HomeMy WebLinkAbout0094 MAIN STREET (HYANNIS) - HAZMAT �� Mein S�r�ek , �"�j�nn�S
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HYANNIS FIRE DEPARTMENT
95 HIGH SCHOOL ROAD EXTEN51ON ]
HYANNIS, MASS. 02601 MJ� �
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CHIEF Swope Oetecta2'd 2.Save / ved BUSINESS: 775-1300
EMERGENCY: 775-2323
PERMIT FOR;FOR REMOyAL-AND TRANSPORTATION-OF STORAGET—TANKS
FDID NUMBER 01922 DATE OF APPLICATION
PROPERTY -OCCUPIED BY T A� PHONE
LOCATION �f'-' S /N,A�n/ ST Rn�► S I
.PROPERTY OWNER 5�,•,e- PHONE
TANKS TO BE REMOVED
ALL TANKS SHALL BY INERTED BY THE USE OF DRY 'ICE AT 1.5lbs per 100 gal.
�, QUANITY SIZ$ (GALLONS) FORMER PRODUCT STORED
PROJECT SUPERVISOR ��- �-
COMPANY NAME PHONE
ADDRESS : Bak 9-(- .SO ... S /IM,4sn- 02660
EXCAVATION COMPANY PHONE
ADDRESS : .
DIG-SAFE NUMBER /LS- 5354 START DATE 6 lql
COMPANY REMOVING USABLE PRODUCT FROM THE TANK(S)
NAME PHONE
ADDRESS :
COMPANY CLEANING THE TANK(S) AND REMOVING THE HAZARDOUS WASTE :
NAME : PHONE
ADDRESS :
D.E.Q.E. LICENSE NUMBER: EXPIRES :
MANIFEST NUMBER:
COMPANY TRANSPORTING THE TANK(S) :
NAME: ��0r-j ' //�,n?lz-- PHONE : 3$S-SIdC�
ADDRESS : &5?c5,k SO :pF_&w,'Sr M-4 .
THE TANKS SHALL BE TRANSPORTED TO
YARD NAME : 'lAm.ts 6P.Ak7r- 00 - ::1:4- C, PHONE :
ADDRESS : vuR L -0 1--' lsT 00,A-z>uiGy;F Y►9Pr
MASS . FIRE MARSHAL ' S APPROVAL NUMBER i
DATE OF ISSUANCE (C-�J �� HYANNIS FIRE DEPARTMENT USE ONLY
DATE OF EXP RATION HAZARD FOUND - SEE LEAK REPORT
;:7--REMOVALjWTTNE`S-S-ED-"—NO-HAZAARD�
SIGNATURE OF APPLICANT __ _ SIGNATURE OF HYANNIS F.D . OFFICIAL
°FtH�E•off Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMAN-%. • 200 Main Street• Hyannis, MA 02601
TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: �t>uor -CX41C-+e1r Date:
Location/Mailing Address. 9 Lf a 1 w S-f- , /4Y4 n V1 i S
Contact Name/Phone: P_ide" Al2150-A-
Inventory Total Amount: MSDS: v.c J QA<"License#: N
Tier II : Pto Labeling: &oAPV Spill Plan: Q5
Oil/WaterSeparator: Floor Drains: 00 Emergency Numbers: V-5 t
Storage Areas/Tanks: m -- I e s alwtcs - S" t(
Emer enc /Containment E ui ent: N s l vt t,e- �a — A
Waste Generator ID: l sf-9, Waste'Product: A b a o tti
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze Dry cleaning fluids
Automatic transmission fluid �— Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (including brake fluid) Windshield wash
Motor oils Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
�— Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS �K-
JC�- Inspector:-,al�+a�*'wLay,,f
��v�,o� Irw utic-�nOI� vw tV�Lt�C�SMA�I Va /—ity
Fac Representative:
WHITE COP -HEALTH DEPARTMENT/CANARY COPY- BUSINESS
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. .�+ PARCEL NO. ,� J
ADDRESS OF TANK: / ? { ,f %A'/ j V I L L A G E
Number �tr��t r"
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : i �014/1/ (
OWNER NAME: 4 fir 4) /i/-,lwlrlll'.4l PHONE: �
INSTALLATION DATE: BY:
I INSTALLER ADDRESS: CERT.NO.
*TANK LOCATION:
(OKOOPR I•t TANK LOCATION WIT" PR=0"KCT TO WU I LD I NM)
CAPACITY /IJ071 TYPE OF TANK M 41/ AGE YRS. FUEL/°CHEM=ICAL � r'
TESTING CERTIFICATION C ] PASS C ] FAIL DATE
LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES C ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED CAA YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE
3 +
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BOARD OF HEALTH TAG NO. C ' ` fir ] DATE / r �l
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* PLEASE PROVIDE A SKETCH SHODII7G THE TANK LOCATION ON THE BACK OF THIS CARD
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"HYANNIS FIRE PREVENT ION,
-HYANNIS FIRE DEPARTr4!Er,,1
95 HIGH SCHOON, RD. ryT
HYANNIS, MA 02601