Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0332 IYANNOUGH ROAD - HAZMAT
0-7 lf-TI 32 g br7, °p IKE roKti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. $! 200 Main Street• Hyannis, MA 02601 �prFOMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 3 Business Name: Date: NurlA Location/Mailing Address: 14dwo.4% 2 ko fte Contact Name/Phone: c 0 - 3 Inventory Total Amount: MSDS: UP n License#: `80 Tier II : AJO Labeling: J Spill Plan 0044 Oil/WaterSeparator: Floor Drains: �� Emergency Numbers: `9 Storage Areas/Tanks: Emergency/Containment Equipment: aste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: I� 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. 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 Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: W4 J04 di b , INFORMATION/RECOMMENDATIONS: j. u , r- y 1 Inspector:' Facility Representative: ' WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS w Pi�s�r Town of Barnstable Office:508-862-4644 Public Health Division '� Q Fax:508-790-6304 BARMA�RLE.$' i 200 Main Street• Hyannis, MA 02601 32—U �-0/j 2 aYb tbS9• `0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT V PrFO MP'�e Business Name: .-Aubaont # 516o Date: 3 »01 Location/Mailing Address: To XSWAIM0- - r e V&j Contact Name/Phone: �� 7� Inventory Total Amount: `�� MSDS: License#: 13 AD Tier II : Labeling: Spill Plan:(AdOil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: A I Emergency/Containment Equipment: Waste Generator ID: Maf 00OW361Ili Waste Product: Coyrost of Date&Amount of Last Shipment/Frequency: 6 1 011 Licensed Waste Hauler&Destination: aen Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers V/Hydraulic fluid (including brake fluid) Windshield wash 1/ Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil y/ Disinfectants Miscellaneous petroleum products: Road salts / grease, lubricants, gear oil Refrigerants %L 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 �L 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: INF RMATION/RECOMMENDATIONS: no reconAgaddRi Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1179 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR --.... ........................ -- ••------ ---•----- ---....--------....---- ------ ........ 1 332 IYANNOUGH ROAD (RT 28), 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 • 7 l� Town of Barnstable Inspectional Services BARNS LE pF F N:TA%E•(EtRFlV U_CONR-11—Is Public Health Division ""�1639-202'4 � e 1639-2014 BARN LY� 1 Thomas McKean, Director KANKto c 39. 200 Main Street, Hyannis,MA 02601 S Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS, IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 � � (G� - CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ OC�a i *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3 D-g 2. IS THIS A PERMIT RENEWAL? I/ 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:_ 5. NAME OF ESTABLISHMENT :U' p 1 _I � o� Sron, LL C � w 6. ADDRESS OF ESTABLISHMENT: 3 3 2 (1CLYIn%)vq V1 '-d 9-V Z N\4 Ck'nr>3 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 4b5 VJ•e s-� yJ-S t pZ3"1 Cl 8. TELEPHONE NUMBER OF ESTABLISHMENT: S C S 7 `7 9. EMAIL ADDRESS: o V,6 1 (5? eh 1 , C z VV) 10. SOLEOWNER: YES V NO IF NO,NAME OF PARTNER: &rn ! v i LLC 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 6n1CirM n SC ptn+ - (4- - C W C M OaM 0 &MA u C PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT C jo.0 DATE Q\Application Forms\Haz Mat Appli Draft Jan20l9.docx `°F�Me royti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA-1Z . • 200 Main Street• Hyannis, MA 02601 16,59. - ptEDMP TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: s Date: 0 / Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: SDS: �J—0 License#: Tier II Alh Labeling: eS Spill Plan: Oil/Water Separator: t Floor Drains: Emergency Numbers: Storage Areas/Tanks: 613 fl aAlf-, V Ol Emergency/Containment Equipment: Waste Generator ID: Waste Product: �( h Date&Amount of Last Shipment/Frequency: Af Licensed Waste Hauler&Destination: C0-V0,VCA 1.ick5je fKAngae11nC/1� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout q5 4 J- *Iv insecticides, herbicides, rodenticides Battery acid (electrolyte) atteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: no Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1179 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR 332IYANNOUGHROAD (RT28), HYANNIS, NIA 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 I KKE Inspectional Services BARNSTABLE O Public Health Division • BARNSTABLE, Thomas McKean, Director MASS. 1639. co a 200 Main Street, Hyannis, MA 02601 0 Office: 508-862-4644 Fax: 508-790-6304'-' X 0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: El CATEGORY 2 PERMIT 111 —499 Gallons: _$125.00--% AVS1 c1h CATEGORY 3 PERMIT 500 or more Gallons: _Sr5ttft� El *A late charge of$10.00.will be assessed if payment is not received by July 1st. 600DI 44 a0o,�_ 1. ASSESSOR'S MAP AND PARCEL NO. 3 a B- 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: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFER-ENT FROM ABOVE: "A 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: S ' pn 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME, HOME AD SS, AND TELEPHONE # OF: CORPORATION NAME k, PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT DATE Q:\Application Forms\llaz Mat App Revised 09-0)-18.do)cx Number Fee 1179 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR 332 IYANNOUGH ROAD (RT 28), HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------ ------------------------------------------ -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r ' Iowa of Unstable �s leg- atory emces Richard V. Scali, Director �t�' G� I u0(q Public Health Division BARNSTABLE `A r BARNSTABLE, Thomas McKean, earvsrnelerrtennue•mrun•rvranrs r� MA6$, A 7 Director 1639-2014 -- -- — -- — 1639 �0 —— -- — — — — — — -- �ED MAr A 200 Main Street,-Hpanrus;MA 02G01---- ---- ---,"-.-"-- �7_5- ------ -_-�; . Office: 508-862-4644 Fax: 508-790-6304 , APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS t.�a 1N 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 g (/S 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 N .� �_S�� I ��� 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4., FULL NAME OF APPLICANT:,�ny,f. o � � L^` f-C " 17- r pyn w , ' �S\-C l 5. NAME OF ESTABLISHMENT: - C, 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: via - _� M"11S 9. EMAIL ADDRESS: o& � 10. SOLEOWNER: J YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PLC PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: i COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE b Q:Wpplication FormsOAZMAT APP 2017 REVIS4. bcxa�i k A� Number Fee 1179 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR 332 IYANNO UGH ROAD (RT28), HYANNIS, MA Is Hereby Granted a License W For: Storing or Handling 111 - 499 gallons of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health I ' Roof Bagnstable egu atory ervlces tKME Richard V. Scah,Director r� Public Health Division BARNSTABLE + eaaxs;wuansic.caxvtrnaivbs_ Thomas McKean,Director ;� ;4F`"`"s + BARNSTABLE, + S��(y 9� tQ f MASS.. �0� cA�sl 0 prfD MAr s 200 Main Street,Hyannis,MA 02601 , b� Office: 508-862-4644 Fax: 508-790-6304 r- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE '`m} 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 ❑ l9. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ $IO La - *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 328/072 2. IS THIS A PERMIT RENEWAL? X 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: Enterprise Rent-A-Car Company of Boston,LLC 5. NAME OF ESTABLISHMENT: Enterprise Rent-A-Car 6. ADDRESS OF ESTABLISHMENT: 332 Iyannough Road 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 405 West Street,West Bridgewater MA 02379 c/o Doug Valeri 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-778-2205 9. EMAIL ADDRESS: douglas.p.valeri@ehi.com 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Enterprise Rent-A-Car Company of Boston,LLC PRESIDENT Brian Duffy TREASURER William Lazzarino CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT �' DATE 8/21/2017 C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx MAIL-IN REQUESTS Please mail the completed application'form to the address below. In addition, please include the required fee. 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 ;4. c Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. In addition, please mail the required fee amount. 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) 862-4 644 C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.0utlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx Number Fee 1359 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Floors + Walls Inc. .•••••••••••••••..............•••••••••••••••••••......••-••••••••••••••...•••••••••......•••••.................................. 332 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 06/30/2022 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 04/06/2021 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r c— ar Town of Barnstable Inspectional Services BARNSTABI,E of t r Public Health Division fi0.+5?WiS N.LLS•OSIERVILL=•MI[sl 0?IL4i4&E 1639-2C14 r Thomas McKean, Director MAM 1659. n59,,E s`� 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ChV-0 2 V64 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. 3� _ 0-4-2L 2. IS THIS A PERMIT RENEWAL? YES ENO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGF/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? ✓YES - NO. 4. FULL NAME OF APPLICANT: (.1` c4d ZG h rr n • 5. NAME OF ESTABLISHMENT: F iC qrs 4- W G I Is ZN L 6. ADDRESS OF ESTABLISHMENT: 33a �-f Gnn cly0h - Hjcinn, rn�- Ga&o 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: J0? - 5 9. EMAIL ADDRESS: 6(-d1SU(-p4Ce P F toorS c.AiG115' COK,- 10. SOLEOWNER: ZYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Rwc S +'W G l I S 1, - C PRESIDENTwid G _ G0- TREASURER ci Zt� Cn CLERK �ln.►c� 7 �N 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT -- DATE �?�11 2_ �j Q:\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING .-------------------------------------------------------------------------------------------------------------------------------- 332 IYANNOUGH ROAD I RT 28, 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 y Town of Barnstable Inspectional Services BARNSTABLE Public Health Division flFRNSTABtE•E'6ONR•MYARNIS 'UiS.CNS N'll5• 5'EMLLc•CFSi 6A0.YST.4&.E 639-20139-1014; • fig a 1 BAM Thomas McKean, Director 0 339. s`� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 50§=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 rlvsT- C.h'� 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. �fOS 1. ASSESSOR'S MAP AND PARCEL NO. / 2. IS THIS A PERMIT RENEWAL? 4/ YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT:. /77C-0S'S L C 5. NAME OF ESTABLISHMENT: ���"� �0,-z- Cr/�-e,,—z J G' 6. ADDRESS OF ESTABLISHMENT: Nyv-a `"y 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: -j�� -?,g r 9. EMAIL ADDRESS: �� RYA 6 ,J d49Ar lrb0fZ 10. SOLEOWNER:DYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT /'�--__� AOD TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat Appli Draft Jan2019. ocx Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332 IYANNO UGH ROAD (RT 28), HYANNIS, ALL 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. ---------------------------- P-AUL 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 m Town of Barnstable Inspectional Services BABSTABLE Public Health Division 1139_--2074 i M GU Thomas McKean, Director prEo5.�a`` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 >m� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE , HAZARDOUS MATERIALS '•�` IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 x V sj j CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ (�" *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. (30?8- 0:�' 2. IS THIS A PERMIT RENEWAL? v YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: m61 sl4 LL C 5. NAME OF ESTABLISHMENT: ���� �- FL�2. (df1E/21A) G 6. ADDRESS OF ESTABLISHMENT: 33� � �I'�i11 p U(� Ft QU►A ( �(-pNn n-N 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: S—d 7' !n 90 9. EMAIL ADDRESS: PA J7YJ3 @, d eA tICLD o(Z, CCe►-• 10. SOLEOWNER: A-YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT M pre K wo 0 6 S TREASURER CLERK I 12. IF PREPARED BY OUTSIDE PARTY: I NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT AN A ,, DATE Q:\Application Forms\Haz Mat App Revised 09-10-18.d x • �1 Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332 IYANNOUGH ROAD (RT 28), 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 r _ Voengatoryof Bqrristable Services TFIE Richard V. Scali,Director . OF Tp� Public Health Division BARNSTABLE MMSTMARKABLE. eawsTe •ar .mrurt•wu ms Thomas Mcgean, Director i�=0 4� " PrE1 659. e`� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V,$ . 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,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: ��Ia S S , &L c a 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 3 3 - ZyoA ANn10;-) G F/ /0,19Z 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: j ,f : 2 it) 9. EMAIL ADDRESS: 77 yA-cd) 10. SOLEOWNER: )( YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME -- PRESIDENT _ 17)0ge- . 1000)� .f TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT TE ,Sad QAApplication Forms\HAZMAT APP 2017 REVISED.do" INE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • snRMASSBLE.9` 200 Main Street• Hyannis, MA 02601 039. �"reO MA'�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Zw4er ,,se- Date: f �� t•7 Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: MSDS: 61t, vim- ' -�°� License#: 1-7 � '�xQ• Tier 11 : )n Labeling: ©.K Spill Plan: M Ly erv- �14KV, Oil/Water Separator: �I�S Floor Drains: Aeov., Emergency Numbers: V Storage Areas/7anks: I � , .� j�,cl�-iatv5� doC�c2o•�ka2oo<s wo Cow}a,hwwn,�-7 Emergency/Containment Equipment: OW Waste Generator ID: Waste Product: C� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: r1A Other Waste Disposal Methods: e01 �of LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 1\o Windshield wash 1.�5`5e Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil 1— Disinfectants 3 Miscellaneous petroleum products: Road salts Z56 f b 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 k q Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: 00,.Z"A S ORDERS: oS k IM5p5 SW INFORMATION/RECOMMENDATIONS: �, t•� a Inspector: Facility Represent WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE .yam i p Name of Offender/Manager 0yL, t.,.�6 ;5 Address of Offender MV/MB Reg.# Village/State/Zip Business Name irq am//pm, on Ohg 201-7- Business Address t '� E n yf ..ra�AA�r./.1�s.�l "/"'x��� '�,,,n•.... ��a� ,,�.•- /�'Hv� J Signature o�/Enforcing Officer Village/State/Zip 0A, Vet i f� too i r Location of OffenseN r Enforcing Dept/Division Offense Cx i`ci•/oI-L s-4vt.k-) Facts I e,-e-<66 JA 14L ,P),?,cyt "2,5, .. 108 16 . ,,f 054 Vv( ��-/ fiAt, v- 5' w/is , This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name . 1%, .R.. ' am/pm, on " 20 Business Address 4 E x " Signature of,-Enforcing-Officer Village/State/Zip Location of Offense ,:;"' �` L p `'" 1t Enforcing Dept/Division Offense41 t Facts This will serve only as a warning. At this time nolegal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in ,. appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health i This is to Certify that _ IDEAL FLOOR COVERING 332 IYANNO UGH ROAD (RT 28), HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Tow1�, of Unstable Regulatoerices Richard V. Scali,Director �tKE °" 'o Public Health Division BARNS ABLE � XtN5:td5�151�VNLY�F3�i�Si P4YMT�4&F `• MA Thomas McKean,Director 639-Y0 1639. 200 Main Street, Hyannis,MA 02601 ' Office: 508-862-4644 / ^�v` Fax: 50&790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE to 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— i 10 Gallons: $ 50.00 ❑. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 4V'6' 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? V YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: /�/ ��G✓S.� �--C.c r 5. NAME OF ESTABLISHMENT: Ch C, 0U� 6. ADDRESS OF ESTABLISHMENT: 3 — A o d O y (Dfi I�-U 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 56T' 9%®"e;[S?9 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT MAiQ K 1J 0 0 D S TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS M A. EMAIL: SIGNATURE OF APPLICANTW)---�TE LA I b 7 Q:\Application Forms\HAZMAT APP 2017 REVISED. cx °pINET°� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS .. g! 200 Main Street• Hyannis, MA 02601 p 1639. , 'FOMp+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4e1( ►�/�evuk- - I Date: Location/Mailin Addres : 2rtvloy 'l4ri1 Contact Name/Phone: 1 So R,--7-7 -a2.p q Inventory Total Amount: -`' 3a G, MSDS: A , License#: I t1 1 Tier II : AIA Labeling: 0�< Spill Plan: C/7 Oil/WaterSeparator: ev Floor Drains: YeA)--7 0W�5 Emergency Numbers: Yes Storage Areas/Tanks: 1- <-.Y&5 OvJ 1v1. A\ �A (paa-c. ,s e-A r ZLAe, ,a Ak x a0 0l,skc S Emercienc&ontainmentE ui ment: Waste Generator ID: A Waste Product: 6 . v Date&Amount of Last Shipment/Frequency: 0-5 4L„, JD6LS t o v4c4A Licensed Waste Hauler&Destination: Other Waste Disposal Methods: OW t) 1vb,e_. 7 aV O�zA k'ti 40 ` 0 LIST OF TOXIC AND HAZARDOUS MATERIALS eco0 '5� Zo7 _�'3- ' ss�- ty NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 110 Windshield wash �10 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 16,* Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: C�J m �a S{21MaK -Q pubes J 04 v t �O O 1 �o,r A Lf\, "VL O Z-.V'e-g Inspector:, 1 , t� \i-e- -2_ Facility Representative: —� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS t, r °a IKE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. • 200 Main Street• Hyannis, MA 02601 i6'9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT QED MP't a n Business Name: Ao Zo L-,-c Date: 4 Q Location/Mailing Address: 332T .> 2 . Contact Name/Phone: 6o8- '-► 1 - 73-73 - �C c�►uu9�� Inventory Total Amount: ���I MSDS: Ow I1 - Q <- License#. 1-7 3 C4�-,s Tier II : 4Jn,k�5 . Labeling: qoo SSpill Plan e�zm g• Oil/Water Separator: A Floor Drains: o Emergency Numbers: `' Tf, Storage Areas/Tanks: N:i?o wWu5k-e. &<c o s L w4,5+e., 0u150 AT"OLS 3.e .9,t+,eCs ,011 , Emer enc /Containment Equipment et< 5wr--2, "i1 , ova 6, Waste Generator ID: A%1RQQMIL-3o3 Waste Product: ar H�� �ol s ,ngigc rep J Date&Amount of Last Shipment/Frequency: ar2-3 ta to z- fA 05. Licensed Waste Hauler&Destination: y-'r- Other Waste Disposal Methods: '3 ,urn., cK A10. k4, , W,<-,% lL -c-ApL ,54ork LIST OF TOXIC AND HAZARDOUS MATERIALS ry144--9 e s44 at 4AV-4) NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids —�� Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers J— Hydraulic fluid (including brake fluid) Windshield wash Motor oils 4 Was-Vc- ,/ Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants ✓ Miscellaneous petroleum products: -7- Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides �— Battery acid (electrolyte)/batteries t corf-s Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink �f 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" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: X10 55RS-bl, "t S i Ze- , Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS III Number Fee 173 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Auto Zone 332 Route 28, 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 s RECEIVE® Town of Barnstable JUN 15 2016 Regulatory Services Richard V. Scali,Director �STABM = BARNSTABLE r Public Health Division N s6;q. p�0 J, uuaA1iNn vseKus�N�v'rsnr aa":e e !"' CEO riot Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 � �(�� � Office: 508-862-4644j( Fax: 508-790-6304 ~ i 7t 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 Y A late charge of$10.00 will be assessed if payment is not received b Jul 1st. • g P � �Y ASSESSORS MAP AND RARCEL NO.. DATE FULL NAME OF APPLICANT:lEbDQ� wittlam-S NAME OF ESTABLISHMENT: aa&ae. 1o(J ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT)MAILINGYY�C Al /6 TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: eoit6zwe- eels SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL CORPORATION NAMEHOME D SS AND T�EPHONE#�F- e PRESIDENT Q� TREASURER CLERK IF PREPARED BY OUTSIDE PARTY:IW ` • S T F CANT Name: C5 Company Address Telephone#: Email: QAApplication Forms\HAZZAPP Revl6.docx Page 1 of 2 `oF�"E royti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BABMS .AS. q 200 Main Street• Hyannis, MA 02601 OI16 3 9. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A.r�o-go v .,-- Date: j -r ,� Location/Mailing Address: 332- !:—YA v�.h® 1e+X8 V tm ►�5 Contact Name/Phone: 1746..Q Spy- ?l- 3?3 ce -7751—Z68•739/ Invento Total Amount: D D MSDS: Cn<Jaf& .c- ,,��be 'k`' License#: ��3 Tier II : r\45 Labeling: �,\ \a ca,�`'�Jr Spill Plan: Oil/WaterSeparator: Floor Drains: V Emergency Numbers: Storage Areas/Tanks: V �-&-1 ww Ski v� 1 oLV A,. Emergency/Containment Equipment: l < A- O h1k4?i Sa 0.5 Waste Generator ID: rA Waste Product: yt, 0% Date&Amount of Last Shipment/Frequency: 8 14 I ! 00 c - rtio►�k�. Licensed Waste Hauler&Destination: Other Waste Disposal Methods: G W- 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. VAntifreeze Dry cleaning fluids %/ Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers 7— Hydraulic fluid (including brake fluid) �— Windshield wash Motor oils — V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil —� Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides �— Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink �— Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/EgcOMMENDATIONS: -0A 14S� � ` ITZavt -1(0 C0 C <' .n, a,A�. I 1 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 173 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Auto Zone 332 Route 28, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS'OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable RECEIVED Regulatory Services JUN 0,8 2015 • Richard V. Sc4 Director ELMINS ` 6 ` Public Health Division ;ATM ° Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 )ax 508-790-6304 Application Fee: $100.0.0 a, ASSESSORS MAP AND PARCEL NO. M 0 DATE I APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 1.11 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Rjj o-Zohe_ S�tlrc llsu�t�, cr NAME OF ESTABLISHMENT f�0A672o%,c-' too ADDRESS OF ESTABLISHMENT 33-2 T-*- -? V TELEPHONE NUMBER SD V - '7? r - '73 7-7 SOLE OVVNER:_X�YES 5� NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.U,L-/-q k 2 OK I.- STATE OF INCORPORATION Ti j FULL NAME AND HOME ADDRESS OF: PRESIDENT "St VAer\phi s l i s 3 L�Z TREASURER CLERK Gam-- SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS_ &010 1 3 S. �K vnd Tu HOME TELEPHONE# C:\cache\Temporary Intemet Files\0=31HAZAPP Rev2015.DOC FIKETor, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • ennM A'�eLE� 200 Main Street• Hyannis, MA 02601 e1639. 0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Av�o Date: 6 13I1 y Location/Mailing Address: 332� R�n,nc., 12} 2d a►nv`�5 Contact Name/Phone: -7 7y-2(bS-g391 Inventory Total Amount: ten' ICI MSDS: Coy 05�ke- License#: ��3 Tier II : nl o Labeling: Gmo Spill Plan: OK Oil/WaterSeparator: Nit Floor Drains: 0 0 Emergency Numbers: YvS Storage Areas/Tanks: 100 aa\ AS 1- V-VL5-ti 0, I, Emergency/Containment Equipment: `ItA Waste Generator ID: 0000I V3O Waste Product: wfA.5+e-- 01 Date&Amount of Last Shi ment/Fre uenc : 5 17 1� 4,1 -._. I X w4 0. Licensed Waste Hauler&Destination: 'e t)t- Ie e-vk-tCc a.,,;Ao,- l,T V-�I bOS YZ Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �)o 0. ©t r✓VA. 5 1V�,I1AV2v��vt S ihc2 �cYSt NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardoudmaterial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes —�- Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil 9 Refrigerants J Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine �— Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers JFloor&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: «W-WA ac,L Inspector: k • LoLof Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date:v/ //7/ /3 TOWN OF BARNSTABLEs .�o� TOXIC AND HAZARDOUS MATERIALS ��" "T "T' " FORM NAME OF BUSINESS: 74,40 �g.,e— BUSINESS LOCATION: $332 7%f,/,k v,v%ov h 2°r3 i �V In A 1 s INVENTORY MAILING ADDRESS: .Sayvc-� TOTAL AMOUNT- TELEPHONE NUMBER: -<v / 7573 44 CONTACT PERSON: r r eP EMERGENCY CONTACT TELEPHO E NUMBER: 77LI -268 - f3� I MSDS ON SITE? TYPE OF BUSINESS: ado o e e--I-e r A S F- INFORMATION / RECOMMENDATI NS: OSP?ed / eew uI!, wrCzyV °� �yn �'/�� � `fie=-lc.--^-/>�4" s -,�. � Fire District: -fee Zol�. 1 !'��0� '9 co-K 7e.. -r-'�.�.jea-� �Q.�J.N Il GGU\PC>0 '/\ i� l 9 Waste Transportation: Last shipment of hazardous waste: Y 3o p 3 Name of Hauler: 5Q ,��:, r`i-<1P�vtr Destination: �°r��s�}o Waste rod uct: 0, c be 4 s.I Licensed? a No I t�-nog g97— NOTE: Under the provision f h. 11 , Section 31,of the General Laws 6f MA azardous material use, storage and disposal of 111 gallons or more a month requires a license from t1r0 Public Health Division. 9 p 9 _� LIST OF TOXIC AND HAZARDOUS MATERIALS ►j L-a jw\je:hA�®Iyy Q� 4+ Store- The Board of Health and the Public Health Division have determined that the followffng products exhibit toxic or hazardous characteristics and must be registered regardless of volume.-ra*22I t ,+) e0rr-1A+a ct Obs rued / Maximum Observed /Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive eNEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes ✓ Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides 2/NEW C/USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil - ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) \/ Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Vf Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Town of Barnstable � o ,AMSTABIE Regulatory Services 16 9. A�O� Thomas F. Geiler,Director F `l 0 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 z f t DATE: - - VVI NUMBER OF PAGES TO FOLLOW: TO:ZFROM: �/�-� L�{l� � xv-fV PHONE: PHONE: (508)862-4644 FAX PHONE: _ FAX PHONE: (508)790-6304 cc: NUNN 4 ettor�3otrR�� e� .,., ib u w E la omme £t NOTES/COMMENTS: 62-1� -- Q:\Fax Form.doc SPILL CONTINGENCY PLAN Emergency Coordinator, Name: Address: Daytime Phone: Evening Phone: Fire Department: Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: Phone: Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. yo � ��' �, � 3 �� .. f k Fax Send Report JUL-07-201115:03 THU Fax Number : 15087906304 Name BARNST HEALTH Name/Number 919014958399 Page 2 Start Time JUL-07-2011 15:03 THU Elapsed Time 00'24" Mode STD ECM Results [O-K] Town of Barnstable Regulatory Services ' Thomas F.Ccilcr,;Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 DATE: tVH NUMBER OF PAGES TO FOLLOW: TO: FROM: PHONE: PHONE: (508)862-4644 FAX PHONE:„G`_ �3 r� FAX PHONE: (508)790-6304 cc: LJ NOTES/COMMENTS: z- Q\Fmc rorm.doc Number Fee g 1120 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332 IYANNO UGH R OAD (RT 28), 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 i N Town of Barnstable • �t *wr Regulatory Services ti Richard V. Scali,Director Public Health Division w BA MSTABLE 1639 10� .. aaeso"s° mos° ueCDwNs;'e axsve �fDNI1A�p Thomas McKean, Director 1639"2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES_ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: /�J�C�✓SS , NAME OF ESTABLISHMENT: �� L /- �U� C Oy e�2 N G ADDRESS OF ESTABLISHMENT: —;?3j-- -- MAV006hf 62b MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER: X YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT fI 29 C�JUU i�S TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: SIGNA OF APPLICANT Name: N1\ - — Company Address VV Telephone#: Email: QApplication FormsUTAZZAPP Rev16.docx Page 1 of 2 r 2. Town of Barnstable Office: 508-862-4644 . Fax: 508-790-6304 yRegulatory Services Department Public Health Division Thomas A.McKean,CHO 14 Ffl11 59. 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $125.00 (Check) on 6/14/2016 Permit number: 1120 `Check number: 7569 Check amount: $125.00 Name on check: Ideal Floor Covering of Hyannis .Business: IDEAL FLOOR COVERING .Address: 332 IYANNOUGH ROAD/RTE 28, Hyannis i i • I Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS . 1oo.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332 IYANNO UGH ROAD (RT 28), 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 rd (16 e:. l Town of Barnstable dF ' ti Regulatory Services • Richard V. Scan,Director t r ` HARMASSNEM1.13M ' Public Health Division Ecru` 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 W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Z7n 6.9 d4�2062 4)(1 eiL rn) G • ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER:,DYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION /77 I FULL NAME AND HOME ADDRESS OF: PRESIDENT AAle 1V00J)j TREASURER CLERK _ • SIGNATURE OF APPLI ANT RESTRICTIONS: HOME ADDRESS i HOME TELEPHONE# Mcache\Temporary Intemet HeAOLMU AZAPP Rev2015.DOC f . W x Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 • ; Public Health Division s* MASS, Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 6/24/2015 Permit number: 1120 jCheck number: 6909 Check amount: $100.00 Name on check: Ideal Floor Covering of Hyannis jBusiness: IDEAL FLOOR COVERING Address: 332 IYANNOUGH ROAD/RTE 28, Hyannis i • Fee Number �? 1179 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR 332 IYANNOUGH ROAD (RT 28), 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 112it"" -00-02 21 :18 1022 15087904187 >> P 1/2 Town of Barnstable • Regulatory Services Richard V. Scala,Director Public Health Division �c1 ° 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. 3 fi -072- DATE 611�5 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Cn krd(I A- r&r _('O 1,29,,n W 0 h1541 t UL NAME:OF ESTABLISHMENT FLn{rj�j-rV-)k _ a t A - • ADDRESS OF ESTABLISRMENT 3 Z 1111A/it K CJ f�J6 n�1s ma '6 Z(001 TELEPHONE NUMBER -nK ZV �S SOLE OWNER: YES Y NO IF APPLICANT IS A PARTNERSHIP,FULL NAME.AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO, STATE OF INCORPORATION FUT,L NAME AND DOME ADDRESS OF: PRESIDENT TREASURER CLERK • r URY OF APPLICANT RESTRICTIONS: DOME ADDRESS HOME TFLEPIIONE C:cachclTcmporary Internet Fi1cs10LKD3)I-IAZAPP RcQ015,00C 7 t SoD .14Z-7 - w � ► 7l if)jLy *1HE► Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • MASS. S�LE,D` 200 Main Street• Hyannis, MA 02601 0 + TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �w+{Y' �se- Q-e-4.o-- (,a.(, Date: G 1311`{ Location/Mailing Address: 4 332 RNV\o Ai�e ✓Iv)►S Contact Name/Phone: L,4✓<a- to v Inventory Total Amount: 'V R) MSDS: 7GS License#: Tier II : Labeling: D Spill Plan: Oil/Water Separator: len- Floor Drains: Emergency Numbers: Storage Areas/Tanks: a-SS r M1JINIQ��►„,(� WwSt- lal ltr� �ti,tQt.r�,iL1 Emergency/Containment Equipment: eQsk q.w IBA!5� 4\v 7 0�l/„���c✓ �cA<ta yr Waste Generator ID: Waste Product: Date&Amount of Last Shipment/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. I 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) %k D Windshield wash Motor oils Miscellaneous Corrosives 4— Gasoline,jet fuel, aviation gas Cesspool cleaners isele 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 < ` a coy4• 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 I Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, N )5 1 cil o I,���ti cl c_wa5� '1�, S hydrochloric acid, other acids) +o Ip.L Aiggn,,L a1% VIOLATIONS: ORDERS: RRkV,1L INFORMATION/R COMMENDA IONS: t<"VKI IS . 4 VA-(:e w+4, .k ,v15 0e, ,Qr-� ti I o I o 0% -94 hi w1 .J PL - t ,Aa C"-kac,r SA coy o«AQ- J Inspector: Q Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 6/ 17 03 TOWN OF BARNSTABLE��,,s, TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: �Yl�ec I BUSINESS LOCATION: SS:t INVENTORY MAILING ADDRESS: ►^w TOTAL AMOUNT- TELEPHONE NUMBER: .3-Ob- Y7,7- Ioo? &-7 4.11 CONTACT PERSON: V&Iz- -`� EMERGENCY CONTACT EPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 6.'_ ye S INFORMATION / RECOMMENDATIONS: keddy c&K6i6, 5 A'TJ` Fire District: ® � �dt °I'v O e k9aa 8t 7G s� � �. / Q fL viv ,eeb-r Waste Transportation: Las shipment of hazardolts waste: Name of Hauler: Destination: Waste Product: 01 w>4,14(- � hp_-4 Licensed? Yes No NOTE:1Ur eta provisions off? 1�;�ectlo 31 he General &At�fL�t/7hazCaLrd-IoLu'�tgat'�-er al use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents(eorteek+,cL+ Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initia s TOWN OF BARNSTABLE BAR_W Ordinance or Regulation 6 WARNING NOTICE Name of Off ender/Manager Rt ' �.. V1 e, lrr-, 't V. r Address of Offender MV/MB Reg.# Village/State/Zip 2 0 Business Name 's „¢�'��, yvt�- �. - , < I 'a + am./pm, on f r Business Address 3' -Z Vr-7r, Signature'_of Enforcin Officer Village/State/Zip 01) D 4 t Location of Offense F—yt4,_<or, Enforcing Dept/Division ..► t } f Offense 1' A. VNr,.4, i v. CC-t ay r_'?_ Facts s., '-�V� d�IrJV�- [ xc1�`a ��GUj� �.. <i � 1( -6 yw1u4 This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BpR_W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager I r ~' t r Address of Offender MV/MB Reg.# Village/State/Zip 1 r/ Business Name ` ,�<F r` F ' am/pm, on 1 F ; 20 t Business Addressf':--- Signature _of Enforcing Officer Village/State/Zip 1.1 Location of Offense i Enforcing Dept/Division Offense IV" Facts -7 3 , This will serve only as a warning. .At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332IYANNOUGHROAD, 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 1 I Town of Barnstable IME r � Regulatory Services Richard V. Scali, Director i MASS.BMWM # Public Health Division VV 039. Alep nna�° 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 /�/ L C NAME OF ESTABLISHMENT C®y •PR i-,y G ADDRESS OF ESTABLISHMENT 233 1- TELEPHONE NUMBER SOLE OWNER: ✓(YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION /)7)3s.S FULL NAME AND HOME ADDRESS OF: PRESIDENT / 7,q/ 1` 000j')S TREASURER CLERK IGNAid OF APPLICA T RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:1Application FormsUiAZAPP.DOC Number Fee 1179 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that ENTERPRISE RENT-A-CAR 332 IYANNO UGH ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable °pTHE T Regulatory Services v � Richard V. Scali, Director &UMSTAMASS. ` Public Health Division Alec►9. 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 1-11 GALLONS OF HAZARDOUS MATERIALS r _ FULL NAME OF APPLICANT r- NAME OF ESTABLISHMENT c kcw ADDRESS OF ESTABLISHMENT2 0 � aa6o� TELEPHONE NUMBER O� SOLE OWNER: YES NO j IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: .FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: �- PRESIDENT TREASURER CLERK IGNATURE APPLI ANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# J AHAZAPP.DOC i MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page J:VHAZAPP.DOC Number Fee 173 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Auto Zone 332 Route 28, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of BarnstableCk �pFTHE ropti Regulatory Services y Richard V. Scali, Director BARNS9 MASS* Public Health Division A'F1 39. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER 7? ( '73 7 3 SOLE OWNER: YES NO ;. Z € IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF-ALL =rA PARTNERS: �°��OC+C✓"'El o+� 12 3 S c vt-� �'.K e..t'- Ste: l [ '� Af el 'J7 D m IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION 4 is FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 12 3 5. Fcc,,-,c--�a-, NQ w tom HOME TELEPHONE# 1-0 S -7A,7 Q:\Application FormsT AZAPP.DOC 6y MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make deck 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 s><on 200 Main Street Hyannis, MA 02601. FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q:\Application Forms\HAZAPP.DOC Number Fee 1120 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that IDEAL FLOOR COVERING 332 IYANNOUGff 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. 2/18/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Barnstable �&d Regulatory Services Department Public Health Division BARNWABLY- MAQQ 200 Main Street, Hyannis MA 02601 1 12� 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT L Dj6 NAME OF ESTABLISHMENT —T 06,q L A:LOOle CO(/P2f/'U G ADDRESS OF ESTABLISHMENT �'��- -ZY�N/1/DU G H 1619,6 I-IMAUNIJ TELEPHONE NUMBER ✓�U - 5 Q——��' SOLE OWNER: X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.3.1 -00-G,5-6 0 STATE OF INCORPORATION INS-rA Chi dse7iS FULL NAME AND HOME ADDRESS OF: PRESIDENT ^9X,9 X� GJOODs TREASURER A'Y ;2 Z-1 o/)j CLERK , SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# J:\inspection handouts\Haz Mat Applitation2008.DOC L Number Fee 173 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 r Town of Barnstable Board of Health This is to Certify that Auto Zone 332 Rte. 28, 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 r 1, F 1 Own of .B;a stable Barnstable Regulatory Services Department Wd I : Pub ic Health' Division MAft on 200-Mainz Street,-Hyannis MA 02601 ! 2007. i Office: 508-862.4644 11 FAX: 508-790-6304 Thomas F.Geller,mrector Thomas A,McRean,CHO Application Fee: $100.00 ASSESSORS MAP AND:PARCEL NO. . DATE APpLi ATI®tV�O1t PERMIT O STORE ANVOR[TTIL E MORE THAN 111 GALLONS'Of HAZARDOUS MATERMLS FULL NAME OF APPLICANT 1�C� G n��� ,,� Q� e i NAME OF tS-TABLISHMENT ADDRESS OF ESTABLISHMENT j TELEPHONE NUMBER_ Sd K- 7 Z SOLE OWNER: ,YES _A_NO w �.. :......-_ . _. .._ IF APPLICANT IS A PARTNERSHIP,FULL NAME A.1vD ROME ADDRM OIL ALLY PARTNERS;: C> IF APPLICANT IS A CORPORATION: `FEDERAL IDENTIFICATION NO. 2 [ ' 74 I STATE OF INCORPORATION j�y FULL NAIVE AND HOME ADDRESS OF: PRESIDENT, TREASUREt CLERK 1 NATURT OR APPLICANT RESTRICTIONS: HOME kD DlRESS 1 e s ti T I � r HOME TELEPHONE q�i -�i .t -7 i I ]AimpeWon handoutMaz Mat Appliewion2008.DOC t Number Fee 173 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Auto Zone 332 Rte. 28, 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 zzs 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 Town of Barnstable �FTHE Tp�, Regulatory Services do Thomas F. Geiler, Director • a BARNSTA ■ s " MASS. " Public Health Division 1639. ptED NIP' A 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 ICU a -�ka� NAME OF ESTABLISHMENT RAO ZO C1(*,s I (o n ADDRESS OF ESTABLISHMENT Poufe .2Z TELEPHONE NUMBER S-O f- 7 71 ^ 7372 SOLE OWNER: YES )C NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: NO IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. f2a y� STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 12,3 S6 e�h �C(j r\f- tS`� • �Ctmphis jtj i HOME TELEPHONE# �(q S - 7,�t Haz.doc/wp/q Business Name AUTOZONE#5160 Address 332 Route 28, Hyannis, MA 02601 if you have a release or a threatened release of hazardous materials ahe Aquire emergency response;call 911;'If, you Have a release orthreatened release tlat is not anEmergencyas decnbed liegethen 911 can be,omitted ,go to,the a ro of �n l a .Notification re uirement betow�_ .,` , t. _ z - _ Person responsible for calling 911: STORE MANAGEMENT A hazardous materials Incident is a spill or release that can be absorbed,neutralized or otherwise controlled at the time of release;and can be controlled by the employees in the immediate work area or by maintenance personnel without exposure or health&safety hazards. A hazardous material Response requires a response effort by employees from outside the immediate release area,or by other designated responders(e.g.Fire Dept),to an occurrence that results,or is likely to result,in an uncontrolled release of a hazardous substance. t7 " §* ° ems � ex 3E Company-800-451-8346-Emergency Response Coordinator Alarm Central-800-313-9693 (Day) 24 hour Manned Store Monitor 800-313-9693 (Night) Barnstable Public Health Division: 508-862-4644 Barnstable Fire Dept: 508-362-3312 MA DEP 24hr Spill Hotline: 888-304-1133 Waste Hauler Safety-Kleen-800-545-3520 , - C) 1. Emergency Release Procedures a I PREVENTION o rr;; ALL PRODUCTS DELIVERED TO THE STORE WILL BE INSPECTED FOR LEAKS. THE STORE'S RETAIL CHEMICAL PRODUCTS AND USED OIL TANK WILL PERIODICALLY BE INSPECTED FOR LEAKS. DAILY USED OIL TANK INSPECTION WILL BE DOCUMENTED ON THE USED OIL TANK LOG. ALL USED OIL WILL BE INSPECTED BEFORE BEING POURED INTO THE TANK. ALL BATTERIES WILL BE INSPECTED FOR LEAKS BEFORE THEY ARE PLACED IN THE STORAGE AREA OR RETAIL RACK. MITIGATION ALL AUTOZONERS HAVE PARTICIPATED IN THE AUTOZONE EMERGENCY ACTION PLAN AND SAFETY TRAINING PROGRAM, WHICH INCLUDES TRAINING SPECIFIC TO HANDLING EMERGENCIES INCLUDING EVACUATION, FIRE ALARMS, FIRE EXTINGUISHERS, FIRST AID KITS, SPILL CLEAN UP AND SPILL RESPONSE EQUIPMENT. IN THE EVENT A SPILL OCCURS, AUTOZONE EMPLOYEES WILL PROTECT ENVIRONMENTAL SENSITIVE AREAS BY USING ABSORBENTS, RAGS OR PAPER TOWELS TO CONTAIN THE MOVEMENT OF THE RELEASE BY CREATING A BERM AROUND THE SPILL. EMPLOYEES WILL THEN PLACE ABSORBENT AROUND THE EDGES OF THE SPILL, WORKING INWARD UNTIL ENTIRE SPILL IS COVERED BY ABSORBENT. BATTERY ACID SPILLS WILL BE NEUTRALIZED USING SODA ASH. USING PROPER PPE, AUTOZONE EMPLOYEES WILL START AROUND THE EDGES OF THE SPILL AND WORK INWARD UNTIL THE ENTIRE SPILL IS COVERED WITH SODA ASH. AUTOZONE EMPLOYEES WILL CONTINUE THE PROCESS UNTIL ALL ACID IS NEUTRALIZED. Page 1 of 2 I ABATEMENT FIRE-MANAGEMENT WILL NOTIFY LOCAL FIRE DEPT THAT A FIRE HAS TAKEN PLACE AFTER THHEY HAVE EVACUATED THE STORE. IF SAFE, EMPLOYEES WILL ATTEMPT TO CONTROL FIRE USING FIRE EXTINGUISHERS LOCATED THROUGHOUT THE STORE. SMALL SPILLS-CHEMICALS WILL BE ABSORBED WITH CLAY ABSORBENT MATERIALS BY AUTOZONE EMPLOYEES USING THE PROPER PROTECTIVE AND SAFETY EQUIPMENT. 3E COMPANY WILL BE CONTACTED FOR CLEAN-UP AND DISPOSAL PROCEDURES. LARGE SPILLS- MANAGEMENT WILL NOTIFY LOCAL FIRE DEPT. TRAINED EMPLOYEES USING THE PROPER PROTECTIVE EQUIPMENT WILL ATTEMPT TO CONTAIN THE SPILL. 3E COMPANY WILL BE CALLED TO RESPOND AND ASSIST IN THE CLEAN-UP AND DISPOSAL OF SPILLED MATERIAL. ALL WASTE GENERATED FROM A RELEASE WILL BE PROPERLY DISPOSED OF BY THE EMERGENCY RESPONSE CONTRACTOR AND SENT TO A LICENSED DISPOSAL FACILITY. 1. Emergency Evacuation Procedures STORE MANAGEMENT WILL USE VERBAL COMMANDS TO COMMUNICATE TO ALL EMPLOYEES AND CUSTOMERS THAT THE STORE NEEDS TO BE EVACUATED AND WHERE TO GO IN THE EVENT OF AN EMERGENCY. ALL EXITS ARE MARKED ON THE EVACUATION MAP POSTED IN THE OFFICE. THE MAP WILL ALSO SHOW THE EMPLOYEE STAGING AREA IN THE EVENT THE STORE HAS TO BE EVACUATED. (SEE Emergencv Action Plan posted in the office) 2. Employee Training Program New AutoZone employees receive on their first day specific training related to all in house environmental operations including: Used Oil Recycling, Battery Handling, Spill Response and Clean-Up. In addition they are trained on the Emergency Action Plan and the California Environmental Policy. All employees are trained annually on: - Proper procedures for storing, handling and labeling hazardous waste -.Proper use of 3E Company services. - Proper procedures for maintaining records using 3E - Instructions in the Written Hazard Communications Program, including reviewing MSDS and safety procedures for materials. - Review of emergency action plans -Coordination of emergency action plans with local fire depts, paramedics, and clean up contractors. - Monthly inspection and maintenance of safety equipment(including fire extinguishers and eye wash stations) -Training on the proper use of fire extinguishers - Review of the Emergency Action Plan and store management's responsibilities in the event of an emergency Page 2 of 2 tiC E. htcw attic C, a 0 CAeS aGC- 1 o 0 0 �0 2 \ nC) o o O o 0 o o M Z s dA M Y / FE SCALE: DRAWING NAME: FPLN516O.dwg �Spt 41} TYPE: NON-PROTO LEIDNG HEIGHT: 12'-6° FIXTURE HEIGHT: 120° 'PIN TRANSFER DATE: 01/30/98 SEISMIC: NONE OPENING DATE 02 0 98 ' SHEET NUMBEfl: r Number Fee 1081 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Balise Nissan of Cape Cod 258 North Street, 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 withlthe 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 a Town of Barnstable �•�+E Regulatory Services Thomas F.Geiler,Director MAW Public 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. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISffiAENT p ,� ADDRESS OF ESTABLISHMENT � TJ IVl. r*e-e-1 / "y�� 0201 TELEPHONE NUMBER- 0�6 I�9-0✓�a� SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: ZE CD IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. d Z STATE OF INCORPORATION' FULL NAME AND HOME ADDRESS OF: PRESIDENT a 4r i &re ,ro - TREASURER 22 204 61v4 M CLERK f r- 4't e SIGNATURE OFfAPPLICANf RESTRICTIONS: HOME ADDRESSf, �` ' HOME TELEPHONE# x0f HaLdoc/wp/q ' TOWN OF BARNSTABLE BAR-W 11,518 Ordinance or Regulation © WARNING NOTICE Name of Offender/Manager I ' i �t Address of Offender MV/MB Reg.# Village/State/Zip Business Name am/pm, on 20 Business Address R4k M4 20) r Signature .of,,,Enforcing Officer Village/State/Zip �/ 'tY1�l t , ✓ ►`7 �� � t Location of Offense tt Enforcing Dept/Division Offense �" 1vCrd. n '� `► r�S4,f6k, f UyS iMA4e_�< sA � Sr,- Facts CA This will serve only As /a warning. At this/time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_w 531 Ordinance or Regulation WARNING NOTICE Name of Of fender/Manager Y "a F Address of Offender MV/MB Reg.# Village/State/Zip f � Business Name %-4 f`O t,. am/pm, on "' 20 1-.= Business Address w a, . �/ . >r � � { j.`J "✓�l' �, . � s .,.. Signature .ofEnforcing Officer Village/State/Zip `/ �t` tj + r ''! V Location of Offense Enforcing Dept/Division Offense I'VI `' , :� • f ` e_ y a t ! Facts t f C o.- � This will serve only as `a warning. At this/ no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. °rIKKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B, S48LE. ` 200 Main Street• Hyannis, MA 02601 ArFDMA�a`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: Z 1 Location/Mailing Address: 3 32- TyaN,nova U-, b Contact Name/Phone: Inventory Total Amount: ^'W 4 4 0 )0 MSDS: * eti k y kwA °" 7, S License#: Tier II : Labelina: e-t A.W1 nj Spill Plan: y� 5 Oil/WaterSeparator: Floor Drains: Q0 Emergency Numbers: ¢S Storage Areas/Tanks: r.( .ti a lo•ti 5 eJkra, Emergency/ContainmentE ui m n : - Waste Generator ID: A Waste Product: Date&Amount of Last Shipment/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. 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 A ��egreasers for engines&garages Pesticides: N 1 Caulk/Grout 5 (� Ae insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" 102 ��lnzgjV�51� "`g� 6„ors (including chloroform, formaldehyde, t7x5��i � hydrochloric acid, other acids) VIOLATIONS: 2.b I ov ORDERS: INFORMATION/RECOMMENDATIONS: a.`� @0 2G Inspector: vJ 'e, Facility Representativ . WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS I SHE►ow� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 a^ MARSB`E.� 200 Main Street• Hyannis, MA 02601 i63 q' �0 '°fFOMA�a TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: rOo-((20Lw-fir Date: Location/Mailing Address: 3S Z :f ^^ ar)AI Contact Name/Phone: - S`'l 7 v J a Inventory Total Amount: Wll <«� [atI Tier II : Z Labelina: it-Aall )64 Spill Plan: OK Oil/WaterSeparator: N Floor Drains: No ImergencyNumbers: Storage Areas/Tanks: 44Jvla �Asac ,w �5 0�l vvl, 6, �� 5 Emergency/Containment quipment: Waste Generator ID: N(A Waste Product: AJIA Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: A� LIST OF TOXIC AND HAZARDOUS MATERIALS �" r lot c1tia 5 1w IA:q -w �l'� Stv�c-� 1&6+ �Ia� 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. -a e-2©lLf 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/Groutl&G%,h,�`� insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: LCo�M Inspector:' nspecto `- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °Q IKEA Town of Barnstable Office:508-862-4644 °* Public Health Division Fax:508-7s0-6304 R"MAIL%. 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I oo4e, VZ-(- Date: �Z Location/Mailing Address: 3Z J- cavr►'1dev Hy4orif6 Contact Name/Phone: M A 710 —2 S-7 G,1 k InventoryTotal Amount: '�-�(7 CN j a�00') MSDS: �S License#: Tier II : V Labelina: `i °O Spill Plan: 17 Oil/WaterSeparator: Floor Drains: A)b Emergency Numbers: Storage Areas/Tanks: Oc�i ti s v\ of Sty YL g - eJ24x. Emergency/Containment Equipment: Waste Generator ID: Waste Product: 10V Date&Amount of Last Shi ent/Fre uenc : �� Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ,1 LIST OF TOXIC AND HAZARDOUS MATERIALS N o %/A-OL al t_\A6L� �- v�v'�w"��'�� 51yk tc5`f' NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, 04-5-�Ld0°'`- storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages ,,you( Pesticides: o4 va aulk/Groutf/td -Q-,,�,-eg So-59�� 41 insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries &,060lb Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: o avr er ©Q yt Inspector. te� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse_ 46�-- ❑Addressee so that we can return the card to you. B. Received by(Pri ame) C. Dat of livery ■ Attach tfiis card to the back of the mailpiece, Q b or on the front if space permits. D. Is delivery add different from item 1? Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I'T,�• JCo�f �ladib�i Island's T /��U / '{ /1 eoz[ ' 3. Service Type ,aWCeri fied Mail® ❑Priority Mail Express- � i ��n��� �/� ba lJ/ ❑Registered Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes ei [itii 7012 1010 0000 2847 820------------ 9' y ' PS Form 3811,July 2013 Domestic Return Receipt UNITED STATES,P6 AL 8900E First-Class Mail I 1y- ' ! Postage&Fees Paid Permit No.G-10 I '7• 5 I I • Sender: Please print your name, address, and ZIP+4®in this boxe' I 7L7 6f, abD �'Iai� St I Do?(, O / I �Q I I I .. ..... . . ... ... E Er . O nU rD 0 tF. I S c Postage $ fIJ `. Certified Fee $�, cp vi Postmark j O Retum.Receipt Fee a p (Endorsement Required) M Restricted Delivery Fee O (Endorsement Required) r=1 O Total Postage&Fees r-I Sent To rl Street,Apt N --PO Box No. a � h. ON State,ZIP+ (00/ Certified Mail Provides: n A mailing receipt a A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years -sue Important Reminders: . ® Certified Mail may ONLY be combined with First-Class Mail®orPriority Mail®. a Certified Mail is notavailable for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certifies Mail. For valuables,please considgr;lrisured or Registered Mail. a For an additional fee,a Peturn Receipt may be requested to provide proof of, delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for,postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save'this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Date: 1 0 / 4 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: COV6.16 BUSINESS LOCATION: 3�'1.�'vuv�vo„�Cn, 'Rr,C , �Iy�wn�s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 0 --I- `7-1 -7�0 a CONTACT PERSON: ae�L SVOOLN EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: �\001 Coy,&(,!4 ('dr,,k INFORMATION / RECO++MMENDATIONS: ���� e�`k, ��s1,�..r5 \ Fi a District: v, c 4k 4r kl, 0 kak-I-w,.ak a Sef4,"k, Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners r Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) ID Caulk/Grout/ 1vf,s 14 W �.s(, Swimming pool chlorine Battery acid (electrolyte)/Batteries G<ou+ Lye or caustic soda Rustproofers /3-J00 I b= Miscellaneous Combustible Car wash detergents 1000 w\ Leather dyes Car waxes and polishes '11910 Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials