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0587 IYANNOUGH ROAD - HAZMAT
3 i��- a� �� oca� .- - -- _ - ,� \ i i 1 a-El co j °p I NE►oy, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. 9 MASS. $ 200 Main Street• Hyannis, MA 02601 �'"rEOMPy TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 9 a &b Date: ® Jt Location/Mailing Address: Contact Name/Phone: —�?, - m5 i Inventory Total Amount: MSDS: on License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers:—_ Storage Areas/Tanks: Emergency/Containment ui " t: v Waste Generator ID: �'S® Waste Product: Date&Amount of Last Shipment/Frequency: 16ho20 Q 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: INFORMATION/RECOMMENDATIONS: WUP Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1334 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Exit Auto 587Iyannough Road, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 26 - 110 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 �a i Town of Barnstable sae yyy Inspectional Services BARNSTABLE 0( ^ R —TABLE-CEMRMU-coma-t ANNA Public Health Division M?SOlSNLS•O 9-201•:lSBA4N54&E \� 163�(95_72014 Thomas McKean,Director ' �•gE 39. 200 Main Street, Hyannis,MA 02601 r.a Office: 508-862-4644 Fax: 508-790-6304 C> 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 ❑ *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. S 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: E X l T A v TO- rAI C 5. NAME OF ESTABLISHMENT: E XI T A UT7 6. ADDRESS OF ESTABLISHMENT: .5'$7 1 YA/J/t/OU CrH R 1) 011AIA111 Mot 0 260 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: I Al ro f- EXITAUTOSAL.ES,CON'I 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME EXl T /4 V To PRESIDENT F u 6-A R 6f vOR byAA1 TREASURER MA R A T M��A Y�1 ✓ CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 411.2 9 Q:Wpplication Forms\Haz Mat Appli Draft Jan2019. ocx Number Fee 1334 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Exit Auto 587lyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------------------------- --------------------------I----•---------------------------------------- -------------------------------------------- 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 G' Town of Barnstable -�t Inspectional Services BARNSTABLE IKE i o Public Health Division " P15 9 201T "` &tiNBTABLE. Thomas McKean, Director 9`l'ATE639. v 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508 790-6304 6: 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 t c1h64 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3 1! 10(15100 2. IS THIS A PERMIT RENEWAL? f�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: �.'k/ / Au f 0 /"C 5. NAME OF ESTABLISHMENT: F xi r g u T o 6. ADDRESS OF ESTABLISHMENT: S'9 7 j y/9.•rN yy (�/ I�/J ,ct�i9,.l�1ZS' jk p c'�Z6o � 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: — 8 a 7- 7 9S6 9. EMAIL ADDRESS: Y / T AvTOSAt5 F0 607A/Z. c�o41 10. SOLEOWNER: YES f/NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME EXIT WrO JAIC rg I Z'rA,-&f0v60fX 1)H yA-✓las S ZkA 0 X6 01 PRESIDENT E k) &A R 6-Ev012 6'>4^1 TREASURER njA t2 A T Nc�i✓A n/y.q•�/ CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 7//r11 I Q:\Application Forms\Haz Mat App Revised 09-10-18. cx I I - IKE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7 BARMASS. Oer. 200 Main Street• Hyannis, MA 02601 1639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MA'S Business Name: ),14 t> Date: 7 �b Location/Mailing Address: If Y&LK A 15 Contact Name/Phone: a A-+ o - (b - 62Zq 810- 1 a✓*`j'�c d Ce. Cel Inventory Total Amount. �' �a Q-� SDS: 60ky- - kc-"S'S License#: 133 Tier II : Labelina: o Spill Plan: 'T Oil/Water Separator: Floor Drains: /J o Emergency Numbers: Storage AreaslTanks: W"A-c « 01 WkA VC o t k 0,t� k <f A-\ Ca w\ of Emer en enc /Containmt ui ment: .III \,Gt W oowtiS 6 ,1' wage Waste Generator ID: Waste Product: 10 1 ail - rk.sc.lr 1���1s Date&Amount of Last Shi ment/Fre uenc : Flo 18 Licensed Waste Hauler&Destination: 0, I L.t vt. yt, Other Waste Disposal Methods: owvt < ,ti t c�,k�ow . k 0.v��. fe- 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 X 'wa5k4-- 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 VMotor oils X WA,okZ 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, 1111 \\ hydrochloric acid, other acids) VIOLATIONS:�t'��,wt��C ,\C�v1ht \5 evc,Q, o '5.D�1�\�v� .D6S{-erg. ORDERS: Z-yH'1 c.ew t 7 a-�,6. � q 1 .p Q� v S e..INF RMATION/RECOMMENDATIONS: ow wa�5t� Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKErok4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA MAS-'.LE.�` 200 Main Street• Hyannis, MA 02601 p 039.A�0 'FOMP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: FX,+ AA a Date: Z Location/Mailing Address: l- Nb1R -,K✓1 i Contact Name/Phone: v✓la vL. G. �v8- - ZZ S�$"S9 - �y 3 InventoryTotal Amount: �` 1 SDS: +o 51A°LJ 9,11616 S License#: ITN C,kk' 1 Tier II : 0 Labelina: pF* v\at� 1 hclow Spill Plan: C. &5+4k Oil/WaterSeparator: / Floor Drains: _IJv Emergency Numbers: Storage Areas/Tanks: I-_5'S y ov` n��Jvw Emergency/Containment Equipment: 3 A i i l �0 oowLS Waste Generator ID: 4,0 S," Waste Product: O% Date&Amount of Last Shipm nt/Freq_uency: 00 0% (J4vP'S y�- 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 I Dry cleaning fluids I Automatic transmission fluid I Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash L I Motor oils % *S S w askQ—4 45o 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 S+Z 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: ivk�k 12tv. , 05 Ct K-, Ivy. -hr ,,> o dL W SD G c c. �• o acc INF MATT /RECOM NDATION S o, ' r W 0%S o %C ', wA s-t-<-- OC V v\,\,j qw '- '�,yv(�i�-S�i9l OK.S,-�,¢.. Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS i Dater//3 / �i7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Ex,I T /9u'M BUSINESS LOCATION: .:5"37 1 Y.4d yoo erf Ay , 1���/1a�'�✓iS, fAA INVENTORY MAILING ADDRESS: ��/ Ve4r M4,4S'r(X1), c.L�T �'vl��r. M/,g TOTAL AMOUNT: TELEPHONE NUMBER: ,5 O � -3(0- 6 2,,Z 9 CONTACT PERSON: W4197" f�u�A.�/y!�'.►/ EMERGENCY CONTACT TELEPHONE NUMBER: �/$ - 51�9'- ��/�% MSDS ON SITE? TYPE OF BUSINESS: VE Nlue /PC 1P,4/g i S;qC,�-S INFORMATION / RECOMMENDATIONS: Fire District: 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 Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages - Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes TV r5E D acv --rfo w i g tpPf PEC.--p,c Laundry soil & stain removers (including bleach) '� IifS/l 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 II _ h IB*okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE, a S 200 Main Street• Hyannis, MA 02601 •0'EDMA�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: T-,rs4 6a55 b+®e 6t,-5 Date: Location/Mailing Address: S '7 .J rrio� 1., R 4MVt Contact Name/Phone: �olLv.• 014L a. D$- -73•-7- -73-Z Invento Total mount: �j�ti1 SDS: owIW-k- Gcee�i License#: 12a2 6k l Tier II : o Labeling: �va Ce Spill Plan: o%&e-wom 51�-f Oil/WaterSeparator: o Floor Drains: !�o Emergency Numbers: ©K Storage AreaslTanks: etc,,vw w k-.A e- 0.1 -tS )r 4 e\S Emergency/Containment Equipment: a w\. U'u. Waste Generator ID: A\J SDP5'l? I Waste Product: ©% < Date&Amount of Last Shipment/Frequency: %'Z 15I►6 SO 9, I Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 0105 • VI-k&cee- o Asa n ��c �C�1,k� nia R.Q LIST OF TOXIC AND HAZARDOUS MATERIALS N O V,,O- bI< � S ncP-\c..5 �- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws f MA, hazardous makerial 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,.a- WwS�.e. 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/RECOMMENDATIONS: N O 0441A, C.pA vLt,C D W v ova Cows, «i%v'- a.-AS kA Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1334 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that ExitAuto 5871yannough Road,Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Q 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 P�Q gj1eg+ to 4 f 3 y TROwrr of Barnstable eg atory ervices oFzK�E t Richard V. Scah,Director Public Health Division BARNSTABLE r : s.awaw�•�hcnue•cmun•nr..r.¢ ��- B"NSMBLF Thomas McKean, Director "��'�"0S i6:`21MASS. 4r-st oa mcrt 200 Main Street,Hyannis,MA 02601 5 k�, m; Office: 508-862-4644 Fax: 508-790-6304-r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 169, 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 ��S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. I 0� 001 2. IS THIS A PERMIT RENEWAL? YES LINO. IF YES, SHIP QUESTION 3. i 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF Q GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? t/YES NO. 4. FULL NAME OF APPLICANT: M A Rtl T H uAfliAl me 5. NAME OF ESTABLISHMENT: r)(1 T A U TO 6. ADDRESS OF ESTABLISHMENT: ' F 7 I Y11, 4110 6,�( 91) , l-r1fl•-vW1 S, 1XI 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S-G �, -3 G 4 G 9 9. EMAIL ADDRESS: lt/YA�G�/' Y17H00.c 0tA1 10. SOLEOWNER: YES V NO IF NO,NAME OF PARTNER: F 6 6-17 fi Gr 104 6 Y4,s,, 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME E)(17- 4U IO IAIC X •S27 IY4A1WCU61f/:4d, S'$-36,D-E229 PRESIDENT E►)6=A e 6,v o C 6�11141 TREASURER r ) 6,.1gR Gr Uo GY411 CLERK M A W A t d U,,VA 1-v141141 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: (� COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT %� DATEc% / y/ Q:\Application FormsWAZMAT APP 2017 REVISED.docx/. " v' YOU WISH TO OPEN A BUSINESS? MF r-Your.I�f rT,9tion;.,.Business certificates [cost$40,00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you ust�clCA, I�IA.r`lied,bUl not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall):and get the Business Certificate that is required by law. DATE: 00 /«, .�., ,.. Fill in lease: :��s1s1tw1 � - APPLICANT'S YOUR NAME S: 111 /� T H y�fl�//f).�/ d" BUSINESS YOUR HOME ADDRESS:t14 C 414 K PrI T6 e/>l 0f71C911 GGL-; PIq w' 6 iSi ,p TELEPHONE # 'Home Telephone Number -s-o Y -3 K o 6 22 y •:i ak'ue}�Eii�l�':iti O:.iJi��Ss�''. . NAME OF CORPORATION: F_ r1 T N)1-0 /A/C NAME OF NEW BUSINESS = X T UT-0 TYPE OF BUSINESS 1/L HI(-L S q Cif' IS THIS A HOME OCCUPATION? - YES NO ADDRESS OF BUSINESS.5'$1 t�y go, 11Y4MN'/f ,[1zA7 MAP/PARCEL NUMBER 3 J I Ot/S' 00/ [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town., 1. BUILDING CO ISSIO R'S OFFICE This individ al h s e inf rm. a y p rmi re uir in nt�s that pertain to this type of business. A t oriz i nature** d �.� r nrC� C MMEI�TS: � 'e .S h v 2. BOARD OF HEALTH V S�� !' L J This individual has been infor rmit requirements that pertain to this type of business. MUftUMPLY WTH ALL IdE�7- —, FrAnI DOU.S MATERIALS REGULATIONS Aut rized Sign ture** COMMENTS:l�J'�-GL.�r G�2fLl' G� /YLI;�J �Z;24� aU!222l L 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Number Fee 1334 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that ExitAuto 5871yannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 of B4rnstable Regulatory Semces Richard V. Scali,Director • Public Health Division BARNST'ABLE Thomas McKean,Director 639_70,, rti� 200 Main Street, Hyannis,MA 02601 ,,y Office: 508-862-4644 0^'l� Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE a �4 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 n CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 �t CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ [p eg b CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ L�t�0 G *A late charge of$10.00 will be assessed if payment is not received by July Ist. 1. ASSESSOR'S MAP AND PARCEL NO, 2. IS THIS A PERMIT RENEWAL? 7YES_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: CPC 1412 5. NAME OF ESTABLISHMENT: F-L (T A OTO 6. ADDRESS OF ESTABLISHMENT: S 0 4 J �A NN O C4 6 H 1 hj 4 A,- 1S 1j11(J 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: S0 Y 0 i� �6 8. TELEPHONE NUMBER OF ESTABLISHMENT: s D y yZ� 9 S 9. EMAIL ADDRESS: t Y ETA L(r O S A-L E @ 6/Y f tL . rV/y 10. SOLEOWNER: YES\/NO IF NO,NAME OF PARTNER: i 1A A 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME E X I T ALI TO PRESIDENT E o c-,q 2 TREASURER FI).c,4el GEv D/u�/� CLERK _L 0 c,d/t- G/''-o 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 0j E2 T(L C:\Users\Decollik\AppData\Locah\Microsoft\Windows\ 0 et Files\Content.0utlook\BMQD49H2UTAZMAT APP 2017 REVISED.docx Number Fee 1334 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that ExitAuto 5871yannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 (•r own, of Unstable Regulatoervices �IHIE Richard V. Scali, Director z.�e & Public Health Division BARNSTABLE a+awsr:mt•Fwruyue•cowff...js ,2- r BARNgrABLF. wraru�:s N�ws•osi:awue•w[sreagnsu¢:a Z, Mass Thomas McKean,Director 639-2014 e1 3.16 200 Main Street, Hyannis,MA 02601 �g Office: 508-862-4644 Fax: 508-790-6304-a APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER A, 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). L —��� APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 V-S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 El CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. .5 I I D�r`S C)® 2. IS THIS A PERMIT RENEWAL? YES IINO. 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)? i/YES NO. 4. FULL NAME OF APPLICANT: MARI1 ! HuNdAlV11-,/ 5. NAME OF ESTABLISHMENT: r YI T /9 UT 0 6. ADDRESS OF ESTABLISHMENT: S 9 7 I y111V1V'0&,q 91) , 1V V1VWW1 s-, Nfi9 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S'G � 3 6 C G 2� 7 9. EMAIL ADDRESS: AlM41&.R Pe Y,4f O0.60!;P7 10. SOLEOWNER: YES V NO IF NO,NAME OF PARTNER: F 6 6=17 R G,yIM 6 Y441 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIONNAME EXIT d(1T% I.✓C o .527 1Y*VW0u616e1), SGY-360-6))f PRESIDENT C 0 G--A k G i v oie F` w TREASURER C 1) 6AR G'f-UG�'c Cr Y4W CLERK AAWA7- H v^(A.y,,-/9`V 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMALL: SIGNATURE OF APPLICANT DATE OG/0 3l)-017 Q:\Application Forms\HAZMAT APP 2017 REVISEDA01/ YOU WISH TO OPEN A BUSINESS? F rt( o¢u r,EP)atioon��., Business certificates (cost$40,00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do :G.L. i cio�s not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: O��/� n Fill in please: AM as 1 L03 APPLICANT'S YOUR NAME/S: M 6 R 14 7- 14 uN/�!n 1%1`19 IV Im BUSINESS YOUR HOME ADDRESS: ti(, 641,1 K P,17 X/) Of7ggVil-11: /hA ' TELEPHONE # Home Telephone Number .S-O NAME OF CORPORATION: 12r/ T nL)i O IMC.: NAME OF NEW BUSINESS - T A U70 . TYPE OF BUSINESS UL k1 L L SA C f IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS S' 7 1 VV'N'U�' f� ,�J , �1% ^�'�f ,/k MAP/PARCEL NUMBER -3) J I OtlS 00l [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COrh2j R'S OFFICE 1,) This individinf rm a y p rmi re uir nts that pertain to this type of business. A t oriz i nature** C MMEI�ITS: �'--.c�� `��..5 �J O n1 "'" n� .S c - ( l o IS 2. BOARD OF HEALTH - .� M-, This individual has been infor f rmit requirements that pertain to this type of business. IfAUSiCCSNIPL WrTN ALL FfAnRDOUS MATERIALS REGULATIONS Al rized Sign ture* COMMENTS:yIue /a 12 L2 i2✓ fi2G1- �/ ,C �Lr�ll 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: t ,��rr Set-,yam �� s zg�•�,a•aF �.wK ���, � � �'' m l. • � i #, 0 Q' Certified Mail Fee Hr Er $ X '9 Extra Services&Fees(check box,add fee as approp2eten' ❑Return Receipt(hardcopy) $rq / C3 ❑Return Receipt(electronic) $ C Postmar 0 ❑Certfied Mail Restricted Delivery $ tA :Y N'O Here 3 O []Adult Signature Required $ ..? ❑Adult Signature Restricted Delivery$ O Postage mr� $ ��t Total Postage and Fei ATTN: MARAT HU NANYAN t.n Sent TO EXITAUTO a _ _____._______._._. 587 IYANNOUGH ROAD C3 Sfreet and Apt.No.,of HYANNIS MA 02601 Ciry,State,ZIP+4® Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label), for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this , delivery. USPS®-postmarked Certified Mail receipt to the •A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service' Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the `L •You may purchase Certified Mail service with signee to be at least 21 years of age(not n First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is not available for requires the signee to be at least 21 years of age international mail, and provides delivery to the addressee specified ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent' with Certified Mail service.However,the purchase (not available at retail). C of Certified Mail service does not change the a To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.ityou would like a postmark on •For an additional fee,and with.a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for F the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an_-appropriate postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, complete PS Form 3811,i)omesic Retum Receipt,attach PS Form 3811 to your mailpiece; IMPORTAIM.Save this receipt for your records. Ps Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 H�E rok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARM�`E, ' 200 Main Street• Hyannis, MA 02601 039. A�FDMP'�a`0� - TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ►"►�S+ C.1<45 ofo<64,rs Date: 41,114 14 Location/Mailing Address: 7 �,n•.� ���� Contact Name/Phone: Z—,9 k,ti. ©I a_—9a_ Inventory Total Amount: A— 3?) MSDS: nw�t•µ- a�ce�a License#: `rs- `J C'4" ( Tier ll : N Labelina: kb I&10- I vaa5'tc 61 Spill Plan: OK Oil/Water Sep arator: I Floor Drains: n Emergency Numbers: ©k',- Storage Areas/Tanks: I— T5"A0 �o-<, waSk�(- o,\ I bkUeVJ%64- I r,l C0441V4.rs Emergency/Containment Equipm nt: 5 mod' aVa, 1 aAo ©vv-5��Q, Waste Generator ID: &/V�vA7-7 11 L22 Waste Product: l9i Date&Amount of Last Shipment/Frequency: I ►now Licensed Waste Hauler&Destination: u QS t2� 2 9 a l / 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. 1 Antifreeze t Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid)y Windshield wash 31 Motor oils to Jr �SevJ 0.0"(-f+o S� Miscellaneous Corrosives Gasoline,jet fuel, aviaQion gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants 3 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 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, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: J a vw a et•�a S �J a o 0WKV-4,� Inspecto . aV2 Facility Representative, WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS S f Number Fee V 1202 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Gold Stone Motors, Inc. D A First Class Motor Cars 5871yannough Road, Hyannis, A Is Hereby Granted a License For: Storing or Handling 26 - 100 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 r A Town of Barnstable • �tMME ro Regulatory Services ti Richard V. Scah, Director ' BARNSTABLE ' IAS& Public Health Division 1639. ��� w�nx"r�ma°aus�uEmwg'ra�iv��e� '°yen►�''° Thomas McKean,Director 15���° 200 Main Street, Hyannis,MA 02601 i-+• Office: 508-862-4644 Fax: 508-790-630r t-+ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE-WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN — ANNUAL PERMIT(RUNS`JULY 1st`-JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 �'S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ N • 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: 2960 V. c�C� NAME OF ESTABLISHMENT: �i r S i C c.SS ADDRESS OF ESTABLISHMENT: � � nn0 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: ZZ- EMAIL ADDRESS: rS—6c"S's -Mr- cc-S -cow) o SOLE OWNER: YES' '---NO IF NO,NAME OF PARTNER: eorlo r6-0 9. w: FULL NAME,HOME ADDRESS,AND TELEPHONE# CORPORATION N "(6 n C A o 7D PRESIDENT /b ( GLA n 0 S-C �G•o2 5 3 TREASURER r(,' Inc> to °�-c 4 0 4- CLERK . IF PREPARED BY OUTSIDE PARTY: SI AT OF APPLICANT Name: Company Address Telephone#: Email: /QAAAp.p1ication Forms\HAZZAPP Revl6.docx Page 1 of 2 r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department aamirnaLL Public Health Division M Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: 50.00 h k n 1 (Check) o 6 3 2016 .Check number: 516 Check amount: $50.00 Name on check: Gold Stone Motors Inc. DBA First Class Motors .Business: First Class Motor Cars Owner: WAYNE L PADDOCK ;Address: 587 IYANNOUGH ROAD/RTE132, Hyannis . ..-- .... ---.-- _-- ___ .................._ - • ICI Number Fee 1202 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health �--- This is to Certify that Gold Stone Motors, Inc. DB First Class Motor Cars 587Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 02/11/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services ti Richard V. Scali, Director .A o, � MASSSB`E'$ Public Health Division BARNSTABLE M s039. �0 ro s°lisps*''EavuE�s° xsasE M AIEo �' Thomas McKean, Director 1639.2014 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 as IV CA 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 ❑ 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: O, J479C C-n G\,C,-- NAME OF ESTABLISHMENT: 6d A S-vn c ,-A om i 5 Fie, D Q ADDRESS OF ESTABLISHMENT: !E�S-4- -I- r►✓t vys MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: 5OAO�,oL "a c-'5 C k oT►rnt c • C U rn SOLE OWNER: YES LXO IF NO,NAME OF PARTNER: �eonw-cC o OV f f FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME 60I0� `'1-00 e MOVr5 2n c- • tk /V107z?r-C f PRESIDENT h V 14otc.,,Lc 3co - -,,.Ro I LjA "-k-54 1AA- OZt.44 c Serfs 437 7 Z 0 TREASURER rLw vrr; i ou Lv- ,i Z347 CLERK f IF PREPARED BY OUTSIDE PARTY: .IGNATURE OF APPLICANT Name: Company Address ` Telephone#: Email: / Q:\Application Forms\HAZZAPP Rev I6.docx Page I of 2 T Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 Public Health DivisionBA • Thomas A.McKean,CHO ba` 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $50.00 (Check) on 2/11/2016 CCheck number: 434 Check amount: $50.00 Name on check: Gold Stone Motors Inc. Business: Gold Stone Motors Inc. DBA First Class Motor Cars Owner: WAYNE L PADDOCK (Address: 587 IYANNOUGH ROAD/RTE132, Hyannis 1 i Note: Category I I ! I • s- SENDER: COMPLETE THIS SECTION- COMPLETETHIS,SECTION ON DELIVERY, ■ Complete items 1,2,and 3. A. Signat ■ Print your name and address on the reverse X 0 Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received b (Printed Name) C. Date of Delivery or on the front if space permits. i¢ 1; -- D. Is delivery address diffirentYrorn If YES,enter delivery address h �,140 ATTN: MARAT HUNANYAN EXITAUTO 587 IYANNOUGH ROAD HYANNIS, MA 02601 II I IIII IIII III III I III I I I I I(I I I I I I IIII(III' 3. Service Type 0 Priority Mail Express® ❑Adult Signature ❑Registered MaiIT"" ❑ dult Signature Restricted Delivery ❑Registered Mail Restricted Certified Mail® 9590 9402 3630 7305 4608 61 Certified Mail Restricted Delivery tmReceipt for ❑Collect on Delivery I.elluvery erchandise 2. ArtieleNumber_(Transfer_from servire.lahe0 El Collecton.Delivery Restricted Delivery ignature Confirmation m ' f 1 1' ''' 1 r t+ ' i ❑Signature Confirmation 7 015 17 3 0 0 0 01 4 9 9 0 6 6 2 3 lestfloted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt USPSA44D!� ; ,t, First-Class Mail Postage.&Fees PaidI 9 PermitNo.G-10 9590 9402 3630 7305 4608 61 United States •Sender.Please print your name,address,and ZIP+4®in this box* II Postal Service Town of Barnstable Health Division ° 200 Main Street Hyannis,MA 0260..1 I III,i,11.111:.ifHIII,I11I pill IiMIJI.III,I111.11il-11'1'I'll il'fII IKE rONA Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 �RMAS,R NSTABLE, ` 200 Main Street• Hyannis, MA 02601 prFOMA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: T�"r5+ L A 5 S Mo oI- Cr s Date: Location/Mailing Address: M 0i'm Contact Name/Phone: ok - 7 (9 Inventory Total Amount: c lit JaJ MSDS: 001"y License#: 1k Tier II 00 Labelino: �<- Spill Plan: Oil/WaterSeparator: Floor Drains: o Emergency Numbers: I I Storage Areasfranks: CA\ I 1 6 0< o �0.��1,'r o r„, Emergency/Containment Equipment: qgLA, W Waste Generator ID: I I 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.-w&6kf.loI&I 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/RECOMMENDATIONS: n aqAakk5 2 VwA. O t,, 10�- oOL 5e�kV�K0 6WCk� ",&--ld_l . Inspector Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS ✓ ow of hmstable �/31 ��., A 7*ovje_ #It1va1iV egul �atorvices n � �t Richard V. Scali, Director � �rPublic Health Division 0010.4 BLE "cxr+ murt.rrcnvr:isu•rrsr?c?xsrce:� co BAPN&rABIX = Thomas McKean, Director 4 AlfCMA�a 1639. 200 Main Street, Hyannis,MA 02601 ��GIGc21 ya9 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 Z �'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 NO. 2. IS THIS A PERMIT RENEWAL?ZYES_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. 4. FULL NAME OF APPLICANT: J P �n Gleam 5. NAME OF ESTABLISHMENT: 5_10nC/44OTUrS JDC3,4 Ji r S i c, cC 5-s r� 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 4 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Hr5T-c1c.ss ,M0Tbcc,,,T (Qho��. row 10. SOLEOWNER: YESk ,NO IF NO,NAME OF PARTNER: LeyneAro�-o (3urn 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME CvO S5 yn c /NO-ibrs T{,-c. PRESIDENTSvno P. 22Z2 ✓c tL,;_ t< + h DJse o _A,,J TREASURER 1,cv f3vn; 100 p;r.� Grown A-V Lb�u.,-.•►..ss , ALA 02r,a CLERK ,y/A- 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE - Q:\Application Forms\HAZMAT APP 2017 RE ISED. cx TOWN OF BARNSTABLE BAR _Wo�� Ordinance or Regulation WARNING NOTICE Name of Offender/Manager qA 0 Address of Offender MV/MB Reg. # Village/State/Zip . Business Name iLy_ 1`06 a /pm; on -7hz'4 20 M3 Business Addressn"`7 ��n ! Signature of,'Enforcing Officer Village/State/Zip q�IA o0 l s / Location of Offense X , Enforcing Dept/Division Offense Q 4.1- f <<lr,�dv5 MA „t- /'� fc� � t Facts 10 CA -h . Rov)-�k) r 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 OFFER GOLD- ENFORCING-DEPT. TOWN OF BARNSTABLE- 010 Ordinance or Regulation BAR -W WARNING NOTICE Name of Offender/Manager Address_of-Offender MV/MB Reg.# Village/State/Zip ,. / Business Name r am/pm;, on Business Address r Signature of�Enforcing Officer Village/State/Zip Location of Offense ' ' Enforcing Dept/Division L i ' ^ r Offense '4 t Facts 1t)r5 -V . 1i�'`t" z�.� �sr L4� 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 OFFER GOLD- ENFORCING DEPT.