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HomeMy WebLinkAbout0137 PLEASANT STREET - HAZMAT 137 �124 ' �s�K� �fl-zmr�- 3a fie- �� �!v�"x�° `� - - - �— -- Number Fee 1257 THE COMMONWEALTH OF MASSACHUSETTS $126.00 Town of Barnstable Board of Health This is to Certify that Helen H.Offshore Fishing Corp. 137 Pleasant Street, Hyannis, MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ......•............................................................................................................................................................. Restrictions: .................................................................................................................................................................... r 'This license is granted in conformity with the Statutes and ordinances relating there to, t 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 Inspectional Services Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 APPLICATION FOR PERMIT TO STORE ANDIOR 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 ❑El / CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 C�' �d 5ti CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 0)h44V *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,SHIP 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. FUL NAME OF APPLI ANT: f 5. NAME OF ESTABLISHMENT: S�o,f e 6. ADDRESS OF-ESTABLISHMENT: 7. _MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5 0`0' -I ci o. 9. EMAIL ADDRESS: CPw,(1 10. SOLEOWNER: V YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: Q:\Application Forms\Haz Mat App Revised 09-10- .docx �' f CO ORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OFAPPLICA DATE G V MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. In addition, please mail the required fee amount. Please make the check payable to: Town of Barnstable. The check must be-mailed to the address listed_above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Q:\Application Forms\Haz Mat App Revised 09-10-18.docx MW I Number Fee 1257 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Helen H.Deep Sea Fishing 137 Pleasant Street, Hyannis, ALL 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.,CHD Director of Public Health V f t ig . Town of Barnstable 6%AIt A� oFt . Inspectional Services BARNSTABI,E PNtN5Tn8!E-�iiFi:::L'.:TL•r.'razixl' xW.SiCEi biLLS.GS'FF'f:LLE-a:5T8WJi.1.[cE Public Health Division ;39_2014 BARNgrABLE, Thomas McKean, Director 1639. cMn+a`• 200 Main Street, Hyannis, MA 02601 w ' Office: 508-862-4644 Fax: 508-790-6304 • -q APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS a 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 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ p *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3,r-*J oo- 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: Zweph "UGWML.VP�C 5. NAME OF ESTABLISHMENT: 2ken 1A 3)PvD �ea C8Da) 6. ADDRESS OF ESTABLISHMENT: 13"1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 502 - `79D Noteo 9. EMAIL ADDRESS: - 5�� 10. SOLEOWNER: VYES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT , TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Jc Q:\Application Forms\Jiaz Mat App Revised 09-1 18.docx COMPLETE •N COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A. Sig a re ■ Print your name and address on the reverse X ❑Agent . so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Receive by(P' ed Name) C. e of�ivery or on the front if space permits. Q' 1fCl 1. Arl. D. Is delivery address di erenf from-item 1 ❑ es ` If YES,enter delivery address below: ❑No ., MR. JOSEPH HUCKEMEYER ` HELEN H. FISHING 137 PLEASANT STREET HYANNIS, MA 02601 3.II II�III illl III II I II II II III II'I III II II I I III ❑dultt Signature uvice eRestricted Delivery ❑Registered Mai 0 Priority Mail l Restricted 9590 9402 4116 8092 9359 16 ertified Mail® Delivery ❑Certified Mail Restricted Delivery �=d'saeceipt for ❑Collect on Delivery 0 Collect on Delivery Restricted Delivery ❑Signature ConfirmationTm 2._A[ticle Number_(TCansfer_fr_om service_labell. t��l p Signature Confirmation 7008 3230 0002 5177 7974 ul Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 940h2A4116 8092 9359 16 United States •Sender:Please print your name,address,and ZIP+4®in this box" Postal Service �1 I Town of Barnstable 0011D Health Division 200 Main Street Hyannis, MA 02601 II .}LD:µ'�:—..—. ,ll�If�#: „ 1111'Iffl tl)III''!'IIlldI:t.l11flWIP,i ill ll'IIli I -- a N tr IN - ! s f a Postage $ "1ru 8�ti a Certified Fee n. f3 Return Receipt Fee s �> Here O (Endorsement Required) E:3 Restricted Delivery Fee O (Endorsement Required) — M fU Total Postage&Fees MR. JOSEPH HUCKEMEYER m Sent To HELEN H. FISHING " co 137 PLEASANT STREET o - ------------- o or PO apt."° HYANNIS, MA 02601 or PO Box N--o. ........I City,State,ZIP+4 Certified Mail Provides: n A mailing receipt © A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the. fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ra For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 NAME OF OF fEfl���` � }l..I 1 BAR 79808 TOWN OF ADDRESS {{OjFOFFEND R nc }(/)(+G'n rt0leV ) J 1 (Tr,F��1lI�� �, BARNSTABLE CITY,STAP�q,ZIP CODE dFTINGE►qIF, MVIMB REGISTRATION NUMBER H OFFENSE NANMASS. .k:. 1 p /y n n r y)�1/�) C� g /�/ +�f /' �J /`� 1 MASS. e + l o kt�'C-"" l+ �1 17 1� � �l..ft e_ I��°' ,q- V L' L� Tr� '.'/Y�- . ��+1.11%)� �j� d i67q•�Q /� i i �,/ � o FD MKS t,J'C kA�/t�r�00.5 t,AA4- r k+ ,}1 ac9�t`�. 11' V�1 )I^a �t C.P.t•1 , > TIME AND DATE OF VIOLATIppI. LOCATI N OF VIOLATION - W NOTICE OF P.M.)ON J _ Z, 20 1 SIGNATUHE,efENFOvIFGtPERS � f ENFORCI G��T, I J BADGE NO. N VIOLATION 0 OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X UJI ORDINANCE Unable to obtain signature of offender. < Date mailed THE NONCRIMINAL FINE FOR THIS OFFENSE IS S r(1 n v LU LU OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL 1 DISPOSITION WITH NO RESULTING CRIMINAL RECORD. N REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, < UJI before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Bamstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. a V)1 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST U NSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature SECTION ON DELIVERY COMPLETE THIS ■ Complete items 1,2,and 3. A. Si natu e 13 s Print your name and address on the reverse X Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Re c by(jFfinted Name) C. Dale of De ivery j or on the front if space permits. 44k T ? i. Article I D. Is delivery address different from item 1? O Yes If YES,enter delivery address below: ❑No JOE HUCKEMEYER � HELEN H. FISHING 137 PLEASANT STREET i HYANNIS, MA 02601� III'IIIII II I III I�I II I llil i I III II�l II l II I l ilk 0 dulresse t Sign ture e Restricted Delivery ❑Registered ce Type r MailRestricted 9590 9402 3759 8032 3749 20 rtified Mail® ,/q1 Delivery ❑Certified Mail Restricted Delivery IBlRetum Receipt for ❑Collect on Delivery II Merchandise 2. Article Number(Transfer from service lab eo _ ❑Collect on Delivery Restricted Delivery ©Signature confirmationTm "Tail ElSignature Confirmation 71' 5 17 3 " OD O 1 4987 919 lair Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530702-000-9053 Domestic Return Receipt USPS TRACKING# ���.�+tz`4'�-�;�-�`�,�`..•`�. F,isst-Giaas f��l Postage&Fees Paid All III III USPS Permit No.G-10 I 9590 9402 3759 8032 3749 20 I United States •Sender:Please print your name,address,and ZIP+40in this box' Postal Service TOWN OF BARNSTABLE PUBLIC HEALTH DIVISION 200 MAIN STREET HYANNIS, MA 02601 ' I ffr:l'lifl 'r11�11'if ���r�ferl�i' r#�Jir r t'I�rflli�l'fif�' ���lhi 11.. � y � Pn,�rr� ��� +ti,•fy, sue: ir N F ?. USE rD Certified Mail Fee Er Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ M ❑Retum Receipt(electronic) $ "t POStmlrk �.�i ❑CerltFled Mail ResWcted DelNery $ ,\_e Q ❑Adult Signature Required $ []Adult Signature Restricted Del ery$ ^•'t `�v� � mPostage B(, � ] Totai Postage and Fees JOE HUCKEMEYER $ HELEkH-FISHING � sent to 137 PLEASANT STREET C3 'Stieei andAp£E,UFF eox Mi r- HYANNIS, MA 02601 City,Sfate;ZIP+4® Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate •Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the j •A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service"' Restricted delivery service,which provides -r) for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. ry Important Reminders: Adult signature service,which requires the 1.1 •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age, International mail. and provides delivery to the addressee specified.3 ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agenta with Certified Mail service.However,the purchase (not available at retail). ,^ of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automaticagy included with accepted as legal proof of mailing,it should bear:al certain Priority Mail items. USPS postmark.If you would like a postmark on M •For an additional fee,and with a proper this Certified Mail receipt,please present your -, endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for !-n the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion.a of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply " You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, ,3 complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. Ps Forrn 3800,,Apai 2015(Reverse)PSN 7530-02-000-9047 NAME Of FENDER BAR 79803 TOWN QF .' ADOREF OFFENDER S (',t-- '.. �� t� 1 K.( t,.,y t ct.. CC tC. •�` BARNSTABLE CITY,STATE.ZIP CODE tNE TDB MVI MB REGISTRATION NUMBER OFFEW - a NAN\S1ANIk. '679+ t 1,�' 11 �✓ 'A �, J C fD IAA Q , }„ ''�yr.�1� YJ 1 Ci✓ i r�.. �' 1 f t +��l d«Y'�..•�-' j TIME AND DATE OF VIOLATIO LOCATI OF VIOLATION ✓ W NOTICE OF t 1) t�t� / P.M.)ON 20 l ��� !ish Ih VIOLATION SIGNATURE OF k111C *N t ENFOfJCIN�EPT� + � BADGE NO. LU O F TOWN f 1LIJ �r o HTREBY ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE ) J Unable to obta-r}s'gnatur of (fender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS S /✓9G�, 0Date mailed r w OR YOU HAVE THE FOLLOW G ALTEANATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD: N REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature f Town of Barnstable Barnstable Board of Health + 1ARNSTABU& " 200 Main Street, Hyannis MA 02601 O D MA6S. D MA'S A 2007 Paul J.Canniff,D.M.D. Office:508-862-4644 Donald A.Guadagnoli,M.D FAX: 508-740-6304 John T.Norman F.P.(Tom)Lee,P.E.,Alternate Certified Mail # 7008 3230 0002 5177 7974 December 26, 2018 BAR# 79808 NON-COMPLIANCE NOTICE MR. JOSEPH HUCKEMEYER HELEN H FISHING 137 PLEASANT ST HYANNIS,MA 02601 RE: Non-Compliance Notice and Ordinance Citation Hazardous Materials Storage/Use License Board of Health records indicate that you have not renewed your Hazardous Materials License in accordance with Town of Barnstable Code, Chapter 108, Section 6, Hazardous Materials. Your latest license expired on June 30, 2018. You have been cited and fined multiple times in the past and will continue to be cited and fined until your license is renewed and you become compliant. `- If you have any questions or would like to discuss this problem, please call Tim Lavelle, Hazardous Materials Specialist, at 508-862-4645. Failure to comply with an order of the Board of Health may result in future legal action against you. Per Order of the Board of Health Thomas A. McKean, RS, CHO, Agent Q:Wazmat\2018-TL\Hazmat license citation-Helen H Fishing 12262018.doc ► I ,,�,�, ►►� vex �Xaly� I IKE►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNnABLE. MASS. 200 Main Street• Hyannis, MA 02601 039. �'OlEDMo��`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: Location/Mailing Address: t -1 Pl n,4 vtr Contact Name/Phone: 02AioGlge- - 0 -066o Inventory Total Amount: q(�AA(+1 bm414)MSDS: Ya i w,444-All License#r7f - Tier II : N o Labelina: Spill Plan: m Oil/Water Separator: /J A Floor Drains: Emergency Numbers: 0` StorageAreas/Tanks: edw-Vk1o..w.c.w� Emergency/Containment Equipment: Waste Generator ID: M So g 7ryd Otto O Waste Product: 6>1 Date&Amount of Last Shipment/Frequency: _b /3 0/rlo { So 44,l 2-3 nie-5 , Licensed Waste Hauler&Destination: C V v,- D I 5 t,v j 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 rake fluid) Windshield wash Motor oils loX� ,- t'S jrifi-e, 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 `-I Battery acid (electrolyte)/batteries y 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: OJQoo< P� ww�o-1 o- a.�rQ\oa��t��erg,A- Q v L k'�.e��{ ORD RS: I m AA' 0-& b o. V&okj. ,a ,c.1 v.0- c,. 4- .s, Qvt i Dots \w. INFORMATION/RECOMMENDATIONS: ''G a.« -t b o \,c c,.�t car►.l0 ev.�a v��.e12, PDS'- 5 " I Lave e.l Inspector: -� u 1 Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS oFWE row Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 • BARMASS. 200 Main Street• Hyannis, MA 02601 �'OreDMP+�` TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 44 5�1 V14 Date: f Location/Mailing Address: I -7 avC g-4A 15 Contact Name/Phone: ed --7 D-0640 Inventory Total Amount: l I I a MSDS: �okb-4 14?-N License#: /JJA CJ t Tier I[ : N Labeling: Spill Plan: Oil/WaterSeparator: o Floor Drains: el - AV, Emergency Numbers: Storage Areas/7anks: kJAti il 1-1/0� 44) Emergency/Containment Equipment: v�0�4 CJ Covt�ca� 'b� �ah��o.� JQf-,-,wk5 Waste Generator ID: o Waste Product: 191 Date&Amount of Last Shipment/Frequency: D g /,-9- r Licensed Waste Hauler&Destination: v MAt Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS N 0 wlA-J vZ G6v�oytS I%A, �\A,JeV4Vt qbV,IG�S�- i lqg ovt , NOTE: Under the provisions of Ch. 111, Section 31, of the General Law of MA, hazardous m; terial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash V Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts 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: J p0 Q ` 1 <- S I"L y 04 d-�w a f, Inspector: • Facility Representative:— WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date:=4 TOWN OF BARNSTABLE � TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 1kt ev BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 13-1 TOTAL AMOUNT: TELEPHONE NUMBER: 5-0ib -7q D - 0L?l,0 G /11 Y..) o. s CONTACT PERSON: � w.c S ice.o�{�v►t. EMERGENCY CONTACT TELEPHONE NU BER:Jam- calk&)--7-76 8435""S'tSDS ON SITE? TYPE OF BUSINESS: fACk1,-k.e,,, %ke-e.�Cl 114y `d"a k-e—o10f,g INFORMATION / RECOMMENDATIONS: -Sam ko Mo,~. Y I�r' o� 1 Fire District: eal l ba S 6® tN, — ,M¢I 8`� �� Sri g o-, gU�v1 ��ofa�,,� , enc..a�,Qs �l.Cr�.Lc� CO+'tC(�c}i,S��IID°�) .F ,�fotec'�',ar�•!-�ew.. Llewu-rt'�'S `/� Waste Trans portatio : ,/MJSoP37900g,1 0 Last shipment of hazardous waste: y Name of Hauler: ��/w o-c��' 0,1. 10� � Destination: �'�- , /►/I,� Waste Product: O%e- e, 1 Licensed?(!& No �S081-3a3 7-7-7 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 Y AItifreeze (for gasoline or coolant systems) Miscellaneous Corrosive o; la's'��ydl NEW O ❑ USED Cesspool cleaners a ' o° .�-' Automatic transmission fluid Disinfectants o��c'� Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake id) Refrigerants �tA,v Motor Oils h�� kO �t'q~�'o W Pesticides dNEW'' USED,��j' Ste (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 Asphalts 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 L �I �QS'�.� v� � �w Go�`�ki yl✓k.�✓yI Laundry soil &stain removers (including bleach) ✓VI,AAk :5 ort, ato Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bugand tar removers , �1 �aS�2 fit � �t ` �dklG,, Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TOWN OF BARNSTABLE BAR-W 5139 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 0d4e Address of Offender MV/MB Reg.# Village/State/Zip Business Name ev,. o :off pm, on S I b 20 Business Address 31 P�Plt,3Q �Ji' Village/State/Zip 4 S ' gnature o nforcing Officer a.vt�1�� � D2(ool � Location of Offense Pelew g V%D cing Dept/Division Offense IA*, oyt5 - IDS-(0 t loge r c-/ "o- k4-'2r�s a yt-t p_'C"j Facts r��` J a. J o�l, t c,e v�� . �vfaQoo S�D r� o �a(-;e L;5 ".e_,', ajS LA)14' 00o r Co m-v%&xAA -• ova Iw!&-a,4_+e_1 I, Ol��►►tirl►G2Kkid 2KdC�u�/L This will serve only as a warning. At this time no legal c ion has been eaken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 5139 Ordinance or Regulation WARNING 'NOTICE Name of Offender/Manager .Address of Offender MV/MB Reg.# Village/State/Zip Business Name �2��V� CtSti►��01 Mo ,D06 /pm, on �)I b 20 I Business Address � 3� ��ea, avt i -� \ ✓lit-1 S\ignature oj�.Fnforcing Officer Village/State/Zip 0 ay A),5 , ©2.("6 1 \ 1 Location of Offense H \1 f Enforcing( Dept i/Division Offense V,D I a�.' &%4 5 - J M3"(+ 00-5 • �fa � x -,za c4Ls Yu4 44-0-Ir l . Facts LJAT ,&J� Al \j C,t t5[ 11 C,P Vk-,', • OILVOCI<4,t 41�c. o� (�k Za r;ey5 ✓LtG�c���•al S LA), `fM0,� Co At eA, vt. ovt-- �,4 7Vv-A wt vv,eV,a4e_1v, 44e,i t lice)f�k_b,j41,��ccly� This will serve only as a warning. At, this time no legal action has been oaken. . It ' is the goal of Town agencies to achieve voluntary compliance of Town' Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance'., Subsequent violations will result in appropriate legal action by the Town. ;10. s WHITE-OFFENDER CANARY-ORD./REG.-FROG. PINK-ENFORCING,OFFICER.; GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 5139 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager r + rAddress of Offender MV/MB Reg.# Village/State/Zip Business Name 0A'v. Iy u ) lrs' :?O am/pm, on 20 tf� Business Address Signature of.Enforcing Officer Village/State/Zip -2("31 Location of Offense f %ly V w- 1 Enforcing Dept/Division Offense V1r)kJ1 ? V"; ^r . 1 t In �, < , � !,� ;�- x r• , Facts yl'r 1l(i^ � ( •7� t C1 �r 's *'!:`N �' s v' 1 s , � (s .„ W' -i''i�U� � �. � ..� YIV�'.k.dl`�'• Y"l �V{... (JIa 7kt�lT t✓ �"•1(� p1•i 't�.f'.�'r/. �i�J'��l� �I!''s1f;`.t /.��Ji^;� � ;� � This will serve only as a warning. At this time no legal action has been taken. -�It is the goal of Town agencies to achieve \.voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. ,�,r. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. \ r TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ;Address of Offender MV/MB Reg.# Y Village/State/Zip Business Name ; - ► am/pm, on r,f' 20_'" Business Address + -- ` Signature ofEnforcing Officer Village/State/Zip r Location of Offense y Enforcing Dept/Division Offense •Facts This will serve only as a warning. At this time no legal action has been taken. t " is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING O 10Ew GOLD-ENFORCING DEPT. Number Fee 1257 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable — Board of Health fl This is to Certify that Helen H. Offshore Fishing Corp. 137 Pleasant Street, Hyannis, MA 4 Is Hereby Granted a License I 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 '�ow�, of B�nstable eg lu atory ervices Richard V. Scali,Director 1NE T Public Health Division BARNSTABLE Y ! g42YS•ABL•CRl1@Yft:E•CUiVts•NIActi15 anarMBM Thomas McKean, Director 1639-2014.15 e.aMict Eo 639. 0. 200 Main Street,Hyannis,NIA 02601 575 Office: 508-862-4644 00-7 _a Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑, CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 p60 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 I *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 • ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS) ? YES NO. 4. FULL NAME OF APPLICANT: La`'C(-7A/k4, R (/� W1 5. NAME OF ESTABLISHMENT: Y l 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 0(0(0 9. EMAIL ADDRESS: _Mg&r-,,e 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: I NAME: TELEPHONE#: . COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T k DATE U 2 I I C:\Users\Decolhk\AppData\Local\Microsoft\ Intemet Files ontent.Outlook\BMQD49 \HAZ T APP 2017 REVISED.docx Number Fee 1257 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable : Board of Health This is to Certify that Helen H. Offshore Fishing Corp. 137Pleasant Street, 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 i Town of Barnstable �TME Regulatory Services Richard V. Scali,Director `ASS.M ' Public Health Division BAMSTABLE 1 639 MCIS a%"s°eew eCOxW a IMF �fOMA�a Thomas McKean,Director 1679-FOla .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 PERiv1IT(RUNS JULY 1 st-JUNE 30th). 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 pUyment is not received bey 1st ld �'�6 ASSESSORS MAP AND PARCEL NO. o1-I31{GJ DATE FULL NAME OF APPLICANT: f NAME OF ESTABLISHMENT: �kf.\ec--, C)gs!��oce_ vs\'r\yngk Corp ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: Ckn - 0 to tQ 0 EMAIL ADDRESS: fie.\P1\�(1h���n�j 1 eaukkoo k an M SOLE OWNER: _X_YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME \r�p 5} $--1qa-e*61 PRESIDENT CeNcps-jA 0 a Los a TREASURER 50T-'nc,-7455 CLERK IF PREPARED BY OUTSIDE PARTY: G ATURE LI ANT Name: Company Address : r Telephone#: Email: C:\Temp\HAZZAPP Rev I6.docx Page 1 of SECTIONSENDER'COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete Items 1,2,and 3. A Signatur t s Print your name and address on the reverse X L ❑Agent so that we can return the card to you. ■ Attach this card to the back of the mailpiece, B. eiv y(Printed N e; C. U e rdry or on the front if space permits. _ D. Is delivery address different from item ? 10 Ye ATTN: JOE HUCKEMEYER If YES,enter delivery address below: ❑No HELEN H. FISHING 137 PLEASANT STREET HYANNIS, MA 02601 !ll I IIIIII I'll 111l ll I I I)Il l III 1111 llli II II I III 3, Service Type ❑Priority Mail sC� ! ❑Adult Signature ❑Registered MailTm aiIT^+ ❑Adult Signature Restricted Delivery �Registered Mail Restricted 9590 9402 4116 8092 9362 96 rufied Mall® Delivery Certified Mail Restricted Delivery etum Receipt for ❑Collect on Delivery Merchandise r�nrricia M mhar/Traacfer from_sarviceJabe4 _ ❑Collect on Delivery Restricted Delivery Signature ConfirrnationT" `I ��I ❑Signature Confirmation 7 01`5 11 j7 3-d i 0 0 0114 99 d'16'6 0'9 s -I I A it Restricted Delivery Restricted Delivery 10) 1--PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt„ First-Class Mail Postage&Fees Paid USPS Permit No.G-10 i 1' 9590 9402 4116 8092 9362 96 United States •Sender:Please print your name,address,and ZIP+411 in this box* Postal Service 001M Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 I 111iillifitiiililtiiiiq!11filld idf 1114'.,7!!!l1-111i1ii1i111.1 0 I . ', Er Certified Mail Fee Extra Services&Fees(check box,add fee as appropriate) Q��O f7 ❑Return Receipt(hardtop» $ % 5 2 rq i -Q ❑Return Receipt(electronic) $ �-- Postmark. tT C ❑Certified Mall Restricted Delivery $ r ( 'Here O []Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage c� Total Postage and Fees 5� A� '� r-qATTN: JOE HUCKE�IVfEYER $ HELEN H. FISHING u1 Sent To � 137 PLEASANT STREET $Meet and Apt.IVo.,or B... m HYANNIS, MA 02601 Ciry,State,ZIP+4® 7 REM Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail taboo. for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this U delivery. USPS®-postmarked Certified Mail receipt to the... ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: P -Adult signature service,which requires the -„ ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age, international mail. and provides delivery to the addressee specified-j •Insurance coverage is notavailabie for purchase by name,or to the addressee's authorized agent 3 with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing,it should bear a, certain Priority Mail items. , USPS postmark If you would like a postmark on^T •For an additional fee,and with a proper this Certified Mail receipt,please present your , endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipients signature), of this label,affix it to the mailpiece,apply -� You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version:For a hardcopy return receipt, _ complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save Uft receipt for your records. Ps Form 3800,Apra 2oh5(Reverse)PSN 7530-02.0006047 h' TOWN OF BARNSTABLE BAR -W �(� , Ordinance or Regulation --��` WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip Business Name 4 ye t- � t on tam/pm.; on 7 '�f 20 1 - Business Address -2 - ��`� -- Signatbre/of Enforcing Officer Village/State/Zip ``1 # f�' n-2-jk j Location of Offense 14. 1 EK ' j t2`U�a We, 1 Enforcing Dept/Division Offense rX�-vt Mrn FCC a�� M r� c-fi /I c2y(`e . � + y �� � o�. r ► Facts �.vr tf�`t -� , Q ytl�-��, � �G2�t�' - tft1,' ' t�t+. bL,s I'V ' r This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts.and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate_legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD- ENFORCING DEPT. TOWN OF BARNSTABLE � Ordinance-or .Regulation BAR -W ... WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg._.# Village/State/Zip . Business Name am/pm; on Business Address Signature/of Enforcing Officer Village/State/Zip A)f rt�� t ��� '�-2- f _ Location of Offense Enforcing Dept/Division OffenseX FactsE>r - - 1�` - Is �t,tt1� �att1'�c 3cJ, t� S- v � . This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town.agencies to achieve voluntary compliance.of Town Ordinances, Rules and Regulations. Education efforts and warning notices'are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD.!REG.-PROG. PINK-ENFORCING OFFER GOLD-ENFORCING DEPT. NAME OMNDER BAD 7 8 7 4 5 TOWN OF ADDRESS OF OFFENDER IO 1►v< BARNSTABLE CITY,STATE,ZIP CODE �{rT ►Ok, MV/MR REGISTRATION NUMBER .%� OFFENSE .uss. �4,i rAO I 4 5 G v" V1Qk 7T ��'1.11�1 Ytr a 11F{_ �QLU ED MFk .;� ►�iGL'�'.a�(L� >LJ r t wi t t 1�1 �1 l�r1 c TIME AND DATE OF VIOLATI Z.? LOCATION OF VIOLATION W NOTICE OF :O C) 0M./ P.M.)ON !. � 20 16 J I? 4 �; VIOLATION " GN A T URE.OF FORCIN SOt{ ENFORCI GDEPT. BADGE NO. N T r OF TOWN I HEREBY ACKNOWL DGE RECEIPT OF CITATION X a ORDINANCE 1K] Unable to obtain Signature of offender. Date mailed ?_ a 1' THE NONCRIMINAL FINE FOR THIS OFFENSE IS = W OR YOU HAVE THE FOLLOWING IA TERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL 0- DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION T You ma elect to a the above fine,either b appearing In person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,lea holida s excepted, Q O Y pay Y PP g P Y 9 aY, 9 y p w before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, d (Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE ggDATE OFyTHIS NOTICE. this matter in a RRNSTABLE DIVISIONou desire to ,COURT COMPOUND,MAIINroceediSTREET,�BAR FIRST NSTABLE,Jo so by 02630,Attnn:21 request written Noncriminal RHeariICT ngs and encloURT se DEPARTMENT, of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature