Department of
Environmental Protection as necessary.
If during the cleanup of the incident and upon completion of work, the Market Manager
shall contact Thomas Giannone to keep him up-to-date on actions taken and results.
It will be the responsibility of the Market Manager to ensure that the following steps are
taken and the required information is posted next to each telephone at the site:
Equipment
• Telephone, two-way radio or other device to summon police, fire or emergency
response teams;
• Portable fire extinguishers and/or fire control equipment;
• Spill control/decontamination equipment;
• All exits to be properly labeled and maintained for access.
All equipment must be periodically tested and maintained to ensure that it will work in an
emergency. A record of inspection/testing to be completed and maintained at the site.
Employees
• All employees are to be trained on waste handing and emergency procedures;
• All employees shall have access to telephone or communication devices.
Local Authorities/Governmental Agencies
• Familiarize the local fire department, police department, emergency medical
services, health department, emergency response teams of the hazardous nature of
the waste, and the site building including entrances and exits;
• Familiarize hospitals with the hazards of your waste and the types of injuries
encountered during work at the site;
• Obtain agreements with emergency response teams, if applicable.
Following information must be posted next to each telephone at the site.
• Name and telephone number of Emergency Coordinator(Market Manager)
• Location of fire control equipment;
• Telephone number of fire department;
• Drawing of building showing exits.
Shop Manager/Assistant Manager
It will be the responsibility of the Shop Manager and/or Assistant Manager to follow the
policies and procedures set forth, and ensure that all employees under his/her control are
in compliance. Should the Shop Manager have questions or concerns regarding this
policy or incidents at the facility, he/she shall immediately contact the Market Manager to
gain assistance.
The Shop Manager and/or Assistant Manager will perform a complete daily walk-through
inspection of the shop and Monro property to determine that no incidents have occurred
that should be immediately addressed. These incidents would include, but not be limited
to, leaks and/or spills of oils, damage to equipment, damage to building and facilities,
tampering with storage of scrap tires, batteries, etc., or any issue that could compromise
the integrity of the site or health of the employees.
NOTE: In the event that a facility has an employee that refuses to follow these policies
and procedures, and/or is creating an environmental issue, the Shop Manager shall
immediately contact the Market Manager for assistance.
Shop Employees
Each Monro Muffler employee agrees to follow all the requirements of these policies and
procedures as a stipulation of their employment. Any employee that knowingly violates
or disregards this policy will be subject to punishment as prescribed by Corporate Monro.
Should an employee have a question or concern regarding any issue of this policy or
steps that are to be taken, he/she should bring it to the attention of the Shop Manager for
clarification.
It will be the responsibility of each employee to do their part to maintain each of the
facilities in a clean and orderly fashion. To facilitate this, the following practices shall be
mandatory:
GENERAL SHOP MAINTENANCE
The shops are to kept clean, without an undue amount of debris, parts, scrap, removed
parts, and other items left to accumulate. It will be the responsibility of each employee to
have only the necessary parts in the work area, and to place scrap in the dumpster, used
oil into the storage tank, tires into the recycling pile, etc., as soon as removed from the
vehicle. This should help to eliminate the possibility of an incident that could create a
spill and/or release of materials that could create an environmental incident.
Floors are to be kept clean of debris by sweeping, upon completion of any work in the
repair area. These materials are to be placed into a trash receptacle for transfer to the
dumpster for disposal. Sweeping of the floors, rather than washing down with water will
reduce the possibility of allowing materials to enter the drain and/or flow into areas that
might cause a non-allowable discharge to the local sewer system and/or waters of the
State, as well as possibly plug the drain system.
Any spills of oils, grease, gasoline, etc, shall be immediate) covered b S eedi-Dri and
p g g Y Y P
swept to absorb all materials. After the Speedi-Dri has absorbed all the materials, it shall
be swept up and prepared for disposal.All repair work in the facility will immediately be
stopped until such time as the materials have been removed and transferred to the
dumpster. This will help eliminate the possibility compounding the problem by sparks
and/or hot metal starting afire.
As materials are delivered to the facility, they will be immediately transferred to the
proper storage area. This should reduce the possibility of tripping/falling and damage to
these items before their use.
NOTE: WASHING OF FLOORS WITH THE WASTEWATER BEING
DISCHARGED OUT OF THE DOORS INTO A PARKING AND/OR DRIVING
AREA WILL NOT BE ALLOWED UNDER ANY CIRCUMSTANCES. FLOORS
ARE TO SWEPT PRIOR TO WASHING TO REDUCE AMOUNT OF SOLIDS
AND/OR WASTES THAT COULD ENTER THE DRAINS.
WASTE ISSUES
Automotive repair generates various wastes that must be handled in an environmentally
safe, cost efficient manner. Listed below are the prescribed methods for handling of these
items as determined by Monro Muffler.
WASTE OIL
Waste oil is to be properly handled and stored so that it can be re-cycled. To accomplish
this the following steps need to be taken:
➢ Waste oil must be stored in tanks or containers that are marked
o HAZARDOUS WASTE
o WASTE OIL
o TOXIC
o DATE WHEN ACCUMULATION STARTED (Updated after tank is
emptied)
➢ Area where waste oil is stored must be labeled HAZARDOUS WASTE;
➢ Sign is to be 1"high, capital letters;
➢ Containers must be in good condition, which means no holes, dents, or rust and
must be managed to prevent spills;
Only WASTE OIL is to be placed in these containers. Mixing other products or
wastes with your WASTE OIL may cause the used oil to be considered a
hazardous waste and increase the cost for disposal;
➢ Storage tanks or containers are to be inspected on daily basis, by the Shop
Manager or Assistant Manager, to ensure that leaks and/or spills have not
occurred, the storage tank is in good condition, and that there is ample room in the
tank for the used oil to be generated during the days work;
➢ WASTE OIL is to be placed into the storage container immediately upon
removal from the vehicle;
Employees placing WASTE OIL into the storage tank must ensure that no spills
or overfills occur;
Oil absorbent materials should be kept in a location that will allow for them to be
readily available should a leak/release occur;
➢ The Shop Manager is to keep records of when the used oil is picked up by the
recycling company and the amounts taken. These records are to be kept in a
location and manner that make them readily available should an inspector from a
regulatory agency wish to see them.
9 WASTE OIL shipments are to be documented on the approved EPA manifest.
The following actions are to be taken with various copies of the manifest;
Copy 6—Retain for records (Original)
Copy 6—Make copy and forward to the State of MA DEP within 10 days
of shipment
Copy 3 — Should be returned to you by the waste facility and you should
compare with copy 6
After comparison of copies 3 & 6, maintain these records for a period of three (3)
years. These records are to be maintained and accessible should a site inspection
occur.
If copy three (3) is not received from the disposal facility within 35 days, a request
should be forwarded requesting the copy. If not received within 45 days, an exemption
report must be filed with the state of Massachusetts.
NOTE: IN ADDITION TO THE TANKS/CONTAINERS BEING CHECKED ON
A DAILY BASIS, A WEEKLY LOG OF INSPECTIONS, SIGNED BY THE
MANAGER OR ASSISTANT MANAGER IS TO BE KEPT ON-SITE.
All records pertaining to the waste oil are to be kept on-site for a period of three (3)
years.
Oil Filters
There are two types of oil filters, terne and non-teme plated, that car repair shops might
see. Terre is an alloy of lead and tin and is used to plate some oil filters for heavy-duty
vehicles like construction equipment. Light duty vehicles typically use non-teme plated
filters. Used oil filters that are non-teme plated are exempted from regulation as
hazardous wastes if you follow these procedures after removal.
r
➢ Puncture the dome end or anti-drainback valve and allow to drain for 16 hours at
60 degrees F or higher; or
➢ Allow to drain for 12 hours at 60 degrees F or higher and then crush the filter; or
➢ Dismantle the filter and allow to drain for 12 hours at 60 degrees F or higher.
After the filters are drained using one of these procedures, the filters can be crushed both
to remove more oil and to reduce the volume of the filters.
Scrap Tires
Scrap tires may be stored on-site until such time as they are to be picked up for
recycling.
➢ If you should have any questions regarding the permits or concerns of them being
valid, you should contact Tom Giannone at 585-647-6400, ext. 378;
➢ The tires are to be stored in a secure area and be piled in a neat and orderly
manner;
➢ Shop Manager and/or Assistant Manager are to maintain the following records;
1. The number and types (auto or truck) of scrap tires that you ship
2. Which haulers you use to transport them, and
3. What facility you sent them to.
4. Keep these records on hand for at least three (3) years so they are available
for an inspector.
➢ Should any problems arise relating to storage and maintenance of scrap tires,
contact Tom Giannone at 585-647-6400, ext. 378.
Used Anti-Freeze
➢ Used Anti-Freeze is to be transferred into the proper storage container
immediately upon removal from the vehicle;
➢ Employees are to perform this transfer in such a manner that spills/overfills will
not occur;
➢ Used anti-freeze is to be stored within a secure area of the site;
➢ Shop Manager and/or Assistant Manager are to maintain records of the amount of
used anti-freeze on-site, amount of anti-freeze sent for recycling;
➢ Recycling records are to be kept on site and available should a regulatory agency
require to see them;
➢ Shop Manager and/or Assistant Manager are to inspect the used anti-freeze
storage area on a daily basis to ensure that no leaks have occurred, the storage has
not been tampered with, and that sufficient storage is available for any materials
that might be generated during the work-day.
Used Batteries
➢ Used batteries are to be transferred to the proper storage area immediately upon
removal from the vehicle;
➢ Employees are to transfer and store these batteries in such a manner as to ensure
that cracks and/or breaks in the battery cases do not develop thereby allowing the
contents of the battery to be released.
➢ Shop Manager and/or Assistant Manager are to maintain records of the amount of
batteries stored, and the amount and location sent for recycling;
➢ Recycling records are to be kept on site and available should a regulatory agency
require to see them;
➢ Shop Manager and/or Assistant Manager are to inspect the used battery storage
area on a daily basis to ensure that they are being maintained in a neat and orderly
manner, and that no leaks/releases have occurred.
Usage of Degreasing, Parts Cleaners & Solvents
Air pollution generated by mechanical repair shops generally comes from the solvents
found in parts washers, various cleaners, degreasers, and solvents. To control the amount
of these chemicals released to the air and to reduce the exposure of Monro employees, the
following practice will be strictly adhered to:
➢ ONLY THOSE MATERIALS THAT ARE PROVIDED AND/OR APPROVED
BYMONR0 CORPORATE WILL BE USED BY THE SHOPS.
➢ Parts cleaners and the associated materials and/or solvents used will be
determined by the Monro Corporate office. The necessary equipment and
materials will be provided upon your request.
Floor Drains
Floor drains and their discharge are regulated by the jurisdiction in which your shop is
located.
Floor Drain Maintenance
➢ Floor drain covers/strainers are to be maintained and kept in place;
➢ The floor areas are to be swept with debris picked up rather than be allowed to
enter the drain;
➢ There will be no oils, solvents, anti-freeze, gasoline, etc. allowed to enter the
drain;
➢ Drains should be checked and cleaned on a regular basis to ensure that no
regulated materials have been introduced and that the drain is able to discharge;
➢ Oil/Water separators, if present, are to be checked on a monthly basis to
determined amount of oil/sludge that has accumulated;
➢ If necessary, contact Monro Corporate, to have the necessary arrangements made
to have the separator cleaned and serviced.
Absorbent Materials & Industrial Wipers Contaminated with Waste Oil
Absorbent materials and industrial wipers (shop towels, rags, and disposable wipers) that
meet the requirements of the "one-drop"rule, do not meet the requirements of hazardous
waste.
To meet the requirements of the "one-drop"rule, absorbent materials used to collect
spills on the floor shall have no free flowing waste. Shop rags and wipers may be tested
by wringing to determine of a drop of liquid escapes.
NOTE: The "one-drop" rule is only applicable to waste oil that cannot be collected
for recycling.
Regulatory Agencies
The regulatory agencies that have jurisdiction over your facility have the ability to
perform unannounced inspections. These inspections most often involve the Store
Manager and/or Assistant Manager being required to answer some questions involving
procedures at the site, producing permits for reviews, producing records of disposal of
used oil, scrap tires, anti-freeze, batteries, and other items that fall under waste disposal
requirements. If an inspector should stop into your facility, the following procedure shall
be followed, without exception:
➢ Ask for identification to determine that the person is in fact a representative of the
agency;
➢ Be cordial and cooperative with the person(s);
➢ Place a telephone call to Tom Giannone, Facilities Manager, at 647-6400, ext. 378
and allow Mr. Giannone to talk with the representative;
➢ Provide any required information that is required after discussion with Mr.
Giannone;
➢ If any deficiencies are noted, immediately notify Mr. Giannone and you Market
Manager to allow for them to be corrected.
SCOPE OF WORK ACTIVITIES
IN AN EFFORT TO REDUCE THE POSSIBILITY OF ENVIRONMENTAL
INCIDENTS, AND TO ENSURE THAT MONRO MUFFLER HAS MET ALL
REGULATORY REQUIREMENTS, THE ONLY WORK CONDUCTED AT ANY
SITES WILL BE THOSE TYPES OF SALES AND REPAIR THAT ARE
DETERMINED AND ALLOWED BY CORPORATE MONRO.
It is hoped that by following the above policies and procedures, that environmental
incidents that could adversely affect the facility and/or the employees can be averted.
f
MONRO MUFFLER
Massachusetts
EMERGENCY SPILL PLAN
This policy has been developed and implemented to meet the requirements of the State of
Massachusetts regarding spills of oil and/or hazardous materials. In order to comply with these
regulations,protect the environment, and ensure the ability of Monro Muffler and its' employees
to have a safe and healthy work environment,the steps and procedures outlined in this plan shall
be strictly complied with. To accomplish this goal, each employee will be provided training on
the plan,be given a copy of the plan, and sign the attached verification,that they have been
provided the necessary instruction and will abide by the outlined procedures.
In addition, a copy of this plan shall be posted in the Vehicle Repair area in a place that is
accessible by all employees at any time of the day.
In discussion with the Massachusetts Department of Environmental Protection, it has been
determined that spills of less than ten(10) gallons that are immediately cleaned up by the spiller,
and do not reach the waters of the state, do not need to be reported. If the spill is larger than ten
(10) gallons and/or impacts the waters of the state,the incident must be reported
immediately.
This plan will outline the procedures that have been adopted by Monro Muffler to meet this
reporting requirement, and the steps that are to be taken by employees to control and clean-up the
spill.
The most effective Spill Plan involves the handling and use of oils and/or hazardous materials in
a safe and controlled manner. Although,Monro is sure that their employees attempt to work
under those conditions,we must prepare for the event whereby these materials are released to the
environment.
Over the next several pages you will find the EMERGENCY SPILL PROCEDURES,
COMPANY SPILL REPORTING FORM, and the outline of necessary notifications that Monro
has determined to implement in order to meet the requirements of the State of Massachusetts.
EMERGENCY SPILL PROCEDURES
Massachusetts
STORE PERSONNEL
Every spill must be reported to the Market Manager(Emergency Coordinator)regardless of the
time. The appropriate telephone numbers are listed at the end of this procedure. Obviously, if the
spill is still occurring, or if there is immediate danger to safety, the actions below must come
before the notification.
STEP 1 —Determine the source of the leak or spill.
STEP 2—Stop any more material from leaking if possible by performing one of the following:
• Upright the overturned container, or;
• Shut-off equipment that is transferring material, or;
• Plugging of holes, tears, or openings in container, or;
f Dike areas with absorbent.
STEP 3—If you can't stop or contain the spill,remove all possible sources of ignition to prevent
possible fire or explosion. If a vehicle is sitting in the spill, do not move it.
STEP 4—Remove all non-essential personnel from the immediate area. Block the area to traffic,
both vehicle and pedestrian.
STEP 5—Contain the spill to prevent the material from spreading.
• Put on personal protective equipment(gloves and goggles).
• Using absorbents to stop the spread of materials.
• Allow the absorbent adequate time to soak up the material,then sweep it up and place the
used absorbents into the disposal drum at the site.
• When the disposal drum is nearly full, contact T. Giannone,Director of Facilities,to
make the necessary arrangements to have this drum picked up for regulatory disposal.
• Perform inventory of absorbents, etc.,to determine if replacements are needed. Contact
T. Giannone,Director of Facilities, for additional supplies,if needed.
!VERY IMPORTANT!
DO EVERYTHING POSSIBLE TO PREVENT MATERIALS FROM
ENTERING STORM, SANITARY, OR OTHER DRAINS!
IF CONDITIONS ARE SUCH THAT STORE PERSONNEL CANNOT DEAL WITH THE
INCIDENT OR IF IMMEDIATE DANGER TO LIFE AND PROPERTY IS PRESENT
CONTACT THE FIRE DEPARTMENT FOR ASSISTANCE.
STEP 6—If the spill/release was the result of failure or breakage of oil storage and/or transfer
equipment, this equipment is to be immediately taken out-of-service until such time as the
necessary repairs are completed. It will be the responsibility of the Market Manager(Emergency
Coordinator)to ensure that these repairs are given immediate attention.
STEP 7—No statements are to be given to the media.Refer all Media to Monro's corporate
offices.
STEP 8—Once the situation is under control and the Market Manager has been contacted by
telephone, it is important that the Store Manager,Assistant Manager, or Employee in Charge fill
out the attached Spill Report Form. Fax the completed form to Attn: T. Giannone,Monro
Muffler, at 585-647-0947, as soon as possible after all information has been generated. A copy of
this report is to be kept on file at the store, with an additional copy to be maintained by the
Market Manager.
Common Sense must be used regarding the treatment of a spill or any other hazard.
The above procedures are suggested guidelines. Each incident is different and may require more
comprehensive measures than are outlined in this text. If in doubt about how to handle this type
of situation, and you are unable to contact your Market Manger, call Tom Giannone at 585-647-
6400, Ext. 378.
EMERGENCY SPILL PROCEDURES
Massachusetts
MARKET MANAGER/EMERGENCY COORDINATOR
As previously stated,Massachusetts requires that all spills larger than ten(10) gallons, and/or that
reach the waters of the state must be reported to the Department of Environmental Protection. To
ensure continuity and maintain a single point of contact,Monro Muffler has designated the
Market Manager as the person responsible to fulfill this requirement.
To accomplish this,the Market Manager will be take the following actions:
STEP 1 —When receiving the telephone call from the store, gather the following information:
• Date of spill
• Time of spill
• Person making notification
• Material spilled
• Amount spilled
• Has spill been stopped
• Has spill been cleaned up
• Were any resources affected, (land, water, air, drainage systems)
• Was Fire Department or other outside agency involved
STEP 2—Make the notification to the Massachuesetts Department of Environmental Protection
(if necessary) at 1-888-304-1133. Give them the information that you were able to receive from
the store and determine if they will require additional actions.Make sure that a Spill Number is
assigned and that you are given this number for Monro records. Ask if a Spill Response person
will be traveling to the store. Provide your cellular telephone to the person taking the information
to allow for immediate contact,if necessary.
STEP 3—Contact the store to determine if any additional information or items of concern have
arisen. Give the Spill Number, if assigned,to the Store Manager so that it can be entered on the
Monro reporting form.
STEP 4—Contact Tom Giannone at 585-647-6400, Ext. 378,to advise of the spill and status of
clean-up.
STEP 5— IMMEDIATELY TRAVEL TO THE STORE TO CONFIRM THE FOLLOWING:
• Situation was as reported
• Clean-up is under way or complete
• All equipment is in good working condition
• All necessary information has been placed onto the reporting form
• Replacement of absorbent materials and equipment, as needed
• Maintain record of spill(s)that material has been placed into disposal drum
• Ensure copy of completed report form is FAX'd to the Corporate Offices
STEP 6—When store advises that disposal drum is full,notify Tom Giannone,Director of
Facilities, to have drum picked up by a registered disposal firm and provide empty drum for
future use.
STEP 7—Ensure that all forms, letters, and any other information generated by a spill event are
forwarded immediately to Tom Giannone,Director of Facilities.
IT IS THE RESPONSIBILITY OF THE MARKET MANAGER/EMERGENCY
COOORDINATOR TO MAKE SURE THAT ALL EMPLOYEES ARE PROVIDED
TRAINING ON THIS PLAN, GIVEN A COPY OF THE PLAN,AND THAT ALL
EMPLOYEES FOLLOW THE POLICIES AND PROCEDURES OUTLINED.
DIRECTOR OF FACILITIES
The Director of Facilities will be responsible for the tracking of spill incidents,replacement of
absorbent materials, disposal of generated materials, and reporting to the State of Massachuestss
to ensure that"Spill Numbers" are determined closed upon regulatory disposal of all wastes.
TELEPHONE NUMBERS
Market Manager TBA
Massachusets DEP 1-888-304-1133
Monro Corporate Tom Giannone 1-585-647-6400,Ext. 378
FAX 1-585-647-0947
te�okti Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARNSTABLE.
MASS. `0g 200 Main Street• Hyannis, MA 02601
�FOMA'�A TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: 44OAro mo-rt 2- Date: 8 30 it
Location/Mailing Address: 16 Z o,, aQ 4 r` , /lN
Contact Name/Phone: nh�s �i�wv�c w So�3-7'►i-'1'l02 cmrp- f3en- 8'7re-66'1
Inventory Total Amount: -^-Q & MSDS: �A�� klv , License#:
Tier II : 00 Labeling: OK Spill Plan: Ye-5
Oil/WaterSeparator: JC6 Floor Drains: Yo Emergency Numbers:�
os'k-
Stora a Areas/Tanks: 1-- t%o JM &1-4 C% -00k(,-titVX6 W, o 1zqqfg-ewe,l�waakc of l
Emergency/Containment Equipment: D�-tt�� -FPS �6z g
Waste Generator ID: Waste Product: o,
Date&Amount of Last Shipment/Frequency: S/1s 1/b 123 I-0 eves 2-3,.�1c S
Licensed Waste Hauler&Destination: 52r-2+-! Kke-e� (�'�cL�IST ewe 1q S
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS Na ,�-a-1�1 �- `�-�,c- W-- 1 V1�1�y g n c la-'►� w,p e c. mu-
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous m1terial 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
J Hydraulic fluid (including brake fluid) Windshield wash
V 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
Paint&varnish removers, deglossers Leather dyes
VMiscellaneous 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: e. � AL162 5D 6 S
AVI,\'S4Zk1-91ow�kCtg`��'¢t,�CQaVk vukp� D •e�!
4XCakv l A'o �C1 N _ _ Inspect
Facility Representative: ,
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
L_
i
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service STORE#422
102 Falmouth Rd., Hyannis, A4- A f,4
Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
----------------------------------------------------------------------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2017 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
07/01/2016 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
Town of Barnstable
�t AE
ti Regulatory Services
Richard V. Scah,Director
r a
` '"R"'ARK ` Public Health Division BAA TABLE
BARNSAOIL•� fD1i1R•tt.VRS
i639� �0 wAs-ovs r3um"` iit;ws.xnAns�
Thomas McKean, Director `
200 Main Street, Hyannis,MA 02601
W _.
Office: 508-862-4644 Fax: 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 DULY 1st—JUKE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00
• A late charge of$10.00 will be assessed if payment is not received by July 1st.
ASSESSORS MAP AND PARCEL NO. DATE
FULL NAME OF APPLICANT: -Tarn G iann anfL
NAME OF ESTABLISHMENT: MG.� V m rye
ADDRESS OF ESTABLISHMENT: 1(.);k rVj th Lu4h
MAILING ADDRESS(IF DIFFERENT): -=
TELEPHONE NUMBER OF ESTABLISHMENT:
EMAIL ADDRESS: Z'CM .
SOLE OWNER: YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
• IF PREPARED BY OUTSIDE PARTY:
SIGNATURE OF APPLICANT Name:
Company Address
Telephone#:
Email:
Q:\Application Forms\HAZ.ZAPP Revl6.docx Page 1 of 2
`aF�"E►or, Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BA MASS. 200 Main Street• Hyannis, MA 02601
Eo'AP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: M6v<<o Rkr r-eLl<e, Date: 9/22 1
Location/Mailing Address: lot- Gd 111-61-lt1 IR 1� 2h✓►IS rewt,.v4s * ,,Q fo /Qoc�¢g N
Contact Name/Phone: , 2wvl%s \=�r,nna�, S'Q --7-71�-7-7o2- Boo- 87%-676 ce
Inventory Total Amount: ^ � MSDS: e5 iVOL- License#:
1 _� � Spill Plan: )e-5 cam«
Tier 11 0 `/ Labelin o0
Oil/WaterSeparator: 0 Floor Drains: 6 Emergency Numbers: Yc 5
Storage Areas/Tanks:;L-1 a k 1--5 0vL w << 5 , a t&in 41 r -o,I
Emer enc /Containment E ui ment: c l So ¢e D 4, .mow oil V)Aite-0-1 t ^—F
s tt
Waste Generator ID: DDO 1 Waste Product:
Date&Amount of Last Shipment/Frequency: 2 Zv2< wee S
Licensed Waste Hauler&Destination: G`i e- Fe-w <Av 9 pc-G
Other Waste Disposal Methods: 9+l S ,J to-( S Arm
6Qk9661<o 10 g,ctA- as< 10v, CA, u t�
LIST OF TOXIC AND HAZARDOUS MATERIAL 7 y y
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.
��k b 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
r"I 0 Motor oils 540•rn.1p k%go Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
---� Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink .
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners �- Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: Aa
Gt KA 4J i 1✓L ICL v L f vrL�
Inspector:
Facility Representative:
611
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
oF� ►off Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
"M G.S.LE y) 200 Main Street• Hyannis, MA 02601
�'DlEOMA'�"`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: logvtco ! � lc r �Ca �t� o<,---0q .Z Date: 6 2-3 /
Location/Mailing Address: 10 a.1yvw av1A(S 4--v ►'�ocl�SkP.t
Contact Name/Phone: DQ-vw%(s <fA--'71. 7 7o Z /C or OC- ,c, 906 97 L 4,61(o
Inventory Total Amount: a MSDS: A, License#: (` 3
Tier II : 0 a Labeling: 0 Spill Plan:
Oil/Water Separator: e)o Floor Drains: f4 -1-0 Emergency Numbers: Ve,5
Storage Areas/Tanks: 1ft r al ."o,11 106D WaSk2 pig Pco,k _ -a- vow 1 St�ga l AST�.l
Emergency/Containment Eq ipment: (5 Q00< I<c,%,,,----7 0,1
Waste Generator ID: /4A(.ZOO 0133<1,* Waste Product: 8 Oil A,,ge 5
Date&Amount of Last Shipment/Frequency: G I a a1 oil V&XL\
Licensed Waste Hauler&Destination: 5OA 1,tP-%A- I D �Z-
Other Waste Disposal Methods: o I1 CUIC4 toa Q< A-,—
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
11 D Antifreeze Dry cleaning fluids
—,5` Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
0 Hydraulic fluid (including brake fluid) Windshield wash
$00 Motor oils(ooj,055%+ 0,k Sc%5( 1., Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
- Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners I Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
1, 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/REC MMENDATIONS: M y , I
k a a, ka l ova !7 n
( Inspector: -�
Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Date: 6l 21/ 13
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 1140 Kro MA14v- 5 er"Lk - L5° ores �22�
BUSINESS LOCATION: /0 r,Jmoy+} 4,n h I S T INVENTORY
MAILING ADDRESS: arm- TOTAL AMOUNT:
TELEPHONE NUMBER: 08 - 771 - 770 2 6,r or*.}e rQ 87b b67b Sfl
CONTACT PERSON: 1-0-VIA 1 b F r-mayu
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: qu+.D rota ►�• -ev�yt� `OP S
INFORMATION / RECOMMENDATIONS: ire District:
J&WA05 1i6L4_4e_1)l-abel (// w2sf� �r�►ytS_�t 5 rf:/fCrs 4 +�I 5
H " 3, �G & O�lt�,r�nas lc�a f� rc�✓,/'k. GorLfew s l.�t � I core ar,
CoK}a1+���5 y� abdorbfn tJJ kK- raYts f� Cov���Vl, o a��T rover` �fams
aoste Transportation: A44 ment of hazardous waste: 7 $ 3
Name of Hauler: 6VI- -V ►- Destination: Q� Jeex- ravisforc
Waste Product: 049&o/ 64 w2eLicensed . es o 611>108`f:902 0 �Z
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 re uires 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
D Antifreeze (for gasoline or coolant systems) �, Miscellaneous Corrosive
E(NEWSS [USED C-4- Cesspool cleaners
s Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
10 Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils / Pesticides
S� 3 NEW00 Q USED%00 (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
O Miscellaneous petroleum products: grease,
Photochemicals (Developer)
5 lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
i6 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) ������'� a�_ 6 �.,� � e✓� „,,����
Spot removers &cleaning fluids
(dry cleaners) 4*0 0 0A.1- ytJVvt hw-(3 af�& 006+
Other cleaning solvents I I I ngg
''—
Bug and tar removers 60 <d 4P+Gt,) I A S 4C6 !K-. U
Windshield wash 10(_ II IVL, 0 - &Lis
WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature 7� �SStaff's Initials
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $loo.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service
102 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
r -
0&/t&/2012 08: 43 4019465487 q::�d � PAGE 02/03
Town of Barnstable
�TH6r Regulatory Services
Thomas F. Geiler,Director
Pub& Health Division
sbgq ��
+a `1`boms McKean,Dirrcctor 1
200 Mafn Street, Hyannis,:MA 0260 i
bike: 503-862-4644 ]Fax: 508-790-6304
Applicab ' Fee; $100.00
ASSESSORS P AND PARCEL NO. DATE
MA
APPLICATION FOR P7ERi'UT,TO STORE ,AND/OR U7'HAZI; MORE THkN
III GALLONS O_�Y k ARDOU"S MATERIALS
YnL N.,UU, OF APPLICANT \�_r39-z UW41CC&4�� , Z\) L
NANLE OF_tSTABL1S=NT UwNUA �NNtt i l RAA�_� -4 4 Z'Z'
ADDRESS OF EST,0LWfiY%NT \O2- I"Y4 l rAo tA+)—\ Qa. ,
TExE,PRONM N- UNWER
SOLE OLYNM. "YES No
2 APPI.SCANT IS A YARTNYRSEP,FUG NAM, AND ROME ADDRESS OF.ALL
PA.RTN%RS=
V APPLICANT IS A COI2POkRATION: FrWMZAL IDENTMCATION NO,t10 F5(D2
ST'ATL OF LNCORPORATION y3 ai'.� Hof
FUL'L WAIN N,AND HOME ADDIZXSS OF;
PRESIDWT Y1,,� VAns h� el a �11���r �Ar�.�nc A �s '� tqt
TREASURER
SIGINA OF APPLICANT _
RESnUCTSONS; ROMADDRESS �o �t�Q 4) 0����► 15
ROME TELEPHONE# 3 �
I mdcc/wpiq
MONRO MUFFLER Brake and Service
Monro Muffler and BJ's Locations
SHOP MAINTENANCE and SPILL PLAN
State of Massachusetts Locations
This policy has been developed and implemented to meet the requirements of the State of
Massachusetts regarding spills of oil and/or hazardous materials, and to outline the
responsibilities and expectations of Monro Muffler employees in meeting the various
environmental requirements and issues that could be encountered.
In order to comply with these regulations, protect the environment, and ensure the ability
of Monro Muffler Brake and Service and its subsidiary companies, and it's employees to
have a safe and healthy work environment, the steps and procedures outlined in this
manual shall be strictly complied with. To accomplish this goal, each employee will
receive training on this plan, have access to the plan, and sign the verification that they
have been provided the necessary instruction and will abide by the outlined procedures.
Training will be provided upon hire with refresher training to be conducted on a yearly
basis.
In addition, a copy of this plan shall be posted in the Vehicle Repair
area in a place that is accessible by all employees at any time of the day.
The primary concept of this plan will be to establish those practices and procedures that
Monro Muffler will require of each of it's employees and locations. It has been
demonstrated that the best Environmental Practices are those that are employed to avoid
spills and/or incidents. To accomplish this result, the required policies for dealing with
various items and issues will be addressed below.
GENERAL FACILITY MAINTENANCE
Market Manager(Emergency Coordinator)
It will be the responsibility of the Market Manager to inspect each facility under his/her
control to ensure that all necessary steps and procedures are being complied with. Any
issues identified, will be addressed immediately to bring the store into compliance with
these policies and procedures. Should the Market Manager have any questions or need
further assistance, he/she shall contact Tom Giannone, Director of Facilities, at 585-647-
6400, extension 378, for guidance.
Market Manager will act as Emergency Coordinator for all sites under his/her control, to
coordinate emergency response measures. Should the Market Manager be alerted to an
incident, they will immediately notify Thomas Giannone and travel to the store to oversee
all containment and cleanup activities.
The Market Manger will ensure that all required notifications are made to the local fire
and police agencies, local governments, health departments, and the MA Department of
Environmental Protection as necessary.
If during the cleanup of the incident and upon completion of work, the Market Manager
shall contact Thomas Giannone to keep him up-to-date on actions taken and results.
It will be the responsibility of the Market Manager to ensure that the following steps are
taken and the required information is posted next to each telephone at the site:
Equipment
• Telephone, two-way radio or other device to summon police, fire or emergency
response teams;
• Portable fire extinguishers and/or fire control equipment;
• Spill control/decontamination equipment;
• All exits to be properly labeled and maintained for access.
All equipment must be periodically tested and maintained to ensure that it will work in an
emergency. A record of inspection/testing to be completed and maintained at the site.
Employees
• All employees are to be trained on waste handing and emergency procedures;
• All employees shall have access to telephone or communication devices.
Local Authorities/Governmental Agencies
• Familiarize the local fire department, police department, emergency medical
services, health department, emergency response teams of the hazardous nature of
the waste, and the site building including entrances and exits;
• Familiarize hospitals with the hazards of your waste and the types of injuries
encountered during work at the site;
• Obtain agreements with emergency response teams, if applicable.
Following information must be posted next to each telephone at the site.
• Name and telephone number of Emergency Coordinator(Market Manager)
• Location of fire control equipment;
• Telephone number of fire department;
• Drawing of building showing exits.
Shop Manager/Assistant Manager
It will be the responsibility of the Shop Manager and/or Assistant Manager to follow the
policies and procedures set forth, and ensure that all employees under his/her control are
in compliance. Should the Shop Manager have questions or concerns regarding this
policy or incidents at the facility, he/she shall immediately contact the Market Manager to
gain assistance.
The Shop Manager and/or Assistant Manager will perform a complete daily walk-through
inspection of the shop and Monro property to determine that no incidents have occurred
that should be immediately addressed. These incidents would include, but not be limited
to, leaks and/or spills of oils, damage to equipment, damage to building and facilities,
tampering with storage of scrap tires,batteries, etc., or any issue that could compromise
the integrity of the site or health of the employees.
NOTE: In the event that a facility has an employee that refuses to follow these policies
and procedures, and/or is creating an environmental issue, the Shop Manager shall
immediately contact the Market Manager for assistance.
Shop Employees
Each Monro Muffler employee agrees to follow all the requirements of these policies and
procedures as a stipulation of their employment. Any employee that knowingly violates
or disregards this policy will be subject to punishment as prescribed by Corporate Monro.
Should an employee have a question or concern regarding any issue of this policy or
steps that are to be taken, he/she should bring it to the attention of the Shop Manager for
clarification.
It will be the responsibility of each employee to do their part to maintain each of the
facilities in a clean and orderly fashion. To facilitate this, the following practices shall be
mandatory:
GENERAL SHOP MAINTENANCE
The shops are to kept clean, without an undue amount of debris, parts, scrap,removed
parts, and other items left to accumulate. It will be the responsibility of each employee to
have only the necessary parts in the work area, and to place scrap in the dumpster, used
oil into the storage tank, tires into the recycling pile, etc., as soon as removed from the
vehicle. This should help to eliminate the possibility of an incident that could create a
spill and/or release of materials that could create an environmental incident.
Floors are to be kept clean of debris by sweeping, upon completion of any work in the
repair area. These materials are to be placed into a trash receptacle for transfer to the
dumpster for disposal. Sweeping of the floors, rather than washing down with water will
reduce the possibility of allowing materials to enter the drain and/or flow into areas that
might cause a non-allowable discharge to the local sewer system and/or waters of the
State, as well as possibly plug the drain system.
Any spills of oils, grease, gasoline, etc, shall be immediately covered by Speedi-Dri and
swept to absorb all materials. After the Speedi-Dri has absorbed all the materials, it shall
be swept up and prepared for disposal.All repair work in the facility will immediately be
stopped until such time as the materials have been removed and transferred to the
dumpster. This will help eliminate the possibility compounding the problem by sparks
and/or hot metal starting afire.
As materials are delivered to the facility, they will be immediately transferred to the
proper storage area. This should reduce the possibility of tripping/falling and damage to
these items before their use.
NOTE: WASHING OF FLOORS WITH THE WASTEWATER BEING
DISCHARGED OUT OF THE DOORS INTO A PARKING AND/OR DRIVING
AREA WILL NOT BE ALLOWED UNDER ANY CIRCUMSTANCES. FLOORS
ARE TO SWEPT PRIOR TO WASHING TO REDUCE AMOUNT OF SOLIDS
AND/OR WASTES THAT COULD ENTER THE DRAINS.
WASTE ISSUES
Automotive repair generates various wastes that must be handled in an environmentally
safe, cost efficient manner. Listed below are the prescribed methods for handling of these
items as determined by Monro Muffler.
WASTE OIL
Waste oil is to be properly handled and stored so that it can be re-cycled. To accomplish
this the following steps need to be taken:
➢ Waste oil must be stored in tanks or containers that are marked
o HAZARDOUS WASTE
o WASTE OIL
o TOXIC
o DATE WHEN ACCUMULATION STARTED (Updated after tank is
emptied)
➢ Area where waste oil is stored must be labeled HAZARDOUS WASTE;
➢ Sign is to be 1"high, capital letters;
➢ Containers must be in good condition, which means no holes, dents, or rust and
must be managed to prevent spills;
r
➢ Only WASTE OIL is to be placed in these containers. Mixing other products or
wastes with your WASTE OIL may cause the used oil to be considered a
hazardous waste and increase the cost for disposal,
➢ Storage tanks or containers are to be inspected on daily basis, by the Shop
Manager or Assistant Manager, to ensure that leaks and/or spills have not
occurred, the storage tank is in good condition, and that there is ample room in the
tank for the used oil to be generated during the days work;
➢ WASTE OIL is to be placed into the storage container immediately upon
removal from the vehicle;
➢ Employees placing WASTE OIL into the storage tank must ensure that no spills
or overfills occur;
➢ Oil absorbent materials should be kept in a location that will allow for them to be
readily available should a leak/release occur;
➢ The Shop Manager is to keep records of when the used oil is picked up by the
recycling company and the amounts taken. These records are to be kept in a
location and manner that make them readily available should an inspector from a
regulatory agency wish to see them.
➢ WASTE OIL shipments are to be documented on the approved EPA manifest.
The following actions are to be taken with various copies of the manifest;
Copy 6—Retain for records (Original)
Copy 6—Make copy and forward to the State of MA DEP within 10 days
of shipment
Copy 3 — Should be returned to you by the waste facility and you should
compare with copy 6
After comparison of copies 3 & 6, maintain these records for a period of three (3)
years. These records are to be maintained and accessible should a site inspection
occur.
If copy three (3) is not received from the disposal facility within 35 days, a request
should be forwarded requesting the copy. If not received within 45 days, an exemption
report must be filed with the state of Massachusetts.
NOTE: IN ADDITION TO THE TANKS/CONTAINERS BEING CHECKED ON
A DAILY BASIS, A WEEKLY LOG OF INSPECTIONS, SIGNED BY THE
MANAGER OR ASSISTANT MANAGER IS TO BE KEPT ON-SITE.
All records pertaining to the waste oil are to be kept on-site for a period of three (3)
years.
Oil Filters
There are two types of oil filters, terne and non-terne plated, that car repair shops might
see. Terne is an alloy of lead and tin and is used to plate some oil filters for heavy-duty
vehicles like construction equipment. Light duty vehicles typically use non-terne plated
filters. Used oil filters that are non-terne plated are exempted from regulation as
hazardous wastes if you follow these procedures after removal.
➢ Puncture the dome end or anti-drainback valve and allow to drain for 16 hours at
60 degrees F or higher; or
➢ Allow to drain for 12 hours at 60 degrees F or higher and then crush the filter; or
➢ Dismantle the filter and allow to drain for 12 hours at 60 degrees F or higher.
After the filters are drained using one of these procedures, the filters can be crushed both
to remove more oil and to reduce the volume of the filters.
Scrap Tires
➢ Scrap tires may be stored on-site until such time as they are to be picked up for
recycling.
➢ If you should have any questions regarding the permits or concerns of them being
valid, you should contact Tom Giannone at 585-647-6400, ext. 378;
➢ The tires are to be stored in a secure area and be piled in a neat and orderly
manner;
➢ Shop Manager and/or Assistant Manager are to maintain the following records;
1. The number and types (auto or truck) of scrap tires that you ship
2. Which haulers you use to transport them, and
3. What facility you sent them to.
4. Keep these records on hand for at least three (3) years so they are available
for an inspector.
➢ Should any problems arise relating to storage and maintenance of scrap tires,
contact Tom Giannone at 585-647-6400, ext. 378.
Used Anti-Freeze
➢ Used Anti-Freeze is to be transferred into the proper storage container
immediately upon removal from the vehicle;
➢ Employees are to perform this transfer in such a manner that spills/overfills will
not occur;
Used anti-freeze is to be stored within a secure area of the site;
➢ Shop Manager and/or Assistant Manager are to maintain records of the amount of
used anti-freeze on-site, amount of anti-freeze sent for recycling;
➢ Recycling records are to be kept on site and available should a regulatory agency
require to see them;
➢ Shop Manager and/or Assistant Manager are to inspect the used anti-freeze
storage area on a daily basis to ensure that no leaks have occurred, the storage has
not been tampered with, and that sufficient storage is available for any materials
that might be generated during the work-day.
Used Batteries
➢ Used batteries are to be transferred to the proper storage area immediately upon
removal from the vehicle;
➢ Employees are to transfer and store these batteries in such a manner as to ensure
that cracks and/or breaks in the battery cases do not develop thereby allowing the
contents of the battery to be released.
Shop Manager and/or Assistant Manager are to maintain records of the amount of
batteries stored, and the amount and location sent for recycling;
Recycling records are to be kept on site and available should a regulatory agency
require to see them;
➢ Shop Manager and/or Assistant Manager are to inspect the used battery storage
area on a daily basis to ensure that they are being maintained in a neat and orderly
manner, and that no leaks/releases have occurred.
Usage of Degreasing, Parts Cleaners & Solvents
Air pollution generated by mechanical repair shops generally comes from the solvents
found in parts washers, various cleaners, degreasers, and solvents. To control the amount
of these chemicals released to the air and to reduce the exposure of Monro employees, the
following practice will be strictly adhered to:
➢ ONLY THOSE MATERIALS THAT ARE PROVIDED AND/OR APPROVED
BY MONR0 CORPORATE WILL BE USED BY THE SHOPS.
➢ Parts cleaners and the associated materials and/or solvents used will be
determined by the Monro Corporate office. The necessary equipment and
materials will be provided upon your request.
Floor Drains
Floor drains and their discharge are regulated by the jurisdiction in which your shop is
located.
Floor Drain Maintenance
➢ Floor drain covers/strainers are to be maintained and kept in place;
The floor areas are to be swept with debris picked up rather than be allowed to
enter the drain;
➢ There will be no oils, solvents, anti-freeze, gasoline, etc. allowed to enter the
drain;
Drains should be checked and cleaned on a regular basis to ensure that no
regulated materials have been introduced and that the drain is able to discharge;
➢ Oil/Water separators, if present, are to be checked on a monthly basis to
determined amount of oil/sludge that has accumulated;
➢ If necessary, contact Monro Corporate, to have the necessary arrangements made
to have the separator cleaned and serviced.
Absorbent Materials & Industrial Wipers Contaminated with Waste Oil
Absorbent materials and industrial wipers (shop towels, rags, and disposable wipers) that
meet the requirements of the"one-drop"rule, do not meet the requirements of hazardous
waste.
To meet the requirements of the "one-drop"rule, absorbent materials used to collect
spills on the floor shall have no free flowing waste. Shop rags and wipers may be tested
by wringing to determine of a drop of liquid escapes.
NOTE: The "one-drop" rule is only applicable to waste oil that cannot be collected
for recycling.
Regulatory Agencies
The regulatory agencies that have jurisdiction over your facility have the ability to
perform unannounced inspections. These inspections most often involve the Store
Manager and/or Assistant Manager being required to answer some questions involving
procedures at the site,producing permits for reviews,producing records of disposal of
used oil, scrap tires, anti-freeze,batteries, and other items that fall under waste disposal
requirements. If an inspector should stop into your facility, the following procedure shall
be followed, without exception:
➢ Ask for identification to determine that the person is in fact a representative of the
agency;
➢ Be cordial and cooperative with the person(s);
Place a telephone call to Tom Giannone, Facilities Manager, at 647-6400, ext. 378
and allow Mr. Giannone to talk with the representative;
➢ Provide any required information that is required after discussion with Mr.
Giannone;
➢ If any deficiencies are noted, immediately notify Mr. Giannone and you Market
Manager to allow for them to be corrected.
SCOPE OF WORK ACTIVITIES
IN AN EFFORT TO REDUCE THE POSSIBILITY OF ENVIRONMENTAL
INCIDENTS, AND TO ENSURE THAT MONRO MUFFLER HAS MET ALL
REGULATORY REQUIREMENTS, THE ONLY WORK CONDUCTED AT ANY
SITES WILL BE THOSE TYPES OF SALES AND REPAIR THAT ARE
DETERMINED AND ALLOWED BY CORPORATE MONRO.
It is hoped that by following the above policies and procedures, that environmental
incidents that could adversely affect the facility and/or the employees can be averted.
MONRO MUFFLER
Massachusetts
EMERGENCY SPILL PLAN
This policy has been developed and implemented to meet the requirements of the State of
Massachusetts regarding spills of oil and/or hazardous materials. In order to comply with these
regulations,protect the environment, and ensure the ability of Monro Muffler and its' employees
to have a safe and healthy work environment, the steps and procedures outlined in this plan shall
be strictly complied with. To accomplish this goal, each employee will be provided training on
the plan,be given a copy of the plan, and sign the attached verification,that they have been
provided the necessary instruction and will abide by the outlined procedures.
In addition, a copy of this plan shall be posted in the Vehicle Repair area in a place that is
accessible by all employees at any time of the day.
In discussion with the Massachusetts Department of Environmental Protection, it has been
determined that spills of less than ten(10) gallons that are immediately cleaned up by the spiller,
and do not reach the waters of the state, do not need to be reported.If the spill is larger than ten
(10) gallons and/or impacts the waters of the state,the incident must be reported
immediately.
This plan will outline the procedures that have been adopted by Monro Muffler to meet this
reporting requirement, and the steps that are to be taken by employees to control and clean-up the
spill.
The most effective Spill Plan involves the handling and use of oils and/or hazardous materials in
a safe and controlled manner. Although,Monro is sure that their employees attempt to work
under those conditions,we must prepare for the event whereby these materials are released to the
environment.
Over the next several pages you will find the EMERGENCY SPILL PROCEDURES,
COMPANY SPILL REPORTING FORM, and the outline of necessary notifications that Monro
has determined to implement in order to meet the requirements of the State of Massachusetts.
EMERGENCY SPILL PROCEDURES
Massachusetts
STORE PERSONNEL
Every spill must be reported to the Market Manager(Emergency Coordinator)regardless of the
time. The appropriate telephone numbers are listed at the end of this procedure. Obviously, if the
spill is still occurring, or if there is immediate danger to safety, the actions below must come
before the notification.
STEP 1 —Determine the source of the leak or spill.
STEP 2—Stop any more material from leaking if possible by performing one of the following:
• Upright the overturned container, or;
• Shut-off equipment that is transferring material, or;
• Plugging of holes,tears,or openings in container, or;
• Dike areas with absorbent.
STEP 3—If you can't stop or contain the spill,remove all possible sources of ignition to prevent
possible fire or explosion. If a vehicle is sitting in the spill, do not move it.
STEP 4—Remove all non-essential personnel from the immediate area. Block the area to traffic,
both vehicle and pedestrian.
STEP 5—Contain the spill to prevent the material from spreading.
• Put on personal protective equipment(gloves and goggles).
• Using absorbents to stop the spread of materials.
• Allow the absorbent adequate time to soak up the material,then sweep it up and place the
used absorbents into the disposal drum at the site.
• When the disposal drum is nearly full, contact T. Giannone,Director of Facilities,to
make the necessary arrangements to have this drum picked up for regulatory disposal.
• Perform inventory of absorbents, etc.,to determine if replacements are needed. Contact
T. Giannone,Director of Facilities, for additional supplies, if needed.
!VERY IMPORTANT!
DO EVERYTHING POSSIBLE TO PREVENT MATERIALS FROM
ENTERING STORM, SANITARY, OR OTHER DRAINS!
IF CONDITIONS ARE SUCH THAT STORE PERSONNEL CANNOT DEAL WITH THE
INCIDENT OR IF IMMEDIATE DANGER TO LIFE AND PROPERTY IS PRESENT
CONTACT THE FIRE DEPARTMENT FOR ASSISTANCE.
STEP 6—If the spill/release was the result of failure or breakage of oil storage and/or transfer
equipment,this equipment is to be immediately taken out-of-service until such time as the
necessary repairs are completed. It will be the responsibility of the Market Manager(Emergency
Coordinator)to ensure that these repairs are given immediate attention.
r
STEP 7—No statements are to be given to the media.Refer all Media to Monro's corporate
offices.
STEP 8—Once the situation is under control and the Market Manager has been contacted by
telephone, it is important that the Store Manager, Assistant Manager, or Employee in Charge fill
out the attached Sp-:ll Report Form. Fax the completed form to Attn: T. Giannone,Monro
Muffler, at 585-647-0947, as soon as possible after all information has been generated. A copy of
this report is to be kept on file at the store, with an additional copy to be maintained by the
Market Manager.
Common Sense must be used regarding the treatment of a spill or any other hazard.
The above procedures are suggested guidelines. Each incident is different and may require more
comprehensive measures than are outlined in this text. If in doubt about how to handle this type
of situation, and you are unable to contact your Market Manger, call Tom Giannone at 585-647-
6400, Ext. 378.
EMERGENCY SPILL PROCEDURES
Massachusetts
MARKET MANAGER/EMERGENCY COORDINATOR
As previously stated, Massachusetts requires that all spills larger than ten(10) gallons, and/or that
reach the waters of the state must be reported to the Department of Environmental Protection.To
ensure continuity and maintain a single point of contact,Monro Muffler has designated the
Market Manager as the person responsible to fulfill this requirement.
To accomplish this,the Market Manager will be take the following actions:
STEP 1 —When receiving the telephone call from the store, gather the following information:
• Date of spill
• Time of spill
• Person making notification
• Material spilled
• Amount spilled
• Has spill been stopped
• Has spill been cleaned up
• Were any resources affected, (land,water, air, drainage systems)
• Was Fire Department or other outside agency i P g Y involved
STEP 2—Make the notification to the Massachuesetts Department of Environmental Protection
(if necessary) at 1-888-304-1133. Give them the information that you were able to receive from
the store and determine if they will require additional actions.Make sure that a Spill Number is
assigned and that you are given this number for Monro records. Ask if a Spill Response person
will be traveling to the store. Provide your cellular telephone to the person taking the information
to allow for immediate contact,if necessary.
STEP 3—Contact the store to determine if any additional information or items of concern have
arisen. Give the Spill Number, if assigned, to the Store Manager so that it can be entered on the
Monro reporting form.
STEP 4—Contact Tom Giannone at 585-647-6400,Ext. 378,to advise of the spill and status of
clean-up.
STEP 5— IMMEDIATELY TRAVEL TO THE STORE TO CONFIRM THE FOLLOWING:
• Situation was as reported
• Clean-up is under way or complete
• All equipment is in good working condition
• All necessary information has been placed onto the reporting form
• Replacement of absorbent materials and equipment, as needed
• Maintain record of spill(s)that material has been placed into disposal drum
• Ensure copy of completed report form is FAX'd to the Corporate Offices
STEP 6—When store advises that disposal drum is full,notify Tom Giannone,Director of
Facilities,to have drum picked up by a registered disposal firm and provide empty drum for
future use.
STEP 7—Ensure that all forms, letters, and any other information generated by a spill event are
forwarded immediately to Tom Giannone,Director of Facilities.
IT IS THE RESPONSIBILITY OF THE MARKET MANAGER/EMERGENCY
COOORDINATOR TO MAKE SURE THAT ALL EMPLOYEES ARE PROVIDED
TRAINING ON THIS PLAN,GIVEN A COPY OF THE PLAN,AND THAT ALL
EMPLOYEES FOLLOW THE POLICIES AND PROCEDURES OUTLINED.
DIRECTOR OF FACILITIES
The Director of Facilities will be responsible for the tracking of spill incidents,replacement of
absorbent materials; disposal of generated materials, and reporting to the State of Massachuestss
to ensure that"Spill Numbers" are determined closed upon regulatory disposal of all wastes.
TELEPHONE NUMBERS
Market Manager TBA
Massachusets DEP 1-888-304-1133
Monro Corporate Tom Giannone 1-585-647-6400,Ext.378
FAX 1-585-647-0947
06f,16l2012 08: 43 4019465487 PAGE 03103
o 00
O
• -�REQLTESI;S
Please mail the completed a' atiou form to a drew below. In addition, please inaludc the
required fev amotiurk Make payable to. Tovin bT lc. O%ir mailing address is:
Tovm of Barnstable
Public Health Division
200 Malin Strut
Hyanis,MA 02601
FOR F, D BEQUEST$
Our fax number is (508) 790-6304. Please fax a completed application form. it addition, you musty
nil the rcgtured fce amoi= (see fees a< bottom of this page). Please make; the check payable- to:
Town.of Bacros-table. The check must be marled to the address listed above.
For farthcr assistance on any item above, call (508) 862-464
LL
[� C,'
4n
1 ,
f
0016/2012 08: 43 4019465487 PAGE 01103
Tousle of Barnstable
ET Regulatory Services
.� 'Y'hoAr,as)F. Cciler,Director
HAHN6rag[.S,
r 9.A��' Public Health Division
Thomas McKean,Director
200 Main trteC,Hyaunis, NfA 02601
Office: 508-862-4644 Wa}roo Miller M.D.
Fax: 508-790-6304 Paul J, Canaift D.K.D.
Junichi Sawayanari
N2TICE .
�TO ALL Bt7SIUSS OPERATORS
WITH HAZARDOUS MATERTALS
x, BARN
STABL]E
The Town of RMstable Town Council adopted, Chapter 108: Hazardous
Materials, a,requirement for each bILSineSS operator to obtain an annual permit and
to remit a fee of S100•.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:
l. Please complete the attached application form
2. Include a copy of your contingency plan (to handle hazardouv waste
spills, etc.)
3. Submit the fee of$100J30 payable to the: Town of Barnstable
MA it all of the above to this office on or before .wine 30, 2011. A late �
charge of$10.00 will be assessed if. payment is not received by July 6, 2012.
Please feel free to view the above Code, Chapter 108: hazardous. Materials on-the
Town Website, ww� .town.barnstabIcgna u§ , which is located wader the E-Code
section if you should have any questions or concen-13. '
I
• i
Q:11-`azmatll"nz MQI Pnrnst Letter.DOC �
i
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $10o.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service
102 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 6/30/2011 unless sooner suspended or revoked.
-------------- -
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.C_ANNIFF, D.M.D._
6/30/2010 JUNICHI SAWAYANAGI —
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
j �j C
f.�
' Town of Barnstable
�opIHE Regulatory Services
P ti
N� °* 'Thomas F. Geiler, Director
- OAR ►,�,
MASS. • Public Health Division
p MASS. �a
rFOMA'�a Thomas McKean, Director
200 Main Strcct, Hyannis, MA 02601
Office, 508-862-464.4 Fax: 508-790-6304
Application Fee: $1oo,00
ASSESSORS MAP AND PARCEL NO. — DATE � fl�we9
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
III GALLONS OF IIAZARDOUS MA.TIART.A;JLS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENT l'�/1lJ l/f�� ✓ �y �,
ADDRESS OF ESTABLISHMENT
• TELEPHONE NUMBER _ �..��J�~ � �
SOLE OWNER: YES NO
IF APPLICANT IS A PARTNERSHIP, FULL NAME AND ii0\RF,, ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FF, ERAL IDENTIFICATION NO.�!
STATE OF INCORPORATION
FUL,i,NAME AND IIONIE 21D) EL
PRESiDEN'I` f� ��/
TREASURER
CLERK
• SIGN/MIRE OF APPLICANT
RESTRICTIONS: HOME ADD
HONE TELEPHONE
Idez.doc:wp,q
Number Fee
193 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Monro Muffler/Brake Service
102 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
. Town of Barnstable "e
=00 t4%
" T�ti Regulatory Services Department
p ;edcaCftv
• IIARNSTABLE. Public Health Division
+
9� ` � 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. DATE
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
j MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANTD N R� \ �� 110,/ 1 4 j-2,
NAME OF ESTABLISHMENT
ADDRESS OF ESTABLISHMENT \ b 2 F�41 M D V�+)--' ?
TELEPHONE NUMBER S O C6 - `� 02 ``?` a
SOLE OWNER:-YES NO77
N �
r'-
IF APPLICANT IS A PARTNERSHIP,FULL.NAME AND HOME ADDRESS F ALID rn
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.'b -53 W--)
STATE OF INCORPORATION
FULL NAME AND HQk1E ADDRESS OF:
PRESIDEN N V hN A-e A'\>o kQ4
TREASURER
CLERK
SIGNATURE F PLICANT
RESTRICTIONS: HOME ADDRESS Zo° '0—)\4&1
HOME TELEPHONE# CS 5-- 4�4C) �� a
Q:\Hazmat\Haz Mat Application2008.DOC
TOWN OF BARNSTABLE gpg_y,T2 3397
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager ,,, ��� �•TttiY_j '0
V1
Address of Offender MV/MB Reg.#
Village/State/Zip
A
Business Name_ 11t �1 ► ! i" l pm; on 20_..�
Business Address f
Signature of Enforcing Officer
Village/State/Ziplsd�
Location of Offense i =' ;_.. ,t '-J.;lie t,y"li ',WV i lk" . �.-d
Enforcing Dkpt/Divisttn
Offense T fj , }� �e.:c•i ,.) rcJt;r <jt`. :. 1-1)ft.^AtV :W2 ` s�
i Facts ftt 'dr ' rr}.`16 r yl' 40f•.
This will sery only as a warning. At t is time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT,
a
t_.. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM G. 44
NAME OF FIRM: [I CC,� / �(7Tat ,l G I �tnS M I55�aY�
MAILING ADDRESS: 95 Fa,I A � `Vho v GQ "GLVll�ls
� V`- , �(
TELEPHONE NUMBER:
CONTACT PERSON: ,
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 and time, more
than 50 gallons liquid volume or 25 pounds dry weight? YES k--- r 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 : ALI. GAPE AUTOMATIC
ADDRESS: TRANSMISSIONS, INC OVLJ?A4
TELEPHONE: h ,
HYAN!NIS, MA, 0260Ll'
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 in quantities
totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put
a check beside each product that you store:
Antifreeze (for gasline or coolant systems) Refrigerants
Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides )
Hydraulic fluid (including brake fluid) Photochemicals
Motor oils/waste oils Printing Ink
Gasoline, Jet fuel Wood preservatives
Diesel fuel, Kerosene, #2 heating oil (creosote)
Other petroleum products: grease, Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Degreasers for driveways &garages Leather dyes
Battery acid (electrolyte) Fertilizers (if stored
Rustproofers outdoors)
Car wash detergents PCB' s
Car waxes and polishes Other chlorinated hydro-
Asphalt & roofing tar carbons, (inc.carbon
Paints, varnishes, stains, dyes tetrachloride)
Paint and lacquer thinners Any other products with
Paint & Varnish removers, deglossers "Poison" labels (including
Paint brush cleaners g
Floor & Furniture strippers chloroform, formaldehyde,
Metal polishes
hydrochloric acid, other
_
Laundry soil & stain removers acids)
(including bleach) Other products not listed
2_
Spot removers & cleaning fluids which you feel may be
.
(dry cleaners ) HEALTH DEPT. list) :
IV D toxic or hazardous (please
Other cleaning solvents TOWN OF BAftNSTASi.E
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 4 1981
Disinfectants
Road Salt (Halite)
f 1
y TOWN OF BARNSTABLE
BOAR ® OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
ADDRESSAe
Major types of materials: 1) 2) r �e 3)
4) 6)
I. Description of material(s) use: ; ,, ,, il
II. Storage (denote product by numbPll'isted above)
A. Containers
metal glass paper plastic
cans,bottles,jars "
drums,barrels '
aboveground tanksY,'
underground tanks
bags,boxes
open,loose,uncovered
inadequate labelling
B. Storage Facility v/or # Remarks/RecommencI:ILi.ons
1. Indoor "
a) separate, contained room
b) stored in general work areaR
i) inadequate ventilation , r
ii) floor drains
iii) inadequate fire protection
2. Outdoor . t
�r1 4
a) uncovered, exposed to weather '
b) pervious surface/catch basins
III. Disposal -*
A. Reclamation/Recycling -unit
B. On-site disposal
1. Town sewer
2. Regular septic system
' 3. Separate holding tank
C. Off-site disposal f`
1. hauled by own firm ""
2. hired hauler Av
a) name of hauler
Af All
b) address or disposal site p/
,,I/
Perso.n(s) Interviewed _ Inspector "
^AL- - - - - - - - - - - -
Date — — — — — — — — — —
6 30 81
r0�!N OF BARNSTA B ��, _ � . " AIG,. �.1 i7<6\.ilJllJ�IcYo
,.. " 'ti sfactmry r Printers -,
BOARD OF HEALTI-f� ' �3. Auto aBodyctu Shops
unsatisfactory- 4. Manufacturers
1 41IS4 p� (see"Orders") 5. Retail Stores
COMPANY � L - --a n `J �r 6. Fuel Suppliers
ADDRESS , ,' 2�7 IJ AN�13 Class:-- — 7. Miscellaneous
�. UANTI"fIES AND STORAGE (IN=indoors; OUT=outdoors)
Q
MAJOR MATERIALS ' Case lots Drums AbOveTanks Underground Tanks
IN UT IN 0 IN UT 21Ave, rest?
Fuels:
Gasoline, Jet Fuel (A) `
Diesel, Kerosene, N2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil. (C)
transmission/hydraulic f• "�
Synthetic Organics: Cj
degreasers
a
Iiscellaneous:
DISPOSAL RECLAMATION Y4REM�.RKS: -
1. Sanitary Sewage 2. Water Supply 41
Town Sewer ublic
omOn-site Private
li
` ,v
3. Incr Floor Drains: YES NO
Holding tank: MDC
`!Catch basin/Dry well -•_-�_ _:�: -----......_.._...--.----__
0 On-site system "
4. Outdoor Surface drains:YES NO A
Q,Holding• tank: MDC
I 1 a
® Catch basin/Dry well
® On-site system
S. Waste Transporter J Licensed?
Name of Hauler_ _D s i nat i on 1jaSte Product Y FS N1.0
1 -
2.
7,
EP s 1 c r D t
TOWN COMPLIANCE: CLASS; 1. Marine,Gas Stations,RFpal.r OF E3ARNSTAf3LE 2. printers
sasacory . uto B�odY Shops
o
CIM R R ..• O F I-I C A LT H Qtift �+
Q 4 3 unsatisfactory- lanufacturers
Retail Stores
COMPANY � I 'F�� (see"Orders")
S.
{� 6. Fuel Suppliers
ADDRESS '� d _ �i�+r ��l � i ��� , �y ;MI class: , 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor.
MAJOR MATERIALS ' Case-lots Drums AbOveTanks Undetgrohnd Tanks
IN )l QUT I g gallons 9t� fs�iS
Fuels:
• Gasoline, Jet 'Fuel (A)
Diesel Kerosene 12 (B)
Heavy Oils
waste-motor oil - (c) rA 9
new motor oil (C)
transmission/hydraulic _
-Synthetic Organics:
degreasers
•Miscellaneous:
11. SaL tiny S T ON REDIARKS: �, 1A� e Z' r c-R 0�( c,���
1. Sanitary Sewage 2, Water Supply W G "71�V I� iv `'
,p
2. O Town Sewer t� public �1/��
4 a On-site Q Private .` '7f � f !!
3. Indoor Floor Drains: YES NO _ \J /_� .
[folding tank: MDC ''� (��V
Catch basin/Dry well �ORDERS:
On-site system
4. Outdoor Surface drains:YES NO
Q Nulding tank: MDC
O Catch basin/Dry well
0 On-site system
S. Waste Transporter Licensed?
� m �jjaylgy ,j)Pstination ylla to Product � �(F.SI_NQ_
fad &V PA,'_ x�c. _ .
2.
L u 23
�-_81" Person(s) Interviewed Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
,�J Mail To:
NAME OF BUSINESS: �Zz 2_�/U Ll�/.e2 < � � 13Sfc�,� Board of Health
MAILING ADDRESS: �l,,(40,-r�'eze Town of Barnstable
TELEPHONE NUMBER: -2 J ??1o7 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 ntities 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
t. Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems),p.- Drain cleaners
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
Diesel 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
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
I
I
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
2. nters
BOARD OF HEALTH satisfactory 3.Auto Body Shops
0 unsatisfactory- 4.Manufacturers
` (see"Orders") 5.Retail Stores
COMPANY � � d'f/ 6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
MAJOR MA.4 �/ "QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
RIALS 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)
new motor oil (C)
transmission/hydraulic OO
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
Town Sewerublic �
O On-site OPrivate , /
3. Indoor Floor Drains YES NO t/
O Holding tank:MDC ,
O Catch basin/Dry well r7�r tow-f 44
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
0 Holding tank:MDC J
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1. oon q Q '
2.
Person (s) Interviewed In pec or Date
I_
_ 4
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: `� Mail To:
hoard of Health
MAILING ADDRESS: %4, Town of Barnstable
TELEPHONE NUMBER: 3 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 qu?ntities 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 when stored i
. Please 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
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel 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
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
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
nters
BOARD OF HEALTH satisfactory 3.2.Auto Body Shops
�,� O unsatisfactory- 4.Manufacturers
COMPANY �is ` i/l0sg (see"Orders") 5.Retail Stores
�9 V �jl 6.Fuel Suppliers
ADDRESS
C18SS' � 7.Miscellaneous
! K-kW QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERSUndergroundove Tanks
IN OUT IN OUT IN OUT #&gallons 7277 Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
qtxv
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. W ter Supply < a
Town ewer Public
0 On-site OPrivate
3. Indoor Floor Drains YES NO
0 Holding tank: MDC
O Catch basin/Dry well f2" &2�� 44ed.Q
0 On-site system
4. Outdoor Surface drains:YES N0ZZ ORDER
O Holding tank: MDC
0 Catch basin/Dry well
0 On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
Perso Inte iewed Inspector Date
TO.V1/fd OF B------B UUMI'�,AN�c:._. I:LAJJ: 1. Nailiic,iia�"-:i�iiCivi o�ncl,aaa
L E 2. Printers
(satisfactory 3. . Auto Body Shops
B OVA R D OF HEALTH O unsatisfactory- 4. Manufacturers
—�-� (see"Orders") S. Retail Stores
COMPANY u-' �w►�L 4 6. Fuel Suppliers
ADDRESS l�� En 'Da' 01- Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor:
Case lots Drums AboveTanks Underground Tanks
MAJOR MATERIALS IN OUT IN IOUTIN T A xl e ffest
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, N2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAL RECLAMATION' REM ►RKS:
1. Sanitary Sewage 2. Water Supply
0 Town Sewer 0 Public
0 On-site 0 Private
3. Indoor Floor Drains: YES NO
O Holding tank: MDC
O Catch basin/Dry well
0 On-site system _
4. Outdoor Surface drains:YES NO '
O Holding,, tank: MDC
OCatch basin/Dry well ------ ------
OOn-site system
Licensed?
S. Waste Transporter
jla of Hauler_ necti nati on Waste Product NO
1 '
12 23 61 Person(s) Interviewed Inspector Date
.' BRANCH OFFICE
RANCH OFFICE
2703
TAUNTON,MA 02780 ATTLEBENGI ENGINEERING
ING
HAYWARD.BOYNTON&WILLIAMS INC. FREEMAN ENGINEERING CO.
178 NORTH MAIN STREET
60 COURT ST.
617-822-9870 617-226 1302
HAYWARD-BOYNTON 87, WILLIAMS INC.
140 SCHOOL STREET- BROCKTON,MA 02402.617.586.0628
Q�0 LAND SGq REGISTERED
LAND SURVEYORS&PROFESSIONAL ENGINEERS
W r• o� Continuous Service Since 1880
March 3, 1986
SS�ONAL
EXHIBIT A
SITE ASSESSMENT REPORT
Cape & Islands Tire Company, Inc.
730 Bearse's Way
Hyannis, MA. 02601
Att. : Mr. Gilbert C. Wood
Subject: 95 Falmouth Road, Hyannis
Gentlemen:
As requested, this office has conducted a visual inspection
of the above premises on February 26, 1986, and found the following:
The premises contains a one-story building on
about III Acres of land situated on the south side of
Falmouth Road.
The site is occupieu,0j.., ali al l iVv moire ccn-any
an auto sales office and a transmission repair shop, and
a fence company. It is understood that the building is
about. 10-12 years old and had previously been used as a
restaurant, a tire store, and transmission repair shop.
Also, that an underground gasoline tank had been installed,
used for about one year and was removed under permit from the
fire department. We were informed that some areas of the
ground surface had become discolored by spillage of oil and
transmission fluid by previous owners and that the contami-
nated soil was excavated and removed by yourself. No indica-
tion of that spillage was observed at the time of this
inspection.
PROPERTY SURVEYS • SUBDIVISIONS
CONSULTING CIVIL,SANITARY&ENVIRONMENTAL ENGINEERING µ
Cape & Islands Tire Co. , Inc. -2- Ma.rch. 3, 1986
The site abuts a car wash, an auto repair
shop, an electric motor repair shop, and a residential
house. The exterior of the premises is partially paved
and partially sand and stone.
Nothing was observed. on the premises which would
_71' riuil'.&mac:, t:LC E,tt::,cli�.G vi taa� LulUllj waatC. file LLSPeC—
tion conducted by this office was a visual ground sur-
face inspection with no chemical or bacteriological
testing performed. No opinion is rendered concerning
past activities on the premises which may have become
obscure by time.
If you have any questions, please do not hesitate to
call.
Very truly yours,
f
Albert A. Pearson, Jr.
Registered Professional
Civil Engineer
OF
ALBERT A.
c PEARSON, JR.
i� CIVIL y
r: A
No. 22618
FOIsTE��C���``�
vAL