The URL can be used to link to this page

Home My WebLink About0014 JOAQUIM ROAD - HAZMAT Iq j6av; fn I 6� s i J Number Fee 1298 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that MD Auto --------------------------------------------------------------------------------------------------------------------- ---------- 14 Joaquim Road Unit# 1, 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 Town of Barnstable Inspectional Services BARNSTABLE Public Health Division'Tn&E•F1639 2,014NR•FY0.ANI5 WthS TlS N'LLS••3i�R�'ilL%%•tF.Sl B?YJ ]9!F 163�(9-2014 w • cUl� BARNsTABL Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES ��,� �� CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 p CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 Elt CATEGORY 3 PERMIT 500 or more Gallons: $150:00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)?�p YES NO. �n 4. FULL NAME OF APPLICANT: A Er,E 1- 0 L,tj �� 1� (� � A 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: QCy -to 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 1� 8. TELEPHONE NUMBER OF ESTABLISHMENT: I)A 3 5 C o 1 9. EMAIL ADDRESS: 1 C-C44 jnChol 1 L� •�L 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL:. SIGNATURE OF APPLICA .� DATE Q�o Q:Wpplication Forms\Haz Mat Appli Draft an2019.docx y I Town of Barnstable 9� Inspectional Services oftit . �1�•Y4_ Public Health Di,vi.sion• „►, te, 1 Thomas McKean,Director MAML .639. p ' 200 Main Street,Hyannis,MA 02601 0 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOW14 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—JUKE 30th). APPLICATION FEES sd Jsr CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 D _ CATEGORY S PERMIT 500 or more Gallons: $15U:60 C] *A late charge of S10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO- 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHERJ BUSINESS HASE OF ZONING/BUILDING APPROVAL FOR HAZARDOUS MA GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? 'YES NO. 4. FULL NAME OF APPLICANT:. 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF.ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE:NUMBER OF ESTABLISHMENT: 2141 35 � rr -4, EMAILADDRESS: EUq '� r10 I •C�¢7�/1 10. SOLEOWNER: „YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: TELEPHONE#: NAME: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICA ;i��DATE ' Q;�Application Forms1H62 Mat Appti Dtatt 019.doex : N , WO s Mb HY/CNNIS,-OA•.p gp.1- 11 . C•1!$�g'1:;`•'~ ; PaY7'A Tj�e .:r. 259i5 Order`" Bankof AACH nreirt . .: �.For � '�'��'.::,._""ram'' •, . ': .C3�tv1''�q Q':1:100 0 i 3�gi� • vyyl '�n Number Fee 1224 THE COMMONWEALTH OF MASSACHUSETTS $50.00' Town of Barnstable Board of Health This is to Certify that MD Auto 14 Joaquim Road Unit # 1, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. - ---------------------------------------- ------------------------------ -- --•- ------------------------------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------- ---------- --- ----------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health ,, cash 17 1#3 Town of Barnstable THE Inspectional Services BARNSTABLE l "o Public Health Divisiona,rAe:F.�_�-�lM °' tt Wpsv-i—s•45'B'ouLLE im wiiK,IE 9EAENSTABLE.$' Thomas McKean, Director 1639.,E e`` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS . IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS MY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 X V6,r 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. 7!7- 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: M A IR C F,10 O li o E 1 k g r-)1 IQ M(q yVq-1 N 0 5. NAME OF ESTABLISHMENT: M D AUTO 6. ADDRESS OF ESTABLISHMENT: ( �j 0 gzU i R 6 4U pt-"ry\5 . 7. MAHIING ADDRESS (IF DIFFERENT FROM ABOVE: �- �i��yl fJ� �kV Q�. 8. TELEPHONE NUMBER OF ESTABLISHMENT: CIA 353 9. EMAIL ADDRESS: ccA 3Cam 10. SOLEOWNER: �C 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 APPLICAP-10-18.doex ' DATE Q: q �Application Forms�l-laz Mat App Revis r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department iBA> STAB ' Public Health Division Thomas A.McKean,CHO s6 �� ,�39 200 Main Street, Hyannis, MA 02601 Payment Receipt .Hazardous Materials Payment received: $50.00 (Cash) on 7/1/2019 Permit number: 2019-2020 i i i Business: MD Auto Owner: EDWARD A TR ROSARIO Address: 14 JOAQUIM ROAD, Hyannis Note: Category I Permit i I II Number Fee 1.224 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that MDAuto 14 Joaquim Road Unit# 1, 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 o B nsxableC� � �� J�ww11��loef gulatory�ervices THE Richard V. Scah,Director Public Health Division BARNSTABLE tAMSTABLE. 1 Thomas McKean)Director ' '°M"'�'°S'�""'lE'.��1 'S"�� MASS 1639-2014 1639.�A�O� 200 Main Street, Hyannis,MA 02601 575 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 v"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 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? / 'AYES_NO. IF YES,SHIP QUESTION 3. tpp 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: ��(� `p ,� j►�I��i/v� 5. NAME OF ESTABLISHMENT: Au l o 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: C&/,&L Y e 7� IY y.4Nly S 02W 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Z. E e df`/t�4/C - 10. SOLEOWNER:_ZYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT M8 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT' ,.57- DATE Q:Wpplication FormsUiAZMAT APP 2017 REVIS D.docx Number Fee 1224 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that MD Auto 14 Joaquim Road Unit# 1, 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 es k`Sig? . v I Number Fee 1224 THE COMMONWEALTH OF MASSACHUSETTS $so.00 ' Town of Barnstable Board of Health This is to Certify that MD Auto 14 Joaquim Road Unit# 1, 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 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health I? ;TNd LTOZ Pia"` �rY r J'` • dJ is-0 0" I IC� �. TRowr of Barnstable eg atory emCeS Richard V. Scah, Director A Public Health Division BARNS TABU M ' BP4NSi4tlLF•iHi1EAVILE.CONIi•HYiF'I:B uu • y MFP3i3:5 H;LLS 1639 2014 IP4x5fte.E . = Thomas McKean, Director 639-2014 G APED�s � 200 Main Street, Hyannis, MA 02601 575 D af � o� / Office: 508-862-4644 Fax: 508-790-6304x�'. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF J GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: MA RGE, 1® 66P'1 I 5. NAME OF ESTABLISHMENT: A U 6. ADDRESS OF ESTABLISHMENT: r� ,—�QA qU I►M@ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: T IrAdZ TVIV O 8. TELEPHONE NUMBER OF ESTABLISHMENT: ~ ,3 ,'q 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 APPLIC. DATE__ Q: ( " C �Application Forms�HAZMAT APP 2017 000��7 cx Number Fee 1228 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Rantuccio Boat Works Inc. 28 Joaquim 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 cllzv� of B nsxable P� 1(41t Voengatory�ervices It 12sl Richard V. Scah,Director THE . Public Health Division BARNSTABLE • ♦ WPNSTA2lE•ff3R9NILLE•fDNR•M'NfY15 MWWABM • Thomas McKean,DirectorMAM 16;0 4"" ° 5T^ iOtEp�A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 11 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE fq HAZARDOUS MATERIALS r� 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 I PERMIT - 26— 1-10 Gallons:- $ 50.00 - El CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 �vs 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? '✓j 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: h it9}Y1 i An ne ReA, n T u cc p 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: J®1' 8. TELEPHONE NUMBER OF ESTABLISHMENT: C�Q j" l zJ " 9. EMAIL ADDRESS: Y) x . c � 10. SOLEOWNER: VYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: _ CORPORATION NAME PRESIDENT TREASURER WiA CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT0 -MkA., DATE Q kApplication Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1224 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that MD Auto 14 Joaquim Road Unit# 1, 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 O5/18/2016 PAUL J.CANNIFF,D.M.D. JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Fr-� 4 l--e Number Fee 1224 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that MD Auto 14 Joaquim Road Unit # 1, 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 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 06/30/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable �tVAE royti Regulatory Services Richard V. Scali, Director ��AB�. BARNS]�r Public Health Division 039. aus oxs nu s•os nwuF.w e,w sme fD 'rA Thomas McKean, Director 1639-2014 V 200 Main Street,Hyannis,MA 02601 $ Office: 508-862-4644 Fax: 508-790-6304 r r 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 �R0 � � Sa .vo CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 '� lr ' —om-3- 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 Jules ASSESSORS MAP AND PARCEL NO. DATE "5 ' Al (P FULL NAME OF APPLICANT: M-*K l0 "oTi-ya NAME OF ESTABLISHMENT: Ao n ADDRESS OF ESTABLISHMENT: �l-A � QJ�r•.. pl ,�,�;'� Mae® MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 1-4-14. .1.sa 514 EMAIL ADDRESS: Le-cC,�Z;j it .P cap SOLE OWNER: _YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT �-Y— TREASURER CLERIC { . IF PREPARED BY OUTSIDE PARTY: SIGNATURE A C Name: r' Company Address : Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 a dF Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 • Regulatory Services Department : .S, ABLt Public Health Division MASS` Thomas A.McKean,CHO o39, �` 200 Main Street,Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $64.00 (Cash) on 5/24/2016 .Business: MD Auto 'Address: 14 7oaquim Road, Hyannis Note: Pro Rate $14.00 + $50.00 Category I Hazmat 2016-2017 ----------- - -- __._. --- ....... Number Fee 1228 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Rantuccio Boat Works Inc. \� 28 Joaquim 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 i 1 Town of-Barnstable �t Regulatory Services MA Richard V. Scali, Director ` BARNSTABIE z r `"�"AE& ` Public Health Division 3 ♦ ausroxs r� -OSTERVIu-wsreuesr� ArED MP't A -2014 r Thomas McKean, Director 1639 � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Q Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-NNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 — X�-L 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 CO hhoI 3 FULL NAME OF APPLICANT: AtIne- iL K", el 1&LV iyrc4;b NAME OF ESTABLISHMENT: 1�a4/ti`ls'11CC 10 'boa_* LjU yzks -zA(, ADDRESS OF ESTABLISHMENT: � J � 1� ® l MAILING ADDRESS (IF DIFFERENT): Po PJD u 1141 W ��'�` a oZS (o TELEPHONE NUMBER OF ESTABLISHMENT:' EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: r`1n d-K�U �G1►1`r�CC� CORPORATION NAME �nei Fd mdS1A RA, iMas h",q_ MA I PRESIDENT '34')D TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev16.docx Page 1 of 2 n Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department w Public Health Division "nsa Thomas A.McKean,CHO o °` 200 Main Street, Hyannis, MA 02601 Payment.Receipt 'Hazardous Materials Payment received: $125.00 (Check) on 6/6/2016 j i ;Check number: 21228 Check amount: $125.00 Name on check: Rantuccio Boat Works, Inc. i i j Business: Rantuccio Boat Works Inc. Owner: STEPHEN T TR DAVID 'Address: 29]OAQUIM ROAD, Hyannis I � i • '3 'r. Number Fee `- 1228 THE COMMONWEALTH OF MASSACHUSETTS $125.00 a Town of Barnstable Board of Health This is to Certify that Rantuccio Boat Works Inc. 28 Joaquim 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 06/30/2018 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 Z: 1'0 Aug 01 17 08:03p Rantuccio Boat Works 774-470-2899 p.1 of BgMstable story �7c eres veng Richard V.Scab,Director Public Health Division $AMST ,� Thomas McKean,Director °t8 200 Main Stteet, Hyannis,MA 02601 � Office: 50&862.4644 Q6 Fax 348-74d 6304 APPLICATION FOR PERMIT TO STORE ANDIOR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 109, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS Nt-kTERiALS GREATER THAN HOUSEHOLD QUANNUITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT{RUNS JULY I st-A NE 3 Oth). i APPLICATION FEES CATEGORY 1 PERNUT 26-1 M Gallons: $50.00 Gl, CATEGORY 2 PERNUT 111 -499 Gallons: $125.00 • �J CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of S10 00 will be assessed if payment is not received by July Ist. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS TMS A PERMIT RENEWAL?,_ YES NO. ff YES,SKIP QUESTION 3. i 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATFRL4LS STORAGEIUSE OF ` GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: l u c l S. NAIMIE OF EST ABLISHIWEI+TI': 6. ADDRESS OF ESTABLISM4ENT: 'Q0 :1 ✓A 7. MAILING ADDRESS(IF AIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 12y" 9k r d� 9. EMAIL ADDRESS: W&n a ea )q bZ.c0 VV1 j 10. SOLEOWNER: YES\/NO IF NO,NAME OF PARTNER: LAY., 11. FULL NAME,H01Y1E ADDRESS,AND TELEYHONE#OF: _ CORPORATION N !&Li_�:g PRESIDENT I TREASURER CLERK > 12. IF PREPARED BY OUTSIDE PARTY: NAME- TELEPHONE ii: COMPANY ADDRESS EMAM: i SIGNATIME OF APPLICANTi-y;V"DATE QMpplication FonnMAZ.MATAFP200 REVISED.dom — rYit.raMvurl1 Y►'t c E • ' IKE ro{�I Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE, 9 MASS. 00. 200 Main Street• Hyannis, MA 02601 ,b,q.p,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rfD MP'� Business Name: Mo AIAO Date: Slls l� Location/Mailing Address: Iq — ' Contact Name/Phone: Inventory Total Amount: <a� SDS: e License#: 1 � Tier II : N10 Labeling: AS Spill Plan: —01111 Oil/WaterSeparator: N 0 Floor Drains: O Emergency Numbers: Storage AreaslTanks: ��l`�� i Emergency/Containment Equipment: I"A�IS aste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: -jn In to 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-t ;Ck 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: , rnw-- Inspector: i Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 0p IKE A Town of Barnstable Office:508-862-4644 1 Public Health Division Fax:508-790-6304 e"MASS. 200 Main Street• Hyannis, MA 02601 Fo39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 1 ft Jk Date: �� I Location/Mailing Address: �O e- v 1116 v not 6q14hh►5 Contact Name/Phone: a.r e.f�I IV' �•nrY��-� 11 `-� ��- (�,f7Sy Inventory Total Amount: -30 k MSDS: I- ►emu sVv License#: 6r,�' Tier II : Mn Labeling: Spill Plan: A1610 k Oil/WaterSeparator: Floor Drains: 27 Emergency Numbers: Storage Areas/Tanks: K,-, 4A Emergency/Containment E ui m nt: k Waste Generator ID: ' b Waste Product: Date&Amount of Last Ship en requenw 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 5 Degreasers for engines&garages Pesticides: Caulk/Grout/Atkz<4 Z 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 l b Paints, varnishes, stains, dyes \10 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: RECOMMENDATIONS:INFORMATION/ kS I �-� M,5 aS2. o inspector�� , Facility Representative: ` 1 `ate. QQQ WHITE COPY- HEALTH DEP 1 ARTMENT/CANARY COPY- BUSINESS Date: I / !o TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: WD AvA-o BUSINESS LOCATION: 14 ��dctie,y�v� f��t�, �1�4 I INVENTORY MAILING ADDRESS: c7 ox 200 TOTAL AMOUNT: TELEPHONE NUMBER: 1� y - �S - (oDS 3Z o�Ilo►�,5 CONTACT PERSON: -rc.,&L o EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: tv\,oe \Ooj 0 INFORMATION / RECOMMENDATIONS: Svcs. -� �� av�• Fire District: CoOk, �,1�W�• D ?A f �K —I e.A]DZg Oy�, VJ 11\1 %Kn %K- I O wti o_T�/Z .D v�c�ai ewc. �{to -kkt o.J�'S� p sw" VQ a�JS`�, Q5 ,1 DQ.tliS Waste Transportation: kkAnkq 60144.� eQ( ast shipment of hazardous waste: Name of Hauler: vk 0 re_r✓�� 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> " I Other chlorinated hydrocarbons, I Lacquer thine rs (including carbon tetrachloride) 1 An other products with "poison" labels 6[I NEWS' USED S (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 + QCIwu,Iy Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials °f IKE*o Town of Barnstable - Office:508-862-4644 Public Health Division Fax:508-790-6304 B"";�`Eg 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: eJ� ut+5 — C Al Vv-&. - 'ookS 11�-COU5,v4-45 Date: Location/Mailin Addres • --Da, two. a,Wyh Contact Name/Phone: a +S o5721--1 1 Invento1y Total Amount: MSDS: I-0AA1C 56 License#: NIA Tier II : Labelina: S a I CAL&A 6,\ Spill Plan: Oil/WaterSeparator: 011K Floor Drains: 0 a �Tmergency Numbers: Storage Areas/7anks: JA4,Jr $ Mk4. 0,k Emergency/Containment d quipment: ,c + �� Kb s� 4, Waste Generator ID: Waste Product: 0+ Date&Amount of Last Shi ment/Fre uenc Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 1 LIST OF TOXIC AND HAZARDOUS MATERIALS` \11��I0,Av( `D OV) NOTE: Under the provisions of Ch. 111, Section 3i, oft the General L�ws of MA, haz dous 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/RECOM ENDATIO S: oC a g o 15 J� + i - Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °FiwE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS .. g! 200 Main Street• Hyannis, MA 02601 �p 039• �0 �EDMA�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o- G l b ok.k W ark Date: l a ! b Location/Mailing Address: Ib i�c `(Z, AA,, anv\� 5 Contact Nam e/Phone: ��l�y�, f _�v �0%-7`7 I - Invent- Total Amount: ^— 1 0- DO t-1 MSDS: OK License#r-1 f3 Tier II Labelin A +o Ia6.1 ��J�S Spill Plan: �oToY� Oil/Water Separator: Floor Drains: tp Emergency Numbers: Storage Areas/Tanks: 2-$S +1 _ a.l 4 ,, Emergency/Containment E w ment: a N45WJLJ Pk&xkeL\c,\1Z1 Waste Generator ID: 0 1 Waste P -duct: Date&Amount of Last Shipment/Frequency: f- ri C*ti co� Licensed Waste Hauler&Destination: A i C'c,S - f ieleL,49 ij&s a 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 t S Miscellaneous Corrosives vl Gasoline,jet fuel, aviation gas SS► 5+� 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 b�— Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine ✓ Paints, varnishes, stains, dyes Lye or caustic soda —� Lacquer thinners +c4vc sv S 2 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/R COMMEN ATIONS: o W -c.. 2- Inspector: ' , LgkJ4& '� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS 4y�03:33p Rantuccio Boat Works 774-470-2899 p.3 IANCR HIS CSG tM-02 Steven Diugoa: Jr 08/31/1S 10:24 PAGE 1 •�� Foml ApprDwd.OMB No.2050-Mg Safety-Ki een Systems, Inc. 3.Egw lWi!r Response Phone 4.ebanri,��=rTcbl�? fiber Suite 240 f `�q *pp� 26�N General Eapy• 0 i� 5 i� ! J.I 'Y SKS Richardson, TK 75080 w CORPORATE. 600-669-5740 :eneratoes Site Address(d dilferentthan ma3ng address) 24 MR FJ'6tCBiCY: 800-468-1760 safety-Kleen) 4017810M REFERENCE Nam. JSTOMERN RA28147 Rantuc60 Boat W4r1cs 679MS1 28 30aquv0 Rd SRVC MEEK: ZOIS-30 Hyannis RA 02601-MBS SRVC DATE: 08/31/15 10:24 PHONE 548-771-87ZS U.S.EPA ID Number ELL 70 CU570HERN BILL TO ADDRESS: ..• ''.` "..':r, A18147 Rantuccio Boat Works 28 Joaquim Rd U.S.EPA ID Number Hyannis RA Oi!60L-206S Pf10NE s08-771-6725 UROULSE ORDERSTA% EXEJIPTB PRODUCT/SERVICES U.S,EPA ID Number SOMCE/ TOTAL PROVUET QTY UNIT PRICE TAX CHARCE - .,;r.-.,•..:. . 6673 USED OIL SW NON PREQ CRE 12S.000 0.0000 0.00 O.DO SEM110E TM 16 WEEK HALOGEN /CLOR-D-IECT TEST RESULT PASS: LWH < 1000 10.contelnerS 11•TOW 12_U ft r IUNAN: 1 7SOF: CH" n4ra*tS19: 0OS02/194SKS FOI/P CD: US SH1P9 L11018116 awltity WLAAeL 13.Waslefodes tta7a. n7 1S08291t4) Q7Y: 125 WT/VOL G p"F4 156016 SHOT 3298 No_ Type .0044 EXTEMEP SERVICE AREA EEE 0.000 0.0000 0.OD 0.00 _-_--'_-------------_-------•------------ :i ... . TOTAL swACE/PRODUC75 0.0000 0.00 0.00 -� i c.•r 'MTAt CHARGE 0.06 CREOQIS 0.00 --------------- TOTAL DUE 0.00 UNPAID BALAkCE TARS RECEWT 0.00 If high risk source. SK rep. certifies that load specific PCB & 1 Silicon testing have been conyleted prior to pun-ping this load. GENERATOR STATUS CESQG: Vehicle _ Costumer certifies that (1) the above-nalued materials are pruperly clessirieJ, pacLagcd, , LeJ and labeled, and are in proper conditiun for tralmyurtativ0 according to Lhe alplicable reuulation5. of the OeparGnenL or Transpurtation and (to nu material change has uccurrcd eiitlmr in the frM r;.rlrr:a al, ..r the wan r!t•r ial ,.r in 'L- rr-« - E`la generatinU the waste/material. Customer agrees to pay the above =�r_I�•-.a, ,.: am:eo:_oe proper shipping name.and amdaSSMW,p0tka9ed• charges alol to be Lmund by llae terra and conditions (1) set forth in E. gOlabOns.IfPxpOAshiprREOt2ndlam Plilnary (a) the Gemeral Tenib and Cuoditions prvvidad separately to Custlalwr or Cb) any SK auree,nent signed by Customer and SK, and (2) iacorpurated herein by rerel,enaae- Unless vtke...6e inrtitot-1 in Lire 10'_r t mr-es-2S'7.-'a"^-�."?'r!2:'d•+7t)iSWa. paymeat received section, SK is autburized to charge Cvstaver's T Marm Day Year AttOmnt full, thin tr+n»aLliutt. Tf Caslaever rails t., •-A-reytat siren '✓ due, an anount equal to the lesser of (i) 1.Sli per month CIS% per 1 t aarYw.) or (ii) the urvavmaY---itollor.ral by law, will he added to all unpaid MWOOLs ou"tandiOg. Custouer certifies LIIat. the individual f T r owg to ;on wnd bind CO>tuuer. The following pruwm;on is applicable to Safety-Kleen's parts clearer and pdint gun aleancr > ,,ices: Custom r agreo that it - rill rnt inlredn•_e any+•.4-E-vice i.etr 0!! --1.•tnt ,•r '%'tvvu. a7rnne�g Month Day -YBaf 'elution, inalUdieg tillmnt 1imllalioe nay harwnFrne :•.e�tw or tR !rr•l,e••lo,w ,;aa• •aa.1 itwr••t. •.,...t 1., t6.. ..l�nr ....t. :.,I..,J..•1:.,.. i. - - r. � .,..:p -.:..., ., ' incidental to the awhal v►e or the umrhirrr. Cu,tomrr rurtlrar agrra _Lhat-it"TV nut clean-_par Ls/rainL rneetetl Month Day Year •itb or ath.a.aix'int rYJaace Pol yc7aTur tba herhiiiJes, pesticideaa dio►ias or listed b"Al l+rrs ante into t1,e x7ara4 rtf *V cvwa r_7eor;XT era.{'a... 4�retY-;'zs• >t� t .±rc• .. J[d i!'Y�^lettld LO�frPt; .an.-r. sr',.•ae r•c`.r. :+e _raz! Fae•t. rlsYe• >a7.eaL: Yati• 'C7reoa-rs +•�lso:s mra K�a•':> yeee-a'.ei�t _ `. . ts0ce; Afr A-1 06.0]w%.:1 `_:et :>:':"hkyrz.. trwc+e• want s: RB ._''fires ''C: ❑FUNe*n. . .�i.L..a:..,eel Cas.r ...-..s-.•,.�.'�_.m. .�-•--v s•..:..L ...- - - teifSa,ea�:a:.k..raa:::.sue a 's53�'=��'C ca." - - '.�._.� -....=:t •�-� � •� - '4'd':5=csT_r^:2�i.;�I�E� el, iaai,rcw>ie�+ Y.+.',•�,c .'."faw'• - •al, rm. ,t.... .+a. � _ � ...`:- ?Gc.1: anlrf agV.".'Irk' !ate area -ab-r.,c•- agr-sa 'to- . al,: U. .•..� Sx - a,es tea, -s1r-i�s.eaarixsa� _-� _ .e?- '•a _a.e _ ��+ •^•- re _ 1aFxu11 Day Y 'a.s �3.- -.•,a., rf ems -..`...+.. .... al,..e•: •..•'_'.�.r.._.:+ %.rr-.••r•r- sa.L. :�!a:'✓r „Y1e�f !'�"'! .. . ie••-a.-uagti:-- �i^ a .!R: awi �,t,sae 14-..arm.:.-'•�. _ -__ - •�- _ 4. •'T's The ;0—e4� •i._i::Y� Sr— �...:�� _w - -e•- - .iiil.igoal eDear9a rr- s�� sfc•="r;-z_i sr :a>c exn a•.r.:.i.a-ro. :ae '4z r16r.. e4r a,•,r.•. `-.'.;L •.s .r ;, race qt. Sf an Tef.1 aat'es is :oro.eaCef t'-t x a•f a. o:= epee dea,prrrLe t![t'reb. 6c�asi_ r_ : i>-e{ �'c:.a:'x :s Cas:r.: s's•a - A10T,th Day Yea:' ,*Were• drat tlac Prea:�"a3^'$art' a'- K es:":rl :a tsa:+'ae•T reasarai'dr " aft>✓'r•rg-> £co nod acts � aSaar.=s:r` +•_i. :re •. Sal,./�.Z�rra•. 9a fur •s•.!+ '= GENERATOR'S INITIAL COPY - � •wr s '- is � ... -sac.`.-_a.•.r•.a arf c`am:�lE's s1iT yar:?,aa Ss p-•arc-: es.�fy �s .atel,'a?>. c �r =s_- at "`.r.!—r-'o '�•'�• c. -- __ems' _