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HomeMy WebLinkAbout0074 IYANNOUGH ROAD - HAZMAT��I �U�Lnh��l� �eV. �-��+�i�S ��� � 7 -- C Fee Number THE COMMONWEALTH OF MASSACHUSETTS 177 $100.00 Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------- ------------ --------------------------------------------------------- ------------------------------------------------------------------------------------- This license is granted inconformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN - PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable �_.. Barnstable okT Regulatory Services Department Asa Public Health Division • BAANSTA13M 200 Main Street,Hyannis MA 02601 l MAl A 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CEO 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 C'��C �/O <S'YST e^_j _�qV"C ADDRESS OF ESTABLISHMENT _77Yg1tW 0()6 H 161 }�y/g'7-7 • TELEPHONE NUMBER SOLE OWNER:XYES NO r-a 21 IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES§OF ALL PARTNERS: ' 4 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION f FULL NAME AND HOME ADDRESS OF: PRESIDENT 22 Y /�a_f/ y TREASURER CLERK SIGNATURE OF APPLIC • R.ESTRICTIONS: HOME ADDRESS �3 Soui y An ytS ,C✓� HOME TELEPHONE# _r29F"7f4P Q:\Hazmat\Flaz Mat Application2003-DOC r , EMERGENCY SPILL RESPONSE PLAN FOR MIDAS MUFFLER AND BRAKE SHOPS MIDAS SPILL RESPONSE TRAINING VIDEO The purpose of the Midas Shop-specific training video is to explain emergency spill response procedures to Midas employees. Employees will be given: • An overview of EPA, DOT, OSHA and other applicable governmental agency regulations as they apply to the Midas Shop • Descriptions and simulations of emergency situations, procedures and equipment found in Midas Shops, including, but not limited to: • How to identify substances covered under the Midas Spill Response Plan • How to initiate and successfully complete an Emergency Spill Response (identification, containment, hazards, emergency spill response kit, personal protective equipment, clean up) • Proper solvent use GENERAL PROCEDURES IN THE EVENT OF A HAZARDOUS MATERIAL SPILL If a spill or leakage of a hazardous .material occurs in a Midas Shop, there are certain containment, clean-up and disposal procedures which niust.be performed at once by personnel in the immediate area of the spill or leak. All employees must train in these procedures during their initial safety orientation. For quick reference, however, the general step-by-step contaipment, clean-up and disposal procedures are set out below: 1. Move away and. maintain a safe distance. 2. Identify the hazardous chemical spilled and estimate how much was spilled. 3. Alert Shop supervisor and co-workers. • Page 1 . 5. Check for injuries, provide First Aid if trained, and summon medical assistance if necessary. 6. Review MSDS for any specific clean-up instructions and put on proper Personal Protective Equipment. 7. Eliminate ignition sources. 8. Shut off source of spill to stop the leakage. This may include actions such as turning off valves or pumps, standing an overturned container upright, or turning a punctured container so that.the puncture is at the high point. 9. Cover or dike-drains, and dike chemical run-off, to prevent spilled material from leaving the area and entering the environment. 10. Remove or block off reactive materials in the area. 11. Contain the spill by applying spill control material. 12. Remove any residual product from an original punctured or leaking container and pour or place it into a labeled and approved secondary container. 13. Clean all Personal Protective Equipment and return to proper storage. 14. Conduct appropriate personal hygiene such as thoroughly washing face and hands. 15. Make sure all containment, clean-up and disposal supplies are replenished. 16. Store and dispose of all cleaned-up materials in accordance with all federal,state and local laws regarding hazardous waste, as required. 17. Complete Incident Report. • _ Page 2 MIDAS SPILL RESPONSE PLAN 1. SHOP INFORMATION Location .. Manager — Telephone. Telephone - Shop c �' /-� t: H0mE. 2. EMERGENCY COORDINATORS CoordinatoriS�Y 'C-/ e��dy�9� Shop�"� _ /_Z2,2 C9;' Homy Alternate s« y Shop �49__ 'moo' Home 3. IMPLEMENTATION OF THE SPILL RESPONSE PLAN The Spill Response Plan will be implemented if an incident might threaten human health or the environment. The emergency coordinator has full authority to make this decision. Depending upon the degree of seriousness, the following potential emergencies might call for the implementation.of the Spill Response Plan: • On-site spillage • Leak or spill • Any in-Shop spill or release of a substance found on the Hazardous Chemical inventory. Page 3 4. AGENCIES TO BE NOTIFIED LOCATION TELEPHONE Police 911 F ire/Emergency Hospitald�ett.,rly Emergency Response Teams Local Regulatory Agency ,cf ,�} ,tJI.C' 790 2lo� 960 Federal Regulatory Agency National Response Center 5. SPILL RESPONSE EQUIPMENT • Spill Control Kit Spill Absorbent Granules Shovel, Broom Rubber Gloves m Disposal Bag, Labels Protective Eyewear Page 4 Hyannis Shop Emergency Plans Types of Emergencies 1.Fire 2.Medical 3.Chemical 4.Tornado 5.P.urricanes 6.Earthquakes Emergency Responsibilities FireTirst individual to detect a small fire will try to extinguish with proper equipment.First determine cause of fire and use approved method of extinguishing.In the event the fire is out of control inform closest individual to call 911.Then get remainder of employees together and designate a leader,preferably management.In the event a manager is not available continue as follows.One person should shut off gas,another oxygen,another electricity and then remove vehicles if possible.Once each person has completed his or her task congregate outside building and wait for help. �• Medical:In case of me dical emergencies closest person should call 911.Only certified personnel in first aid or CPR.must accomodate injured. Chemical-in the event an employce comes in contact with a chemical refer to safety manual MSDS. Determine what chemical was used and follow emergency and first aid procedures.lf no results call 911. Tornado:When a tornado may occur employees must stay calm.Stay away from windows and congregate in area which will not be exposed to glass which would the compressor room.Be sure to shut off gas and electricity. Hurricanes:When hurricane warning is in effect all employees should get together and tape all glass in X formations.Shut off electric,gas,oxygen,secure building and leave premises. Earthquakes:In the event of an earthquake employees should all congregate in compressor room after shutting off gas,electricity and oxygen. • - - - ® 77 CAPE AUTO SYSTEMS INC. ROCKLAND TRUST COMPANY` ® - 74 IYANNOUGH ROAD ' ROCKLAND, MA 02370 HYANNIS, MA 02601-2027 (508)_790 2664 53 447 113 PAY- r s i'a t It • 9/2 TO THE �0'a ORDER OF TIbw Of Barnstable.r s sum 00.00 rI 1 One`Hundred and 00/100 *************r***********ram**,F*****ram*** DOLLARS Town of Barnstable' .' Public Health,,Division " 200;Main,Street' �` s Hyannis Ma.` "02601 MEMO r y i _., §: ; _•. .;-.��. `.;.. r,. a ,r:' �" '`' r t�AUTHORIZED SIGNATUR t. II'0 164 5 7U■ 1:0 1 L 3041, 761: 4oil 5 491I' -- t Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Midas of Hyannis .................................................................................................................•-----......---- 74 Iyannough 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 10/11/2011 10:55 15087901065 MIDAS PAGE 01 Town of Barnstable Inspectional Services BARNSTABLE r Public Health Division '`° 1 IO)9-7.1 4.4y 1 , Thomas McKean,Director 200 Main Street, Hyannis,M.A.02601 C) r- X 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 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 6Yvsr *A late charge of$10.00 will be assessed if payment is not received by July 1st I. ASSESSOR'S MAP AND PARCEL NO. 34-1 —o%3 2. IS THIS A PERMIT RENEWAL". / YES_NO. 17 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. PULL NAME OF APPLICANT: Wowe au+u, t6nw - Aek-s 3r- , mac. • 5. NAME OF ESTABLISHMENT: A,DAS. 6. ADDRESS OF ESTABLISHMENT: '14 �Aw�rcJe N R-� 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE; 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50%-—'U40 1- ?46 4 9. EMAIL ADDRESS: LMgN^4 a C*FtM 4 b*3� . Co,,K 10. SOLEOWNER: YES_NO T.F NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME fjouuge -& Mont- ObtW U X!wc. PRESIDENT bcw%at: C.ge -f-j--r6 TREASURER. to t J¢E w& IAA.4AtJ CLERK LA yA&0e& 12. IF PREPARED BY OUTS ARTY: NAME: TELEPHONE#: COMPANY ADDRE EMAIL: SIGNATURE O APPLICA DATE 6 AFLZO Q\Application FormsWe2 t A en2019.docx Number - um THE COMMONWEALTH OF MASSACHUSETTS Fee $1Fee 50.00 Town of Barnstable Board of Health This is to Certify that Midas of Hyannis 74 Iyannough Rd. (aka 74), 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 6 Town of Barnstable oFI VHWE Inspectional Services BARNS LE r� -ry RM1aw5TA8_'•iC:lr3::L.Cq'U!i.r!rArykt' i'"*_ Public Health Division :��9 '° w,=1539920..,.5, E _zn:A i • ' ��LE. ` Thomas McKean, Director i639. prEo o,�p 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 CD APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 XVS1_ C� FW *A late charge of$10.00 will be assessed if payment is not received by July 1st. - — 1. ASSESSOR'S MAP AND PARCEL NO. j 4 O +`� 2. IS THIS A PERMIT RENEWAL? /YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: �OLJeCAN& K tot (4 4 VS �jr C 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: } �f A►w��aC�i-1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: SbIT -"4j®- zz ro-p 9. EMAIL ADDRESS: LMA 4A#%J @GyP& Uli��.Cdvv% 10. SOLEOWNER:. YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Jj)at- lj;E xJ& &kwyw— c"aks $ ram` PRESIDENT +sL CA-cojArog-& TREASURER tq ,n wCc- CLERK (,4W4k dGt. 1,A 12. IF PREPARED BY OUTSIDE Ty- NAME: f!!� EPHONE#: COMPANY ADDRESS MAIL: • SIGNATURE OF PLICAN ATE �2-0 Q:\Application Forms\Haz Ma x Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS-OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes'and ordinances relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIF_F,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI W y_TH,OMAS A._MCKEAN,R.S.,CHO Director of Public Health r 1, C' J Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74 Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Y T© . of Baxnstable °f Regulatory ,fie victs T1io-mas F, G61ex,Di dar ,s,a Public Health Division Teo-.as M�KEan, 2W Main Stzzt, HT=v�s, LIA. 02601 F= 50a-790-63�)A Oficz. 50S4fi 4644 Appliiatan Fee: V00-DO ASSESSORS �/J,,J P ABI PARCXL NO. DAZE AyPLIOATIO-N FOB PERT El TO STORE A, /OR UIE=MQRZ DEAN 111 G_ -LLONS OF HA-Zz RDOUS MATERiAIS _i UAL NAl� OF APPIJCA� �✓ �L;:�tl; Jon ANC. OF EST.A.BLLTDAzNr ✓�/�DAs � �(�G✓! A�Dl�ESS OF ESTAB .�N'I' � T=HO_�NUMBER SOLE 0��: YES PTO L�APPlICAN'T IS A PAB.T ,F UI T N-' ANC HOB ALDDRESS OF ALI, P ART1 I�BS:: N O L APFI ICAPTT I.S A C-OR ORATION: FED] L IDEIN=CATIOI�T�0• 'i�6'G�SS'37��a's� � � i • N cn I � STATE OF 2TC0RP0RATION w f —8=NAB HONSE ADDRESS OF: PHES�E�t 'I .5 4 Q T{ C_LII= TURE 0 i T�'S'I3�ICTIO�iS: HONE ADDRESS i 1 EON 1K=H0N:R] 9 I ' L � • • • T Number um THE COMMONWEALTH OF MASSACHUSETTS Fee $1Fee 50.00 Town of Barnstable Board of Health This is to Certify that Midas of Hyannis \� 74Iyannough Rd. (aka 74), 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 0ee,(.p 824 P 9 Inlof ftnggble �� ��'(l 3 4 atores ;�b15IDb gyp C. Richard V. Scah,Director Public Health Division BARNSTABLE aA�NSt'AeiE.ernes Thomas McKean) Director e A� 200 Main St cct, Hyannis,MA 02601 !� Office: 508-862-4644 (',,, 5U6 APPLICATION FOR PERMIT TO STORE AND/Olt U`I`IL1ZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAT'-1 i It 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE;OR STORE HAZAARDOU) MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO 0B 1 AIN AN ANNUAL PERMIT(RUNS JULY 1st—1UNE 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 V, *A late charge of$10.00 will be assessed if payment is not received byuly 1st. (4 n " 1, ASSESSOR'S MAP AND PARCEL NO. 3*3 -0► -5 2. IS THIS A PERMIT RENEWAL? ✓ YES_NO. IF YES, SKIP (QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS.HAS ZONLNGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE (IF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. • 4. FULL,NAME OF APPLICANT: Q,wt o 2 5. NAME OF ESTABLISHMENT: Al oc j-4 6. ADDRESS OF ESTABLISHMENT: 1 A ,-- 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: _5p$- 9-6.3 4 9. EMAIL ADDRESS: LM4 i+A4 (p (ry e M•DArs L<�M 10. SOLEO'WNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK- 12. IF PREPARED BY OUTSIDE TY: NAME: HONE#: COMPANY ADDRESS IL: -"--- • SIGNATURE OF PLIC DATE _T , Q: Application FOMUUiAZ APP 20 ocx TO 39tid SdQIH 990T06L8091 61:81 60OZ/ZT/TT •aolnaas aaal sit;jol do u6ls o;mot ;no pull o;LLMVGV-999-L ;e Aepo;suoi;nloS Aedl Ilex lia;se� noA o;Aeuow inoA Bul;;a6 '8 awl;nog( BUTAeS ;un000e jueq inoA o;ul papsodep;oajlp 's;uewAed ajn;nj lie se llem se ';uawAed slt;anet pinoo ssaulsnq ino k • 00'09l$ lelol 91OZ/£/9 a;eQ 1990-L£9Z0 VN 'gD'mPueS 3 L 99 X08 Od 00'09l V/8/a Oul 11 S�JoM Jo;ow auuanloM siuueAHJ0sepiw Z 8 9 L S O T S T 0 :;unowd :aweN aaplOH;un000b :aagwnN ;un000b sluueAH 10 sePHN :aweN ;un000b Bill Payment Processing Center PO Box 258819 Oklahoma City, OK 73125-8819 * 1085 1 AB 0.405 *0014694 S1 TOWN OF BARNSTABLE PUBLIC HEALTH DIVISIO• CD vvvww#ttt8WW1 200 MAIN ST «' HYANNIS MA 02601-4002 I���III�JII'llll��l"I'��1��111'I1II1�1'I'�'IIISI'I��'�II111�1�� 6696T00 :AVdI 600'XH6b90Z ZIT v CSI REV 040616 JHACHK; • i • °p IKE r, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE.`E ' 200 Main Street• Hyannis, MA 02601 Et 639. 0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A+ a 5 Date: Location/Mailing Address: -7 eLvnn k, +2$ Contact Name/Phone: 1QD->r a `S L.A D .. /I1�l�VL11.4 s,D. ���reg� S'02, -?7t-;2r,3'7 Inventolly Total Amount:" 1-7aO a0i SDS: 7-e5 " c License#: 11, Tier II : 00 Labeling: D -'x�W.W.As t Spill Plan: e — Oil/Water Separator: Floor Drains: Emergency Numbers: `�25 Storage Areas/Tanks: 16o 1 AS 15 - v,w .2150a+3ofl loo ASK - vkw o,I 2S0 0 A5- -W-o, Emergency/Containment Equipment: _� r.Z cvwt5 waS� a.. '. Waste Generator ID: MA &&Q7-Z g2o!ry0 Waste Product: o i 1 Date&Amount of Last Shipment/Frequency: -1 t t'7 1 b 2 0 4 A- "ti vK o Licensed Waste Hauler&Destination: es+�� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS s µw 1e� ��"q'"'u- "`ti "�.r� c 5�wC4_ 14,5(' IvtS�,ox— 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. J 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) y— 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 w� 7 Refrigerants Degreasers for engines&garages�1� Pesticides: Caulk/Grout 0IR1 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 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" go-1 o [rrst (including chloroform,formaldehyde, �0 `�`4 ' hydrochloric acid, other acids) VIOLATIONS: r ORDERS: INFORMATION/RECOMMENDATIONS: k avt G ear. v o1 Ind a. -e.1 1 w�0��-�Z 5 co O o •2 — c� w d<,-A-A-4 Inspector- o tx�1 �o -1-�1�Ire. aA.e, >Lv44_-{ ,tic vvKMc,rj bvf if III Facility Representative: w -Z r-WA 6 k- i save XdW kex&k x t.J-o cQ X q,,C,,,k WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS c1 Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74Iyannough Rd. (aka 74), 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 Regulatory Services Richard V. Scali, Director MAS& Public.Health Division BARNSTABLE � �wn" Yals�or wNg",'"eam"sus M+ Thomas McKean, Director 1639-201 4 s 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 led Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1-PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 UPS • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. 34.3 — O/3 DATE FULL NAME OF APPLICANT: `il�D4✓ENEdt42 !/W� �� NAME OF ESTABLISHMENT: %S &4E ADDRESS OF ESTABLISHMENT: 9 1 110V IO,-64 .eO MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: so 9-- 790 — Z664 EMAIL ADDRESS: L/J116H. ,91 e-C00:Leir1.t4s.)Eol SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME A10&0aVAOV !'Yorm A,)4*k S J7, -rvc PRESIDENT DwpV�EG. 1-4co✓Tub TREASURER ri✓ q/fA� CLERK A . IF PREPARED.BY OUTSIDE PARTY: IGNATURE O PLI Name: Company Address : Telephone#: Email: Q\Application Forms\I-IAZZAPP Rev I6.docx Page 1 of John Dinan Client Services (508)771-2637 Fax: (508)790-1065 74 Iyannough Rd JDinan@capemidas.com Hyannis,MA 02101 www.Midas.com A FRANCHISEE OF MIDAS INTERNATIONAL CORPORATION d Your next appointment: BRAKES-FACTORY SCHEDULED MAINTENANCE-TIRES ENGINE DIAGNOSTICS-SUSPENSION-FLUIDS-EXHAUST-ALIGNMENTS t STARTING&CHARGING SYSTEM-BATTERIES-AIR CONDITIONING HEATING&COOLING-BELTS-HOSES-HEADLAMPS-LIGHTS&MORE r; A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMASS.Le, 200 Main Street• Hyannis, MA 02601 1639. �p�EDMP�a`0 ATOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: MIA-5 Date: 26 !6 Location/Mailin Addres 7`� aAvld k Contact Name/Phone: �tUj ✓-� �e �� - Inventory Total Amount: ' 1106-11 141 MSDS: dz �&4J2f-V °ti'0"`t '� License#: 1-1-1� ca117+ .�. Tier II : 1)o Labeling: lvoee Spill Plan: �eS Oil/WaterSeparator: NSA Floor Drains: h30 Emergency Numbers: yP.,e2 Storage AreaslTanks: 160 pal ftl`. - cobja tfi g,W6, 'LSO 0AK, 6o-r300 AL-K4 0�tw o,1 , 2XarM41 KA5�- Emergency/Containment Equipment: <,j 5 &^,s.A-.c 4dr,,m7 o,I -r.F: G"T` Waste Generator ID: AAAbDDO 00 D Waste Product: Of 0414-, Date&Amount of Last Shi ment/Fre ue c : ;Z.00 1011 + to A, i IVIW Licensed Waste Hauler&Destination: t5 rA o* fe,2w D• I � '-r ,N1�1 Other Waste Disposal Methods: CV 5+a,1 C ,e�,,, ., QA ..f 9L2.11,6 itlw 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. �L'IO Antifreeze 160 -f 1%0 4'�` L Dry cleaning fluids Automatic transmission fluid 4. %%O Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers to Hydraulic fluid (including brake fluid)10 I(oo Windshield wash ttoC 6 by0 Motor oils A +5�510 4.1X<0 wc,5{,c, Miscellaneous Corrosives Gasoline,jet fuel, aviati`an0gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants i o Miscellaneous petroleum products: Road salts grease, lubricants, gear oil % Refrigerants 10 Degreasers for engines&garages 3v \ Pesticides: Caulk/Grout 4V Iiksp- insecticides, herbicides, rodenticides 17 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 —5 Miscellaneous Combustible S Paint&varnish removers, deglossers Leather dyes 10 Miscellaneous Flammables to 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: o t 55 v<-s o< tie o v✓t ,o-#S o, Inspector. Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °aIKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM SABLE. • 200 Main Street• Hyannis, MA 02601 _ t639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO MP'�s Business Name: MIL. Date: Location/Mailing Addres : N ayl y?, a n Vol IS Contact Name/Phone: a.v f) -7-T I- 3 Inventory Total Amount: ti A MSDS: e4i-V44ee k ori64R, License#: 1-7-7 Tier II : Labeling: Coo ek Spill Plan: 'ye 5 Oil/WaterSeparator: N10 Floor Drains: U Emergency Numbers: Storage Areas/Tanks: 0 &I Woj-W&%1 14 oat Y ge t,o%I �•d2<w.�s wxot 0.1A.V, a z (60 AS"r-cL Emergency/Containment Equipment: I ��!t f ca s ���'" "�A^rt=J z+''�t) aK�. ��' Waste Generator ID: tAAt)000-7 3`b_O Waste Product: 0%1 , aw+A(eeV_, brA5 xz ,Zt�e 5, Date&Amount of Last Shi ment/Fre ue c : Oil Licensed Waste Hauler&Destination: 0,6+0v,&, zevi.- 4Ak &,eA ,4X% &_6 -Qx.+, r Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS A 0 ,nA J of i_-\AJtVLV5 .S I1ncP— ,gg+ ty�5��.aw 31311`} NOTE: Under the provisions of Ch. 111, Section 31, of the General Law 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 20.0 Refrigerants 3-30 10 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 Qecasols 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 Z h� ,k5 A 6144A,ran, So c co a w� (n� •l\ tvt.� . <7 �Sgv�h 0.� �5 �iV_"Jlnspector: 1Aw_ 1e, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date.• /Z 1 3 / 7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGUMIUMON FORM NAME OF BUSINESS: AA5 ,,M,,- BUSINESS LOCATION: -7y ar�mv �.. &d— lDif,ZHY40416 INVENTORY MAILING ADDRESS: Sam TOTAL AMOUNT: TELEPHONE NUMBER: Sob --7-7 1 --Afo 3 7 A-/4115roa&1 4 6o 16 CONTACT PERSON: 49aw I Rost, EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 4%)f. r.,- 4,y M41yt 0Lvce-e— yes INFORMATION / RECOMMENDATIONS:/� cyer� s l40 Fire District: IWI © d&A P.6 o,4 Z)AI Izo— 44\ an I M - 4 , C.J vKS -)ffu d# ariks GcA+*I kt:.f3 Cho uvlA. �fC./►yl cl�cQ,�vl �Rl+S c�Gauef) yl t/�G �orbc►1,�h ✓hem 4��Gw�-t•I Waste M fl-738 o Last shipment of hazardous wa to:�1t/is 13 Name of Hauler: 65fort_ T:v l Co. Destination: Oh zr " Albms4eig. Waste Product: Waste o, I /Qvt+i freed Licensed es No "Wb 2/g q83 p8O 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 A-10 Ant' reeze (for ga oline or coolant systems) Miscellaneous Corrosive Ant 7USED 110 Cesspool cleaners 5' Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) S Hydraulic fluid (including brake fluid) 6011� Refrigerants Motor Oils Pesticides .-X,nV LdNEW Ld sT— USED�-Ts/��/ (insecticides, herbicides, rodenticides) I I� �et fuel,YAv ation gas Photochemicals (Fixers) GaXine, Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 90 lubricants, gear oil ❑ NEW ❑ USED 3d Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout 1 p Swimming pool chlorine 21"s 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 I 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) 10 Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 0�I I - Z � +a Laundry soil &stain removers (including bleach) k6c,066 I '�,Q t, tlew-eQ , 1 oo< veoalflls Spot removers&cleaning fluids (+ (dry cleaners) Qr�y�vv�,0•1- �•� «� 5 IV40 At, &C46 CS Other cleaning solvents Bug and tar removers pry v �a <.e tQGl 11001 , Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS. Applicant's Signature .�rle m 6 Staff's itialsi� c Pe 5•�a[)ep� ` 67M Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74 Iyannough Rd. (aka 74), Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------- ------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 60 ch)v-;* t 32::� d owr�of Unstable P egu atory ervices Richard V. Scali, Director " THE A o Public Health Division BARN STLE Il !4L45 W.S t�W.S (51 aY1LLF�lU.@ Ms"Isl w NsrABLE. Thomas McKean,Director 1639-2014 1 �' 165p.�ab 200 Main Street,Hyannis,MA 02601 ��g -a Office: 508-862-4644 Fax: 508-79,,B ti6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE i1 HAZARDOUS MATERIALS Sh IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V-S . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 34 3 O t 3 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: VwW 6,ewE mp"tz Wee'leS :d , '.rN C. 5. NAME OF ESTABLISHMENT: M i,aS of 41.j"vl S 6. ADDRESS OF ESTABLISHMENT: 7 XJAWo�&H Ab 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 60 H - '4—+1 2 C. '3 �- 9. EMAII.ADDRESS: L #APriA ltJ Q C- e9M 4%t)A,�, . CyrW'- 10. SOLEOWNER: /YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME VJ0LJt(L%P4L tAO-%X 00XIG3 PRESIDENT 'bw\y4%E,` La c.*,yryrtt TREASURER w ce CLERK GAu•►fept& a.ko 12. IF PREPARED BY OUTSIDE PARTY: NAME: LEPHONE#: COMPANY ADDRESS MAIL: SIGNATURE OF APPLICA T DATE Q:\Application Forms\HAZMAT APP 2017 ocx Number Fee 177 THE COMMONWEALTH OF MASSACHUSETTS 100.0o Town of Barnstable Board of Health This is to Certify that Midas Muffler and Brake 74 Iyannough Rd. (aka 74), 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 G rr - - i ' w Town of Barnstable ofTME Regulatory Services Richard V. Scan,Director ` BARNSTAEM6Public Health Division � '' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. S%43 - o 0S DATE - (a - IS APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 0au0eft4NE mo-40Z "4XS SL iac. NAME OF ESTABLISHIMIENT _ (�►IDAS on ��rwN• • ADDRESS OF ESTABLISHMENT _' TyA.,"o jg.t ,2J TELEPHONE NUMBER 50$- '4-+1 — 263-+ SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS* _� •ems CA Cc.,-t.r it.�c LAwaamicfc �iA wt+a.1J IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 4 6-0 SS'3`}>s S STATE OF INCORPORATION KIA - - FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER (,.o�. Vzj�jcE vgt4waV zoer CLERK Rt�►CE : « j` • ._ O LICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# �• 9y - �y Mcwhe\Temporary lntemet Files\OI.K MAZ.APP Rev2015.DOC ttT Town of Barnstable Office: 508-862-4644 .� Regulatory Services Department Fax: 508-790-6304 • nnxNscaot.K' Public Health Division v MAj� Thomas A. McKean,CHO '" arr►� ' 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 8/14/2015 ;Check number: 1243 Check amount: $100.00 Name on check: Wolverine Motor Works II Inc Business: Midas of Hyannis `Address: 74 Iyannough Road , Hyannis w i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ` NAME OF FIRM: f MAILING ADDRESS: 71 IYAK#v , TELEPHONE NUMBER: l v CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at anytime, mo than 50 gallons liquid volume or 25 pounds dry-weight? YES NO This form must be returned to the Board of Health regardless of a YES or NO answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address : ADDRESS: . �;ry �yay e. i A-/ TELEPHONE: 'Z7 / LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasline or coolant systems)w Refrigerants Automatic transmission fluid Pesticides (insecticides, QZ Engine and Radiator flushes herbicides,rodenticides) ; Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCBs Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains , dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers (including bleach) Other products not listed Spot removers & cleaning fluids which you feel may be (dry cleaners) R E C E I V E ® toxic or hazardous (please Other cleaning solvents HEALTH DEPT. 11st)1F Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants MAY 2 0 1981 Road Salt (Halite) \ 164CE� CLAS5arine,Gas Stations.Repai.r TOWN OF BARNSTA�B ,E BOARD OF HEALTH Satisfactory `. 2 rioters 3. • Auto Body Shops �� unsatisfactory- 4. Manufacturers ,J •- p -�, I _ . +,� { ? ,.., 5� Retail Stores COMPANY , �/ 6 ;; !f I j''� (see"Orders") ----� 6. Fuel Suppliers ADDRESS , ) l-, - Class:` 7. Miscellaneous L QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbOveTanks Underground Tanks IN LIT IN IOUTINIOUTIons Aperest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 Heavy Oils: waste motor oil new motor oil. transmission/hydraulic Synthetic Organics: ti degreasers L I 1 • Miscellaneous: 1 -r j j 1 T' DISPOSAL CLAMA ON REMU."RKS: 1. Sanitary Sewage 2. Water Supply � . OTown Sewer :public -On site Private 3. .I door Floor Drains: YES NO Y w O Holding tank: MD _ O Catch basin/Dry well URVERS 0 On-site system ' 4. Outdoor Surface drains:YES�C Q Holding tank: MDC O Catch basin/Dry well OOn-site system S. Waste Transporter. Licensed? Name of Hauler_ Destination Nast - Product: NO 1 ZI 12 23 81 r ,,.' InspeclEo Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: - Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 15TP.O. Box 534 CONTACT PERSON: .kpllz/ Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalli , at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when store _ Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners _* Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners [� Hydraulic fluid (including brake fluid) (!'' Disinfectants Y' Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint &varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2.Printers 3.Auto Body Shops l O unsatisfactory- 4.Manufacturers COMPANY %�IPI _ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ' Class: 7.Miscellaneous ;, 4' / UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER S 1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: . waste motor oil (C) new motor oil (C) transmissi ydraulic eP Synthetic Organics: degreasers Miscellaneous: 12 � i47 w � am �. DISPOSAL/R.EC TION EMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer 'ublic On-site QPrivate 3. Indoor Floor Drains YES Y NO i O Holding tank:MDC Q Catch basin/Dry well On-site system 4. Outdoor Surface drains:YES NO O Holding tank:MDC 0 Catch basin/Dry well rvl�L ` O On-site system;'4'A . 5.Waste Transporter Name of Hauler Destination Waste Product �.zYESNO 1. 2. 'Pe rso�4�) In te iewed Inspector Date