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HomeMy WebLinkAbout0155 ROSARY LANE - HAZMAT �� Sc�✓� L�� �ja���`s� 1 o o �" � ., 9 e ,P i � � s F o O_ - � @ - .. - .. i a i I '� t G+• � :, U .. 9 o ,; ` `� a _ '_ ., e � ® t .- .4 .. .. .. t � o �. � _ _ � .. _ b 'o � � :' i. � - 4_ —_ Number Fee 1256 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Fastenal Co. 155 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 Barnstable Inspectional Services BARNSTABLE pptNE Tp�_ 4R1:T..-tTn�AWU-CO -1-- , MAE Public Health Division"�-��9-2014 ��" • 1639-2019 1 �,&rAB . 1 Thomas McKean, Director �g 1639. 200 Main Street Hyannis,MA 0.2601 . 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 30th). APPLICATION FEES �.�d M� CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 Elat#09L&4&T3 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 O *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? OYES 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: 4ii A on n 5. NAME OF ESTABLISHMENT: J'ASs-TE)O A L o . —r 6. ADDRESS OF ESTABLISHMENT: S� 1�Of AA Y LAh.t- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: ,SCE 8 , —7 r O 81 J 9. EMAIL ADDRESS: _MA �-f yA ST 6A E f4-r &VA 10. SOLEOWNER: NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME r`o n,4T N PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS_ EMAIL: SIGNATURE OF APPLI ATE ZZ O Q:Wpplication Fonns\Haz Ma ppli Dra 9.docx t � °F IKE T° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMS�LE,g` 200 Main Street• Hyannis, MA 02601 1639 e,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rfD MP'� 99 -- Business Name: EC G Date: -3 Q. a 6 Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: . .2 SDS: License#: Tier II : Labelina: Spill Plan: Oil/Water Separator. Floor Drains: /V6 Emergency Numbers: EF- Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: 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 r 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 PCBs 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) 1/IO QL. T_ WS: S->'�� l)� t�e� C�q J j�[� e --1.3SC` ORDERS: y Ve- w ci r INFORMATION/RECOMMENDATIONS: Inspector: C Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FtNE*off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MASS.LE. • 200 Main Street• Hyannis, MA 02601 MASS. �Ore%639. 0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C.4 +0 190ok-e is Date: ' Location/Mailing 1 Address: SS HobkvN i 5 Contact Name/Phone: Lu(S V Inventory T)tal A ount: � IMSDS: License #: Tier II : Labeling: QK Spill Plan: Oil/Water Se Separator: Floor Drains: Emer enc Numbers: p 9 Y Storage Areas/Tanks: � 2 I�l Z�M tea. rj o !3 K Emer enc /Containmen i ment: 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 f p , o 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 Woad 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: , e-k J2 Inspector: ua j4e, Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS YOU WISH TO OPEN A BUSINESS? FoP Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:( Fill in please: ,.. ;•. APPLICANT'S YOUR NAME/S: / i/iS &,�uri Ja BUSINESS Y R HOME ADDRESS. /70 w,_3fl tiivr S t- all r. ;54,ef, vr�in f2/,5 TELEPHONE �# Home Telephone Number �i 7 - -- --- - - - -- - _ _NAME_OF-CORPORATION: CaZL T NAME OF NEW BUSINESS TYPE OF BUSINESS z "- 4r2Z IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS c5 a L— /�-& O!� MAP/PARCEL NUMBER,,,?q _ v [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) .to make sure you have the appropriate permits and licenses required to legally operate your business in this frown. - 1. BUILDING COM BID ER'S OFF E This 1ndivldu I he ee ❑ eapatMlt requlr me is that pertain to this type of business. ALit orized Signet COMMENTS: I (,/_<C�4b �f 2. BOARD OF HEALTH MIJS GOMPLY WITH ALL. This Individual has,been informe o p re ants that pertain to this type of business, IAZARD©US MATERIAL$REGULAT16NS Authorized Slgna Lire** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This Individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: / It / TOWN OF BARNSTABLE DatearS TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �'s�f�'6' Alto /NO).(G)zS BUSINESS LOCATION: S/ ,e:X INVENTORY MAILING ADDRESS: 5,0,,4 TOTAL AMOUNT: TELEPHONE NUMBER: _ '�p7 '75",S�'� 3 ") / �S CONTACT PERSON: c,�S f1'►QI�A'l-S EMERGENCY CONTACT TELEPHONE NUMBER: p ''7r; 1 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: IL0 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 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) 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 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials • monk (a! 00 °F.ME,oh� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"M�`E'$ 200 Main Street• Hyannis, MA 02601 039. M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 A'S Business Name: Pa&k Date: O l q 119 Location/Mailing Address: ( 5 l A Contact Name/Phone: _ 0$ -77j• y Inventory Total Amount: SDS: License#: 56 Tier II : Labelina: C Spill Plan: LP N Oil/WaterSeparator: O Floor Drains: O Emergency Numbers: Storage Areas/Tanks: VO Emergency/Containment Equipment: i - -Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: KI Licensed Waste Hauler&Destination: �f 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) eAsphalt&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 PCBs 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: N Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1256 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Fastenal Co. 155 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.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services :*: LE OF THE Tn, ,nrinr • o Public Health Division .��" f..w LE. ` Thomas McKean, Director 9q'ArE039. .�a`0� 200 Main Street, Hyannis, MA 02601 r ,Mx 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 DVS - CATEGORY 2 PERMIT' 111 —499 Gallons: $125.00 ❑ �, ,I) 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. VY00 bvLac 1. ASSESSOR'S MAP AND PARCEL NO. �f�""a �/ 2. IS THIS A PERMIT RENEWAL? _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: -phtj id- RPt � 5. NAME OF ESTABLISHMENT: F-A41-atj4L- to. 6. ADDRESS OF ESTABLISHMENT: 5 S �OS 4a y LA n& nA DZGo 1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: SDe - _1_7 S OS 1 —7 9. EMAIL ADDRESS: �� }{ � � STO R LSS. ��is?'C/'��11 Co l"\ 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: A1 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME S�reN#L- C c l.'l kohA ,M061. PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATES Q\Application Fonns\Haz Mat A evised docx 30 CIO Number Fee 1256 THE COMMONWEALTH OF MASSACHUSETTS $50.00 i� Town of Barnstable = Board of Health This is to Certify that Fastenal Co. 155 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 r,e. " own of Barnstable eg atory emces ZHE Richard V. Scali, Director � Tp,_ Public Health Division BAMSTABLE -- snxivsTna[L, � ;: MASS. Thomas McKean, Director 163955-772�{014 5' -- - - -- - -039-- - -200 Van Stiseet�Hya , A02601-- - _ ---.----- �Lh- .',;,1y--- - - -- ';nOfice: 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 1691,1 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 V,!S CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charpte 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?_0 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: ­DA cc 9 r4&Ihv1 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: LA►L- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: �V 6 7 r- O 7 9. EMAIL ADDRESS: &I,A H y A rf ST &F-S.FA17EAIA I o L mac, 10. SOLEOWNER: YES_lr( IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME �%�l_S 7r/N�tt_ CI) , PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICA ATE Q:\Application Forms\HAZMAT�APP<21 <' E VI docx i. Number Fee 1256 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Fastenal Co. 155 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 06/30/2018 unless sooner suspended or revoked. -- - ---------- --- - - - -- ------ - -- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r ' 474 4 'Rowl%of Barnstable Wcb�� 0?31W'2&v9 eg atory ervices Richard V. Scah, Director Public Health Division BRNSTABLE Y enarcSatL.E•�:�viu.t•corun•xraa:is • BARNSTABLE, � Thomas McKean Director WWII& A ) aw,. 1639-2014 9Q� 1639. 575 200 Main Street, Hyannis,MA 02601 r� Office: 508-862-4644 Fc: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIA HAZARDOUS MATERIALS N� Cn 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 v,5 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. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?___C_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. pp 4. FULL NAME OF APPLICANT: v` DP'AMX/J CCn . 5. NAME OF ESTABLISHMENT: fAS-FL`wA L C O . 6. ADDRESS OF ESTABLISHMENT: I S S A 03 AA-1 LA n e y yA n n,S , M A O L 6 O l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5-©,3 "j -7 S- ]- 9. EMAIL ADDRESS: /V\A N y A a S-ro 0,E S. PAST .R L Co M 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME rA 17-CA6t i- GO "Z,o01 "11�C�1'ed' (�i J�, W%400, MN ST�S-7 PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT 1-7 Q:\Application Forms\HAZMAT APP 2017 RE 80.do Fee Number 1256 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Fastenal Co. 155 Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -31- 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. J� ---------------------------------------- G�J 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 F Town of Barnstable 592�co134v �t►�r°,i�' Regulatory Services °^ Richard V. Scali, Director .R . STAB _ BARN TABLE MAC. $ Public Health Division VABLr-MMWue•corff—.ms �„ A i6$9• �� eax"ST0aras•os*eaue•werauWTAR� TFD�A0�A Thomas McKean, Director 199 2014 200 Main Street, Hyannis,MA 02601 z Office: 508-862-4644 : Fax: 508-790-6304 N m W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERALPRDINANCE, 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—NNE 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 g��s FULL NAME OF APPLICANT: g(L.A N A Y) NAME OF ESTABLISHMENT: rAS7r- N'A L C t)• ADDRESS OF ESTABLISHMENT: Ms ��0SAa1 L�13 e— , I1 JJA '� t MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: _r, 08 r-7 7 S.D 8 S-7 EMAIL ADDRESS: A\A H YA r' S'r®Re-9. r^ASTelUA L - C 0 n-\ SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME FAS EIVAL Co- 2.ca6l 'rhe-ur'er BLV8- "p^ , s�'98 7 PRESIDENT ,->A h TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIG RE LICANT Name: Company Address Telephone#: Email: Q:\ApplicationForm.s\HAZZAPPRevl6.docx Page 1 of 2 IKErok1 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAN-q ` 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 1:Zs 6VkA k Date: !6 Location/Mailing Address: ►S� qoSa4V LqK'e- A Qvt✓l+ Contact Name/Phone: Mid Inventory Total Amount: k l MSDS: License#: C4f7 k Tier II : Labeling: (tea,% Spill Plan: o Oil/WaterSeparator: Floor Drains: 0 Emergency Numbers: Storage Area 5-Is'l V&VXA') Emer enc /Containme t Equipm6t. 5 { 2v a.-, Ve-&,A y,key Waste Generator ID: r- v Vol Waste Product: Date&Amount of Last Sh ment/Fre uenc : 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 a Bug and tar removers 1J Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives 5' 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: Jo Caulk/Grout�+I- t IS 4.JawAS insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink 'I, Car waxes and polishes Z Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine 1 Paints, varnishes, stains, dyes I Lye or caustic soda Lacquer thinners _� Miscellaneous Combustible- Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables \Oke4 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" I2 �� (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/ COMMENDATIONS: 5 VL �. \ ��R, o•� A. 2�• S � Inspector: ] 4V2 c�.S. Facility Representative• ; WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: TOWN OF BARNSTABLEAspee ,o,,"— TOXIC AND HAZARDOUS MATERIALS N FORM NAME OF BUSINESS: BUSINESS LOCATION: I SS n ri►5 INVENTORY MAILING ADDRESS: 54tVIl-4— TOTAL AMOUNT: TELEPHONE NUMBER: 5-00 - ?7_<- -7 41 0VL6 CONTACT PERSON: _ EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 41 1 11-J ���7�.re. yeS INFORMATION / RECOMMENDATIONS: S.p,11 tib sorbe4e, om- ►fe_ - Fire District: Waste Transportation: AJIA 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 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 ❑ 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 2p 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 17 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 3 Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) 3 Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials