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HomeMy WebLinkAbout0130 ROSARY LANE - HAZMAT it ° o ° a ° s g Y ° ° Cyr 3 Town of Barnstable t;. Barnstable ° T Regulatory Services Department Public Health Division ,t �ar> , 9 A 16 ��� 200 Main Street, Eyannis MA 02601 2007 OfFice: 508-862-1644 Thomas F.Geiler,Director FAX: 508-790Z04 Thomas A.McKean,CHO Application Fee: $100.00 Lj ASSESSORS MAP AND PARCEL NO.3 — d DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS PULL NAME OF APPLICANT Vt V I NAME OF ESTABLISIEVIENT h • ADDRESS OF ESTABLISHMENT g _ r TELEPHONE NUMBER ,7�Q SOLE OWNER: YES NO cr IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS C& LL N PARTNERS: G W � p C5 r IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO 0 1 STATE OF INCORPORATION Y FULL NAME AND HOME ADD S OF: (frr y fj l�e !•�"'�j �Ky /3Ok 7?- PRESI6ENT TREASURER �5 CLERK �O A47- -97- 169re- • �� C IGiYATU E O A LICAiYT CT 1 T ZL �� HOME ADDRESS HOME TELEPHONE# i -3 P � a Q:\Hazmat.Haz Nlat Application2008LOC 1 i • MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow time for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax nuunber is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In . addition, please mail the required fee of$100. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow time for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page • QAHazrnat\Haz Nlat A.pphcation200STOC I 1 °Ft►+Erokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMARSS. 200 Main Street• Hyannis, MA 02601 �prFDMP+N,e� TOXIC AND HAZARDOUSMATERIALS INSPECTION REPORT Business Name: 0 0(�, I Date: Location/Mailing Address: I i3b RO EA Contact Name/Phone: S ^ Inventory Total Amount: Oy MSDS: License#: Tier II : A18 Labelina: Spill Plan: 011 41 Oil/Water Separator: Nr Floor Drains: Emergency Numbers: Q Storage Areas/Tanks: shfIvIln Q I �` 1 Emergency/Containment Equiomen . AN ali Ai Waste Generator ID: Waite Product: ADate&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: INFORM TION/RECOMMENDATION : G Inspector` Facility Representativ r WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1236 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Colonial Floors LLC 130 D Rosary Lane, Hyannis, Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable " Inspectional Services o�� roe BARNSTABLE Public Health Division R 355fd?.:•iEM1::4`:U G4lTL',T•M?":1 v.�.LS::�.Ni'�::JS•.Ji:Ei1::.-.:Y i'P.i�:i5iM:. 16'.i7CIA r BARNSTABLE, Thomas McKean, DirectorCD • 9q'Ar1639o.�01 200 Main Street, Hyannis, MA 02601 N) i Office: 508-862-4644 Fax: 508-790&iO4 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 .9 ch" CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by 1st. 1. ASSESSOR'S MAP AND PARCEL NO. (3Yr-i)18 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:­t� —_ 5. NAME OF ESTABLISHMENT: _ L locL, LLC 6. ADDRESS OF ESTABLISHMENT: � Rb s k —y 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: � 8. TELEPHONE NUMBER OF ESTABLISHMENT: JV 0 9. EMAIL ADDRESS: L� C'-���v-� l • 10. SOLEOWNEI2: 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 APPLIC T DATE l b API Q:\Application Forms\Haz Mat App Revised -IQ IS doc I I Number Fee 1236 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Colonial Floors LLC 130 D Rosary Lane, Hyannis, Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 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 errs Pd Tow of Unstable � ah� eg3atoervices of t rqy, Richard V. Scali, Director ue-li3STo J Public Health Division BAMSTABLE f BARNSCABLE. XASIORAC.ILLS 1OSTNILLE•C WEST BARNSTAB v WVLST9N5 M.ilS•OSiEA�iLL'•q'6f 9AFNSI42:E Mass Thomas McKean, Director 1639-20t4 ATF1 �a -200 Main Street;Hyannis,-MA-02601-- --- - --- - D�- --- --- , C) Office: 508-862-4644 Fax: 508-790-6304 �d APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE X HAZARDOUS MATERIALS Cry 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 PER-MIT 26- 110 Gallons: $ 50.00 El CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 -.Fxr V.S . CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by Ju!Y 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:qD-�► C> U< ��-t�� y S 5. NAME OF ESTABLISHMENT: C O L-o t--)i jo-� VL,,C, 6. ADDRESS OF ESTABLISHMENT: !�>D — Lzkr--,C 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE`,:© �^ 8. TELEPHONE NUMBER OF ESTABLISHMENT: V 9. EMAIL ADDRESS: Tn0o i.(-� 1CJ� �rn 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 +MAIL: SIGNATURE OF APPLICA T E Q:VWpplication Forms\HAZMAT APP 2017 REV Number Fee 1236 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Colonial Floors LLC 130 D Rosary Lane, Hyannis, Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ---------- ------------------------------------------ -------------------------------------------------------------------------------------------- `O ----------------=------------------------------------------- ---------------------------------------------------------------------------------------- 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 f� v -,L• M l_ 1a�9D ' owr>1 of Barnstable egu atory ervices oFt ram, Richard V. Scah, Director . Public Health Division BARNSTABLE + F<ft;15!A--CrNIEWL:-COTNT•HYi.js BARNAB . ; NARSOs Mi_l5•PTtxRVlt!E•'N:Ti^4RYTTAp1 Thomas McKean, Director 16l9-201� 9`hA b9. 1%. 200 Main Street H annis MA 02601 317g rFo near � Y � � Office: 508-862-4644 > Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR 19TILIZE 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 ! PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 . V's CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �,t-� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: , q 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: ELEPHONE#: COMPANY ADDRESSWdo,, (:� MAIL: SIGNATURE OF APP IDATE Q:\Application Forms\HAZMAT APP Ol S * I Number Fee 1236 THE COMMONWEALTH OF MASSACHUSETTS $125.00 _ Town of Barnstable --_ �s- Board of Health This is to Certify that Colonial Floors LLC 130 D Rosary Lane, Hyannis, Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------- -------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/201.7 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 J Town of Barnstable • �� r Regulatory Services Richard V. Scali, Director '01 KASS. Public Health Division J BON.ABLE 6,9. A 1639• ♦� 1" BPKws os- 15 av 0-1-4"n�ou 1"' 1639-2014 n^A Thomas McKean,Director ( �� �Dg 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). _ APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 'r L' 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 :IWjl' FULL NAME OF APPLICANT: 1,JW L'D NAME OF ESTABLISHMENT: ��- ) lAL �CX>�—� U—C-- ADDRESS OF ESTABLISHMENT: MAILLNG ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT:. EMAIL ADDRESS: AaI.J`(--� (2, CL I dllanu' —' f oocs ► Co m 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: SIGN TURE F Name: Company Address : Telephone#: Email: Q:\Application FormAiAZZAPP Rev16.docx Page I of 2 Number Fee 1061 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health 3 Vs This is to Certify that Treescapes 130 Rosary Lane (PO Box 721), MA 02668 Is Hereby Granted a License 0ftV%1 s 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 30, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health =w Town of Barnstable �FTHE lqk, Regulatory Services p Thomas F. Geiler,Director wMANSTAMAS& ` Public Health Division 09 Pd � (n 9Q i639. ,0g' UiOrFD MP'�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 t f t��l�(a Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 f Q t ASSESSORS MAP AND PARCEL NO.3 y,�-o DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT O iV ,/T�L L f S`�d 9 NAME OF ESTABLISHMENT /3 D 4 k .H Y a h 4 B ADDRESS OF ESTABLISHMENT r/ *(2 K n ( ,S TELEPHONE NUMBER ✓v �/ /D����S' SOLE OWNER: YES ENO IF APPLICANT IS A PART HIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: l � CD IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Iq • STATE OF INCORPORATION IM /'T' / FULL NAME AND HOME ADDRESS OF: 2 Pp0 PRESIDENT �✓ ` ,�`Ai e TREASURER G r144q jP 4 Aj: ` CLERK 01::��A �,j jpo 'l- ''''I//LGNAT FwADPPLICANT p�`i (� RESTRICTIONS: HOME ADDRESS gkeh 1 t1 r y. •I trhS' HOME TELEPHONE# _ r � � Os3 Q:\Application Fomns\HAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division,p ' 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is,(508) 790-6304.1, Please,fax a completed application form. Also, please fax us a ;. copy of your contingency plan(to handle hazardous waste''spills,etc). In addition, please mail the 4 "required fee,.amount of��$10U.06 Please make the check.payable to'sTown of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health,Division'Pa�e` s 10 Q:\Application FormAHAZAPP.DOC I►Eroq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. • 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Cok 0,n.aA IF I vo,Cs Date: 1-0 Location/Mailing Address: t bSQ!L ,n.e- 4v,h1 s Contact Name/Phone:7 6>&,J0 Inventory Total Amount: A- �J Q, MSDS: Cq�Z License#: Tier II : Labeling: OK Spill Plan: 0,5 t- Oil/WaterSeparator: 1A Floor Drains: 61) Emergency Numbers: Storage AreaslTanks: A " AA C6WVA1%&4-W5 Emergency/Containment E,quip a t: I < VkI a L oN t kia, Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 4-oww+-C-6,vk-s 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: 1 Caulk/Grout JcA4-4,vt510+b insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) rL Rustproofers 541tIq-.,A S t wa.X,6S Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes ,,��cc`� Wood preservatives(creosote) Asphalt&roofing tar X���$ Swimming pool chlorine ° Paints, varnishes, stains dyes �XA- o Z Lye or caustic soda Lacquer thinners k�� �'-�Q�N�S4�Z�k3 Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables tnk, 01 Fertilizers Floor&furniture strippers VNI ���5 PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" _I� av�u•n1ok..l.� g � th (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: 00 INFORMATION/RECOMMENDATIONS: tw�� �S v�F'�. �i Q,IvtRt �y Inspector: �.- Facility Representative: yl �w S WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESSCCLO"4-c-, �?-� 5 Date:10 TOWN OF BARNSTA;;Ii�o�"N TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: BUSINESS LOCATION: 30 �) gvbcl, LAI INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MS�DS ON SITE? TYPE OF BUSINESS: 1 otr! uZyw6 %\L1\4AJO INFORMATION / RECOMMENDATIONS: '� ���ti�w SAS l,�.e. �� Firg District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum _ �'jo,r Ce,w�,N s as ,MAX Observed / Maximum Antifreeze (for gasoline or codlant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar 09 PCB's Paints, varnishes, stains, dyes Is Other chlorinated hydrocarbons, Lacquer thinners S �° $ (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash 1-15 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Init' s TOWN OF BARNSTABLE Ordinance or Regulation BAR -W {fl8 WARNING NOTICE Name of Offender/Manager /0'�e '1U n Ck Address of Offender MV/MB Reg. # Village/State/Zip Business Name �G�Wi' at FloOf 5 LLC 21o' 03 am/p, on 050 20�d _ Business_ Address Go V Rbs"'-1 Lo ern V— j S'gnature of Enforcing Officer 1��'rAc Village/State/Zip HA(wn //A\c/ o2fo J Location of Offense Colonial l` 000 Lk H eCA j t� 1 Enforcing Dept/Division Offense V►i�1aw � wn C l `'6 t �>f enS Gfl CC4)11V4eM4 P)OA) p � !` � Facts lxhih� S owntir ;5 Ar►04 <111 CVAIIM5 0� ktkza(Wf Q+er."'(A '1.40u� 1)row 1"CenS110 S��rn,ir appli C di;on -fee + Iv'� 1� e fee here ion sul� yi n S J 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 �05 Ordinance or Regulation BAR -W �/ WARNING NOTICE {� Name of Offender/Manager aye tU'cKCIA" Address of Offender MV/MB Reg. # _ Village/State/Zip. Business Name ColonIiak FWS LLC am m on C/SAl 20�� Business Address &) 0 ksa(c Ln 1 Signature of Enforcing Officer Village/State/Zip HaUl1n+S ZA\o f Ga(oj j y}, Location of Offense (ulonia Ikas LL( e" #'t �/ Enforcing Dept/Division Offense Vi'd t�u-i l� 4wn C k "'C t L;rP C"A (colt'noentq AM) Facts rwnef- ),nit culmn 0� karxrt6f flviler"tA X4'AQU - 1)fader k(tn;;D0, - I - - . Submit CA94(co;o1l.fee 4 1A We fee fie-e �4)r :06., tuo �p SvciR+ fo fh)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 OFFER GOLD- ENFORCING DEPT.