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0409 IYANNOUGH ROAD - HAZMAT
/ C Town of Barnstable Inspectional Services BARNSTABLE �n,e rq • A LOR>WSTA&R S B EPublic Health Division 1639-2014 r 1 I R+MSTABL ' Thomas McKean Director �g ►� Fuss. r+. 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 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ -C TEGORY_2.PERI4IIT 111 -499 Gallons: $125.00 RVST- 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. � i-+02J4 1. ASSESSOR'S MAP AND PARCEL NO. 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 TORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 G LLONS)? YES NO. 4. FULL NAME OF APPLICANT: 9� �E 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 401 l 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 7 7- 9. EMAIL ADDRESS: S A a!-54R VA =p-: 411• C O"-A 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS AND TELEPHONE#OF: L CORPORATION NAME �°rp F 2 t PRESIDENT �-s A (A.,k 1 TREASURER AQ� AtNl Q i CLERK A2+ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: roe • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICA DATE ,.,t QA Application Forrns\Haz Mat Appli Dr an2019. ocx Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO CENTER ................................................................................................................................. 409 IYANNOUGH ROAD, HYANNIS, MA ........................................................................................................•............................................................... Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. .................................................................................................................................................................... Restrictions: ....................................................................................................••.............................................................. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI TAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------- ----- ------------------------------------------------------------------------------------------ ------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health f \p! . T Orn of Barnstable a I e`ctional S.erviecs- "THE BARNS,�,�7�n LE Pub Nr.M1�i M�Ui-141E/aJe�:e I .c H.ealth Division 's ia�r�er.�are• � .. t T;.y •as McKean,.Director ►�oNw� . •200 I' -Strd&,,.Hyd i iis,:NA 02G:01 Office: 508=8G2-4644• I fax: 508-790=G3'0�}' APPLICATION F ��` PERNUT TO'.STORE AND/OR UTILIZE ARD•OUS MA'TERrAX.S. IN ACCORDANCE:WITH TILE TOWN 0 •ARNSTABLE GENERAL OnI'NANCE,,CHAPT$R 108, HAZARDOUS MATERIALS,ALL BUS SI?S TI4AT HANDLE OR STORE RAZARDOUS MAT S.EkrA GREATER THAN HO'USEIIOLD QUANJ 1.Mg ARE`UQUMED TO OBTAIN AN ANNUAL.PERMIT(RUNS. MY 1st-DUNE 50%). AElbe TION FEES CATEGORY I. 26•— 110'Gallons: $ 50.00 ❑ C`ATEGO'RY 2.' I'll —499 Galloiis: $12'S'UU ❑' . CATEGORY- 3 500 or more Gallons: $1�50.00 *A•11te char a of'S-10.00' sessed if gaymentis riot received by July 1st. 1. ASSESSORI's MAP AND PARCEL . &I . IS'THIS A PERMIT RENEWAL? YES_NO. IF'YES,SKIP QUESTION 3. • 3. FOR ALL N1CW PERMIT APPLIC • IONS,INDICATE'WHETHER DUSM——HAS ZONING/BUMI)ING,APPRO'V'AL R•HA.ZARDOUS MATERIALS STORAGZUSE OF GREATER THAN HOUSEHOLD Tff— MS•(25 GALLONS.)? YES N0: 4.. FULL NA—OF APPLICANT: • &mLhi. L . C ' S. NAATE'OF ESTABLISHMENT: 6-.. ADDRESS OF ESTABLIS NT: -4 D� 7. MAMING ADDRESS (JY.DIFFERED FROM ABOVE: S. TELEPHONE NUMBER OF EST SENT: 9. EMAIL ADDRESS: (` 10.. SOLEO1MR: ' YES NO•IF ,NAME OF PARTNER: 11. FTJLLNAME,HOME ADD SS,.A T EPHONE#OF: Lt_C . NAME a� L L- P mQT (5. 1 �.La�•��- •I a a . 12, IF PREPARED-BY OUTSIDE PARI I ; NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SxGNATURk OF•APPLIC., ATE Q:Wpplieation Forms\Hdz Mot AppRoyis -!0 Is. o jl ' I I s.� Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI FAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------ --------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ' Vwofol B4rnsxable eg atory Semces Richard V. Scali,Director LTA Public Health Division BARNSBLE 1 Thomas McKean)Director ° ""� ` ' 5` 7 MASS. � 1639-2014 ec 9. `0 200 Main Street, Hyannis,MA 02601 575 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 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 )g V,S *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? VYES 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: 4,)q rc/-- 7. MAIMING ADDRESS (IF DIFFERENT FROM ABOVE: y� f 8. TELEPHONE NUMBER OF ESTABLISHM �J u y ENT: 1 1-1�— �J 9. EMAIL ADDRESS: /h -fi0 CR 11"'44,0 -e&h0,u�,d P•h+e-r—.C&T'l- 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: � TELEP .:#: • COMPANY ADDRESS EM SIGNATURE OF APPLIC T DATE Q:\Application Forms\I-IAZMAT APP 20 VISE .docx Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA5M. g• 200 Main Street• Hyannis, MA 02601 t639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'� Business Name: I^�0� -���-�- A-+- C� �1 Date: of I`�i Location/Mailing Address: 0j I &K ov �— avt✓t Is Contact Nam Phone: ¢.S a H^�4�c C v.�,r `, o�ao. vK r 5 0 �17 -0�77 Inventory Total Amount: ^� V0 t SDS: 107+ Ov',kkw- acc-0 License#: 6.4-4-3 . Tier II : I a Labeling: OTC Spill Plan: e51 Oil/Water Separator: t�J A Floor Drains: r)o Emergency Numbers: ` 6 _ Storage Areas/Tanks:I3 o A ZX Z.-ISneL->e&I A ITs I-K7-00 t Qg'�Q eo, A Yg ,reeee f,A�w 4 Emergency/Containment Equipment: Q��S k 5 &1& 06 qa+ U X 57 wt•,, Waste Generator ID: e- O I I Waste Product: Date&Amount of Last Shipment/Frequency: 9517 , ILI; ob a l n-L40014&J I x o, Licensed Waste Hauler&Destination: Glvt. L•�K „tw Other Waste Disposal Methods: ll LIST OF TOXIC AND HAZARDOUS MATERIALS N o a- Dl u� 11 W1 L` /l ►w t vlV�,1T0,�y s KGB Ia5 J' I►t5�io►1 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous aterial use, ' storage and disposal of 111 gallons or more requires a license from the Public Health Division. JAntifreeze fi 04.6kw- 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 -r wa5kt 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" C (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: W OLg ti Avg. t l i 7: e,t Cvw<. ccnt(�fzyL otit 2 � oPrV Inspector: Facility Representative: i WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I� E °F THE TOk4• Town of Barnstable - Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MASS. 200 Main Street• Hyannis, MA 02601 �p'FOMP'�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Jo-r1J CA I,zc-L AAo Date: #V-1<—S Location/Mailing Address: --J-)(-tv%AaueL fQJ. 9yarivirS Contact Name/Phone: WeLVA-a, ,_ owv�-.r`T�/�v 'Ro6n s J 508-778-0377 J_ Inventory Total Amount: �-' fto w� SDS: 1 e,S +1 ov1,kwi- k((66 License#: Tier II : Labelino: IiPz Y, a. Spill Plan: e-, Oil/WaterSeparator: Floor Drains: D Emergency Numbers: V61S Storage Areas/Tanks: 'JO :2X�'1�vaA,J e I,at�,'(s oc� �.I W.o, a s 1 w,o A s op,—,4�' Emer enc /Containment Equipment: a + -e, -< ,%-K�' Waste Generator ID: M ksee)f) I 28 I Waste Product: Date&Amount of Last Shi ment/Fre ue c : Z 2.0 a ,-1 Jar 2 �2R. 84 % Licensed Waste Hauler&Destination: �- Other Waste Disposal Methods: ,I LIST OF TOXIC AND HAZARDOUS MATERIALS p V% ol( C,Aga NOTE: Under the provisions of Ch. 111, Section 31, of the Uneral Laws o MA, hazardous materigl use, t V,,s�a ,art. storage and disposal of 111 gallons or more requires a license from the Public Health Division. JAntifreeze-V w,-j4— 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 1`151QI AS-C Motor oils v ws,6Ae, Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts / grease, lubricants, gear oil Refrigerants J Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals (Fixers) Rustproofers Photochemicals(Developer) 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: n(� ORDERS: w v�ah e- " CQIL��, s--j m.. er-K 5&ivSw ,ecQ; ato.ry - �`'�ja„ oc aw INFORMATION/RECOMMENDATIONS: c_�— Inspector: Facility Representative: WHI -HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI FAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------- ---------------------- ------------------------------------------------------------ -------------------------------------------------- ------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health a TRow1 of B nstable P eg atory ervices 1 'IH�E r Richard V. Scah,Director Public Health Division BARNSTLE 9PRN51.10tE•iErvEFYILLE•CONK•HTn.1:15 swiwSTAst.a. = Thomas McKean Director rus 1639 2 0 x� steac"RaE Mass r �+J 200 Main Street,Hyannis,MA 02601 f Office: 508-862-4644 D/ J 0?079 Fax: 508-7P0-6304 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 OB AIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ,� VS *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO.HaJQ,''�97q/44po 1 12 Of* 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 STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. W 4. FULL NAME OF APPLICANT: ak-r Y , l�l evl-,-"- VV , 5. NAME OF ESTABLISHMENT: ttd LAAA --01 A4&t , 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: !R, 5 a 11- ` T 9. EMAIL ADDRESS: J,n4 . w-orld-F e6h Q.¢ L vL` .0 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN ATE�I jJoe) Q: 1o, O1'I" �Applicarion Forms\HAZMAT APP 2017 RE Q' Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS $150.00 s �1 Town of Barnstable �- Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI FAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1. Town of Barnstable • �t KEE rti Regulatory Services Richard V. Scali, Director MASS.� � Public Health Division BARNST�_ L T� i639• a�0� &"wino°a Kms 'ru�COPws as ws QED MAC Thomas McKean, Director 1639-2014 200 Main MA Street, Hyannis, 02601 � Office: 508-862-464-4 � Fax: 508-790-63� 07 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: $150.001 " • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. 32- t DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: U9 EMAIL ADDRESS: `ye6"" C"W SOLE OWNER: Y YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK - IF PREPARED BY OUTSIDE PARTY: SIGN URE OF CANT Name: Company Address Telephone #: Email: fQ:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 r Town of Barnstable Office: 508-862-4644 ' Regulatory.Services Department Fax: 508-790-6304 • = Public;. � . Health Division MAS& Thomas A.McKean,CHO 'a �` 200 Main Street Hyannis,Y ,MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/14/2016 Permit number: 1168 i V Check number: 9508 Check amount: $150.00 Name on check: Kamberi Family, LLC ;Business: WORLD TECH AUTO- KAMBERI FAMILY LLC Owner: DEBRA HENNESEY TR Address: 409 IYANNOUGH ROAD/RTE 28, Hyannis I i ......... .........-..... .............. ..._.. ................. _.... _.......1 • °U IKEA Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • snR �`E.Mj,: 200 Main Street• Hyannis, MA 02601 f1639. ,, 11 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Wo! ¢L A,+o "ew4'-e-1 Date: - l7 f. Location/Mailing Address: ` a,n+�o� �- 12 ".vi, s _ Contact Name/Phone: es <k o -J -D3�� <- o,(,S -\)o dawn J Inventory Total Amount: ''" la, MSDS: License#: (1 b$ 3 Tier II : 0 o Labeling:4A�%q<t4IL- . Spill Plan: Ye.S Oil/WaterSeparator: N A Floor Drains: N� Emergency Numbers: �S Storage Areas/Tanks: 55 1'4,1 0+I - &%\A.- c.t�kcA -A+.I,, k cw -r X ob Wm)ti o,I f11" 1,1 -36 fi 2x,2'7S,,u,a Emergency/Containment6uipment: Waste Generator ID: o o l 8 ( Waste Product: o t KA ce- a Date&Amount of Last Shipment/Frequency: 2� Z I(0 6o~"4- Mos. Licensed Waste Hauler&Destination: I)Pgkewv- 0, 1 L,0►e J,n., y2,-V- Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS o v�A NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous malterial use, f - storage and disposal of 111 gallons or more requires a license from the Public Health Division. v Antifreeze Dry cleaning fluids V 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&garagesV ,�d4c Pesticides: Caulk/Grout °o �� 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/RECOMM DATIONS: - O,\& %jP `001 \V n.V.Vt Gow%- o -o a ntis k k,& S o C1n. k., S b ct�� 12.2-�� WAS �CJwL, Inspecto Facility Representative WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°F�►+E►o,,� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9g^Mper`E�, 200 Main Street• Hyannis, MA 02601 �PrFDMP�p,� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: V""l,� Date: Location/Mailing Address:: ' w vt i s Contact Name/Phone: bes KzV_-1_%c� o P,--7-? -b J-1-7 Invento Total Amount: ti t S a l SDS: +" "Y` License#: Tier II : N o I Labeling:4 A&k-el Spill Plan: �e g Oil/WaterSeparator: NIIN Floor Drains: N o Emergency Numbers: —� Storage AreaslTanks:aX2-p°wash e`I As-(-, oir.1w.o.gs`C� a �o � 33oa 2x2'tS�c,Jo.1 Rs'Cg � .) Emergency/Containment Equipment: ev-&-,--j6de 64A,.QSAcw 175 l WW :2 - t 64 Waste Generator ID: Waste roduct: 1 a►�� ��t%� Date&Amount of Last Shi ment/Fre uenc : �1 2-1 ►-7 225, I o. Licensed Waste Hauler&Destination: e e«.6% 1 Lswcol 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�`�a'SS S Dry cleaning fluids Automatic transmission fluid 1V Other cleaning solvents&spot removersg�Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid)3 Windshield wash9 Motor oils 10.t W i-4K 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 g�, ,,� Refrigerants 7- Degreasers for engines&garages Zk q Pesticides: Caulk/Grout insecticides, herbicides, rodenticides 3$ Battery acid (electrolyte)/batteries ZS V%° 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" 10 (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: RDERS: J a O11 ✓L INS %n S vra C'ooM,, —v°OC '� 1 S mµ. fS c►1 VVV��_ t^125 0 12.Vfy* c-V,51 S t s OvA o A&AAA- 9111 C.oN. A. s e�r�e. INFORMATION/RECOMMEN ATIO S: vat iv v , Dv M o4- Q 10o�}1.es S 01 L a4 a\\ ">c�o�n cmw�4 S ..o.-►— 1-�- b.j 4- o 6PA Inspector: J , c0rr,eck(p4 Ad0oo 132g )1acility Representative: w ks-K-S col o 16t(5P0sa1 W& 0,6,5+4-M,0,1. WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Q Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI FAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health T Apo Town of Barnstable Regulatory Services Richard V. Scali, Director r a MAS& a a Public Health Division ►un Thomas McKean,Director � 200 Main Street, Hyannis,MA 02601 (Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 32Ci ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS e FULL NAME OF APPLICANT eS O-k< NAME OF ESTABLISHMENT • � ADDRESS OF ESTABLISHMENT '1 j-V&KA&U-" Q3 TELEPHONE NUMB R 0 0' r4 r' 0- SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: I IF APPLICANT IS A room : FEDERAL IDENTIFICATION NO. 240- $tq649W STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: a 4 s • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\cache\TemporaryIntemetFiles\OLKD3UIAZAPPRev2Ol5.DOC AftTown of Barnstable Regulatory Services Richard V. Scali, Director MAABU9. Public Health Division A'f1639. Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous • Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2: - 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2015. A late charge of$10.00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us , which.is located under the E-Code section if you should have any questions or concerns. Q:\Iazmat\Haz Mat Permit Letter.DOC i arc ` Town of Barnstable Office: 508-862-4644 `1• Fax: 508-790-6304 Regulatory Services Department HARNTnt: Public Health Division �► Mom, , Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015 i a Check number: 8153 Check amount: $100.00 Name on check: World Tech Auto Center Business: World Tech Auto Center Owner: AIRVIEW LLC ,Address: 467 IYANNOUGH ROAD/RTE 28, Hyannis { I I IKErogti I Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAcL%% LE.�` 200 Main Street• Hyannis, MA 02601 i639 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO P'� Business Name: orgy her- . Yk4o Date: Location/Mailing Address. q o J. a v�+wv IQ 4 K 5 Contact Name/Phone: st� a<+ < a8- 7 S- -77 M r or,5 JodgVov Inventory Total Amount: "�a( MSDS: e-'S License#: M00 �ak Tier II : a Labelino: IK Spill Plan. e-5 Oil/WaterSeparator: Iv A Floor Drains: b Emergency Numbers: es Storage Areas/Tanks. aw1e-cecw 6,e,,,mwea c "O-Q &rs C,t- c. + every40 Emergency/Containment Equipment: &b �e, r V&,I ,b CLvL X ,--vle_ Waste Generator ID: J 'l'1 b Waste Product: 01 <a A-wlSceelee Date&Amount of Last Shipment/Frequency: 12 i -1 D 10 2 OAA A( Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS o vA"\01 Cingng v1 i►nV2w-�or� %ytt v lqg-�' i vtg ,s� ,,��� , NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, haza dous material use, eacc '►•o.1 storage and disposal of 111 gallons or more requires a license from the Public Health Division. SS ,�I AVOM. a �r!4 c lestw q6fd5v 1 110 Antifreeze SSWaO)k4" Dry cleaning fluids mq'l t-<��� � Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes --� Bug and tar removers —� Hydraulic fluid (including brake fluid) Windshield wash I i b0 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 S� Degreasers for engines garag����b�ay. Pesticides: Caulk/Grout ��g��.�. insecticides, herbicides, rodenticides D Battery acid (electrolyte)/batt ries 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/RECOMMENDATIONSIQ 44, }'o ",/ 00 4345 t%6e,55 04-Ae.©, 4,0 AA<4 j���<+L a 55�Jt g v� C2Pspr� vL, �Oti S �i-1' Inspe or: E W��.�t F�ak- V\o V Sr� Facility Representative: resentative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1168 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that WORLD TECH AUTO-KAMBERI FAMILYLLC 409 IYANNOUGH ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable w °F1He,�y, Regulatory Services ti Richard V. Scali, Director &UMSrBLEMASS. Public Health Division 039. ptED MA'S s Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 "`l Fax:. 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 2 60116 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS I�FULL NAME OF APPLICANT 'balb (Li/A-btv(, NAME OF ESTABLISHMENT 1` � i 1x ''.0�.✓�` ~' !Vq L dM ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: y YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A C -_ LL6 STATE OF I V FULL NAME AND HOME ADDRESS OF: /"^ ! PRESIDENT . ty _ _ y TREASURER CLERK SIGNATURE OF APPLICANT I RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Application FormsgiAZAPP.DOC r t .a 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 I I � Q\Application Forms\HAZAPP.DOC f� MA SOC Filing Number: 201484612950 Date: 5/16/2014 2:31:00 PM _ # The Commonwealth of Massachusetts Minimum Fee:$500.00 William Francis Galvin rj Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Yt Boston,MA 02108-1512 Telephone: (617) 727-9640 Federal Employer Identification Number: 208996820 (must be 9 digits) Annual Report Filing Year: 2014 1.a. Exact name of the limited liability company: KAMBERI FAMILY,LLC 1.b. The exact name of the limited liability company as amended, is: KAMBERI FAMILY,LLC 2a. Location of its principal office: No. and Street: 409 IYANOUGH ROAD City or Town: HYANNIS State:MA Zip: 02601 Country:USA 2b. Street address of the office in the Commonwealth at which the records will be maintained: No. and Street: 409 IYANOUGH ROAD City or Town: HYANNIS State:MA Zip: 02601 Country:USA 3. The general character of business,and if the limited liability company is organized to render professional service,the service to be rendered: AUTOMOTIVE SERVICE AND REPAIRS - MA STATE INSPECTION STATION 4. The latest date of dissolution, if specified: 5. Name and address of the Resident Agent: Name: BESART KAMBERI No. and Street: 409 IYANOUGH ROAD City or Town: HYANNIS State:MA Zip: 02601 Country:USA 6.The name and business address of each manager, if any: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER BESART KAMBERI 409 IYANOUGH ROAD HYANNIS,MA 02601 USA 7. The name and business address of the person(s) in addition to the manager(s), authorized to execute documents to be filed with the Corporations Division, and at least one person shall be named if there are no managers. Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY BESART KAMBERI 409 IYANOUGH ROAD i HYANNIS,MA 02601 USA 8. The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property: Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY BESART KAMBERI 409 IYANOUGH ROAD HYANNIS,MA 02601 USA 9.Additional matters: SIGNED UNDER THE PENALTIES OF PERJURY,this 16 Day of May,2014, BESART KAMBERI,Signature of Authorized Signatory. ©2001 -2014 Commonwealth of Massachusetts All Rights Reserved MA SOC Filing Number: 201484612950 Date: 5/16/2014 2:31:00 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that, upon examination of this document, duly submitted to me, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articles; and the filing fee having been paid, said articles are deemed to have been filed with me on: May 16, 2014 02:31 PM J WILLIAM FRANCIS GALVIN Secretary of the Commonwealth i oFt►�r� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 "MASS`E ' 200 Main Street• Hyannis, MA 02601 Fo►' 6 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o f o-[�- >���o C�v`+�r Date: I Z Location/Mailing Address: t) J- arihs� L ,1AVA? Contact Name/Phone: _&64r4 Sob --7?8-o3"7-7 o%J0LA6 / , Inventory Total Amount: %-I�( MSDS: 1es License#: 128(o Tier II : Iv o Labeling: a K Spill Plan: A-6 6-e- Oil/WaterSeparator: Floor Drains: Igo Emergency Numbers: y25 Storage Areas/Tanks: c0 33D 7,'15'*-r5 V45441 a IX-1S + So AIV i. 5,4"mI XCW--g,cG(� Emergency/Containment Equipment: .5 A�k< Waste Generator ID: Md o 17 0 7 Waste Product: o% ow c,Q<e..e;q--e_ Date&Amount of Last Shipment/Frequency: b / 7o0 4! wkifc o�) a rox a+tc{ m0. Licensed Waste Hauler&Destination: 'Oa +-e r•,, 0, / /NGo/w %� IQ► oDoS0002 5' Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS of NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardou material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 1 o Antifreeze Dry cleaning fluids 10 Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers to Hydraulic fluid (including brake fluid) 1 Windshield wash lobo 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 H o Battery acid (electrolyte)/batteries 4D 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: jl ",-e- Fo 4ti use ai,e. Co- JA0 IVl J`SC. CJkyI21 wasj 4vr} �rl22��-/QCJw1. G4-r6ZF-- % -I�a, �! -E�n4.�. laSt �.n5-0FL�iaul Inspector: L&1•Q- �e P FacilityRepresentative: 1 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date:12117 / 13 TOWN OF BARNSTABLE --- t,o,-- TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: /aarld 1&b- 4,J+6 BUSINESS LOCATION: 1/01 Rd PyAyin,S INVENTORY MAILING ADDRESS: .54VUA*— TOTAL AMOUNT: TELEPHONE NUMBER: -5-05- 7-78 -03-7-7 4 3-7 c,,1 CONTACT PERSON: Ae-64 -� �Caw�b�c EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: glAo Ye 5- o (T INFORMATIONS' yy/ RECOMMENDA IONS: I)Qea� o,I � ��'� looe i % -�S4e- Fire District: m\e&Z)V �olbv,,�-0 aoQb 0K-,4r W-5+=1-a w l2s -}•o p2 wm±)PLLk4,ls= o K fo A Kav All eoAti wc�,, + +.tvks e-,Lo 4a le,�C no4'- 4- v,.K-,) yl A,vL 05 4K4YALT ,( K, 1 4 V, 4G+ aw•,P1oYc"&,s 4CNa0 how *0 'cGwr-+LL�vK- Waste Tafrsp&A&fian: ,My, 877803-77 Last shipment of hazardous waste: Name of Hauler: kes-Ie-<� I Destination: k)esk-rA A/. GI KeOht Waste Product: 0a.St-o- oil J avt�,AfeGge-, Licensed?� No t�l 000 5- 2 5 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 An/tifreeze (for gasoline or coolant systems) Miscellaneous Corrosive Cd NEW 5�5'Q USED 5S Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) 10 Hydraulic fluid (including brake fluid) Refrigerants n Moto oils �( ��� Pesticides dal (insecticides, herbicides, rodenticides) C��NEW��� Ussp q�l A�f-<,�c�s �yQ�,,,�,sre,�r1�,�,, Photochemicals(Fixers) Gasoline, Set fuel,Aviation gas Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED I Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine 3� 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 Bug and tar removers t1 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 176 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Meineke Car Care Center 409 Iyannough Rd/Rt. 28, Hyannis,MA 02601 ' is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------.-----------------------------. e-h,\\ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 >JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable � Barnstable WE Regulatory Services Department o ;ericaC"i • Public Health Division sARNSrABLs. MPS& 200 Main Street, Hyannis MA 02601 ej f0��► m 2007 Cr Office: 508-862-4644 Thom .Geil�Director FAX: 508-790-6304 �, Thomas A.McKean,CHO GJ 3z' CI' t Application Fee: $100.00 W m vn 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 SAM 0,49 `k& OfEWMIC Zllel— NAME OF ESTABLISHMENT MPIAJEeP CAt t. ADDRESS OF ESTABLISHMENT 0G- 6AWYQ/ TELEPHONE NUMBER ���-rI'I I—SY 96 CID C-- r_ CJ [i SOLE OWNERA YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES c4 F ALLY PARTNERS: w IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.J-5 STATE OF INCORPORATION MA534CbL1fEM,!9 FULL NAME AND HOME ADD SS OF: PRESIDENT 0 W / O TREASURER Ch W 004-10 ho AA CLERK IGNATURE O T RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# - -.I/F1 Q:\Hazmat\Haz Mat App1i:ation2008.DOC EMERGENCY SERVIES PHONE-NUMBERS FIRE DEP '._ 50&775--2323 POLICE DEPARTMENT 508-775-1212 AMBULANCE SERVICE 509-775 2323 NATIONAL RESPONSE AGENCY 508424-8842 POISON CONTROL CO+i IM 8W-222-1222 ENVMONAERTEAL PHONE NUMBERS LOCAL DEP OFFICE 508-946-2850 CLEAN HARBORS - 617-849-1800 SAFETY KUHN 508-697-4648 SPELL CONTINGENCY PLAN 1) Evacuate the ire area,if necessary 2) Shut off all oxygen and.Propane valves,pumps,and electrical equipment :- as appropriate 3) Restrict or remove any potential ignition source from the area if the material is flammable 4) If not already covered,cover or dilce all existing sumps and stoirm drains 5) Codain the spill by use of absorbent socks/booms,then applyrate absorbent material or tonal absorbent socim%ooms . contact spill response f on reverse side,if necessary to assist in these activities 6) Remove all absorbed material or cow liquid and pa+cge in DOT approved con Used absorbed materials should be packaged separately from liquids 7) Label all containers with t1m type of waste and to start date of adcumutation - g) Notify the app!9 agencies 9) Once the spill has been controlled and dial collected and secured, inspect the areafor clews decomdaate all equipment used in the clean up 10)Replace all used materials and ensure all response eguipoxent is in good working cordition, 11)Manage and dispose of collected absorbents and liquid is accordance with Federal and State envRommental regulations 12)For m spill greater than 25 gallons,this plan shall be implemented and proper records of action shall be kept on-size 13) Spill.clean up equipment is looted in the or1 cage supply room 15)The following is a list of spill confainnnent equipment on site: A Spill response Idt capable of containing a so of at least 25 gallons included in this kit absorbent spill Pads,socks and/or booms B. Adequate amount of nitrnle gloves c_ Fiat aid kit D. Eye wash station E. Fireelttiiishers c l WhM to do whlen a s o �Q occur s i � - Suggestions for the use of- SPC Spill Kits Identify spilled product. If you are NOT familiar with the liquid and its chemical properties, vacate the.area and contact proper authorities, 1. Risk Assessment Evaluate the type of material spilled.and identify the source. i 2.Protective Clothing .t Wear the appropriate protective gear for the situation,if the source or the material:are not identifiable assume the worst. - 3. Containment 1 Contain the liquid and seal drains. l I ; 4. Stop the Source Close valves, rotate punctured drums and plug leaks where it is possible and safe to do so. f 'Mm ik 5. Begin Clean Up C Use SPC sorbents to absorb spilled liquids. 6.Contact Authorities Report the spill to the proper legal authorities in-your community.Be sure to fill out all necessary reports in'accordance with local laws. 1-1 1 7. Disposal of Used Material Alk Absorbent materials take on the characteristics of whatever they absorb.Be sure to dispose of =�abso.'oen's and spilled liquids in accordance with local la:vs. 8. Decontaminate 1 - - clean all tools and'reusable materials properly before reuse. 9. Restock Materiels -- 10. Review Contingency Plans and Procedures! E.AS=_�:rTE:THE SPC SPILL KIT IS A STOP-GAP MEASURE FOR MINOR SPILs_.G—EV4-UR it A SERIOUS SPILL OCCURS. -_T LOCAL AUTHORITIES FOR DIRECTION AND ASSISTANCE FOR THE PROBLEM. FLUIDS ABSORBED,SPC DOES NOT RECOMMEND DISPOSAL PROCE0 === 7" -- �� Number Fee 176 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Meineke Car Care Center 409 Iyanough Rd. Rt. 283, MA 02601 r Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAULJ. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health SNOWTREE CAR CARE CENTERS LLC 6705 Town of Barnstable 6/6/2007 FEE FOR PERMIT TO STORE HAZ MAT. 100.00 SCCC APPLICATION FEE 07-08 100.00 f Town of Barnstable oF , Regulatory Services Fd ON °,. Thomas F. Geiler,Director �SIOLE,MASS. Public Health Division .9 i639, ♦0 ' 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 SA10YVFf 0,4.0f 040e£ CEAM& hhC—, NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT A/A/v 6-4 # 0.XG 01 TELEPHONE NUMBER SOLE OWNER: YES NO o IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS 01 ALL A PARTNERS: C£? (Do s' ) -Y_7 J , N C�7 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.1 D -9af7 ' STATE OF INCORPORATION TPlfi 5=Ua FULL NAME AN a�O ADDRESS OF: r PRESIDENT J0 N ,+b0,V q u/i aP pL wd 1'**j YA O 1 pp/�� ,TREASURER C R kn G S• l -Mk O94� CLERK SIG A OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE r SPILL CONTINGENCY PLAN 1) Evacuate the immediate area, if necessary 2) Shut off all oxygen and propane waives,pumps,and electrical equipment as appropriate 3) Restrict or remove any potential ignition source from the area if the material is flammable 4) If not already covered, cover or(fice all existing sumps and storm drains 5) Contain the spill by use of absorbent socks/booms,then apply appropriate absorbent material or additional absorbent sock&%ooms . Contact spill response firms on reverse side, if necessary to assist in these activities 6) Remove all absorbed material or contained liquid and paclmge in DOT approved container_ Used absorbent materials should be packaged separately from liquids 7) Label all containers with the type of waste and the start date of accumulation 8) Notify the appropriate agencies 9) Once the spill has been controlled and material collected and secured, inspect the area for cleanliness and decontaminate all equipment used in the clean up 10)Replace all used materials and ensure all response equipment is in good working condition 11)Manage and,dispose of collected:absorbents and liquid in accordance with Federal and State environmental regulations 12)For any spill greater than 25 gallons, this plan shall be implemented and proper records of action shall be kept on site 13) Spill clean up equipment is located in the oil change supply room 15)The following is a list of spill containment equipment on site: A. Spill response kit capable of containing a spill of at least 25 gallons included in this kit absorbent spill pads, socks and/or booms B. Adequate amount of mtnle gloves C. First aid kit D. Eye wash station E. Fire exgnguishers SPILL CONTINGENCY PLAN EMERGENCY SERVIES PHONE NUMBERS FIRE DEPARTTNT 508-775-2323 POLICE DEPARTNi NT 508-775-1212 AMBULANCE SERVICE 508-775 2323 NATIONAL RESPONSE AGENCY 508-424-8802 POISON CONTROL CENTER 800 222-1222 ENVIRO PHONE NUMBERS LOCAL DEP OFFICE 508-9462850 CLEAN HARBORS - 617-849-1800 SAFETY KLEEN 508-6974648 Whcut(D JIM rs ft CCUrs Or Suggestions for the use of SPIC Spill Kits Identify spilled product. If you are NOT familiar with the liquid and its chemical Properties, vacate the area and contact proper authorities, 1.Risk Assessment } Evaluate the type of material spilled and identify the source. 2. Protective Clothing Wear the appropriate protective gear for the situation. If-the source or the material are not identifiable assume the worst. 3� 3. Containment r . Contain the liquid and seal drains. 4. Stop the Source Close valves; rotate punctured drums and plug leaks where it is Possible and safe to do so. 5. Begin Clean Up Use SPC sorbents to absorb spilled liquids. G. Contact Authorities Deport the spill to the proper legal authorities in your community.Be sure to fill out all necessary reports in accordance with local laws. t 7.Disposal of Used Material 1 ` Absorbent materials take on the characteristics of whatever they absorb.Be sure to dispose of L�scj absote!-As and spilled liquids in accordance with local lass. 8. Decontaminate 111.1 95,& Clean all tools and reusable materials properly before reuse. _ 9. Restock l�teiais f Review Contingency Plans and lures! a-=-5=N'0TE.THE SOC SPILL KIT IS A STOP-GAP MEASURE FOR MINOR SPi; CL{E P W A SERIOUS SPILL OCCURS, -CT LOCAL AUTHORITIES FOR DIRECTION AND ASSISTANCE FOR THE PROBLEM. S FLUIDS ABSORBED,SPC DOES NOT RECOMMEND DISPOSAL PROCE- ___ Y Number Fee 176 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Meineke Car Care Center,` 409Iyanough Rd. Rt. 28, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. June 27, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health SNOWTREE CAR CARE CENTERS LLC 4072 Town of Barnstable 6/23/2006 FEE FOR PERMIT TO STORE HAZ MAT 100.00 Citizens Bank-SCCC APPLICATION FEE 100.00 Town of Barnstable °FTME 1�� Regulatory Services Z7 °. Thomas F. Geiler,Director • r BARNSTA MASS. Public Health Division dy�y� 1Dt6n3S9s. ,fig' 1639. 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SAAQ"rLjjgEE CM 0�Q� NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT AklUls IYW od-4 TELEPHONE NUMBER S —S� Q, SOLE OWNER:_XYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL! PARTNERS: c� rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. '���o' L STATE OF INCORPORATION NISI-CAUSEIJ-�Vr FULL NAME AND HOME ADDRESS OF: j PRESIDENT TD A) wi4;tAr k14 On7t TREASURER W!wf-jp 1A CLERK G URE O T RESTRICTIONS: HOME ADDRESS HOME TELEP # Q:\Application Forms\HAZAPP.DOC 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 hah'aAe'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 thd.address listed above. Allow up to four days for in-house processing. t For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page IN Q Upplication Forms\HAZAPP.DOC Number. Fee V 176 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Meineke Car Care Center 409Iyannough RdIRt. 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 6/30/2010 unless sooner suspended or revoked. --------------------------------- - WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ' Town of Barnstable 4 Barnstable I �� kad Regulatory Services Department bcftzg • Public Health Division - EAPNs-raeLe, 9�A 161 9 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �AIO Y11gFt Okt l x LL° NAME OF ESTABLISHMENT P&AWF CAR CALF ('41E, ADDRESS OF ESTABLISHME NTb9 tBW 0 6O TELEPHONE NUMBER SOLE OWNER: X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: T PRESIDE N So /t) W/ LLAT1�ASU s. R C "' f � (/ v1G M CLTRK �x • M GN T RE OF AP L C 1 M N U_ R TRIC NS: HOME ADDRESS 31. HOME TELEPHONE# 550eF-32,F- /�� Q t N Q:\f•fazmat\1-laz Mat Application2008.DOC • SPELL CONTINGENCY PLAN 1) Evacuate the immediate area,if necessary 2) Shut off all oxygen and propane valves,ports,and electrical equipmerrt as arppropmate 3) Restrict or remove any potential ignition sour ce from the area if the material:is$amiable 4) Knot already covered,ever or dike all existing sumps and storm drains 5) Contain the spill by use of absorbent sockslbooms,then apply Vpropti%W_ absorbent material or addigon absorbent sttcksJbooms _ =Contact Spill response bans on reverse side,if necessary to assist m these activities b) Remove all absorbed macial or contained lipid and pa&age in DOT approved Used absorbent materials should be packaged separately front liquids 7) Label all s with the type of waste and the start date of ac3cumala 8) NOW- the apria a agencies 4) Once the spa has been ccmtEEvIled and meal collected and secured, • inspect the area for cleanliness and decorate all egtt used is the clean up 10)Replaice all used materials and ensure all response equipment is m good woddng c6hdftion 11)Manage and dispose of collected and liquid in accordance with Federal and State en ' moons 12)For any Will W=W than 25 gallons;this plan.shall be implemented and proper records of action shall be lit on-site 13) Spill:clean up equonent is located in the oil di ange supply room 15)The following is a list of spill contaunaertequipment on site: A_ Spill response kit capable of contanung a spill of at least 25 gallons included in this kit absorbent spillpads,socks aondlar bosoms B. Adequate amount of nitrnle gloves C_ First aid.kit D_ Eye wash station E_ brie extinmishers l 1 � � What to do LUhen . a O MOR occurs 1 1 I Suggestions for the use of SPC. Spill bits 0 � Identify spilled product. If you are N OT famlhar with the Ilgwd and its chemical 4 properties, vacate the_area and contact proper authorities, 1.Risk Assessment Evaluate the type of material spilled-and identify the source. fl �. 2. Protective Clothing Lj Wear the appropriate protective gear for the situation.If the source or the material are not identifiable assume the worst. t 3. Containment Contain the liquid and seal drains. 4 4.Stop the Source Close valves. rotate punctured drums and plug leaks where it is possible and safe to do so. 5. Begin Clean Up • t Use SPC sorbenis to absorb spilled liquids. sP q s- r, 6. Contact Authorities Report the spilt to the proper legal authorities In-your community.Be sure to fill out all necessary reports in accordance with local laws. 7. Disposal of Used Material. � Q Absorbent materials take on the characteristics of vrhatever they absorb.Be sure to dispose of;;sue abso$a^ts and spilled liquids in accordance with local fa..Fir s. { a 8.Decontaminate + ' f Clean all tools and reusable materials properly before reuse. t 9. Restock #''atenais _ I t 'J f p 10. Review Contingency Plans and Prc uresl , =.S=_�:OTE:THE SPC SPILL IOT 1S A STOP-GAP MEASURE FOR MINOR SPii G=='--UR iF A SERIOUS SPILL OCCURS, =CT LOCAL AUTHORITIES FOR DIRECTION AND ASSISTANCE FOR THE PROBLEM. • -= �-_ --_ _•O'_!S FLUIDS ABSORBED,SPC DOES NOT RECOMMEND DISPOSAL PROCEC ==� r zh.0 • SPILL CONTINGKNCY PLAN MAERGENCY SE RV ES PHONE-NUMBERS FIRE DEPARD&ENT 508-775-2323 POLICE DEPART OM 508-775-1212 AMBULANCE SERVICE 509-775 2323 NAnONALRESPONSEAC CY 50"24-8802 POISON CONTROL:CENTER 800-222-1222 ENVIR0104ENTAL PHONE NUMBERS LOCAL DEP OFFICE 508-94f-2850 CLEAN HARBORS 617-849 1800 SAFETYKI.E 508-697-4648 • f - L • 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 time 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 of$100. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow time for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Pag QAHazmat\Haz Mat Application200S.DOC LM STREET ADDRESS-OF.. PROPERTY BEING SURVEYED; j 409 Tvanough Road - Hvanni� Mass;;n .�.. , }� 'L)eCm I OWNER : Alrnort Motors Inc. PHONE: ADDRESS OCCUPANT: Airport Adto Body PHONE:771-4926 ADDRESS 409 Iyanough Road - Hyannis, Massachusetts PRESENT FLAMMABLE PERMITTED STORAGE AT PROPERTY; TANK PRODUCT LOCATION. AGE CONSTRUCTION SIZE (GAL) 10 gal _ _1st floor _19R7 Z cr-mlt=-celled la 4a1_--_ o;t z, n ,, F mm }l 1 a� _ �.�� h s nred when in auto repa;_r and body r fin hl *To en not n use. in a metn1 - cahinet or rghinPts vPntPri to r1,o n„tcide. TANKS REMOVED FROM THE PROPERTY; TANK PRODUCT- ," LOCATION CONSTRUCTION DATE S 1 ZE (GAL) a REMOVED 1000 gal —Gnsn1inP —ITnrlarornnnr� 2000 gal. Gasoline ►r rt rr 1000 gal " Gasolin tt I' .i. SPILLS l LEAKS AT THE PROPERTY; — DATE: MATER I AL APPROX. SIZE OF RELEASE Nona rare�rtprl Fire Prevention Office - .Hyannis Fire Department INFORMATION PROVIDED BY; R T. Fr;, — � Frie- 1.11ble,, 74�n- D •, ion Officer DATE ; 06/05/90 • i i i i s. .. 54€- 65.9 949 r Receipt for Certified Mail © No Insurance Coverage Provided UWEnsries Do not use for International Mail vo SERME (See Reverse) pMj S D 01 t r t an o. O P t e d ZIP Cod O O Pos ge CID CO- E ied Fee O u' Special Delivery Fee U) a IRestrKR, e,il,Y—r,7�F:e i , I,et rn f;Qceipt,S,owing III ,to Whom&.Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address In leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return M address of the article,date,detach and retain the receipt,and mail the article. r 3. If you want a return,receipt,write the certified mail number and your name and address on a 2 return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number., co 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, V) endorse RESTRICTED DELIVERY on the front of the article. E `o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item t of Form 3811. a 6. Save this receipt and present it if you make inquiry. 105e03-93-B-021@ i Town of Barnstable Department of Health, Safety, and Environmental Services MAW Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health November 29, 1996 David Johnson, General Manager Urban Retail Properties C. 4 Copley Place Suite 400 Boston, MA 02616-6501 Dear Mr. Johnson: RE: CAPETOWN PLAZA, RT. 132, HYANNIS According to Title 5, the State Environmental Code, Section 15.301(6), all septic systems with a design flow of 10,000 gallons per day or more shall be inspected before December 1, 1996 and at least once every three years thereafter. You may not have been aware of this requirement until now, therefore, please feel free to give me a call at 790-6265 if you should have any questions. In the meantime, please make the necessary arrangements to have the septic system(s) inspected. Attached is a listing of DEP certified septic system inspectors. Sincerely yours, Thomas A. McKean Director of Public Health r s LARGE TITLE 5 SYSTEM INVENTORY Data collection Sheet Town: Facility Name: �o N 0 Facility Address: �� d�� /2.7 / 'I ���� LAO_ Facility Contact Person: Phone Number: _ 0'D 2— Type of Facility: Campground Commercial Plaza-Retail f' (_D 1 6,0►� L y,, Condominium/Apartment Complex mu Correctional Facility Nursing Home/Rest Home u Mobile Home Park/Family 11�, ►� Mobile Home Park/Retirement !�( 5 Motel/Hotel/Boarding House o 0 Office Building/Medical t ,S Office Building/Professional `l L• II � . P Restaurant School/Elementary School/Secondary School/Boarding or College Other: �, q 2, 1 System Design Flow: 000 Approved Flow: G7 Y4,` V ) Date of System Installation: Board of Health/Contact Person: Board of Health/Phone Number: Plans/System Data on File at Board of Health: ���� LARGE TITLE EM INVENTORY ata collec ' eet c,s�5 r I rb1a U Town: Facility Name: Facility Address: Facility Contact Person: 1" Phone Number: Type of Facility: Campground Commercial Plaza-Retail Condominium/Apartment Complex Correctional Facility Nursing Home/Rest Home Mobile Home Park/Family Mobile Home Park/Retirement Motel/Hotel/Boarding House Office Building/Medical Office Building/Professional Restaurant School/Elementary School/Secondary School/Boarding or College Other: Design Flow: System g � Approved Flow: o 6 Date of System Installation: 6 Lg Board of Health/Contact Person: Board of Health/Phone Number: Plans/System Data on File at Board of Health: V SENDER: I also wish to receive the C •Complete items 1 and/or 2 for additional services. H ■Complete items 3,4a,and 4b. following services(for an 4) ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. v ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 4) permit. ,R . y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery to .0 ■The Return Receipt will show to whom the article was delivered and the date a c delivered. Consult postmaster for fee. o d 3.A le Addressed to: 4a.Article Number d • E a5 4b?Se ice Type «' 0 ��� ❑'Registered � Certified � (n � Exprlless Mail ❑ Insured o _ 0�Re)um Receipt for Merchandise ❑ COD a T4Date of Delivery ° YY4 it` 'o ZlZ A 5.Received By:( Tint Nam 8.Addressee's Address(Only if requested r W and fee is paid) t ¢ H g 6.Signatur Addressee or Agent) PS Form 3814, December 1994 Domestic Return Receipt 4.1 First-Class Mail. UNITED STATES POSTAL SERVICE Postage&Fees PBId USPS Permit No.0-10 • Print your name, address, and ZIP Code in this box • Vealth Departmei `.vwrr Ot Bamstable ��...BOx 534 -+vannic k'assacttu ,ttg 026M A