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HomeMy WebLinkAbout0058 PLANT ROAD - HAZMAT e—d Ns' — ol�p � �p(ME TON, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 C BARMASS. 200 Main Street• Hyannis, MA 02601 1639. 'ATFOMP�a`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT �f✓?l�/S Business Name: L t he- - X Date: _ Location/Mailin Addres KS a" �{% yti 0;!Vir Contact Name/Phone: ray O - - 0 !o -7 - 9 - 1.800 3 q �.1 Inventory Total Amount: A, � SDS: 47 License#: �zao Tier II : Labeling: OK Spill Plan: . ag Oil/WaterSeparator: Floor Drains: o Emergency Numbers: e", Storage Areas/7anks: le;� e k vc,\. Erner enc /Containmen E ui ment: t A Waste Generator ID: PJ 10, Waste Product: ova 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 5 Dry cleaning fluids. I Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash 1-, Motor oils ti 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 1 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 a�{oSb`'5 �t&- Lacquer thinners 20 Miscellaneous Combustible ;La \ate ray Paint&varnish removers, deglossers Leather dyes — Miscellaneous Flammables 6Zce-A^4 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" tib� �'^'SS'-13��2St5St�V+i p (including chloroform, formaldehyde, 1�S PS� vice. ��k 3o+3u hydrochloric acid, other acids) VIOLATIONS: 3 11►�rt crrc��.k Sk 5' ORDERS: INFORMATION/RECOMMENDATIONS: D t550eS o,( Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FTC rower Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 B""M�`E'g 200 Main Street• Hyannis, MA 02601 1639. �`rFOMA+�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: Z 3 I Location/Mailing Address: vl- S1 ,40,115 Contact Name/Phone: Inventory Total Amount: St 001VU- ALl69 License#: 106 C'4 2 Tier II : Labeling: OK Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers- Storage Areas/Tanks: 'Wa,5'c-c— v. 1g`i Emergency/Containment E ui mint: 5agAd, &I a.ya.1 ovk 5,k Waste Generator ID: 01A — I Waste Product: wawtc- o, ►�ST- �� (o.�c�u-,� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Igo Jul o l CV )V" 11A�Z CQ � NOTE: Under the provisions of Ch. 111, Section 31, of the G�neral Laws f MA, hazardous m t%real 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 VMotor 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: ii �fJwt, 26i�w a r�N1 5 J p1 w n vL %u v.?I aft �� GO�ib� a<-,0J lylnspector""r, y Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS I - `°Ft"e*otti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS. g 200 Main Street• Hyannis, MA 02601 '6 39 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MA'S pp Business Name: �- n-e- -� Prot e-t v-c. lfoc-", S Date: z Z b Location/Mailing Address: qi:: Qv.v�o.� wit rtrl!S Contact Name/Phone: o-. -7� -07/ 7y- - /fop Inventory Total Amount: 'V h ad MSDS: Eli- o,n.1�wL License#: -1�16 I> n Tier II : I'AA Labeling: Spill Plan: o o Oil/WaterSeparator: RA Floor Drains: 0 L? Emergency Numbers: 1k Storage Areas/Tanks: - av vwl5 — ���i�-�' a a< I cif G�w�a�,n�,�-S a v1 o`AvkL Emer enc /Containment Eaqup ent: { A\]".Aabte, Waste Generator ID: f Waste Product: Woti,o,I iw Fl5-1:- Date&Amount of Last S ipment/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 S 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 G 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 :ZV Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables 51, 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: N.FORMATION RECOMMENDATION o G a ka 5 IV. �t, .erg S•-1 10 to PI&% -- av,A P,e k Iv,, S V,o� � � ( e"e�'o►n e� Inspector: \—�t Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p INE r Town of Barnstable Office:508-862-4644 °� Public Health Division Fax:508-790-6304 •1BARNSTABLE. \ ,„ASS. 200 Main Street• Hyannis, MA 02601 ��Fo3y TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: - Date: 6 i8 I Location/Mailing Address: 3-7 715y4ykiao L IU 19 n1 S an , Contact Name/Phone: -•7-7 - Oe? Inventory Total Amount: �� MSDS: US License#: iJ Tier II : Q 9 Labeling: 0 Spill Plan: Oil/Water Separator: W A Floor Drains: MO Emergency Numbers: ©2c� Storage Areas/Tanks: Emer enc /Containment E ui ment: Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc 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: A-' o ✓ i 0 V< < Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS >�/� / TOWN OF BARNSTABLE Date: /5 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: QPI 4! C6 BUSINESS LOCATION: AI r INVENTORY rt MAILING ADDRESS:229 CV4A1V0UeN AQA,0A1>J-,r A /)�&A 0260� TOTAL AMOUNT: r,z 14 TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: aA%�/A1, fiU/1/1�� lpJ INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: LZA Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes I -�S b hp �If ry stain removers Laundry soil & in (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash �e� // WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS plican ' Signature Staff's Initials &4z4w i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certific tes [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you p rmission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town C erk's Office,"!st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: B Fill in please: APPLICANT' YOUR NAME/S: vt✓~ t ' BUSINESS YOUR HOME AD ESS: �'t@ GsY. lnf,r� awe 'L1A TELEPHONE # Home Telephone Number ,0 i NAME.OF.CORPORATION: NAME OF NEW BUSINESS v. TYPE OF BUSINESS IS,THISA:HOME,OGCUPATION? O ADDRESS OF SUSINESS J Okad MAP/PARCEL NUMBER [Assessing] When starting a new business there are several things you must do in order to be in comIpliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may needl You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make.sure you h ve the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER OF C This individ al h e n i`nf- m fa y p r it re uirements that pertain to this type of business. I c Au orized$ign re** Y � _ I 2. BOARD OF HEAL This individual has!b en inform d f the uire ents that pertain to this pe of business. __ s� MUs c t w1,TH ALL Authorized Signat re** `HAZARDOUS MATERIALS REGULAtT1�f1�IS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING A THORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signet ire** COMMENTS: Dater TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: (, ,. DtA b,,,.Y BUSINESS LOCATION: J-J)c,. - G 11A 0il INVENTORY MAILING ADDRESS: ca �1�n.� TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: A1�. EMERGENCY CONTACT TELEPHONE NUMBER: y)3) 3")kj-J�Lj MSDS ON SITE? TYPE OF BUSINESS: ���11-- Aj.4A,Sns.rc„L), Yes INFORMATION / RECOMMENDATIONS: Fire District: s� Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: 13Ut\ 4L,, Licensed? Yes . No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) J( 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 n (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ppli nt's ignature Staff's Initials „;.. COPY Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: ALre. .s 15Axo id l� 4 BUSINESS LOCATION: .5_' t®l _ 'ja�1rL .MAILINGADDRESS: INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: �5'�3 -� � 0 — H S6 c� CONTACTPERSON: eve G vi EMERGENCY CONTACT TELEPHONE NUMBS FIDE Q(57�1� TYPEOFBUSINESS: S `r�� C=, '�1 , OTHER INFORMATION: l/ �i .c 0 � s eLAe_ , �, or? 54n Waste Transportamn: A� �'�.�►"�. Name of Hauler: Destination: Waste Product: Licensed? s No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides +"NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel.fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED Degreasers for engines and metal 2 5 Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car wakes and polishes Leather dyes Asphalt& roofing tar Fertilizers SPaints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc, carbon tetrachloride)- .Paint& varnish removers, deglossers Any other products with "poison” labels Paint brush cleaners Floor&furniture strippers (including chloroform, formaldehyde, hydrochloric acid, other acids) Metal polishes Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or.hazardous (please list): 2 Spot removers & cleaning fluids Misc.: (dry cleaners) Other cleaning solvents Bug and tar removers f Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: ArTees Island Designs Fax: — Corp Name: Mailing Address Location: 58 A Plant Rd.,4 Street: 58 A Plant Rd. mappar: City: Hyannis Contact: Steve Gayner,Admin.Or Patrick State: Ma Telephone: 508-790-4800 Zip: 02601 Emergency: Person Interviewed: Business Contact Letter Date: 4/20/2004 Category: Inventory Site Visit Date: 4/27/2004 ......... Type: Follow Up/Inspection Date: 91 public water ❑ indoor floor drains ❑ outdoor surface drains license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc currently licensed W town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ❑ on-site sewage ❑ indoor on-site syste ❑ date: ONVY ".outdoor onsite system ✓� REMARKS: Osha Certified.Water filtration system water. MSDS compliance: available will be tested before pumped to treatment plant. PPE Satisfactory available. Fire extinguisher serviced annually. Flame retardant cabinet for chemicals. Spill kit available. 4f24gn4 u-� u ntopi4orQnew 301W. Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials d❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more description: qty unitof,measure. ..; Media Carbon 35 gallons _._ Mineral Spirits jallons `jam- YYL __. ........................_....__..___ _ Adhesives 2cases Acetone 1quarts Inks 25;gallons -5?.v-4Ar cAew w1 IQ Waste Transporter G - Fire District: �"�/ �✓��'S II' Last HW Shipment Date Waste Hauler Licensed: vV �c�rtee� lI I Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: Location: 15_1F "q lala4l, Date: o Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): 2. Waste storage areas: e-J11' � _ 3. Satellite accumulation points throughout: k A 4. HazMat container storage area: 5. HazMat generation points: 6. Shipping and receiving areas: 7. Run down of shop activities: . �� 8. Housekeeping practices: kj/_A. ,� _ i HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs DBA: 5 fa-nol- .ns Location: 5-9 A Site visit date: ` -- 2-7- O L-/ • Hazardous Waste Manifests: • Employee training documentation: /Vr IA • Hazardous substance spill control and ontingency Ian: j�� (�v.56kC � • MSDS on site? L( e4z- • HazMat Inventory records (if applicable): • HazMat Shipping documentation: • Spill records (if applicable): /1i�j/4' &C-,:l cil-e-r/t 20 Printers A`�3 D OF -HEALTH � satisfactory 3. Auto Body Shops l / n O unsatisfactory- 4. Manufacturers COMPANY ( � (see"Orders") S. Retail Stores 6. Fuel Suppliers. ADDRESS ,�A A;� Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT-outdoors) Case lots Drums AbOveTanks Underground Tanks MAJOR MATERIALS IN UT K e Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, N2 (B) r Heavy Oils: a , ` I waste motor oil < new motor oil (C) transmission/hydraulic �( Synthetic Organics: A6 ® /� A� /a' j degreasers �� l , V / - /Y\ s5e N:isceilar.E�ai+�: [46ty 46 _ I�0 " DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supp>`y. Town,Sewer Public / /�✓� �� =��� On-site O Private c 3. Indoor Floor Drains: YES N0 _ -� 4 Holding tank: MDC O Catch basin/Dry well �u1 ul�l�� /, �;') l ,•` y. On-site system ✓ � j -- (50oa 4. Outdoor Surface drains:YES No 0o lbs MA1 f6 O Holding tank: MDC O Catch basin/Dry well O On-site system 6 F � 5' S Waste Transporter I� � �, fl f�(��J(� 7�C/ Q f0tf censed? Name of Hauler_ J Astination 070 1 © r - 12 23 it PezKson(s)&Interviewed Inspector Date r —.a ;. �:;, , = 7UX 1G 1�N!] Hp,ZAP�DOCIS F► - . . . , .,----•-- NA)•fE OF ..FIRki" U�Ie P� /�C:. Mail to: i,WILING. ADDRESS: �� (Zou � 13Z �j9�N./!If, HA .a2a.oV. Board of Health • . Town of Barnstable TELEPHONE NUMBER: ?'7'/'- 5(1 y l: . '. ,` . ' P.O.Box 534 .� y. Hyannis, MA. 02601 CONTACT PERSON: "2 ,L 'Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your•own use, in quantities' totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to -the Board of Health regardless of a YES or NO answer. Use the• enclosed envelope for your convenience.. If you answered 'DES above, please '.indicate if the materials are stored at a site other than your mailing; address: ADDRESS: �-e P1 4t j-7-- F"�t> 6+y0PAiS( tile,- TELEPHONE: _ LIST OF TOXIC AND HAZARDOUS MATERIALS The: Board of Heath has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 ag llons liquid volume or 25 ' ounds dry weight. Please put a check beside each product that you store.,r V0 tJ-'7"c»U.C_ Antifreeze (for gasline or coolant; systems) Refrigerants �Automat:ic transmission fluid.. Pesticides (:insecticides , Engine and Radiator flushes herbicides.rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils _ Printing Ink Gasoline, Jet fuel. Wood preservatives Diesel fuuel, Kerosene, #2 .heating oil (creosote) Other petroleum products: grease, . / Swimming Pool_ chlorine lubricants Lye or caustic soda Degreasers; for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) —" Fertilizers (if stored Rust•proofers outdoors) Car wash detergents PCB' s _ . Car waxes and polishes Asphalt & roofing- tar Other chlorinated -hydro- Paints, varnishes, stains, dyes Sa�U S carbons, (inc.carbon Paint and lacquer thinners `. :tetrachloride) � ' Any other products with Paint & Varnish removers, dleglossers; "poison" labels (including : Faint brush cAZiners > ' chlor formaldehyde, Floor . & Furniture strippers :..... '' f•:Jr': " ydrochloric aci ') other Metal polishes k. aci s Laundry soil & stain removers Other :products not listed including'bleach) ' ' r . which you feel may be Spot removers & .cleaning fluids (dry .cleaners ) ;�1;:' <' toxic or. hazardous (please Other' cleaning solvents ; ,.'; ' list®: Bug and tar .removers Household cleansers,. even cleaners Drain cleaners Toilet' cleaners Cesspool �l cleaners Disinfectants 'u Road Salt ' (Halite) I Q � A( S'7 9 4 (� PC) C&/z 671ctaro '77?1 cto2 yo ?(Js �-� d f bs -PC.,) d5S -TOWN ( Ir- [3TR �I H 't� pintnu CL'?L �: I:'FI3I 211C j�lil3 :3lHC1Uly� .c�.o . v • V Vl�, 1� �I �tisfacto r� 2. Printers BOARD OF H EA Lf H �' 3. Auto Body shops �s unsatisfactory- 4. " Manufacturers COMPANYLa�_ _.`, _ (see"Orders") S. Retail Stores ' 6. Fuel Suppliers ADDRESS '� :" ~T Class. 7. Miscellaneous 1 f r QU T TIES AND STORAGE (IN=indoors; OUT=outdoor ,t ase lots Drums AbOveTanks Undet roua�d Tanks MAJOR MATERIALS t g � J IN OUT IN IOUTI gellons.Age Test Fuels: ✓" Gasoline, Jet Fuel (A) .Diesel, Kerosene, N2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL RECLAMATION „ REW,RKS. G1. Sanitar Y Sewa a 2. Water Supply QTown Sewer Public - � ' 'On-site Private', 3. I door Floor Drains: YES N0-1 - v ' VA r`wJ' Holding tank: MDC `'� ` x t Y —� d" i O Catch basin/Dry well _ -- +� On-site system _...�-.-._...._. ..----- - - •-- ------ -- ,n 4. Outdoor Surface drains:YI:S NO �', " f O Holding- tank: MDC f -- - • OCatch basin/Dry �„4 _ __—_�__ � _-•_-- OOn-site system S. Waste Transporter Licensed? Name of Hauler_ •�stination -Vast Product - YES NO h erson s In rvi'ewea— >z za a t e Number y4\ Fee 1200 THE COMMONWEALTH (7F MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Polymers, Inc. DB "Line X Cape Cod" 58 Plant Road, Hyannis, ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 .Y ' Town of Barnstable Inspectional Services BARNSTABLE �FTNE lq`_ n,cxsrneL¢•cenEavnt.mlurt•rranNLs Q, Public Health Division 1639-.•L.iS'C#LS N'iLS• 39-,RLE•iFST Ba4N5T4BLE 2014 =�BAMSrABM s Thomas McKean, Director 1639 � C..' 200 Main Street, Hyannis,MA 02601 �7 1;7 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE' HAZARDOUS MATERIALS wd 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 L9lJ v*r 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 N 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/�TORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? V YES NO. 4. FULL NAME OF APPLICANT: _ C_C._wl, !S 1k\cs. 5. NAME OF ESTABLISHMENT: L7 5A13 6. ADDRESS OF ESTABLISHMENT: TGtytDjl 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS• 10. SOLEOWNER:IYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SAND PHONE# OF: 1 .�% CORPORATION NAME Pw('A 01 e C. A ,i ne e,Cod PRESIDENT nar TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Oblazoan Q:Wpplication Fonns\fiaz Mat Appli Draft Jan20l9.docx iL Number Fee 1200 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Polymers, Inc. D 'Line X Cape Cod" 58 Plant Road, Hyannis, 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 06/30/2020 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 Town of Barnstable ; Inspectional Services BARNSTABLE THE h.. tnr.MBILe•�.-a_•caurt•1-- -• Public Health Division "��"'"`5.°5�""•" a° M" :aas-m:a BARNSTABLE, ' Thomas McKean, Director fc �8.`°� 200 Main Street, Hyannis,MA 02601 �1 Office: 508-862-4644 Fax: 508-790-6304 rr n. -K APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 6; 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 3 0th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY! PERMIT 111 -499 Gallons: $125.00 S VST--chg4* 13&1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ J *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. a g y O?r 00l 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 • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: AD A M TAUFAL 5. NAME OF ESTABLISHMENT: Chi IfG p 0(1y )2 V-5 t NC , ChG L.._iAE°> 6n & 6. ADDRESS OF ESTABLISHMENT: a LA ki Q-1 y A N All j O�-�G J 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: n /' / 8. TELEPHONE NUMBER OF ESTABLISHMENT: `7-6-—0 / ,h I r 9. EMAIL ADDRESS: $ C',cn P-e. 0 d n Q! �c,in N)(10. SOLEOWNERYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPH NE#OF: CORPORATION AME PRESIDENT DAM TREASURER CLERK 1L 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT,/ DATE c d 1 Q:Wpplication Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1200 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Polymers, Inc. 4A "Line X Cape Cod" 58 Plant 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 a� DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health TRowunl of Unstable eg atory ervices Richard V. Scali, Director ] t►E rphy� luiftd.�.f� Public Health Division B TABLE ♦ 8/.HNSf,1olE.,�yf N LL CMIT.HY Js • mmsrABLE Thomas McKean Director NFRS�.�..�. 2014 S`PR''H'TS6 MASS. 7 �,rzn9-zoia '°revs a` 200 Main Street,Hyannis, MA 02601 �g i� Office: 508-862-4644 -do/6 Fax:�k8-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 0 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 X V-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. 1. ASSESSOR'S MAP AND PARCEL NO. I'VI K FA 10!gy(0� a 9 VO -26ZG C) 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 TORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? V YES NO. 4. FULL NAME OF APPLICANT: p-U A�C !ZA mc< 5. NAME OF ESTABLISHMENT: CAef CdD ?Cky ME9--41P44- jo Ljme,-X CA P4_ CVD 6. ADDRESS OF ESTABLISHMENT: ��R ?CA ikn &D HY A IAJII. NA 0a6a 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �57, _t7 o6.s -) 17 16 9. EMAIL ADDRESS: C UD n.0 o m A.-L - C 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME r A pL GO'D 20V M4,1t5, 4l C- PRESIDENT G AA-) 'SSA r 4X= TREASURER R A,1 CLERK A A,A oAf— 12...IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE QAApplication Forms\HAZMAT APP 2017 REVIS doc �J_�G� AA .�C Number Fee 1200 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Polymers, Inc. DB f"Line-X Cape Cod" 58 Plant 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 TROwA of B rnsxable eg atory ervices Richard V. Scali, Director Public Health Division BARNSTABLE • MSTONS Ml•-ilfENVILLE•l]7NR•"YFWM �... sAENgrABLE. = Thomas McKean, Director "^�°"s"'�i o;"% N5 "� MAS& ti ATEo a 200 Main Street;Hyannis MA 02601-- - --- -- ---— r Office: 508-862-4644 0 0/g Fax: 508-790-6304 :-'�_1 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 x V S 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 1. ASSESSOR'S MAP AND PARCEL NO. * PAizc%-.,110 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: ADA M SH 1A tfl 5. NAME OF ESTABLISHMENT: CA PC, COS &V W CSC• 6. ADDRESS OF ESTABLISHMENT: S--2i bL pir I� ���', f�r"1 S. G2Coo 1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: S2) t�19' ! ��' (5 �1V/ 9. EMAIL ADDRESS: 1 r p p x e-CxnCA 0\ 'I r Cc l� 10. SOLEOWNER:'�__YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME CA?@- GGT) p a(-yM C2'25, PRESIDENT AJ)A M c,;H(A AL �k TREASURER 1 N CLERK f2T-C4 F� 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE , �%�l�' _ Q:\Application FormsUiAZMAT APP 2017 REVISED.docx Number Fee 1240 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Luziettis Heavenly Pools Inc. 58 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 t, f Town of Barnstable �TNE row Regulatory Services Richard V. Scali, Director `"MMAR& $ Public Health Division BARNSTABLE 1659. �fD MAt A V 1639-2014 v Thomas McKean, Director \ � 3�g i.• 200 Main Street, Hyannis,MA.02601 a Office: 508 862 4644 Fax: 508-790-6304 y CA APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 �,L CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE ��I FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: k v z►4E" 'S �- ADDRESS OF ESTABLISHMENT: cJ MAILING ADDRESS(IF DIFFERENT): l ( 9 �o b-' V I e �4C. C-e.�L�e-^d a le il* 2 TELEPHONE NUMBER OF ESTABLISHMENT: O �- EMAIL ADDRESS:—/i.M tJ 'Z SOLE OWNER: V YES No IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: ' CORPORATION NAME PRESIDENT TREASURER < < CLERK C ' IF PREPARED BY OUTSIDE PARTY: • SI ATURE OF A LICANT Name: Company Address Telephone#: Email: Q:\Application FormS\HAZZAPP Revl6.docx Page 1 of 2