HomeMy WebLinkAbout0035 HINCKLEY ROAD - HAZMAT 3 � � 1
Number Fee
1196 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Heritage Turbines, Inc.
.--------------------------------------------------------------------------------------------------------------------------------
35 Hinckley Road, Hyannis, MA
...---------------------------------------------------------------------------------------------------------------------------------------------------------------------
Is Hereby Granted a License
For: Storing or Handling 111 - 499 gallons of Hazardous Materials.
------------- ------------------------------------------------------------------------------------------------------------------------------------------------------
Restrictions:
.------------------------------------------------------------------------------------------------------------------------------------------------------------------.
This license is granted in conformity with the Statutes and ordinances relating there to,
and expires 06/30/2021 unless sooner suspended or revoked.
----------------------------------------
JOHN NORMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2020 PAUL J.CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable
Inspectional Services BARNSTABLE
�n+e
Public Health Division PU Y'T.&E•416-39 2014 R•FYANNIS
• � � MRYSI(Nlc.q'LS.OS.E0.VIl.LE.:F_5f BPgtISiVBiE
1fi39-2014
Thomas McKean, Director �Dg
�'i0reeY9. ►` 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 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00
CATEGORY 2 PERMIT 111 —499 Gallons: _ - $125.00 RVS-r
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.
2. IS THIS A PERMIT RENEWAL? /YES NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT:. r i fa g Tu Y b i n e s
5. NAME OF ESTABLISHMENT: ii e-y-t fim C, 1 U Y b w-c 5
6. ADDRESS OF ESTABLISHMENT: '35 t11 nGK.I Z�j RA• A' yghni 5 MIA- 0 2(o01
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 1 J I Pi
8. TELEPHONE NUMBER OF ESTABLISHMENT: l50�� r 1 18 _ 7785
9. EMAILADDRESS:4-D/ 6(jr—
10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: f/ _
CORPORATION NAME u AX IT�t,�-c Ric,
PRESIDENT ��ou�� (3 g9✓ ew
TREASURER 54o.-E
CLERK S�
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE 49::r/2-b-fr1-
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
Number Fee
1196 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Heritage Turbines, Inc.
35 Hinckley Road, 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.GUADAGNOLI, M.D.
07/01/2019 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
T
�f
n
Town of Barnstable
� d: hlspection.,,il Services
BARNSTABLE
Niblicealth Division
�aa�e ou
a>isua ie rr s Th0. uis McKean,Director
x
MACC
200'Maita Strad,H aranis M.A 02601
O fficc: 508-862-46414 Fax. 508-:190-6304
APPLICATION FOR.PERN11T TO STOIZE A I)/OTC UTILIZE
HAZARDOUS VMA°I ER:[,A IA
1N ACCORDANC' Vr'ITH THE I'OWN OF BARNSTABI.E GENERAL()I- ' INANCE,CIIA.I'TER 108,
14AZARDOV9 MA'TT-.RIAL,S,ALL BUSINESSES'MAT HANDLE:'OR STOKE;HAZAR.0 OUS MATERIALS
GRr,A'rER T1=1ATKT BOUSI-1 fOI..T)QUANTITIES ARE REQU[R} 1.;)'I.0 ORTA?N AN ANNUAL 1Y.F.R.A41T(1WNS
JULY I st—JUNNE 301h). APPLICATION
gPy grI /ty FEES
CA 9 LCORY 1 PERMIT 26-- 110 (lallons: $ .50_.00 .9 l="4 .
CA C(r'OI3.Y 3 I'I'l-MI TT 500 or inure(.iallons: S 150.00 1 %
*A ate c�Ir.�l c of S40.00 will.be assessed f0<r�„Tentis not._receivect tag Yalu 141.
1. ASSESSOR'S MAP AND PARCEL NO.
..
2. 1S-1'I:IIS A I'1,1ti�i7'Ill 1",1 .AI.:P /11-ES y NO. IF YES,SKIT, QU S`I'm 3.
3. FOR ALL N'E P.ERMIT AIIIII lCA`i`IO3NS,'IN.UI(:A`J'E W1-TE-1't1ER BUSINESS:E1:lS
Z.ONIING/BUILD NG AI>PRO'VA:1.,FOR.HAZARDOI)S MATERIALS STORAGE/uSp.OF
• GREATER.TRAIN ITOUSETIO.LD QUANTITIES(25 GALLONS)?______YES ..NO.
4. BULL i1AME OF APPLTC ANT: 1-4
._..�
5. N A A I E OF ESTABLIS.IfMENT: t►
6. ADDRESS OF ESTA,t3I.AS HMT±;*r: ...........
ws ..._ t .....a .e__. _.
7. IYLMI.I:NG'.A.I)DRIESS(IF DIF"x:ERE:N'T FROM ABOVE:
A. TE:LFP140NI>NUMBER O 11S'T'ABL1'SHVIENT: _-.. .... SO.`�'_... �,7_�r '?:.ir.- �t�...._... ....._
9. EMAIL AD1).RESS: ...�i � t"lcr�t l...... ',.�" 1�.w� ��
10. SC)I..l?(}'4�':1l it:_ V,.Y1 4 w ;4.) Tx NC7,,�IA?V E OF I'ART:NER:
f 1. FULL NA>IV E,HOME ADDRESS,AM)`I'I.I:F YJIONE#OF.
CORPORATION' lTA.�'I1? #r3•-rA lVlc'�mP.3'
PRESIDEN'1
...__...�_... .._.
TRYASURER
CLERK
1.2. IF PREPARED 73Y 0(JTS11:)E PARTY:
NAKh- 1`It.I A'.I'ITt3itI,;Y:
COMPANY ADDRESS EMAIL:
�x/ 7^ }(�y� (fig gyp--Y;p---�--_ .� ..W.�.�.. t,A g y^ ..
S'lGNA'1.uRt,, t, F AL I I,].',-'AN,i l- Ilri�t�J.�
.. ,......,...6./.'/ftj.J�"""'."`f',.✓f� _..........
_...
f
K� Q.1Applic4tsu FcxrnSHaz A{at Ajs(i ftcvtsrti 09•10•5:$.ducz
Number Fee
1196 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Heritage Turbines, Inc.
35 Hinckley Road, 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 06/30/2019 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
J
1
Vow of B nstable
egu'atory Services
Richard V. Scali, Director '
�t r
Public Health Division BARNSTABLE
r • BARNSfABLE-[ ERVILLE-mflllT-ANN1S
1ARNbTABr.E. Thomas McKean,Director ""�°S""�i�".0 4� ENn
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 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 g V S .
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10.00 will be assessed if payment is not received by Jules
1. ASSESSOR'S MAP AND PARCEL NO..
2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES, SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: '6,4 19f4N)1 SO
5. NAME OF ESTABLISHMENT: n u;: y *ypbmA
6. ADDRESS OF ESTABLISHMENT: 35 4 Ncluy PUM
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: Ape— A&S A fit • lave.
10. SOLEOWNER: VYES NO W NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME Aegil te. 7Vrbrs4
PRESIDENT "bcw &6*0ha.0
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE
Q Upplication FormAHAZMAT APP 2017 REVISED. x
`oF�"EToy� Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
98ARMABLE.�• 200 Main Street• Hyannis, MA 02601
.63q.
MP'�A"0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rf0
Business Name: f�,r4A,5,z I Date: 3 17 17
Location/Mailing Address: 3S ►nCclg!t a Art►
Contact Name/Phone: 0,V- w Sob--718- 17SS
t.� �,1
Invento Total Amount: � SDS: 12S License#:
Tier II : o Labeling: cod'-' — Spill Plan: e S
Oil/WaterSeparator: Floor Drains: o Emergency Numbors:
Storage Areas/Tanks: I al,lr,,w Atlet V- 1 SCa► pa-rt5 cica,�
Emergency/Containment Equipment: 5� I I �paaQS .t- sd�-�s�+�C�,r �L s�+-c._°
d14 ,�
Waste Generator ID: SO$"Y1 87'�S$ Waste Product: IJ23f�rwa �rf 40N
Date&Amount of Last Shipment/FrequencX: 110 a l ! I I 2.Qtaw�s rrc vmovadl ro,.c s, e- - ,vloal
Licensed Waste Hauler&Destination: n ge-+ ale crc. -7 CIeyx -14 r r5 CletFel4 O{-1
Other Waste Disposal Methods: Cowkewa'r ! (o too �,ac-jp b w 4' K\,Q.1-y, way er
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 �1� I
Automatic transmission fluid I Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers tT y
► Hydraulic fluid (including brake fluid) Windshield wash ��ox \.e-t-
► Motor oils 1 C .1 01\ o r`�
�pret,�,�v W� 3 o Miscellaneous Corrosives :� 3$P�'rL1�aw`-
Gasoline,jet fuel, aviation gas N Cesspool cleaners C
1201 AQzo
Diesel fuel, kerosene, #2 heating oil �) Disinfectants NI-�'R
Miscellaneous petroleum G n—� products:p Road salts
P
A va �
grease, lubricants, gear oil �\ Refrigerants �„�r. -Ir ��
Degreasers for engines&garages 1S�x5 Pesticides: �7�stk.r��4ptk tS���
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 �e�a\a Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
— Lacquer thinners �tvtt«\hQ,� Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
1 Miscellaneous Flammables COO+ ,C&t+"'l 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/RECO MENDATIONS: 100 4�4. ^fJ*5 'CkVcoyS -Ve W41 AE " �✓e
Si X Wla► S. I-I QZyK J D'vt 5,+e- kel IP4 w�-f.avL Inspector:
40 It55-I-Pn.�.11�i:�' a�'�.�L.w} „sas ��e�,e.�sly o►a.s��e .
13v 3►►„�-s s ►K- G.qb w�l►a nr,-e-W �e awl /Facility Representative:
lr,L4olaf,ob�,-- No 155U-e5p ar
WOTE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
I
i
B I0rs, WASTE MATERIAL PROFILE SHEET
q
xclim can* Profile No. 1359922
A.GENERAL INFORMATION
GENERATOR EPA ID#/REGISTRATION# MV5087787788 GENERATOR NAME: Heritage Turbines
GENERATOR CODE(Assigned by Clean Harbors) HE20586 CITY Hyannis STATE/PROVINCE MA ZIP/POSTAL CODE 02601
ADDRESS 35 Hinckley Rd
PHONE: (508)778-7788
CUSTOMER CODE(Assigned by Clean Harbors) HE20586 CUSTOMER NAME: Heritage Turbines
ADDRESS 35 Hinckley Rd CITY Hyannis STATE/PROVINCE MA ZIPIPOSTAL CODE 02601
B.WASTE DESCRIPTION
WASTE DESCRIPTION: waste water diluted acids-NCW
i
PROCESS GENERATING WASTE: cleaning airplane parts
IS THIS WASTE CONTAINED IN SMALL PACKAGING CONTAINED WITHIN A LARGER SHIPPING CONTAINER? No
I
C.PHYSICAL PROPERTIES(at 25C or 77F)
PHYSICAL STATE NUMBER OF PHASES/LAYERS VISCOSITY(If liquid present) COLOR
SOLID WITHOUT FREE LIQUID 1 22 3 TOP 97.00 Q 1-100(e.g.Water)
POWDER Varies
MONOLITHIC SOLID %BY VOLUME(Approx.) MIDDLE 0.00 101-500(e.g.Motor Oil)
LIQUID WITH NO SOLIDS BOTTOM 3.00 501-10,000(e.g.Molasses)
❑ LIQUID/SOLID MIXTURE >10,000
%FREE LIQUID 95.00-100.00 ODOR
%SETTLED SOLID 0,00-5.00
RV%TOTAL SUSPENDED SOLID NONE BOILING POINT°F(°C) MELTING POINT°F(°C) TOTAL ORGANIC
SLUDGE MILD <=95(<=35) CARBON
95-100 38(35- ) <140(<60)
GAS/AEROSOL STRONG 140-200(60-93)
101-129(38-54) 1-9%
Describe: >=130(>54) 0 '200(>93) a >=10%
FLASH POINT°F(°C) pH SPECIFIC GRAVITY ASH BTU/LB(MJ/kg)
<73(<23) <=2 <0.8(e.g.Gasoline) < 01 >20 <2,000(<4.6)
73-100(23-38) 2.1-6.9 0.8-1.0(e.g.Ethanol) 0.1-1.0 Q Unknown 2,000-5,000(4.6-11.6)
101-140(38-60) 7(Neutral) n 1.0(e.g.Water) 1.1-5.0 5,000-10,000(11.6-23.2)
141-200(60-93) 7.1-12.4 1.0-1.2(e.g.Antifreeze) 5.1-20.0 >10,000(>23.2)
>200(>93) 12.5 >1.2(e.g.Methylene Chloride) Actual:
D:COMPOSITION (List the complete composition of the waste,include any inert components and/or debris.Ranges for individual components are acceptable.If a trade name is used,
CHEMICAL MIN — MAX UOM
PHOSPHORIC ACID __ _ 5.0000000 -- 10.0000000 %
................................................................ __
SODIUM HYDROXIDE - - 10.0000000- — 30.0000000 �%
-WATER ......................'------.............._-------------- ---------------- 70.0000000---r- 80.0000000---% --
DOES THIS WASTE CONTAIN ANY HEAVY GAUGE METAL DEBRIS OR OTHER LARGE OBJECTS(EX.,METAL PLATE OR PIPING>1/4°THICK OR YES NO
>12"LONG,METAL REINFORCED HOSE>12"LONG,METAL WIRE>12"LONG,METAL VALVES,PIPE FITTINGS,CONCRETE REINFORCING BAR OR
PIECES OF CONCRETE>3-)?
If yes,describe,including dimensions:
DOES THIS WASTE CONTAIN ANY METALS IN POWDERED OR OTHER FINELY DIVIDED FORM? YES Q NO
DOES THIS WASTE CONTAIN OR HAS IT CONTACTED ANY OF THE FOLLOWING;ANIMAL WASTES,HUMAN BLOOD,BLOOD PRODUCTS,BODY YES Q NO
FLUIDS,MICROBIOLOGICAL WASTE,PATHOLOGICAL WASTE,HUMAN OR ANIMAL DERIVED SERUMS OR PROTEINS OR ANY OTHER
POTENTIALLY INFECTIOUS MATERIAL?
I acknowledge that this waste material is neither infectious nor does it contain any organism known to be a threat to human health. This certification is j
based on my knowledge of the material. Select the answer below that applies:
The waste was never exposed to potentially infectious material. YES NO
Chemical disinfection or some other form of sterilization has been applied to the waste. YES NO
I ACKNOWLEDGE THAT THIS PROFILE MEETS THE CLEAN HARBORS BATTERY PACKAGING REQUIREMENTS. YES NO
I ACKNOWLEDGE THAT MY FRIABLE ASBESTOS WASTE IS DOUBLE BAGGED AND WETTED. YES NO
SPECIFY THE SOURCE CODE ASSOCIATED WITH THE G02 SPECIFY THE FORM CODE ASSOCIATED WITH THE WASTE. W110
WASTE.
f
Report Printed On:Friday,January 06,2017 /WINWEB/ProfilelWaste Profile.rdl Page 1 of 3
Profile No. 1359922
E.CONSTITUENTS
Are these values based on testing or knowledge? Q Knowledge Testing
It based on knowledge,please describe in detail,the rationale applied to Identify and characterize the waste material. Please Include reference to Material Safety Data Sheets
(MSDS)when applicable. Include the chemical or trade-name represented by the MSDS,and or detailed process or operating procedures which generate the waste.
SPOKE WITH DON.SAID SAME WASTE STREAM EXCEPT RUST AND SCALE REMOVED AS PAST AS THIS PROFILE HAS BEEN ON HIS ACCOUNT
Please indicate which constituents below apply. Concentrations must be entered when applicable to assist in accurate review and expedited
approval of your waste profile.Please note that the total regulated metals and other constituents sections require answers.
RCRA REGULATED METALS REGULATORY TCLP TOTAL UOM NOT APPLICABLE
LEVEL(mg/1) mg/l
D004 ARSENIC 5.0 I
D005� BARIUM .........-•••••••-•••• ---•--------'•---•...............................
100.0 p;{'••••-..
.6006 CADMIUM ......................1.0 ...._.........__......••••-•••••-•-••-----•--••••-IJ '••-••-
...... ..................... •---•-...............--•-•-.....................•.
D007CHROMIUM .0L�,1 ........
•D008----LEAD... ..........................-....5.0................................................... -••-•--'-
... ...............-... 0.2. ..._._...•-•--•---••-...............--•...._._--
D010 SELENIUM 1.0
D011....
SILVER.......................
5.0...................................................Rf........
------------------------------- - --------
VOLATILE COMPOUNDS OTHER CONSTITUENTS MAX UOM NOT
bm BENZENE 0.5 APPLICABLE
6019 CARBON TETRACHLORIDE •0* •• BROMINE i
...................................................... .................................................. ......
D021 CHLOROBENZENE 100.0
CHLORINE•
........................•••• ..-....._..._............ ...................................................
D022 CHLOROFORM 6.0 FLUORINE
15028 ---1,2-.............................0.5.........._.0.5.................
•IODINE ....•••••.........._.__..................•.... •.....
OETHANE
•••••••-••--'--........••••••.._....••••-••-•---...... SU ••-•••••--.._------------------*.......... �L1( .•••••
D029 i,t-DICHLOROETHYLENE 0.7 LFUR I"I
...................................................... ..._....._...._.....'--_..._...._•-_... � ••....
D035 METHYL ETHYL KETONE 200.0 lrl
POTASSIUM
DD00430 .TTCHLOROTHLEE 079 SODIUM
TRI HLOROETHYLENE •_--•-••- 0.5 .-•_.•••••••-. -AMMONIA—
---_•--------------------------------------------
•••••..• i
CYANIDE AMENABLE•D043 VINYL CHLORIDE ..................................0.2 ...................................................'9 ......
------------------------------------------------- ------•---- -- •-• I
SEMI-VOLATILE COMPOUNDS CYANIDE REACTIVE
_ _ ................................ .....
D023 o-CRESOL 200.0
CYANIDE TOTAL
_ _ _ i
D024 .._m-CRESOL.......................................200.0 •---_..._.....-•--...•--'•••--'-••_•t",y -•••••
..............'-•'......------'
SULFIDE REACTIVE-------------------------------------
EACTIVE
-D025 p-CRESOL 200.0 Cs Bs
D026 CRESOL(TOTAL) 200.0• •••- .- •.. •.••_.-• •.•-•••-.-••-•. HO PC
............•• � NONE a NONE
D027 1,4DICHLOROBENZENE...............5
.D030. 2,4-DINITROTOLUENE 0.13..................
• <1000 PPM <50 PPM
.............. >=1000 PPM >=50 PPM
D032 HEXACHLOROBENZENE 0.13.......................................................
•'•'•"'•••••'•...............................
IFPCBS ARE PRESENT,IS THE
D033 HEXACHLOROBUTADIENE 0.5 WASTE REGULATED BY TSCA 40
�D034 HEXACHLOROETHANE• �• 3.0 •-•� CFR761?
•D036 NO
- -• NITROBENZENE-- -- - •
•.._.._••_ 2.0 .•.•._• YES O D037 PENTACHLOROPHENOL• 100.0--------------- i
D038 PYRIDINE ....._... 5.0 400.0---------------
.
�D041• 2,4,5-TRICHLOROPHENOL
D042 2,4,6-TRICHLOROPHENOL 2.0
-------------------------------------
PESTICIDES AND HERBICIDES
D012 ENDRIN 0.02
......................................................
....._..... ...................... ._.•-_._._.....
E 0.4
------------------ ------------•-----------••--------
10.0
D015 TOXAPHENE -•-----•-•••••-•...0.5 - -
... . ......................._.......
D016
......................................................
D017 2,4,5-TP(SILVEX) 1.0
15020•- CHLORDANE - - 0.03•- •-- -
-15031• HEPTACHLOR(AND ITS EPDXIDE) 0.008- -• ----• -
------------------------------
ADDITIONAL HAZARDS
DOES THIS WASTE HAVE ANY UNDISCLOSED HAZARDS OR PRIOR INCIDENTS ASSOCIATED WITH IT,WHICH COULD AFFECT THE WAY IT SHOULD BE HANDLED?
YES 0 NO (If yes,explain)
CHOOSE ALL THAT APPLY
DEA REGULATED SUBSTANCES EXPLOSIVE FUMING OSHA REGULATED CARCINOGENS
POLYMERIZABLE RADIOACTIVE REACTIVE MATERIAL Q NONE OF THE ABOVE
Report Printed On:Friday,January 06,2017 /WINWEB/Profile\Waste Profile.rdl Page 2 of 3
8It
logo, Profile No. 1359922
i
F.REGULATORY STATUS
Q YES NO USEPA HAZARDOUS WASTE?
D002
YES Q NO DO ANY STATE WASTE CODES APPLY? !
Texas Waste Code
YES Q NO DO ANY CANADIAN PROVINCIAL WASTE CODES APPLY?
Q YES NO IS THIS WASTE PROHIBITED FROM LAND DISPOSAL WITHOUT FURTHER TREATMENT PER 40 CFR PART 2687
LDR CATEGORY: This is subject to LDR.
VARIANCE INFO:
YES NO IS THIS A UNIVERSAL WASTE?
YES NO IS THE GENERATOR OF THE WASTE CLASSIFIED AS CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR(CESQG)?
YES NO IS THIS MATERIAL GOING TO BE MANAGED AS A RCRA EXEMPT COMMERCIAL PRODUCT,WHICH IS FUEL(40 CFR 261.2(C)(2)(II))7
YES Q NO DOES TREATMENT OF THIS WASTE GENERATE A F006 OR F019 SLUDGE?
YES NO IS THIS WASTE STREAM SUBJECT TO THE INORGANIC METAL BEARING WASTE PROHIBITION FOUND AT 40 CFR 268.3(C)7
YES Q NO DOES THIS WASTE CONTAIN VOC'S IN CONCENTRATIONS>=500 PPM?
YES Q NO DOES THE WASTE CONTAIN GREATER THAN 20%OF ORGANIC CONSTITUENTS WITH A VAPOR PRESSURE>_.3KPA(.044 PSIA)?
YES Q NO DOES THIS WASTE CONTAIN AN ORGANIC CONSTITUENT WHICH IN ITS PURE FORM HAS A VAPOR PRESSURE>77 KPA(11.2 PSIA)?
YES Q NO IS THIS CERCLA REGULATED(SUPERFUND)WASTE 7
YES Q NO IS THE WASTE SUBJECT TO ONE OF THE FOLLOWING NESHAP RULES?
Hazardous Organic NESHAP(HON)rule(subpart G) Pharmaceuticals production(subpart GGG)
YES Q NO IF THIS IS A US EPA HAZARDOUS WASTE,DOES THIS WASTE STREAM CONTAIN BENZENE?
YES NO Does the waste stream come from a facility with one of the SIC codes listed under benzene NESHAP or is this waste regulated under the benzene j
NESHAP rules because the original source of the waste is from a chemical manufacturing,coke by-product recovery,or petroleum refinery process?
YES NO Is the generating source of this waste stream a facility with Total Annual Benzene(TAB)>10 Mg/year?
What Is the TAB quantity for your facility? II Megagram/year(1 Mg=2,200 Ibs) f
The basis for this determination is:Knowledge of the Waste Or Test Data Knowledge Testing
Describe the knowledge:
G.DOTITDG INFORMATION I
DOT/TDG PROPER SHIPPING NAME:
UN1824,WASTE SODIUM HYDROXIDE SOLUTION MIXTURE,8,PG III
i
H. TRANSPORTATION REQUIREMENTS
ESTIMATED SHIPMENT FREQUENCY ONE TIME WEEKLY MONTHLY QUARTERLY Fo] YEARLY OTHER
!
Q CONTAINERIZED BULK LIQUID BULK SOLID
1-2 CONTAINERS/SHIPMENT
GALLONS/SHIPMENT: 0 Min-0 Max GAL. SHIPMENT UOM: TON YARD
STORAGE CAPACITY: 2 j
CONTAINER TYPE: TONS/YARDS/SHIPMENT: 0 Min-0 Max
PORTABLE TOTE TANK BOXICARTONICASE
I
CUBIC YARD BOX a DRUM i
OTHER:
DRUM SIZE: 55
I.SPECIAL REQUEST
COMMENTS OR REQUESTS:
I
NCW
GENERATOR'S CERTIFICATION
I certify that I am authorized to execute this document as an authorized agent.I hereby certify that all Information submitted in this and attached documents is correct to the best of my knowledge.)also certify that any i
samples submitted are representative of the actual waste.lf Clean Harbors discovers a discrepancy during the approval process.Generator grants Clean Harbors the authority to amend the profile,as Clean Harbors
deems necessary,to reflect the discrepancy.
A IZED SIGNATURE NAME(PRINT) TITLE DATE
Ile 7
Report Printed On:Friday,January 06,2017 /WINWEB/Profile\Waste Profile.rdl Page 3 of 3
I
IB*o Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARNSTABLE. 200 Main Street• Hyannis, MA 02601
�'DlFOMP'�a` TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: Date: 1
Location/Mai ling Address: �35� �u< , N•f��v,,s
Contact Name/Phone: b off- lSeGty 1�c.2 !�-o 1? -T 8 -7-7 8
I ventoTotal Amo nt: > I .O �' I S MSDS: 'l e 5 hV 6 License#: M(o
Tier II : 0 Labeling: c 46) Spill Plan: 29
Oil/WaterSeparator: Floor Drains: 1N 0 Emergency Numbers: `�S
Storage Areas/Tanks: wwY-,-� aOlk �w ware-�wvs� o *�yv S�a�
Emergency/Containment Equipment: l Ie-
Waste Generator ID: My0 70 7? Waste Product: armor cle4vV-4- to
Date&Amount of Last Shi ment/Fre uenc : 157 a- 3 Z2 ►l0 g l
Licensed Waste Hauler&Destination: 54 6-� }<le-e�
Other Waste Disposal Methods: _Wkg+zwP--cw �as-� p,cl,c-�,D2bly
LIST OF TOXIC AND HAZARDOUS MATERIALS ce, tai fi
NOTE: Under the provisions of Ch. 111 Section 31 of the General Laws df M p A, hazardous mat�rial 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 V 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
J Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Gapxaslxdetsrgeu#s Sot'�u a� lts 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: Ova �a a, JS o ce z�e�
%R v`o 4- a e- i 1 l e G • S f S or oc.
o
rt-1 pQ<Jvv—g
Inspector:
Facility Representative: „a
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS
f
IKE toque Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMA�BLE.9` 200 Main Street• Hyannis, MA 02601
,6„ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rF0 MPy a
Business Name: 6 A. A, Date:
Location/Mailing Address: 3 5-
►k c Q� ,
Contact Name/Phone: o 0 'o - --7-7 8
Inventory Total Amount: >II MSDS: g S License#-�-r
Tier II : Labeling: o C.�u �- Spill Plan: ON 005
Oil/WaterSeparator: !�4 Floor Drains: o Emergency Numbers:
Storage Areas/Tanks: 2-S54,t,I g4-LI-4cg way 4.r w aD{� /ArUc &-5 c%4w,-✓
Emer enc /Containment Equipment: mao+S 5,1 N
Waste Generator ID: A V550 Waste Product:
Date&Amount of Last Shipment/Frequency: q /3 / 5 ZQt 3 3 Q S U
Licensed Waste Hauler&Destination: SA-I--A ti- �R►tis �� � �
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 Miscellaneous Corrosives 110
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 7�p�a � Pesticides:
Caulk/Grout c�, t insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Ger�vaski detergents 30160 Sv44k"a S Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes O 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: Cokk t S vq 0,-f aK- GJ 1�t
Q ,ccc,+�l�v�i.
IN RMATION/RECOMMEND TI NS: a. Ci. fvvbCS u2� w4w-c i5 WA, vtJe�Z c� v
SSoc, Co�roS+v o ,
` o .prDJ� Oo`�'<<`�- �a"� Inspector: a
I AV�vL`�dr�.
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
���aoi�
h� �Tb��
i
SPILL CONTINGENCY PLAN
Emergency Coordinator, Name: �- *.q .F4/sw
Address:
Daytime Phone: ;'Uc0s- 77 8 '776 8
Evening Phone: Sag- y�?o- 72C.o
Fire Department: ,j
Barnstable Public Health Division: 508-862-4644
DEP 24 Hour Spill Hot Line: 888-304-1133
Waste Cleanup: Name:
Phone: /- 666 - --/68- 17� d
Building diagram indicating hazardous material/waste storage area, location
of absorbent scavenger materials, fire extinguishers, fire alarms (if present),
and evacuation route (if applicable). P'°„f
Z sd
UA Sell
Keel
ot
5� IPA,pre 5� elic
eAdf L
Actions to be taken to -.on trot a spill or release, an preven ing it from
reaching a catch basin, sewer system or the
// ground.
JUN.2v 2017 P42:13
Number Fee
1196 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to certify that Heritage Turbines, Inc.
35 Hinckley Road, 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 06/3012018 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
rDr.P $/o'Faie� S�
"ROn�of Brnstable
ewg atory Services
d
THE r Richard V. Scali,Director ���� r
Public Health Division BABSTABLE
• eaxrcsrw ..lEa.eruiue.rourt.M'uris �"u6
y BARNSPABLE, ` wmsnvs F;r3163-201•w3r ea:nsreac :
MASS. Thomas McKean,Director 639-2014 ND
fo ,� `� 200 Main Street,Hyannis,MA 02601Dg
a '
moo/$ -X,
Office: 508-862-4644 Fax: 508-790-6304 CP
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-NNE 30th).
APPLICATION FEES
CATEGORY I PERMIT 26- 110 Gallons: $ 50.00 ❑,
CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 jx V S
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. 31) - 01 0
2. IS THIS A PERMIT RENEWAL? ✓YES_NO. IF YES, SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
• ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
.I •
4. FULL NAME OF APPLICANT: o L1
5. NAME OF ESTABLISHMENT: J UrLb l
6. ADDRESS OF ESTABLISHMENT: 3 S 14)ryr l-R D • &nn'" t
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: 4 f!g J n!jc -f vrbr%e . GOB
10. SOLEOWNER: V�ES_NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONY#OF:
CORPORATION NAME Hein44!5e, 14biat
PRESIDENT J
.TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT .ATE b-7-I"7
Q\Application Forms\HAZMAT APP 2017 REVISED.docx
Number Fee
1196 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable s-
Board of Health
This is to Certify that Heritage Turbines, Inc.
35 Hinckley Road, 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
Town of Barnstable
Regulatory Services
ti
Richard V. Scali, Director
MAS& Public Health Division BARN LE
1639
Thomas McKean, Director 16
200 Main Street, Hyannis,MA 02601 ;,
Office: 508-862-4644 Fax: 5 90-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILI
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 V
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
• A late char a of$10.00 will be assessed if pUment is not received by July 1st.
ASSESSORS MAP AND PARCEL NO. DATE
FULL NAME OF APPLICANT:
NAME OF ESTABLISHMENT: pg*'h ,e
ADDRESS OF ESTABLISHMENT: 35 /}15444 R�
MAULING ADDRESS(IF DIFFERENT):
TELEPHONE NUMBER OF ESTABLISHMENT: 50'2 - 7 7 8-7 7 S$
EMAIL ADDRESS: 'botJ *t4) �TVrrh�n+�w. c0►'�I
SOLE OWNER: AS NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME ;SAW a.s N2MIF
SAW
PRESIDENT =
TREASURER A11A
CLERK
• IF PREPARED BY OUTSIDE PARTY:
SIGNATURE OF APPLICANT Name:
Company Address
Telephone#:
Email:
Q:WppGcation FonmsUiAZZAPP Rev I6.docx Page 1 of 2
I
r Town of Barnstable Office: 508-862-4644
Fax: 508-790-6304
Regulatory Services Department
BAMnABM ; Public Health Division
Mom. Thomas A.McKean,CHO
200 Main Street, Hyannis, MA 02601
Payment Receipt
Hazardous Materials Payment received: $125.00 (Check) on 6/14/2016 Permit number: 1196
i E
Check number: 5304 Check amount: $125.00 Name on check: Heritage Turbines
Business: Heritage Turbines, Inc. Owner: DENNIS&JILL
Address: 34 HINCKLEY CIRCLE, Osterville
I
•
Date: 5,1,13 / iq
TOWN OF BARNSTABLE -ems ��,a,�
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: �1') mac.
BUSINESS LOCATION: 35- , )kx vtAI s INVENTORY
MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: �o�� -�7�- o G 411avk-5
CONTACT PERSON: AV1 �2v a►c�61rerrl�
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: ye 5
INFQR/JMATION/RECOMMENDATIONS: on . v�� 2 Fire District:
o 1 3 052_ 4 uw, o,a42 ( 5} _LC Ccvw
(1�pI :49vs.4 y 3)A)o e>`f Ai (, c�coat a-�►ons of`>�i�S �'�✓k�-
�.e1tw('ot, o r Waste Tea el� MV5087787789 Last shipment of hazardous waste: 17- t
Name of Hauler: j2� e�e�t. Destination: C retKs+-,,_ zY y
Waste Product: I Licensed e No F11>08`WZ-0 -�
WaS�Q— Eh
c,24
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The board of health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid,,other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers q may be toxic or hazardous (please list):
Metal polishes �D Imo\ gJf��Lk0.Ak
t
Laundry soil &stain removers
(including bleach) 5 Q41 C0t6o51w_
Spot removers &cleaning fluids
(dry cleaners) 5,010
Other cleaning solvents t k Bug and tar removers �5L 10. r A-6 �-Q. (��g mt` 1 (��
Windshield wash + co<<-+
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initia