HomeMy WebLinkAbout0082 RIDGEWOOD AVENUE - HAZMAT g� , �/Z�� -ate �-u-e-�
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Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
.--------------------------------------------------------------------------------------------------------------------------------
82 Ridgewood Avenue, Hyannis, MA
.....-------------------------------------------------------------------------------------------------------------------------------------------------------------------
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
i
Town of Barnstable
Inspectional Services BARNSTABLE
o�TME RiRMSTS NlE E!.'iFEV[LLF•CONK•fY<�%IS
Public -Health Division 1 'SH:�.639-2014 117�
1639-2014
• BAJWgrABM Thomas McKean, Director
bUm
p 39. 16 200 Main Street, Hyannis,MA 02601
NJ
Office: 508-862-4644 Fax: 508-790-6304 ham.''
Ar
2
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 - 1.1.1.—499 Gallons: _ $12.5,00 — -
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: �{�1�
5. NAME OF ESTABLISHMENT: ;�O/�E/(,�47oT072 611e O/f
6. ADDRESS OF ESTABLISHMENT:
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT. D. � �
9. EMAIL ADDRESS: Z&JlI ICE{ J Y� 60 C D
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS z z EMAIL:
SIGNATURE OF APPLIC N TE
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, 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 06/30/2020 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 BAB TABLE
OF THE Tp W N nee=.c-i vL:w ,rnxxr
Public Health Division �'°w°,5.
::il9yy772014
r • U N1
RARN ^BLE, ' Thomas McKean, Director
ti
1DrFo +a`0 200 Main Street, Hyannis,MA 02601 y
W
Office: 508-862-4644 Fax: 508-790-6304
�.7
y_.!
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ''
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS
GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS
MY 1 st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 5ZV81 Pc (
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charize of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: �/�= S
5. NAME OF ESTABLISIi'VIDNT: Zoxell&/1701--al2 C41C O�C4�G COx:�,
6. ADDRESS OF ESTABLISHMENT: 9_-��Z klgi G G�
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: ///g
9. EMAIL ADDRESS: ��//�/r/�Cf�.S� C�') Vl",!90 CDC
10. SOLEOWNER: YES NO W NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLIC DATE
Q:\Application Forms\Haz Mat App Revised 09-10-18.docx
i
ISE T° Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMs�Le.$ 200 Main Street• Hyannis, MA 02601
1659.
�prEOMP'�b`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: o<e i V"lo4or C'a.( a CQ CoGk' Date:
Location/Mailing Address: I 14 -ctiv%. S
Contact Name/Phone: -7-7 It t
Inventory Total Amount: AL SIDS: License#: -70 3 (A+2
Tier II : 00 Labeling: VV7 Spill Plan: 0 K
Oil/WaterSeparator: NJ Floor Drains: P Emergency Numbers:b _
Storage Areas/Tanks: l 01 1 <wv., w a e
Emergency/Containment Equipment: ,a e- t
Waste Generator ID: AA\/ 9-7-7DO Waste Product:
Date&Amount of Last Shipment/Frequency: (o 100 a al a
Licensed Waste Hauler&Destination: 4 w ov ka
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALStv� i VI�Z�/6�i S�VIC.Q, '�t5-�
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws df MA, hazardous mate ial use, I yt5 p ef �ov�
storage and disposal of 111 ga'lons or more requires a license from the Public Health Division. 1
Antifreeze Dry cleaning fluids
Automatic transmis3ion 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: v ' S5 veA o-< (e-Ga w✓ MR,h a t ovL C` IS i V'c1Z_
Inspector:
Facility Representativ . 4Y
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
°F1ME rokti Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARNSTABLE.
MASS. g, 200 Main Street• Hyannis, MA 02601
�1639.+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: L La.v i-)e- wC- Date: 6 $ /
Location/Mailing Address: SZ vsoo vi- q,vk vt%s
Contact Name/Phone: I-ov Co .s08 - o - '7
Inventory Total Amount: 4 °i�1 SDS: S1. `►ice- License#: �
Tier II : v Labelina: -A Spill Plan:
Oil/WaterSeparator: Floor Drains: EmercienckNumbers: �
Storage Areas/Tanks: 4 5L c1V4.S Mkvt.a! OLW byv�,k5
Emergency/Containment Equipment: _YQA-�g am,ti.�- m4~Zv%c-Vm n lo ,0-
Waste Generator ID: 0 1 Waste Product: MI A
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: n
LIST OF TOXIC AND HAZARDOUS MATERIALS N�IW"4V0V1 S vv�(�l J��S �tBr4o
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, vk 9 ��
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze Dry 9 cleanin fluids
Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (including brake fluid) Windshield wash
Motor oils Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOM NDATIONS:
b �a, 2s cA gttc�, Caµ.� o�c,l, Inspector:
Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARMAq . • 200 Main Street• Hyannis, MA 02601
1639.
TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 0116
Business Name: y-C L-av��ScQ �. Date:
Location/Mailing Address:
Contact Name/Phone: Loves Goe1 h.n �08-400--7 C e-lke Sob-Yoo - yy/6
Va`` Inventory Total mount: A, MSDS: 1�o - ko License#:
Tier II : a Labeling: 0A< Spill Plan:vto =
Oil/WaterSeparator: N Floor Drains: 0 o Emergency Numbers:
Storage Areas/Tanks: C,It to C\A w4,&�c pv\ ,k�e,
Emergency/Containment E ui ment: I, c &,%1
Waste Generator ID: Waste Product: a
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods: vwA-,-*-�
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
10 Hydraulic fluid (including brake fluid)%o 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: 2
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 S Lye or caustic soda
Lacquer thinners Miscellaneous Combustible 2 �efoso�s
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
'L 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:
IS v c , .)S
cm 11e�-r�ova- dZa 1 La
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARNSTABLE.
\\ MASS. $ 200 Main Street• Hyannis, MA 02601
'DtFD MP�6 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT q
Business Name: C L l Date: / �� (S—
Location/Mailing Address: o .tA/
Contact Name/Phone: Lev 5CoeJ - OD- r-Q el 6 08- Yoo
Inventory Total Amount: �< I� MSDS: ? License#:
Tier I[ : a Labelino: Spill Plan: AJ A
Oil/WaterSeparator: Floor Drains: Emergency Numbers: 4//
Storage Areas/Tanks: ( a CmK.fi�rcr,�.Fs �e o t� s tied ®f i rc. �o5c.-�'
Emergency/Containment Equip ent:
Waste Generator ID: WA Waste Product:
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze Dry cleaning fluids
Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (including brake fluid) Windshield wash
✓ Motor oils Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts ,boa/b
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 11de-A Lye or caustic soda
Lacquer thinners v 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: as-h,l c o
't wc..� w— v S m /
Inspector: 2VeJfP,
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, 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
f
TRoewil of B rnsxable
g atory ervices
THE Richard V. Scali, Director
Public Health Division
t BARNSTABE �{
9wxtvsrnar.E. : �' ��w6T SA-'+�n�staeE tT
Mass Thomas McKean, Director 1639-2014
('k.:•.
Y -
QED ,a 200 Main Street H anus MA 02GO1- - -- - ----- -
10
k..0
Office: 508-862-4644 Fax: 508-790-.66304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS °F
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 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 July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. 3-�,e -00/
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: z-
5. NAME OF ESTABLISHMENT: �Oe,616 l���r6W le/ Q� (/�/� G�
6. ADDRESS OF ESTABLISHMENT: F-2
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: Cog— 1/79— lk-
9. EMAIL ADDRESS:
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS 19 ,11 EMAIL:
SIGNATURE OF APPLIC DATE �20
Q\Application Forms\HAZMAT APP 2017 I ED.docx
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 111 - 499 gallons of Hazardous Materials.
-------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2018 unless sooner suspended or revoked.
----------------------------------------
PAUL J.CANNIFF,D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2017 JUNICHI SAWAYANAGI
THOMAS A:MCKEAN,R.S.,CHO
Director of Public Health
r' TRowr of Unstable
eg atory ervices
�t r Richard V. Scah, Director
o Public Health Division iA�M�T-_AVOWR
• BARNSTABLE. = Thomas McKean,Director 16 9'?a°<
9`6Aff 3,ts`�� 200 Main Street, Hyannis, MA 02601 �g
ol
Office: 508-862-4644 Fax: 508-790 C{304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER�08,
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 29.
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(6 �d
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: / az_5
5. NAME OF ESTABLISHMENT: '/7F(�rA�TZ CG9d� D �9�G�CD/�
6. ADDRESS OF ESTABLISHMENT: 92 eLzo( ae y 4,2 d(�� . �/Yr9r�rl1/S•;7�/� 0 6�
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
S. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS:
10. SOLEOWNER: Y YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS A EMAIL:
SIGNATURE OF APPLIC DATE
Q:
�Application Forms\HAZMAT APP 2017 VISED.docx
°FtNEr, Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
' BARNSTABLE
MSS. 0�, 200 Main Street• Hyannis, MA 02601
%6A\ S9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
FOMP�A
Business Name: Date: S
Location/Mailing Address: Z 91 vv'oOae. -5
Contact Name/Phone: v8-7 S-'I I
Inventory Total Amount: nJ 0'��'S MSDS: 2S License#:
Tier II : o I Labeling: Spill Plan: _f>yC
Oil/WaterSeparator: Nk Floor Drains: N' 0 Emergency Numbers: OK
Storage Areas/Tanks: VJ4.5 ,
Emergency/Containment E ui ment: e-
Waste Generator ID: 0%"1 1 Waste Product: o 1_,
Date&Amount of Last Shipment/Frequency: too
Licensed Waste Hauler&Destination: Cv,A- 1�1 1 -k-o.,g L��o�-/ M A
Other Waste Disposal Methods: et d au
LIST OF TOXIC AND HAZARDOUS MATERIALS ' a
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
V Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
�— Hydraulic fluid (including brake fluid) V 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 4 Lye or caustic soda
Lacquer thinners V Miscellaneous Combustible
Paint&varnish removers de lossers Leather g 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:
ORDER'S:
INFORMATION/RECOMMENDATIONS: O V S VV-S p( Ca,t.o
r
Inspector: L ex
Facility Representati
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
IME►okti Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BA MAs-; LE. • 200 Main Street• Hyannis, MA 02601
MASS.
�p i639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rF0 MPS a
Business Name: oce- P oI CAVII Ala Cady Date:
Location/Mailing Address: 82 Woo
Contact Name/Phone: A44.AC e 4
inventory Total Amount. /` �� MSDS: t5 License#: - 3
Tier II : NJ o Labeling: 600ey Spill Plan: 4 C
Oil/WaterSeparator: tj1A Floor Drains: Qv Emergency Numbers: '
Storage Areas/Tanks: w.t. w A.s te, r,
Emergency/Containment E ui m nt: t XQ 9� S A-, 4- 1
Waste Generator ID: 7 Waste Product: OI A VA,T<e�
Date&Amount of Last Shipment/Frequencv: 10 l 1
Licensed Waste Hauler&Destination: S24 KA
Other Waste Disposal Methods: 1
LIST OF TOXIC AND HAZARDOUS MATERIALS �O y�q� a! C1�0�vv` `� �v(, 1 V�V�2vvio��
NOTE: Under the provisions of Ch. 111, Section 31, of the Gelral Laws of MX�, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze 5S wagk 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 1ko tik9e 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: Clat Of o VIQ-5 0C
Inspector: ��-6��
Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, Hyannis, MA
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
--------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2016 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF, D.M.D.
07/01/2015 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
r J
j
Town of Barnstable
THE
° � Regulatory Services
F r
ti
Richard V. Scali, Director
`" MASS"M ' Public Health Division
v� 1639.
�FGMA�A Thomas McKean,Director ,.. .
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 :;;Fax: 508-790-6304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. $ 00,/ TE (p/ /5
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT ///�T� i� Z�jI ,S
NAME OF ESTABLISHMENT _ Aofglkl IZ7K 6/Z
ADDRESS OF ESTABLISHMENT 0042 / • //�� /�/� 7
TELEPHONE NUMBER
SOLE OWNER: /YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
• IdN E OF APPLICANT
RESTRICTIONS: HOME ADDRESS
HOME TELEPHONE
C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP ReQ015.DOC
THE rod Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• RARMASS.. • 200 Main Street• Hyannis, MA 02601
t639.
o TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT c� 3�fc(
Business Name: Moe 641f d� CoJQ Date:
Location/Mailing Address: 2 P4 VJt .Q A e. -k"%h%5
Contact Name/Phone: ar So - - i I I.
Inventory Total Amount: MSDS: f1,7 License#: 703
Tier II : M D Labelin oo Spill Plan: 69k<
Oil/WaterSeparator: 00 Floor Drains: o Emergency Num rs: LS
Storage Areas/Tanks: 5 a1 Cvvk--S 2 00 A k&zse. - C�2�•�-�- 2,
Emergency/Containment Equipment: , oo eavt_
Waste Generator ID: MJ 1 11 -Waste roduct: Oike�
Date&Amount of Last Shipment/Frequency: (.AL ti
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS IJati k
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws Cf 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
yHydraulic fluid (including brake fluid) V 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: 00 tS J a o D
Inspecto ..�aw-Al e�
Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Date:12131 / l 3
TOWN OF BARNSTABLEg eGto�
TOXIC AND HAZARDOUS MATERIALS N FORM
NAME OF BUSINESS: }"o --e b7w MD+2>I Car X Coc
BUSINESS LOCATION: $2 Q,&+ 8.44 ►CIve_ , 4yAV1V11 5 INVENTORY
MAILING ADDRESS: _S�twt� TOTAL AMOUNT-
TELEPHONE NUMBER: S08- -7?8- 11/ S
CONTACT PERSON: Kt-f-k [4a)�eS
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE?
TYPE OF BUSINESS: \/ClNi e- ye
INFORMATION / RECOMMENDATIONS: ��_ �,rT��a��r o rgk�, �er,P Fire District:
ko eo l.a I sv g HYgy1,)ls
Waste Last shipment of hazardous waste: 1
Name of Hauler: C yh oil Destination: CY- of/, o,z, Mil-
Waste Product: Wagt� 6>1 Licensed 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
A:�Tfeeze (forrine or coolant systems) Miscellaneous Corrosive
3EW SEDSS' Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
2 Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
C(NEW 1.5' O/USED Ida (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
10 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
Laundry soil &stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
'L Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, MA 02601
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
----------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires June 30, 2008 unless sooner suspended or revoked.
---------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
SUMNER KAUFMAN,M.S.P.H.
7/20/2007 PAUL J. CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
1 Public Health Division
i63g, 10�
Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. 4'el0~6)61 DATE /— 3 0
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE
THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT 9MK 51 f�i9IF S'
NAME OF ESTABLISHMENT S /GW M��o/C CAI i� OFi� CO,I�-
ADDRESS OF ESTABLISHMENT 9lAlr6?.1",0
TELEPHONE NUMBER
SOLE OWNER:_XYES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
-4114
GNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS YOV11f`/<
HOME TELEPHONE 36
���• a �'+ r � +� aJ
>3r Z Spill Contingency Plan..
Mark S Hayes
Foreign Motor Caro
82 Ridgewood Avenue , }
Hyannis, MA 02601 t`
t a4 >
(508) 778-1118
,May 2, 2005
A.
t
'' �r', -;1) Evacuate tlie.immediate area if necessary.
r2) Shut-off main electrical breakers, heating system and:, it compression Lump. , T
� f
4 3) Remove or restrict any potential ignition Source frorll d le area if the material is
�tF flammable.
4
F, ) Contain the spill by the,use of boom coils, spill pillow:> and Ab Sol,belll 111.1tC1'lal, , r,�• +l, , s�
�Sr* Contact Cyn Environmental Emergency Response at 7�'1-341-5108. ,
5) Notify appropriate agencies: Hyannis I"ire Department and Barnstable Board of -' {
r Health within one hour of detection of a release of haz u'clous nlatcrial.
{ 6) Remove all absorbed materials or-contained liquid and package in D.O.T.
approved containers. Package used absorbent material. separately from liquid.
7) Once the spill-has been,controlled and the materials'co lected and secure(l, inspect
the area for cleanliness and decontaminate all cclLllplll�nt used in the cleall up.
8) Replace all used material-'and ensure all response-equil�lnent is in good worsting
.
y order.
J j II }ry.
9) Manage and dispose of collected absorbents and liquids in accordance with the
t< state and federal guidelines
+r
V� 10)For any spill greater thaii:the reportable quantity or 25 Iallons, Whichever is less, r
�,
this plan shall be implenionted and proper records of�i pion shall be kept on site
,,ttia} lh as prescribed in Section'IX. a'
1 11)Emergency spill kit is located next to waste oil and us: l ants-h'cezc drums, Which `
are located near garage door entrance. 1�
t ;� 12)Drunls are labeled with the type of 111MIRIOLIS waste al; I the Start date of
ar
� rt�r�hrr accumulation.
13)The following is a list of the spill equipment on site: ;.
A. One emergency.spill kit which contains 3 univ�IIrsal boons coils; 6 spill s r'
1p5 ry,4` pillows, 1 bag of absorbent material, 1 pair of'cllcnucal splash toggles, 1
r e, I
,, ti •', pair of extra large.pullover boots, 1 pair of extra large chemical resistant
; k gloves, l hazardous waste label. 1 non hazardous waste label, I hazardous
c,�!�0 tI �P
y Waste disposal bag and l lieavy duty apron.
B. First aid kit:
L' •.:z _ C. Eyewash. ,
4 D. Tire extinguishers,,,
`
7 r
t
4"
Number Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $100.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, Hyannis,MA 02601
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
- ---------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------- -------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires June 30, 2009 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER, M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.D.
07/01/08 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
f
Town of Barnstable
Barnstable
Regulatory Services Department
p ericaC-
nnwvsrast.E,
• Public Health Division
9 ems. Public
Main Street Hyannis MA 02601039.
�m
�Fv MA't" 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. DATEr
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT
NAME OF ESTABLISHMENTD� ��ti
ADDRESS OF ESTABLISHMENT
TELEPHONE NUMBER
SOLE OWNER:—�/YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS C F ALLY
PARTNERS:
to w
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ry
cn M
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK
SIGNATURE OF APPLICANT
RESTRICTIONS: HOME ADDRESS-4 'OWIAi2p 'ow''
HOME TELEPHONE#
a
Q:\Hazmat\Haz Mat Application2008.DOC
S ..
�l L
Spill Contingency Plan
Mark S Hayes
Foreign Motor Car 3
82 Ridgewood Avenue. -
- 3. ..
Hyannis, MA 02601 �Y
(508) 778-1118
,W
4 .Yee Lx
May 2, 2005 .
1) Evacuate the immediate area if necessary.
{ 2) ff main b system n electrical breakers, heating J� and dll'C011lpl'CSS1011 pump.
3) Remove or restrict any potential ignition source front `the area if the material is
w
flammable. .
4) Contain th6 spill by the use of boom coils, Spill pillows and absorbent material. r; ,
Contact Cyn Environmental Emergency Response at 781-341-5108.
5) Notify appropriate agencies: Hyannis l"ire Department and Barnstable Board of
Health within one hour of detection of a release of hazardous material.
6) Remove all absorbed materials or contained liquid and package in D.O.T.
approved containers. Package used absorbent materials separately from liquid.
7) Once the spill has been controlled and the materials collected and secured, inspect
the area for cleanliness and decontaminate all equipnlerlt Used in the clean up.
8) Replace all used material and ensure all response equip►ilent is in good working
order.
9) Manage and dispose of collected absorbents and liquids in accordance with the
state and federal guidelines.
10)For any spill greater than the reportable quantity or 25,gallons, whichever is less,
this plan shall be implemented and proper records of action shall be kept on site
as prescribed in Section IX.
11)Emergency spill kit is located next to waste oil and used anti-freeze drums, which
are located near garage door entrance.
12)Drums are labeled with the type of hazardous -waste and the start date of
accumulation.
13)The following is a list of the spill equipment on site:
A. One emergency spill kit which contains 3 universal boom coils, 6 spill
pillows, 1 bag of absorbent material, 1 pair Of chemical splash goggles, 1
pair of extra large pullover boots, I pair of extra large clemical resistant
gloves, 1 hazardous waste label. 1 non hazardOt1S Nwaste label. 1 hazardous
waste disposal bag and 1 heavy duty apron.
B. First aid kit.
C. Eyewash.
D. Fire extinguishers.
9
Number
Fee
703 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00
Town of Barnstable
Board of Health
This is to Certify that Foreign Motor Car of Cape Cod
82 Ridgewood Avenue, MA 02601
Is Hereby Granted a License
FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS.
------------------------------- ------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires June 30, 2007 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
SUMNER KAUFMAN,M.S.P.H.
June 27, 2006 PAUL J. CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
r
6
t; Town of Barnstable
O*'THE Tph, Regulatory Services
ti os Thomas F. Geiler,Director y���� I�I,
BARNSTABEE, Public Health Division
3
9� 16 ,0� _ ..
Thomas McKean,Director
200 Main Street; Hyannis, N1A 02601
Office:..508-862-4644 w _ Fax:.508-790-6304 -
Application Fee: $100.00
ASSESSORS MAP AND PARCEL NO. 522 21�0:- DOl DATE Z 2j— O �v
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN
111 GALLONS OF HAZARDOUS MATERIALS
FULL NAME OF APPLICANT ///i�/� _ S. lll yG- -
NAME OF ESTABLISHMENT 7a-/2 OW J� CW/ic CO
ADDRESS OF ESTABLISHMENT k2 pC� 1 ."O�4G/�. IIIV4 fI'?Ils. /V O2(o C)/"
TELEPHONE NUMBER
SOLE OWNER:_ YES NO
IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL
PARTNERS:
NJ _
IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ---LQ rr,
STATE OF INCORPORATION
FULL NAME AND HOME ADDRESS OF:
PRESIDENT
TREASURER
CLERK %
/W Z114 6
SIGMA OF P ICANT
RESTRICTIONS: HOME ADDRESS J-Olylme leig
HOME TELEPHONE# ` D - �12/- 1 9 pZ(0 3 Z
Q:\Application Forms\HAZAPP.DOC
x N
MAIL-IN REQUESTS
Please mail the completed application form to the address below. Also include a copy of your
contingency plan (to handle hazardous waste spills,.etc). In addition, please include the required
fee of$100. 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. Also, please fax us a
copy of your contingency plan (to handle hazardous waste spills, etc).. In addition, please mail the
required fee amount of$100.00. 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
{
Back to Main Public Health Division Page
Q:\Application Forms\HAZAPP.DOC
,A.'S�-ak��•„i�.t,,�.„��,� '>r� i {�'.Sr��s.r�q'��`I,. a,�s`� ��'k �x,s. .Ik • ��t,'`',��n. k .
Contingency.Plan
lVlark S;Hayes' } ;
Foreign IVlotot Cai
82 Rid ewood Avenue
Hyannis MA 02601 .
, # x �r � ,t 508 Z78 111.8
•�"- `i��"0 s k1rTf'4r .fr a���(r .�d� •.� i ,fi'
y
�
�riyty''',a We ✓s ,.•r q t j
t 7 y� 'n•�{ � ,!Y.+'�" s �„' �'3r r},F .'. R,au ..,... f r
p ,=Evacuate the immediate area if necessary ! 3 i
Shu>t,.off'mairi electrical brea 'C01)CCS5101 Pcul1p.kers, heating system and 11
s
r35Remove or restrictany potentiaTnignition source from she area if the material is
:flatniliable:
4) Contain the spill by the irk of boon co►Is spill pill and absoroel:t material
f Contact C i `Eilvironmertal Ener eric Response at.2 S 1-341-5105. = '
5) :Notify"appropriate agencies Hyannis l"ire'Departmen't and Barnstable Board of
3-1
tJ Health:within one`hour of detection of a release of 11a7 u'cfous material. a `�
Remove all absorbed materials qr contained liquid and package in D.O.T. e *`
approved containers Package used iibsoibet�t material, sepal•ately from liquid.k {
h 7) Once the spill has been controlled and the nuiteri ls co Iect&l and secured, ins sect
� r � xLeh the area for cleanliness and 1 decontari"hiateall"equipnir cit used in`ille clean up.' E k
s8) Replace all used mate ria,P,and ensuie=all response ecluil.'ment is in good working
order: .Y fr <
'< T *t ) b .p
> _ x 9 Manage and dis ,ose of collected absorbents and liquid in accordance. with the.
state and -federal'gUidellimb }' ° ,
u <
�'�"I 10)For any spill'g"reater thaiYthe reportable quantity or 25 gallons ��Ilichcver is less
u . I { , ,
this plan shall be implemented and proper records of action shall be kept on `A
x 'as prescribed ir1:Sectroii°TX x� Y,f SJ
d FF Y 11)Emerge
shill kit is located next to waste oil and us�'d anti freeze drums w a ' Kr ,
are located near garage door.entrdncc l
12)Drums are labeled with tire,type4ot haiarclous \'vaste air I the start(liitc ul'
accumulation ' f { N
y U Y
rt - 13)The following is a list bu-je spill equipinc,ilt on site:
A. .Oire emergencylspill left"which contains 3 universal boom coils, 6 spill x{.
v `3tr pillows, 1 b1g of absorbent material, l pair of c�lcmical sj�lash goggles, 1 `; t ,,
r. 2 air of extra lar e"' allover boots '1' air of ext 7 s t *"
p I i large chemical resistant
q t.
Eli'
€ , gloves,"1 hazardous waste label, 1 non Ila7ardci'Is waste label, 1 hazardous , 175
y , } waste dis osal ba 1 and lheav clotY
'
p )• apron.
' B: l,ir st aid kit
rxai r :r, 4 )
f � C
Eyewash'-1z
e extinguishers yk > JR «>
' h F
•r�a�
a � Y
'WO
+
4 rt d
! {�
3 r.
.
1
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory
BOARD OF HEALTH 2.Printers3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY �/�ilt `�/ 1/ ��Lxe (see"Orders") 5.Retail Stores
'�: '� 6.Fuel Suppliers
ADDRESSf�'l Cl d sf��l.U�12� / Class: 7.Miscellaneous
//''AX�tl QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSUndergroundove
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECI.AMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer OPublic
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank: MDC
0 Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
0 Holding tank:MDC
0 Catch basin/Dry well
O On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
Person (s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH 0 satisfactory 2.Printers
Shops
O unsatisfactory_ 4.Manufacturers
COMPANY f j ,,. �y ,. (see"Orders") 5.Retail Stores
�y 6.Fuel Suppliers
ADD RESS�'� � ,W xwfi'I�� 7 � Class: 7.Miscellaneous
r
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
'I
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer OPublic
O On-site OPrivate
t
3. Indoor Floor Drains YES NO
O Holding;tank:MDC 4
O Catch basin/Dry well
O On-site system,4. Outdoor Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2. '
Person(s) Interviewed ;` Inspector Date
TOXIC AND HAZARDOUS MATE RIALS"REG I TRAT ION FORM
� trb �-v Mail To:
NAME OF, BUSINESS:)%b4,.,/, •1 / +d-r417 Board of Health
z
MAILING ADDRESS: 4eX Town of Barnstable
TELEPHONE NUMBER: (�C p- & S'� �- ,So 6 P.O. Box 534
CONTACT PERSON: Hyannis, MA 02601
materials li I w Does our firm store an of the toxic or hazardous listed below, either for sale or for
� y Y ,
your own use, in gyaptities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES V 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 YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be registered,v#i-:em r- :�n q rti lki� t=z t = lint id
Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel ✓ Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
r/ Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Batter acid (electrolyte) Wood preservatives creosote
Y ( Y ) P (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
r
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers tither chlorinated hydrocarbons,
Paint brush cleaners (inc. carbo6 tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
I
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
' .satisfactory 3 2.Printers t BOARD OF HEALTH . ody Shops
O unsatisfactory- 4.Manufacturers
COMPANY ZIqllj c-E'�r�t.��s_ (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS ' 0 Class: 7.Miscellaneous
�atis� QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIA SUndergroundove Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B) 4/�
`
Heavy Oils: ,r
waste motor oil (C)
new motor oil(C)
transmission/hulic<'= 1ju y
Synthetic OrganicsIrz,
degreasers cu
v "V5
Miscellaneous:
146
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply Z'
O Town Sewer JVPublic r'
O On-site OPrivate
3. Indoor Floor Drains YES—LINO
Holding n _
O d g tank:MDC
0 Catch basin/Dry well ' 5 3
O On-site system
4. Outdoor Surface drains:YES NO /� ORDERS: {
0 Holding tank: MDC Vlkefi,
O Catch basin/Dry well _
O On-site systems
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
2.
u -a)"1 , '
Pers i(s) Int ewed Inspector Date
�I
F I
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORMV� r��" '-
NAME OF FIRM: ®1 e 6r3 nn c7
MAILING ADDRESS: 6®X y's '/Y,"""is
TELEPHONE NUMBER: 2 X5--/ 6Y3
CONTACT PERSON: 12/c h/7n0 E 6"1/10
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 YES above, please indicate if the materials are stored at a
site other than your mailing address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AMY HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic
i
or hazardous characteristics and must be registered when stored in quantities �.
-totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put
a check beside each product that you store:
' CS Antifreeze (for gasline or coot"d- t" systems ) Refrigerants
�5 Automatic transmission fluid ;$ Stcides (insecticides
Engine and Radiator flushes ' i
Hydraulic fluid (including brake fluid) her bicides,rodenticides)
z-s Motor oils/waste oils IMF
hotochemicals
es :Printing Ink
Gasoline, Jet fuel �
Diesel fuel, Kerosene, heating oil -mood preservatives
Other petroleum (creosote) I.
P products: grease, "' swimming Pool chlorine f lubricants g
gives for and metal
Degreasers De en Lye or caustic soda
.� g
Degreasers for driveways & garages Jewelry cleaners
Battery acid (electrolyte) Leather dyes
-- _ Rustproofers Fertilizers (if stored
�VCS Car wash detergents outdoors) i
Car waxes and polishes PCB' s `
Asphalt & roofing tar Other chlorinated hydro-
Paints, varnishes, stains, dyes
carbons, (inc.carbon
Paint and lacquer thinners tetrachloride) i
Paint &. Varnish removers, deglossers Any other products with
Paint brush cleaners "Poison" labels (including
Floor & Furniture strippers chloroform, formaldehyde,
Metal polishes hydrochloric acid, other
Laundry soil & stain removers acids)
(including bleach) Other products not listed
Spot removers & cleaning fluids r�' which you feel may be
rr 0 toxic or hazardous (please
(dry cleaners) HEALTH DEPT. list) : s� i
Other cleaning solvents TOWN pF BARNSTABLE
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 1 4 1Q&1
Disinfectants
Road. Salt (Halite)
_TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
1
FIRM
ADDRESS
Major types of materials: 1) J' 2 �► �/
4) �'� 5) i}43 6)
I. Description of material(s) use:
II. Storage (denote product by number listed above)
A. Containers
metal 5
m glass paper plastic r
cans,bottles,jars
drums,barrels "�
aboveground tanks
underground tanks
bags,boxes
open,loose,uncovered -
inadequate labelling
B. Storage Facility Vor.# Remarks/Recommendations
1. Indoor
a) separate, contained room
b) stored- in general work area
i) inadequate ventilation
ii) . floor drains
iii) inadequate fire protection
2. Outdoor '�
a) uncovered, exposed to weather
b) pervious surface/catch basins , \i\ 1
III. Disposal •\ M Qa, or
A. Reclamation/Recycling unit
B. On-site disposal
1. Town sewer ✓ a�U pS1 e 0 Vn I�bW
2. Regular septic system f
Vat
3. Separate holding tank
C. Off-site disposals°t� h 0, Lj i YES '
1. hauled by own firm
2. hired.hauler
a) name of hauler
b) address or disposal site
Persons)) Interviewed — Inspector
Date - - - r- -'�F — - -
� 8AR
BARNSTABLE COUNTY HEALTH DEPARTMENT 1^9.
SUPERIOR COURT HOUSE
OJ ARNSTABLE, MASSACHUSETT 02630
ASO '� NONL aas-ate
Vrr. stt
DRINKING W LABORATORY PSIS
Client: MAhk Rnhinann Name of Ccllector: Mark Robinson
Sample Location: Dick. Beard's Chevrolet Affiliation: CCPFDC
MAnnig Time and date of collectiRn: July 3, 19$1
Type of Supply:
Date of Analysis: July 3, .1981
Parameter Sample Result Recommended Limits
Coliform Bacteria (organisms/ml) 0
pH 6.7
Iron (ppm) 2.0 0.3
RIR Mogen (ppm) .5 10
C-inductivity (micromhos/cm) 400 500
Water sample meets the recommended limits of all above tested parameters.
Water sample is drinkablo but harp higher than average livels of
This does not represent a health hazard but future monitoring is recommended.
Water sample is drinkable but may present aesthetic (staining, Actor, or taste)
pro)%I ms to users.
Water sample is of poor quality and is not recommended to be used for human
consumption.
Resampling and retesting is suggested.
Results only.
REMARKS:
cc: Mr.' John Kelly, Director
Barnstable Board of Health
cc:
Analyst:,
:•„ - - ,
y f,
Dick Beard's Garage
Drum containing liquid
Smell didn't indicate gasoline -or kerosene but smell could be from antifreeze;
suspecting ethylene g3�yc62 (BP. 7.1g8° C)
i) Boiling Point Investigation
125 ml of the (watery) liquid evaporated. and checking BP.
Result: no increase of BP. of 1000 C indicating no major presence of any
7,7 'r e e 2-e.,
i .) non-flammable
iii) spec. gravity check: 1.00 which excludes any major presence of low
or high boiling organic compound.
iv) the small residue from evaporating 125m11 0 the sample was dissolved
in C for 1'Q)test of ethylene glycol
r
Result: traces� of a hydrocarbon compound (not iaentified)
no probability of ethylene glycol presence
Pl. note: the above exp;oratory analysis was geared to' ethylene glycol
presence.
OWN OF-BARNsTAB �E ; _ V-
1 µ �, 2. Printers tt
1 ? Q satisfactory 3,, Auto Body 10l s!�_
,BOARD OF HEALTH satisfactory- 4.' Manufacturers 4
s 4 1 see" )Orders" S. Retail Stores
,�COMPANY v l�. '�% g' ' ( 6. Fuel Suppliers
ADDRESS _ 1r� � t� � 11lA% Class: 7. Miscellaneous
QU J'ITIES AND STORAGE (IN=indoors; OUT=outdoor
Case lots Drums Abdvel'anks
MAJOR MATERIALS Undetgzoued Tanks
IN UT N 6 gallonse i
Fuels:
asoline,' et Fuel (A)
ODiesel, Kerosene, A2 (B)
Heavy Oils:
waste motor oil (C) '
new motor oil (C)
transmission/hydraulic Q-
Santhetic Or9„anics,. ti
degreasers
a� -�� `�'�..,--mod,;. A ts.... � ,s•- /
Miscellaneous: _
PkEAJ
4' DISPOSAL RECLAMAKFION REW RKS: ,
1. Sanitary Sewage 2. Water Supply ;
9 V, k-A V
Town Sewer Public _
On-site rivate
-T
3. Indoor Floor Drains:. YES NO s ` 92
Holding tank: MDC- d
Catch basin/Dry w611 ��...�_._._._.-• -- --..._.... ._ _w
0 On-site system r
./ '4. Outdoor Surface drains:YES NG�'"
0 _Holding• tank: MUC ` � ` S
0,Catch bas in/Dry we 11 ------
O. On-site system
Waste Transporter Licensed?
Name of Hauler- DeSti na i or r Watee Product_ '
c`
�. r `lc,..��,."� ��5y '•� r�,+".��`9� ��Y•'l./i "l.a��"�S„ �4�"'/ /b_,, /„',."" • r �'f,¢ ��f� -
Person s), fnterviewe� r ' „�_ , ., 1 pector Date
TU V V V 2• Printers
A .•R D OF HEALTH O satisfactory 3, Auto Body Shops
0unsatisfactory- 4. Manufacturers
a 1 11�� 11 `� (see"Orders") 5. Retail Stores
COMPANY , '--4'',1' �' , �. 6. Fuel Suppliers
ADDRES =-'a Class:V. 7. Miscellaneous
L!� QUANTITIES AND STORAGE (IN=indocsrs; OUT=outdoo
.J Case lots Drums AbOveTanks Undetground Tanks
MAJOR MATERIALS IN OUT IN IOUTIN OUT N 6 eellonse Tes
Fuels:
Gasoline, .let Fuel (A)
rN
Di.esel,. Kerosene, 02 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
I fA//,
Miscellaneous:
n n� / cNnP
-H A "�
N __ P
-77
DISPOSAL RECLAMATION REW
1. Sanitary Sewage 2. Water Supply RKS: W l/�„�-
O Town Sewer Public CJ�J1-1 +_'n7 o � 4�
0 On-site O Private A /(/ 7`1 OV 6 �O�
3. Indoor Floor Drains: YES NO
O Holding tank: MDC
O Catch basin/Dry well
URDERS
On-site system s�/oJ40 Y � /)..1////�•/�'
4. Outdoor Surface drains:YES NO �r�O O
0 HoldinL• tank: MDC
Catch basin/Dry well V _ Mal,6 ic V�v�e_co �V='
0 On-site system l.� .�e S. Waste Transporter Licensed?
-Jame of Hauler_ Uestinatinn WaSte' Product_ '
�/ Y I �`- ��irn��. }►I --tom' i� ho-mm_
u ei Person(s) Infer, `In'spector Date `'
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
M ^��
DATA
0 COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL.QUALITY ENGINEERING
-_ DIVISION OF SOLID AND HAZARDOUS WASTE
One Winter Street
Boston, Massachusetts 02108
Plei' e print or type.(Form designed for use on elita(12•pitch)typewriter.)
UNIFORM HAZARDOUS °'` s
1.Generator US EPA ID No. Manifest 2.Pa go 1 Information in the shaded are::
Document No.
WASTE MANIFEST rf,' ! `y', t ? �`� of is not required by Federal law.
3..Generator s Name and Mailing Address f ° A.State Manifest Document Number
�• .,, MA C'260214 s
J �_ F, jf1f , i,:y/f %` �'�e ✓'• tr'%r' B.StapGen lD E i z` t t
_47-rene,.t. Phone(/`' 1 •* {r» ' 33
5.Transporter 1 Company Name US EPA ID Number C.State Trans ID
�, ' f' . I
Transporter 2 Company Name ' B. US EPA ID Number D.Transportar's hor ne
.'
C'! 1.State Trans.Ip �..
® 9. Designatgd Facility Name and Site Address 10. US EPA ID Number I 'I ( i ' I�r I » I 1 (' I I I I
00
!.} F,Transporter's Phon ) -
`'�f'I G,State Facility's ID NOt R2gUlt r
;t .. r.; a`f H,Facility's Phone
r7 12.Containers 13. 14 CU
1 1. US DOT Description(Including Proper Shipping Name,Hazard Class,end ID Number) Total Unit t IN,,'!:, Un
No.. Type Quantity WI/vol
C
N —�' �r �p—Sr F� rl D�f. r( v1f. s,•j r) rr Yl
c G b ,'y
0 E ;
V) N t
+0
co R ^d
.c I
U J.`Additionial Descriptions foCMatorials l fisted Above(include physical store arfrl harrrd code.) s. K. )lancfling Godoa farllra9te Gi tee AUcte, '
b.
_._._._•-. --_ 6 1 •w s
15.Special Handling Instructions and Additional Information
!�' a;-��. � y•;, ) c :N'a.
to �.•"� [�.� a.. {fir '' s•� �.. '•''�d=:._"=..._ p. -..:= r _ ,e•' '' :- "' '� �' _...—.._.-. __... �..�
0 116.GENERATOR'S CERTIFICATIO14 I hereby declare that the contents of this consignment are luhy and. ur teiy described above by
>_ proper shipping name and are classified,packed,marked,and labeled,and are in all respects in propel condition for transport by highway _
U according to applicable international and national government regulations.
C:
If I am a large quantity generator,I certify that I have a program in place to reduce the vob,,me and tuxic:t y of vastc generated to the doareo I have determined t4 bt:acUnonticJiiy r)ta
and that I have selected the practicable method of treatment,storage,or disposal currently w4lable to me which minirnizes the present and future three;to human health and the t•
ment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is ava.table to t to
can afford. -
(i r-- D,r
0 r-, Printed/Typed Name f— S)gngy)ie
T j 17. Transporter 1 Acknowledgement of Receipt of Materials t D
I.
C N Printed/Typed Name /` i Sidnat e t Air
-Mvnrh
P !fit rf r�, t+.''_i —^-3•- A--�..r - _ ' 1 fw �•r�• �r•'' ��,b+w-t.. j.r
0 16' ransporter 2 AcknowledgerngprSf Receipt of Materials
E Printed/Typed Name Signature `Morl'h, Da; I i;•.
19.Discrepancy Indication Space
F 4
A 't
C
L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19.
T Date._.._
Y Printed/Typed Name Signature " Month'. pay r
Form Approved OM8 No.2050-0039,Expires 9.30.88
EPA Form 8700-22(Rev. 9-86)Previous editions are obsolete.
COPY 8: GENERATOR-RETAINED BY GENERATOR '' ?
�. . .. ''x %.1 a a ,..xy.., ",' ;','91-'*�'p,�.,,,•^,.°n.+.wcr.-it c;�rStactr.•.,,tar?rn' -v'i. w-n`..,'�-;r%"
f
.77
1.
(617) 986-8393 (617) 925-1203
24 HOURS
f
MAYFLOWER SALVAGE CO., INC.
P.O. Box 603
Taunton, Mass. 02780
i
t
r
Date
Name � ii'"i! 7r,. f `t
Address v,' i',• !
Bill of Lading/Pickup Receipt Oil N.O.S. Combustible liquid N.A. 1270 }
7:
' Quantity Description
r
j
This product is hazardous waste as per Federal Regulations.
P.O. # Customer Sig.
Driver Sig.
1167
Payment due upon rendering of i
service, unless previously arranged.
r
' 4
97MM AM
U CORPORATE HEADQUARTC=
�} R 703.620.47
1.800.237.13'
Environmental Services
INVOICE
VOICE
--------------
DICK BEARD CHEVROLET
ATTENTION ACCOUNTS PAYABLE
RIDGEWOOD AVE
H YANN I S9 MA 02601
CUSTOMER II) i# : MAMA1006JM CONTRACT DATE : 10/07/E'7
TERMS NET 10 DAYS INVOICE DATE 10/22/87
CONTINUING .SERVICE CONTRACT - To
remove waste paint
--------------------------- thinner from body shop
Your present contract has expired.
The terms of your renewal contract
will allow for 4 pickups ��r 66(21
gallon_, whichever occurs first .
Your prompt payment will assut, AMOUNT DUE
you of uninterrupted sere i cr . If ----------
yo u have any questions or q i sh 850. 00
to make any changes to yq u service
contract call our sery l c? de art filent
at. 1-800-257--1 33.
'�';�';;.�'.;�.;q.•u•�•'�•-�•-�•�-�'�s"��t•'x•;? ?�-�#�'�'��##�E'.�•�-�'��-'�•'x-�.�.�.�..�..�'��!-�•.�..d.�.p.�•�t'#��E'i���!•�-�•iE'#*��#*�it•a''a: a .
PLEASE RETURN THE YELLOW COPY WITH YOUR REMITTANCE
}y ..y. . •• •.x.;.,w. .�. TO ENSURE PROPER C:REDITING OF YOUR ACCOUNT. IF
THIS IS NOT FEASIBLE, PLEASE WRITE YOUR CUSTOMER
ID NUMBER & CONTRACT DATE ON YOUR CHECK.
.�"S�'TC n'!f'R..�'�("1f"�:�'.#'�"�"�:':'�'3f'•�"rt"!(•.•�'�74"�'�.l,•�'.�"�'SF'¢'.�"��..�'.��t"jf"#'#..�'.�"�•�'.j(..�-�Q"�C'#'•�-�."�')�-•�•'*.�.#'�'A.�..�.�..�..r4.�.#.�#.��'.:y.
1891 PRESTON WHITE DRIVE 9 P.O. BOX 2459 9 RESTON, VIRGINIA 22091
f.' '+
A DIVISION OF Dii1-r_N Oi!
r•
+ ..
. . _ t ) rV (7 1 73
BalthtPOr&MD:(30n;574-5000 Y 1^ns._r,PA 215 347 G300' Cew s4er 1 93&/838
Orlando,FL:(306)859-3000•...•s., {glop.D.C.:(202)34T-55 it•Richmond,VA:(604)643 9000 11"ST�Re
College Park,GA:(404)767-6000•DaRon-GA:(404)278-1540•Frostburg.MD:(301)689-8950
`Since 1803 Worcester,MA:(617)791-3201 •Charlotte,N.C.:(704)392-8111 •Detroit Ml:(313)834-3600 Established 1888
o BEARD CNC 11F,C1Lt1 BEARD CHk VROL-El' INV41 12703
0 1L� J F:11(GE!�►t2i1I( AVE. 100. RIDGEWO�1L( AVE.
}} > •tL�1 HYAL�N NA 0`?601
T 1-7YI�i�:l�1 J } 1'/� t7�O y?. A -
O ^
•, ..y...., ,....�:3_'•`.. _.�. .,,... .; . .-"•"" _.... .:.w�r•t.:.,s. yKx T,tv' .ns,...v-t• "�L-.,,-S •«n;..s�
+.CUSTOMER-;��F3 �-�...h-3'��-�.,_,,,, -'' .•.a '> a: �'f�r;na. .„ --*--�.CUSTOM[RORD[RNUMB[R a,-'+v;C .r."a..;;.d`O DHR DAT[ h�«a ""- D[UV[RY DAT[ y �,.,a t'SAL[SMAN,AtX'
��.� ,< d _TAX fiXHMPT NO'� ^'a. ,e.,; b`x';-a;G*z�,4. ........:..-.. - .'t..!.,.� ..>�._ c�.t •�.i`�--TA !5.. A1SY uiA e:..
�,., `t�..,�1^ ,.;:�G� : _ ......4.. , ... .., `...
! lJ ; II J
/( 7 4`� 1l1H/83 -�� // ��/� 1 `� ; 1D
.
OUANTRY.
...'�i:='F'-s ,,... .aa,. -v+•+-i,:,,y �.;..., ...;+ ;.' u.+..�,. n ice, wa+ `' "v ` r • -.
`PRODUCT COD[ <. , ' DfiSCRiPT10N- t$-,' F*�,E' UNRS OFBILLINOtU /RI'C�[� yUN
.:.-:....0 ...+ '& = x„.s` : `-'- ';.a>s '�, ,;.,--a.Y "W.`.C'a � s._ ;s `€, ,"y3 -::.,t• E,
ORDERED"" SHIPPCD BKJORD. i _ -
r ,-IV ii-)i i`: Si EL-1tiL- ?'1iR 01i JAE 10 I.f-3J
0..5�- i � ✓ t r`Ir-.
PEDERAL EXCISE TAX STATE SALES TAX TAKE.THIS DISCOUNT I.'' ..,sv ';:.;��_DRUMS- _".E,'" ,' `�" ,"�, ,aFREIOHT�y�ja pqy THIS
IF PAID IN 1 O DAYS ex ',,
F
y.. P CHARGE RETURN q�11®UNT �:G'3SC>
•TERMS:Net 30 days.Thereafter,service charge of All claims for defects and shorts es must be noted at the time of.delivery.
i h%pelr month(annual rate of 18%-)'" 8
l
MWEE 43AG LLIEV " �1c )' PAGF 1
k A DIVISION OF DRYDEN OIL COMPANY
RD E
—�..•a,.ir�r.�- 7p"� fix,,
'i POST OFFICE BOX 73124 FALTIMORE. MD M21273
t
Baltimore,MD:(301)'574-5000•Warminster,PA:(215)674-5300.Lewisberry,PA:(717)938-1838
Orlando,FL:(305)859-4000•Washington,D.C.:(202)347-5541•Richmond,VA:(804)643-9000 wnarcAwrs {
College Park,GA:(404)767-8000•Dalton,GA:(404)278-1540•Frostburg,MD:(301)889-8950
Since 1893 Worcester,MA:(617)791-3201 •Charlotte,N.C.:(704)392-8111 •Detroit,MI:(313)834-360O
1
o BEARD CHEVROLET BEARD CHEVROLET
� 100 RI.DGEWOOD AVE. 100 RIDGEWOOD AVE .
T HYANNISP MA 02601 HYANNISP MA 02601
0
CUSTOMER -
NUMBER TAX EXEMPT NO. CUSTOMER ORDER NUMBER ORDER DATE DELIVERY DATE SALESMAN INVOICE DATE INVOICE NUMBER
Ak
8340A-2 042-030-681 1/18/88 12 2/12/88 112703
OUANTITY
PRODUCT CODE _ PACKAGING DESCRIPTION - - - UNITS OP BILLING. UNij PRICE NET AMOUNT
ORDERED SNIPPED - BKJORD. -
12900 38 .30 38. 30 BULK OZ SPECIAL MTR OIL SAE IOW-30 38 GAL. 2 .939 112 .60 ?: I
11900 253. 40 253 . 40 BULK OZ SPECIAL_ MOTOR OIL SAE 5W-30 253 GAL 3 . 120 790 . 61
j
FEDERAL EXCISE TAX STATE SALES TAX TAKE THIS DISCOUNT DRUMS FREIGHT PAY THIS m
IF PAID IN 10 DAYS
CHARGE RETURN 903.21
AIIiiOUNT
0 .00 18.06
"TERMS:Net 30 days.Thereafter,service charge of
1 il%Per month(annual rate of 18%.)" Atl cielma for defects and sflortagaee must be noted at Ow time Of de9ttrevy.
-rrs%t�kr month(annual rate of 18%.)••- All claims for defects and S'aortages must be noted at the time of.delivery.
�PyoFTHE T TOWN OF BARNSTABLE
OFFICE OF
saaMAM = BOARD OF HEALTH
2639.
rasa
367 MAIN STREET
HYANNIS, MASS. 02601
July 13 , 1.939
Mr. O:Connell
Dick Beard. Chevrolet
Ridgewood Avenue
Hyannis, MA 02601
Dear Mr. O'Connell :
On Thursday, June 6 , 1989 , Donna Miorandi , Health
Inspector for the Town of Barnstable perforined a routine
inspection at Dick Beard Chevrolet .
The following violations were observed :
1 . ) Four 55 gallon drums of solvent and waste antifreeze
were open and on the ground . There: were also Solne pans
left on the ground containing hazardous residues .
2 . ) Uporl a previous inspection ( 3/8/88) Jim Mueller of Dick
Beard Chevrolet stated that a shed was about to he built
around the two ( 2) above ground outdoor tanks used for
waste oil and new motor oil . As of Julie 6 , this ..has not
been done . Please see enclosure regarding regulations
for secondary containment of above ground Outdoor tanks .
YOU are directed t.o have the drums removed and di.spo'sed
of by a licensed hazardous waste hauler within forty-eight
( 48) hour-s of receipt of this notice . You are also directed
to rectify the above ground outdoor tank situation within
thirty ( 30) days of receipt of this. .notice.
You M,9y rsegUe t a hearing before the Board of. Health if
written petition requesting same is received within seven (7 )
days of receipt of this: notice .
PER ORDER OF THE BOARD OF HEALTH
Thomas. A . McKean
liir•ector of Public. Health