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1165 IYANNOUGH ROAD - HAZMAT
I�aA h"Af, M4-p- 82-, FVIMn�K fkA-2,MA:r ty a s h r Town of Barnstable Regulatory Services VA A1 Thomas F. Geiler.Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 To: CUMBERLAND FARMS INC Date Tuesday,February 20,2007 777 DEDHAM ST V 1284 CANTON MA 02021 RE:Underground Storage Tank at: 11h�IYANNOUGH ROAD/ROUTE132 Map Parcel: 273082— Tank NO: OS Tag NO: 00857 Our records indicate that your underground fuel(or chemical)storage tank is over 20 years old,and has not been removed as required by section 326-3: subsection 2 of the Town of Barnstable Code regarding fuel and chemical storage systems. You are directed to remove this tank within sixty(60)days from the date of this notice. After your tank is removed, please furnish this office evidence in the form of a permit from your local Fire Department within ninety(90)days of the receipt of this notice. You may request a hearing provided a written petition requesting same is received by the Board of Health within ten(10) days after this order is served. Per Order of the Board of Health Thomas A.McKean,RS,CHO Health Agent p tNE T Town of Barnstable 9-7 Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMASS , . $ 200 Main Street• Hyannis, MA 02601 �p 1639. MA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 'S Business Name: C0 � l Date: OG16314 Location/Mailing Address: i Contact Name/Phone: Invento Total Amount: MSDS: R License#: 1131 Tier II : Labelina: e,! Spill Plan: i?il Oil/WaterSeparator: WA Floor Drains: Emergency Numbers: LA O Storage Areas/Tanks: 111000 r RIWOCOLS, Emer enc /Containment E ui ment: I y SOlv 0f-bmk Anom 11 ek. RA A Waste Generator ID: 'd Waste Product: tr/L4 Q, Qi I .10 Date&Amount of Last Shipment/Frequency, -04/27 11 ti t Licensed Waste Hauler&Destination: V V� Ski y, !� la� 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. V Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers rtrc fluid (including brake fluid) Windshield wash otor oils Miscellaneous Corrosives ! ¢'asoline,jet fuel, aviation gas Cesspool cleaners I iesel fuel, kerosene, #2 heating oil Disinfectants V Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: aulk/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 V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: W w rS S S 0 )CdW Inspector: r Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee Q , 1131 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS#2187 1171 Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,.CHO Director of Public Health Town of Barnstable ►w,ti Regulatory Services Richard V. Scali, Director *� MAM Public Health Division BARNSTABL • 16 9 0� euwsno�•oxrtaNue.mron•�rrnnrs 3 ♦ w,as-ma rus•os*eanuF.wslewxrusit RFD 11°� Thomas McKean, Director 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-63 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE w HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 04 5 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. 7 "Orly DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: - - Cumberland Farms Store#2187" - - ADDRESS OF ESTABLISHMENTa 1171 Iyannough Road Hyannis,MA MAILING ADDRESS(IF TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: L SQL G�An�/0'7lc-o rs s ® Goy SOLE OWNER: v YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT , TREASURER Sy— e CLERK • IF PREPARED BY OUTSIDE PARTY: SIGNAT O I T Name: Company Address ournier Telephone#: Tax Manager Email: Q:\Application Forms\HAZZAPP Rev 16.docx Page 1 of 2 Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department Public Health Division Thomas A.McKean,CHO A 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/14/2016 Permit number: 1131� Check number: 393380 Check amount: $400.00 Name on check: Cumberland Farms Business: CUMBERLAND FARMS #2187 Owner: MATTHEW L&AMANDA S Address: 1170 IYANNOUGH ROAD/RTE132, Hyannis i .. .......................... Consulting Engineering Remediation 95 State Road Sagamore Beach, MA 02562 (508)888-3900 Fax(508)888-6689 http://www.ensr.com November 17, 2003 TOWtil OF BLE Town Manager ``AWN i = € ` ' ICE ENSR Project# 2140-252 Barnstable Town Hall 367 Main Street '03 NOV 18 All :23 Hyannis, MA 02601 RE: Notice of Document Availability CFI Facility#2187 11651yanough Road Hyannis, MA 02601 Release Tracking Number 4-10850 To Whom It May Concern: Per the public notification requirements of the Massachusetts Contingency Plan (MCP), 310 CMR 40.0000, this letter is to inform you that ENSR Corporation, on behalf of Cumberland Farms, Inc. (CFI), submitted to the DEP a Revised As-Built Construction Report (As-Built), Phase IV Completion Statement, Final Inspection and Remedy Operation Status (ROS) Report Phase IV. This document is available for your review and copying at the DEP Southeast Regional Office, located at 20 Riverside Drive, in Lakeville, Massachusetts. If you have any questions, please contact Oliver Udemba of CFI at (781) 828-4900 extension 3415 or either of the undersigned. Sincerely, ENSR Ghd-U/IZ.Q- Derek T. Margarit Christopher G. Mariano, P.G., LSP Project Manager Senior Hydrogeologist cc O. Udemba; CFI DEP Southeast Region Office i INE�oq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 RARMASS. .g` 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED MA'S Business Name: COM 6 401f at Location/Mailing Address: P ICA n etan.,r Contact Name/Phone: Inventory Total Amount: _ MSDS: License#: J hI Tier II : NO Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: CAS M u oA Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 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 —V(Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts /Degreasers; grease, lubricants, gear oil Refrigerants for engines&garages _Pesticides: Caulk/Grout insecticides, herbicides, rodenticides — 1 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 thinnersMiscellaneous 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: V1I` Inspector: Facility Representative: 1 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1131 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS#2348 .-------------------------------------------------------------------------------------------------------------------------------- 1171 Iyannough Road, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services $ASTABLE Public Health Division. .M.`�' Ir'"." Numo ays•us'.avae�re �=►9-aou , Thomas McKean,Director _"g +• 200 Main Street,Hyannis,MA 02601 t Office: 508-862-4644 Fax: 508-790=6304 : APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE : r� HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st—JUNE 30th).. APPLICATION FEES CATEGORY.I PERMIT 26- 110 Gallons $ 50.00 CATEGORY 2 PERMIT 111 =499 Gallons $125.00rGh CATEGORY 3 PERMIT 500 or more Gallons: $150.00 (� *A late charee of$10.00 will be assessed if payment is not received by July 1st L . ASSESSOR'S MAP AND PARCEL NO. . a 73'O�d 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. ✓ AW 4. FULL NAME OF APPLICANT: t4 rin b&r Ian a, i 1 . 5. NAME OF ESTABLISHMENT: Cl.�rn 6>cr , - 6. :ADDRESS OF ESTABLISHMENT: // 7/ cc nn no u q 7. MAILING ADDRESS(IF]DIFFERENT FROM ABOVE: &_C G�Can�l c GSTbrt/'p 8. TELEPHONE NUMBER OF ESTABLISHMENT: 3 9., EMAIL ADDRESS: S wy G ism! 10. SOLEOWNER: ;/YES : NO IF NO,NAME OF PARTNERS 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.APPLICANT By:Matthew T.Durand : DATELD --�� • zed_Agent) QAApplica0w FmmsWaz Mat Appli Draft]sn2019.docx 1 Number Fee Number THE COMMONWEALTH OF MASSACHUSETTS Fee 25.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS #2187 1171 Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 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 r !7 Town of Barnstable o`t Inspectional Services BARNSTABLE , tunwsue=.ppe�,trL OD'U*•.rua;• yam. ( �' rSR.'ti�St•GKK'ut+:Sl W9fy+: '^.. Public Health Division &ARMABLE. ` Thomas McKean, Director lkr 'OrEc p` 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 iz 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 DVS- T" t-16GOLaq CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if-payment is not received by Juice 1. ASSESSOR'S MAP AND PARCEL NO. 75 - a 9 2. IS THIS A PERMIT RENEWAL? YES"NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF ® GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: CUMBERLAND FARMS#2187 -- -- 1171 IYANNOUGH ROAD HYANNIS, MA 02601 6. ADDRESS OF ESTABLISHMENT: *7. MA FLING ADDRESS (IF DIFFERENT FROM ABOVE:/Zg�,P.-s / , 8. TELEPHONE NUMBER OF ESTABLISHMENT: J7/�.S3Gd 9. EMAIL ADDRESS: LSalvucci@cumberlandfarms.com 10. SOLEOWNER: �YE$ NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,A TE EPH NjF,#OF: CORPORATION NAME 5 G PRESIDENT _ TREASURER CLERK ��' 12. IF PREPARED BY OUTSIDE PARTY: NAME: COMPANY ADDRESS MAIL: SIGNATURE OF APPLICAN DATE S /G/y Q\Application Forms\Haz Mat App Revised 09-10-18. cx Richard Fournier Tax Manager • i �� Cumerla F A R AA 5 Date of Incorporation: September 14, 1984 State of Incorporation: Delaware Principal Address: 1.65 Flanders Road, Westborough, MA 01581 Office Telephone: 508-270-1400 Federal ID No: 04-2843586 PRINCIPAL OFFICERS: Ari N. Haseotes President and CEO 165 Flanders Road Westborough, MA 01581 Howard S. Rosenstein Treasurer • 165 Flanders Road Westborough, MA 01581 Brian E. Glennon, II Secretary 165 Flanders Road Westborough, MA 01581 John T. Daly Assistant Treasurer 165 Flanders Road Westborough, MA 01581 Cumberland Farms, Inc. 165 Flanders Road, Westborough, MA 01581 508-270-1400 www.cumberlandfarms.com Number Fee 1131 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS #2187 1171 Iyannough Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. -----=------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r ` own of B nstable egulatory ervices Richard V. Scali, Director ® �pFSHE Tp _ Public Health Division BAB LE BARNSSMBLE. : Thomas McKean, DirectorMASS- warxs,usx�s s wt4 ' a63q. �0 9°°pren tiu,+" 200 Main Street, Hyannis, MA 02601 'y. y:. Office: 508-862-4644 Fax: 508-79'00--,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 LPERMIT 26— 110 Gallons: $ 50.00 i<J CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 'PGQ CAV— '4q 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. O? 7 3 '� 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ® ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ! l .lir�S , 5. NAME OF ESTABLISHMENT: ��mb��7�� ��/ rr 7 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:/ P 8. TELEPHONE NUMBER OF ESTABLISHMENT: 77l-s'34gd 9. EMAIL ADDRESS: 45,VAVacc &G&rr,1.r Goy 10. SOLEOWNER: 1/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 APPLICA C:\Users\Decotlik\.4ppData\Local\Microsoft\Window , emp ary I ernet r es Content.0utlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx Richard Fournier Tax Manager Number Fee 1131 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS #2187 1171 Iyannough Road, Hyannis, MA Is Hereby Granted .a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. CIO -- --------------------------------------------------------------------------------------------- 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 ap TRowr of BTstable eg atory ervlces Richard V. Scah, Director Public Health Division BARNSTABLE w + —ST—i,FR VII!C•CM11- —15 * BARNSTABLE, + Thomas McKean, Director un nra Ml 5-E 20-"isl lsrQe Oren A``� 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 aL9IF —10p Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO 21,73 -O�Q / 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: 5. NAME OF ESTABLISHMENT: Cmb�la�c! rarrlzs *t- 6. ADDRESS OF ESTABLISHMENT: Qal ft44 7. MAILING ADDRESS (IF DIFFERENT.FROM ABOVE: /G ,�„���5 (il/rsi"�bpr 8. TELEPHONE NUMBER OF ESTABLISHMENT: 17/-S3/<�c.) 9. EMAIL ADDRESS: 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 APPLICANT 0X4- ATE a Q\Application Forms\HAZMAT APP 2017 REVISED.docx r �IKE►o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B`"M SSSBLE'g 200 Main Street• Hyannis, MA 02601 Eo39. � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C.,w� �� r� r"arw�g S-j P`� --W2i R7 Date: $ /o /b Location/Mailing Address: -T I T av%.na V%n 19 Contact Name/Phone: 54-e-ve— Ai 1P , ?C>g --771-S 3&0 Inventory ento Total Amount: �� MSDS: e5 — License#: ( r3 t2 Tier II : A Labelin : e�a k a I-1 Spill Plan: YeS Oil/WaterSeparator: o Floor Drains: o Emergency Numbers: 'Yex Storage Areas/Tanks: �w" e, No"A-,or av (,,I,{., Emergency/Containment Equipment: «5 So ov`. Waste Generator ID: M Ae-'>D o 0-0 6 (o Waste Product: Cis "'ai�G� �^"x 5,P1 I s Date&Amount of Last Shipment/Frequency: Y ,(e 200 S 9& -t o Licensed Waste Hauler&Destination: r- r.11-a� -- sa\ �-s RO - 4". water r,.y o-,,k week-L y 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 �'r b Dry cleaning fluids �— Automatic transmission fluid '� t Other cleaning solvents&spot removers 1 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 40 Windshield wash 3,->-t Sts 3\ Motor oils I llo Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil I Disinfectants I 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 'L Miscellaneous Flammables Z Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons :5 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: e- -e— � . V\.C_t.J 5 Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p,HE roe Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAN LE. • 200 Main Street• Hyannis, MA 02601 039. "'EOMP�a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C�,�(G c.r(a,.ti 1�a rwt fmre 7 Date: 2- !b Location/Mailing Address: t t-7 1aHv�o n�I S Contact Name/Phone: S te.ve- A lo", SOS-'771-�3102� Inventory Tota mount: 1Q1 t OW'�J� AGsLicense MSDS: #: 1 13 1 Tier II : �l V Labelina: 2�ta 1 Spill Plan: oaf Oil/WaterSeparator: N O Floor Drains: 'O Emergency Numbers: Storage Areas/Tanks: e p- , a,Vk,\ab vt,614r,2 + i yes . f_0-4ev� Emergency/Containment Equipment: -5Kt 2-IOK q olvw V5`�5 a Wa Z s,, �OvLlw-I ctva � Waste Generator ID: Lab 0 I-I Waste Product: qetil Date&Amount of Last Shipment/Frequency: 0- I(�/ Licensed Waste Hauler&Destination: 1J?<1?1D Other Waste Disposal Methods: lO'P�(7 o2S owg o! C-t4AV,- 1) �v 1,es �ti}eta S 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. 2.q Antifreeze �2 t 2�0�` � °��? Dry cleaning fluids to Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 33 Windshield wash I�-� Q,-A Motor oils to,. -2 Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil �_ Disinfectants 1 Miscellaneous petroleum products: 5oI6 Road salts Sot b grease, lubricants, gear oil Refrigerants Degreasers for engines&garages t Pesticides: t 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 1 Paint&varnish removers, deglossers Leather dyes 3 Miscellaneous Flammables L Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers I-L (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMEN TIONS: k 0, 0ckdejr ,A does — 4 O 4 6�"s It,, i � I e�1 P U-SA-Lj-. 6AU44-W%6&= Inspector:4 - 14 (��/ �� Facility Representative: �11K^'� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1131 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS#2187 1171 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 w { Town of Barnstable Regulatory Services Thomas F.Geiler,Director . NAM ` Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. '7 21 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT' 7r TELEPHONE NUMBER_ 629 ' - '/J,� SOLE OWNER:_VY/ES NO 1F APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.=(9 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIG ATU PPLICANT RESTRICTIONS: HOME ADDRESS Cu Hand Farms I11C': r;",: . .)V HOME TELEPHONE# Cl-ossin I—SUTWMrd Framingham, MA 01702 °Ft rogti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RaRMASS. 200 Main Street• Hyannis, MA 02601 s,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MA'S Business Name: Date: �2 9 Location/Mailing Address: 1 % 7 1 1-5L) thi-qYlY115 Contact Name/Phone: 54,e.v,-e- --7-71 - 53160 Inventory Total Amount: I kQ 3b DO0 1t1-U3-(9 MSDS: 2 S License#: (13 k Tier II : N 0 Labeling: 'r6ftleg Spill Plan: A6 Oil/WaterSeparator: MIA Floor Drains: a Emergency Numbers: �2S Storage Areas/Tanks: 9,1 t0o0 `L-1 o aoo v - 0-1) l- Emergency/Containment Equipment: S 64 e�. e011� Waste Generator ID: MAJ.3 0000t Waste Product: ,301(va- 01 o b )9 Date&Amount of Last S 1?ment/Frequency: 1111-5114 6 141 Licensed Waste Hauler&Destination: / a- - & o avaP_ n Jay 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. �-V _ Antifreeze lb -t-12- Dry cleaning fluids �- Automatic transmission fluid Other cleaning solvents&spot removers t Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash 20 4-S �VA +33 H0 Motor oils ttt 22 Miscellaneous Corrosives 6 oo o Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants I Miscellaneous petroleum products: 5-o 16 Road salts so 16 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 2- Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons — Laundry soil &stain removers ►kv (including carbon tetrachloride) (including bleach) t Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: h5O 0(- �DYt.- oL Dv'//wwy Sr.>, -�ol 7" 1 L-Av�)14- �Dyl " Ada tQo�S wcC6k� l'�-/ t �Py ,5 y J Inspector: a v�t2 s a� �01) t1t.k�e 1-k6t'G o 1 -- S- 5k,do Faci//lity Representative: t� 0 6[, �'o &ooei 1"lS GQs�. WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE (-z,Date: I l 1�6 / I�tSQ�-f• TOXIC AND HAZARDOUS_MATERIALS REGISTRATION FORM NAME OF BUSINESS: CV14k 6,4 'rg-ev►15 ReJI V31/1 BUSINESS LOCATION: 132, INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: S OQj _-7-7 1 - /�.3 ko �ztv\s�. A- � CONTACT PERSON: �' k�y� A\ oV\-4\* , 140 l 5 �7 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ve-5 INFORMATION / REC MpENDATIO S: v Fire District: ,Ir��kk(. v'Nk1 WPOA C�tJWGw o�\ r0 v�nko� ��k l -- hr7�S 3 t ►4 — ea ll� loael� ;t)4V4 f —hpi, olti t hyevt�o -"oo * flcfn — o �,1 �N✓ -��YD�� cq,�o /IZ- Name Waste : �[A L000pl-ilo5 Last shipment of ""h����a""zardous waste: 5 �of Hauler: �M C. ����<�a�\ Destination: o=Try\�h cv\jlk'.e t,� Waste Product: w�t.5ot\r t, u)I Licensed Ye No Ay> 0`((:>ol °> -3 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 KNEW I ❑ USED Cesspool cleaners (O Automatic transmission fluid(p Disinfectants II Engine and radiator flushes Road salts (Halite) I qo I Hydraulic fluid (including brake flu' ► Refrigerants I`d�t',2 s (� Motor Oils !A0/" `� �p Pesticides NEW Q USED W�S�-� �`'I`�S ` (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 2. ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers I (including bleach) V2 i Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers I b Windshield wash ^—.!Lt,5`' Ll WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initial Number Fee 1131 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that CUMBERLAND FARMS#2348 1171 Iyannough Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 3/18/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f� Town of Barnstable �,►+E, Regulatory Services Thomas F.Geiler,Director MWffABM MAW Public Health Division �+ Thomas McKean,Director , 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 } ASSESSORS MAP AND PARCEL NO. �5-'3 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE? THAN 111 GALLONS OF HAZARDOUS MATERIALS R . FULL NAME OF APPLICANT NAME OF ESTABLISHMENTy,, 41=3 9 ADDRESS OF ESTABLISHMENT 12—ah'm /4, TELEPHONE NUMBER -6'0 e- 12111- .5136&) SOLE OWNER: ✓ YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.�i_.3YTT STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT _ TREASURERS a CLERK Richard Fournier Tax Manager S'GNAVVIRPQV APPLICANT Im RESTRICTIONS: A RESS TaA L'rZnartMWt HOME TELEPHONE 0 inn GFOS ing Q..,,sward Framingham, MA 01702 y°pTME lOk4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 �RMASS. . ` 200 Main Street• Hyannis, MA 02601 �A t679.p�0 rEO MP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: - Date: GlA 9 Location/Mailing Address: G 1ws 1 Run5h4if F4 165 00&4s � 1 r`C Contact Name/Phone: 5360 Inventory Total Amount. SDS: Oh�,�ne, Pa ✓ License#: � Tier II : Labeling: farm t Spill Plan: Oil/WaterSeparator: N 0 Floor Drains: n! 0 Emergency Numbers: J ,�.5 Storage Areas/Tanks: -k �� b JaSollnt, �u-1 vVUSite �rj)jm a-'�U�►�lC� Emergency/Containment Equipment: rGeneaste rator ID: /�/�/��- aD 0 Waste Product: �1�5 t+�GiCI Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: n P rD wa+&- Other Waste Disposal Methods: �d i 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 an 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 ngine and radiator flushes ug and tar removers Hydraulic fluid (including brake fluid) indshield wash (� otor oils q0 Miscellaneous Corrosives Gasoline,jet fuel, aviation gas esspool cleaners iesel fuel, kerosene, #2 heating oil Disinfectants y Miscellaneous petroleum products: Road salts "Degreasers grease, lubricants, gear oil Refrigerants 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: 04M, Inspector: Facility Representativ . WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ... -.�.r-H._..s—.— •-x..�. .�.in.-.-_. ..-Ni^ -�-r,.r}r•.Yw.! .-.-ue.+.h'v Y.n.!'4nN✓Y.'J w ..v- r •.f JY. t.... _ - _ _ TOWN OF BARNSTABLE BA,R_w Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager Address of Offender MV/MB Reg.# Village/State/Zip '� �f3 20 ►q Business Name t.,,r,v4'L��t-�'t�.,n<� 3" �� ,��� It7 ;am•/pm, on _ Business Address 11-7 1 �,n,n �, .;� I ,4 ��''' '` ` '•'�""� �- Signature of Efif6rcing Officer Village/State/Zip -4 rIvl ; r ...�.Location of Offense (�,�,,,���.�-,r r,V, A<'rY1 O''. p.1 i Enforcing Dept/Division Offense7fra'�irr �,r ��� t+fYl"�x.: )yf "r� C.: l&' ✓tr-� Facts iv,�T t._ �rtv1 i. , - i n d", a _tom i ')I-cif" This will serve only as/ a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNS TABLE B _W1',, Ordinance or Regulation WARNING NOTICE Name of Offender/Manager - Address of Offender MV/MB Reg.# Village/State/Zip Business Name 2� ,t am/pm, on -T �- 20_ Business AddressSignature of Enforcing Officer Village/State/Zip Location of Offense i t • ' ._ ` Enforcing Dept/Division Offense � t I Facts _ 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. 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"'-�";•[7p' , }t�i _�F' ,i �_ ..,�j..a::.•�..++,} �-. �! 1F`1 ,:, � !;,�. ... � , 'v .• j -fir�,,.�far,t' — � l�Y " - F c , r. , r s��z „� k .;._4 ��r R:�� • -� ���_�'�0� ��k��� l �" ,gM��AC^�' .__"AiI�O .n � airj 6JT0 PARTS s�ys..IfSr� �l�0 `fb I V1.��. 0%a•�r, \ � - ^ } ' per ...A. y �• NI ,� r��1 1 �+t�;""�t�'!1` r-, �1'1�f�� i r, lrl. p ,aryl JJ 4, APA HYMOS _SIIQ - ;'�71 ! Y ���'�p r• Ii Al ..�.. �.. r 1 _ . � r • ice+ � � f i- rl, � ' �t$ ! � -- � r>..�.��.Y..�„l;..�.r„-�= ". ..max•. , � s _ ^ .. ..... . ... r - . Nil Mill _ r 3 - c . .. S � _ >. �•�„4'�..�_ �_ _ --=§•"+ram %k""^.fie. y.T�-�LL � - ice_ -_C,<`- �Z` .. �L''�._�•' - ti•. _ I f; 7 ��� - y xb �> hAt yIr/ 6 14 lk— - f %$+f4 ;4�i ♦.' 'ri?!t $1/.»s -. ',.`�.�..'�v • �e>4H b� P4 ,r - �t s.r,. �"yt �,r r�i� �` „'�...,, f y. i rx.xywi _ 7 ''. } r , 1 �p. i ' ..: •yr: /lift - AL we - 1 7' x. r- :;- ^ r ^ F MrA' i - -_ .. It �rY-r� �.+i+ � ?j.� � f^"#"� '� _7 > •> n � ^�' � F k i r,r Z� ...+I.,�.,M" •:. ` #r.:r ,� r � s'``� T*r y ., r+� r •. Kik 1 , r.ro n4•�� I � x *k y t jr r ny l { 1.t. t ��n k tl it 7/ �� ������J �� ��� (��m ��_ ram " TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 273 PARCEL NO. 83 ADDRESS OF TANK: 117JDIyanouah Road VILLAGE: Rvannis Jai Numbmr Otr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 777 Dedham St.. Canton. Ma. 02023. OWNER NAME: Cumberland Fa=s. Inc. PHONE: 61.7-828-490n INSTALLATION DATE: 1981 BY: INSTALLER ADDRESS: 'CERT.1-40. *TANK LOCATION: Tank D is furthest from building . "` F^ (ommo z aG YANK, L-OQAT I ON WITH RQOPQCT,-•TO =U i LD I NO) CAPACITY 10,000 TYPE OF TANK Fiberglass AGE 8 YRS. FUEL/CHEMICAL dielkel TESTING CERTIFICATION [)C3- PASS [. ] FAIL DATE February 26. 1986 � o v� LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND Red Jackets 10 ZONE OF CONTRIBUTION [ 1 YES C�l NO DATE TO HE REMOVED FIRE DEPT. PERMIT ISSUED CR] YES C ] NO DATE February 26, 1987 � ti b CONSERVATION [ ] CHECK IF N/A DATE f HOARD OF HEALTH TAG N0. [ ] DAfln TE /�f.� PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD �'.� ` S o S�Or� �- B ��- [ 3 Z TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION f MAP NO. 273 PARCEL NO. 83 ADDRESS OF TANK: 11730Ivanowah Road VILLAGE: HYannis Nurnb�.:r Y t *- MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 777 Dedham St., Canton, Ma. 02021 OWNER NAME: Cumberlana' Farms. Inc. PHONE: 617-828-490,0 INSTALLATION DATE: 1981 BY: INSTALLER ADDRESS: 'CERT.�JO. *TANK LOCATION: Tank B is second closest to building (DROOR z nC TANK LOCATION WITH RCOPCCT TO =U 2 LD S NO) CAPACITY 10.000 TYPE OF TANK Fiberglass AGE 8 YRS. FUEL/CHEMICAL gax.roline TESTING CERTIFICATION C R] PASS C ] FAIL DATE February 26. 1986 LEAK DETECTION C0�: CHECK IF N/A TYPE/BRAND Iced Jacket G{ST� ev� ZONE OF CONTRIBUTION CY YES L` J, NO DATE TO BE REMOVED /Vrs Airve Ihir FIRE DEPT. PERMIT ISSUED C X] YES C ] NO DATE February 26, 1987 0- CONSERVATION C ;) CHECK IF N/A i DATE I . BOARD OF HEALTH TAG NO. [ � � ] DATE f ;Jll r A i PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS' CARD r 1 siO f no � 0 TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 273 PARCEL NO. 83 ADDRESS OF TANK: 11701yranough Rand VILLAGE: Hyannis 1; MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 777 Dedham Street, Canton, Yfa. 0202 i OWNER NAME: Cumberland Fams, Inc. PHONE: 617--828-4900 INSTALLATION DATE: 1981 BY: INSTALLER ADDRESS: 'CERT.1-40. *TANK LOCATION: Tank C is third closest to building agora:as TANK L-ooAT I oN WITH na=mwCT Yo HU 2 LD S NO) CAPACITY 10,000 TYPE OF TANK Fiberglass AGE 8 YRS. FUEL/CHEMICAL Rasolien TESTING CERTIFICATION C-U] PASS C ] FAIL DATE Gratus February 26, 1986 LEAK DETECTION C93 CHECK - IF N/A TYPE/BRAND Red Jacket LI ST P.�,�� ZONE OF CONTRIBUTION [A YES C ]° NO DATE TO BE REMOVED / r p FIRE DEPT. PERMIT ISSUED C X] YES C ] NO DATE February 26, 1987 CONSERVATION C&] CHECK IF N/A DATE , 1 BOARD OF HEALTH TAG NO. C ' : ] DATE Cj) ,/ C .- PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD S A g TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 273 PARCEL NO. 83 ADDRESS OF TANK: 0 j' rou �S 1gh Road �A VILLAGE: RYannio ;i Numbwr etr^wm! MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 777 Dedham St., Canton, Ma. 02021 OWNER NAME: Cu- berland Farms, inc. PHONE: 617-828-4900 INSTALLATION DATE: 1981 BY: INSTALLER ADDRESS: -CERT.1-40. *TANK LOCATION: Tank Bi is located. behind the store a (DGmOPt Zan TANK LOQAT Z ON W Z TH P�COPCQT TO oU Z LD I NO CAPACITY 550 TYPE OF TANK Fiberglass AGE 8 YRS. FUEL/CHEMICAL waste oil TESTING CERTIFICATION CX] PASS C ] FAIL DATE April 17, 1,986 b- LEAK DETECTION Cam] CHECK IF N/A TYPE/BRAND Red Jacket ZONE OF CONTRIBUTION C ] YES L ]� NO DATE TO BE REMOVED r �' FIRE DEPT. PERMIT ISSUED C X] YES C ] NO DATE February 26, 1987 CONSERVATION Cy] CHECK IF NN//A`� DATE t BOARD OF HEALTH TAG NO. [ / "J ]9 DATE 7 'A PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD � . _��S�� `-�J �� �� �' � � ��o�e A � � q � � �� _ Revised - per letter of 12/9/81 TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME R. C. Haufler (GULF) ADDRESS Rte. 132 & Bearse' s WaylILLAGE Hyannis LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL within the property Two 2- 700 gals. new fiberglass lines described above Four-10,000 gals new " (Give same information for any additional tanks on reverse side of card) During 1981 all other tanks removed DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS L .. - TOWN OF BARNSTABLE U'DERGROL�D FUEL AND CHEMICAL STORAGE SYSTEMS LB NAME -.. R C. HAUFLER ( ) ADDRESS Rte 132 & Bearse' s Way VILLAGE Hyannis LOCATION OF TA 7KS: NO OF CAPACITY: TYPE OF FUEL AGE: TYPE: TANKS OR CHEMICAL � . a within the 1 550 gals waste oil 1956 steel property .lines. �195 .desc- ied a�,,.�,02 3000 (ea) asoline 6 steel — 1 4000 gasoline 195 �� steel 1 4000 gasoline 1957e2steel 2 4000 " (ea) gasoline 196 f steel (Give same information for anv additional tanks on reverse side of card) \\ - DATE OF PURCHASE OF EACH: 1. 2. 3 4. �,__ DATE OF FIRE DEPARTMEN-T PER`fIT: Q �- TESTING CERTIFICATION SUB\,IITI-ED: �` /d G �°-Ifl Fl PASSED DID NOT PASS . pm/mp 71580 ,. NAMF LOCATION < . f HAUFLER, Robert C. Jct.Bearse's lay & ~Rte. 132 10 Tremont St. Hyannis Boston., Mass. 02108 ROOK R: PAGE - PATE: GRANTED A-MC)TENT STORED 77/0 January 23, 1956 77/61 January. 29, 1957 77/164 April 20, .1956 Total 24,000 gals. DATE' PA1 D 1973 - April 27 (Paid by Gulf Oil) 1974 MAR 301916 NpR ^ 1475 MAR 71977 C�coD;Li;D LP al uoy — NEW ENGLAND MARKETING DISTRICT J.J.Murray P. O. Box 4279 MANAGER,OPERATIONS E. Providence. RI 02914 December 9 , 1981 Board of Health South Street Hyannis , Mass. 02601 Attn: John Kelley Re: Gulf Service Station Rt 132 & Bearses Way ' Hyannis, Mass. Gentlemen: In order to update your records we are advising you that during 1981 the following steel. tanks have been removed from referenced station. 2 550 gallon tanks 2 3000 crallon tanks 4 4000 gallon tanks These were replaced with the following fiberglass tanks. 2 700 gallon tanks 4 10 ,000 gallon tanks Very truly yours , GULF OIL COMPANY - U.S . R. P. Boduch RPB/cm cc: A. R.Kennedy. R. W.Doolittle Gulf A DIVISION OF GULF OIL CORPORATION oFyNEto� TOWN OF BARNSTABLE ` OFFICE OF m, i BAfls9T`flL : i BOARD OF HEALTH 11 ooDM1�Yh�eO 367 MAIN STREET HYANNIS, MASS. 02601 December 2 , 1980 i Mr. - R: C. Haufler i. Rte.. 132 .&- Bearsel s Way- .Hyannis,Hyannis, •-Ma. Dear Sir: - on August 14, 1980, you.. were notified. to have your under- ground fuel storage tanks tested,using the Kent-Moore Pressure Test, by November 20, 1980. To date, we have not received the results of any testing performed. If this- testing is not done immediately, the Town Clerk' s -office will be notified by this office to withhold your registration for .storage of fuel underground. In addition,:'.you , are subject to a fine of twenty (20) dollars for ' each days failure to comply with a Board of Health order. Very truly-.--yours, John M. Kelly Director of Public Health JMK/mm THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA r•J!. , .. •` Data Curt for Tank System Tightness Tester 21103364) USING KENT-MOORE CORPORATION TANK TIGHTNESS TESTER MODEL 1000 t Copyright©Kent-Moore Corporation 1977 PLEASE PRINT f 1. OWNER Property ElRp f'�Cs✓� � , d �)�r� I !-�i�l/ (•�1'�.,; ' b ;C{� �1�/i / �jj� "�- 5 Name Adtlress _ Representative Telephone Tan ks) /. /_�C. (?f/ �. �_1 f?/,/• � f�/, / /,' Name Address Representativef Telephone j - F` .�I L �'/r' fJ j l''��! �'. �',)�'°r-7/;'r - ,y/f; /l �j.j!"-%'•i�'' .' %'��' -1.� �_ . 1 2. OPERATOR Name Address Telephone 3. REASON FOR TEST' (Explain Fully) 4. WHO REQUESTED (_? U c. r 0 / C :i TEST AND WHEN Name Title Company of Affiliation ate Address Telephone 5. WHO IS PAYING UC-! FOR THIS TEST? Company,Agency or Individual Person Authorizing Titler Telephone Billing Address - r - .Ciry State Zip Attention of: Order No. Other Instructions Identify by Direction Capacity Brand/Supplier Grade Approx.Age Steel/Fiberglass ' 6. TANK(S) INVOLVED ��000 �'�:' CvC Jc C �_ vi,l Location Cover Fills Vents Siphones Pumps i 7. INSTALLATION iiorl,r 49f i;( �. r ,,;� rr 1/i,, DATA C r> T 10 t North inside driveway, Concrete.Black Top. Size.Titefill make.Drop • Suction,Remote. Rear of station,etc. Earth,etc. -tubes.Remote Fills Size.Manito'ded Which tanks? Make if known 31 8. UNDERGROUND Is the water over the tank? ' WATER Depth to the Water table Yes ❑f—N6— i Tanks to be filled F%� hr. !`If Date Arranged by I2r )';}Te_ � 9. FILL-UP Name ot Telephone i ARRANGEMENTS Extra product to"top off'and run TSTT. How and who to provide? Consider NO Lead. Terminal or other contact for notice or inquiry . Company ! Name Telephone 10. CONTRACTOR. MECHANICS, i_/ J any other Contractor involved ! a 11. OTHER Ili [-;6 INFORMATION OR REMARKS j n C/!c ! ['% .i)!t/ Additional information on any items above.Officials or others tobe advised when testing is in progress or completed.Visitors or observers present during test etc. t Tests were made on the above tank systems in accordance with test procedures prescribed for Kent-Moore Tank Systems Tightness Tester Model 12. TEST RESULTS 1000 as detailed on attached test charts with results as follows: Tank Identification Tight Leakage Indicated Date Tested yl- c .it�?'c. 6 ) This is to certify that these tank systems were tested on the date(s)shown.Those indicated as"Tight"meet the criteria established by the Na(jonal 13. C RTIFI ATION Fire Protection Association Pamphlet 29. :/ ELRICK ELECTRIC, INC. 3 Date 1i MEEI.<ING HOUSE I.AI`L_ — To ting ConUactm ur or Company. By: Signote �RSNFIE;.n, MASS. o�o�b Sena,No.of Tester Technicians fJtl."uun J Address r G- /��r%4;yr i,'/'i ✓{fir{� /'��J t /. Name of Supplier,Owner or Dealer Address No.and Streets) - City State Date of Test 15. TANK TO TEST _ 16. CAPACITY `i j "4 From I Q 20 Station Chart ,-�? By most accurate 6 t n Tank Manufacturer's Chart Nominal Capacity capacity chart available % -� Identity by position Gallons ' Gallons O Company Engineering Data Is there doubt as to True Capacity? FJ 0 Charts supplied with TSTT Q C Brand and Grade See Section"DETERMINING TANK CAPACITY" Other 0 r , Stick readings C 3 17. FILL-UP FOR TEST to%in. Gallons Total in Tank Stick Water Bottom _ before Fill-up Inventory Q to'%in. Gallons Z Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP ' OR EACH METERED DELIVERY QUANTITY Product in full tank(up to fill pipe) Tank Diameter _ -- o 8 7 M, = 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK DSee manual sections applicable.Check below and record procedure in log(26). 4 0 D) X A (n Water in tank High water table in tank excavation Line(s)being tested Vapor recovery systems Stage I Stage II Oo O Ut Z 19. TANK MEASUREMENTS FOR 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK TSTT ASSEMBLY Inventory Top_'F Center_'F Bottom_'F On Truck 'F Expected Change A= ® Bottom of tank to Grade'....................... D 22. Thermal-Sensor reading after circulation .F 0 Assemble tubing+30-for 4"L............ digits Nearest O + 24'for 3-L.................• 23. Digits per 'F in range of expected change Z - digits Total tubing to assemble (Approximate)......... � 3 24. !,��i o X 0(?C�j = / gallons = 20 total quantity coefficient of expansion for volume change in this tank lull tank(17) for involved product per 'F Tank top to grade'............................. z 25. % 1f)�;L — D Extend hose on Test Elbow 6"or more / _ � � _ ����''! --% This is A volume change per'F(24) Digits per'F in test. Volume change per digit. test to below tank top................................ Range(25) Compute to 3 decimal places. factor(a) N W ' *If Fill pipe extends above grade,use top of fill 21 G S 7)-� Ti oo �'j.. 13Z 4 �d r yvl 26. (Y UC f L/LES 30. HYDROSTATIC 131. VOLUME MEASUREMENTS 34' TEMPERATURE COMPENSATION 38.NET VOLUME 39• ACCUMULATED LOG OF TEST PROCEDURES PRESSURE CHANGES n I — �'Z/ CONTROL IV) RECORD TO .001 GAL. USE FACTOR (a) ........ EACH READING CHANGE, 27 28. 29. Standpipe level 32. Product in 33' Product 35. 36. 37. Temperature At High Level record in Inches Change Computation Adjustment total and deflection Date Record details of setting up Read- Graduate Replaced(—) Thermal Higher+ (c) x (a)= Volume Minus Time and running test.(Use full Ing Beginning Level to Sensor lower— Expansion+ Expansion(+)or At low level compute (21 hr.) length of line if needed.) No. of which Before Alter Product Reading (c) Contraction— Contraction(—) change per hour Reading Restored Reading Reading 'Recovered(+) r Iv)—It) (NFPA criteria) Q 2-62 C�_ 70l eq q � ,�% "lPb1 .,tip � r �;='�'•; %O�) -- j I/a 7p7 sZ ^ire F3 S/ _3� .20 6') i �y LJ � C� � yZ 12, � �� V 26 30. HYDROSTATIC 31• VOLUME MEASUREMENTS 34• TEMPERATURE COMPENSATION 38 CHANGES NET ME 39' ACCUMULATED LOG OF TEST PROCEDURES PRESSURE (y) RECORD.TO .001 GAL. USE FACTOR (a) ..... CHANGE CONTROL �L EACH READING 28 29• Standpipe Level 32. 33. 35. 36. 37. Temperature At High Level record 27. In Inches Product in Product Change Computation Adjustment total and deflection Date Record details of setting up Read- Graduate Replaced(—) Thermal Higher+ (c) ■ (a)= Volume Minus Tirtle and running test.(Use full Ing Beginning Level to Sensor Lower— Expansion+ Expansion(+)or At low level compute (24 r) length of line if needed.) No• el which Belore Alter Product Reading (c) Contraction— Contraction(—) change per hour / Reading Restored Reading Reading Recovered(+) (v)—(t) (NFPA criteria) ro 0;L' 1�/���,ov ;�.��,: j, V �— y�='�, u�., � 1 10 To ��2 s�1;ti I '(: �r?i,t�. 2.v.i�-�. (�1'�v %�� �r� • �i C� '7.'7 r ,�� �/ _� ti - (( y a�- _ IX _ ram' S r r T•(c S'L '��'`. (' �.�� �. city State Date ol'Test — 1 1 Address No.and Sueet(s) Name of Supplier,Owner or Dealer From - /7'-) 16. CAPACITY ,4 `�cz-f� 11 Station Chart ANK TO 7ESTG�o c.�SI ' By most accurate �-z ,� � _ Tank Manufacturer's Chart j;U;q. `a` capacity chart available Nominal Capacity Gallons Company Engineering Data 7 J O 1 Identity by position Gallons ❑ Charts supplied with TSTT f' 1s there doubt as to True Capacity 7 Other EJ TANK CAPACITY'" Brand and Grade See Section"DETERMINING Stick readings Gallons Total in Tank to%in. ILL-UP FOR TEST Inventory Hater Bottom re Fill-up to'A in Gallons STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY OUANTITY �L/ Tank Diameter _------ ct in full tank(up to fill pipe) SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK ,anual sections applicable.Check below and record procedure in tog(26). (v�--.j ' Stage 11 Vapor recovery systems Stage 1 OLine(s)being tested - Water in tank High water table in tank excavation TANK MEASUREMENTS FOR 21. TEMPERATURENOLUME FACTOR (a)TO TEST THIS TANK _ —' F Center_'F Bottom_'F On Truck—'F Expected Change � TSTT ASSEMBLY Inventory Top r 'F nm of tank to Grade'.......................• 22. Thermal-Sensor reading after circulation digits Nearest amble tubing +30-for 4-L.................. --- + 24'for 3-L................. 23. Digits Per 'F in range of expected change digits gallons nl tubing to assemble (Approximate).•-• 24. 4 .rt X volume change in this tank total quantity coefficient of expansion for per 'F full tank(17) for involved product 'Y l ( � This is A top to glade'............................. 1,_9 } 25. pigits per'F In test Volume change per digit. test and hose on Test Elbow 6"or more _ volume cliatr a per'F(24) Range(25) Compute to 3 decimal places. (actor(a) ow tank top................................ Fill pipe extends above grade,use top of fill. �-r J L r% 1�} . �_'I f�� }✓z S ��>'� � ;9 f t� rug C, JA S 26. 30. HYDROSTATIC 31. VOLUME MEASUREMENTS 34. TEMPERATURE COMPENSATION 38•NET VOLUME 39. ACCUMULATED LOG OF TEST PROCEDURES PRESSURE CHANGES .— (V) RECORD TO .DO1 GAL. USE FACTOR (a) ..iry.. EACH READING CHANGE I �^ CONTROL 5. c�.. 27 28 Z9. Standpipe level 32. Product Product in 33 35. 36. 37. Temperature At fAgh level record in Inches Change Computation Adjustment total and deflection Date Record details of setting up Read. Graduate Replaced(—) Thermal Higher+ (c) x (a)= volume Minus Time and running test.(Use full Ing Beginning Lovett Sensor Lower— Expansion+ Expansion(+)or At low level compote (2 hr.) length of line if needed.) No. of which Before After Product Reading (t) Contraction— Contraction(—) change per hour Reading Restored Reading Reading Recovered(+) (v)—It) (NFPA criteria) ifj�7 e.��(� l �� 'L yid i�. c�'t� ya c� 7 / 3 /moo t ,/fed 17 t� ,�„zUc2-L ; J c:�� JQ `/ , , a l� �. 71 yyyy6, 97 - ' t , y obi `rS yy 0,3 DAL TO (,ul L112 -- _— ------ i r2 ley c'n1,, [,"'C,x C Y S.� � . � f.. (3- c[ {�C1q/Z<�t'� j.L}n� �`1 i'fiU 111f .S �'� �SS• 30. HYDROSTATIC 31. 38.NET VOLUME 39. 26. VOLUME MEASUREMENTS 34' TEMPERATURE COMPENSATION CHANGES ACCUMULATED LOG OF TEST PROCEDURES PRESSURE IV) RECORD TO .001 GAL. USE FACTOR (a) .. r EACH READING CHANGE c%Lam' ="c�! CONTROL OC I Standpipe Level 32. 33. 35. 36. 37. Temperature t High Level record 27. 28 29. Product in Product Change Computation Adjustment total and deflection in Inches Graduate Replaced(—) Thermal Higher+ (c) x (a)— Volume Minus Date Record details of setting up Read- True and running Test. (Use full ing Beginning level to Sensor Lower— Expansion+ Expansion(+)or At low level compute 7 hr.) length of line if needed.) No. of which Before Alter Product Reading (c) Contraction— Contraction(—) change NFPA criteria) Reading Restored Reading Reading Recovered(+) ( )—(t) ( ) t�! /b 2`/ o o 7 J • 1 � ) >�r� I � �--,�Lv }�F:L) t�C --�.�` ; :_1 t:• t� L_ V7 ! �� _ i tAJ lt % , C y.� l('a 1 MW 4 Supplier,Owner or Dealer Address No.and Sireet(s) City State Date of Test TEST /, �;c S% T U 16. CAPACITY �) From r.. >/J ��!� (� By most accurate r'? _�, ❑ Station Chart Nominal Capacity capacity chart available J C J ❑ Tank Manufacturer's Chart Identity by position Gallons Gallons ❑ Company Engineering Data ,g o Is there doubt as to True Capacity? ❑ ❑ Charts supplied with TSTT Brand and Grade See Section"DETERMINING TANK CAPACITY" ❑ Other FOR TEST Stick readings to S in. Gallons Total in Tank m Inventory to SG in. Gallons ,EFORE AND AFTER EACH COMPARTMENT DROP t1 METERED DELIVERY OLIANTITY A.(up to fill pipe) Tank Diameter CONDITIONS AND PROCEDURES TO TEST THIS TANK ans applicable.Check below and record procedure in log(26). in tank ❑ High water table in tank excavation ff-Linets)being tested ❑ Vapor recovery systems ❑ Stage 1 ❑ Stage 11 -ASUREMENTS FOR 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK SEMBLY Inventor y Top_'F Center_'F Bottom_'F On Truck_'F Expected Change =6 .Grade'....................... 22. Thermal-Sensor readingafter circulation -F + 30"for 4"L.................. digits Nearest t 24'for 3-L................. 23. Digits per 'F In range of expected change ;semble (Approximate) ........ digits 24. gallons total quantity coefficient of expansion for volume change in this tank full tank(17) for involved product per 'F : ............................. i est Elbow 6"or more 25. S' ''I + This is volume change per'F(24) Digits per'F in test Volume change per digit. test .............................. Range(25) Compute.to 3 decimal places. factor(a) ds above grade;use top of fill. J r dt1/ t-S 6 1;q S 26. 3O. HYDROSTATIC 31. VOLUME MEASUREMENTS 34. TEMPERATURE COMPENSATION 38•NET VOLUME 39 ACCUMULA710 PRESSURE CHANGES LOG OF TEST PROCEDURES IV) RECORD TO .001 GAL. USE FACTOR (a) > CHANGE CONTROL on�j L� EACH READING 27. 28. 29. Standpipe level 32. Product in 33 Product 35 36. 37. Temperature At High level record Record details of setting up in Inches Graduate Replaced Change Computation Adjustment total and deflection Date Read- D (—) Thermal Higher+ (c) ■ (e)= Volume Minas Time and running test.(Use full ing Beginning Level to Sensor Lower— Expansion+ Expansion(+)or At low level compute (24 hr.) length of line if needed.) No. of which Before After Product Reading (c) Contraction— Contraction I—) change per hour �> Reading Restored Reading Reading Recovered(+) (v)—It) (NFPA criteria) I/b�`> c'o -. ��°f> % % �" �- / rf�.6 UC y/L �J ov. vsL�F�c eU -.; 1;-7 yV1� 7-0 / � �rl1 / i tK Pc91 /X /< ) 19 777 73 To 3 76, - n -iZ t3l r} , / yEo , 33aY Tc) �'� r a J y oe G a: o 7'0 ( (2v L 75- - 43 j�LK e L- ya ly 7 0 7 , . . '�, 03 / :oil _051 a o 5 - �1 `) L � — `. ���,�f� t 7 L.)�__�i��:c.sc�.�1r">� l�.'�l c/�tZ,;✓��/ 1 %i�'/%3.S�; . (/ l t' �n .NET VOLUME 39• 3O. HYDROSTATIC 131. yOLUME MEASUREMENTS 34' TEMPERATURE COMPENSATION 38 ACCUMULATEDZ6. LOG OF TEST PROCEDURES PRESSURE CHANGES CONTROL IV) RECORD TO .001 GAL. USE FACTOR (a) .. y. CHANGE ' � �S,�. EACH READING 29. Standpipe Level 32. Product in 33. Product 35. 36. 37. Temperature At High level record 27. 28. in Inches Change Computation Adjustment total and deflection Date Record details of setting up Read- Graduate Replaced(—) Thermal Higher+ (c) , (a)= Volume Minus Time and running lest.(Use full ing Beginning level to Sensor Lower— Expansion+ Expansion(+)or At low level compute (2 hr length of line if needed.) No. of which Before After Product Reading (c) Contraction — Contraction(—) change per hour Reading Restored Reading Reading Recovered(+) (r)—It) (NFPA criteria) 33/i_ ko1, ) ol �1 j TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP NO. 273 PARCEL NO. 83 ADDRESS OF TANK: Iyanoueh Road VILLAGE: Hyannis ` ' Number Ytr��t R MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : 777 Dedham St. Canton, Ma. 02021 ' r , OWNER NAME: Cumberland Farms. Inc. PHONE: 617-828-4900 INSTALLATION DATE: 1981 BY: Al INSTALLER ADDRESS: 'CERT.1'40. *TANK LOCATION: Tank A is closest to building (DQOCPi 2 LC TANK ILOCAT 2 ON W 2 TH IRQOPQCT TO �U 2 LD 2 NO) CAPACITY 10,000 TYPE OF TANK Fiberglass AGE 8 YRS. FUEL/CHEMICAL Gasoline TESTING CERTIFICATION ED] PASS C ] FAIL DATE February 26, 1986 LEAK DETECTION C431 CHECK IF N/A TYPE/BRAND Red Jacket &57- /IJ ca C44 ZONE OF CONTRIBUTION [ YES [ NO DATE TO BE REMOVED I *W1.5/-'I� fJt �T1402/�� FIRE DEPT. PERMIT ISSUED C X] YES C ] NO DATE February 26, 1987 CONSERVATION . CHECK IF N/A DATE a BOARD OF HEALTH TAG NO. [ 9 ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD O 4o,� TO T p of �ttr rtts ` DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION j, PERMIT February 26 19 87 Date TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY In accordance with the provisions of 527CMR9.24 this permit to maintain an existing/new underground storage facility is granted to: r Location of property: 1171 Iyanough Road (Rte. 132 & Bearses Way) Street address Owner of property: Cumberland Farms, Inc. i � Full name of person, firm or corporation Restrictions: S'- :�e.-Q�Ss �i9�v/�S /•�t`e�/ L�ft� Fee Paid:$ 10.00 (M.G.L.A. Chapt. 148 Sec. ) Form F.D. 290 Part s This permit will expire 19f 9— Date ignat a of Head of Fire Dept. or appointfd designe (Owner's Copy to be posted, at the storage facility with F.P.290 Part 3) elm CUMBERLAND FARMS, INC. 0 - ,. 777 DEQHAM STREET.CANTON.MASSACHUSETTS 02021-9118 ' PHONEt617-828-4900 TELEX:710-348-0130•icunneFnanns-crows February 3, 1989 Mr. Thomas A. McKean Director of Public Health Town of Barnstable Office of Board of 'Health 367 Main Street Hyannis, MA 02601 RE: 1171 .IYANOUGH ROAD(RTE. 132 & BEARSV 9 WA)0, HYANNIS, MA 395 WEST MAIN STREET, HYANNIS, MA 3.75 BARNSTABLE ROAD, HYANNIS, MA 725 MAIN STREET, HYANNIS,' MA. Dear Mr. McKean: In reference to the above-mentioned .locations, enclosed you_will find the completed Town of Barnstable— Underground Fuel and' Chemical Storage. Registration cards. rIf everything ,is in order, I would appreciate your telephoning my office and 'I will arrange to have the valve tags picked.up and attached to the filler pipe of the underground tanks at each. ste. I can be reached at - 1-800-225-9702, .Extension 3314 or 3315. Very truly yours, CUMBERLAND FARMS, INC,. MVJ _ ` Murie White, Office Manager Construction Department • maw • -. Encs. ID- • �•tip .} I ..V .t' ,