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HomeMy WebLinkAbout0039 FERNDOC STREET - HAZMAT ��`/���OO�C �Cs�'�� ' /�i�iL ,� a o !I .' I� �� } n i, , if a �:i _ - ,. f t �_ a '�, ., r, _ _ _ s .. 1 - � Q d i �. :.. ' c t �i p � I f .. :. ArW40,90C sri�e.� f MASSACHUSETTS FIRE INCIDENT REPORT Y > .>.>...... DEPARTMENT Revised Form U.. . 1922 Hyannis Fire Department Report If Ex• In de 1 Date Arrival In Service 0001 120 Fi 1 1 /21 /97 Day I Friday 1 8 :47 1 8 :5 4 21 : 1 8 SIT FOUND ACTION TAKEN MUTUAL AID Leak w/ No Ign 4 1 Remove Hazard F ED PROPERTY USE (OCCUPANCY) IGNITION FACTOR C BUS FLEET PARKING AREA 8 8 3 Im ro er Fuelin Technique "4 2 <s:: OCORRECT ADDRESS ZIP CODE CENSUS TRACT D 39 FERNDOC STREET 02601 20 O TELEPHONE ROOM or APT.. CANAL FUEL COMPANY 508 888-1469 N / A 11 OCCUPANT NAME (LAST, FIRST, MI) F, OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE 12 LAIDLAW TRANSIT INC. 39 FERDOCK ST. 508 775-8187 G 13 METHOD OF ALARM CO. DIST. © PERSONNEL _. ENG RESP. AERIALS RESP. >'1 RESP.P.. 0 SHIFT HAZ MAT PRESENT? Y TANK. RESP. - JOTHER RESP. D 0 Telephone (Direct) N0. AL SUBSTANCE 12 0 2 1202 1 SPEC. EQUIP. USED? SPEEDI DRY & ABSORBENT PAD O 20 FIRE G TA q rn G SERVICE 0 >> 0::«:: OTHER 0 ;: O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTI14ATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. T CLAIM PD 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX AREA OF - >zEQUIP INVOLVED IN IGN. LL�jK ORIGIN H FORM OF EAT IGNITION ''> MATERI AL FORM ': TYPE IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE O EXTINGUISHMENT Li EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE op Material generating FORM TYPE most smoke OQ AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date JOSEPH P.CABRAL JR. CAPTAIN 1 1 /2 1 /9 7 • Comments for this incident have been printed on an additional comments page. Comments for Incident: 97 001120 Exposure: 00 Date: 11/21/97 WE RECER-'E i A CALL FROM A JIM GIFFORD REPORTING AN UNKNOWN SIZE FUEL SPILL AT LAIDLAW TRANSPORTATION CENTER 39 FERNDOCK ST. RESPONCE ENGINE 826 ONLY WITH FIREFIGHTERS COLTON AND SYLVESTER. •ON ARRIVAL FOUND A CANAL FUEL COMPANY DELIVERY ON THE PROPERTY FILLING THE FLEET OF BUSES THAT LONGS TO LAIDLAW TRANSPORTATION.THE OPERATOR OF THE CANAL FUEL TRUCK WAS TIMOTHY M OROURKE DOB 1/20/61( AGE 36) HOME ADDRESS 176 MAIN ST. SANDWICH MA. THE SPILL IN QUESTION IS BETWEEN 10 GALLONS AS THE LOW SIDE OR 20 GALLONS ON THE HIGH SIDE.THE SPILL WAS DIESEL FUEL AND THERE WAS A CATCH BASIN INVOLVED.THE BASIN IS A PRIVATE TYPE ON THE PROPERTY STORM DRAINAGE SYSTEM.THE DRIVERS STATEMENT TO ME IS AS FOLLOWS:GIST- I ARRIVED INTO THE BUS YARD AND THE BUSES THAT NEED FUEL HAVE EITHER A RED CIRCLE OR A YELLOW CIRCLE ON THE LOWER RIGHT HAND CORNER OF THE BUMPER. THE FIRST BUS WAS#55 IT IS ALSO MARKED AS PUBLIC SCHOOLS, HE STATES THAT BUS 55 TOOK 31.4 GALLONS. HE THEN MOVED UP TO THE NEXT BUS THAT HAD A RED CIRCLE BUS MARKED AS THE JENNIFER LEE HE PLACED THE NOZZLE INTO THE TANK TURNED AWAY MOMENTARILY TOWARDS HOOD MILK AND WHEN HE TURNED BACK THE NOZZLE HAD POPPED OUT.AND THE FUEL WAS FLOWING ON THE GROUND. HE QUICKLY RAN UP AND STOPPED THE FLOW OF FUEL AND THEN USED UP ALL OF HIS SPEEDI-DRY AND WENT AND GOT MORE.WHEN WE ARRIVED HE WAS USING A PUSH BROOM AND SWEEPING UP THE AREA. I COULD TELL BY HIS PERSPIRATION THAT HE WAS DOING ALL HE COULD TO EFFECT CLEAN UP. A CREW OF WORKERS ARRIVED FROM CAPE COD OIL COMPANY OF P-TOWN WITH ABSORBENT PADS AND MORE SPEEDI-DRY.THEY REMOVED THE COVER OFF THE BASIN AND USED ALL THEIR PADS UP.A PART OWNER OF CANAL FUEL THE RESPONSIBLE PARTY REGAN JASON WAS ON THE SCENE. FOR LAIDLAW BUS COMPANY WE HAD SANDY GIFFORD BRANCH MANAGER AND SHOP FORMAN BRIAN COULSON.THE FIRE DEPT.NOTIFIED THE BARNSTABLE BOARD OF HEATH AND INSPECTOR DONNA MIORANDI CAME TO OUR LOCATION.ALSO NOTIFIED FROM THE DEP WAS JOE LEARY OF THE LAKEVILLE OFFICE CALLED AND SPOKE TO ALL CONCERNED PARTIES BY PHONE.THE DEP RELEASE TRACKING NUMBER ASSIGNED FOR THIS SPILL IS 4-3513502. THE MA. LICENCED CLEAN UP COMPANY HIRED BY CANAL FUEL OIL WAS ENVIRO SAFE MA. LIC.#329 THEY ARE BASED IN SANDWICH MA.TELEPHONE AW08) 888-5478. THEY SENT DOWN A VACTOR TYPE ( PUMPER)AND PUMPED OUT THE BASIN. LCP TESTS OF THE JIL ARE GOING TO BE DONE TONIGHT AND A BOOM AND MORE DRY PADS WILL BE LEFT IN THE BASIN FOR FURHTHER PROTECTION AS A HEAVY RAIN STORM IS PREDICTED OVER THE NEXT 12 T0.24 HOURS. I ALSO HAVE ATTACHED TO THIS REPORT A COPY OF THE PRINTED TICKET FROM THE OIL TRUCK, WHICH STATES THAT A TOTAL OF 41.5 GALLONS ONLY HADBEEN PUMPED OFF AT THE TIME OF THIS ACCIDENT. THE REGISTRATION OF THE OIL TRUCK LISTS THE OWNER AS MICHAEL J TASHA 123 BRIDGE STREET SAGAMORE MA.A 1997 VOLVO MA. REG. F54009. THE INVOLVEMENT OF THE FIRE DEPARTMENT ENDED AND THE CLEAN UP WAS IN FULL SWING BY ENVIRO SAFE OF SANDWICH MA. ENGINE 826 CLEARED THE CALL AND RETURNED TO QTRS.AT 2118 HRS. CAPTAIN JOSEPH P.CABRAL JR. 11/21/97 . I 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 01 HYANNIS FIRE DEPARTMENT Y 95 HIGH SCHOOL RD. EXT. HYANNIS, MA. 02601 HEM ICAL All HAROLD S. BRUNELLE, CHIEF SNT STUDENT AW406NSU o;FIRE ERucM S SPA FIRE PREVENTION BUREAU 1, BUSINESS PHONE' (508)775-1300 FACSIMILE PHONE;(508)778-6448 LT. DONALD H. CHASE,JR.,CFI LT.ERIC F.HUBLER,CFI FIRE PREVENTION OFFICER FIRE PREVENTION OFFICER FACSIMILE TRANSMITTAL SHEET THIS FAX IS GOING TO: .. ... . ....... ..........,/r.•. ... ..... THIS FAX IS BEING SENTBY: SUBJECT OF THIS FAX: DATE: FAX NUMBER: NUMBER OF PAGES: (INCLUDES OVER) NOTES: .................. ............ . . ........... ... ..,. ......... ........ . .............. ............................................ y.. ... ... . .............. . . .......................................... .... ........1.�;. . .. . .... . . . . ....... .. ........... .,�� ..i, 9 ..... ............................................. .... .. .. .. .......... ...... . ,� ........ 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 02 HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 PAUL D.C HISHOL.M,CHIEF FIRE PREVENTION BUREAU L.T. DONALD H, CHASE„JIB, LT. ERIC HURLER Inspector Inspector NOTE FOR FILE: 39 FERNDOCK RD. CALLED TO THIS SITE TO WITNESS THE REMOVAL OF FOUR (4) TANKS FROM A CONCRETE VAULT IN WHICH THEY WERE INSTALLED. THE TANKS CONSISTED OF THE FOLLOWING GALLONAGE: 1) 20,000 GAL #2 FUEL OIL 2) 20,000 GAL #2 FUEL OIL .3) 10,000 GAL DIESEL OIL 4) 6,000 GAL GASOLINE ALL TANKS WERE REMOVED WITHOUT INCIDENT OVER A PERIOD OF 5 DAYS ENCOMPASSING THE CHRISTMAS HOLIDAY. FOLLOWING THE REMOVAL OF THE TANKS, I NOTICED THAT THERE WAS SOME PRODUCT OF SOME SORT IN THE BOTTOM OF THE VAULT. IT WAS EVIDENT FROM THE SMELL THAT IT WAS OF A PETROLEUM BASE. THE BOARD OF HEALTH WAS NOTIFIED BY MYSELF ON CHRISTMAS EVE (MR. McKEAN). DEC 26TH, I RETURNED TO THE SITE TO WITNESS THE REST OF THE TANK REMOVAL. I THEN NOTIFIED THE BOARD OF HEALTH TO RESPOND TO INSPECT THE VAULT AND REMAINING PRODUCT, THEY STATED THAT THEY WOULD BE ON THE WAY TO CHECK OUT THE SITE. AN INSPECTION OF ALL. FOUR TANKS SHOWED THEM TO BE IN EXCELLENT CONDITION WITH NO SIGNS OF RUPTURE OR LEAK, IT APPEARS THAT THE PRODUCT IN THE VAULT COULD HAVE COME FROM OVERFILLING THE TANKS OVER A PERIOD OF YEARS. LT DONAL.D H, CHASE, JR. FIRE PREVENTION ' X 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 03 DIMENSIONS Tank Remov From Width Length _ (no. s t r ee,,V� Tank 1 --- X ---- - - - - - -------------- ---- Tank 2 1V- X (city or town) Tank 3 ----- X ----- Fire Department ql Permit # ----�"' ------"----- Tank 4 --- X - (if applicable) Tank 5 ----- X ----- (feet) (feet) DIMENSIONS tank Remov From Width Length1-"' Tank 1 - X - - --- � -------------------- Tank 2 ----- X -- (city or t wn) Tank 3 ----- X Fire Department Permit # ---- /il�--------- Tank 4 ----- X - (if applicable) Tank 5 ----- X ----- (feet) (feet) DIMENSIONS Tank Re oved F m Wi dh, Length (no. street) c� Tank 1 - -- X ----------- - - -- - - ---------------- Tank 2 ----- X ----- (city or town) Tank 3 ----- X - Fire Department Permit # - Tank 4 ----- X (if applicable) Tank 5 ----- X ----- (feet) (feet) 03/14/2006 15: 45 5087786448 HYANNIS FIRE PAGE 04 RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK NAME AND ADDRESS OF -8-IN-age APPROVED TANK YARD I) -tis APPROVED TANK YARD NO. ., 91 355 Tank Yard Ledger 502 CMR 3.03 (4) Number: _ I certify under penalty of law I have personally examined the underground steel s delivered to this "approved tank Yazd" by firm, corporation or partnership and accepted same in conformance with Massachusetts Fire Prevention Regulation 502 OIR 3.00 Provisions for Approving Underground steel Sto age dismantling yards. A val' t was issued by LOCAL Head of Fire Department FDM# 7� �to transport tanl a ficial ti a of am owner or owners authorized representatives l� -� '! / S TITLE DATE SIGNED This si of disposal Host be returned to the local head of the fire department FDID# 2-VELrsuant to 02 CHR 3:00. (EACH 1711M MUST HAVE A RECEIPT CF DISPOSAL.) FORM F.P, 291 (rev. 9/88) (OVER) PIA,SSACWSEITS STATE FI1M PW-%iAL'S OFFIC RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK' NAME AND ADDRESS 1vfT -55 '2.C7TY CIF�A �f�i}�i.�el�.S�Fl�2 1ee1 �• APPROVEDFTANR YARD — 5.48 APPROVED TANK YARD NO.1_� Tank 'Yard Ledger 502 CMR 3.03(4) Number: Q 35 0 I certify under penalty of law I have personally examined the!underground steel stow delivered to this "approved tank Yazd" by firm, corporation or partnership . and accepted sane in conformance with Massachusetts Fire tat Regina 'on 502 CMR 3.00 Provisions for Approving Ucdergrouud Steel Stora �tsnantlirg yards. A d t was issued by LOCAL Head of Fire Depattwnt FD3D# Q�� -to transport N Loisl ti of app tank owner or camera authorized r�resen ve: SIGNATURE TITLE DATE SIGNED This siffW of disposal must be returned to the local head of the fire department FDID/ L �yrsuant to 302 CHR 3:00. (EACH TANK MST WE A RECEIPT CF DISPOSAL) FORM F.P. 291 (rev. 9/88) 10m) MASSACHUSEP15 STATE FIRE MARSHAL'S OFFICE RECEIPT OF DISPOSAL OF UNDERGROUND STEEL STORAGE TANK NAME AND ADDRESS 13") }�rPEe}'-1£A�S:S:�lrra{ ��► �` OF ----%s APPROVED TANK YARD Y : ltkMd, 2790-0152 APPROVED TANK YARD NO. �_ �_ yq g c Tank Yard Ledger 502 CMR 3.03(4) Number: I certify under penalty of law I have personally examined the underground steel storage tank delivered to this 'appr0ved tank yard" by firm, corporation or partnership and accepted salve in conformance with Massachusetts Fire Prevention Regulation 502 CMR 3.00 Provisions for Approving Underground Steel St aetik��dismantling yards. A val' t was issued by LOCAL Head of Fire De�partrnent FDIDN transport ieial ti a of tank caner or owners authorized representative: 71 1"-5 :a 7- 91 TITLE GND This Sir ipt of disposal mist be returned to the local head of the fire department FDID# x— suant to 502 CKR : WE T111�II( MUST HAVE A FM:a?T' CIF DISPOSAL) FORM F.P. 291 (rev. 9188) (OVER) PPZSAQWSMS S=E FIRE RAP01AL'S OFFICE 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 05 HI-ANNIS FIRE DEPARTM-P—NT 98 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D• Chisholm eNier Sim ohe Oetectou Save Zved BUSINESS: 775-1300 I:MERG ENqY: 775.2323 PERMIT FOR; FOR REMOVAL AND TRANSPORTATION OF STORAGE TANKS FDID NUMBER 01922 DATE OF APPLICATION /xb 7 l 9 / PROPERTY OCCUPIED BY sa ra D aBR ,►` 4 ycoe ��� C'o . PHONE 8 775-7/8S LOCATION nlbo PROPERTY OWNER Ot& es. PHONE ;edgit 775- 7.,Q� TANKS TO BE REMOVED ALI TANKS SHALL BY INERTED BY THE USE OF DRY ICE AT E, 5lbs er 100 aal• QUANITY SIZE (GALLONS) FORMER PRODUCT STORED z rived. / Poo FNEL Poo PROJECT SUPERVISOR PHONE >t Igo-6s/j COMPANY NAME f1EE'7 dF4 C 7w/C- Apr14A&AI 0 yl- G ADDRESS :,T6S G/�iuT�Roe.l'T. 'TiwtiTc�l, Mn/r►� 0A7J'0 EaXCAVATION COMPANY :CLEFT 1ti►ivii?a�l .s�ENTI1wdeeweFS. /'rvC. PHONE Q f a0ng - ADDRESS: S �M icEc7 irar7m A7�1 027>:a . DIG-SAFE NUMBER 9'iSo/ r90 START DATE COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S) NAME : PHONE : ADDRESS: COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE : NAME cEeT �iRaw sAJTq� Rvicos Swe. PHONE o>< pYe-6ti.L ADDRESS : Sipy JV,wrwRao a 02720 D.E.Q.E. LICENSE NUMBER: MAd A71163A. EXPIRES : 12 - 9 MANIFEST NUMBER: mg •/i 6 0d, 7.'r COMPANY TRANSPORTING THE TANK(S) NAME: c �ivv o EouTiIL fE.svicFs ?wi c, PHONE 7'sa-68/ ADDRESS : 'r R p .S` REE roN 7 fv a a, 16 THE TANKS SHALL BE TRANSPORTED TO PHONE f,t.� YARD NAME .. e e v ADDRESS /P7. e 7 .e'T A • ° MASS. FIRE MARSHAL' S APPROVAL NUMBER 2 L DATE OF ISSUANCE _ /�--��-344�// HYANNIS FIRE DEPARTMEN40, �LEPRT DATE OF EXPIRATION HAZARD FOUND - SEE RE REMOVAL WITNESSED HAZARD NATURE F APPLICANT ra SIGNATURE GNATURE OF HYANNISR.D . OFFICIAL SI 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 06 ROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. TOWN OF BARNSTABLE V A Cs UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS l r 6 . ASSESSORS MAP NO.- `3 PARCEL NO. C? DO C.- ��'. VILLAGE: N !J :RSON . D �J'jJ�,� y J L�v A PHONE NUMBER )F TANKS; - .. CAPACITY: .. ,TYPE-. OF FUEL.- AGE: TYPE: LEj OR CHEMICALS DE1 V e6 V Z,'O o o CI '� I j �L 5YS .a ►' �' tt. 43 G ,4 o J a 03/14/2006 15:45 5087786448 HYANNIS FIRE PAGE 07 ` F.Y. 292 a�': (LTilc CFDiltinalifuraltil d Alub-6atllimrtls Department of Public Safety--Division of Fire Prevention p a� APPLICATION FOR PERMIT FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD 064,01 C,82 S.40 M.G.L. To: HEAD OF F RE DEPARTMENT DIG I G SAFE A F E NUMBER RE w 17 T 7 rjlorl Dole e with the provisi0 of Chapter 148, G.�,O_A�rov' ded n (!pr:pe:rmission Application is hereby ade by C oe Name o erson, lr or orporatonress move and transport underground steel storage tank(s) from 0 ,fR—re-e-f address (city/or wn i FDID G 17y 7, to approved Tank Yard# /V;W a ew��y � State clearly type of inert gas used in steel storage tank Iype of -injert, gas use Name of Person, Firm, Corporation disposing tanl _,�/ Date issued -1Pd / 19 � By Date of expiration 19 d/due �gnatu�eopp �nt 1Zije Commontnealtb of fflag5ac1ju9ett5 =- DEPARTMENT OF PUBLIC SAFETY--DIVISION OF FIRE PREVENTION P" r; P M I FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD c•e2 s,so H.G.L, DIG SAFE NUMBER In accordance with the provisions of Chapter 148, G.L. as provided in 121-trft21 Section 38A this gra ted to start Dole Name: @ Full name of person, firm or Corporation To transport underground steel storage tank(s) to Approved tank yard#/g20/ State clearly type of inert gas used in steel storage tank steel tank me loir Name and address o cont ac r disposing tan I N' r wh an wi Fee paid Location to is be transported 7 eras r+u • i7�" ,.,17' rxVt.•r rflf cia granting renmit(7 �) (11 ad of Fix a Dept.) rf. \ TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS �'1 __ � .y0 r V fly ASSESSORS MAP NO. ` PARCEL N0. 0 d ADDRESS; -N bo - j7'"' VILLAGE x r ! 191 9 CONTACT PERSON U j-L\y A PHONE NUMBER LOCATION OF TANKS CAPACITY: TYPE. OF* FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION It "2- t 6"1� SYSTEM! tll� 1z, DATE OF PURCHASE OF EACH: 1. ,B 2. 3. 4. 0 $ 5. _ DATE OF FIRE DEPARTMENT PERMIT: o� / � �I g l oI a TESTING CERTIFICATION SUBMITTED: �� "� PASSED X DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. ttMUvj?a1* of sBMrltsrits DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION PERMIT 9�� ' Date t;fir TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY In accordance with the provisions of527CMR9` 245this permit ,to maintain- ",' existing/new underground storage facility 'is'granted.to Location of property: 3-g �eryel.oc. Street a dress Owner of property: cU A U,•.; • Full name of erson,'firm or corporation Restrictions: Ta/Cs Al Le.vcre. e:: G4/' 000 file/ Fee Paid:$ (M.G.L.A. Chapt 1148 Sec Fq F P. 290 ? art a This permit will expire v19$7 ��,►---, <s, Date, r g a ure of'Head,of Fire Dept' or' ppointed de gnee y ,fib" ... . •... ..;.} - (Owner' s Copy to be posted at the storage facility with F.P.290 Part '3)k r _ 11 5 c, c�c (� 2 (/a y 7 /Z !�=�2n!Df)G 5 i /�•���v�i r.rw.N{uptl.r,O-nM w Ourr A"-$ Ne.end S-11.1 Cnt ful. O.r N 1..1 From 15. TANK TO TEST 16. CAPACITY 7 I Sidon Cnwn Y ST I p�O OO Kv mat•ccur•p V�7i) � Tank MenNenww'.Co.." R,2 T1-1 T F2tn1 P, Nominal tepee"" �c.aan. ceo.c•y ctwt wel.Ma a.bune l Cenw.nr Ero n.w+w 041, y, erMtllr.r pul..n - �..Oj le*we eloubn as toTrue Capacity 1 ❑ - i I Charts slrod+a wntl ,_lrQT11f Kos Socha-DETERMINING TANK CAPACITY" AID -W T. Compensation Stick RoWinge _Total Gallons . 17. FILL-UP FOR TEST to e in. Gallons1 - ' ••.ReadingCA[-.t:(4LAfc-,p -Ar`cI C� Stick Wet«901111011% Qj� A PPL i E D k,wmery ---product 974? before FWup to N In. fie110ns �.- water �. FIE up.STICK MORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DEWtRY OUANTITY product in Tull Unit(up to Rp Wp•) -JolalTW*Manuel" 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK AN Gravity Cdlculalion TEST PHASE- a _ fa.rlwwl sections appfceble.CMck aloe and rscerd Ve.adla•N leg 4261• ��• cZ® �U 1"' PHASE( ' O Walor N tank ❑Hip water table In tank onco"00n ❑Lk*s)akg 60e1•d• LVLLT PHASE U ' 21. TEMPERATUREIVOLUME(ACTOR ta)TO TEST THIS TANK Its 't ' 19. TANK MEASUREMENTS FOR k Taps wamis)1 Gender/;i-•F pr11d1rEi a Tank_•F fa up Prolud On iruU-°F Eepeta0 Cn+rga A a l 9 TSTT ASSEMBLY twm a tal eoc itsGrade•.................... _ 22. tlrrwLLS.nfer'F.:dtno ate! Add Sr for e-L............... . w. etw 2 2 Add 2a'for r L or er seal....... 23. Were por'F in re rge a ospoctod cti^a `� Yf Tadu tbi q lo•uamOM �Ame.knet. .. " (�p ,QO0,jh3y_. �a 73361 gaeona $ 20. EXTENSION HOSE SETTING total p 6i"t,to ooenclent of ospsrrsbn for volume ctenge in this tank is Trek lap ee tY•a•................................... full tank(if or 17) kwolved product pair A / Emma toe.n auction k1W C or m.r. 3o2 W � � Q�B 9 �c�� Tlws k ............................. .. O 25.r welter us charge pat IF(2+) +Digru per IF In lost volume change per digit. test , Z 'R Fa pip...WA&abo t Aped..wig 10p of fill Range(23) compute to.aurae pieces. lector(a) 38.06 MOLUMt 39. 26. 30: ttroflosTATtt 31. WIN KUMN=IR 34' RNKEOFK teN1ItSNlO! CHANUS ACCUUUlAtlO tog Of TEST emao1M1t msum ELCM"ill CAL ESE fItIOE W Wit k(AMkc CaARGt CORTROt ' 35. 36. 37. Te.re.r e b n.ae te.n,wrf 27. 28. 29. sadri.ta.1t 32. P•N.tt hM.a cluaee U-0.14:e e+l••re•a1. noel w s.%o- eeT Record details of setting ev a..r.l Is adet, rows a N.flsal 4-1 Tbanwal Ryser. lrl•1•1- wrnw lenw N w t...rwrr.l. and resnieg te%L(Use1.11 4 RieN ti t.•.er ea.w 4Nui.e• (.p.nlgn l•1 u _ 1. length of line it ettdtd.) M " • Sdw ANer Plan Real:q 1.1 C."beti.' Car.rereao t-1 Whu°y'-n tan k.Miy Annual 111"44 Kaef a Nsn.wN 11•1 .331v)-.31111 IN 1r) i`vED iiE S uC A o2_ �I T A Ae �3 5CA/5a,2 IF o ---'- 1 1/2- 400 , 9o0 -.0a0 6 O 1 20 .o -.too S /5 17- , (00 -- . L ll-S .14-1 - - A L __ � - �� 72 n t5 ><a o /l e q,2- ,770 � -Sl o •/-.o LZM Qy - ee ` - - 14. sC.(J�QP� ✓�oP � /S�DC sr //�Y•�i��I, 's ��� --- .� �-�7 N•rr..11 f..ewr,O-n•r w D.•Iw .IIr..1 No.•M Snwll.l Cn. SI•I• O•r.ur 1.., {r0 g•17 15. TANK TO TEST 16. CAPACITY h�1 ,,,, T-+ 47 i/A)7-P�LIe (�e fried cvV0 !v lwu.ccw.0 /�, 97y LM M.nuluwu!•CAnI Nwr:nM Gpacnr—Y--- c.o.cwr chars a..aal.—� OWwwN.r pwrww G•e,rn. � � CorM.nr lnerrww,p u.r. 10 J � Fv` ` J 1•there"t as to Tme capacity i ❑ I CNwts cupph d wqN F!g !1_" he,•ne•na ,r. G•.. there Sao S.etron-DETERMINING TANK CA►ACITr I I Off, W.T. Compensation stick Rowing• g Intel G.n... 17. FILL-UP FOR TEST lo W In. GoRoAa a..R..durg Stick Water Eloff«n product/,P�J�� Inwm«Y _ y/ before F — — ' to M Nt. .non• rraldr FIX up.STICK BEFORE AND Arm EACH COMPARTMENT DROP OR EACH METERED DftrVtRV QUANTITY fra OWrtslw - product 1.WB lank(up to tw Opt) total — _A"/ 18. SPECIAL CONDmONS AND PROCEDURES TO TEST THIS TANK API Gravity Calculation TEST PHASE Sea,nut.0.actions spokable.Chad,bebw wW record pacadrNe in In(26)• thr PHASE 1 ' ❑Wrw In tank O No was«table In tank esCdv06orl ❑ Une(e)MInO Mstw carol MLT ❑ PHASE 11 ' 21. TEMPERATURE/VOLUME FACTOR Is)TO TEST THIS TANK V I g ' 19. TANK MEASUREMENTS FOR It Tooth warmer?I 1 CDleat 11—F pmdM is Tea—•1 F"promta on Tract—•r fxoWtd Charge 1•a 1 TSTT ASSEMBLY Boom of tank tocrw.•.................... 22. ,Titrrma4s.n.er r.e0kw.nor da�sDon, JZ_�y/,.l� . Add 2r fw r L.................. Z 3 - Add 24-For r L or six Goal....... 23. 010,per-F In rrlps of eepatlw ctrarge >�•` P O " a"„- Total t.raklg lo asaemMa Approaknalo ........ o 14. 970 x ,o 0 0 � _ . �y S g.lio.s $ 20. EXTENSION HOSE SETTING low quLvjq in coefficient of expansion tot V*kM*t:hange In this tank 4_ (, Y O Tons tap r Oraea................................... fun tank(1s or t7) Involved product per'F 7(G, // �7 'Od r- Eawre kor on ow".tube r or oars 9, C _^/ //� 91 pet- 7 blow tank rep..................................... " 25., I / /� 4- �P f� - , dV / This is vokow idtwlgs par IF(24) Dlgha par IF In lost Volume change per digit test 2 •It Fa pip extends above goad.,rase sop of li - Range(b) Compute to s docilnsi places. lector(a) 26. 9�26 TAT9 31. �RBr[ ,�fq 34- 38•CRARGtS wiT HE 39. GRE Rrr[aOOR CORrERSOgs AttWANC tro lOG Oi TEST►ROCIWREt OI It=is it t'i• 101 Was W IACN READING [HANG[ 27. 28. n.e.0 nosed Ear" a-rnniw 1.aaNatwo Idal EW at w.c Wastes 32. 35. 36. 37. AIIeu-a.t w w.4—ter• sat Rec«/details of setting N s aosrt. Rnhoe 1-1 The'" wow. kl-DI- wb1i'as wars. - and ronnin�tact-(Use IuR .wl w S.— I—.- E.ea•e+.• 4prNrce.l.)a •tw Uwr.e-W Msgtk of lttis.if nooded.) .kid- 0.Ira Atwr n.wd bed" III C.wadie - Caw.aiea l-In- aatifies R..eky B.afis Rdam-•31III S.E71 UP ��SE�c%So.E E DiuK o .2 --- -—--- i �- ,$1 D F•7a0 ,o O ' f-/S .�a3 / 51t FVSV SS —=- - - 1500 0 o 151Y +1 O 370 _.— l. 1 (q05 o F t O U -I�µ --- - 6, - i- v - o1S 1 fib' :a13. U d- 5-0 e350 D act-$ - / So 3(Oo -t,0/0 eOOVW 2 OAAW + - tt 4 10 725 t p r S t i Ir 0:1 F1' ti".00 / —t--—-- ll, 7E'G t "r;of 3 _,,0.3-{. , - — -- — s _ T -- /f'!�, -i6 -ifs 14. �LA&_�—(Ay L U 1�- �E� OL 57— l'►5(A It1,l/;5 _- -- Nero.et 16-nit.Own.r a ours Add.- No..nd Stu•tlsl b fYn O•t or toff `fro'/m 15. TANK TO TEST 16. CAPACITY Sr.t-Ch.rl �' N'` ,/'('' ,( By mm1 accwne /O lank Mmutactunra coot, k Tl/ ��:!( I IV Nor.in.l C.wcity D OU D capacity chart waMW_;gi- . Ow.nnM1 4.pO.n•on Gtlbm wO°"• I Comp.nr trio-ne Dab .1/ / IC's / ^ 1.then doubt n to True Capacity 1El I CNna tupplud wnh(NI^;-O Tlr V J Br.L�-ems cr�.!`l Sao Section"DETERMINING TANK CAPACITY" I Ott- W.T. _... -... .-_ /Ek�•te YStick Recall Total Ckllani 11._ FILL-UP FOR TEST Compensation tow in."°s Gallons a..Reading — Stick water som Nvenory J,}BolroduCl al«e Put-up �yT to tic In. Gallons 0 woter --. PIN up.STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY ' 1-n nN Product In tug lank(up to fRt pipe) total - Ln Tank Dlsmetar (� £ 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK API GtOVlly COIGUIOIIOn TEST PHASE Sae manwl sections applicable.Chock below and rac«d precadurt in log(26)• .. - PH4E I ' Water In lank High water table In tank excavation. Lkw(e)being tooled with LVLLT_ PHASE It - ' 21. TEMPERATURE OLUME FACTOR(a)TO TEST THIS TANK leg ' 19. TANK MEASUREMENTS FOR Is loday Wiltttn�YCO.411?i!_'f Pfodua re tank—•f Fill-up Product on Truck—'.f-f.pected Change! 0f 1 m of ASSEMBLY �.V 3� � Bottom of tank to Grade,..................... / 'P r. R 2 21. -TMmuLSsns«nedkp atwr e[rculatbn o!3 O Add Se'for t'L............ .... - a" 3 Add 24-for 2-L or air$eal....... 13. Digits per'F 1n reselp of axpeetad change- .r Taal tubing to a.aemW Appoatmala ........ 11,71 x . O O✓T S S yss�3 8 o a gagons 2 20. EXTENSION HOSE SETTING 24' total Quantity In Coefficient of expansion for a volume change In this lank 0 Tank top to Oraee................................... full tank(16 or 17) EnvWwd product per'F Y to"ho.e en suaion tub.o'anon r Al S 5-1� ��/- O/3/�/ •• 25..r t 1LJ a lost Is _ Obelow tall top..................................... _ 4 2 YOWrr.e Change per IF 124) Range(22) N Usl Volume change per digit left 1 '11 F!pipe extends As"grade.use top or fig. Compute to a decimal places. b.Ct«(A) 26 30. HYDROSTATIC 31. 34- 1E11PERQUIE COuKritOa WHET VOIUCHANGES M[ 39•A[CCHARGE[0 l0G Oi 1ESi►f10UDURE3 PRESSURE �REWs010D.At CA m ISE FAC10E W EACH READING CNaNGI CONTROL leetuu.n b p.lord recce ' 21. 29. 29. SudFwe lnd 32. nN..t le h.t..t 35. 3 � 37. ..r.m Eat Record details of setting up fees" i.lost.$ GNuu. R.Wsed 1-1 Ta•r.al NyMr• 1<I•DI• trowme tAnv. u t..u.w swore and running test.(Use full_ - - era. s.1�. t.,cl e --�..-. -- s.asar lean- W.riu. -E.p.raron 1.1 or e•we err�,- length of line it needed.) N dais► Olen. Alen hWn MNiy Isl C•'o�ie'" Contracrron 1-1 lest M.file R.nN.d R..4" MNiry R•su.nN 1.1 •Ulvl-.])Ill Inn ua.rw- 04 err] o _400 a ---- 5 .6 ya- ,.1.Sd G S —,cats 141 ks- y.�•a , /ors- . sou OL v/5 / to f-o__a2- -.vier /o ,fib .;too .P-3s tPj 4 c _-- 7 2 .3V. 60 Ho3cr L b / f d toa7 ^._v_07 ol. .3� caol_ -•.�1/... 375,eX, — ---- — — ` tea. ✓. vt� v. ✓..., ✓ .v.�t�v.. ::.t.A✓ �JJI./� Ui %..1. .+. a Comtttorcbeatfj t3fiagMlyu> tttj DEPARTMENT OF PUBLIC SAFM—DIVISION OF FIRE PREVENTION C.82 S.40 M.G.L. 1010 C0mm0NWZ"TW AviwUR. "lom DIG SAFE NUMBER �ar,-z�r �p.iy, l9e � s +Z-a�wb r7G wL.ii..�... art o01� PERM 1 T n accordance with the provisions of Chapter'148.G. Las provided in. ) C1 'CAD this pennit is granted to N., h(X 1/u ftmm N " O~. Inw fr.Wf+ntWl oiNN {rprrrll ,a �asba l l (1� �o Q� J G'�c3 I l c7� �r�L2 Wr3A l Stara clan►1Y y�`��. • which pon,it is granted Restrictions: PQC cm R C) Dcj IGM 1retWr ti MfMI W nr�w hw+•w rr wur rwrw M t�IR�M MrN�r•rrnatKu�M d leaarrnr Fe*Paid )b_- 1 �••1 NfwN{' f'^I Mt�'�Ir ;This pmm+it will expire.._..__ 19 ITill�l Fir (THIG PERIATT MUST 139 CONSPICUOUSLY POSTED UPON THE PRItMiszz.1 �'rl V OF�Nt 1p v is 3A1riTAM _ ■tea \�ter•tr� TRA REGIS TION R $ �36? A1A1,I 5S&02 1 3ARt�ITA3Lr" ��•"'� i .. 29' (City or Town) (Date) .. . _. This is to certify that has, in accordance veitb the provisj of Chapter 148, Section 13, of the General Laws, filed with ne a certificate of registration setting forth that N'• is the.holder of the license granted !n same as above I . t t�, Aueu�st :12 _ 29 69. for the lawful use of the building(sj or•other stru_du '(s) situated or to be situated at A TRUE COPY ATTEST- - 150,000Contain ize` r Undergrounds Te acity M gallons: Aboveground 0 IGnd oguid t ote stored: - SN S 1 AB LIFature and Ofitcia!Tulc) Note:A eertiGc+te.of registration must be filed on or before April 30th of each rear. } (THIS REGISPRATION MUST BE CONSPICUOUSLY POSTED ON THE PREMISES.] ENVIRONMENTAL COMPLIANCE SERVICES, INC. 3 '-oz1 ; ►l. r f -W �," , Company Name: 1 d W) D P HYAvM'� - MINS 771*L Attention: y tFiZ N A _ � S'v g- 4.V- 3.9 y From: _ No. Page: ow (Ineluding 'his.Page) Re: �1 °� � 'T S I Tc. S !r Job No. cz ca Date. mlenn comments',-Com : 777dn/t vv S6 270ch . far ovr_ hel an S -T `1f1�ri.w�. 6i?rrx_loG Moe, I r'►f�'��e��'c+�i !yL 3 1'' .Yr'14aC I i C',64 S e s ���� l� If'r_ 'h s es C la.-A r7 q Ve$j Should transmission be Interrupted or documents appear illegible, please phone our office. , Originals of the transmitted item(s) havelhave not been mailed 588 Silver Street•Agowam,MA 07001.413-789-3530.203-291-9229 FAX 413-769-2n6 _ I Owes Name(ltofn WWI)I) � ,r-� R tf� Leeallotl(hews fiRsoNon� � r�4�_Paps No,.1lf ti pW F fes ' r / / r .. Tank Idonilleallon No.(e.g.,ABC•123),or Tank No. Tank k Tank No. Tank No. ' 'fin No, ArbMradly As vd blo wntiat Numtmt(t,a.,,,g,�.�,) ✓ rV r 1.Status of TVk (Afarlr�N fhaf apply mJ � Gumntly in We [M ® I"�l l�1 Liu r Yvmporadly out cl use p + . Permanorltly out of use �' 7 Sravght Into use after 6/W 2,mans A aen 1 I -- 1.Illeilrnalad 11shl 2!2!#ty Motions) b • `4 O b o G Q o' 4 Msbdal of Canshwdon Stnnl �� N Co rMin ®_ (Mae one m) Concrete' FlDerplaas Rsinfprr:M Plastle Unknown C. Q C7 I•� C'] Othrr. �Please Spoeify s.Intornal prpleetion Cathodic protection r I (JNerit aR firesapply gy�pp)) Trlarlor Lining to.0•,opoky reins) l� r' None Unknown Other,Mom 9paeify ........P� -- a atern.l Proteollon Cathodic Protection {ttarrral�fJtflfsppJ)►m1 wlnuff(e.ti..+raphwltla� I C; C� EM I END f'Iberplasa Ralr>tnroed Plastic UAW NAflANOMA i Unknown ] A 4t.. v dC T#N ti e Ntltrt'!�t �/� Lr Other,Please Apeotty T.PIPIN tiara t3tael [� (AloskaHffiefflpp4►ISJ GalvanIzed9teef U 'EM Ei] R CM F{berglass Relntoroed Pifwt{c � �;,] , � �.-1 ` Cathodlully Protected Q Unknown' Other,PleanSolmity — IL Substance CunarNty m Last Stored e. Emply dbdE Ltn 1 In amplest QWaMlty by Volume b. Prhoie p (lgllrk ep flat oAAh►mf Dieasf Kerosene � , Gaspllne Jlnaldtlitlp a1Ct?hol blldo Used Oltit r Other,Please Specify '� �dL 'w 7.. Iru�1. fi. INalartlatna�trbaraaae ('...� I.�� � C.7 [� Please Indtcate Nsmn of Prtnelpal t IPIClA Substsme -- 4 ChomIasi Abstract Servlee(OAR)No. —�,.. —�--- ----. Mont box 0 it tank stores a Mlxturo Of aubitanaeo d. Unknown III,Additional Information(for tanks pormeneillir low"out of ulv oo) a. Estimated dale last Mato(Ina/yr) -- b. F8111"AMd quantity ateubatanes remaining Joel.) o Mark twitMif tank was filled with Inert material. (e.g.,sand,concrete) Holificallon for Undergr&ndStorage Tanks L . FtR Oi11, ItAn NN ONLY f e"afito a lr I,A;Nun+btu Llubmit LOCAL' rTRE D>I:DARTMENT oe Nowka%Iml la r rN(7 Pirdcraf 11e b,all wrily rovM)total Owl hall bran 4 1pelinr taclill t thlctuding gathers Owl ti`(IWI1tcd ulwct Ihl \atulel tlrh Iral to staff relNle M wMtaNaa alnn�tnu.ry 1 1914,Ihm Art In Ilia jimid lu u( pi w6rar lain)Avi of 19p(l,or ft Mull 00 Lryuld Pip<IiPt S Idv And 10,111 Milt ILloll.or thataril l Itniolm4naMoyl,lop,Y11alnI#nnot6n udN %h►hi.antncnaetopllwlinvfeviHI%ocsubledutnle,SWlCiarl1 YrulnlbrArrlien1001.f1ho11wetplNE�nwrraMseuldA/wwgAct,f�llAt, 6,eulfu�ciu,pvunJuwnlh,hh�pulnl>.tagltntnr; � ,wtnrm irakr of wpwte Nali I paltetiun n)awutt. I 6•' ';: aaslNealtlN. �, �,1inN•IhntvghMrtro,IwanMhi The primary pvrpoee ofthla noel Ion pproffahl U to ImIl bnd erahattt woth toun0 links I et agora or hall a1 1 tro1um or hanfifoua tobalanaau. It le kliyu;dnrp,nrr►rneleledpthcrin/lit difro;l)f111elY,ftuuil,aras{ulNunhtnrna I I pthenn�np,aulldttly vkpeelad ghat thy InroraaNltnl i'ou F e will to:naiad on rtaho"biv aullbl It 0. fW.... tanl.t •Iluawd in on underprtnind vrou (such a% u ha`anl.•nt. ttb,u. :rY•' t%vitta.,u.to 11w dit"hwYrawil i titndK)1tYf AntrMlCllye.bellcG m milo)lecilon. mintru tnh,ny.dri,i.shark,oNunnap lrkdr aiurubr tan0 i•.hYu1cJ„pn„ttf ab,»o the who Meat IV011[1t !imlun 9WZ of AVAA,MN Omcntlyd,wqqulroa Iha1.Valets utq,weNt rho nos►. hrmpu N'M a.Ofll of en/ltpfobnd faokh AM afore ft•Yulrteo 116111fill,mail nnliry ..,^ dnignped Mail or local 4bMdea of the Ialalcntx of Iholr uhCN,oN'ner nrrvfn— Whir AuMunees Are Corlrfdt The ntttifiusliun mlutrinwMa 1ppl► 10 under 1a) to%ne retie or an underground 4Oragt look In an with Now"locr 9,1914,or Mrnontl►urn fe unKc iDel onntaln►eoulrlctl wa�lglxcr'I hi ndude►Rm�utManee brought inlo n►r oW that dolt.aej•purtan 1t'ho o%t•nt an underground Nlorajo lank dallrald ah haiudom In v0din 101 (141 or Iho Compmritilm Q bntuunmrntal ubtClvtlhetttul6at.UK,utdnlrouat of,vayla,cd,u1„14flomsod l,lability Act oiN1101C'!RL'LA),M'tlhthteMccpttun114' (b) to dtr trhv Vf I'll'vmlcrgtuwtW rwrage ink in uH bafOnt!iul'emhcr N.Ilad, 1110K huboonca*rsyuktvd at halvrdoua mic urm NuogUa C of Rl'RA. It aho but no tona�oor In Will owhat dau.an)flgfoon N'he othivdhaal,lauA kntuvdiv,vq bul'ure intludot povokum.►.a..%:suite 0 v%an)Mc11nn thggnrtll Nhkk la n uld ill htanoard i Iha d'NaenlWuatien of ibt wt. N►n141ona of leropavai m aril prehnue(60 dc+rN►1'abtwdvil and�4.r ptwndh prf wbal tanks An Llei ultlar Unkrarouna storage tllnk ik dollold as ar)One or %4u&n inch ob.91MI, colflblMl10t1 of Iinkr 11"I 11)la VIM 10 eontiln an YhkimYlatinn Of"tvgutalcn lea Wham To Notify?Cnmpl9ltd notifialion Ibnity IdNt41d b0 Matt lit Ihr addraa i h%rlrcn"and ail rrhYrr 10 t(Indudang eorinwitd wdaf/round filing kl 101S w given of the gulp M Nis vast, i martbinvothwh•groud. aotumpka art vittlogrounOtA}IMNhtorrnp: .P1011ne, Nodrot u%citing,Vr OWN)iu.I.and d.InduNulal►Vl►vntr.pratim/ah,harbleldrxorrurnipfilh, WhenT� aittni hCAvrJwmirk niary1,174.boinnInlil14 htirt-W,%tugrateiw.n WMI,lsns Are kickmW llnMa Ilmotid front the round are not tietljell 10 ta1wM nut of npen%iun atlrr Jenuorc I,19T4,eul MITi In the r,ntnd.mu.l 1a11ii)h. i Ma'N.Ilttb.7,OMj,in M'ho bit�und,:�n„md hntngc tan�o inw uc fact May It, notllkatlon,Other Iankhenduded Pulp n0tl 9lion AN! I911,;,,nn,it'),N1hhin ftOda)� brtn`ina iNJ tatlk,into UK. f rmoderns+wdamWunsaotl,IWalltlonhorkwat)weit)uwdforhtorinyuia+totfuol �a Ally 111" r.rMknowbylyhlU19 1 �Yehrvsirlww litsfat.kliamokn tax nonlonm+rrrie!oqr otetC Ihl not e�3,tinitoforslotif4hulinjoillorcon:umpthtutlanIhtpremi-aV.herthtnrtd pw vana�wh�rhhb�IK4i f gnat1tKtvhMh t Flusta7pearprinlin Ink all hhaa�myc�lexcepl"llianature"iffSMIO"V.1111isform must DyOMp�t�DIO144for indicate number of hfhlaatflM (alnhtl r e noreguld�i.Ifmomhan5lanksareowned&IIhialr+wnetn, � . c`>�ti�tionaheatlt I 1 r ry lannettVahl*Ii ero0rsti0n,in Wpolo Apitily,or0thiflollh) (H"meNi3e0lia%1,rretrk Wit hare l e su o p n tit w a a 1 L. _ p iysohy Nome or Company Bite identlni►,so oppll" M 8tnxot Address � �.�„�, 7�g�►�. � 4�►L7 . Sit '�y 4e R. 0�L iM Dt"AOMW Or 629 ROad,M apptittttat SSAy RNS,n-AtatIr -_ 'TC RpzIe.V, AIAb„•,^ . ' Iia �C"• /� A.(� $�at. zi P�code It,[ja3Sunty r��y 110 Area COO Photo Number Clfv(net t-_- S to ZIP Cnda� ' Type of IDwror (Alsdr aY Ott 0) indlotte Mark box here Ii tt k(s) i Current ❑ ttilab Or l aerl GoVI Ift lull nwinber a►tl I led on Nn�wkd+in ❑ �ner a rr--11 p tank Ill t iI an IrIan r�ervatlon of ❑ Former O 14FW3A t"lObvt ility LC,n0, u NflOR In oillh On othtar Indlan taut lAnda 11, Name(If same so Qootion ern bar hero ) Job Title Arse tbde More Nlnnlau a u L 4l V A It/ CMA i WAN . yl � 1 7 7 7 • I © (Nark bait har*only U thl l ll to amended Or auDmu*rn nottfioalim lar this lombon, Ma M i certify under Penalty of law that I have paraor%ally axar111ned And Am famllinr with the Information subrrlltted In this and ail atteehed i dneumer+te,ptirl that based ort my Inquiry of thane Individuals Immodletely resWillble for obtaining the Inrpmnatlon,I believe that iA0 avbm111ed Information It true.Itcourate,and otsrnplote. Name arN off lolal title vt,wmaf w owllvr's svtttorIWO r*p f'%Ove ture t Nato s /� l St.atrl.IVA-0 jCMV01. AA fidg ,Jain.;t.p. IAA AIINt f .. .. ......•.._r,_..,..... _...... ...__.,....,.- ._ .�t --- r lV2-J � 'riNINIS R EPART 1" 00 HIGH SCHOOL ROAD XXTUNDION (� u�JJbU fl (� NYANNIOI MASON OSAOI , Smohs Sam , 1mi s t six PSRMIT FOR$ � �r 4 _ FOR REMOVAL AND TP"GPORTATION OF sToRAVB TANKS IDZD NUMBER t 01922 RATS OF APPbICATION p4 PROFERTY OCCU?XXV sY Nate V. AyLoR ��� �0 PHONE S' LOCATION : PROPERTY OWNER PHdN1I: ar • ' TANKS TO BE REMOVED a . TBi�b� UN& AX TNzjtTxp ,� �.SibN. �vAN177 IZZB (GALLONS) FORMER PRODUCT 8 ORED ._� -Ar,..�s, .r....�_ AdMAWAr PROJECT lTiYpRRVT80R i r COMPANY NAMN I" X ApOREB>:t ' jaillft BRCXVATYaN COMPANY wr PHONE 1 ��=L� ADDRE88: 191 DI6-SAYS NUMBSIL si-rd rPo START DATE : t COMPANY REMOVING USABLE PloDUCT FROM TH$ ` kNK(S) : PHONE s NAME • 1►DDRESS: 40MIANY CLBANINO TIM TANS M AND XXmOV?NO THE HAZARDOUS MASTS t • HAMS ; t �r rr tt 2'Nts OHONS ����t�:1-1 ADDRESS: w Se D.B.Q.$. LICONSS NUMDlitta Ili EXPIR86: MANIFIST NUMBER: COMPANY TFM5l?0XT=* V94 TJWX( 1 I P1i0N8 �. NAM A t o ApDR$8S: THE T4NKS SHALL BE TRANSPOR TO PHONE YARD NANX t ADDREss t A HAS s. FzRa M INAL's Arracub NUMBER : DATE t?P >:88VANC8 s -. _ _ Ill ANN16 FIRE DE$ARTMEN Y DATE 0>Y EXPIRATION HAZARD FOUND - BES BpORT I REMOVAL WITNESSED - HAZARDJ A&AF pw--� I �a gI NA'1'UKA Y APPLICANT gIONATURS OF 31YANNIB .D. OFFICIAL TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: ,�,/ 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 quanj ies 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: S�- TELEPHONE: `7 7 — � 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.' - w t. 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 t"o"/Motor oils/waste oils Road Salt (Halite) I gasoline, Jet fuel Refrigerants I/Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Dther petroleum products: grease, lubricants rodenticides) egreasers 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 COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD :OF HEALTH O satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY VAdALf A.Ci. ;Kr s d1rs O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous t-a %� UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATE]ffLALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,J-et1,:(*)' Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C), transmission/hydraulic 101 Synthetic Organics: degreasers Miscellaneous: J s DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer -,'Public �' c ,� (�'On-site OPrivate 3. Indoor Floor Drains YES_k:�_NO r O Holding tank: MDC �,'„yam _ ` R O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES-NO ORDERS: , O Holding tank: MDC -Ae O Catch basin/Dry well G 1 O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product /? YES NO 1. (.� • � � per" 'N / -P= �� �<� �� 2 14 Inspector Date Person ( nterviewed p TOXXIC AND HAZARDOUS MATERIALS REGISTRATION FORM_ NAME OF FIRM: Boo-11511o,61@ GUS Co. ='ne, MAILING ADDRESS: i'Crndoe 5i're e- j {lya""^'S ma, 0a601 TELEPHONE NUMBER: -??j - 81 f 7 _ CONTACT PERSON: Ai. LrKc� 1 elv J"ov&oil 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: �KF 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 Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals X Motor oils/waste oils Printing Ink Gasoline, Je-t 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- KK— 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 chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids ) Laundry soil & stain removers(including bleach) Other products not listed which you feel may be Spot removers & cleaning fluids toxic or hazardous (please � (dry cleaners ) list) : Other cleaning solvents Bug and tar removers Household cleansers , oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants Road Salt (Halite)