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HomeMy WebLinkAbout0038 ROSARY LANE - HAZMAT � �� �" �� It Town ofBarnstable officss08-862-4644 Fox�oou'roo'e3O4 ��U��lic Health Division � 200 Main Street° Hyannis, K4AO28U1 . TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: caq� CDA� L\ Inventory Total Amount: MSDS: QPa64�09 License#: IZ3 Tier 11- LaJSliIaOil/Water Separator: /V Floor nr;;ins: Emergency Numbers: tA J � [Waste Generator ID: Waste Product: Shipment/Frequenc � � ther Waste Disposal Methods: LIST OfTOXIC 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 � V Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Oiainfectanta Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Peoticideo: Cau|h/Gnout insecticides, herbicides, rodenticidea Battery acid (o|eotno|yte)/batteheo Photmchennioe|a(Fixers) Ruatproofera Phodoohemioa|o(Oeve|opeh Car wash detergents Printing ink Car waxes and polishes Wood preservatives(oreoaote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners e Miscellaneous Combustible Paint&varnish removers, deg|ooaera Leather dyes yNiaceUoneouoF|annrnab|ee Fedi|iznro Floor&furniture strippers PCB'o Metal polishes O�herchlorinated hvdnocarbona — -------- Loundryuoi| &ntoinnonnoveru --------- Uno|udin0carbon 'tetrachloride) - (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, � hydrochloric acid, other acids) VIOLATIONS: ORDERS: Insp or Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY � COP ' BU8NBS � Number Fee 1263 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Marble & Granite, Inc. ...------------------------------------------------------------------------------------------------------------------------------ 38 Rosary Lane, Hyannis, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of BarnstableInspectional Services E*DPublic Health Division MAIML" Thomas McKean,Director inn Main Srr et. Hvinnic.M.A 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st—JUNE 30th). APPLICATION FEES d CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ©-P CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. 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 • n TIN T♦ Ti7f`,►1�T _X0TTQVjXflT I1 nTTAN TTiTC!9C �/ .,......T.A.;>. u T r eT:T.QNCyyI? �F.S No, 4. FULL NAME OF APPLICANT: C,0D Mf ZC 61LA v'i76 ,L0 C.- 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: D24G'O1 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: Q 8. TELEPHONE NUMBER OF ESTABLISHMENT: ­711 Z- I 9. EMAIL ADDRESS: � d� �. CbtALbl (M tC C� 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. 1 Y1.TT{): 1' PREPARED 3 v viiui%i t�i\Y NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT 'AA,_/ DATE Q kApplication Formsftz Mat App Revised 09-10-18.docx f `°Ft►+e►oy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 e"M s,q 200 Main Street• Hyannis, MA 02601 �A t639. 'FOMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cape- 1p t: &rck%, t Date: Location/Mailing Address: Contact Name/Phone: SOS-171 'AA00 Inventorx Total Amount: �� M � SIDS: (PPA& License#: 1�6� Tier II : Labelina: 'Q Spill Plan: Q S Oil/WaterSeparator: AEO Floor Drains: Emergency Numbers: UPS Storage Areas/Tanks: `Q IS' Emergency/Containment Equipment: Waste Generator ID: Waste Product: rG"" Ih4crlCI It Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: W ci 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 yHydraulic fluid (including brake fluid) Windshield wash Motor oils 10 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 V 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" ur*0 d�,�d- (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 910 6Pt P V � Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1263 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Marble & Granite, Inc. 38 Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAG_NOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health e .. Town of Barnstable Inspectional Services BARNSTABLE �p SHE TpL� nnausrae:F•az+ran;l:•cmnr..rtxxr= C Public Health Division wvsmsur:!.s:asv�maa-srecxsr.E .;. Thomas McKean, Director cc� ATE1639. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 h.,NR 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 xv? 44 CATEGORY 2 PERMIT •l 11 —499 Gallons: $125.00 ' ❑ CATEGORY 3 PERMIT 500 or more Gallons:. $150.00 Elof *A late charge of$10.00 will be assessed if payment is not freeceived by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. cw--00 2. IS THIS A PERMIT RENEWAL? V YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: l I Gl /�� pi 5. NAME OF ESTABLISHMENT: W Q C 6. ADDRESS OF ESTABLISHMENT: ?^' 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �� 9. EMAIL ADDRESS: nv�\ul�� �G�1� 1� / T`� com 10. SOLEOWNER: VYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT 9`JU — 2 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT —DATE I� Q:\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1263 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable 4 Board of Health This is to Certify that Cape Cod Marble & Granite, Inc. Qr 38 Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Ion of Unstable egu atory ervices ppIHE r Richard V. Scali,Director Public Health Division BARNSTABLE "ley • : ` w NSTASU-EMERVIUE.=Uff;W'=415 s/ BARNSTABLE, Thomas McKean, Director ���5.�i�a o 4vr�w.cnsTw L'7r 9 MASS. `1iA,En �a`` 200 Main Street, Hyannis,MA 02601 575 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS - IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 'rl-- CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGO T 500 or more Gallons: $150.00 ❑ *A late char e o $10.00 be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND P CEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: H Q r j 2 u S l I V Q 5. NAME OF ESTABLISHMENT: C(�pe C Oct M Grb 12 G Y Q n l+-Q, 6. ADDRESS OF ESTABLISHMENT: 32 R p SQr U Lome. 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: (S 0$-)2-1 I - 2 2l®0 9. EMAIL ADDRESS: Ste `nn le, @ CK-m01.r bVe rant fie. Cor -1 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 EMAIL: SIGNATURE F APPLIC a MATE R/S/18 Q\Application Fonris\HAZMAT APP 2017 ISEDAbcx Number Fee 1263 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Marble& Granite, Inc. 38 Rosary Lane, Hyannis, MA (� Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. aJ ---------------- ---------------------------------------------------------- ------------------------------------------------------------------------------------ ------------------------------------------------------------------------------- ------------------- ---------------------------------------------------------- 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 c'e? 0 r un• 27. 2017 4:49PM k 2806 P, 1/1 '�gw of B stable P� � f/0 5a lfevAatory bervices Richard'V'.Scali,Director Public Health Division BABSTABLE • 1 I Thomas McKean,Director ""` FMCM1 qI-.%% LO�9 200 Main.Street,Hyannis,MA 02601 Office: 508-862-4644 6W q_0?0l0 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(DUNS JULY 1st-NNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 Q CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150,00 ❑ *A ate charge of$10.00 will be asses ed if payment is not received by Jul 1st. I. ASSESSOR'S MAP AND PARCEL NO. 7. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGIBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)?_YES NO. • 4. FULL NAME OF APPLICANT: v 5. NAME OF ESTABLISHMENT; ' V>�. 6. ADDRESS OF ESTABLISHMENT: .315 RO Sjru 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: (506) :1 4% - QLCI Co 9. EMAILADDRESS: � �phcsr,�P. rt'i, C.LntiarhleC���tnt �, •Ga`rv� _, 10. SOLEOWNER:—YES—NO IF NO,NAME OF PARTNER: I1. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Cr-pc Ln6 m jrM Q"A Cjmn��p� PRESIDENT p1 ` TREASURER�� CLERK 12, IF PREPARED BY OUTSIDE PARTY: NAME: Sttdh te p,abe o TELEPHONE#:{'Vic ) a1 - cN Cn COMPANY ADDRESS"' fc1ne.-1A ,A tn!EMAIL:sj eVV%an tejpu�rf_t+ r�lp-gran►}t•COrr► SIGNATURE OF APPLICANT�� DATE fo l as/g o i 4 C:\Usels\Deoollik',Appbata\LocallMicromftlwindgwslTc pozary lntemet FileslConett-OutlooklBMQD49H21HAZMAT APP 2617 REVISEA.docx • t Tow of B stable -Regulatory ervices Richard V. Scah, Director Public Health Division BARNSTABLE BARNSI'ABLE, Thomas McKean Director ""'s SX"5-mTE uE.Ms`s-srA� rya MASS, ) 1639-2014 OTpO 39. b � 200 Main Street, Hyannis, MA 02601 575 Office: 508-862-4644 070/F-0 v Fax: 508-790-6304 ri APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS say 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 5d CIS CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ 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: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 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 EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Fonns\HAZMAT APP 2017 REVISED.docx I Number Fee { 1263 THE COMMONWEALTH OF MASSACHUSETTS $ro.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Marble& Granite, Inca 38 Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- -------------------------------------------------------------------------------- ---- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Or { Town of Barnstable Regulatory Services , Richard V. Scah, Director Public Health Division BARNSTABI MA89. i639 �� esaa r si cwrtcr,.,aster xv +,G,'3Tt$Y Y S 'i Thj33f9@ rf 3a�g i.,, �fDN � Thomas McKean, Director `qt 575 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6 N APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st ASSESSORS MAP AND PARCEL NO. DATE d FULL NAME OF APPLICANT: Nrx/Y,P "Cz"-Lto NAME OF ESTABLISHMENT: ( ^('�M Q- M Q CA--..D ADDRESS OF ESTABLISHMENT: 3� My pig, MA OoZ6O MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER: } YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT • TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: • SIGNATU LICANT Name: Company Address Telephone #: Email: C:\Temp\HAZZAPP Rev I6.docx Page]of2 • • COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A Si item 4 if Restricted Delivery is desired. i ❑Agent ■ Print your name and address on the reverse X s so that we can return the card to you. Addressee ■ Attach this card to the back of the mailpiece, B. eived b (Printed Name) e� li ry or on the front if space permits. �aV t. - e 1. Article Addressed to: D. Is delivery address different from item 1 ❑Y s If YES,enter delivery address below: ❑ o Cape64(b/e 6an 4-4 ,38 gZa 1-an e n O 3. Service Type ?r)n 5 �! A Certified Mail® ❑Priority Mail Express- ❑Registered §?Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes fF tFii _- 2 (r� 7�12' 1�101 F�000' 21347 876'6 `�,5'' PS Form 3811,July 2013 Domestic Return Receipt UNITED STATE$ oOftQ$A%tt"'.-. First-Class Mail �'� y•z f Postage&Fees Paid USPS -O ALYC; ' � Permit No.G-10 • Sender: Please print your name, address, and ZIP+4®in this box* I I I � I ,w Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 �. _:�' .....M;��; sass]slslsi�iiisslllslls}j4i�tr�slli�iilsis�sslsllllij'tllls3s�ijl I TOWN OF BARNSTABLE BAR-WC Ordinance or Regulation WARNING NOTICE Name of Offender/Manager r Address of Offender MV/MB Reg.# Village/State/Zip /, � Business Name C toz G�c�iX i�'1�}41e`1*).� <v�l ��yti � -e� T��'0(��/pm, on 3/1-r 2016 Y Business Address ?j�',�, >�,�,1.� )x A vy- / Signature 1of'' Enforcing Officer Village/State/Zip 011,1100151 Location of Offense ,4 -P Cos F� }�_ � t '{ �t�-�Q. e ► ►� ` Enforcing Dept/Division Offense VJJt1-A a �(a �Ir�. �J-�r��r� S�-Ii1 C. <i� tt^�e -1 efvL Facts 4AA -i. T t� �s t.�eAL�� tk 11r # e• rC�{?vV' (lJ / ►yC lie j1 �P— This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Of f ender/Manager �f �- �� ,, V r Address of Offender MV/MB Reg.# Village/State/Zip Business Name f f w ,�;�f .� ,� �k t r�a� :� am%pm, on 20 Business Address , ^ .;+t.t 1 :; b� �"".- /IT G Signature ;o.f` Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense o ,�- 1Fr1- . ){ ^ P, ��i, �:� ;`vr� � . •,yt 1. # ;�,. ,;� iy l Jj F f i Facts �' 't �,' - ;/ •rtit t '.; , �. Yri tip• , F.t,,..ice , ; , r�' {< r. �05(_ • 1 ..� E This will serve only as a warning'. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. NAME OF OFFENDER t D(,D 7'9 4 TOWN OF ADDRESS OF OFFEND E t C a! aqK. c Y 67 .0 t ►+t 14'e 3 S.°r- BARNSTABLE CITY,STATE,ZIP CODE �TME►per MVIMB REGISTRATION NUMBER � OFFEN RAR\Sl'ARLE. �- .� ► t ,,._ �'r- i,a't. fEOM. c1 fir, � �. S ►M� < a i , r� ��- 1t �, �, �!rl�;-� . > TIME AND DATE OF VIOLAT 0N,` L ATION OF VIO ATION Z �t y 1 1 W NOTICE OF :b . (A.M.,/ P.M.)ON �l rj 20 � � - �In V'�l av-640 C�r'rt��fd1?t f SIGNATURE 0 FOR RS ENFORCING DEFT. BADGE N0. N VIOLATION . ,(,` / t� o OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION XLU ORDINANCE JV Unable to obtain sig ature pf offender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed �^ `� w OR YOU HAVE THE FOLLOWING ALTER ATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a. DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION < P. (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 M.,Monday through Friday,legal holidays excepted, yaj before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. d (2)If you desire to contest this matter in a noncriminal proceekL'ng,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET ARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature TOWN OF BARNSTABLE BAR _W01� Ordinance or Regulation WARNING NOTICE Name of Offender/Manager CTe f)z,y 5 r 1V4- Address of Offender MV/MB Reg. # Village/State/Zip Business Name .��,��. �� V't k� �t �`.X -''� ,n � 2 `'=��� a pm; on. �! - 20 Business_ Address ' Signature of Enforcing Officer Village/State/Zip d,1 r2 N VI ,e Location of Offense (2,44jZ t_o, - ! Enforcing Dept/Division Offense r)elbI-(t- de42..C/�C�S �A ��tif,� 1 ; � LL05--- . 0,9�f+�r©,�c Facts e.K'� IA-)+`� .+ � �' �y S►+�a S �� y S u � This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary.compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD- ENFORCING DEPT. TOWN OF BARNSTABLE. ��� Ordinance or Regulation BAR -W WARNING NOTICE r I Name of Offender/Manager { e I�-^f ` ' Address of Offender MV/MB Reg. # _ .Village/State/Zip Business Name zi-jx_ am/pm; on -7/2-Q 20 Business Address / L=t Signature.of,4Enforcing Officer . Village/State/Zip Ov V1 W. +� . 441� 0 Z h n I Location of Offense V1+ (7 } Enforcing Dept/Division Offense Nt, 4 1 11 f 1- -'� Facts 1,0 �' ,�R vly✓ This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations-will result in appropriate legal action-by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD-ENFORCING DEPT. NAME Of OFFENDE< L2 AD D` D 78741 ej G n TOWN OF ADDRESS DFOFFENDER BARNSTABLE CITY,STATE,Z Cd)E IIHE►qY MV/MB REGISTRATION NUMBER OFFENS l Y1 � U ter^1 1 4/A LJ ,esv. 'Fo rts+' r t�M.�i fi� 9,A 4 G�V`5 sL z-r A,15 aJ)-41 J} Lt. �f,>.�1 � �t+:���.• > ` TIME DATE OF VIOLA�a� LOCATION OF VIOLATION t W NOTICE OF • arP,f1I.)ON7 Z� 20 { ^ o ,f' (gf123� h�� ft VIOLATION SIGNATURE ENFl1RClr5 B SONI l ENFOR INGD PT. BADGE NO. N ,terra ��-�' .. ( OF TOWN I FKREBY ACKNO a GE RECEIPT OF CITATION X a ORDINANCE )ZJ Unable to obtain sign ure of offender. < THE NONCRIMINAL FINE FOR THIS OFFENSE IS S Date mailed 1 1 �S ' 7� w OR YOU HAVE THE FOLLOWING A TERNA IVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. lau REGULATIONCn (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, W before:The Barnstable Clark,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or posts note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. a- ((2)If you desire to contest this matter in a noncriminal proceeding,you may do so 15 making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature IB rower Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASSBLE.g` 200 Main Street• Hyannis, MA 02601 ,639 e,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT TEO MP'� Business Name: CQ . Cm� y Vlc�b��� (j�-a v�,-gyp. Date: Ol S f g Location/Mailing Address: 3 a.,nc_ H ,n Contact Name/Phone: a.v .e. 1--4 ' ec Inventory Total Amount: SDS: License#: Tier II : Labelino: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: 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 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: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IME r°k� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 vB""MASS. 200 Main Street• Hyannis, MA 02601 �A�fOMA�°`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT ' Business Name: Vk 14 e Date: Location/Mailing Address: 3 kn�' c,l H v,,V1 A 1% _ Contact Name/Phone: �r�� �/ �IU�' awu.c r // SDI-7'l I -Z�oa Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: 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 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: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS THE r� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMARS- • 200 Main Street• Hyannis, MA 02601 �'OrFOMn+a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ( QL& C Arc '4 Gteuv, k Date: 21 l b Location/Mailing Addr ss: s 2vw Contact Name/Phone: 2 ate. a et e 68-771-.Z bO 411�<- Inventory Total Am unt. ti MSDS: a +am, License Tier II : WA ,7 Labeling: OK,. Spill Plan: 03-1- Oil/WaterSeparator: Floor Drains P—s 7 Emergency Numbers: Storage Areas/Tanks: Yo A-V e. Emergency/Containment E ui ment: Waste Generator ID: Waste Product: ebl Ae. t Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: k< C �4�.c o P�oX• •e�c�ty `3 v"�� 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 �V Hydraulic fluid (including brake fluid)ID Windshield wash Motor oils Miscellaneous Corrosives J 2v asoline,jet fuel, aviation gas fie: Cesspool cleaners .� �. Diesel fuel, kerosene, #2 heating oil 20 Disinfectants is�aneous petroleum products: Road salts grease, lubricants, gear oil 1 Refrigerants Degreasers fof engines&gar es 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: go J�Su� Q.,A C&&� . ORDERS: Gk\I0.% a�p�,�e. 0 q)MAOIR5 . INFORMATION/ COMMENDAT ONS: DC-- W c d r.C,a 0 C,NA 5 \.Q 0 Vv� �o Q N V1 V ! 0 cco-"�� �a 5���e,��t,¢, eol ate, Inspector: m- � c�.� �t' 4 V1J �Spresentative: Q, WATE COPY- HEALTH DEPARTMENT/ AWARY COPY-BUSINESS will faI t o o-v,Q WI tk owqP� 1 m_)�>4ee_eVVL)9e�� r Date:// / .5'/ 1 ,3 TOWN OF BARNSTABLE , e-+,o,,� TOXIC AND HAZARDOUS MATERIALS REMSTRAPM FORM NAME OF BUSINESS: Calk_ Coco m4rwe_ BUSINESS LOCATION: _ INVENTORY MAILING ADDRESS: _ �ay+ti� TOTAL AMOUNT: TELEPHONE NUMBER: 5�0 f3 --7-7 1 -'Z 9 p e4 on CONTACT PERSON: P-tc-i e!,j 6,iyet , ot,>-uz EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ovu INFORMATION / RECOMMENDATIONS: YOJ?I�IN_ ✓►'IcS�S 51fs Q )<ee0 Fire District: Drt. v►}e, 4Vg �a61e �o emlp�o�/ees79n5oWtt y+a11r_"icaj orobc,�_s 14!44V,%V1I5 am CoveT 10 Vt QN IS , �r afeet ✓vJLor S k r VTVj v jAj w�5�2c�cc�e� V10 l t,qi t&vn1,CS -to .� ®�k av� A. �� .��a Jc o Ie_- Waste Transportation: o r Qva1 Last shipme`ht of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils _ Pesticides ❑ NEW USED .> (insecticides, herbicides, rodenticides) p Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) S 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) I Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes `VL,5A64K+, 1,yam> �9 Laundry soil &stain removers . (including bleach) DD "� yr— C qA) Spot removers &cleaning fluids (dry cleaners) A&y 1 d,0_ S Other cleaning solvents ovkmbk Bug and tar removers r EL a —`l ` ,g Windshield wash � , I WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature �I taff's Initials TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: y(/L/'f3� Lo w 6IV MAILING ADDRESS: a O Sly(RY TELEPHONE NUMBER: 7 7 S 8-9 7 CONTACT PERSON: D Does your firm. s:tor.e -any--of the toxic or ha-zArdous materi is 1` sted below, either for sale or for your own use, in quantities totalling, at anytime, mox 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 AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic 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: Antifreeze (for gasline or coolant systems)_ Refrigerants Automatic transmission fluid Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals t Motor oils/waste oils Printing Ink : Gasoline, Jet fuel Wood preservatives ,�L'7f4lgiesel fuel, Kerosene, 4�2he�ati<n�ol� Other petroleum products: gxr ase, y= (creosote) Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal i it Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCBs I' Car waxes and polishes Other chlorinated hydro,- ! Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) Spot removers & cleaning which you feel may be p g fluids toxic or hazardous (pleaser (dry cleaners ) EC. � list) :s� Other cleaning solvents W;E4LTH W-PT. Bug and tar removers TOWN OF BARNSTARE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants SEP 2 8 Road Salt (Halite) �L TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: .s 42-hue Board of Health MAILING ADDRESS: •� �� Town of Barnstable TELEPHONE NUMBER: ' P.O. Box 534 CONTACT PERSON: �� �jri �•„f'�,� 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 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 AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when store gh Please put a check beside each produff-t-fiat you store: V Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners V 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 MPLlANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores S j f 6.Fuel Suppliers ADDRESS Class' / 7.Miscellaneous 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/h�draulic , Synthetic Organics: degreasers &,,Mis v d cella�J�ngous. L�_4 9 ft-A DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 444 O Town Sewer WPublic On-site OPrivate 3. Indoor Floor Drains YES NO _ O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES P/NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product LicensedT 1 qjl pa YEs No 2. _ Person (s) Interviewed Inspector Date d