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0116 RIDGEWOOD AVENUE - HAZMAT
� 0 n.�s 7 �� INE*okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 �(BARNSTABLE. ' 9 MASS. g 200 Main Street• Hyannis, MA 02601 t639.0 MPS M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE Business Name: UA-- P.,'s r?c Date: Location/Mailing Address: let 6 Contact Name/Phone: Q,kn,T_!;n -7-7 t- - 4 tt 3 S 7 JAL - 79y- O V d 3 Inventory Total Amount.,-,- d 1l dw-5 MSDS: �FS License#: Tier II : A/8 Labeling: YES Spill Plan: ?4 Oil/Water Separator: V 114 Floor Drains: NO Emergency Numbers:YC-.s Storage Areas/Tanks: - s•- 1- Wr 1 - W r Emergency/Containment Equipment: : _ S r"' Waste Generator ID: +a9 Waste Product: U►1 d, �ir,.zr, pe'� �ry. Date&Amount of Last Shipment/Frequency: / 2y�a� /a��-/9 :514 jk&w /I-a(�- L✓as -U;1 Licensed Waste Hauler&Destination: ��. k/%f , 01-/ Other Waste Disposal Methods: p/1rc� 7 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. +/te Antifreeze Dry cleaning fluids L,-'-'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" V11pC (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: 014 11 (°� T14 S�4.14 ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: &J Facility Representative: _ l- WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS I L ' f `°F�►+E ro�ti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 :(B"MASS. 200 Main Street• Hyannis, MA 02601 0 0 39. M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT WI-8 Business Name: �G IQ,r S J-V�G Date: Location/Mailing Address: Yqvi-4►S Contact Name/Phone: 6-ArJcAf ✓ Oa-^T-1$- 3 775!- -b 23 Inventory Total Amount: "J_%Goa SDS: Ye Z-7 11 License#: b(,0 CA. 3 Tier II : v Labeling: Spill Plan: YES Oil/WaterSeparator: Floor Drains: O Emergency Numbers: ` e,5 Storage Areas/Tanks: 2-SDD g ti t 1��5`l"�'$'I A S 15 Emergency/Containment E ui me t: \/-,�e,, QK 6 8 Waste Generator ID: 6 Waste Product-o 1 a-+ GIPSt Date&Amount of Last Shipment/Frequency: f sv ���►'✓� '� - I.��iS-��rl 1 N UY13000'5- Licensed Waste Hauler&Destination: Oil V4,P4, ft 5 t tA, 1,-&-1 <VW Other Waste Disposal Methods: S 6L of kr 5 e- wuf 2 2 I f S ;? �y(- 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+0A,%4w Dry cleaning fluids �— Automatic transmission fluid Other cleaning solvents&spot removers ., Engine and radiator flushes Bug and tar removers VHydraulic fluid (including brake fluid) Windshield wash Motor oils.*u)ASke, Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants 4 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" �/ p (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: iSSv o G Yk-Q Ot�S' i5�"ikc�2 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE Town of Barnstable Office:508-862-4644 Public Health Division ,.. Fax:508-790-6304 BARMASS, 200 Main Street• Hyannis, MA 02601 �prFOMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ��cic\�.•rs Yr.� Date: q 6 I to Location/Mailing Address: Contact Name/Phone: &a, Inventory Total Amount: A-&Qg&J MSDS: lee; 'Y License#: Tier II . No Labeling:' Vk-10kP-, . Spill Plan: Oil/Water Separator: l f� Floor Drains: Emergency Numbers: Storage Areas/Tanks:�-'!�0D q al o W" e wkqI Emergency/Containment E ui ment: al o s zL r�tdQ s t�- Waste Generator ID: 0 1Sb Waste Product: o�� V. tkcKs Date&Amount of Last Shipment/Frequenc : Licensed Waste Hauler&Destination: 9aI4,4 Cees Other Waste Disposal Methods: dtltAm-t, (�- p. ti �•.p b C-•-e-as � c 5 LIST OF TOXIC AND HAZARDOUS MATERIAL ` � NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, ST storage and disposal of 111 gallons or more requires a license from the Public Health Division. o.t'� 1'f Antifreeze\SXS�yti�Sx3o Dry cleaning fluids �— Automatic transmission fluid\0 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 0 Windshield wash (g \�\d Motor oils �tp.r'12owa�}c Xfbo "'\ Miscellaneous Corrosives Gasoline,jet fuel, aviation gas ��,� ` ,� Cesspool cleaners Diesel fuel, kerosene, #2 heating_oil of `' Disinfectants ti0 Miscellaneous petroleum products: i,��� Road salts grease, lubricants, gear oil too X\y Refrigerants Degreasers for engines&garages30 Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries 7 Photochemicals(Fixers) Rustproofers oo x 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 10 Miscellaneous Combustible ko 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. `C r0OA�! D� 4OV17k 14, oTo— dv� oo f , ,,,-AC:o r a 5o r"". Ana-,.D INFORMATION/RECOMMENDATIONS: Get U cfi Inspector:�dv - ©►t ,Facility Representative: WHIT COPY- HEALT=EPA�RTM �/CAN=ARY OPY-BUSINESS Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Inc. 116 Ridgewood Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- --------------------------------------------------------------------------.. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 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 Y Town of Barnstable • a�s"E►ati Regulatory Services o �- Richard V. Scah,Director MASS. ` Public Health Division BARNSTABLE W 1639 s""z as ma u s�E"os �huemivs� D N1 Thomas McKean Director 1639-2014 575 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE /OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY I 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 char a of$10.00 will be assesse if payment is not receiyedrby July 1st. ASSESSORS MAP AND PARCEL NO. tg DATE FULL NAME OF APPLICANT: ; NAME OF ESTABLISHMENT: S ' ADDRESS OF ESTABLISHMENT: a MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: �n` SOLE OWNER: ✓ YES NO ' IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT -. 7S TREAS R CLERK jv - . l9a- PCs . IF PREPARED BY,OUTSIDE PARTY: SI ATURE F APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 �`oN n1 V V1 Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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 ` Town of Barnstable Regulatory Services ° Richard V. Sc s ah,Director RAJEMISTABM MAL Public Health Division Ec wu�' Thomas McKean,Director Fm.;. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fait-508-790-6304 Application Fee:$100.00 �'( q f ASSESSORS MAP AND PARCEL NO.( U 1 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT kA NAME OF ESTABLISHMENT • ADDRESS OF ESTABLISHMENT � TELEPHONE NUMBER SOLE OWNER: 'AS NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: t J IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION � c�c,(1�� � FULL NAME AND HOME ADDRESS OF: PRESIDENT C _ - TREASURER �. (�� ,� _ CLERK NCAr-e-,pr\9,)�� Ve—r- • GNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESSn55 POVAne.,AA HOME TELEPHONE# - j Mcache\Temporary Internet Files\0LKD3\HAZAPP Rev2015.DOC f r Im Town of Barnstable Office: 508-86274644 Fax: 508-790-6304 Regulatory Services Department • ; ,,, ��;, Public Health Division Mas9. e$' Thomas A. McKean,CHO 39.E ` 200 Main Street, Hyannis, MA 02601 Payment Receipt ,Hazardous Materials Payment received: $100.00 (Check) on 6/9/2015 Permit number: 660 f ;Check number: 11433 Check amount: $100.00 Name on check: Buckler's, INC. :Business: Buckler's Inc. 'Address: 116 RIDGEWOOD AVENUE, Hyannis 4 • I IME Tp Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMARA Le.� ± 200 Main Street• Hyannis, MA 02601 =639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'� Business Name: 80c-W ev-S -1-wc- Date:4kaAl — Location/Mailing Address: I 1 L IRS o -J e— S Contact Name/Phone: SoS - -775- Ce.11-7 Il-F -D 23 Inventory Total Amount: ^' /f-It MSDS: e5 Li nse#: 6(.10 Tier II : Labeling: 0 pill Plan: Oil/Water Separator: Floor Drains: /Emergency Numbers: ` Storage Area �-, kt b L.2M44 m r Emergency/Containment Equipment: 5 111 5 t Waste Generator ID: MA O 6 ? Waste Product: �5 k�1� , atik,�Cgej �5 r Date&Amount of Last Shipment/Frequency: 2 I t q0 ,VL-0s. a{ 4.,-w a �- Licensed Waste Hauler&Destination: M Other Waste Disposal Methods: 0 11 b,,e" i S SD4t-e, .5t- e, LIST OF TOXIC AND HAZARDOUS MATERIALS /)o Na.' or c AApL i vt- I w,J-e-y.}�'Z gi vit.- 14S-I' rts� �►�- NOTE: Under the provisions of Ch. 111, Section 31, of the eneral Laws 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 V Hydraulic fluid (including brake fluid) �� Windshield wash Motor oils SvoY O O 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: S O Gt -- o�►t �� 10-5 149 5 2 INFOR ATIONI/RECOM ENDATIONS: f t,Qg or- +a..-No Cs a l &,JLe1 i vc5 i t.Qt� �i>�i vtR, r v�s b+PCt orL . Inspector: Facility Representative: ` WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS L , °p IKE fo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMATBLE. • 200 Main Street• Hyannis, MA 02601 059. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: & �e.-rS Date: I o 1 l Location/Mailing Address: 1 ( Contact Name/Phone: 6'ar a So S-7 W`-13 e-e.11 -7 LI - 4-o �L Inventory Total Amount: —1400 4 j MSDS: `k 5 License#:�— Tier II : Oo Labeling: OK Spill Plan: .2! < Oil/WaterSeparator: Floor Drains: 00 Emergency�Numbers: e5 Storage AreasRanks: Vol 9A I A14-f1' - ',� �w o.k Pc •wAS fi o•1 ,K, 0ev.ka1vi.r1.,eK4►►� n.poc5 f Arlwe. o►c �al(�fi5 Emergency/Containment Equipment: 4111 k, b o.k E Waste Generator ID: MA Dre i b 2-7S Waste Product: D►1 �' s a r�sc% Date&Amount of Last Shipment/Frequency: zY 3 oar<I Q,4&g &4eA+�� 94.0 11Y s0 4 41 •�/ -7/x z/r 4 Licensed Waste Hauler&Destination: r1a le�n� ('rk�atow,, irZy �.rf- o,ev �oQ* ae.* f)j Other Waste Disposal Methods: of LIST OF TOXIC AND HAZARDOUS MATERIALS �o w�c• v1 e.\n,a.v�-> ,vim ,w w v, Av<y 5lv.ce- le1s4' NOTE: Under the provisions of Ch. 111, Section 31, of the Qeral Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. f 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 y''oo 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 V 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: DA1012{ 6 A.11 A- O�� ' �.10 atO ,yw 5AvJ o A wk. ORDERS: kr.t- 4,\CQ .5 o CI INFORMATION/RECOMMENDATIONS: k. tc oC Inspector: 1 ` Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date:lZ/30 / 13 TOWN OF BARNSTABLE $ TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: BUSINESS LOCATION: //(* Aye , Py4vlri, s INVENTORY MAILING ADDRESS: - 40&0- TOTAL AMOUNT: TELEPHONE NUMBER: S09- -776--30-3 5oy4 lie,ns CONTACT PERSON: 8vLkke-,c- EMERGENCY CONTACT TELEPHONE NUMBER: tell 77y-99q-oY23 MSDS ON SITE? TYPE OF BUSINESS: ���� ,Ntaln}cYt4nc�t INFORMATION / RECOMMENDATIONS: 0,94 mo1'e- Ji4I la•.t+ 1n ",O V4 Fire District: 0&641e OUNC&, CIeAA- C1e4n, `lt-S 04pe 0,/ Co-rren +9 y pne ►t-4nW NY901135 (,t O AJ UT' JsE - rA a-btQA R Jib D�,�ex� �.�-��te_ Q,Ga,45 0 0 1 l.0-e 3) G►u.4�&,l V)o �oe 1 gets I— 9&ocQ v�4 y� No v,alile-)e- &S'K� �, 304 o c�c5- Waste T 'on: /'1► -DDO6 S1S627S Last shipment of hatardous wa te: me!i! Name of Hauler: Ah'obady L1/4,0 Qec� Destination: MuYho (, 6&,69, / w,9606L,m04 Waste Product: (f aste I ' QwF,�«e�� Licensed . e No jVAb�66PSoos arl-s al�av�c _ �y K lea-vk- t1 7/i 3 c3t)f r-/ Cr-nsto K D08 y8o2.8` T- OTE: Under the provisions of Ch. 111, Section 31, of the Genera Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum ✓ Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive U'NEW 01 SEDssf`I,e`.,,�.. Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) ✓ Hydraulic fluid (including brake fluid) Refrigerants Mo Oils �,I/ Pesticides EW AO USEDS�A (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers A f may be toxic or hazardous (please list): Metal polishes '"0 rvt 4 0 C iri- ) �/.�tti�o� �1✓IGZ Laundry soil &stain removers (including bleach) 4� - t�g�.�-,ova r (I LIS-10Spot removers &cleaning fluids (dry cleaners) ., �X�A�io� ,�ja� Other cleaning solvents Bug and tar removers -�leg�1 1CXLL44J6A-` l t),,� . /40j0{px • 10 ? gKllan5 Windshield wash ©9-614e,40 vt_- +04-t) �Q7-014� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signatur Staff's Initial • Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Inc. 116 Ridgewood Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 r Town of Barnstable • Inspectional Services BARNSTABLE Q` ^ � ft4RM:TaeLE•CENLEtY[LLF•CONR•„Y4NNI5 f Public Health Division MIS 1639-2019 .. 3Dg &umgrABLF, 1 Thomas McKean, Director u Ft639. 200 Main Street, Hyannis,MA 02601 lei L Office: 508-862-4644 Fax: 508-790-6304 t t'i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE j= 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 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El Gh v-4 *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. t 0 /,Q )h 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 Q TITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: L9 Ga6 i 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: nA ry 8. TELEPHONE NUMBER F ESTABLISHMENT: ``7'3 9. EMAIL ADDRESS: \ i L' 'Co 10. SOLEOWNER: V/ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATI �T NAME 5 "� C_ PRESIDENT y TREAS R CLERK • 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application FonnsWaz Mat Appli Draft Jan20l9.docx I A� Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Inc. 116 Ridgewood Avenue, Hyannis, lllA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------- ----------.------------------------ -------------- ----------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 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 I Town of Barnstable Inspectional Services BABSTABLE OFT KME�{�. � STA:e•ta+r,ivL•cMJ •-H.xm= o Public Health Division `S° "''° jai<'. �.E rBARNgrABLE, Thomas McKean, Director �fota`0 200 Main Street, Hyannis,MA 02601 r.y Office: 508-862-4644 Fax: 508-790-6304 r. X APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ! 4 HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 �zvg-pd c�v-zw ay *A late charize of$10.00 will be assessed if-oaym ent is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?YYES_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: —O---�ACCA 0— Lr�-fte= 5. NAME OF ESTABLISHMENT: lr✓' 6. ADDRESS OF ESTABLISHMENT: ; �3aLs0` 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS��n,TggjE 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIO NAME -:r, C. PRESIDENT ja 5 TREAS R $ - CLERK Akq �-' 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:-Application Forms\Haz Mat App Revised 09-10-18.doc 1j Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Inc. 116 Ridgewood Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -----------------------------I--------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health of B nsxable T�4 Voewg8atory Services THE Richard V. Scali, Director ' OF Ta,_ Public Health Division BARNSTABLE t NRNSiMLE•CFNiERVLLIE•mfUR-MMS CAB = Thomas McKean, Director i "557[0�41659.- "S� --200 Main-Street,-Hyannis;Iv1A Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). 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 0 VIS *A late char a of$10.00 will be assessed if myrnent 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: 0---)aCCA 0, L 5. NAME OF ESTABLISHMENT: C, 6. ADDRESS OF ESTABLISHMENT: n J S Da(9U� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: � f1� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS:/ t e 10. SOLEOWNER: V YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATI N NAME PRESIDENT - 5-- TREAS R CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE ,� Q:\Application Forms\HAZMAT APP 2017 REVISED.6c4 Number Fee 1265 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Towing Service Inc. 116 Ridgewood Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- 6 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 © pehe* 139-7- "�ow1� of B nstable / Kegulatory Services eF Richard V. Scali, Director I Public Health Division B a y STABLE �ANt ADWCEniEGVILLE•CONK•H-11S BARNSTABLE, r Thomas McKean, Director MASS. �• �'(`] A 1639-0 4 9`l'ArF1 �.i�`0 200 Main Street, Hyannis, MA 02601�^/�^/ v'"' Office: 508-862-4644 F 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZZ 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 Ist—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 4'S *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?IYES_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 QU TITIES (25 GALLONS)?p �✓IES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 1�}l �� l —�G'���f ll G SC r Vl Ge 1r . 6. ADDRESS OF ESTABLISHMENT: �itk. Vay) 1�1ti�j 9 �V�'C� CSfJ O 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES JNO IF NO,NAME OF PARTNER: j(G�� �(W tf 11. FULL NAME,HOME ADDRPS,AND TELEPHONE#OF: CORPORATION NAME fS 0-,1 PRESIDENT t 19.-- TREASURER r vz w CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS JA EMAIL: SIGNATURE OF APPLICANT ' DATE Q\Application FormMAZMAT APP 2017 REVISE'P'.docx x. Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health :rt Town of Barnstable F�HE rti Regulatory Services Richard V. Scali,Director 9 MAS& $ Public Health Division 1639. �0 i0lfa �° 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. DATE 91 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �� NAME OF ESTABLISHMENT ,o 212L ' `5 =J=Inc , ADDRESS OF ESTABLISHMENT 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 INCORPORATIONM�JZ:W&� FULL NAME AND HOME ADDRESS OF: PRESIDENT (� - 9 TREAS R -3 \ \ lj CLERK � M t i S GNATURE OF APPLICANT ,�n0 RESTRICTIONS: HOME ADDRESS a` A r 1 VY�Gc.3t�. HOME TELEPHONE#��/ -?,tea_ xs� I Q\Application Forms\HAZAPP.DOC r Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 Ridgewood Avenue, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of larnstable Of1HE Regulatory Services 3 Thomas F. Geiler,Director y !� 7p� Division p� 9� i63g',�$ JSII itAJ��33.. p A a Thomas Me-Kean Director 200 Main Streit, Eya=iS,MA 02601 Office: 508-S62-4644 Fax: 508-790-6304 Appiicaticn Fes: $100.00 ASSESSORS MAP AND PARCEL NO I DATE APPLICATION FOR PERNET TO STORE AND/OR UI'ILIZIJ MORE THAN 111 GALLONS OF 19"d Zd QUS MATERIALS j FULL NAYIE OF APPLICANT NAME OF ESTABLISMiENT �� Cd w ADDRESS OF EST_ABT,I.SEMENT ¢ -ra TELEPHONE NUIYIDER - /6 r x SOLE 07 NE.R: /YES NO Z5 •- cn IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL tv M PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME PD HOME ADDRESS OF: PRESIDENT CLERK �Vi 1 ie s r�A C� �S TREASURER `j !� SIGNATURE OF APPLICANT i RESTRICTIONS: HOME ADDRESS I!�`U11he, F►4 �c• P-. (�"(� HOB TELEPHONE#,Sr —acaa-LQ:%R 1 i HAz dcc/wp/q i .pl Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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 6/30/2013 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director H"R ASS.`�•y' Public Health Division 9� 1�3 �00' prf0:19. s 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. dIIDATE �2. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS. FULL NAME OF APPLICANT f NAME OF ESTABLISHMENT �j e, ADDRESS OF ESTABLISHMENT TELEPHONE NUMM R 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 �� rT TREAS R" A >/ CLERK. Av-\2-, } t / SfGNATURE OF APPLICANT i RESTRICTIONS: HOME ADDRESS N4 Cb � HOME TELEPHONE Haz.doc/wp/q s.� Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Bucklers Inc. 116 Ridgewood Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. III - --- -- - — - --- -- - -------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ------- ------------------------------------------------------------------------------------------- ----------------------------------------------------------- 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 ' owr of Barnstable eg atory ervices Richard V. Scah, Director oFt Tom' Public Health Division BABSTABLE sr ,'W�.aarer iue.Co g-Mn ZjS BARNS'ABL r Thomas McKean,Director 16'9 za; 'ArE1 39. s`� 200 Main Street, Hyannis,MA 02601 �ll� Office: 508-862-4644 �--p� `� 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 3 Oth). 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 W *A late charge of$10.00 will be assessed if myrnent is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? V1 YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: Alk Int-& 1176. 6. ADDRESS OF ESTABLISHMENT: ��Qnrin abO, 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 2� e_ S. TELEPHONE NUMBER OF ESTABLISHMENT: V �-��;� 9. EMAIL ADDRESS: . " 10. SOLEOWNER:-I&ES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME AD RESS,AND TELEPHONE#OF: CORPORATION NAME o PRESIDENT — TREAS R CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT, DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.doc f Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Buckler's7nc. 116 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 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2010 JUNICHI SAWAYANAGI �v— THOMAS A. MCKEAN, R.S.,CHO Y Director&Public Health LW ¢ � Town of Barnstable Regulatory Services yP °� Thomas F. Geder, Director • BARNSTAHLE, 9 MASS. ( Public Health Division t6gq. ♦� AIEDMA�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. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ( C NAME OF ESTABLISHMENT ADDRESS.OF ESTABLISHMENT �� �, l C, � kan�\S•��.O2c0 • TELEPHONE NUMBER1 � SOLE OWNER: / YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: e IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION STATE OF INCORPORATION `►`� `� ������ 6cJ FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK \ tL \ \ • SIC TURF OF APPLICANT RESTRICTIONS: HOME ADDRESS ���(L, , t.. HOME TELEPHONE # Haz.doc/\gip/q Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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 6/30/2010 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. _ 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Barnstable �aTti Regulatory Services Department- � Q g y prtment alAnaicacity • Ag Public Health Division 9 , 9. 200 Main Street, Hyannis MA 02601 m 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 N -0 (M DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 01 NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT • TELEPHONE NUMBERC 7 SOLE OWNER:_ILYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES 1 OF ALL PARTNERS: �f c) --C. Z cc IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 7358 STATE OF INCORPORATION .-,- n FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIG TURE F APPLICANT • RESTRICTIONS: HOME ADDRES a } gix HOME TELEPHONE# - (� Q:\Hazmat\Haz Mat Application2008.DOC a rs BUCKLER'S INC. SPILL CONTINGENCY PLAN 1. Remove any ignition source if material is flamable. 2. Contain all spills with Spill Response Kits. 3. Remove all absorbed material or liquid and package in DOT approved containers. 4. Label all containers with the type of waste and the start date of accumulation. 5. Notify proper agencies. 6. Once the spill has been controlled and secured, inspect the area for cleanliness. 7. Manage and dispose of collected absorbants in accordance with Federal & State Environmental Regulations. Spill Clean Up materials are located at the waste oil tank. 9. The following is a list of spill and safety equipment on site: a. Spill Response Kits: includes pads, socks & protective gloves b. First Aid Kit c. Eye Wash d. Latex Gloves e. Fire Extinguishers EMERGENCY SERVICES #'S Hyannis Fire Dept. 508-775-2323 Barnstable Police 508-775-1212 Ambulance 508-775-2323 National Response Center 800-424-8802 Clean Harbors 617-935-9066 OP Office 508-946-2850 Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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 Town of Barnstable Barnstable IKJE Regulatory Services Department ;eriea i Public Health Division + BARNSTABLE. ' 9 MASS, 1639• 200 Main Street, Hyannis MA 02601 �� 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 -T"aIS6640 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT bar I!n &C V)f-,r— NAME OF ESTABLISHMENT i��X'.� 6,r_ ADDRESS OF ESTABLISHMENT 1 TELEPHONE NUMBER ' 77s-3yy C= SOLE OWNER: YES NO ; IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRFOF Aq6L PARTNERS: 0- CD r- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. (� /•off y7�S STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT (-�aru C.'. rk1et= 1��l�)i I i ��a Q<l � >a�, P rL. Ch e 6aLr� TREASU R CLERKNALk( / t GJ&- SI ATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS !' �'� ✓��?' HOME TELEPHONE Q:\Hazmat\Haz Mat Application2008.DOC SPILL CONTINGENCY PLAN 1. Remove any ignition source if material is flamable. 2. Contain spill with Spill Response Kits. 3. Remove all absorbed material or liquid and package in DOT appreoved containers. 4. Label all containers with type of waste and start date of accumulation. 5. Notify proper agencies. 6. Once spill has been controlled and secured inspect area for cleanliness. 7. Manage and dispose of collected absorbants is accordance with Federal and State Environmental Regulations. 8. Spill Clean Up materials are located at the waste oil tank. 9. The following is a list of spill and safety equipment on site A.Spill Response Kits (Kits include Pads, Socks, and Protective Gloves) B.First Aid Kit C.Eye Wash D.Latex Gloves E.Fire Extinguishers EMERGENCY SERVICES NUMBERS Hyannis Fire Dept. 508-775-2323 Banstable Police 508-775-1212 Ambulance 508-775-2323 National Response Center 1-800-424-8802 OTHER PHONE NUMBERS Clean Harbors 617-936-9066 DEP OFFICE 508-946-2850 i Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. 116 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. 7/1/2007 PAULJ. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services Thomas F. Geiler,Director fff_6 1 ' Public Health Division " l Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 -Office:-508-862-464-4-.-- _...-- --- -- - -_ .. - __.-- __ Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. DATE 6 L12,16:Z APPLICATION.FOR PERMIT.TO STORE.AND/OR UTILIZE MORE THAN 111 GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT jog Lt 0, R ve(tLaP r- NAME OF ESTABLISHMENT ��t�t.IGI�(J l�ijl C_ ADDRESS OF ESTABLISHMENT /c161 &z)Q 0 ,l�,u.� ���Ji���4 dZ 6 a/ TELEPHONE NUMBER A. SOLE OWNER:�YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF�L -- PARTNERS: P— c? ca W rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. -33 STATE OF INCORPORATION Cal FULL NAME AND HOME ADDRESS OF: PRESIDENT gocklir ' TREASURER W gotk(0- iQ epv-t�eo- .% oz y CLERK A U/,. SIG 'NATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS l S� IVI l// ZA Vma4a4 f#-;e Aei HOME TELEPHONE# Hazdodwp/q EMERGENCY SERVICES NUMBERS Hyannis Fire Dept. 508-775-2323 Banstable Police 508-775-1212 Ambulance 608-775-2323 National Response Center 1-800-424-8802 OTHER PHONE NUMBERS Clean Harbors 617-935-9066 DEP OFFICE 508-946-2850 SPILL CONTINGENCY PLAN 1. Remove any ignition source if material is flamable. 2. Contain spill with Spill' Response Kits. 3. Remove all absorbed material or liquid and package in DOT appreoved containers. 4. Label all containers with type of waste and start date of accumulation. 5. Notify proper agencies. 6. Once spill has been controlled and secured inspect area for cleanliness. 7. Manage and dispose of collected absorbants is accordance with Federal and State Environmental Regulations. 8. Spill Clean Up materials are located at the waste oil tank. 9. The following is a list of spill and safety equipment on site A.Spill Response Kits (Kits include Pads, Socks, and Protective Gloves) B.First Aid Kit C.Eye Wash D.Latex Gloves E.Fire Extinguishers Number Fee 660 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Buckler's Inc. -' H*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 19, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services (Pleb P� 1 r v . . � �• .. _; ` .�, Thomas F. Geiler,Director ncb;a :fir `. Public Health Division 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. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 6 o ck-ly l`S NAME OF ESTABLISHMENT 13vc°k le r 1 1 �- ADDRESS OF ESTABLISHMENT �/� /1�41 /Vo loe A: TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: C-0 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. o� STATE OF INCORPORATION �1fI ids FULL NAME AND HOME ADDRESSn//'� 0yPRESIDENT ( 6 vcktl�l- / Zc l'Lvl.Ct�7�i ✓ /Ll' z� TREASURER Lkej .k e r- • 1 j ' _ -V1 V,He 1,44 6 z `L. CLERK 'Z SIGNATURE OF APPLICANT RESTRICTIONS: HO-�ADDRESS d r eN HOME TELEPHONE. , Xsz.doc'wp,'q 4F MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Bamstable. 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 FA)MD-REQUESTS - Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). 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 assist -ante on any item above, call (508) 862 4644 Back to Main Public Health Division Page r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS 621-� -Q I�Z -v Board of Health MAILING ADDRESS: 7 j � Town of Barnstable TELEPHONE NUMBER: `7 7/ - 2 P.O. Box 534 CONTACT PERSON: 5'�oG—i�/, /?��i.Ys� Hyannis, MA 02601 Does your firm store-any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua ees totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES VNO 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: DRESS: TER 1ViARKET EOM AV5. TELEPHONE: RV,AR 100 RIDGEWOO'0t AVE HYAN.NIS+ MA 026 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 when store , Please put a check beside each product that you store: Draincleaners Antifreeze (for gasolene or coolant systems) Dr a 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) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (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) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon 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 » TOWN OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY A&,ir° /67 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS //�'Y? J bl1�IIED J�,eC18S5: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATILALS 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 as ' cellary,ous• Arlo Ar C DISPOSAUR.ECI AMATION REMARKS: 1. S nitary Sewage 2RP"ublic ter Supply ' C,' /�i��Q a" Town Sewer O On-site OPrivate 3. Indoor Floor Drains YES_�_NO O Holding tank: MDC X Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES V NO ORDE S: O Holding tank:MDC Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES I NO 1. U-I'd 2. Person s) Interviewed Inspector V Date C PLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r OF BARNSTABLE O A ers R D OF HEALTH satisfactory 2. Auto Body p 3. Auto Prod Shops O unsatisfactory- 4. Manufacturers COMPANY A C (see"Orders") S. Retail Stores -ff6. Fuel Suppliers ADDRESS I 1 ¢ Class:--�— 7. Miscellaneous Q UAN7ITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetground Tanks I I N IOUT IIN IOUT IN OUT # & iz2llonse rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: i i waste motor oil (C) I new motor oil (C) i transmission/hydraulic Synthetic Organics: degreasersc _ I Miscellaneous: DISPOSAL RECLAN TION REMARKS.- J. -'Sanita Sewage 2. Water ply 7-41 s 6Town Sewer Public O On-site O P ate 3. Indoor Floor Drains: YES NO �+ O Holding tank: MDC 4 Catch basin/Dry well On-site system ' 4. Outdoor Surface drains. NC 0. Ho ing tank: MDC atc asin ry well OOn-si a system S. Waste Transporter Licensed? Name of JjaUler Desti na ;on 72 -57 I D Q Person(s) Interviewed I Spector ate- �� �3 ei p ,,..,.. �. r OWN OF BAR S T A� B- rGsapL ��� . 2. Printers tisfactory 3. . Auto Rody Shops ABOARD OF HEAL.1`H 4, Manufacturers satisfactory- � �� ' (see"Orders") S. Retail Stores COMPANY 1'1� !� i 1.�`+�� i tr:•-�, ; X 6. Fuel Suppliers ADDRESS ,• %;$� .- rrL;t` class:1 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor! MAJOR MATERIALS Case lots Drums AbOveTanks Undetground Tanks IN )UT IN IOUT IN ellons Age s ' Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, N2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Orgatic degrease s �;,,•��,J 1 ,,��..{. -�.:-�f.n _;3 tit _i , ��ro'dt-' Miscellaneous: •~ rt DISPOSAL RECLAMATION REMI.RKS:1 1. Sanitary Sewage 2. Watery Supply 'n e !,1, ^, , ,__ •: .-,� -_... " U O Town Sewer Public O ,, On-site O Private „ •S, 3. Indoor Floor Drains: YES NO_, f,i.`�,:v Holding tank t, MDC OCatch basin/Dry well -•-• -- -----...___....-•-- ----- — On-site system 4. Outdoor Surface drains:YES NC__ O Holding• tank: MDC _ O Catch basin/Dry well QOn-site system -- ��_�, cens`�ed? S. Waste Transporter10 �ctination }ri ft Product ; 12; V Interviewi. ; !;� �". Inspector Date