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0090 HIGH SCHOOL ROAD EXT - HAZMAT
C Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Cape Cod .-------------------------------------------------------------------------------------------------------------------------------- 90 High School Road, Hyannis, MA ..---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------•---......------------------ Restrictions: ......-------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health LAW OFFICES OF JOHN W.KENNEY 12 CENTER PLACE TEL.(508)771-9300 1550 RouTE 28 FAx(508)775-6029 CENTERVILLE,MA 02632 E-mAmjohn@jwkesq.com TO: 2 HERE IT IS. . .41 J�\� In order to get this to you promptly, I am sending it without a confirming letter. r , r Town of Barnstable Inspectional Services 4BAMRNSTAB9LE Public Health Division '"'�� '' 4.4 E 8Ap�11MOM � Thomas McKean,Director .` 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 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 i GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY i st—JUNE 30th), i 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 ❑ ?01 0� 4 A late charge of$10.00 will be assessed if payment is not received by July 1st. I 1. ASSESSOR'S MAP AND PARCEL NO. 309 / 265 2. IS THIS A PERMIT RENEWAL? YES._NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? x YES NO. 4. FULL NAME OF APPLICANT: Ford of Hyannis. Inc- S. NAME OF ESTABLISHMENT: Balise Ford of Cape Cod 6. ADDRESS OF ESTABLISHMENT; 90 Hiah School Road Hyannis, Ma 02601 7. MAII.ING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 608-815.4007 9, EMAIL ADDRESS: lebtfbaliseauto.com 10. SOLEOWNER:_X_YES^_NO IF NO,NAME OF PARTNER: 11, FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ford of Hyannis. Inc. PRESIDENT James E Ballse Jr TREASURER Tim Inaero ion CLERK Tim Tmerson 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE M COMPANY ADDRESS EMAILt SIGNATURE OF APPLICAN �"'"'� �' DATE_(p w C:\Users\crookershlAppData\I.ocarN"4crosofl\ Indo elCockoXContentOutiook\82W8EZFW1Haz Mat 4p11 Draft 1an2019.doox Date: I / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Balise Ford of Cape Cod BUSINESS LOCATION: 90 High School Road Hyannis,Me 02601 INVENTORY MAILING ADDRESS: 90 High School Road Hyannis, Ma 02601 TOTAL AMOUNT TELEPHONE NUMBER: 508-8154007 CONTACT PERSON: Jason Arruda EMERGENCY CONTACT TELEPHONE NUMBER: TYPE OF BUSINESS: Automotive Dealership MAR 005769 INFORMATION I RECOMMENDATIONS: Fire District: Waste Transportation: Cyn Envinormental Last shipment of hazardous wash: Name of Hauler: Destination: Waste Product: Licensed Yes No MAD082303777 NOTE:Under the provisions of Ch.111,Section 31,of the General Laws of MA,hazardous material use, storage and-disposal of ill gallons or more a month mouires 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 I Maximum Observed I Maximum • X Antifreeze(for gasoilne or coolant systems) Miscellaneous Corrosive O NEW O USED Cesspool Cleaners x Automatic transmission fluid Disinfectants X Engine and radiator flushes Road salts(Halite) X Hydraulic fluid pnciuding brake fluid) Refriigerants X Motor Oils Pesticides D NEW 0 USED (insecticides,herbicides,rodenficides) X Gasoline,Jet fuel,Aviation gas PhotocheinirsJs(Fbcers) Diesel Fuel,kerosene,#2 heating oil O NEW O USED Miscellaneous petroleum products:grease, Photdchemtceis(Developer) X lubricants,gear oil O NEW O USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) CaulkfOrout Swimming pool chlorine Battery add(electrolyte)/Battedes Lye or caustlo soda x Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Carwaxes and polishes Fertilizers Asphalt&rooflng tar PCB's x Paints,varnishes,stains,dyes Other chlorinated hydrocarbons, X Lacquer thinners (Including carbon tetrachloride) Cl NEW O USED Any other products with`poiscre labels (including chloroform,formaldehyde, Paint&varnish removers,deglossers hydrochloric acid,other acids) j Miscellaneous.Flammables Other products not IlsDed which you feel Floor&furniture strippers may be toxic or hazardou@(please list): Metal polishes Laundry soil&stain removers (Including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers I X Windshield wash WHITE COPY-HEALTH DEPARTMENT i CANARY COPY-BUSINESS APPI ignatum atafPa initials Town of Barnstable Building Department Brian Florence,CBO Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable,ma.us Pre-application for Business Certificate Date 06/10/2020 Map 309 parcel 265 i l Applicant Information Applicants Name James E. Balise Jr 122 Dot Circle West Springfield,MA 01089 Applicants Address Y Email Address jeb®ballseauto.com Telephone Number 413.736.1002 Listed ❑ Unlisted ❑ Business Information Now Business? --------------- --------- -------------- Yes No Business is aregistered corporation? ------------------------- Yes No If yes Name of Corporation Ford of Hyannis,Inc. Does business operate under the registered corporate name? Yo No Is the business a sole proprietorship or home occupation? --------- Yes E) If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business Balise Ford of Cape Cod Business Address 90 High School Road Hyannis, Ma 02601 Type of Business Automotive Dealership Building Commissioner Office Use Only Conditions Building Commissioner Date I Clerk Office Use Only I i IKE►o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • MASSBLE,D 200 Main Street• Hyannis, MA 02601 '�Fo39+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 61,I r f'o rpe oS y a o n i s Date: Location/Mailing Address: D 1 Iti g- o, f, a n Contact Name/Phone: ��e•f'�. C'a s s�.��� Sda Mg� /Do ,t�ona�nye-, Per 1yl�r :fo$- J 4.•j Lj k a*-<.-%-* .• o s 4 s Inventory Total Amount: '-�J� MSDS: CA1 i r v 104 Dr--KPA License#: Tier II : Nn Labeling: s 'L�-�-�bk�5 `aQN��� Spill Plan: w eas—�" PGG Oil/WaterSeparator: A6 Floor Drains: YtS Emergency Numbers: �e-g StorageAreas/Tanks: -1loOaala. h-Q,) t tcVvwk. A<vv-.slk,Cf" Emergency/Containment Equipment: ae- mrt s.#c- -�,c� .c,c+� „1M,r o, tb 2o Waste Generator ID: AOA60W0 Waste Product: 61 �'�lj�fs Date&Amount of Last Shipment/Frequency: 8123 11 Licensed Waste Hauler&Destination: ar�Akl Gk,w - �� +uly, pu s (XIY r Other Waste Disposal Methods: A\ 7 l31((o LIST OF TOXIC AND HAZARDOUS MATERIALS lv "^L"\ve, L"Va6le- tV% 'KQ4A NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardo s material use, storage and disposal of 111 gallons or more requires a licgnse from the Public Health Division. Antifreeze 5� Dry cleaning fluids ✓ Automatic transmission fluid 11 ar Other cleaning solvents&spot removers Engine and radiator flushes �� Bug and tar removers Hydraulic fluid (including brake fluid) V Windshield wash I 1b0 a'-k Ai-f Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas y�a4k-ll\ ' Cesspool cleaners Diesel fuel, kerosene, #2 heating oil 5�* Disinfectants Miscellaneous petroleum products- k5X Road salts t5OOIb / grease, lubricants, gear oil �,iX %� — Refrigerants ✓ Degreasers for engines&garages F� Pesticides: Caulk/Grout 3°ate, insecticides, herbicides, rodenticides JBattery acid (electrolyte)/batteries Q o 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" �; SS (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: VLI�,c-� "(� ? ort �(oo� t vto� ORDERS vA� all A g, tk Ca",e �utivuerQk tr•r 5�2nL b v a";r ,- VVo,U,--� Jt�to,(a%9;e-I c, I"-e-p el „wk-1-}darts -E-< INFORMATION/RECOMMENDATIONS: C� Sv«CO 4'0"Xdi-AA-L'S-�*C tv.- 445 4"t, i rt S� v a �J�" ulacl Qom, oayti ,�' �06 o t+&-� 01 t/j spe y- t'L w�. 5 to la VPdA / a r�OS �c.� Fncillily Representat' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I� Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $150.00 -� Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- --------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health . Town of Barnstable �z ►o,,, Regulatory Services 0 Richard V. Scah, Director M�AB�, ` Public Health Division BARNSTABLE . BPRtIS*AOIL•CVJIERNLLE•fDNR•�ttAtC.tllS 1639 A�0 uunas Ku s•osre-101•ws auxnAe� '°yen rrar e� . �b���Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN - ANNUAL PERMIT(RUNS JULY 1st-JUNE 10th). 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 , V'b . A late charge of$10.00 will be assessed if payment is not received by 1st. .4 JA AC ASSESSORS MAP AND PARCEL N0309' O9- o?jSDATE /) FULL NAME OF APPLICANT: n NAME OF ESTABLISHMENT: `t to S C ►5 2 ✓d / _ ADDRESS OF ESTABLISHMENT: q` � 1, (� ( .�� ►S IMA 001 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: "V-1Q,k� " e'ta:6 . Nib./ SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,VITELEPHONE# OF: CORPORATION,IVAME h �� _ n . NSF PRESIDENT wQ O aq TREASURE 01 O CLERK IF PREPARED BY OUTSIDE PARTY: MS NS NATURE F P T Name: AXA Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev 16.docx Page 1 of 2 \1 �\ Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services Richard V. Scab,Director s6 39 Public Health Division "gym R.� Thomas McKean,Director , X 200 Main Street, Hyannis,MA 02601 Orrice: 508-862-4644 = 508-790-6304 nu Application Fee: $100.00 �. ASSESSORS MAP AND PARCEL NO.Qjp 9 - �� DATE / r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERLA-LS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT � o V1Y1 I S ADDRESS OF ESTABLISHMENTL-' L4( Kklf S , TELEPHONE NUMBER -<G SOLE OWNER YES c--'NO IF APPLICANT IS A P_4RTNERSEap,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. J2 of O 7-3 STATE OF INCORPORATION ID1A FULL NAME AND HOME ADDRESS OF: PRESIDENT �r _5 E. ` ��. �} TREASURER ,-! O r. + �� �I CLERK 6 i 0 e-5 ,ppSIGNATORE OF APPLICAl\T RESTRICTIONS: HOME ADDRES �, - HOME TELEPHONE# CAcacheUemporary Intemet Files\OLKD3\HAZAPP Rev2015DOC i °PINE rok$ Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 RARMASS- 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MPS Business Name: AAA e- YerA- a-0ywyl1 S Date: Location/Mailing Address: D r G oa RX 6 -f- � Contact Name/Phone: 2-I'P�. + 5 V o n. o K c.�•mac. ��� ag-t.6$--?,g l O L-7 �1a4 .1�+.-s-F�-- J'•lavt�F'e -/Yj�.c 9a N.G� Invento Total Amount: 4 36 D f -1 MSDS: SPA -o'���-t ��ekovm-License#: � / - o 2►w�14$ Tier II : 0 7 Labeling: OK Spill Plan: Yes-S-PC� _ � Oil/WaterSeparator: yQ� Floor Drains: y85 Emergency Numbers: S �s5 Storage Areas/Tanks: o---fat-,&-.t a.l"o fl51-,; -C r Emergency/Containment E ui ment: ,togs/,(li ar -S a✓�,/aL�l-�t rc �"t�� ' �S 4�, Waste Generator ID: D0 Q 7 Waste Product:011,-t!'�l�cfs, avtf,-�'ree�e,el, Date&Amount of Last Shipment/Frequency: 3 fs 501A a 41�5 Licensed Waste Hauler&Destination: C� f e""` a a� ✓ Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 1�►° ^L��o< <- - 5 K- /rtof� 3/vtG2.lGs`�"�" � c�-'o�t, NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze + 14-s--6- Dry cleaning fluids Automatic transmission fluid V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) �— Windshield wash 46< Motor oils ,r vX*g , Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants V 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: G,vt, 001 x- Vitt vl oc v� all e. &0a-,cc- a� v%-, CQ-ANc�t Ef le,,. v,tt'A k �. t2 +0 0-)� G���a ee---, . ��e S0(.4- cove �� s aQ-5'tOC?,X-/�I IA- SVl0 iM �/01 Inspe 4^e,�R-< 0 V G�t�'�"�r� jv�� �� Facility Represent ive: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS SPELL PREVENTION,CONTROL, &COUNTERMEASURE (SPCC)PLAN BALISE FORD OF HYANNIS PART A: GENERAL INFORMATION 1. Name of Facility: Balise Ford of Hyannis 2. Type of Facility: Automotive Dealership 3. Initial Date of Facility Operation: 7/11/11 4. Location of Facility: 90 High School Road Hyannis,MA 02601 5. Name&Address of Owner/Operator: . Craig Brissell Balise Ford of Hyannis 90 High School Road Hyannis,MA 02601 6. Person Responsible for Plan Management: Service Manager 7. Spill/Release Response Plan: See Attachment(C) 8. Periodic Review This SPCC Plan has been prepared to conform with the requirements of the applicable Federal regulation, 40 CFR 112. To ensure it remains current, it will be reviewed and evaluated at least once every five years. Within six months of the review, it will be amended to include more effective prevention and control technology if the technology is field proven and will significantly reduce the likelihood of an oil spill event. This plan will also be amended within six months whenever there is a change in facility design, construction, operation, or mpLintenance that materially affects the facility's potential for the discharge of oil. All amendments will be certified by a Professional Engineer in accordance with 40 CFR,Part 112.3(d). 9. Management Approval I Tl e management of this facility shall implement this SPCC Plan as herein described. Signature: Title: Name:Ora,14 Date: 9 a2© �- 10. Certification I hereby certify that I have, or my agent has, visited the facility and that I have examined this plan. Being familiar with the provisions of 40 CFR, Part 112, I attest that it has been prepared in accordance with.good engineering practices, including applicable in standards and procedures for inspection and testing. I consider the plan adequate for the facility. T Vim✓ Signature of Registered Professional Engineer (seal) j,pl Prj6d.Name Date/ Balise Ford of Hyannis SPCC Plan 10-10 r � PART B: SPILL PREVENTION, CONTROL,& COUNTERMEASURES 1. Responsible Person The dealership's Service Manager is responsible for oil spill prevention, control, and countermeasure activities. 2. Potential Spills of Oil—Prediction and Control Note: A facility map illustrating the location of each listed tank/container is included as Attachment (A). Source Probable Type Quantity Maximum No. Description of Failure (gallons) Flow Rate Probable Direction of Flow Secondary Containment (Gals/hour) Small lea'k.or 1 Aboveground new oil complete 330 gals Immediate Completely contained in tank room Double wall steel tank tank in the tank room rupture total release Aboveground new oil Small leak or Immediate 2 tank in the tank room complete 330 gals total release Completely contained in tank room Double wall steel tank rupture Aboveground new oil Small leak:or Immediate 3 tank in the tank room complete 500 gals total release Completely contained in tank room Double wall steel tank rupture Small leak or 4 tank in the tank room Aboveground A complete 275 gals Immediate Completely contained in tank room Double wall steel tank rupture total release Above ground used Small leak or Immediate 5 oil tank in the tank complete 330 gals total release Completely contained in tank room Double wall steel tank room rupture Above ground used Small leak or Immediate 6 oil tank in the tank complete 275 gals total release Completely contained in tank room Double wall steel tank room rupture 1 Small Ibak or 7 Aboveground new oil complete 280 gals Immediate To the south across the shop Double wall steel tank tank rupture total release towards the west side exit door Balise Ford of Hyannis SPCC Plan 10-10 i 3. Spill Prevention and Containment a. Aboveground Storage Tanks i. Source 1 (330-gallon aboveground.new oil tank): UL listed double wall steel tank. Overflow prevention is limited to manual observation. The tank is filled by an oil supplier who pumps new oil into the tank through a hose/pump dispensing system. Transfer quantities are first verified by checking the amount of new oil in the tank prior to refill. This amount would then be subtracted from the tank capacity and the amount transferred would be less than or equal to the difference. Overfill prevention during filling consists of direct audible communication between the oil supplier and the facility's designated employee monitoring the tank refill. If any tank overfill were to result, it would be immediately known to the oil supplier who would immediately stop any further transfer. ii. Source 2 (330-gallon aboveground new oil tank): UL listed double wall steel tank. Overflow . prevention is limited to manual observation. The tank is filled by an oil supplier who pumps new oil into the tank through a hose/pump dispensing system. Transfer quantities are first verified by checking the amount of new oil in the tank prior to refill. This amount would then be subtracted from the tank capacity and the amount transferred would be less than or equal to the difference. Overfill prevention during filling consists of direct audible communication between the oil supplier and the facility's designated employee monitoring the tank refill. If any tank overfill were to result, it would be immediately known to the oil supplier who would immediately stop any further transfer. iii. Source 3 (500-gallon aboveground new tank): UL listed double wall steel tank. Overflow prevention is limited to manual observation. The tank is filled by an oil supplier who pumps new oil into the tank through a hose/pump dispensing system. Transfer quantities are first verified by checking the amount of new oil in the tank prior to refill. This amount would then be subtracted from the tank capacity and the amount transferred would be less than or equal to the difference. Overfill prevention during filling consists of direct audible communication between the oil supplier and the facility's designated employee monitoring the tank refill. If any tank overfill were to result, it would be immediately known to the oil supplier who would immediately stop any further transfer. iv. Source 4 (275-gallon aboveground ATF oil tank): UL listed double wall steel tank. Overflow prevention is limited to manual observation. The tank is filled by an oil supplier who pumps new oil into the tank through a hose/pump dispensing system. Transfer quantities are first verified by checking the amount of new oil in the tank prior to refill. This amount would then be subtracted from the tank capacity and the amount transferred would be less than or equal to the difference. Overfill prevention during filling consists of direct audible communication between the oil supplier and the facility's designated employee monitoring the tank refill. If any tank overfill were to result, it would be immediately known to the oil supplier who would immediately stop any further transfer. w v. Source 5 (330-gallon aboveground used oil tank): UL listed double wall steel tank. Tank is filled via an air driven pump located in the service shop. Tank presently has no overfill protection system. Within 90 days of management approval of this plan, the dealership will install an overfill device that will automatically shut-off all pump functionality when the tank reaches 95% capacity. This notifies technicians to immediately cease pumping operations and to report the condition to his supervisor. Balise Ford of Hyannis SPCC Plan 10-10 i vi. Source 6 (275-gallon aboveground used oil tank): UL listed double wall steel tank. Tank is filled via an air driven pump located in the service shop. Tank presently has no overfill protection system. Within 90 days of management approval of this plan, the dealership.will install an overfill device that will automatically shut-off all pump functionality when the tank reaches 951/o capacity. This notifies technicians to immediately cease pumping operations and to report the condition to his supervisor. vii. Source 7 (280-gallon aboveground new oil tank): UL listed double wall steel tank. Overflow prevention is limited to manual observation. The tank is filled by an oil supplier who pumps new oil.into the tank through a hose/pump dispensing system. Transfer quantities are first verified by checking the amount of new oil in the tank prior to refill. This amount would then be subtracted from the tank capacity and the amount transferred would be less than or equal to the difference. Overfill :prevention during filling consists of:direct audible communication between the 'oil supplier and the facility's designated employee monitoring the tank refill. If any tank overfill . were to result, it would be immediately known to the oil supplier who would immediately stop any further transfer. b. Containers None c. Underground Piping: None d. Aboveground Piping i. Lubricating Oil and Automatic Transmission Fluid Tanks: Sources 1, 2, 3, 4, and 7 are all tied into a system of overhead distribution lines. These lines are pressurized by air driven pumps mounted on the tanks and provide lubricating oil and ATF. An unattended failure of one of these lines could result in the entire contents of one of these tanks (330 gals, 330 gals, 500 gals, 275 gals, and 280 gals) emptying onto the shop floor. This line is mounted on the shop ceiling and is at a height that will protect them from passing vehicles. Pumps are also shut down (air compressor turned off and air lines bled) at the end of each workday, thus preventing any significant release during nonworking hours. During work hours,the area in which these lines run is continuously staffed by service technicians. Any pipe failure would be immediately known and the respective pump promptly shut off and secured. ii. Used Oil Tanks: Sources 5 and 6 have an aboveground pipeline that enables used oil to be pumped into the tanks. The line is charged only when-oil-is being pumped into the tanks from the one remote pump-out station, this occurs only when a technician is present to operate the pump. Should the technician detect any problem, or if the automatic shut-off is activated the technician will immediately turn off the pump and or notify his supervisor. e. Containment Drainage: All sources are either fully enclosed, double wall tanks, or are located under roof where rainwater accumulation is not an issue. 4. Material Compatibility: The materials and construction of all l5etroleum bulk storage tanks and containers are compatible with the substances stored and the conditions of storage. 5. Tank Truck Loading/Offloading: Tank truck operators are expected to comply with regulations established by the Department of Transportation. In particular, the following procedures are observed during the filling of the gasoline tank, lubricating and transmission oil tanks, and during the pumping of used oil tanks. Balise Ford of Hyannis SPCC Plan 10-10 i a. Smoking is prohibited while dispensing or loading petroleum products. b. The delivery/collection truck driver remains with the vehicle at all times while loading/unloading. c. Each delivery/pickup is supervised by the delivery/pickup driver and overseen by a competent facility representative. Throughout the process, each party must be alert, have unobstructed view of the delivery/pickup vehicle and the storage tank, and be within 25 feet of each. Unless the truck engine is used to power a loading/off-loading pump, no flammable liquid is.to be transferred while the.engine is running. d. The facility representative ensures that the delivery/pickup vehicle is properly parked in an area designated for that purpose, and that the driver has provided a physical barrier,.warning sign, or other appropriate device to prevent the vehicle,from departing before complete disconnection of transfer lines. e. Containment socks and/or absorbent materials are maintained nearby in case of any unexpected release. In the event of a release,those items shall be employed as specified in Attachment (C). f. The unloading of product into a dealership tank does not begin until the level in the tank, is checked and it is verified that the tank has sufficient capacity to receive the volume of product to be transferred. g. If product transfer is via a gravity fed line: when transfer is complete, the drain valve on the truck is closed and inspected for leakage, and residual amounts of product remaining in the unloading line are drained into the tank before disconnecting the unloading line. There is no containment system in place during tank truck loading or offloading operations that is capable of holding the entire contents of a truck tank or truck compartment. Therefore, a release could occur at the dealership during loading or offloading due to a tank truck structural failure, equipment failure, or human error. However, delivery/pickup trucks are equipped with the means to allow the driver to immediately stop transfer operations in the event of a spill or a leak. Given the varied locations from which vehicles conduct loading or unloading operations, the relative infrequency of these operations, and the ongoing vehicle traffic throughout the facility, a containment system dedicated to this operation is considered impractical. The loading/unloading procedures detailed above, especially the presence of a second person, are considered adequate precautions to prevent or contain a reasonably anticipated spill event during loading or offloading. 6. Spill Response Kit: The dealership maintains a portable spill response kit that includes oil-absorbing socks and oil-absorbing floor sweep material. This response kit is readily available for use in the event of a spill or other release. 7. Inspections and Records: All aboveground pipelines, bulk storage tanks, and containers are in locations that are frequently observed during working hours. Any leak or other tank/container failure would be quickly detected. A more formal visual inspection is conducted atVleast monthly by the Responsible Person or his designee: Each such inspection includes a visual check for leakage and deterioration of all components of the tanks and containers, containment structures, valves, and aboveground piping. Any overfill prevention devices are also tested to ensure their proper operation. In addition, any oil-water separator is checked for possible excessive accumulation of oil and/or bottom sludge. The date and findings of each inspection are recorded on the Inspection Log form, a copy of which is included as Attachment (B). These inspection logs shall be retained with this SPCC Plan for at least three years by the Responsible Person. Balise Ford of Hyannis SPCC Plan 10-10 i All equipment and service deficiencies shall be promptly addressed as specified by the Responsible Person. Any accumulation of oil due to a leak, spill, or other release shall be addressed as specified in Attachment(C). Additionally, each aboveground tank is inspected by a qualified independent tank inspection and testing service.at .least once every five years, and whenever a repair is made. Supplementary nondestructive testing may be undertaken if recommended by the inspection service. The Responsible Person.shall ensure that the initial independent inspection of each aboveground tank has been completed within_five years of the tank's original installation at the facility. If such inspection has not been completed, it shall be done within one year of the adoption-of this SPCC Plan. 8. Employee Training: Oil handling.personnel at the.dealership shall receive.:annual training on the following: a. Operation and maintenance of equipment to-prevent oil discharges. b. Spill response training focuses on quick reaction response to contain a release. Training also notes that the dealership relies primarily upon community emergency response agencies to_carry out cleanup activities. Employee training includes emergency response activities, use.of personal protective equipment, and information on product labels and Material Safety Data Sheets. c. The contents of this Spill Prevention, Control, and Countermeasures Plan. Records of who received the training, when they received the training and their signatures should be kept on file for at least three years. 9. Security a. Access: Access to areas where bulk storage tanks and transfer systems are located is normally limited to dealership staff. After hours, all access to property is secured by a locked chain link fence. b. Pumps and Valves:=All-lubricating oil and,use&oil, transfer-pumps art1ocated inside.enclosed spaces accessible only to authorized personnel.These spaces are locked after hours. c. Lighting: Facility lighting is commensurate with the type and location.of the facility. It is sufficient to enable the discovery of spills during hours of darkness, both by operating personnel and others. The facility is sufficiently lit to reasonably reduce threats of vandalism against any tank or container. f Balise Ford of Hyannis SPCC Plan 10-10 ATTACHMENTS A. Facility Map B. SPCC Inspection Log C. Spill/Release Response Plan D. Certification of the Applicability of Substantial Harm Criteria E. Title 40 Code of Federal Regulations, Sections 112.1-112.7 APPENDIX 1. Facility SPCC Cross Reference with 40 CFR 112 I r Balise Ford of Hyannis SPCC Plan 10-10 i Balise Ford of Hyannis Cape Cod N 90 High School Rd, Map Legend Hyannis,MA 02601 QWaste oil pump out station ATF Reel Dispenser Source#3:500 Gallon ® New Oil-Reel Dispenser 5w/20 New Oil Tank �I��A01\1 ———— ATF Distribution Line Source#4:275 Gallon 6 ATF Tank ———— New Oil Distribution Line Source#5:330 Gallon Waste Antifreeze Used Oil Tank —O" Used Oil Distribution Line Source#2:330 Gallon Spill.Response Equipment 15w/40 New Oil Tank Source#6:275 Gallon at= Used Oil Tank New oil/ATF dispenser Source#1:330 Gallon 5w/30 New Oil Tank Direction of Flow\ b r--"I IJU I I I I I I I 1 I I Body Service I I Shop I I I I I I Showroom I I I ^= j----- �:! I Parts I I I Map Not To Scala —7—- - De tail -------_— --Dirqctio 'SwA oflow k•B, Source#7:280 Gallon 5w120 New Oil Tank rPrelpared by KPAity Layout p 1.88&381-9992 Attachment A i Attachment B SPCC Plan Inspection Log Note to Inspector: Date and sign upon completion of each inspection. In.pection Signature Inspection Signature Inspection Signature Date Date Date Note to Inspector: Document any oil storage or Spill Response Kit deficiencies on the form below. (Use additiona sheets, if necessary). Be sure to sign and date each corrective action. Observed Deficiency Corrective Action Signature Date Signature Date ,i mature Date Signature Date Balise Ford of Hyannis SPCC Plan 10-10 i Part 1 Spill/Release Response Plan 1. Emergency Equipment at the Dealership: Balise Ford of Hyannis relies primarily upon community provided services for emergency response. Consequently, the variety and availability of on- site emergency equipment is limited. Response equipment typically present at the dealership includes: a. Spill Absorption Material: The dealership usually has on hand a supply of absorbent material (grease-sweep) in the service areas. This material can be used to dam off the flow of a hazardous material. After any release is contained, this material can also be spread over the released liquid until it has been placed in sufficient volume to absorb it. The contaminated absorbent materiat.should then be collected and placed in a drum or other containment for proper disposal. b. Personal Protective Equipment: This equipment is limited to the following: Equipment Location Gloves Technician Bays Goggles Technician Bays Face Shields Technician Bays Dust Masks Technician Bays This equipment is available for use when routinely handling hazardous materials common to this dealership. It can also be used under emergency conditions. c. Hazardous Waste Hauler: Under certain conditions, hazardous waste haulers can be of great service during a release or threatened release of a hazardous material. For example, a,hauler can empty a tank that appears to be failing. If a spill is contained, such a service may be able to pump up a substantial portion of the released liquid. Haulers who can be contacted include: ■ Waste oil and oil/water separator: Safety Kleen at(800) 669-5740 ■ Hazardous Waste Hauler: Safety Kleen at(800) 559-5740 Note: In the event the above haulers cannot be contacted, additional haulers can normally be located in the yellow. pages of the telephone book. Possible headings include: "Oils-Waste"and "Waste Disposal-Industrial." 2. Spill Containment and Clean Up: a. Shut off/eliminate all sources of ignition. b. Attempt to prevent any additional release (if possible). An example would be closing a leaking valve or turning off a pump that is causing a release. 14 c. Contain the spill by diking around it using sand, earth or other absorbent material. Ensure special attention to preventing spilled material from reaching a sewer or storm drain inlet. Balise Ford of Hyannis SPCC Plan 10-10 Part 1 d. Absorb spilled material using sand, earth or other absorbent. Floor cleaning/sweeping materials are appropriate and are normally available. Note: It may be possible to pump up a significant portion of contained liquid. e. Avoid skin contact and breathing vapors. Wear appropriate protective clothing and equipment. This. equipment can include chemical resistant gloves,.eye protection and supplied air respirators. i f. Ventilate the area with local exhaust systems or by opening available doors and windows. Note: Avoid use of compressed air to speed.evaporation of spilled .liquid. This practice increases airborne concentrations and increases the possibility of injuries such as eye damage. g. Dispose of contaminated absorbent.in accordance with applicable regulations.. This will normally involve disposal of the material as a hazardous waste. If the material is a corrosive, .place contaminated absorbent material in polyethylene or polyethylene-lined container for disposal. Note: If the material released is a corrosive (i.e., battery acid), it may be possible to neutralize it after it has been contained. For information on how to neutralize it, the dealership should call the emergency numbers provided on the product Material Safety Data Sheet. 3. First Aid Procedures: First aid information for an individual chemical is available on its Material Safety Data Sheet. It may also be appropriate to consult a physician. General first aid responses include: a. Eye Contact: Flush with large amounts of water for at least 15 minutes. Occasionally lift upper and lower lids. Consult a physician. b. Skin Contact: Remove contaminated clothing and immediately flush contaminated areas with large amounts of water. c. Inhalation: If overcome or affected by vapors, remove from exposure and call a physician immediately. i d. Ingestion: Call emergency medical aid immediately. Consult MSDS to determine if vomiting should be induced or if individual should be provided other first aid measures. 4. Evacuation: Supervisors have the authority to direct an evacuation of the facility. Refer to Part 3 of this Action Plan. 5. Reporting: a. Obligation to Report: Depending upon the volume involved, the dealership may be required to report a release or threatened release of a hazardous material! No report is required for small, non- harmful releases such as a quart of drain oil on the shop floor. b. Reporting Authority: Any employee who detects a release or threatened release of a hazardous material (other than an incidental spill) should immediately notify his or her supervisor, who shall then be responsible for assessing and beginning a response to the hazard posed. If the release/threatened release involves a significant volume of hazardous material, the supervisor should promptly notify one of the following, who shall have reporting authority: , Balise Ford of Hyannis SPCC Plan 10-10 Part 1 ■ General Manager ■ Service Director ■ Parts Manager If none of these parties can be notified,the supervisor has the authority to make the report. c. Reporting Procedure: If uncertain as to whether a report is required, the responsible individual should first query one of the below listed agencies. If it is determined that a report is required, it should be made to the following: ■ OSHA South Boston Area Office 639 Granite Street 4th Braintree,MA 02184 PH: 617-5 65-6924/Fx: 617-5 65-6923 ■ MA-DEP at 888-304-1133 ■ EPA National Response Center at(800)424-8802 ■ Poison Control at(800) 222-1222 ■ Local Police and Fire Departments at 911 The report should be made as soon as possible so long as it does not impede immediate control of the release or interfere with emergency medical measures and should include the following about the release or threatened release: ■ The exact location - ■ The name of the person that made the report ■ The type and quantity of hazardous material(s)involved ■ The potential hazard(s)presented (if known) Appropriate emergency response agencies and dealership managers should also be notified. d. Written Record: A written record of all verbal notifications should be prepared by the reporting individual and provided to the dealer principal. This report may be handwritten and should include the following: ■ Date and time of call ■ Person making call ■ Agencies notified ■ Individuals contacted ■ Summary of conversation(s) �r Balise Ford of Hyannis y s SPCC Plan 10-10 FtHEti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMASASRLE, • 200 Main Street• Hyannis, MA 02601 `rfoMn+° TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: &a)i5A- Fo',4 a� a,/avlvl,S Date: 7 o ly Location/Mailing Address: D 41 k6e-4-%A Q KAls Contact Name/Phone:Akm Ufr', r I 6 Sse.( , svc D -S - Inventory Total Amount: MSDS: 04\vJ-- K?A 00 icense#: 15 I Tier II : o ck Labeling 04 Oearak o� 2 0 Spill Plan: owIw,,— Oil/WaterSeparator: o Floor Drains: o Emergency Numbers: Storage Areas/Tanks:.A STs o!C AxW o,f'�3 A-—Ir,' , S t"2 a A+,46.p OS.� G '07—,.� -Y��w. v �oodG,cap g ••, fLbl^. L.9asb. Emergency/Contain �t�auipmer�f: go�b��, n s au ��� � � +* e. P�—AV \ `I l•t2�� Waste Generator ID: MK,OOc)DOS-ll,ci Waste Product: Oi�f-� r`� � ���� Date&Amount of Last Shipment/Frequency: A /4 a_ wot o,/��r,/wk ,I c�t 5 Licensed Waste Hauler&Destination: l4K,-� -1, 0 kkK A /M� 0 Other Waste Disposal Methods: &,6+e- Mavt• e-46 .G r-all 6a 1 i sc.�1-or� {�,-) ct,�' 1 yc, e r • -a a or , t,- v o / LIST OF TOXIC AND HAZARDOUS MATERIALS N7 �k(� ��n� _6 v�- kv�ve�n�cor 5 inch f,4 `,'ro✓t, NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardou material use, ,t,5-�i storage and disposal of 111 gallons or more requires a license from the Public Health Division. ✓/ Antifreeze Dry cleaning fluids �— Automatic transmission fluid �— Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) V Windshield wash — Motor oils Miscellaneous Corrosives — Gasoline,jet fuel, aviation gas Cesspool cleaners VDiesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for a ines& arages Pesticides: Caulk/Grout z°`l`y 94'r{S (-1411'`` 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: FORMATION/RECOMMENDATIONS: ig Inspecto . i ✓` CkAGI(-W t4l-:N---r-�-CQ r`e`'^'`� ''�R`t IL" Facility Representative: ('JLrtiervat.,I WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 1 /I 1 y TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS 95 ,o� FORM NAME OF BUSINESS: 46a jis.e- C'or.� 9f N, a ✓IYt ► S BUSINESS LOCATION: - qo tt►ck School lqz x+p P gvin.►s INVENTORY MAILING ADDRESS: 6o vw,e- TOTAL AMOUNT:-g. TELEPHONE NUMBER: "--, 360d 441 SON: � CONTACT PERSON: v�E EMERGENCY CONTACT TELEPHONE NU BER:Ca/;c, or-1/ RoA-;?S54gq , MSDS ON SITE? TYPE OF BUSINESS: 40fv 6&4-e-s a Kd 3;e-ryice, Ye S INFORMATION / RECOMMENDATIONS: 9 Kee all Co v41-51bue,40-le, Fire District: G6t Q P G yGA,�2 LJ�4VL- Ylo vt y 5-L >o /l)�U is c t:r/l L.t dCn 064 4 K- 14-v q n,1► S bv �- 40 ✓L J� � d �VJt 5f_ � A, G/0-4YL , w1e-I v), e'-eOQ-6 ka:1 Waste n: /0ROOQOoSI6`j Last shipment of hazardous waste: / X-7 13 Name of Hauler: Destination: 1R= Waste Product: o;l, Licensed?� No _RjbOB�002$el,2-- NOTE: Under the provisions of Ch. 11 r, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Anttiifreeze (for gasoline or coolant systems) Miscellaneous Corrosive U NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Moo r Oils / Pesticides l NEW CI USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED /✓/ Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes No C- a A,-om I-All-6 Laundry soil &stain removers If (including bleach) i kiy O rj w�- Spot removers&cleaning fluids 1' (dry cleaners) �Q�►T►D✓l ei ' �, 'SSq�i, �r,1 rK S o � � Other cleaning solvents Bug and tar removers —�D Cox-L 3 1!j > \/Atlt-o-5 o C? Windshield wash ,. & VLQO �al�� �k5 DVL�� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials M I ITow� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"M��E.� 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT �fD MAC i �1 Business Name: cc.%�e d `11C Date: 7/q I1 Location/Mailing Address: O k �` Contact Name/Phone: tic 7 ID 'I s 110 ti 9`1 C Inventory Total Amount: 26 0 CkS: Ae S License#: e z Tier II : N6 Labelina: OtOl - n 1< Spill Plan: Oil/WaterSeparator: 2S Floor Drains: � - Emergency Numbers: _ Storage Areas/Tanks: d Wo�oU1l pm 11t. Emergency/Containment Equipment: i ` r Waste Generator ID: /IAA 0 77,g q)_ Waste Pr duct: Date&Amount of Last Shipment/Fre uenc : I- a V 19 Licensed Waste Hauler&Destination: K196 DORMT-1 Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Z6 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 aint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOM ENDATIONS: d Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS i Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"Mp,q e. . � 200 Main Street• Hyannis, MA 02601 ptEOMA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ce►Aw+10 A v t o RV9V Date: Location/Mailing Address: 90 01 4L 'Se-L&o Y VQA 6x-)( rca,� Hy,%h,1 o 60X l f y3 Contact Name/Phone:--ro,Ly 'D. 1 g 771 -S Z Inventory Total Amount: � 1�a� SDS: Ye 5 License#: (.10S 6AA'2- 2�� Tier II : n Labeling: Oki Spill Plan: Yes Oil/WaterSeparator: e`✓ Floor Drains: e•S Emergency Numbers: ye 5 Storage Areas/Tanks: 30eiel WW' od IQvk` r-AAo5- Emergency/Containment E ui ment: �V PI.- 5��e Waste Generator ID: NVV Da -T 19 S12 Waste Product: WA144 Date&Amount of Last Shipment/Frequency: t b1 l O Ik -1 X Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �v V►�a��E'�� %A %wV-Cw� SIW-e, -'S� t"nar,4-., NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardou material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. V/ Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers �— Hydraulic fluid (including brake fluid) Windshield wash ✓ Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers fQr en Ines&g rages Pesticides: Caulk/Grout t b• 1i 9110 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 P,�� Swimming pool chlorine Paints, varnishes, stains, dyes J� 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: v D a� v<1 t v�,g &%o�-- ORDERS: Oq oyc. a� yes v�oo�5 - INFORMATION/RECOMMENDATIONS: o s wwqk ec"k, (ems ) Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °a� r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASSB��/h. 200 Main Street• Hyannis, MA 02601 % 59.°tee TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: CC,14v4&I Av-f o 16o�Q Date: D y 1 b Location/Mailing Address: `�� ke-t-ool x4 j 4t-%^, Contact Name/Phone: 1 ov V v� ,S SOS-7-7t - $842_ Inventory Total Amount: A-7,g 5'1 41 MSDS: c g k �°'^ g�5 License#: I L$ Ck4 2 Tier II : N 0 Labeling: OK Spill Plan: Oil/WaterSeparator: e5 Floor Drains: Y&S Emergency Numbers: Storage Areas/Tanks: 50 10 ,1 S a1 w k� q Emergency/Containment Equipment: S ;62t BH ,A--e, Waste Generator ID: MV o q I Waste Product: ate Kw�� Date&Amount of Last Shipment/Frequency: 94511t, Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �o vH A:,0 V, z-"A,��k NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers ✓ Hydraulic fluid (including brake fluid) �- Windshield wash ✓ Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout boii insecticides, herbicides, rodenticides Battery acid (electfolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) T Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes S &0SS Lye or caustic soda �— Lacquer thinners �,k4-, <,,a� V 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:. F. ORDERS: eS�11Oia.n. t,ti `5IAVQ. INFORMATION/RECOMMENDATIONS: twa A- Iou. t -7 5�4C-'� �� IZG�, 5j S�-a-e_�5 0'Wa2 �e-�P Inspector' l,�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i •KETo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. " 200 Main Street• Hyannis, MA 02601 1639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Acc� "I Ao & 8oaey Date: 1 2,Z 1� Location/Mailing Address: q& 14, 'l • ..,Vij S Contact Name/Phone: o O o -'7-T I - A S 9Z Inventory Total Amount: ti a�� MSDS: e5 License#: ILE Z Tier II : o Labeling: I covAmv-�- Spill Plan: o ate Oil/WaterSeparator: 25 a(�5c 'tee; ,�g� Flo r Drains: eS Emergency Numbers: �5 Storage Areas/Tanks: 30 4 LI waskg o, J--r4V, s wA.Yt6 4,4AX-<"9-f-3--?n���r/,A4,�� Emer enc /Containment Equipment: ka- Waste Generator ID: l g 2 Waste Product: o%t ixtA*, J(� Date&Amount of Last Shipment/Frequencv: 1' rJ „4wxe r '144 Licensed Waste Hauler&Destination: �' <'a S o I Other Waste Disposal Methods:Aa qa e o ,e, v ( t-, 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. 90 Antifreeze 1 O k%o 4'00("'t9- Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers 2 Hydraulic fluid (including brake fluid)7., ID Windshield wash !'45r 10 Motor oils to 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/10c J1 �\IIZt t+y insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) 10 Car wash detergents to Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda —�~ Lacquerthinners � �co�w`'30 Z Miscellaneous Combustible l Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables 6°%1`'-�\a'"A" Fertilizers Floor&furniture strippers PCB's Metal polishes -� Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) 2� (including bleach) Vv r �e,p`'Z� Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: a, �6 vJ(ti ��Ot XkVV01 , p� h�Vl z Inspector: I ' Laves Facility Representative: -4 � ), " WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE.� 200 Main Street• Hyannis, MA 02601 Fo3 A+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: GC t ckv� ,)k �60 9 Date: 30 Location/Mailing Address: o t� -(- et,n-,\,5 Contact Nam Phone: , S --7 ( Inventory Total Amount: So0 0 a\ MSDS: License#: Tier II : I)0 Labeling: Spill Plan: ye- Oil/Water Separator: 1r Floor Drains: ' ���OWS Emergency Numbers: Y9:!�i Storage Areas/Tanks: w�p� .�,�t5 �NI� �oova. a�Nk v��c ea,u� c� el f�„K ay , Emergency/Cont i'r ri1'en qulp171er1t: Sod, ,.� - ..� 36 —k&r4w- Waste Generator ID: MV50b1-7 19z2&L-• Waste Product: 0; o�� C4LO -�Q- _�4 Date&Amount of Last Shipment/Frequency: 3 3 `f 109,0 waste o 1 , 1132-Ib v-344{e Licensed Waste Hauler&Destination: gC��.} ae.� 'JN►� �I� }� kow L Other Waste Disposal Methods: \tiv (4 LIST OF TOXIC AND HAZARDOUS MATERIALS Po �Ma` o.( G1ia � �y� �n.�tan�so cy ��vwe, I[►s .,,.g deck ,, NOTE: Under the provisions of Ch. 111, Section 31, of the General LaWs of MA, hazardous fnaterial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engi es&garages Pesticides: Caulk/Grout/body �,I1.4.r 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: 61 - 1 1 Inspector: 005 �,HK. o,71V 42-ooC�5 Rak+ FB1-1 Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Date: 1 I l Sal 1 y TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: t7GG ►•�-�-a �`�-o o BUSINESS LOCATION: INVENTORY MAILING ADDRESS: PO J3&xf 19q 3 kI an r11,S TOTAL AMOUNT: TELEPHONE NUMBER: 8 - 771 - 81 1Z_ ti 3o7g 4 CONTACT PERSON: ny D o& i S EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: o boeZ 4 a r r `2 - v date cj,fl-t ' k 1v,1,q y 1,E 6 le— INFORMATION / RECOMMENDATI NS: ferhnks eY2ck , (t� FS District: ,eae ,M ui6� j zivL-s, 1XdA5 fe, ►S of yb� Co�C'ly �140� a� �a����ovs Nla.��{'�a.� ay� S►�e- ��'af2 �b >!�gLT v�/v5c�b1� o� . Waste yet�tation� ^16-0g771S892 Last shipment of hazardous waste: Name of Hauler: Sa'�'-�-�y }�IezK Destination: C v-avts Waste Product: a, /Aa ,+, feex-ge- Licensed es No R 1 D 09y00ZA>q2 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 �© Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive O NEWS' C/USED fS Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) / Hydraulic fluid (including brake fluid) Refrigerants 3 Mot r Oils Pesticides L NEW Z Q USED 30 (insecticides, herbicides, rodenticides) � Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 1 lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) /0 Caulk/Grout/booty C,llef Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible 10 Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's 100 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 1 Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) -7 Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes WkOe A,4ref 15 �vfD�2rJ� I►1- ��g�t, Laundry soil &stain removers (including bleach) ary✓►� � vKn c a ���ovw .6 Spot removers&cleaning fluids (dry cleaners) A Vt 44 4(l4.Vt, A, Other cleaning solvents Bug and tar removers J I d 1 e- 5011 A 4& aver bttw A5,��� Windshield wash 2J49I0t+0 j1 WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signatu a Staff's Initials-.1;�t— COMPLETE WELLNESS a place for healing mindbodyspirit Integrating conventional and alternative medicine NNE 10 Main Street at Rte. 28 C.Patricia Fater, M.D. Cotuit,MA 02635 (508)428-1969 Date:'f12-0/ oy TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: pl� `'V���✓l BUSINESS LOCATION:_Ttmo(,'r) .MAILING ADDRESS: -t�� �t -S� , C , MA 62��" INVENTORY TELEPHONE NUMBER: r- t�SR — CA Z TOTAL AMOUNT: CONTACTPERSON: C-. Q c,i,-L EMERGENCY CONTACT TELEPHONE NUMBER: 1=t RE pt 51�— TYPEOFBUSINESS: -� r ���esAn 2/yi_ OTHER INFORMATION: -- N A Waste Transportation: / Name of Hauler: Nr� Destination: Waste Product: Licensed? Yes No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCBs Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride)- Paint &varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels Floor&furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.: Si yze vises- l�rr�G�� (dry cleaners) Other cleaning solvents LLB Bug and tar removers v's " , WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS U _Number Fee �- 168 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI, THOMAS A.MCKEAN,R.S.,CHO Director of Public Health cR U 4i Town of Barnstable Regulatory Services Richard V. Scab,Director Public Health Division Ec ` 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. tJ� ��� DATE f(o APPLICATION FOR PERNUT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT (:2�V h t Il 0 'YI WID V U r S NAME OF ESTABLISHMENT (C c f' d e V-fQ- I /:A-U 2 o d V r Tin • ADDRESS OF ESTABLISHMENT 0) 0 H q It S cUto d TELEPHONE ER g 7Z L O 30j 2r SOLE OWNER7- ,YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: W APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.2 2o3 g,2 4- STATE OF INCORPORATION y S-t*S FULL NAME AND HOME ADDRESS OF: PRESIDENT A- n+b O n.�4 W U P U i E 139 l3 i vs- 9+ (fw,b re)ke. , M k�' TREASURER C 13 C 9 CLERK X SIGNATURE F APPLICANT RESTRICTIONS: HOME ADDRESS 130) Imo' Y-C)L, HOME TELEPHONE#7 ►-293 g-oj Cache\Temporary Internet Files\0LKD3IHAZAPP Rev2015.DOC r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 . Regulatory Services Department sn �is~cnaL� Public Health Division v MASS. Thomas A. McKean,CHO 1634- '° o ru•+�' 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment.received: $100.00 (Check) on 6/24/2015 Permit number:: 168 ,Check number: 1367 Check amount: $100.00 Name on check: Accidental Auto Body Inc. Business: Accidental Auto Body Inc. Owner: WAYNE TR Address: 90 HIGH SCHOOL ROAD EXT, Hyannis f • Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------ PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health I cr . +r �t6n,Cii Town of Barnstable Inspectional Services BARNS TABLE • �� M Tclls WO.S,1ERiR:l'•L°'UR•:YaHhl_ " Public Health Division '° °'S.°59r«<.�., :ryE O :678-�ma �STABLE.T Thomas McKean, Director SAT fo ,�0� 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 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 '91/6f Vq- *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? V YES_NO. IF YES,SKIP QUESTION 19 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: � 1P� C emj 1 5. NAME OF ESTABLISHMENT: r(-)r- Cam" 4&nn i 5 6 d iYl. 6. ADDRESS OF ESTABLISHMENT: qU h �L!!�I K1X .1` `�.�n �' ►m�-�' �O��v! 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: (�!� '��t5' 3 96�) 9. EMAIL ADDRESS: I H V-e l flat gebwj 15P .e D m 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: j51fa 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:&f®f"e&,�-39-5Z) CORPORATION NAME t7 PRESIDENT 112 TREASURER 5 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: 4 TELEPHONE#: • COMPANY ADDRES EMAIL: ' C4, 60M SIGNATURE OF APPLICAN a DATE tO) ��r♦y Q\Application Forms\Haz Mat App Revised 09-10-18.docx I Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health y:J 1U • • • w:0RD • o�� Of B nsxable �egulatoryYervlces t� Richard V. Scali, Director � ram, Public Health Division BARNSTABIE • ` BAItNSfAEIE•fEtRQtVILLE•mfUR.MYMW15 BARNgrABL& Thomas McKean, Director M A83. � 1639-2014 h•my -- - —-- - 1639 �� -- -- — - - — --- h-a arEo s 200 Mam Street,-Hpanrus-MA 02601 ---- �D�- --- - Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ' IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 x V,.s . *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO.3 3aA G 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES,SKIP QUESTION43 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: �YCAY A (:, b&1QZ 3C-_ 5. NAME OF ESTABLISHMENT: roc t� SL Al 6. ADDRESS OF ESTABLISHMENT:1�0 oayo\ 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: SCE 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: b Liz, G'���S-��Jt� • cam 10. SOLEOWNER: YESXNO IF NO,NAME OF PARTNER: SXS:�,A�i�s 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: 5�� So CORPORATION NAME 1'o z-& ANc,tZn P �s-� o c-cg PRESIDENT trcr� E �d�y., J r 1a7, G rc W,� P0laB5 TREASURER CLERK vJ� r \ ► 12. IF PREPARED BY OUTSIDE PARTY: _ NAME: 13CRA10 c.,� c v TELEPHONE#• • COMPANY ADDRESS 110 t Iti a E k j EMAIL:-bC115 t Cz� SIGNATURE OF APPLICAN DATE (play l� r�zg Q\Application Forms\HAZMAT APP 2017 REVISED.docx Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN ZDONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Ci is � i • ��' �. aQr.G�k� f31a�• FORD TROe lu a B stable g ry ervices Richard V. Scali, Director �t E*1 LE Public Health Division Cz • • ut:15 Thomas McKean Director ""`�WAS& ) py� QED Me93 . 200 Main Street, Hyannis,MA 02601 Office: 508-862-464-4 7'pc�` Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 0 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 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO.OJ •3a GC 3:�)9-o(los 309 -al E 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 NAME OF APPLICANT: 3_am'ZS E c 5. NAME OF ESTABLISHMENT: �orc� IFa C- 6. ADDRESS OF ESTABLISHMENT:COA-i��ScN,601 U 1-iyo,nrvi.S Mom, va�00\ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: SAM►G 8. TELEPHONE NUMBER OF ESTABLISHM.NT: 9. EMAIL ADDRESS: \pr1i s-�l CO 'bQ`� S�.Gy�� •CO 10. SOLEOWNER: YES X NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT 9 c- QgZ, cc�.W F, O l Ogg TREASURER � M '(n i tv c CLERK 12. IF PREARED BY OUTSIDE PARTY: NAME 0RX1dz)o` tJ 1 % t` cO TELEP 01 TE# :. • COMPANY ADDRESS l-\ Y1 c7 '�EMAIL naS'V:I-co e Q C,v� �G0'� SIGNATURE OF APPLIC `0Z) DATE �jaa-_0`7 Q:1Application FormsIHAZMAT APP 2017 REVISED.docx Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons 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 S S°� Town of Barnstable itMME Regulatory Services Richard V. Scah,Director a�artsrneLe. � 1 V ifta � �. Public Health Division rcrcs�Thomas McKean, Director �200 Main Street, Hyannis,MA 02601 `.. Office: 508-862-4644 Fax: 508-790-614 .I� 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—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 1l CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by duly 1st. ASSESSORS MAP AND PARCEL NO. DATE Yi FULL NAME OF APPLICANT: K/zrrw4t" u S NAME OF ESTABLISHMENT: CG/ 2 4'C_- 4Co ADDRESS OF ESTABLISHMENT: 74) ��8�/ s� �"�. �?� 7- MAILING ADDRESS(IF DIFFERENT): -�7 g� c, TELEPHONE NUMBER OF ESTABLISHMENT: 30 ? ` 77 �V / P-- EMAIL ADDRESS: ��U� L/I S �CC/ WeAy�*Z r CO eTC3jZ. NET SOLE OWNER: YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,� T LEPH �T�� E� �� � CORPORATION NA �H`JJ '�--vv PRESIDENT W v G1/ TREASURER �A, . CLERK . IF PREPARED BY OUTSIDE PARTY: NATURE O A PL C T _ Name: Company Address Telephone#: Email: Q\Application Forms\HAZZAPP Rev I6.docx Page 1 of 2 Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/13/2014 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 �J r n , Town of.Barnstable o�IME, Regulatory Services - Thomas F. Geiler,Director 3 a HARN.GTAA(�. public Health DiYision A � Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-S62-4644 Fax: 50&790-6304 Appfica#icn Fee: $100.00 AY ASSESSORS ASAP AND PARCEL,NO.S 3p DATE Ltl 8 APPLICATION FOR PERM TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FURL NANSE OF APPLICANT NAME OF ESTABT,7SM= /O/4 z,-` al ADDRESS OF ESTABT,T.4"FTIV(T+'NT i TELEPHONE NUMBER SOLE OWNER. YES_z(o IF APPLICANT IS A PARTNERS,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. G (3 STATE OF INCORPORATION Z�)IS),:j5n //U,Sr .S FULL NAME AND HOME ADDRESS OF: PRESIDENT �/ m�,� � ��is� �,� () / O�f��C�T. Gt/�%�A�n �/=/L� �/y►"/� O/08�I ' CL.E.RK SIGNATURE OF APPIJCANT RESTRICTIOINS. HOME ADDRESS �.� S /YtiA Oldy� HOME TELEPHONE F_az.dcc/wp/q I I(PA The Nation's Compliance Expert Safety ♦ Environmental ♦ HR • I EMERGENCY RESPONSE ACTION PLAN Ford of Hyannis Overview The quantity and type of hazardous materials handled at the facility and the nature of our operations present a relatively low risk of a dangerous incident involving exposure to hazardous materials. Further,we rely upon community provided emergency services for primary emergency response should such an incident occur. Nevertheless,there are certain emergency response activities that facility personnel may undertake. This is especially true in the event of a spill or other unplanned release of a hazardous material. Should,for example, a bulk oil storage tank fail, a significant release could occur and a prompt facility response may be required to prevent an environmentally damaging incident. The facility can also respond in a very limited way to a fire. It is emphasized, however that the local fire department should be immediately called for anything except the most minor incident. Questions on any element of this plan should be directed to Craig Brissell who is the Emergency Response Coordinator. Emergency Response Action Plan- Ford of Hyannis 1110 MILL ©KPA,LLC Page 1 Spill/Release Response Plan Ford of Hyannis 1. Emergency Equipment: Ford of Hyannis relies primarily upon community provided services for emergency response. Consequently,the variety and availability of on-site emergency equipment is limited. Response equipment typically present at the facility includes: a. Spill Absorption.Material: The facility usually has on hand a supply of absorbent material(grease- sweep)in the service areas. This material can be used to dam off the flow of a hazardous material. After any release is contained,this material can also be spread over the released liquid until it has been placed in sufficient volume to absorb it. The contaminated absorbent material should then be collected and placed in a drum or other containment for proper disposal. b. Personal Protective Equipment: This equipment is limited to the following: Equipment Location Safety Glasses Facility Wide Goggles Facility Wide Face Shields Facility Wide Dust Masks Facility Wide Nitrile Gloves Facility Wide This equipment is available for use when routinely handling hazardous materials common to this facility. It can also be used under emergency conditions. c. Hazardous Waste Hauler: Under certain conditions,hazardous waste haulers can be of great service during a release or threatened release of a hazardous material. For example,a hauler can empty a tank that appears to be failing. If a spill is contained,such a service may be able to pump up a substantial portion of the released liquid. Haulers who can be contacted include: Waste Type Waste Hauler Waste Oil Hauler Safety Kleen(800)669-5740 Hazardous Waste Hauler Safety Kleen(800)669-5740 Oil-Water Separator Contractor Safety Kleen(800)669-5740 Note: In the event the above haulers cannot be contacted, additional haulers can normally be located by searching online. Possible search terms include: "Waste Oil Hauler"and"Industrial Waste Disposal' 2. Spill Containment and Clean Up: a. Shut off/eliminate all sources of ignition. b. Attempt to prevent any additional release(if possible). An example would be closing a leaking valve or turning off a pump that is causing a release. c. Contain the spill by diking around it using sand,earth or other absorbent material. Ensure special attention to preventing spilled material from reaching a sewer or storm drain inlet. Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 2 d. Absorb spilled material using sand,earth or other absorbent. Floor cleaning/sweeping materials are appropriate and are normally available. Note: It may be possible to pump up a significant portion of contained liquid. e. Avoid skin contact and breathing vapors. Wear appropriate protective clothing and equipment. This equipment can include chemical resistant gloves,eye protection and supplied air respirators. f. Ventilate the area with local exhaust systems or by opening available doors and windows. Note: Avoid use of compressed air to speed evaporation of spilled liquid. This practice increases airborne concentrations and increases the possibility of injuries such as eye damage. g. Dispose of contaminated absorbent in accordance with applicable regulations. This will normally involve disposal of the material as a hazardous waste. If the material is a corrosive,place contaminated absorbent material in polyethylene or polyethylene-lined container for disposal. Note: If the material released is a corrosive(i.e., battery acid), it may be possible to neutralize it after it has been contained. For information on how to neutralize it, facility management should call the emergency numbers provided on the product Material Safety Data Sheet. 3. First Aid Procedures: First aid information for an individual chemical is available on its Material Safety Data Sheet. It may also be appropriate to consult a physician. General first aid responses include: a. Eye Contact: Flush with large amounts of water for at least 15 minutes. Occasionally lift upper and lower lids. Consult a physician. b. Skin Contact: Remove contaminated clothing and immediately flush contaminated areas with large amounts of water. c. Inhalation: If overcome or affected by vapors,remove from exposure and call a physician immediately. d. Ingestion: Call emergency medical aid immediately. Consult the MSDS to determine if vomiting should be induced or if individual should be provided other first aid measures. 4. Evacuation: Supervisors have the authority to direct an evacuation of the facility. Refer to Part 3 of this Action Plan. 5. Reporting: a. Obligation to Report: Depending upon the volume involved,the facility may be required to report a release or threatened release of a hazardous material. No report is required for small,non-harmful releases such as a quart of drain oil on the shop floor. b. Reporting Authority: Any employee who detects a release or threatened release of a hazardous material (other than an incidental spill)should immediately notify his or her supervisor,who shall then be responsible for assessing and beginning a response to the hazard posed. If the release/threatened release involves a significant volume of hazardous material,the supervisor should promptly notify one of the following,who shall have reporting authority: Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA,LLC Page 3 r Reporting Authority GM Service Manager Parts Manager If none of these parties can be notified,the supervisor has the authority to make the report. c. Reporting Procedure: If uncertain as to whether a report is required,the responsible individual should first query one of the below listed agencies. If it is determined that a report is required,it should be made to the following: Agency Contact Information Barnstable Police Dept (508) 775-5466 Barnstable Hyannis Fire Dept (508)775-1300 911 911 The report should be made as soon as possible so long as it does not impede immediate control of the release or interfere with emergency medical measures and should include the following about the release or threatened release: • The exact location • The name of the person that made the report • The type and quantity of hazardous material(s) involved • The potential hazard(s)presented(if known) • Appropriate emergency response agencies and facility managers should also be notified. d. Written Record: A written record of all verbal notifications should be prepared by the reporting individual and provided to the owner. This report may be handwritten and should include the following: • Date and time of call • Person making call • Agencies notified • Individuals contacted • Summary of conversation(s) Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 4 r Fire or Explosion Response Plan Ford of Hyannis 1. Fire Prevention: The best means of managing a fire/explosion hazard at the facility is to prevent such an event. In that regard,facility management has prepared a Fire Prevention Plan that is included as Exhibit(a)to this Response Plan. 2. Reporting: Any fire or explosion should be reported immediately to the local fire department or by dialing 911. 3. Fire Fighting Activities: g g a.Fire Department: The facility will rely primarily upon the local fire department for response to a fire or I explosion at the facility. The facility is not equipped,nor are personnel trained to respond to anything except the smallest fire.A fire in a trashcan or in a pile of rags could be an example of a small fire. b.Facility Fire Fighting Activities: i.Fire Fighting Equipment: Facility equipment is limited to small,hand-held extinguishers.Properly used,these extinguishers can put out a small fire or control it until the fire department arrives. Portable fire extinguishers are not designed to fight large or spreading fires. These extinguishers carry notations that indicate which class of fire they can be used to fight. These notations consist of a series of numbers and letters(ex: 2A,20BC)and are further explained as follows: • "A": Effective against wood,paper and rubbish. Many fire extinguishers have a triangle surrounding the A. The triangle is the international symbol for an A type fire. The numbers in front of the A,in our example the number 2,means that the extinguisher has been rated as being capable of putting out an A type fire two square feet in area. • "B": Effective against flammable and combustible liquids. The square that often surrounds the B is the international symbol for a liquid fire. The number in front of the B,in our example the number 20,is a relative term and means only that the extinguisher can handle a B fire 20 times larger than an extinguisher rated IB. • "C": Effective against electrical fires. The circle that may be around the letter is the international symbol for an electrical fire. There is no number rating system for the C designation on a fire extinguisher. Note: A 2A, 20BC extinguisher may therefore be used on any fire that might be anticipated at the facility. Of note, most of the portable fire extinguishers present at this facility are rated as "ABC" units. Further, a `BC"extinguisher may be effective on a Class Afire. ii.Precautions: Before any effort is made to fight a fire,the individual(s)involved should make sure of the following: • Everyone has left or is leaving the building. ■ The fire department has been notified. • The fire is confined to a small area and is not spreading beyond the immediate area. • The individual using the extinguisher has an unobstructed escape route to which the fire will not spread. • The individual using the extinguisher is trained in its proper use. iii.Use of a Portable Fire Extinguisher: There are general guidelines that apply to the use of portable fire extinguishers. In general,an individual using an extinguisher should stand six to eight feet away Emergency Response Action Plan— Ford of Hyannis 1110 MILL ©KPA,LLC Page 5 f from the fire and follow the four-step PASS procedure. If the fire does not go out immediately,the individual should leave the area at once. The PASS procedure is as follows: • Pull Pin: This unlocks the operating lever on the extinguisher and allows discharge of the extinguisher. Some extinguishers may have other devices that prevent inadvertent operation. • Aim Low: Point the extinguisher nozzle(or hose)at the base of the fire. • Squeeze: Squeeze the lever below the handle. This discharges the extinguishing agent. Releasing the lever will stop the discharge. Some extinguishers have a button that can be pressed for release of the extinguishing agent. • Sweep From Side to Side: Moving carefully toward the fire,keep the extinguisher aimed at the base of the fire and sweep back and forth across the fire until the flames appear to be out. Watch the fire area. If the fire reignites,repeat the process. 4. First Aid Procedures: a.Smoke Inhalation: Remove the individual to fresh air immediately. Call a physician immediately. Report the situation to representatives of the Fire Department or other emergency response organizations on the scene. b.Eye Irritation: Flush with large amounts of water for 15 minutes or until irritation subsides. Consult a physician. c.Skin Contact(dermal): Remove contaminated clothing and wash skin thoroughly with soap and water. If material is a caustic,flush thoroughly with large amounts of fresh water. d.Ingestion: Call emergency medical aid immediately. Consult the appropriate Material Safety Data Sheet (MSDS)to determine if vomiting should be induced or if individual should be provided other first aid measures. e.Burns: Remove the individual from the heat source and call a physician immediately. Report the situation to representatives of the Fire Department or other emergency response organizations on the scene. 5. Evacuation: Supervisors have the authority to direct an evacuation of the facility. Refer to Part 3 of this Action Plan. Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 6 r Fire Prevention Plan Ford of Hyannis 1. Potential Fire Hazards: Facility management stores the number of products that are potential fire hazards. These products generally fall into one of the following categories: a. Flammable liquids such as gasoline and some paint related products. b. Flammable gases. Acetylene is a good example. c. Combustible liquids such as diesel fuel,lubricating oils and some solvents. 2. Proper Handling and Storage Procedures: Flammable materials are to be used only in well- ventilated areas. This will prevent a buildup of vapors to a level that could pose a health or fire/explosion hazard. Containers of flammable and combustible materials should be closed when not in use. They should also not be stored near a heat or ignition source. Smoking is not permitted when working with flammable liquids. Compressed gases are to be securely stowed at all times and,when not in use,valves are to be closed. 3. Responsibilities: a. Supervisors are responsible for the overall safety of the work areas under their respective control. b. Individual employees are responsible for keeping their work areas free of excessive debris and unwarranted accumulations of flammable and combustible materials. c. Facility management is responsible for ensuring available on-site fire fighting and fire suppression equipment is properly maintained and available for immediate use. d. Supervisors are responsible for ensuring that significant spills of flammable and combustible liquids are contained and cleaned up according to facility guidelines. 4. Training: Supervisors shall ensure that subordinate employees receive appropriate training on this Plan and on how to respond in the event of a fire emergency. In particular,this training shall include: a. Fire/Explosion Response b. Facility Evacuation Procedures Emergency Response Action Plan— Ford of Hyannis 1110 MILL ©KPA,LLC Page 7 Evacuation Procedures Ford of Hyannis Under certain circumstances,most likely a fire,it may be necessary to evacuate the facility. In the event a supervisor concludes that evacuation is required to protect the health and safety of subordinates,that supervisor has the authority to evacuate those serving under his direction. The supervisor shall,however,ensure that other appropriate personnel at the facility are notified of the decision to evacuate. The key to a successful evacuation is accountability. Supervisors must be able to quickly account for assigned personnel and to report any who may be missing. With that in mind,evacuation procedures shall be as follows: 1. Order to evacuate is given by Supervisor. 2. If time allows,the following activities should be performed: a. Shut off all power to the facility or area being evacuated. b. Close all doors,windows,vents,etc. c. Call 911 for emergency response support(fire dept.,etc.). 3. All employees shall promptly evacuate the facility by using the exit point most convenient to each.The primary evacuation assembly point shall be in the front of the facility next to the dealership sign.. Should assembly at that point prove impossible,the secondary evacuation assembly point shall be refer to primary. 4. Notify adjacent businesses of the incident that necessitated the evacuation. Following the evacuation, supervisors shall account for their personnel. In the event someone is determined to be missing,that fact shall be immediately reported to the senior facility manager present and to the responding emergency response organization(fire department,etc.). Notes: (1) No one should reenter the facility in an effort to locate a missing individual. That is the task of the Fire Department or other emergency response organization. Individuals with these organizations are properly trained and equipped to undertake such a task. (2)Personnel shall not leave the evacuation assembly point without the specific approval of their supervisor. Supervisors shall render all possible assistance to fire department personnel and other emergency responders. This shall include providing information on the general location and nature of hazardous materials located in the facility. Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 8 Other Emergencies Ford of Hyannis First Aid Response: This facility does not maintain a trained first aid responder. It is our policy that first aid response be provided by the local emergency medical response organization,which can be contacted by calling 911. Flood: With regard to hazardous materials,the primary concern in a flood is the loss or displacement of these materials by floodwater. For example,water can run into an unsecured underground oil storage tank and,since water is heavier than oil,it will displace the oil. If floodwaters rise high enough,above ground tanks and drums could be similarly affected. When flooding is threatened, it is therefore important to ensure that all hazardous material containers are tightly closed or otherwise fastened shut. Further, steps should be taken to tie down or otherwise secure drums,etc.that might float free during a flood. In addition,utilities to the facility should be shut off. Any flooding that would result from broken pipes should be incidental and would normally be controlled by shutting off water service to the building. Should assistance be required,authorities should be notified by calling 911. Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 9 Tornado Response Plan Ford of Hyannis The threat of a tornado is real. Every year many tornadoes ravage the countryside and communities of the state. While avoiding property damage during a tornado is certainly difficult,there are several steps that can be taken to enhance personal safety. Some general guidelines for personal safety include: 1. Seek Shelter: Try to get inside. If you cannot get inside,crouch for protection beside a strong structure or lie flat in a ditch or low-lying area and cover your head and neck with your arms or a piece of clothing. Beware of water runoff. If inside,a good place to be during a tornado is in the basement of a building. If a basement is not available,try to move to a protected interior room on the lowest floor of the building,as far as possible from exterior walls and windows. Try to avoid large-span roof areas. Service shops may be an example. Try to use a piece of clothing or your arms to shield your head and neck. 2. Driving: A tornado can literally pick a car or truck up off the ground and throw it several hundred feet. If an individual in a vehicle finds himself immediately threatened by a tornado,he should normally stop,exit the vehicle and seek shelter immediately in a nearby building. In some instances,the best option may be to get out of the car and lie flat in a ditch or other low-lying area. This can offer some protection against flying debris and reduce the chance of being carried away by the tornado. Shield your head and neck and beware of water runoff. 3. Accountability: Tornadoes come and go in a matter of minutes,or even seconds. They typically displace not only objects,but people too. As soon as danger passes,it is important to account for everyone at the facility. It is easiest to account for everyone by assembling at the evacuation assembly area(see Part 3 of this plan). Once at the assembly area,don't leave until told to do so by your supervisor or other responsible facility manager. 4. Hazardous Materials: There is little that can be done to prevent the spilling or other release of these materials if a tornado hits the facility.However,as soon as the storm passes,every effort should be made to contain any release. Proper authorities may also have to be notified. Additional details on spill response activities are included in Section 1 of this action plan. 5. Beware of Hazards: Some steps to take following a tornado include: • Stay away from downed power lines. Report them immediately to the utility company. • Stay away from damaged buildings until cleared by a qualified inspector. • Evacuate if gas or other dangerous fumes are detected. Notify appropriate authorities. • Avoid the use of candles(in many instances more people die from candle-related fires after a disaster than from the disaster itself. I Emergency Response Action Plan— Ford of Hyannis 1110 MILL ©KPA, LLC Page 10 r Hurricane Response Plan Ford of Hyannis KPA presumes that facility management will receive a hurricane warning sufficient to dismiss employees from their work. In that regard,it is important as the hurricane approaches to clearly communicate to all employees the time they should evacuate the facility and any procedures they should follow. The following are some general guidelines that can assist a facility expecting to be struck by a hurricane. 1. Hazardous Materials: Similar to preparing for a flood,containers of hazardous materials should be tightly closed or otherwise fastened shut. Items such as drums that might float free or be upset by high winds should be tied down or otherwise secured. 2. Utilities: Utilities such as water,gas and electricity should normally be shut off. 3. Doors and Windows: All doors and windows at the facility should be closed and locked. 4. Facility Records: Care should be taken to safeguard important records. If they are to remain at the facility, possible options include placing them in a waterproof container,and if flooding is a risk,storing them on a higher floor. If an individual is inside one of the buildings on the property and it is too late to evacuate,he should attempt to fmd refuge in a room,closet or alcove without windows. If not in a location susceptible to a coastal storm surge,seek out an interior room on the lowest floor of the building. If coastal storm surge is a risk, seek out on area on an upper floor. Also,if winds die down,do not be lulled into a false sense of security. It could simple be the eye of the hurricane passing overhead. j After a hurricane,beware of hazards. Some common steps to take include: • Stay away from downed power lines. Report them immediately to the utility company. • Stay away from damaged buildings until cleared by a qualified inspector. • Evacuate if gas or other dangerous fumes are detected. Notify appropriate authorities. • Avoid the use of candles(in many instances more people die from candle-related fires after a disaster than from the disaster itself. Emergency Response Action Plan— Ford of Hyannis 1110 MILL ©KPA,LLC Page 11 r EMERGENCY RESPONSE ACTION PLAN Ford of Hyannis EMPLOYEE TRAINING CERTIFICATION I hereby acknowledge that I have received information on facility emergency response procedures so that I can be better prepared for certain facility emergencies,including a release or threatened release of a hazardous material. Specifically,I received information on the at least following: • SpilURelease Response Plan(chemical handlers only) • Fire/Explosion Response Plan,including use of hand held fire extinguishers • Evacuation Procedures • Response plan for first aid and flood • Tornado Response Plan I understand that I should contact my supervisor should I have any questions or concerns about the information presented. S' atur (_a 16 f-l :5 e Print Na e Date cc: Employee File Emergency Response Action Plan— Ford of Hyannis 1110 vALL ©KPA, LLC Page 12 I Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons 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.GUA_DAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health FM Town of Barnstable Inspectional Services BARNSTABLE �t r �wsrneF•ahrea:u=.Cmt•n7umr vs*aet pros•as�xv:ue•vr ewvss;e Public Health Division BARNSTABLE. ` Thomas McKean Director ' MAW ��Ar f0�59p.�p`0� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6364, APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS s 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 Xvs-rl of� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El6 *A late charge of$10.00 will be assessed if payment is not received by July 1st. t 3� 1. ASSESSOR'S MAP AND PARCEL NO. �`_�®�� 02(A 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 S GE/USE OF �• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 74 �d 1i(� ✓/`� 5. NAME OF ESTABLISHMENT: CC f`J Wit/7-a IKE 6. ADDRESS OF ESTABLISHMENT: o / �'e�o-oL /6"OrtJp 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: — Z71 FP f o, 9. EMAIL ADDRESS: v V/ 04ee", t G�2CG E lli'�T 10. SOLEOWNER: VIIYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,A TELEPHON #OF: CORPORATION NAMECGi PRESIDENT 14 oc TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE QAApplication Forms\Haz Mat App Revised 09-10-18.docx Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA 43 Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- -------------------------------------------------------I----- 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. C -------- ---------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN S DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI 5- THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Toe gulw1� of B nsl able °� �� It Katory ervices oFt Richard V. Scali, Director r �� ° Public Health Division LE 051'nb:E Ba MASS. • Thomas McKean, Director y mass. $ 1 39. a`` 200 Main Street, Hyannis, MA 02601 �Dg 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-XNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CAT ERMIT 500 or more Gallons: $150.00 ❑ *A late char of$10.00 w' 1 be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD Q ANTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: AYL7) \S 5. NAME OF ESTABLISHMENT: CC/ o 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ,( O Kr Ct�d �� 9,3� 8. TELEPHONE NUMBER OF ESTABLISHMENT: � - J S6214 77 9. EMAIL ADDRESS: ! UCc J ;2ee: • Lo /-',2X3T,9!Z , ,&ZF7 - 10. SOLEOWNER:JZ`YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE# OF: j CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSID PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT �4�DATE As Q\Application Forms\HAZMAT APP 2017 REVISED.docx I Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons 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 Z: 0-Hd LTOZ 61 c j.r ACCIDENTAL AU BODY Collision Specialists Tony Dupuis tdupuis@accidental.comcastbiz.net J 90 High School Rd.Ext. Hyannis,MA 02601 P:508-771-8892 .,. www.AccidentalAutoBody.com 508 771-2160 Y i We'll Pu+a smile bock on Your facet . Tower, of Bqrnstable Regulatory Services Richard V. Scali, Director , �T MWE , :rs. RNSTABLEPublic Health Division �lE•ti.En1FtY1•ARNSTABLE, Thomas McKean,DirectorA�1639 201ymste<nsrtat .fw MASS %639 .� 5775 rM i0rfn�,�a 200 Main Street, Hyannis,MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 m 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 x CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? �YES_NO. IF YES, SHIP 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: 4 / 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: '0 6 %�'Y ' `p�1X> C,X J 1 L t�l41�L 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: ,��F" 271— '8 2 z— 9. EMAIL ADDRESS: T,P vpU/,5 � CC/ e� �(i• ��21(,dui✓/��L �t/ ?� 10. SOLEOWNER: NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME AD RESS AND TEL PHONE# F: CORPORATION N ME ec � Tm,�L� �! 1.7 PRESIDENT it TREASURER CLERK S 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN AT __j1!5/5//-2 QAApplication Forms\HAZMAT APP 2017 REVI ED.docx Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, 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 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M-D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health L�- Town of Barnstable f�Do:� �THETgy Regulatory Services Thomas F. Geiler, Director MASS. Public Health Division 'OrFo 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 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT GG e .ADDRESS OF ESTABLISHMENT C��/re S�C.ltftj 91*'k ��G o TELEPHONE NUMBER 77/ k#yP;L 4)I a SOLE OWNER:ZYES NO 3 Cr IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: wrn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND OME ADDRESS OF: PRESIDENT 0 yr/ epy" ba3�f► TREASURER CLERK — 5n-rvt C 711sj 6F APPLICANT RESTRICTIONS: HOME ADDRESS sue° -W )44F&V%f- HOME TELEPHONE# / .6 2Z?a Haz.doc/wp/q l t� Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2013 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable pPtHE l Regulatory Services t1`�g ry Thomas F. Geiler,Director '9 qj MAS. Public Health Division l ibgq. °TFo Ma's°i Thomas McKean,Director 200 Main Street, Hyannis, MA 0260.1 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. `1 DATE E2 Z F Z APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT `l TVPV7 / NAME OF ESTABLISHMENT AC ADDRESS OF ESTABLISHMENT �� / r� s��o�s� � C—'X/ yc/3 BZ6d-/ TELEPHONE NUMBER 67_41,�V— SOLE OWNER: YE S NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3 k,2 ky STATE OF INCORPORATION FULL NAME AND HOME ADD SS OF: PRESIDENT lv TREASURER CLERK SIGNATURE OF APP CANT I RESTRICTIONS: HOME ADDRESSAF 5tw�f r-r lFekyyOOVALf Pei o2;S� HOME TELEPHONE#7 br/ Haz.doc/wp/q I r Town of Barnstable Regulatory Services Thomas F. Geiler,Director y 3 • A Public Health Division �39 ♦� Thomas McKean,Director 200 Main Street, Hyamnis,MA 0260.1 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO, _ DATE b APPLICATION FOR PERMIT TO STORE AND/OR UTILIU MORE THAN 111 GALLONS OF OUS MATERIALS FULL NAME OF APPLICANT [J NAME OF ESTABLISHIVI.ENT Acr � ADDRESS OF ESTABLI,SEMIEN r' TELEPHONE NUMBER !d;>- �, / b' 2- SOU OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND ROME ADDRESS OF ALL PARTNERS: IP APPLICANT IS A CORPORATION: FEDFIIAL IDENTIFICATION NO. 2 a D 3k o2 kY STATE OF INCORPORATION FULL NAME AND HOME ADD SS OF: PRESIDENTS TREASURER CLERK .� SIGNATUM OF APPEkANT RESTRICTIONS: HOME ADDRESS/7? 9-F- A,;WX* "Ae 010- a2-35F HOME TELEPHONE#7 kr/ t, 3,PY f Haz.dodwp/q Z0 39Vd 091ZZLL 91:ZZ VOKILO100 Number Fee 168, THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, 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 J l- . Town of Barnstable Barnstable 'VHE Regulatory Services Department o- edea V MA + nntuvsrABLE.,` Public Health Division 9 SM 200 Main Street Hyannis MA 02601 �63q. I `b �� � Y Arfa3�A ,�, 2007 Office: 508-862-4644 ThordL.F.Geiier,Director FAX: 508-790-6304 i Thom.M*an,CHO CYN Application Fee: $100.00 x cn r- J rn ASSESSORS MAP AND PARCEL NO. DATE a fr- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT - A rVT iA a trj U Doio o a_C NAME OF ESTABLISHMENT A CC jj P a)-J--cam( Rj 4--y 2 o�c ADDRESS OF ESTABLISHMENT 9() f- jQc �o-.,C Qd f'f., UAnm)eS A nx'0j TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.k-Z3 M� L/ STATE OF INCORPORATION (p FULL NAME AND HOME ADDRESS OF: PRESIDENT Pjw�1nnq g,s I ��i RI'P-I . Sf �vrn,b^y fc J'bA 40 ?-Is- TREASURER 'T CLERK SIG URE OF APPLICANT RESTRICTIONS: HOME ADDRESS 13c1 21rck Y4 &,64-�.►a,� n23�7 HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable °piHE Tqk� Regulatory Services Richard V. Scali, Director t a ► s 9H"R S. Public Health Division i639. �0 039. 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 h APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �"Ia/Yf a "r- 64"M, NAME OF ESTABLISHMENT GAL.!�l#,t4g /-L ADDRESS OF ESTABLISHMENT D j�2 02,(o0l TELEPHONE NUMBER -775 SOLE OWNER: YES IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. "d q 3 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: ` PRESIDENT I J;S TREASURER / CLERK I IdlUX2'� SI ATURE OF APPLICANT RESTRICTIONS: HOME ADDRE V � HOME TELEPHONE# rJ lJ Q:\Application Forms\HAZAPP.DOC Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health FAC7TAL AUTO BODY Collision specialists Tony Dupuis i tdupuis®accidental.comcastbiz.net 90 High School Rd..Ext. I Hyannis,MA 02601 P.508-771-8892 j www.AccidentalAulaBody.com 508 771 2160 ' We'll put a Smile.6ack on your facet Town of Barnstable Pd /60' °pTHE Tp� Regulatory Services CL-r/M %/,//y ti Richard V. Scali, Director '" MASS.` Public Health Division eT1639. a Ea�+ Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 22 NAME OF ESTABLISHIVIENT G G, ;_ ADDRESS OF ESTABLISI-IMENT �O " '1 �SJ TELEPHONE NUMBER 771 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.20 Zo 3 fJ Z�rlv STATE OF INCORPORATION . FULL NAME AND H ME ADDRESS OF: PRESIDENT W v v TREASURER CLERK NATURE OF AP LICANT RESTRICTIONS: HOME ADDRESS r-v� HOME TELEPHONE #k 20e(C2/3 Q:1Application Forms\HAZAPP.DOC r 03 14 11:00 PAGE 1 BRANCH RI$ CSC 1' Jonathan Holt 03/ / 'i if'•i }fill! �,l�l Jr=.t„It's o, 41673 - stems Inc. gal: 5 a}_:i_ t_it-IFt�'TC r�l_s Safety-M een Sy i Li 7 .- 2600 N Central Expy, Suite 400 .,,• 1;;i 1 a,� ha i_. =i 17. c } CO. t�,�a.Ll?1 ! Richardson, TX 75080 ._ .1 �� t?!ti Nt_15i..E CORPORATE: 800-669-5740 ' _ •--.,,, u n Sir? . t::,i,1"7:I_:•i:i L I'F.' " `-"•--- - ------'----•----- -"-- 24 NR EMERGENCY: 800-468-1760 (Safety-Kneen) ____.__._.____.�.____._..___.-__-_-•- ,._ 4017810808 REFERENCE NBR. ;,-f I-�,F 1.C.A CUSTOMER# AC17S71 Accidental Auto Body SRVC WEEK: 2014-10 90b High School Road Ext Hyannis MA 02601-38Z0 SRVC DATE! 03/03/14 11:00 r ,L,• � ,Ir!.. i .�Ij i 1;,�1 ,:: '_ ! .i:�.? ifiti.`-}, ..1} "i",it�. � 1._„ ti :•y_: PHONE 508-771-8897 C n BILL To CUSTOMER# BILL TO ADDRESS: I��•S,.l $ AC17571 Accidental Auto Body , gob High School Road Ext Li° fii; Hyannis MA 02601-3820 PHONE 508 L�1'�'''L' i'n� TAX EXEMPT# C�y: :ii_'. '3}`�t }�i_t•-' f SW='lt•f.:) PURCHASE ORDER# ..�:_L_}•-' ( _ 1-}s:}FJ-1 PRODUCT/SERVICES t;s a TOTAL !? 0,}`-f SERVICE/ IAX CHARGE 'r t_ _)7 ?i 131 r ;::;;fStjsl'I') Q1Y UNIT PRICE �,-�i_,t.L PRODUCT 0.00 3L3.OU te•Y` {. �"'k.' }�! !t`:F_:i) �1..}i�,�..1'�i�l::tfi_� RE`fk021j'-'_, %7809 SSGL PAINT WASTE W/U SEC 1.000 323.000U i-�..} . CLEAN 1.000 SPENT 1.000 t?, j;j�_ -1,;4� i �,,}_} i.v_'}+ii_',=fi: SERVICE TERM 24 WEEK }1r_IC r+ -'r-+ 1 ;-C., (= A WNIS: 1 7SUF: OOR MANIFEST#: 009140330SKS FUHF7 CU: US 5K SHIP# L1ZS1Uti7L �''_,-•',_-!•; CNT#: 140226589494 QTY: 43Z WT/VOL P PROFILE: 0150375 SKU01 11bS3 - 766400/ 875021 LQD FUEL WITH SLUS 30GL 1.000 199.0000 0.00 199.00 SERVICE TERM 13 WEEK A CONTS: 1 'ISUF: SMR MANIFEST#; 0041403315K5 FUHF1 CD: US SK SHIPA 212510683 CNT#: 140226589507 Q7Y: 30-- WT/VOL G PROFILE: 0766400 SKUOT 7449U5% .12 100001 FEE, FUEL SURCHARGE- 1.600 16.1200 0--- 16--- -------- - ------- TOTAL SERVICE/PRODUCTS 538.1200 0.00 538.12 TOTAL CHARGE 538.12 CREDITS 0.00 --------- TOTAL DUE 538.12 UNPAID BALANCE THIS RECEIPT 538.12 - GENERATOR STATUS ,• 220-2200 lbs/month [!-- f7}-• f-•<`. ,: e E v �.;.ENE: _. i..j�'�ik �'3 ll• i I }S �'-nf Customer certifies that <i) the above-naued materials are properly •`-tr r _s classified, packaged, warkeJ and labeled, and are ill proper condition for transportation according to the applicable regulations of the Department of Tr•anspurtdtion and (ii) no material char,ge has occurred _ either 111 the characteristics of the waste/mlaterial or in the process 1 generating the waste/material. Customer agrees to pay the above. charges and to be bound by the terms and coedit'iulis'(1)-set'fortI in (a) the General Terms and Conditions provided separately to Customer or (b) any SK agreement signed by Customer and SK, and (2) incorporated her"eill 4—reference• Unless 0thel'Wl')2 lfill lCated 'ill the payment received section, SK is authorized to charge Customer's account for this transaction. Customer certifies that the individual _ signing this Service Acknowledgement is duly authorized to sign and' m bind Custumer. Tile following provision is applicable to Safety-Kleen's parts cleaner' and paint gun cleaner services: Customer agrees that it will not introduce any substance into the solvent or aqueous cleaning solution, including without linlitatiun any hazardous waste or' hazardous waste cuustituenl, except to the extent such intruductimr is - incidental to the normal use of the machine. Customer further agrees that it will not clean Parts/paint guns that have beer, cuotaninated with or otherwise introduce polychlorinated biphenyls (PCB's), herbicides, pesticides, dioxins or listed Ilazai'duus waste into the solvent or aqueous cleaning solution. Safety-Kleer, has the capacity and is permitted to accept, store, and/or reclaim the spent parts washer solvent; Paint thilmers, solvents and paints generated by customer; or dry cleaning filter cartridges, powder, and still - residues containing perchloroethylcite, Petroleum naphtha, or - triflurutricilluruethalle dry cleaning solvents. Customer dyl-etS that it is responsible fur Properly classifyingm its waste streams as Used Oil or Nonhazardous Waste in accordance with the provision of 40 CFR 262.11 and applicable state laws. Customer agrees that it will not introduce any non-conforming substance into the SK Property, including, without limitation, any hazardous waste 0r Hazardous waste constituent,(i.e., polychlorinated biphenyls ("PCBs"), herbicides, listed hazardous wastes) except to the extent Pesticides, dioxins, or such introduction is incidental to the normal use of the SK Property. _-.•---_-•- In [he event of the inh•oduclimh of such sun-conforming Kazan sus waste, Customer agrees that it will be responsible for all costs and remedialion expenses related to or arising frolm the proper lllallagelllenht and disposal of the non-conforming waste, including the cost of equipment decontamination and subsequent disposal. If any legal action rT is commenced because of an alleged dispute, breach, default or the Customer a urepresentaliun, lso agrees that lire prevailing Pdrty isr h•.M---�.+--- -i-;,-_{-------'--•-� i_t_.I i L. will be entilled to recover reasonable attorneys fees and costs Y associated with the sun-Collformling cuntaninalimr event Safety-Kleen's t•�O (_�}? { y}!�_.3J t failure to screen Cusluuer's material or take a retain sample, in no way constitutes a waiver of Customer's obligation to Properly classify .i. i Y w 1'-3 ' i Lr F I_01 { its materials. Safety-Kneen relies on Custunrer's 1'Cpl'C5e11tdt1U05 and Custumer is responsible fur informling Safety-Kneen of any Process chan m ges that ay alter the characteristics of the metn•ials provided. IN lHE LVENI Of AN EMERGENCY CALL 24 HR EMME�RGGEEN1CYY0 11-800-468-1760 (,Safety-Kneen) n Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable oj1HE Regulatory Services 3 °-* Thomas F. Geiier,Director 3 } ;pR SS. Public Health Division A? `� Thomas McKean,Director 200 Main Stret# Hyannis, MA 02601 OfEca: 508-862-4644 Fax: 50&790-63 04 Appflca#ion Fee: $100.00 ASSESSORS AT AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR TTT'TT= MORE THAN III GALLONS OF ILAZARDOUS MATERLALS FULL NANE OF APPLICANT A*A4ey Alu NA-NH OF ESTABT_ISI MLN'T ADDRESS OF ESTABLISIEM NT �o ��6 N �Gh flo� 9a*p &1' &Pwj J#pW CZ j�p f I TELEPHONE NU-M3/ER F—ov- -77'I Y $U a- SOLE OWNER: rYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAAU AND HOME ADDRESS OF ALL PARTNERS: I I IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 020oZO pj�f'a�� STATE OF INCORPORATION FULL NAME AND OME ADDRESS OF: PRESIDENT I owl CZERK SIGNATURE OF APPLICANT i RESTRICTIONS: HOAU ADDRESS H0M1 T=HONE# _9 3 ;a y 9 e z � Faz doc/wp/q i } DEPAR1;NIENT dF ENVIRONMENTAL MANAGEMENT Office of Waste Management 235 Promenade Street,Providence,RI 02908-5767 asa print or type. (Form designed for use on elite(12-pitcti)typewriter.) (401)222-2797 t � � � oz1�D��cS enerator s o ent est age Information in the shaded areas is ! r, �� (' ! Document No. not required by Federal law,bui AST �.N{ �i ;t # ' ram'. _' of may be required by state law. I enerator s ame and S5Mailing A dress A.State Manifest Document Number ` - 8,8 'iJ I {� �t B.Generator/Site Address . l e e Ut'1 ' 3 8- 1.' A t t`a t t ON iiU UIS) i i f. Gooarator's Phone { . j 6 Transporter I Company Name �R� b. US EPA 10 Number iR .I "r• t: ;rJ:)1 ..:i`S r S ,i L• J 8:J 2 h. dd J `].`, t). 0 !.. a7 L�.? �:• t5. i .. B 7�rransportempany Ntima 8. U5 EPA ID Number G:State Transporter ID/kicense Plate A , — �^ ' J. Designated Facility Name and-S to Address 10. US EPA ID Number D ,Transporter's Phone "2 9 2 8-¢ 45- { U'lITED 01i PE OVIERY, 1�!C ,E.StateTransporteriD/LicensePlate ' t`n r, r F.Transportecs Phone; [� 3 -G.Facility.Mailing Address ` . ' i l _....>a .,.l .Y ,Y t �t '..rr' i>• i1• Ei L{ 4.. 8 01 2 8. .1 •1 / — H.Facility's Phone, 40i=467-3820 i J A 12.Containers 13. 14 I. CD 11.US DOT Description(Including Proper Shipping Name,Hazard Class, and ID Number) Total Unit We 3377 No.' Type Quantityd (A ast No: d I ` N r �ki4.fe WAS 1 9 t'1..�a)`)alt�OLC 3.,IQsJ.l 0 i40% ( rt��.,�.�t�' F)a lA 077,b. .L i Michael Degrasse. 7 SALES AND SERVICE REP Safety-Kleen Systems,Inc. �' tel, Ieen 167 Mill Street t ): Cranston,RI 02905 . ®808 C(401)473-7031 F(401)781-7593 . it n.com Z. . �J Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis,MA 02601 re Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -� ----------------------------------------------------------------------------------------------------------------------------- ----------------- S, ---------------------------------------------------------------------------------------------------------------------------------------------------------------- c9 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 Town of Barnstable Barnstable Regulatory Services Department Public Health Division t RARMABLE, + �m 200 Main Street,Hyannis MA 02601 r fD 2007 Office: 508-862A644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERAUT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT A . �A� 1" c = ADDRESS OF ESTABLISHMENT C CC) TELEPHONE NUMBER a)t SOLE OWNER: YES X NO, IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.S\ STATE OF INCORPORATION FULL NAME�AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK \lam V) \ev SIGNATURE OF APPLICANT RESTRICTION'S: HOME ADDRESS HOME TELEPHONE# Q:\Hazmat\Haz Mat Applicati=2008DOC L Number Fee 186 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Puritan Pontiac GMC 90 High School Rd., MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health L ta4��Town of Barnstable /oo I►GE.> Regulatory Services C /00 96 Thomas F. Geiler,Director -200 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE -/'-4 APPLICATION FOR PERMIT:--TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MAT FULL NAME OF APPLICANT PURITAN BUICK-PONTIAC-GMC NAME OF ESTABLISHMENT PURITAN BUICK-PONTIAC-GMC °w ADDRESS OF ESTABLISHMENT bolK .TELEPHONE NUMBER JM 7 75- 711 SOLE OWNER: YES_NO� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 7 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D 16 STATE OF INCORPORATION //i'/✓� FULL NAME AN HOME ADD S OF: PRESIDENT TREASURER CLERK SIGNA OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Number Fee 168 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Accidental Auto Body Inc. 90 High School Rd. Extension, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable y Regulatory Services 1 Thomas F. Geiler,Director I AS& ' Public Health Division '°r�aru•�" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE s APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS i FULL NAME OF APPLICANT p) � _�,,) r NAME OF ESTABLISHMENT CACC i ,6rj�-A 0 �yt-o IkU4 ADDRESS OF ESTABLISHMENT q0 I'll G44 aAr%`-S M6 aa6o o TELEPHONE NUMBER E SOLE OWNER: YES NO Z. cr; �• IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS ALL N co PARTNERS: a. ;> d= w ca co ri IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ` ,�a87L STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: n PRESIDENT �r jk:, , (j n ,oU�-1141 met Ck3 `ass TREASURER ., , .P CLERK it SIGNATURE O APPLICANT RESTRICTIONS: HOME ADDRESS SGl Olti r6 st HOME TELEPHONE# '�$`- o��' C$4 Town of Barnstable kw Regulatory Services • ,� °� Thomas F. Geiler,Director WMIASM Public Health Division 9� 039. '°ree rne�' Thomas McKean,Director (LA 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF H ZARDOUS MATERIALS 7/Y FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT • TELEPHONE NUMBER S 7 ;71 SOLE OWNER: AYES NO IF APPLICANT IS A PARTNE HIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. d 2 7 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT VC-e &I o l ® &- ��1 TREASURER 3 C CLERK SIGNATURE OF APPLI ANT RESTRICTIONS: HOME ADDRESS IX t9 1i�cll �� • HOME TELEPHONE#;?& Haz.doc/wp/q MAIL-IN REQUESTS • Please mail the completed application form to the address below. Also include a copy of your contingency plan(to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. • For further assistance on any item above, call(508) 862-4644 • Number Fee 151 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health Cam' ] This is to Certify that Balise Ford of Hyannis 90 High School Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------- ----------------------------------------------- . -------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ti of Barnstable l gnialoly Services. h} nas F Gei[er,Isar NAM I'uc Health Division - McKean,Dhvc$Gr j 200 Street, Hyannis,MA 02601 Office: 509462-+Its ` Fay 508-t90 fi3� • an Fee:$i*OAo t V _ TM ASSESSORS MAP AND PARCEL NO :: HATE All,' aa_ ii APPLICATIO117 FOR P O STORE AND/pR I7 12Z MORETHAN l 1 i GAhLfl1Y - HAZARDOUS MATERIALS FULL FAME OF APP'Y.ICANTi`. NAME OF ESTABL SYMM i TELEPHOn N ER = f SOLE OWNER: YFS /NO X IF APPLICANT IS A PAXTNXRSHIE I71.L NAME AND HOME ADDRESS OF ALL PARTNERS: F� IF APPLICANT IS A CORPORATIOW FEDERAL]DENTIOCATION NO. � y-� �'D STATE OF INCORPORATIONt _ FULL NAME AND HOME TREASURER I�/'Y1 6 mog}_,/ CLERK #. _ X� Qfo I i GNATUR5FAPP Nr ,22�g Aot- RESTRICTIONS: fi ' HOME ADDRE nor"TUNHONE# Ha.dodwptQ ih ' 1 V 1 ■ Complete items 1,2,and 3. RIsde e ■ Print your name and address on the reverse ❑Agent so that we can return the card to you. ❑.Addressee ■ Attach this card to the back of the mailpiece, d by( e Name) C. Dat live or on the front if space permits.1. Article Addressed to: ry address different from iti5 1? LAYe -?T1V:—Erff--T Sn11 1 orreS i address below: ❑No .511 Hyannis-Rd, 3arnstable,'MA;1'02632 _ -II I�IIIII I�I I�I I II II II I I I III II I I II I II I I I III t ce type f El Priority Mail Express® •Adult Signature ❑Registered Mailrm ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1338 72 O Certified Mail Restricted Delivery ❑Ret�Receipt for ❑Collect on Delivery Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT _n_i. ' ngail ❑Signature Confirmation 7 012 1010 0000 2 8 4 7 9824 1ga�il Restricted Delivery Restricted DeliveAry PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I 9590 9402 1933 6123 1338 72 W United States •Sender:Please print your name,address,and ZIP+4®in this box. Postal Service �C I own �t Barnstable � - �� Health division 200 Main street, Hyannis, MA, 02601 I I E CO Er r` .s F I C I A L U S CO Postage $ f1J Certified Fee O Postmark Q Return Receipt Fee Here 0 (Endorsement Required) 1 0 Restricted Delivery Fee O (Endorsement Required) ll l r-q C3 Total Postage&Fees ra IN- mmerson orres 1`;i 1 Hyannis Rd, Barnstable, MA, 02632 �b4 Certified Mail Provides: ■ A mailing receipt n A unique identifier for your mailpiece m A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ® For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for, a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. © For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail w receipt is not needed,detach and affix label with postage and mail. . IMPORTANT,Save this receipt and present it when making an inquiry.' PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 1 tCOMPLETE • ON DELIVERY"=' - A. $I TUre ■ Print hste ifsrrr ;;end 3., ��� ■ Print y6i�r'rila}�ed,address on the reverse Agent so that vae ►: turn the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B• Re(fived by(Printed Name) C. D to 4 Delivery or on the front if space permits. A.U 0 t' 1. Article Addressed to: D. Is delivery address different from item 17 1 If YES,enter delivery address below: 15 r4 NO 31 tArv4 YL d LS M)k ovpo SeType ❑Priority Mail Express® ❑AdultdultService Signature El Registered MaiITM [0�duft SignatureRestricted Delivery ❑Registered Mail Restricted ertified Mail® Delivery 9590 9402 1933 6123 1339 57 Certified Mail.Restricted Delivery (114, tum Receipt for ❑ oilect on Delivery �f Nferchandise _Article_Number_Mransfer—from.service_labell ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM I Mail ❑Signature Confirmation 7 015 17 3 0 0001 4988 19 7 5 - 1 Mail Restricted Delivery Restricted Delivery ool PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USP 3 e Permit No.G-10 I A 9590 9402 1933 6123 1339 57 I United States •Sender:Please print your name,address,and ZIP+4®in this box- Postal Service I �ti I ^� Town of Barnstable f I Health Division 200 Main Street I Hyannis,MA 02601 I I I 1�11►1��')'�ip1#(dar����at11��Ittir�''11�it�i#lti�'1�'IrlI11�'�t� I Ln .. N a- N CIO Postage $ rU Certified Fee I3 Postmark O Retum.Receipt Fee Here O (Endorsement Required) M Restricted Delivery Fee O (Endorsement Required) r-q p Total Postage&Fees 91 r nWn: Jonathan Tyler 67 Cranberry Lane r Centerville, Ma, 02632 0 L $: Certified Mail Provides: ■ A mailing receipt s A unique identifier for your mailpiece ® A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. ,+ t IMPORTANT,Save this receipt and present it when making an inquiry-, '} 1 PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I d COMPLETE / / / / ■ Complete items 1,2,and 3.- A. Signature ■ Print your name and address on the reverse Agent so that we can return the card to you. Addressee ■ Attach this card to the back of the mailpiece, B. ceived by(Printed Name) C.Date of Delivery or on the front if space permits. 1. Article Addressed to: D - ,P.-,s differP, ° z- .o ❑Yes 'TN: Emmerson Torres l 1 Hyannis-Rd, i rnstable, MA4:02L32 _ - a,_ l ❑Priority Mail Express® ❑Adult Sian:ature ❑Registered Mail ❑Adult£'ignature Restricted Delivery ❑Registered Mail Restricted 14 Certified Mail@ Delivery 9590 9402 6702 1060 1008 78 ❑Certified Mail Restricted Delivery ❑Signature ConflrmationTM ❑Collect on Delivery ❑Signature Confirmation .2. Article Number(transfer from service label) ❑Collect on Delivery Restricted Delivery Restricted Delivery Mail 7 012 °1010 0 0 0 0 2847; 9 81.' I om0)it Restricted Delivery PS Form 3811,July 2020 PSN 7530.02-000-9053 Domestic Return Receipt USPS TRACKING# ® First-Class Mail Postage&Fees Paid USPS 5 L Permit No.G-10 9590 9402 6702 1060 1008 18 United States •Sender,Please print your name,address,and ZIP+4®in this box* ,�- Postal Service -'own Of Barnstable A Health division 200 Main street,, Hyannis, MA, 02601 . __ — 1illEfl►!�s1lfrr�� �>>: tllirf►�(►,�1� 1fl��rr1'1► r���,���t1,3� ti CO OFFICIALEr co Postage $ IlJ Certified Fee 0 Postmark Q Return Receipt Fee Here � (Endorsement Required) C3 Restricted Delivery Fee (Endorsement Required) 0 0 Total Postage&Fees $ Yl+ rq - ATTN: Emmerson Torres/Jennifer Marshall , 1511 Hyannis Rd, Barnstable, MA, 02632 y Certified Mail Provides: to A mailing receipt © A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e. Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. o Certified Mail is not available for any class of international mail. I I n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.._i PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 r