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0193 IYANNOUGH ROAD - HAZMAT
p�-t-1�-- Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane .-------------------------------------------------------------------------------------------------------------------------------- 193 Iyannough 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 i Town of Barnstable Inspectional Services BARNSTABI,E pith Evaxsi48EE•CEP1Et'Al -COWU—AKMS Public Health Division5�5�.«51639�g4:S0W5A&E sT� Thomas McKean Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 � , s- k. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZEr:� 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 ❑1�� Gh - CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 L�JI 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? "A 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: �� � ►eaxlt�q, 0"is -T�.=1- M!�n�,ar C-ov � s 5. NAME OF ESTABLISHMENT: Pro &^a d. ilk• h�cu��S, M C12,po tJ 1 6. ADDRESS OF ESTABLISHMENT: 1 q 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: I 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508•'7'15 9. EMAIL ADDRESS: eUC1 eAa- k2 i e 4 a,s. G G Vngxa s.. I-OwN 10. SOLEOWNER: YES ,)( NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: ' CORPORATION NAME A yr �V fnhs '�r-o�a n�. glob AJ-6.lrk pd ICk� 06 'Prussia PRESIDENT 1-�uc�i�. C�u t\ac�� —� &10. 3 3 7 700 d TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: f NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE - 2-0 Q:\Application Forms\Haz Mat Appli Draft Jan2019.d0cx 6 :B D oestl;wtttC °F1ME rok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7 BARMAN`"E�,, 200 Main Street• Hyannis, MA 02601 �ArEDMn+p`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT QQ Business Name: GC6 fro i Unni Date: Location/Mailing Address: oV Contact Name/Phone: ^7 —b6 7 Inventory Total Amount: < SIDS: _ e- License#: Tier II : A10 Labelina: Spill Plan: Oil/WaterSeparator: Floor rains: Emergency Numbers: �J Storage Areas/Tanks: taou3fQ W0DC D, Emergency/Containment Equipment: `�C Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: . U 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 7/A disposal of 111 gallons or more requires a license from the Public Health Division. ntifreeze Dry cleaning fluids Automatic transmissuon fluid Other cleaning solvents&spot removers ' Yn gine and radiator flushes Bug and tar removers ydraulic fluid (including brake fluid) Windshield wash otor oils Miscellaneous Corrosives asoline,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 a,® .Lye or caustic soda Lacquer thinners it Miscellaneous Combustible- 01 Paint&varnish removers, deglos ers Leather dyes Miscellaneous Flammables P�� �� 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/RE OMMENDATIONS: 6e, e- S Inspector: Facility Representative: A WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS THE►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 YBA MMcL%BLE.�` 200 Main Street• Hyannis, MA 02601 y/2-7 "rfoMo+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A^4r,ies Date: Location/Mailing Address 193 y a,�-,. a,,A, Contact Name/Phone: eat e ► v _ �g �. CA � ` InventoryTotal Amount: "J 2O�'2.5-0 0 SDS: ��5 License#: 2- 6+2 Tier II : • �co ate- Labeling: 9 oo Spill Plan: g Ar+T-4-1V-1.,r� Oil/WaterSeparator: Floor Drains: �o Emergency Numbers: 2 Storage Areas/Tanks: ono ti l 02{ , a�, t%-- OAN6C. C�.'raIkn.,r S Z�c o 000 ( 2'x s yA1 Emergency/Containment Equipment: 1 �11 �2��S o,n., cr �! 4'o g,c<11-e- �o�- Waste Generator ID: tJ PS Waste Product: N Date&Amount of Last hS ipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ,`� LIST OF TOXIC AND HAZARDOUS MATERIALS Nv �� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws 8f MA, hazardous mateYial use, w exc-ep� storage and disposal of 111 gallons or more requires a license from the Public Health Division. 0(C �,5�vs 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 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 V Paints, varnishes, stains, dyes Lye or caustic soda V Lacquer thinners Miscellaneous Combustible T 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" J MCA,k&-.V,( (including chloroform, formaldehyde, �D G hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: o )vtu5 a. a<KNq.e.--o %(l �Co�hc2�v� •ia-�-�o SQ^I� �I�'ivl�nsPector L� �I� / Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS THE fo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. MASS, 200 Main Street• Hyannis, MA 02601 � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: e,�( &5 Date: 2z / Location/Mailing Address: V l 4 3 so V1 t s Contact Name/Phone: D - 7'1 -D c, ' Inv nto Tot A ount A.,`7- 046-1 �MSDS:2 o License#: 6 WL Tier II : Co vue Labeling: vvut-ol kvA',Mty5i ill Plan: e Oil/WaterSeparator: PJA Floor Drains: No Emergency Numbers: 3 Storage Areas/Tanks: 50 000 fd 9,Co vLt, Emergency/Containment Eaui nt: O t' ll Waste Generator ID: Waste Product: Date&Amount of Last S ipment/Frequency: Licensed Waste Hauler&Destination: 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. (o Antifreeze�9 Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers V Hydraulic fluid (including brake fluid) l o Windshield wash 3 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 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 btq Paints, varnishes, stains, dyes(�,D Lye or caustic soda Lacquer thinners 1� r/ Z Miscellaneous Combustible Paint&varnish removers, deglossers y 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" 15S M�AgAkv-o 1 3k4s (including chloroform, formaldehyde, 3 D EF 3 (n� `,y hydrochloric acid, other acids) VIOLATIONS: 0%)Vo0,e `- 6144-4,, ak �ot Zyg =� ua 60\2� cov a�y�vv.�w N�\SS iTa1 �abt-�S , eeA Ge G ORDERS: ` Tn b " t b e- G SR O! D JL o�V� US �O �Uy. ,�1� I FOR ATION/R COMMENDATIONS: 6S2kCc e7 0,-)k v\6� XA Inspector: La�+���� Facility Representative: C,,� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �1 v 1 Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough 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 ri zy Town of Barnstable Regulatory Services • ° Richard V. Scan,Director _ MASLA ' Public Health Division '639' - Ec ram'` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 i'-T= 508-790-6304 Application Fee:$100.00 Psi ASSESSORS MAP AND PARCEL NO. �nA DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Gor%G. ")4&lz.\,1A NcxA� 6ev' xweyh (2,S NAME OF ESTABLISHMENT A4 Wuv 0's&dl S P ro p at'.g • ADDRESS OF ESTABLISHMENT R 3 �C a lnn p IRa tl a nis MA Cx bo l TELEPHONE NUMBER 506 • ?7 5 O(o a(� SOLE OWNER: YES_�LNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. I STATE OF INCORPORATION pA FULL NAME AND HOME ADDRESS OF: PRESIDENT 1&rw Sha n:day . 14W IV •6Ktk pS Rd_ 'Cl ng of ?K%s l a �� lQ��► TREASURER CLERK • boa- I�+�.t=�bus A+�e�r.� SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Mwche\Temporary lmemet Files\O=3IHAZAPP Rev2015DOC °F IKE r°�,.. Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMASS. • 200 Main Street• Hyannis, MA 02601 0 39.°�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Nam Vill<,14 5 Date:41-1/J1 — Location/Mailing Address. Iq-L yanv%b vwt 15 Contact Name/Phone: C <,S l` ",]c-U S05--7 1--0(o Inventory Total Amount: 7 0,ci S MSDS: 1 eS License#: bs�- Tier II : Lb — Co QkWl ;) Labeling: 0 Spill Plan:Q Oil/WaterSeparator:_lA Floor Drains: 00 Emergency Numbers: Storage Areas/Tanks: 0 - <g-&, v�, CovtkA o o Z _ l o<5 Emergency/Containment Equipment: +1D b4- 0l�11 Waste Generator ID: A Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NO cAaw�c 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 Z 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 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 JPaints, 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" 1 J p qK�1 (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: E F ORDERS: INFORMATION/RECOMMENDATIONS: "cis c<-,L-1 4bt owx, MvoU0 'o\h-S4 Inspector: _lk Facility Representat WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS `oFT►+E►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. ` 7 MASS, y, 200 Main Street• Hyannis, MA 02601 �p t6M 6, MA'S TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT ' TfD Business Name: o - Cvl << ovk CQt AA Date: 61116117 Location/Mailing Address: Contact Name/Phone: 64'Opek - %ar. "1 02. 0&-, V.b�- ooc. (01 -5'42- SZ$ C p2 Inventory '�Total mount: AJ SDS: 1i5 K �'•k� License#: , ') �T Tier II : 13 0 1 Labelina: W Spill Plan: - vuvo `� Oil/WaterSeparator: D Floor ai : '05 Emergency Numbers: �a Storage Areas/Tanks: 0 V)046k,tt wil Emer enc /Containment Equipment: Waste Generator I D: O tot-1-1 q D Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: 2 w Other Waste Disposal Methods: A' LIST OF TOXIC AND HAZARDOUS MATERIALS Iv o °`j �`l ��G�w 1►� {vtV�vt,�oc� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws ofVMA, 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) V 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 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 —J 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: INFO MATION/REC MMENDATIONS: I GPiIA \h I v,�, 0 WI Inspector. l , Q�►'���e. Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough 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 Town of Barnstable Inspectional Services BABSTABLE -r x�aFS�U�'q(p�lLLC'.5'"--aT 34PL�iT'S:E Public Health Division 5771< BARNSlABLE. ` 9 , $ Thomas McKean, Director , Qj i659. ♦0 Aifo;r,p.�> 200 Main Street, Hyannis,MA 02601 rt;.7 Office: 508-862-4644 :_ Fax: 508-790-6304 hk� 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 9 U&j CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ r *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 13 a 0 a 03 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: C9sn� i na _ 0 y sky :� M��nac: �ts 5. NAME OF ESTABLISHMENT: i 66-5 P pQry� 6. ADDRESS OF ESTABLISHMENT: 1 �Uy�hr�t�c�ct� et.r�o;:i5 M'1� Uz6�t 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508. `7-7S 0joV L, 9. EMAIL ADDRESS: --coca N�►� >SX:1 Q.zi►.ck 0,WM,,r1 4a5 ze%,VN 10. SOLEOWNER: YES 7(NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Anievk&*-3 Pmpara :y Ira IV�Gul pi.- fl- `Lj . c��tt�ssi�;PA I�141 DID PRESIDENT IA"; , &d h ac 1IS� 1 C 4';-1- 7 00o TREASURER Aakr te-u CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE try° ~7. 2- k Q\Application Forms\Haz Mat App Revised 09-10-18.docx 0 0- Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �tow of B nsrable egulatory Services Richard V. Scali,Director ' of THE Tn Public Health Division BARNSTABLE Bmwer"M& Thomas McKean• enarlRae •atrtmhul.mrurt•xvaawls S SMi S•639-01-p5 BAJ5 AEp MA8$. A 1 Director 1639-2014 a639 ♦0 -- — --2 0 IVlain Street-Hyannis;MA 02G01--- --- _ ----------— Office: 508-862-4644 C20/y 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 DULY 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 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Ge- �i t^(� ID i ti��- M,&-r V er (:;P v r=t f o s 5. NAME OF ESTABLISHMENT: A-yr" &e�-s p ro Pan Q 6. ADDRESS OF ESTABLISHMENT: 14 �,� aly�n�l`� M•� L�L�O� 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: COMA 10. SOLEOWNER: YES_J�NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Awww,`t Cea Prvpa.ha , W�,b Ill-&q1p 11 P- - , it a m PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT hojp DATE (Q Lt, X V 1 b Q:W.pplication Forms\HAZMAT APP 2017 REVISED.docx Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -- --------------------------------------------------------------------- C� ------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 t 1 E 4• owrl of Unstable eg atoervices Richard V. Scali,Director , ` r°"'"„ Public Health Division BABSTABLE .S L • fiPRX6TAHIF•iEntPP.414E•[OTUR•NTUI:IS Y'-" NJJIS1tY.5 t11L5�MIEfY1LLE•4•tSt Paa+ISta� BARNSTABLE. = Thomas McKean,Director 1639-2014 P' 200 Main Street,Hyannis,MA 02601 �a 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-NNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 R g 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: Gene- ����1`� r �i s�� M r, 5. NAME OF ESTABLISHMENT: 4tr,&v,6tt-S �Emrft& 6. ADDRESS OF ESTABLISHMENT: 1T-3 QLU O wti► 1v 51 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S 09 ' Z-7 5 • 6&gi� 9. EMAIL ADDRESS: C°u Q�.r�.. �z ���,i I'al (1, G me v-1 ncLs- ZO 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ayrvso�G&g tcr,,— 4 bO ut &tkl W4 PRESIDENT' 1C1 r 4 oB D sfiA , -P4 1 q Li 0L TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS r EMAIL: SIGNATURE OF APPLICANT ( DATE a Q:\Application Forms\HAZMAT APP 2017 REVISED.docx Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable o � Board of Health s This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough 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 • �'THE v Regulatory Services Richard V. Scali, Director B" KARA Public Health Division ltlxg A 16;q �00 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ,-& Office: 508-862-4644 Fax: 508-790-63(B t� 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 Y`� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: &P—A\a "DY.1 g-L6 AA �CIVS A"\-P 't&et's VV-- NAME OF ESTABLISHMENT: �lS PDPC�VlE ADDRESS OF ESTABLISHMENT: MA C7 Z(o D I MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 5 Cog • `Z Z 5 D� EMAIL ADDRESS: F-Lw .y�� .�Zaec��l na Lp �t acts eta Li SOLE OWNER: YES_XNO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Am&%;,6" Y'r-ore�,� , y(P o N-Pnu vl @d, Y/ nS P+t�s i dc., PA 1 Q 40(o PRESIDENT �TfN±,, %Na'r-ti cw\ b0 33?—'"7 TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: IGNATURE O APPLICANT Name: Company Address Telephone#: Email: Q:W.pplication Forms\HAZZAPP ReY16.doex Page 1 of 2 Town of Barnstable Office: 508-862-4644 Fax:508-790-6304 • Regulatory Services Department SAM Public Health Division MAW. Thomas A.McKean,CHO 659, s� 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $125.00 (Check) on 6/15/2016 Permit number: 652 ;Check number: 1 Check amount: $125.00 Name on check: Eugene 3 Dziedzina I � I !Business: AmeriGas Propane / Hyannis Address: 193 IYANNOUGH ROAD/RTE 28, Hyannis I I Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough Road, Hyannis,MA 02601 I� 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 44zo-3via l /�z< < C uc K4 [t) Town of Barnstable ( l d 0. 0 0 THE rq,�� Regulatory Services Thomas F. Geiler, Director Lup) ' $UMAS&LE. ` Public Health Division 9� sb `0�' iOrFn Nay°i Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 cfle cK*' 1010 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 ti SQ M O.r K AmeriGws m a a r NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 193 ZV ann oyq h (L cL 14y anOX', nM L-n cn TELEPHONE NUMBER .50 P)• - V5 " O G 8 ( SOLE OWNER: YES )d NO i IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF AIL co PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 1.2. 145 304 STATE OF INCORPORATION Ren n Sv l Vcn i 0►-r FULL NAME AND HOME ADDRESS OF: PRESIDENT G n B i sc-il ` g N . Gy 1 pb R d PA I q HV TREASURER CLERK •rn SIGNATURE O PPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doe/wp/q Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough 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 a r Town of Barnstable otl r Regulatory Services Richard V. Scali,Director " MASS. ' Public Health Division 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 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT CkN S -J AI.UC NAME OF ESTABLISHMENT PIS ADDRESS OF ESTABLISHMENT ��� I��l m'U�11t 1�1�JDrLS TELEPHONE NUMBER -0 0b SOLE OWNER: YES,)� NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: •r 0 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION PA FULL NAME AND HOME ADDRESS OF: PRESIDENT -:T�,RW4 Sl Cr.NjA j If go pv 60U>& A JZ►" 4� PRusS l�l Q� 1��Pb� TREASURER CLERK NATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:1Application Forms\HAZAPPLOC R r AmeriGas Emergency Plan ❑ Contact Fire and Police Departments ❑ Isolate spill or leak area immediately ❑ Keep unauthorized personnel away ❑ Stay upwind ❑ Take immediate action to turn off valves, giving priority to EMERGENCE' SHUT OFF device ❑ Turn off main power switches ❑ Eliminate all sources of ignition, including appliances in office (turn gas supply off from outside) ❑ No vehicles within the gates of the property ❑ Stop leak if you can do so without risk ❑ If ignition occurs consider using fire extinguishers, BUT ONLY IF the source of gas can be shut off. Your main concern in any fire caused by or involving LP-Gas should be to prevent injury to yourself or anyone else in the area. u All employees to meet at Subway by the Radisson Hotel EMERGENCY CONTACT LIST Police: 911 Fire: 911 Ambulance: 911 Local FBI: 617-742-5533 Local Manager: 0" Market Manager: 508-400-6949 (Roger) Region Safety Manager: 7 1e e 0-6-�s CTda) i_ Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health ty{ Town of Barnstable &1HE Regulatory ,Services Thomas F. Geiier,.Director 3 } 9p° MASSA .$ Public Health Division ib39• 1` ' raoy Thomas McKean Director 200 Main Streit, Hya=is, MA 02601 O!Ecc: 508462-4644 Fax: 508-790-63 04 Application Fee: $100.00 ASSESSORS IMAP AND PARCEL,NO, DATE APPLICATION FOR PERNffT TO STORE AND/OR UI'IJ= MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL,NAME OF APPLICANT - NANSE OF ESTABTISIBl NT A7 p)'eAA/(, *d ADDRESS OF ESTABLL51EM +,NT 117,3 TELEPHONE NU13ER 79J' 0 69 SOLE OWR: VfES NO IF APPLICANT IS A PARTNERSHIP,FULL NAT)IF,AND HOME ADDRESS OF ALL PARTNERS: I J IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Z 3 " 17 LF?7/7 STATE OF INCORPORATION FULL NAME AND H01MI ADDRESS OF: PRESIDENT 21:1 TREASURER CLERK SIGMA OF APPLICANT RESTRICTIONS: Ho1�U ADDRESS /f ���. ��.� 1, ����y�/ �d,�r . ,,u 3 HOMI TELEPHONE 1?a7-doc/wp/q i i ram• ! __. _..._ • ,r MAIL IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 026b1 FOF,FAXED REQUESTS, Our fa;number is (508) 790-b304. Please fax a completed application form. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. For further assistance on any item above, call (508) 862-4644 4 S I i I I i I •I I I I � I 1 I I AmeriGas 1 Safety Training Propane �2.1 PURPOSE Safety Training is intended for any AmeriGas employee who handles or transports propane or other hazardous materials and could therefore be potentially exposed to such materials in case of an incident/accident. To meet the requirements of the regulations, Safety Training must include: 1. How to identify the known hazards of materials in the work place. 2. How to use personal protection measures available within your district. 3. How to avoid accidents. 4. How to respond to a hazardous materials emergency. NOTE: This training is not intended to meet the requirements of hazmat employees whose primary function is emergency response. It is simply meant to provide basic safety training to those with limited emergency responsibilities. ■ Goals and Objectives of Safety Goal: To ensure that each AmeriGas hazmat employee knows what to do in the event of a hazardous materials incident/accident at the district or customer location. Objectives: 1. Review the Emergency Response Guidelines(ERG)for propane. 2. Review Basic Personal Protective Equipment. 3. Review other emergency procedures in place at your district location. 2.2INTRODUCTION ■ To ensure that each hazmat employee know how to respond if faced with a hazardous materials emergency. 1 3 REVIEW OF THE=EMERGENCY RESPONSE GUIDEBOOK . Anyone involved in the handling or transporting of hazardous materials has a potential for exposure to these materials during hazmat incident or accident. In such an event,the Emergency Response Guide(ERG)is an excellent tool for guiding actions. One of the first statements in the guidebook is of extreme importance: fumes and sinoke. Approach any inei(lent froni upNiiind, if possible-stay clear of all spills, Napors, AmeriGas 2.0 Safety Training Propane Our employees who may be exposed to a hazardous material in the event of incident/accident must know how to use the Emergency Response Guidebook(ERG). The Guide is divided into color-coded parts: Yellow Pages: Lists hazardous materials numerically by ID number. Blue Pages: Lists hazardous materials alphabetically. Orange Pages: Lists safety recommendations for each guide number. Green Pages: Lists initial isolation and protective action distances. p2.4 IDENTIFY THE MATERIAL A. Find one of the following: • 4-digit ID number on a placard or orange panel • 4-digit ID number(listed after"UN"or"NA")on a shipping paper or package • name of material on shipping paper,placard or package B. If you cannot locate the ID number or name: • And you can see a placard,try to find a placard like it in the table of placards. Then refer to the 2-digit guide number next to the sample placard. C. If you cannot find any reference to a guide, but you believe the incident involves a hazardous material,turn to Guide 111 and use that until more information is available. 2.5 FINDING THE 3-DIGIT-GUIDE NUMBER FOR LIQUEFIED PETROLEUM GAS 3 A. Yellow ID section. B. Blue name section. NOTE: Guide numbers of explosive hazardous materials are printed in the middle of the first page of the guide. They are: a. Explosive A Guide 112 b. Explosive B Guide 112 c. Explosive C Guide 114 d. Blasting Agents Guide 112 Turn to the numbered guide (orange pages) in the ERG and read the information. 2 Training Propane VERY IMPORTANT: If the entry is highlighted in the yellow or blue section,turn to the green section: "Initial Isolation& Protective Active Distances"for information. NOTE: The Emergency Response Guide(ERG) is not intended for use during the cleanup phase for spilled materials,nor should it be used to determine compliance with any regulations. 2.6 FINDING THE 34DIGIT`GUIDE NUMBERaFOR LIQUEFIED PETROLEUM^GAS Guide GASES—FLAMMABLE ERG 2004 ERG 20O4 GASES—FLAMMABLE Guide 115 (INCLUDING REFRIGERATED LIQUIDS) (INCLUDING REFRIGERATED LIQUIDS) 115 PMf ITiALHAZARDS ENERGENCYRESPONSEWN EXTREMELY FLAbdNVIBLE . Do NuT EICTONGUISH A LEAKING GAS FIRE UNLESS LEAK CAN BE Witbooasiyignittdbybcnl.�&kr'arfiaatee. STOPPED • WR form a tpicalve mlxtu.•es with air. Small Flrve • Vapors from lulunnod gas are hntsaty haefer than an and spread along ground. Dry chemical or COL. Vapors may travel to source of ignhlon and flash hack, Large Firm • Cylinders exposed to fire may vent and release Fammab)a gas thrcurp prumne Water spray orfog, reliul dravi=. • Move containers barn fire area H you can do It Without risk, • cCmnalners may explode 1Nleh heated. L.1-*lying Other Tanks .__Ru used cylinder-easy rocket . F7ght lire front morwirn r..rSiciasce er use rnnnulned hose holdars ormanitr 11�76d11 nuzzles: • Vapors may cause dizzirwss or asphyziatlon without warnhif, Cool conlauters Witt flooding quan klos.of mcs,ua5:won;dh o fire is oil. • Some may be irilalin;it Inha`ed at high em»entratione. - Do not Scoot water at source of limh ar aaley devk*a;idng may occur. • Conl;xi with go$a9que'red gas may cause burns,severe iroiryandforfrostbite. • WilidraN Immediately In case of bang nourd front v.wiring eatery dewoos or Fire MM EME- brit,'I,g;m 'nr toxic gases._ • discoloration of tank, ALWAYS GUY away from to As ingrained in Ga. PUBLIC SAFETY • CALL Emergency Response Contact Telephone Number first For massive Gro,ruseim urvmanrted nose ore burn, w mm k r nozzles;U this to • As an immediate precautionary measure,Isolate spill or leak area ktr at least TOP. A nle,wifidnr^'Iron ouch and bet Ore bum meters(aut feel)toe ow.eoaw rLIMINATC all igr ilInn sources(no smoking.flows.sparks of flame s in Keep unaulhodzed pars •are]away, • hrrineflate area). • Stayuprdrd. • 11foloa to la heavier than.ak and will spread along ground and ooffint In I Dow Or • At equi;mcrd used when hnadfitV the prod tot must be grounded, nanfinod art+ar.(sw�e a,knrsrnerds,tanks). Do not touch or weldhIuMh*#tied m t.ndal. areas, . Stop look V you can do it without.risk Karin mil of Fix . •�- ^^^ It possible,bum leaking containers Fa that qaN us pee relher then NukL Meer posh preshne aellKeontained breahhfr>tl appavlus(SCBA). • Use warier sproy W reduce vapufa or divert vapor cloud drift,nvoid idming vmWr • Structural firefiglif-e pnde;five Cbenblg will only provide lftled protection. vanor.to contact spired ma%*d. Do rot dUW water at evil]or sourer.of lock, MW s wxrar Jrmrmal proterXm cletlyrng. . Prevent spreading ail vapors threugii scwrrr wrr.5kt6on systems and dornfined Large Spin areas. • f onslder Initial daNnwlnd evacuatian for at least OW rnotcrs(I P.mik), Isolate area until gas has ni'spersed, Elm If tank,mil car or ink(ruck is Involved in r fie,15OLATE for i8na motors(1 • Movs vleft to fresh air.Call O1 for omergemy medical setui're_ rn"-)it.0&-clio ni;also,consider uta%al evacuation fur lGW motors IN mild)to Give mt:Odal respimtrcn if vwfnf{s lint bnxnUltg, ell dMcj-. • Administer oxygen abreathing is difficult. • Remove and Isoklte rari anlimind clotting and shoos, • Clothing tmzen to the skin should bo tlsntstd lufte being renared. • In case of contact wen Fqua5W gas,thaw frmOod parts txith Wkeaamt water. • In case of burns,immedgtoly cool affected oWn for as keno as pa sildo w1lh add water. Do not removo clnthing ifadhoving ki skin.Keep MWLn tvamn and quiet. F nmra that mut iaal personnel air;tvare at(he nlaletiaYa)Involved and take . pmeau6ons W prrAnd Ihnmzolvex Page 178 PaBc)79 List 3 other Hazardous Materials and look up in the EGR guidebook and record the guide numbers below. HAZARDOUS MATERIAL GUIDE NUMBER 3 1 Safety Training Propane NOTES: 2.7;REV" OF�PERSONAL: PROTECTIVE EQUIPMENT.US EDIN YOUR DISTRICT „ - --� Your instructor will review the personal protective equipmenti ment available for your use in case of a hazmat incident/accident. You should become familiar with this equipment (gloves, safety glasses, fire extinguisher, etc.)in the event that you will need to use it during an emergency. See AmeriGas Operations/Safety Policy&Procedure Manual, AP 3.7, Personal Protective Equipment(PPE)for additional information. NOTES: +2.8�REVIEW OF PLANTEMERGENCY`PROCEDURES Basic elements of any emergency response plan are: A. How to get help in case of emergency ■ In the event of a hazmat incident/accident, it is of utmost importance that all employees know to contact their immediate Supervisor/Manager. NOTE: The emergency telephone number listed on the shipping paper must be answered by someone(no answering machines)knowledgeable in hazmat emergencies. AmeriGas uses Chemtrec: 1-800-424-9300. B. Basic emergency response actions ■ Proper use of a fire extinguisher ■ Do not walk into or touch spilled material or vapor cloud ■ Avoid inhalation of fumes, smoke, and vapors, even if no hazardous materials are thought to be involved. 4 'AmeriGas 2.0 Safety Training Propane C. Characteristics of LP-Gas (Propane) ■ Gas can be liquefied at ordinary temperatures with moderate pressures. ■ As liquid, LP-Gases are easily transported and stored. ■ All LP-Gases burn cleanly and have high heat valves. ■ LP-Gases are not poisonous. ■ LP-Gas liquid is volatile and will vaporize quickly if spilled. ■ LP-Gas vapor is heavier than air and can accumulate in low spots. ■ LP-Gas vapor will diffuse slowly into the atmosphere unless assisted by wind currents. ■ LP-Gas vapor leaking into the atmosphere cannot always be detected by the eye. ■ One gallon of(propane) liquid will produce about 270 gallons of propane vapor in the air. ■ One gallon of propane liquid will produce about 10,000 gallons of a combustible propane-air mixture in the atmosphere. 2.9 eR view`of Plant:E�mergency Procedures, ■ Rapid removal of vapor from a tank containing LP-Gas liquid will lower the liquid temperature and reduce tank pressure. ■ Rapid removal of liquid from a tank will generally have no affect on liquid temperature or tank pressure. ■ LP-Gas (propane)liquid volume will expand 1.5%for every 10°F rise in temperature. The first few minutes after a hazmat incident/accident are the most crucial. Please list the first three things you would do if a hazmat incident/accident occurred: 1. 2. 3. One of these items must be the name of the person you would contact for help. NOTES: 5 y Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that ArneriGas Propane/Hyannis 193 Iyannough 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 6/30/2013 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 0,*1HE�qk� Regulatory Services Thomas F. Geiler, Director 9 "� � Public Health Division i639• 'OrEo nervy°i 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 ��ne lbz I&A z) Va M • Cv y- i NAME OF ESTABLISHMENT p'mom«S 4-op pub, ADDRESS OF ESTABLISHMENT `193 "�A-NJ VGAJ644 RD TELEPHONE NUMBER '506 -n S Dta SOLE OWNER: YES NO LO IF APPLICANT IS A PARTNERSHIP,FULL,NAME AND HOME ADDRESS OF ALL A PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ti a-14 S 3 041 STATE OF INCORPORATION PA FULL NAME AND HOME ADDRESS OF: 'I PRESIDENT a�9r�ty `� � r. . `�(o® u !n�l p1. 11A.}' a xo aE P'rLL%-Q1 d PA 11 Li d( TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q l _= 3 _ x UE 11 o Contact Fire and Police Departments ❑ Isolate spill or leak area immediately ❑ Keep unauthorized personnel away ❑ Stay upwind ❑ Take immediate action to turn off valves, giving priority to TV'_ device ❑ Turn off main power switches ❑ Eliminate all sources of ignition, including appliances in office (turn gas supply off from outside) o No vehicles within the gates of the property ❑ Stop leak if you can do so without risk o If ignition occurs consider using fire extinguishers, BUT ONLY IF the source of gas can be shut off. Your main concern in any fire caused by or involving LP-Gas should be to prevent injury to yourself or anyone else in the area. �r_ __ _.. .�; EMERGENCY CONTACT LIST Police: 911 Fire: 911. Ambulance: 911 Local FBI: 617-742-5533 Local Manager: 508- 46--�-3•1-it (G-i-- rr-"\ Market Manager: 508-400-6949 (Roger) Region Safety Manager: (a4 7:: 31 -4 0 00 X BOVPI ff) J Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 11.1 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.CANN_IFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI „TH-OMAS A.MCK•EAN,R.S.,CHO Director of Public Health I Town of Barnstable °FIME Toy, Regulatory Services ti • yP °� Thomas F. Geiler, Director ' BARNSTABLE, 9 MASS. g Public Health Division o,,:Q�d" o i639 ♦� AlF (11 OMP�a' Thomas McKean, Director �O 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 HAZARDOUS MATERIALS FULL NAME OF APPLICANT L S Ame-r; Crcs mand.ctof NAME OF ESTABLISHMENT _Arne,r� G�5 i'rO�ar�e l,�iS►r�c-t-# 55591 ADDRESS OF ESTABLISHMENT 193 I�ta n n o "G k R d y c nn is 0 a-6 0 f • O t� - � Q TELEPHONE NUMBER SOLE OWNER: YES )C NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: ... 41:- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. of • I!6 30411 i STATE OF INCORPORATION -?e-n n S I•ya r1 i 0— WZa co FULL NAME AND HOME ADDRESS OF: PRESIDENT E-jqcn-e 'd;sse-o Hbd 4. GvlpbRd G'j of ?rusS;G , A 1'140(p TREASURER CLERK • SIGNATURE OF PPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Haz.dochap/q Number Fee 652 - THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that AmeriGas Propane/Hyannis 193 Iyannough 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 6/30/2010 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 e Town of Barnstable Barnstable 'THE Regulatory Services Department M-fteftaCffy . Public Health Division 1 1 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS - FULL NAME OF APPLICANT Lisa Marx Amex; a o er NAME OF ESTABLISHMENT A m er i Q5 Pr •p o pl(b;.�-r�cT 'S55 �l ADDRESS OF ESTABLISHMENT 1-I 3 1 h r1 i / • oz 401 TELEPHONE NUMBER -50 SOLE OWNER: YES )(NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADD SS OF'�L r PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION e n n S •yc n i p.. FULL NAME AND HOME ADDRESS OF: r PRESIDENT [•j Luc n< S S-� 1 I `� 0 ►� :V�� ;in o t p i C. :a PA TREASURER U CLERK 0. t0 C. SIGNATURE OF APPLICA • RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health 1� This is to Certify that AmeriGas Propane/Hyannis \� 193 Iyannough 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 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 Town of Barnstable Barnstable s"ETti Regulatory Services Department o A!-AmerieaCitY Public Health Division BAMSTABLE, ' 9cb ;�; `0� 200 Main Street, Hyannis MA 02601 AIFD"A0�A 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT L_; act Mar K I eJ . Ma n a g Cr f 2r Arn r;A a S , ► rnn+S NAME OF ESTABLISHMENT AM er; ci a S ?r o par)-e ADDRESS OF ESTABLISHMENT I9 3 J-y a rims!$h l d H j n n r)i S . rq A O;t 6 O 1 TELEPHONE NUMBER ,50 S - -4 -4 5 - 06 S L, SOLE OWNER:—YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL-- PARTNERS: f rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Ha " 145 30H, STATE OF INCORPORATION e-nn5y I V a n; a FULL NAME AND HOME ADDRESS OF: PRESIDENT_�'rer P- B;SSe II 460 IJ • GJIph Ad K;na o[ l�.utS1a_'PA 19406 TREASURER CLERK G ATVRE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that AmeriGas/Hyannis 193 Iyannough Road, 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, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town"of Barnstable °f Regulatory Services ° Thomas F.Geffer,Director Public Health Division �� 1 Thomas 1VMcKean,'Director 1 200 Main Street, Hyannis,MA 02601 Office: 508-W 4b44 F= 508 790-004 f— �. Application Fee:$100.00 N w c-n ASSESSORS MAP.AND PARCEL NO. DATE N ry r APPLICATION FOR PERMIT TO'STORE AND/OR UTIL TZ MORE THAN Ill GALLONS OF HAZARDOUS ARDOUS MATERIALS FULL NAME OF APPLICANT S t&a ,�+�146, L►P. NAME OF"ESTABLISHMENT WMI 64 `�P-JWA WE ADDRESS OF ESTABLISHMENTt�3 � �0�1� �.c�. }�W 49+1, tt{tl,6Z,�d( TELEPHONE NUMBER SOLE OWI fER: .V YEs NO IF APPLICANT IS A PARTNER;SEV,FULL NAME AND HOBO ADDRESS OF ALL- PARTNERS: X AMEMNArS P2opAwFLP ?q ljo LlMtrE'D PArm t-12SYIProq*NFsr Vt AM A-5 FA§!Z h(VI.-ID t'JV JS �? rf! .A6, b 41 A,I- AiYF CDkP ('tA4Put COM19KI ZwC) 4 p, IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER {CLERK V60 N.1Vu.cP4 "ho KINg D P ?2U ss tA. to+ 19V4 S1GNAWRL OF"FLICP1 a RESTRICTIONS: HOME ADDRESS E HOME TEI:EPHONE4. 4 -D �goo f •r Americas Emergency Plan ❑ Contact Fire and Police Departments ❑ Isolate spill or leak area immediately ❑ Keep unauthorized personnel away ❑ Stay upwind ❑ Take immediate action to turn off valves, giving priority to EMERGENCY SHUT OFF device ❑ Turn off main power switches ❑ Eliminate all sources of ignition, including appliances in office (turn gas supply off from outside) ❑ No vehicles within the gates of the property ❑ Stop leak if you can do so without risk o If ignition occurs consider using fire extinguishers, BUT ONLY IF the source of gas can be shut off. Your main concern in any fire caused by or involving LP-Gas should be to prevent injury to yourself or anyone else in the area. o All employees to meet at Subway by the Radisson Hotel EMERGENCY CONTACT LIST Police: 911 Fire: 911 Ambulance: 911 Local FBI: 617-742-5533 Local Manager: TBA Market Manager: 508-400-6949 (Roger) Region Safety Manager: 856-498-7409 Town of Barnstable _ vofsher Regulatory Services Thomas F. Geiler,Director Public Health Division iOFEca+°c - 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 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT &G-w— 'bi1ek-_'tna Mecn!ax, v s-v►���Cx�g , "layanr:�S NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 1`t 3 �y c�n c�tAc,� pc � Vk�q a mnl g ; M A . OX60 TELEPHONE NUMBER be e`17 S 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. ` ,;- 1qG 104 1 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: -` PRESIDENT C am. 8l sgeA gtoo Ili Crc�l�1� R-cx�� , l�1 nc� 6>4- P ssta pd4 i k 0(v. s TREASURER 4 �„ CLERK NATURE OF APPLICAII T RESTRICTIONS: HOME ADDRESS HOME TELEPHONE 4 Haz.doc/wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). 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 T FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above.} Allow up to four days for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Number Fee 652 THE COMMONWEALTH ,OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that AmeriGas/Hyannis 193 Iyannough Road, 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, 2007 unless sooner suspended or revoked. ---- ------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 9, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health .r Town of Barnstable - a Regulatory Services t Thomas F. Geiler,Director , TOWN OF BARriS�TABLE Public Health Division Thomas McKean,Director 2005 APR 25 PM I: 24 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 u Fax: 508-790-6304 Application Fee:$100.00 . DIVISION ASSESSORS MAP AND PARCEL NO. DATE '-I 0!;- APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT v c, � �z� r� �� r -� s/ �n►�j s NAME OF ESTABLISHMENT Ayr���� s ����h�- , r,•P ADDRESS OF ESTABLISHMENT 1 q_ U A mnbu k RCaA, TELEPHONE NUMBER 500" -7 7S' 0(001,1 SOLE OWNER: YES_KNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Ll'3�- 14 5 3011 i STATE OF INCORPORATION Phy 3T i Ctt� - N�o.i�i i� FULL NAME AND HOME ADDRESS OF: 1 PRESIDENT Ec� tee, �3�ssel\ L%C) �dv f�,.\ Rc��c� Po gox `1105 TREASURER €,. w �c► ��r`� p PA I q Lt O via v" Pbrg e, CLERK PA igg6Z Ma,oq e-c- Gor Arnim s,=�(x�s,l i FAI 7 NATURE OF AP CANT RESTRICTIONS: HOME ADDRESS 1' ' X.0—r\nou4\ Rd' , 1\va nnly Mk ©*?( k HOME TELEPHONE# 5Og,400-(og!SO Ilmdodwp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your u waste spills,etc). In addition lease include the contingency plan(to handle hazardous w p } , required fee p 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,NU 02601 FOR FAXED REQUESTS Our fax number is 508 790-6304. Please fax a completed application form. Also,please fax us a ( ) P PP 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 AmeriGas Emergency Plan Contact fire and police departments - Isolate spill or leak area immediately - Keep unauthorized personnel away - Stay upwind -Take immediate action to turn off shut off valves, giving priority to EMERGENCY SHUT OFF device. - Turn off main power switches - Eliminate all sources of ignition, including appliances in office (turn gas supply off from outside). - No vehicles within the gates of the property. - Stop leak if you can do so without risk - If ignition occurs consider using fire extinguishers,'BUT ONLY IF the source of gas can be shut off. Your main concern in any fire caused by or involving LP-Gas should be to prevent injury to yourself or anyone else in the area. -All employees to meet at Subway by the Radisson. EMERGENCY CONTACT LIST Police: 911 Fire: 911 Ambulance: 911 Local FBI: 617-742-5533 Local Manager: 508-400-6950 (Gene) Market Manager: 508-400-6949 (Roger) Region Safety Manager: 856-498-7409 (Jim Vizzini) Number Fee 652 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that AmeriGas/Hyannis 193 Iyannough Road, 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, 2005 unless sooner suspended or revoked. ---------------------------------------- SUSAN G.RASK,R.S. WAYNE MILLER,M.D.,CHAIRMAN April 25, 2005 SUMNER KAUFMAN,M.S.P.H. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �,l TOWN CLERK STIIiL {. r BARNS {..I f`t.iSS.LlIt ® t , - a►l a ? i �\cc�l ,e7G• `� L Z� Z U EGISTRATION '�� ��� t� RS :52 � 397Tvi,ITS S7r y`"T lvvSS. 02601 (T Barnstable April 1 19 )Gry of i own) This is to certify that Petrolane Gas Service Limited has, in accordance with the 1 prmisiozW)of C�pter 148, Section 13, of the Gtneral Laws, filed with me a.certificate of registration setting forth that �.. Beaum4nq -1'etrole Gas Service'Limited Partnership-c/o Joseph P. is the holder of the Iic-�tse granted l+b 1 Fk,fi-6 i for the lawful use of the building{s) or other structure(s) situated or to be situated at �= 1 h 'Road H annis Mass. py r4TTEvT 'Underground O Total cater ty i�allons 121,000 Container j/ - j Kind of fluid to be stor ed:' gas AbovegroundO Tovvn Clerk re and piftcial Title) n :'. Not=A ccrtificnte of rcrictratian must be filed on or before April 3Cfth of meCh p'ar.-;,•_.'.: (THIS REGISTRATION MUST BE CONSPICUOUSLY POSTED ON THE YREMIS.S.) s ,] l ' . `�'�-moo o-� C--, TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. �AgPARCEL NO. A(9k ADDRESS OF TANK: Iq - 1- YA V D UG4 M— VILLAGE: MIS J��IS NuFFEl^ YtBOVE 0 Y-Adhllo MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 6 4 fffppA...///YYYIVV//// ��J / OWNER NAME: fi���L4 6 (9A� -� I� PHONE: �� INSTALLATION DATE: BY: INSTALLER ADDRESS: �-� 'CERT.NO. *TANK LOCATION: ��- � � zA&,)yl .r (n (MCOOR!ON TANK LOOATION WSTH RQOPQOT TO =U2 >D��S��N,O���� CAPAC I TYlgl TYPE OF TANK AGE YRS. FUEL/CHEM I CAL �pLy11--[a TESTING CERTIFICATION [ ] PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUE,,D [X] YES C ] NO DATE CONSERVATION [ ] CHECK I`F N/A DATE BOARD OF HEALTH TAG NO. C /®/ ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHE`MMICALL STORAGE REGISTRATIIOO}N lJW os MAP NO. PARCEL NO. ADDRESS OF TANK: 1 YA 110 6;�( AZD- VILLAGE: lyyflols Number Ytr��! ta/4! PDX � i ,�� I E /�aAl I`�....1 •• MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : a � /�/'' .1 4 / ,�` OWNER NAME: �+ f�l'11 v ) -J G (l!, PHONE: / / t/.�C) INSTALLATION DATE: BY: -INSTALLER ADDRESS: -CERT.1JO. *TANK LOCATION: 1 1�' !'rt:1 Y� re3R 12AtD r (6moom I nG TANw LOQAT 2 ON W 2 TH RGOPQCT TO mLl2 L,DyI NO t CAPACITY ! I� TYPE OF TANK AGE YRS. FUEL/CHEMICAL � 1�✓ TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ A CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION YES [ ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [X] YES C ] NO DATE CONSERVATION [ ]. CHECK IF N/A DATE r HOARD OF HEALTH TAG N0. [ ] DATE * PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ,�j �-/V -. its Ca NAME OF FIRM: 5 V 03 U 6 0 /� /� 0"' ZZ 4 MAILING ADDRESS: TELEPHONE NUMBER: 7 7✓ ' 4 CONTACT PERSON: -Q-W I �4 Does your firm store.any=of:.:the.toxic_or hhazardous=-mat.er:ials --listed--below-,.- either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the B rd of Health regardless of a S or NO answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored 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, 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, lubricants Swimming Pool chlorine Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids R E C EIV' E D toxic or hazardous (please (dry cleaners ) HEALTH DEPT. listYF Other cleaning solvents TOWN OF BARNSTABLE Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 4 1981 Disinfectants Road Salt (Halite) TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 1 Mail To: NAME OF BUSINESS: �"� -� 5---`�'�' Gyp' Board of Health MAILING ADDRESS: own of Barnstable TELEPHONE NUMBER: D P.O. Box 534 CONTACT PERSON: oUr� Hyannis, MA 02601 Does our firm store an of the toxic or hazardous materials listed below, either for sale or for Y Y your own use, in qua (ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or h azardousjplease list): (dry cleaners) , , ele., e,9- 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 satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY �� (see"Orders") 5.Retail Stores / 6.Fuel Suppliers ADDRESS jaSS: Ce 7.Miscellaneous QU ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT I I OUTI IN OUT IT&gallons Age Test Fuels: Gasoline,Jet Fuel (A) v Diesel, Kerosene, #2 (B) Heavy Oils: IH waste motor oil (C) new motor oil (C) v transmission/hydraulic Synthetic Organics: L degreasers a Miscellaneous: e , . L zt DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. ater Supply i own Sewer ublic On-site OPrivate 3. Indoor Floor Drains YES N01-� O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destinatidn Waste Product 1. 2. Person (s) Interviewed Inspector Date