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Home My WebLink About0038 PLANT ROAD UNIT 7 - HAZMAT ��--�r,";� �� /�%� l i i - � Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Advanced Embroidery ................................................................................................................................. 38 Plant Road, Hyannis,MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Ir Town of Barnstable Inspectional Services BARNSTABLE T [4RY:TaBtE-alnlVlllE•CONIi•tY4AN15 Public Health Division 1s"�i639-2".•'.s�, ` :639-2014 1, 1 B&AM Thomas McKean, Director 1639. 200 Main Street, Hyannis,MA 02601 7 h.i �h Office: 508-862-4644 Fax: 508-790-6304 r: x APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE C 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 �V61-pXJ(Gw-�4 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ 0 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. Lf 06 1c� G 2. IS THIS A PERMIT RENEWAL? 4YES_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:. I-A0 6-MA2.fA-b!✓-YZ—y 5. NAME OF ESTABLISHMENT: C, 6. ADDRESS OF ESTABLISHMENT: 3 L ( 1Z� 1�r-`I ►J IS, ttPr'n 661 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S S- f)7 S—�s 1 (G 9. EMAIL ADDRESS: -no+J Ca P�tl PrN t-� L�82=gh b er—Y 1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME -TVdL.P�� D6t1r PdDVA-+JL�II C N�E�-� PRESIDENT �� C-n L�-- 1 N S TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICA DATE (o Q:\Application Forms\Haz Mat Appli Draft Jan2019.dlcx L ►Wlu(�Cl•� - ISE)° f Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMST�BLE.�' 200 Main Street• Hyannis, MA 02601 .639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT • rE0 MA'S Business Name: N Date: 7 �� Location/Mailing Address: $ rS OI Contact Name/Phone: .io�(-12a -6SI Inventory Total Amount: do— 110 SDS: Q S License#: 1151 Tier II : Labelina: oja _ Spill Plan: Oil/WaterSeparator: NO Floor Drains: Emergency Numbers: Storage Areas/Tanks: ` W Emergency/Containment Equiomen : Waste Generator ID: Was a Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: IV Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS No ftVWGy- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws o 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 Moer oils baSd t; Q 96AAO Miscellaneous Corrosives Gasoline,jet fuel, aviatioli 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: 'rc i U r co me.n 0 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F� ►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B`"M�`E�, 200 Main Street• Hyannis, MA 02601 �prFO 39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: VQCj1WCtk Date: 1 l2 t Location/Mailing Addr ss: 'Sg7 av�k a+nv�, Contact Name/Phone: Inventory Total Amount: ti S-�� a 1 MSDS: E 5 License#: Tier II : Labeling: OK Spill Plan. O �^s Oil/WaterSeparator: N Floor Drains: _A Emergency Numbers: OK Storage Areas/Tanks: I noLk e Al 1wk/L -D� QA1A<& .k Emergency/Containment ui ment: a A � V\ ors V IJ Waste Generator ID: Waste Product: -IJ Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destinat' n: Other Waste Disposal Methods: kj a je 1,- - \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. 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 vi Paints, varnishes, stains, dyes IW\L4- 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, --�� \'C°0"1 ✓ s hydroc_hloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/R COMMENDATIONS: w 44 o-< 1 <,0AS I I t 0,1 1 -Dte� `� -e� v.. eS 5 Inspector: I Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Date: 11/ Z / /3 TOXIC AND HAZARDOUS MATERIALS � �� T ORM NAME OF BUSINESS: A Jt oat BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: ,5-09 -77 S - CONTACT PERSON: C011-VL EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: a�� SG �►� C�n�i -t �o o eQz•l ,, INFORMATION / RECOMMENDATIONS: Fire District: -�q v<e- G v V Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's o Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) S Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health i This is to Certify that Advanced Embroidery 38 Plant Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. --------------------------------- ----------------- ----------------------- ----------------------------------------------- ----------------- ---------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 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 00 Town of Barnstable Inspectional Services tt LE �.axxr Public Health Divisiona°". E�`-�.sT� . = Thomas McKean Director 9q'ArEo a`0� 200 Main Street, Hyannis,MA 02601 w Office: 508-862-4644 Fax: 508-790=§304 C> ;.+.4 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 VST- CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ a�LJ *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 l L4 D � I ()0 () __ G' 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: Aar 1)Pj'N C-ej�) e!!�-rl6 kO 1,J1) ,e-!2 6. ADDRESS OF ESTABLISHMENT: 3 1-1F�� T � -}} Y PS N'fJ lS� Pi 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: r 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: �f�Md n) (c�_ l�PVA)L_Qb 6M_6 [�D t� - I 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME )f� r�� lO(_— PRESIDENT .a-�7�71 NSt_L_I NS TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE Q:Wpplication Fonns\Haz Mat App Revised 09-10-18.docx f F.. r Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Advanced Embroidery 38 Plant Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. --------------------------------------------------- ----------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health of B bleToewg8atoryevxca of t"e Richard V. Scali, Director Public Health Division BARNS LE MAS& Thomas McKean Director �,� MA83. � 1 1639�--/7J2�0{14 - - - -- - SG 9 - -575- ArFo�p` --- --- - _ ---2001VIain Stitreet,Hparinis�MA 02G01--- -------- ----- ---------- -- 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 X 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 July 1st 1. ASSESSOR'S MAP AND PARCEL NO ,29 4 (' 9900 Pi- --G 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: 1 H (L e-p b we7- � )N L, 5. NAME OF ESTABLISHMENT: . Ab t!ppQ 1:--lb��- 6. ADDRESS OF ESTABLISHMENT: 3S -� A-iJ-F 4A-Y +r�OkS r't-A 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 'bA*^o�� r�VJ[ ��'�`lb Pj� �• 1 10. SOLEOWNER: YES GNO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ��R-- ) �n1 C.� j cb PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANTe:l DATE 6 5 / Q:\Application Forms\HAZMAT APP 2017 REV610sm Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Advanced Embroidery 38 Plant Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health A., Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Advanced Embroidery 38 Plant Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 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 EZ:T Owd LT OZ 6 1. Mild` �0-. 3Io5f TRowr of Banstable eg atory ervices Richard V. Scali, Director OF TFIE o� Public Health Division BAMSTABLE • e.aras7nnaxr�vi�•cmun•rrca:;as BAPNs r,ABLE xwnas3 nws nue•rrsr epPnsrse Thomas McKean, Director 1639 16,9_Zo,q ATf0 9. bi 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 JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $1'25.00 ❑ 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? ' 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: A'w\&K) 0-0 �-L-i N S 5. NAME OF ESTABLISHMENT: &-]Z y 6. ADDRESS OF ESTABLISHMENT: ?J'& -- LA-n1 t � N`f�-n�rJ tS, 01 pF .pz-601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: -:b pr-.•+J p_ 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ��c� t�E �� tN(-- JbGk PsN)p"JL-0') cnu1c�, PRESIDENT —DA Mo 0: 1-7'+ i_P,;�S W l m1w—S TREASURER (le CLERK t-ksA- c-o►_L-► n)S 1-?5 CAA&1c�CLES UAOjN 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q: (, �Application Forms�HAZMAT AFT 2017 R SED.docx Number Fee 1254 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Advanced Embroidery 38 Plant Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 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 fir u1 - • f Town of Barnstable Regulatory Services ti Richard V. Scali,Director dt BARNST Health s Public Hlh Division 1639. Thomas McKean, Director =639-201' �Dg o5 200 Main Street, Hyannis,MA 02601 q3 Office: 508-862-4644 l Fax: 508-79004 Cal 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 306). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00l 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. 7-)vp ASSESSORS MAP AND PARCEL NO.15 C-, G, DATE FULL NAME OF APPLICANT: lfrt-'U ) C-0 LL.1 rx/S NAME OF ESTABLISHMENT: 1j' ) ADDRESS OF ESTABLISHMENT: Icy A-k)01 ?-Jv MAILING ADDRESS (IF DIFFERENT): /V/ TELEPHONE NUMBER OF ESTABLISHMENT: e50'j- 9 `1 j I Co EMAILADDRESS: � v�J > JVL�J E�►/S -t�� , Q1 SOLE OWNER: t/ YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT fFl TREASURER t. 1 L M 0 z l `f T 'CLERK. IF PREPARED BY OUTSIDE PARTY: SI O PLIC Name: Company Address Telephone#: Email: Q:1App1ication Forms\HAZZAPP Revl6.docx Page 1 of 2 ��►� To,wh of Barnstable, e 508 862 4644 . Public Health Division.` Eax 508 790=6304. •'.tBARNSTABtE. ::. . MAC. 200 Mam Street Hyannis 'MA 02601 �FO:MA�'a TOXIC AND HAZARDOUS MATERIALS INSPECTION,REPORTfi Business Name: - k l-c Date LocationlMailin4 A�ddr' s t: ' {� e Contact-:Name/Phone: ��a: .�� C_�41.: -7 7 . (� ►C A-_"�ra ..�C� �. j MSDS. � 4 I o 'n ., n —F Tier-1 - ;Labelinctp rm? Sgill Plan E Oil/WaterSe Separator I floor Emer. enc Numbers O _ P a Y Storage Areas/Tanks. r . G 'f_ r `. A, y v,u,<-� Emer enc /Containment. ui ment s i to p P r � ,.T� Q 4a �C � Waste Generator ID. Waste Product: Date&Amount of L•ast`Ship ment/Freq uency:, . Licensed'V1YasteHauler-&Destination`:, OtherWasteDisposal..Methocis th) `�, LIST OF TOXIC;AND HAZARDOUS.,;MATERIALS NOTE:Under the provisions of Cti: fi11, 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 An."tifreeze Dry cleaning flwds Automatic transmission'fluid` Other_cleaning,solvents,&spot`remove. Engine and radiator flushes Bug an- ar removers Hydraulic;fluid (including brake#luid) Windshield waslif Motor oils Miscellaneous Corrosives . Gasoline,jet fuel,?aviation gas Cesspool cleaners Diesel3fuel kerosene, #2 heating oil Disinfectants Miscellaneous,.petroleurn products: Road salts grease,aubricants, gear oil - Refrigerants Degreasers for"engmes_&garages Pesticides CaulWGrout insecticitles; herbicides, rodenticides Battery,ac d:(electrolyte)/batteries Photochermcals(Fixers) Rustproofers Phbtochermcals(Developer) Car wash detergents Prin Jng.ink Car waxes and polishes Wood preservatives.(creosote) Asphalt&roofing tar s Swimming pool:chlorin0, .Paints, varnishes,, stains;..dyes< s �R:: Lye or caustic soda Lacquer,thinners t Miscellaneous Gombus#able ' Paint&varnishrernovers, deglossers Leather dyes Miscellane'ou's Flammables Fertilizers' floor&furrnture strippers PCBs: ' Metal polishes Other;chlorinated hydrocarbons Laundry Soil&stain rern'overs . (including carbon tetrachloride)' (including bleach) Any other,.product ,with".poison labels" (including chloroform,formaldehyde, hydrochlonc acid, other acids) VIOLATI"ONS. ORDERS: 1NFORMATIO IRECOMMENDATIONS • "(t'�t V., .�-� �i �.� `": .. r1 G n�i 1 .p �t"^n r,t.. :.�A C. � (",� !f ��. ,�'� t"' .. � �;..: Inspector's "' i Facility Representative: : BUSINESS WHITE COPY-HEALTH DEPARTMENT/.CANARY COPY=