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0035 SCUDDER AVENUE - HAZMAT
1 / --- - - - \ - _ / \ � �� �I i �, �� COMPLIANCE: CLASS 1. Marine,Gas Stations,Repai.r row-N OF BARNSTAB `E 2 .Printers satisfactory 3. Auto Body Shops BOARD OF HEALTH 4. Manufacturers Qunsatisfactory- �-° S. Retail Stores r (see"Orders") COMPANY"`It AA �d; �.�" r'`�?`�-� t • '! 6. Fuel Suppliers E ,r _. -•--~ Class!" ; 7. Miscellaneous WAMIRM ADDRESS ` TORAGE (I indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums ' AbdveTanks Undetg=oued Tanks IN OUT R e e Cest? Fuels:. U l c Gasoline, Jet Fuel (A) lJ Diesel, Kerosene, 12 (B) t Heavy'0ils: j{ ' waste motor oil (C) new motor oil. r transmission/hydraulic Synthetic Organics: ti - degreasers ,s, Miscellaneous: v _ DISPOSAL RECLAMJ FION REMRKS: <�i r 1. Saary Sewage 2. Water Supply A� ��.,;`,-;,, ,-•,. r> �;-�� `7 n t _�� i. • Town Sewer public �� �� , �. �� A"' On-site 0 Priva e 3 •Indoor Floor Drains: YES NO Holding.,, Cat tank: MDC • ` `r 0 well Catch basin/Dry —�,---URVE �...� t. 0 On-site system 4 ,, I� 4. Outdoor Surface drains:YES NO 777' r Huldin •• tank: MDC Uy O Catch basin/Dry well -- - - On-site system S. Waste Transporter. Licensed? fame _of Hauler_ —jJpetination Wit ste Product 51 NO f., 'K N� t"i/ �t �!°{� ���r�....+ r � 1• t ...Y, A ' L;h ✓�a. �,• 6J //`� r i erson sy)' lnterviewe p ,...0 23 81 � r inspector Date w l�SE1,ND0tz Compho iterua1,2,and 3. o Add ytha addrssa to She"REILTtZYi Ta^tjeo.as ,reverse. `o ..1. .The fonming service is requested(check.om) XX® Shoir to whom and date delivered ..........._ Shaw to whom,date and address of d4tveay.,.._.Q -.s U USTRICTED DELIVERY Show to whom and date delivered.........«..._,.i ®`-RESTRICTED DELIVERY. Sj&0 a to-,whom,.date,and address of delivery.5— (CQMSULT'MTMASTER FOR FEPS) 2 AW MLE ADDRESSED TO: ` m Mr. Frank Reagoso,Mgr. Dunfey' s Hyannis Resort 'a West End Circle,Hyannis ,Ma.( 2601 __ 8. AHTiCLE_DESCflft►TlON: REGISTENED NO. CERTIFIED W1 . :t6vvtlflED 1d0. I 0523320 m (ANveys obtain signature of address or agent), eJ In . I have received the article described above. � SIG14AT Addressee C)Authwtwd spat m D m D,T L! RK r _ S. .aak7ta- (eose+rdetn only if revuatdi, C`P ', 1. m 6. il'U"LETO DELIVER.BECAUGE: r LEFtK'S- ! rS IALS D r: �Gf+D:7�76$tlJ439 UNITED STATES POSTAL SERVICE '1 OFFICIAL BUSINESS PENALTY FOR.KWATE ' SENDER INSTRUCTIONS USE TO AVOID PAYMENT I Print your flame,address,and ZIP Code in the space below. OF POSTAGE.SM uti; ` I • Complete items 1,2,and 3 on the reverse. • • Attach to front of article if space permit% I otherwise affix to back of articia. I • Endorse article"Retum Receipt ReQuastaq' II adjacent to number. RETURN 7 i BOARD. OF HEALTH (Name of Sender) TOWN OF BARNSTABLE i P.O.Box 534 Street or P.O.Box i HYANNIS NIA 02601 0534 qitY..State,and to ;V , t�. ,y, t + .•' j . +, ., ` . T. . . ,;4 � � }.r to t {',•, f t• � y 1 .. , _„ Y- - ;April 14-,..1982 z` { "Mr,. Frank Reagos , Manager , _ 3 •, _tom `; } Durfey s :Hyannis'Resart" West End'. Circa® .. `Hyannis; Ma. . Y=NOTICE' O, ABATE VI©U ION'S OF `.TH9, TOWN`OF:BARNSTAHLE TOXIC��AND+ r'? .;HAZARD01US WASTE Y ,IAIW d r; The •.property_4 managed' by you, DUnfey!a Hyann s.�'Ressort; was i6gpected { on April 8, 1982 and re�- .nspectcd -on Al,;Ap +13 ••1982., by John ,Jacobi, Health ' Inspector+.+€oir.they Town,, Barnstable. '�'�The f4116wiriq vio1'atiQna of.-�the�•Town of',.Barnstable'�.Tox c and Ha`zar`dous°'_haste By»►T�aw,wt�re`:oli r ,. served. , < SECTION 5. °(A)', Fa.. , rilure; to report to`,the:�Boa_rd ;6f,_Health btorage •of 4 . toxic and•hazardous` materzal� in quantites.. xceeding 25 pounde dryr.weight, and 50 gallons.'Aiquid"weight:'`•:,"+PeS;ticides:-and fertilizers ,stored far yin,excess ok' this amount.` eta SECTION 5 forage of restractecl -pesticides+not,.separate-•from ` those,:o€,+general"`uses �Storagefi:o'f `op®nsd pesticides,, end �herbibides;,� on storage,.room floor,''not, in plastcbags'sor garbage pails '. 'Storage"of ;liquid;,pesticides with nor, label$.- as':to contents. , Storage ` o€ waste oil..in Unmarked55;:.ga , on 'drums c You are dzrbcted? to correct ,the, above, viol'aticjW, within; seven (`7) days " .. nk of receipt. of this +notice. ;You fare fOrther dixected, toyprq ride' separate• t s 5 locked ,and 1gb�11ed -water_ tight 'donta' ners,�for 'all 'restricted�pesti"rides.; addition,,`you•,,must` provide.°,suitably label-led+ water tight` containers = r ` ! to'r`,all '6penea',powi46red.prt granular -pesticides;`herbicides;-`and ; r-fert .l :zers.,; Disposal o ,all'<1i id i qu and powdered ;pest c des Wand herb3«* rides must;be;`done in:rstrctV:•accordance`wa:th ,the -regulations of the 3 ;`State Food arid'.Agr .culture,Departient .azid }the;.Degartment~ of: Envirorrieental Quality En4ineering: '�: In adc you lnust,'submi-t an,inventory of a ,l y Y esticides and fertilizers` ator®d on our:property b Ma l =and Noweinbe P ,y .y Pop Y Y y x , ,., .� . You'mays request a hearin *before ' Ehe+ Board,of'` ealth if written 9'_ -petition, r:equest�i.ng .same is, received`seven (- ) 'days after ' the 'date; order `yv -.served ,.. i i +"3� lx ^ti i• ,tea.. ti: i+ i - 1' + r� .t Wit. raj v. r.• r '-. s+Y,, ,, .ar 7 _ .ti. .t x ('~R *o r,.•' ; '-`�-•'` 4` + •i 4�4«JY�/ sty• S !,'� 4 i,4 ! ; .., S � . - a+ In ... i i ! i '> +x +.! a '} '"•y e• �rf.ti-3- ,. + i� Y 'r _ f _ ' � . + }v `P.,'•C[. �t { .• ` -M ./a5 F � - n 1! ` • t IS r, Y _ •fir. S ys+. mot,? ,t q `• r�ti t t. t} 7- } t •'. 4 e - - .,� '�`+/..-r1 a�,M, t -s } ~ 15 `i.• r r i � a � •.� f e�•"•- r.. i .* �4'" �4 =; k�l �� �.� }?if�f�- � _ 4 ...-� 4 •'�"! y�'S" �"F-�° 4:"w,4S r f r� k4. � . 1 T.TM . Cam• �s`��,a.4 1 e { Mr.',-Frank Reagoso Manager' Dur fey"s Hyannis.' Resort :.� •Page 2 .� r:, z� • t � ,° ,�>, � r, •yr _. �. >{�Ap`r"il .i4 1982 . . ;,� ,l � .� rtrs z� _ .�� �•4 a..4�" ,#� � � >}�• ` , s"'• '... rocs * } ec ; ,�;� 4 a Y ,+. ,� .,,s,�. 1a r ' - r, ,....r-•. 41 .I ,tr`t f�a h, ;x�•• 1" r w, S „s.,;�„ `s' v _ - r 4 4 - .i- T,,{v y r '�� C ! �., '' ✓i 'r>' "��,. � •4i �Fr , 4. � 4 stf r � .f f ],F r �� ' f>', •' r •i S. # ; ,, r .:�, �r - t t ..`' t - 4 ,r r Y .�,r.. � ,� ;t a •, h'�.. � 't• '_�,'Yk w;a4i�t d'� ^q:"'t'"� � ,•' �•. roi Y •3, a.:�' Y '.a e :, � • 4 wt~ Non=compliance .could result 'ina3`fine `of up to�'.$200.� . "Each-;days • ..failure"t - 'd ;I w r .d o ..comply with an: -order shall, :coris titu�te_ ::a::.separate v "ol_ ation. . �}t '. •_r S v - -. � a3,*. fir •r f ,r� ro� :� �. - {� S a r � r a ..a. +s � 'F ,x -PER:`ORDERjOF THE,BOARD. OF 'HEALTH-,",.,-, r .,, ..< •f ` � ;:. .'' d may. .� �,� , i .try ,, y John�M - Kelly'- Director of -Public Health .,� •,�Vi'JiL1'1mm •n ,a' a' '> s >a lC i•,cc. Mr Tho ?',� F ,! e°Y'yty�•(�x'S'4;'hF*� 7'+'� rda. r E•'' 4 Y .fT + a t mas;Mullen Chief ;Richard`Farenl�opf t t a v ti, r �, •r.' s rev =,,. .J d `t. - f� s`- t i:" � � � r:: } - * Ja.: "+$Y::� T Ea ,`»a• .'R• -w�� -a$. r�� + y, a Y..,ri! x 'f = •'#'. . i., •fa . y ,, r +,'r.�.`�. t i� �r 4�a'4i�.ty - C /'y�^'�. yl.. rx5r $1�r.j ::� a ., r ''r' � .. Cr` at. .� � ay � •.et � •.� "�•4 f x rr�� �' � }� S aL�a 4'a�i ti f S Ad`"'a` . ,kt`.., y ` i t` t5,y.+•.,.hr .�'r h ',`. ' o •�rf t�. � r r a r a '`» Mry, t� }.f".,4s. _ +,' r� J"i C-,.°„ .i fir.`.Y 4 y E, Y •, .� -"" c ,4.. .,,,7 n i qa9 1 r .`�� +:• w r `t 4 _ r °`' . .`r i h? xy 7. •y�. �•G°' ��,�yy � lrY`''",& i !j rosi la ": ,r}+�y `>,:�>'> 5 ; a'« � , i• a }-.� 4" Z Y � 4 � Y i 1t n✓'� :R` >A :(„ � :Y" Y ,��'�t I,�f "T' b S�i (, •„ i � P i,, J. .r +, �> ; •ti '�C r5i'4 i� �+f.''a) y,,`�. �i:'sy a�' �. � t .f# ' � .Li t,t kv '• w* k r.�'t ,..Yw 'Ry I "•r� u>#x� tir l.• - t < - _ 4 "b' .f3 - -. 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I a' �..�` �,• >�4 ' � r` � , �" J , ` �Y :� ., s ��, '1 ,F. L f4 4• � ,�, � `5' .i ., t q z ro' �'f} .' - i. Y '.�e '. • •' ,? ' _ 4. _ s � 1'4`'r, rf: ti. t.. :Fri'• '' . ' � � � 3 v 1 � � , ,t 1 3 v" •r 414,* T•- .•S E .•., r�. P� .. r'"y 4. .t ". f 1 �..A } ..a.d+ ,ar :.,� t 4 _ t a z�.,.• :�-. .•r f '-�r 'S-�.5.. - rt'+� '� > •y' t a �, �4 .r t' �, t1 .-.f ♦• - - .. t f y.•,.i s S rt 4�, TOW ]OF BA R N STA BL E COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r O satisfactory 2. Printers E3rUA f�D OF HEALTH 3. Auto Body Shops o unsatisfactory- 4. Manufacturers J COMPANY P j(see"Orders") S. Retail Stores d,�C� � 6. Fuel Suppliers ADDRESS l U)/)C/� Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots " Drums AboveTanks Underground Tanks •IN IDUT IIN IOUT IN IOUT # & zallons Aize rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (8) I Heavy Oils: waste motor oil (C) S5 new motor oil (C) transmission/hydraulic , ✓ Synthetic Organics: degreasers t 1 ) 1 Miscellaneou . DTSPOSAL RECLAb'.ATION REMARK 1. Sanitary Sewage 2. Water Supply A j2rTown Sewer ublic ,"A, ) On-site Private ;� j g„ 1114 � r 3. Indoor Floor Drains: YES NO �� 4 Holdingtank: MDC ' Catch basin/Dry well 0 On-site system - 4. Outdoor Surface drains:YES v-_"NO O Holding tank: MDC rq ` ° ' f 41 '6�'�atch basin/Dry well y- Oon-site system S.�✓Waste Transporter Y('L Licensed? ame ofHauler- Desti ation f Wastc Product NO \ / An CV D 12 23 e1 Person(s) Interviewed Inspector to ti t T I r i � ' r i f b • I I Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that TFG Hyannis Hospitality LLC/Resort& Conference Center 35 Scudder Lane, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------- --------------------- ------------------------------ -----------------------------------------------------------------------•------ ---------------------------------- ----------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Barnstable �az, T Regulatory Services Department o� Al-3�ne�ca�+j Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director . FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. C) M DATE l I APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT P MN Krg, P(9�; (/(� Ue NAME OF ESTABLISHMENT d64 K,��DU Wff&W cam • ADDRESS OF ESTABLISHMENT 3, Ai . t�'�WRO ND� Mk TELEPHONE NUMB R �' �:�_P j`7` S SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS T3F ALL t PARTNERS: Q fXa C7 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • SiGNATUAUFAPPL1CAVr RESTRICTIONS: HO E ADDRESS 56,25 CAgtp=0 PLACC, e0CA QA1'IW, PL 351/1 HOME TELEPHONE # Q:\Hazmat\Haz Mat Application2008.DOC OGRE ft)-)ens � �� IktTv From; _it f Hazardous Material Contingency Plan Hazardous contingency plan for TFG Hyannis Hospitality LLC, dba Resort& Conference Center at Hyannis exists as having a spill response kit available for easy access including: For spill containment: -absorbent socks -absorbent pads -drain cover mat -speedi dry Personal Protective Equipment -protective coveralls -goggles -gloves For disposal: -2 poly bags w/ties Posted in shop area emergency contact information: -Hyannis Fire 1-508-775-1300 -Cyn Environmental 1-800-899-1038 -MSDS Sheets/Book INE rokti Town of Barnstable Office:508-862-4644 Public Health Division ��ax:,508-Aso-9304 BARM. B% g` 200 Main Street• Hyannis, MA 02601 �y 1639. TOXIC AND HAZARDOUS MATERIALS INSPECTION-REPORT QED MAC O Business Name: �Vi 0 cyo Date: q// 16 AQ 0 Location/Mailing Address: V6 ` Contact Name/Phone: Inventory Total Amount: MSDS: License#: �IG� Tier II : N, 0 Labelina: Spill Plan: Oil/WaterSeparator: AMA Floor Drains: I Emergency Numbers: Storage Areas/Tanks: i I VA.%- Ili Emer enc /Containment E ui ment: Waste Generator ID:AvSoKA 0, ' ' Waste Product: wd&C Oil Date&Amount of Last Shipment/Frequengy: Licensed Waste Hauler&Destination: ®1 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 IHydraulic 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 f 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 Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ .-------------------------------------------------------------------------------------------------------------------------------- 35 Scudder Avenue, Hyannis, MA ..---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: ..-----------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNSTABLE Public Health Division ���_„�" ��tNn 6aNYt0.1Nif4&E 1639-3014 1 HA MAE&LE s Thomas McKean, Director a � n .` CIO � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 x: APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE r 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 VVsr 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 • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: S S 5. NAME OF ESTABLISHMENT:&p20 Qt�dL � 17-P1J'-P/Y�L�� 6. ADDRESS OF ESTABLISHMENT: �� S&L"W &9—_ &ZA22^ 94 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:8. TELEPHONE NUMBER OF ESTABLISHMENT: (Dry p —"2 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION N ME PRESIDENT 0Mffi:j; TREASURER CLERK LXta-04 e, dby 74hype, 177 R a 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat Appli Draft Jan2019AM ��� 1 Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ 35 Scudder Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ---------------------------- -------- --------------------------------------------- -----------------------------. ---- -------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Ott Inspectional Services BARNSTABLE F S.1E xro`s"�c.�E'.s�• SPublic Health Division l639-2014 BARNSTABLE, Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304:r.-: 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 39 VS`1' C h Kw-- 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 N �� 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: 94A17k-Vy 5. NAME OF ESTABLISHMENT: o C 6. ADDRESS OF ESTABLISHMENT: P� 7. MAILING ADDRESS (IF DIFFERENT.FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: ��C��G e� � �� J 'L Pi 6pw 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT ,,.- �Q�GQ TREASURER CLERK t,,p eQ y10,Pi Moa Mw))O jL f l T 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT ATE Q:\Application Fonns\Haz Mat App Revised 09-10-18.docx Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that TWIN BROOKS GOLF COURSE 35 SCUDDER A VE, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ---------- -------------------------------------------------------------------------------------------------------------------- -------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health `a Town of Barnstable A Inspectional Services E*: LE OF THE f[1 •�NIk1=Public Health Division � 9 MASS $ Thomas McKean, Director �A i639. �0 rfa a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 1 (�C Fax: 508-790-6304 X: APPLICATION FOR PERM-IT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS MY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 g�p�� Z� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El1 *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. R 05 -I/0 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 ESTABLISHIVIENT: `����0�/l - bi-yemA3, el t4 oZ( a� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: )52>f— 42 CC 9. EMAIL ADDRESS: �ai )`Yt��l� GJ C�^"�8�!►� ?' 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: F. CORPORATION NAMEad451-c, t r A/� Jct-�C�crr ,)-t PRESIDENTS ��ovnul TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE C Q:Wpplication Fonns\Haz Mat App Revised 09-10-18.docx Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center(TFG Hyannis Hospitality LLQ 35 Scudder Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- ------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ------------------------------------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r x 1� an Keg, a o y zwmc ble g rY �C /9©� Richard V. Scah,Director f2S- Public Health Division *:MWCX-4 yi ASTABLE. • Thomas McKean Director 1 US& p )Ec `0200 Main Street, Hyannis,MA 02601 ,' C> w Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZES 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 2-6- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El *A late charge of$10.00 will be assessed if payment is not received by 1st. 1. ASSESSOR'S MAP AND PARCEL NO. �/�� 2. IS THIS A PERMIT RENEWAL?_YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. r 4. FULL NAME OF APPLICANT:5. NAME OF ESTABLISHMENT:QMY- ckj (I rr�"e4e, [ � /�JIS 6. ADDRESS OF ESTABLISHMENT: D` 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 4:203;- 9. EMAIL ADDRESS: Cam/'/� Cape& 10. SOLEOWNER:_JYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER s - �- � CLERK Gee"ne -- 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE_ Q:\Application FormsUiAZMAT APP 2017 REVIS Aocx Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable .Board of Health This is to Certify that TWIN BROOKS GOLF COURSE 35 SCUDDER A TEE, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------ --------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health P Vo ° �ervic ble ewgiaatory �j lehle Richard V. Scali,Director Public Health Division BARNSTABLE C��# 9rABL 1 Thomas McKean,Directo BARNSTABLE 1639-2014 �, � 16 �a`0 200 Main Street, Hyannis,MA 02601 ��g lNO w�= IX) Office: 508-862-4644 Fax: 508-790-6304 T' 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 )g 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?_ZYES_NO. IF YES, SHIP 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: CqAn� ^ YV 5. NAME OF ESTABLISHMENT: f �/W �7f .� (S • C 6. ADDRESS OF ESTABLISHMENT: A%�, - JZ�v 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: `z -- e( 9. EMAIL ADDRESS: CO P6 rA-C-&10 I F 0 G�UC& j 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT [Ze J► orlrtl� TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE /y _ Q\Application FormsUiAZMAT APP 2017 REVISE :docx j Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ 35 Scudder Avenue,Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------- ------------=--------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and S and expires 06/30/2018 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ' owr of Barnstable eg atory ervices Richard V. Scali, Director�. � S.w Public Health Division BARNSTABLE f M4RS1V:5 M L�b5 ERV�Il1E�Sf P4?x5f40;F �� • �Ngs BLE. Thomas McKean, Director 1639-2014 - 9`l'ArE1639. 200 Main Street, Hyannis,MA 02601 o�Dl Office: 508-862-4644 77..d0/9Fax: 508-790-6304 X 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 A 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 • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ZZ4 5. NAME OF ESTABLISHMENT: 01.J 0Vy&neA±e. Qr7L aS 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �� 9. EMAIL ADDRESS: L Me- 10. SOLEOWNER:LYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEP HONE#OF: CORPORATION NAME 4e� PRESIDENT n -C -0?C0 TREASURER CLERK 12. IF PREPARED BYOUTSIDE PARTY: NAME: TELEPHONE#: � COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT ADATE Q: / �Application FormS�HAZMAT APP 2017 REVi.d�ocx i • oil • � Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that TWIN BROOKS GOLF COURSE 35 SCUDDER AYE, HYANNIS, MA �J --- l Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health { (833 TRow of Barnstable eg atory ervices Richard V. Scah, Director tHE Public Health Division *:.06 • R i:t:ISti�M�BTABLE• Thomas McKeanMAW. , Director` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 /����1� Fax: 508-790-63-4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE tl HAZARDOUS MATERIALS r 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 'zV'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 Jules 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: cctnT 9i 7�C�(11-_-- ,ylm 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: z5--- 2�0m -AVC MA-Z)AW 1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: f?bC— ( 9. EMAIL ADDRESS: CbftS }-(,(os lE OwlCa 10. SOLEOWNER:4LYES_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 Forms\HAZMAT APP 2017 REVISED cx • F �3 Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable - Board of Health s' This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ 35 Scudder Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 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 Town of Barnstable • �tH�f rti Regulatory Services Richard V. Scali,Director MAS& Public Health Division BARNSTABLE w r 1639. p�0 yen"sro a,ws�N�.i.iem"wsie�n � v �fD MP Thomas McKean,Director 1639-2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 'W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 0th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ 1r CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V'� 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 o20 FULL NAME OF APPLICANT: /t NAME OF ESTABLISHMENT: 6'&'zn!!e 0kc ADDRESS OF ESTABLISHMENT: �1,(—/�� 4WZUe:- L MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER:OYES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADD SS,AND TE EPHONE#OF: CORPORATION NAME h PRESIDENT TREASURER CLERK • IF PREPARED BY OUTSIDE P Y: SIG TURF OF AP LI T Name: NO Company Address : S V'CGpy4' /YbA4 Telephone#: _ �- 1 l '� �- Email: QAAp`pT4da �s� APP Rev 16.d� Page 1 of 2 _ ^Y Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department SAM rrns Public Health Division MASS. Thomas A.McKean,CHO 161,3911. fo 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/14/2016 Permit number: 1062 �Check number: 100228 Check amount: $125.00 Name on check: TFG Hyannis Hospitality, LLC i ,Business: Resort&Conference Center(TFG Hyannis Hospitalit Address: 35 SCUDDER AVENUE, Hyannis I i i • Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that TWIN BROOKS GOLF COURSE 35 SCUDDER A VE, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- 1 WAYNE MILLER,M.D.,CHAIRMAN ,3P _C� PAUL J.CANNIFF, D.M.D. -11:� 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO 6 Director of Public Health (F F4; Town of Barnstable • �IMME i� Regulatory Services Richard V. Scah,Director z Public Health Division BARNSTABLE 16;9. �0 x"s00�os*eaVWm a ansi U ,4 DOTED NAA�a 1639-7014 E.a Thomas McKean,Director ,�� �y 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 • N m 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 lst-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 Jul ASSESSORS MAP AND PARCEL NO. DATE 2Y V FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: ��(�►� �✓ /%S C ADDRESS OF ESTABLISHMENT: i5�.thi VK- pt-1 I MAILING ADDRESS(IF DIFFERENT): 6 TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: _ CORPORATION NAME CD Lr 6C(— 1�wkr%? PRESIDENT Vt'--d4h/ \fb'f"(C' TREASURER PAN hi�Ah6C2 CLERK (ten I V</ G1 • IF PREPARED BY OUTSIDE PARTY: SIG F APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev I6.docx Page 1 of 2 v Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ 35 Scudder Avenue, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------- ---- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health I JA ¢ Town of Barnstable Regulatory Services Richard V. Scab,Director Public Health Division Fc " Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.0.0 ASSESSORS MAP AND PARCEL NO. G '/ DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLLSH3*1ENT�Q � ��rX p���� L �,y 44 &"fllS • ADDRESS OF ESTABLISHMENT DJ TELEPHONE NUMBER � J'��/ SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK . • SIGNATURE 01P APPLICANT RESTRICTIONS: HOME ADDRESS,36,�5 6rl�n )%ee, a,&,i�1q7) HOME TELEPHONE#mil (h Ct{ S IkMe- FPd ems' : /l jde-* Grid 8- -5144 A49 iet) . Mcwhe\Temporary Intemet Files\0LKD3EAZAPP Rev20I5DOC I 4 Town Of Barnstable Office: 508-862-46.44 Fax: 508-790-6304 Regulatory Services Department Bn grnnM Public Health Division MASS. Thomas A.McKean,CHO fib `$ 200 Main Street, Hyannis, MA 02601 Payment Receipt (Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015 Permit number: 1062 !Check number: 15030 Check amount: $100.00 Name on check: TFG Hyannis Hospitality, LLC !Business: Resort&Conference Center(TFG Hyannis Hospitalit !Address: 35 SCUDDER AVENUE, Hyannis ! Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS joo.00 Town of Barnstable Board of Health This is to Certify that TWIN BROOKS GOLF COURSE 35 SCUDDER AVE, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------- ----------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ----------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f� F?� Town of Barnstable pF114E Tow Regulatory Services v ti Richard V. Scali, Director ♦I Y • IVan MASS.�. ' Public Health Division Thomas McKean Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. a�9r(l� DATE U 1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C(F NAME OF ESTABLISHMENTr� ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER 5Z)&- SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ?? STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: /- PRESIDENT J� � jV J YQ,1 64ae-3 2L,-0- iQ,&_egg-ice$ TREASURER CLERK • SIG UR OF APPLICANT RESTRICTIONS: HOME ADDRESS jftQ WN7*6 OA HOME TELEPHONE# 7k7 y J:\HAZAPP.DOC m r Town of Barnstable office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department w BA' HM Public Health Division MAsa. Thomas A. McKean,CHO A 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: 1$ 00.00 (Check) on 8/4/2015 Permit number: 1107 ,Check number: 1589 Check amount: $100.00 Name on check: Coastal Golf Management, Inc. ;Business: TWIN BROOKS GOLF COURSE 1 jAddress: 35 SCUDDER AVENUE, Hyannis ! Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center(TFG Hyannis Hospitality LLQ 35 Scudder Lane, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �r Ile- Town of Barnstable Regulatory Services Richard V. Scali, Director -MAS&` ' Public Health Division •s639 a1�� fD 59 Thomas McKean Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304,. Application Fee: $100.00 G} ASSESSORS MAP AND PARCEL NO. 1 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT KZ ' NAME..OF ESTABLISHMENT ADDRESS OF ESTABLISHMENTS TELEPHONE NUMBER SOLE.OWNER: YES I NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF AA LICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# yl— rn�; r'S j c�-�i� Cl' e, , Q:\Application Forms\IIAZAPP.DOC LQ..j�ry o r Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Resort& Conference Center (TFG Hyannis Hospitality LLQ 35 Scudder Lane, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health L i „ L Town of Barnstable ofrH Regulatory Services 3 Thomas F. G-61e •,Director ps MASS. Public Health Division y 'Thomas McKean, Director 2DO Maim Street, E7aniis,MA 02601 OfEcz, 5084i2.4644 F= 50&790-6304 Applioa#ion Fes; $100.00 ASSESSORS ASAP AND FA R=NO, DATE APPLICATIGIN FOR PERNUT TO STORE AND/®R UTT'TT=MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NA TE OF APPLICANT S �' MA3U, OF ESTA.BT,T = Az, TeQ0r+ &Ak ��DRESs OF JSTABLIS= r= U-,o TELEPHoINI NUMBER 507.E Ow=: YES y N0 IF APPLICANT IS A PARTNX=,FULL NAME AND HON.9,ADDRESS OF AID PARTNERS: i I ?, ATFLICA'I-T IS A CORPORATION: FEDERAL IDEI=C.ATION t TO. S T ATE OF INCORPORATION ALL IT_A'IE AND EOM ADDRESS OF: E I C = 81IJdTtRE OF AP CANT �Wner'�S � 1R.F_'.ST3ICTIO ITS: HOMEADDRESS�(�5"� -p1te zy,� �� HOAE TE=HONI #(ZZ; 9e-a Uo Ha.dD�iq I�lcI+�c.�g-er'S �� Sid►w t dt ��r MAIL,-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the 1eqL�Ted fee amount Make check payable to: Town of Ba= table. Our mailing address is: Town of Barnstable Public Health Division 200 Main Strut Hyamus, MA 02601 FOR FAXED REQUESTS- Our fax number is (308) 790-fi304. Please fax a completed application fozm. In addition, you must mail the required fee amouni (see fees at bottom of this page). Please make the check payable to: Town of Bamstzble, The check must be mailed to the address listed above. For further assistance on any itzm above, call (508) 862-4644 I I 1 II I I i I i i I I I Number Fee 873 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Four Points by Sheraton Hyannis Resort 35 Scudder Avnue, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 24, 2006 PAUL J. CANNIFF,D.M.D. m THOM,AS A._MCKEAN,R.S.,CHO Director of Public Health Number'.' Fee 873 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to-Certify that Four Points by Sheratoir Hylam is Resort 35 Scudder A vime, MA 02601 Is Hereby�Granted a License c FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license se is ranted in conformity with the Statutesalai ordinances relating there to, and g Y g , andexpires June 30 2 0 0 6 unless soonu• suspended- or r �c okcd. SUSAN G.RASK,R.S. - WAYNE MILLER, M.D.,CHAIRMAN Y November 155, 2005 SUMNER KAUFMAN,M.S.P.H. THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Nov �01 05 10-: 23a Lynn Marble 15087753674 p. l Town of Barnstable TM Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 _...---Office:-508-862-4644___._.--._.....-____._..-._. ._..__.._.----..._.___...--_-..__ Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO. 2 8 9/110 DATE October:-.31 , 2005 APPLICATION.FOR PERMIT.TO STORE.AND/OR UTILIZE MORE THAN 111 GALLONS.OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SLT REALTY LTD. PARTNERSHIP d/b/a NAME OF ESTABLISHMENT FOUR POINTS BY SHERATON HYANNI S RESORT ADDRESS OF ESTABLISHMENT 35 SCUDDER AVENUE, HYANNI S, MA 0 2-6 01- . TELEPHONE NUMBER 5 0 8-7 7 5-7 7 7 5 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: KENNETH S. SIEGEL 57 GREENFIELD DRIVE WESTON, CT 06883 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 9 5-4 5 Q 9 414. STATE OF INCORPORATION CALIFORNIA FULL NAME AND HOME ADDRESS OF: PRESSIDENT THEODORE W. DARNELL 914-640-8100 TREASURER RUSSELL C. SAVRANN 914-640-8100 CLERK PETER MORROW 602-852-3900 �e.yred VM -I-A of rL6,t rAA,.! SIGNATURE OF APPLICANT t �. RESTRICTIONS: HOMEADDRESS 18 COCHESET PATH, W. YAPd�.OUTH HOME TELEPHONE# . 0 8—7 71—3 8 7 8 Hazdadwplq Town of Barnstable Regulatory Services °.� Thomas F. Geiler,Director Public Health Division 9Ateo °'` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office.-5084624644 __ ......__.._. .. Fax,.....508_790-6304 Application Fee:$100.00 ASSESSORS MA P AND PARCEL NO. 2 8 9/110 DATE October:;.31 , 2005 APPLICATION.FOR PERMIT.TO STORE.AND/OR UTILIZE MORE THAN III GALLONS.OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SLT REALTY LTD.; JPARTNERSHIP d/b/a NAME OF ESTABLISHMENT FOUR POINTS BY SHERATON HYANNI S RESORT ADDRESS OF ESTABLISHMENT 35 .SCUDDER AVENUE, HYANNI S, MA 0 2 6 01 TELEPHONE NUMBER 5 0 8-7 7 5-7 7 7 5 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: KENNETH S. SIEGEL 57 GREENFIELD. DRIVE WESTON, CT 06883 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 9 5-4 5 0 9 414 STATE OF INCORPORATION CALIFORNIA FULL NAME AND HOME ADDRESS OF: PRESIDENT THEODORE W. DARNELL 914-640-8100 TREASURER RUSSELL C. SAVRANN 914-640-8100 CLERK PETER MORROW 602-852-3900 r- _. t j2r r UV1an� �r vzrz-6--n 4n-3AA s ' SIGNATURE OF APPLICANTe RESTRICTIONS: HOME! DRESS 18 COCHESET PATH, W. YARPOUTH HOME TELEPHONE# 508-771-3878 Hazdoc/wp/q �/a FP� (�Wf UV4 -relv10 YD VAq OIL WASTE OIL OIL FILTERS ANTIFREEZE WASTE ANITFREEZE ` GASOLINE WASTE GAS WASTE W/W FLUID ATF wo OtAV4) SOLVENT \`y HYDRAULIC MISC. MISC. MISC. MISC. FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM FREON ACETYLENE CAR WASH CAR WASH PAINTS/THINNER WAX DETERGENTS SEALANT CLEANING BATTERIES POISION/TOXIC CAULK/GROUT SOLVENTS FERTALIZERS DIESEL FUEL 206D 1jo© (�ov-e:) 90 �i3D ou , bv� La ud-i. o u)(i .r -h riav off i'1iL�'YV �l �1CCQ� �� � Woks' Number Fee 1062 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that TFG Hyannis Hospitality LLC/Resort& Conference Center 35 Scudder Lane, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------------------------------------------------------- --------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2012 unless sooner suspended or revoked. -------------------------------- ------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f r 1 i N� Number Fee 1107 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that COASTAL GOLF MANAGEMENT, INC./TWIN BROOKS 35 SCUDDER A VE, HYANNIS,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 11/1/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health y 1 . Town of Barnstable Barnstable . Regulatory Services Department. > aH i Public Health Division KAM � 200 Main Street, Hyannis MA 02601 639- 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �� (�'L �onl I �'�MY`� >l WP-"JT'_ V�!C' NAME OF ESTABLISHMENT �i u11� V W S C-C —r ADDRESS OF ESTABLISHMENT ?� SCOD D&A_ MLL�f Vs via l TELEPHONE NUMBER SOLE OWNER: YES NO ►- O IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADD OF A4:I�L PARTNERS: Z 4 W rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 5-103- GJ STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: ` , n PRESIDENT ►1J �t7JT�o 3`� Q 1Wl"IV- 4 JN 1 ', W-U2[PL(( TREASURER S',�•� CLERK SIGN>eM OF L ANT RESTRICTIONS: HOMEADDRESS �IILLi lCi� I�N�xSi��/Sd`c��l-��e1 HOME TELEPHONE#(5-'S)4W-3fl JAinspection handouts\Haz Mat Application2008.DOC 9 . 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 number is (508) 790-6304. Please fax a completed application form: Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please mail the required fee 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 J:Vnspection handouts\Haz Mat Application2008.DOC _} giazardaus"lVfat�'Yal'C€�liIlt�n����71 �`. Hazardous contingency plan for Twin Brooks Golf Course exists as having a spill response kit available for easy access including: For spill containment: -absorbent socks ` -absorbent pads -drain cover mat -speedi dry Personal Protective Equipment -protective coveralls -goggles -gloves 3 E For disposal: -2 poly bags w/ties Posted in shop area emergency contact information: -Hyannis Fire 1 5.8.e 75 1300 -Cyn Environmental 1 80040;10381 -MSDS Sheets/Book a I fs p: 41 Commonwealth of Massachusetts .. m Asbestos Notification Form ANF-001„ DecaINumber f : Important: A. Asbestos Abatement Description When filling out::.., ' forms on the computer,use 1. a. Is this facility fee exempt-city,town,district, municipal housing authority, owner-occupied only the tab key residence of four units or less?0 Yes ,✓7, No to move your cursor-do not b. Provide blanket decal number if applicable: ' use the return Blanket Decal Number key. 2. Facility Location: I RESORT-CONFERENCE CEN_T_ER I (35_SCUDDER AVE' - a.Name of FaGli i b.� nBARNSTABLE tree MA . 0201 R c.Cityfrown d:State_. e.Zip Code �fTe=1e p h o e Number - INSTRUCTIONS 3• Worksite Location: . 1.All sections of this CORRIDOR r ��{ form must be a.Building Name/Building.Location ab.Building#m,— i c.Wing d.Floo� L----------�----J completed in orcer e:Room to comply With 4. Is the.facilityoccupied? ❑✓ Yes :o No DEP notification requirements of 310 cMR7.1s. 5. Asbestos Contractor: and the Division of Occupational NEW ENGLAND SURFACE MAINTENANCE 850.WASHINGTON STREET. 'Safety(DOS) a.Name , notification D.Address requirements of 4153 WEYMOUTH 02189 .-;` A. 7813372117 t CMR 6.12 + C.Cityffown d.Zip Code e.Telephone Number, ` f.oos License Number 7 g. Contract Type El Written . ['j Verbal h.Facill Contact Person_ i.Contact Person's Title 6. PAUL W,BROWN ASO40577 a.Name of OnSde Su ervisor/Foreman b.Supervisor/Foreman DOS Certification Number JERRY LEBLANC- AM061397 { �' a Name of Pro ect.Mondor b.Pro ect MonitorDOS Certification Number ENVIROTEST'LABORATORY AA000128 ��. $' a.Name of Asbestos Anal •cal Lab' �� 1. b.Asbestos Analytical Lab DOS Certfication Number. : 03/31/2008 - �0 .9' a.Project Start Date(mnVd 04/03/2008 _. b.End Date(mm/d o 18-4 N c.Work hours Mon-Fri. id.Work hours Sat-Sun. i —0 10. a.What type of project is this? 0 ❑ Demolition Renovation F Repair Other, please specify:': t b.Describe 11. lCheck abatement procedures: mot Glove bag [Q,Encapsulation Enclosure ❑ Disposal only LL- [ Cleanup ❑Other, specify: N ty --Z [��tull containment W_ _ ._ b.Des«tbe �-� 12. Is tte job being conducted_ []✓ Indoors? Outdoorsy - .. LIM anf001ap.dGCG=L-10/02 1. t c , Asbestos Notification Form•Page 1 of 3 Commonwealth of Massachusetts � Decal Number_ Asbestos Notification Form. ANF-001 A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or encapsulated: 10 3300 a.Total pipes or ducts(linear ft) f`E Totalother er fii —surfaces square c.Boiler,breaching,duct,tank I �� d.Insulating cement �--�I surface coatings �Line Sq. Lin.ft. rSq�.ft�—� e.Corrugated or layered paper L—� (�I pipe insulation Lin.ft. S ft. f.Trowel/Sprayer coatings q• Lin.ft. Sq.ft. g.Spray-on fireproofing �—I � h.Transite board,wall board �1ir..ft. Sq.ft. �Li"n..'IL. i.Cloths,woven fabrics .ft. t j,Other,please specify; L � 3306 Lin:ft. S ft. Lin.ft. S .ft. k.Thermal,solid core pipe CEILING PANEL insulation Lin.ft. Sq.ft. L Specify 14. Describe the decontamination system(s)to be used- AS REQUIRED 15 .Describe the containerization/disposal methods to comply with 31,0 CMR 7.15 and 453 GMR 6:1,4(2)(9) AS REQUIRED. 16 For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency_: a.Name of.DEP Official b.Title c.Date'(mm/dd/yyyy of Authorization tl.DEP Waiver# &..Name of DOS Officialf.DOOfficial:Title I � N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# �0 17: Do prevailing wage rates as'per M.G.L. c. 149, §26;27 or 27A—F apply to this project? Yes ✓�No B. Facility Description N �0 1. Current or prior use of facility: CONFERENCE CENTER 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes [✓ No SAME 3' i.Facility Owner Name --- b.Address -- 0 o c.City/Town d.Zip Code e.Telephone Number area code and extension ��LL 4... a.Name of Facility Owner's OnmSite Manager b.On-Site Manager Address Q C.Citylrown d.Zip Code. e.Telephone Number(area code and extension) anf001ap.doc•.10/02 Asbestos Notification Form•Page 2 of 3 Commonwealth of Massachusetts ■ 100068601 Asbestos Notification Form ANF-001 Decal NumberIL T B. Facility Description (cont.) 5' 1 F— a.Name of General Contractor b.Address c.Cit frown d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer rg.Policy Number �p.Date(mm/dd/yyyy)� 6. What is the size of this facility? ' - a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): NESM, LLP Note:Transfer a.Name of Transporter b.Address Stations must �e comply with the C.Cityfrown d.Zip Code e.Telephone Number Solid Waste Division 2, Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 IRED TECHNOLOGIES a.Name of Transporter b.Address c.Cit frown d.Zip Code e.Telephone Number a.Refuse Transfer Station and Owner_._ L( b:Address c.City/Town d.Zip Code e.Tele hone Number 4. MINERVA.E_NTERPRISES INC a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD_ , WAYNESBURG c.Final Disposal Site Address d City/Town OH: 44688 e.State. f.Zip Code g.Telephone Number O D. Certification N The undersigned hereby states, under the �JIM O. � oO penalties of perjury,that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations — �� 03/03/2008 for the Removal,Containment or c.Position/Title d.Date mm/dd/vwvl Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15, and that the information 0 contained in this notification is true and correct e.Telephone Number f.Representing c) to the best of his/her knowledge and belief. o Q.Address h.Cityfrown i.Zip Code Z ■ anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3■ i .Y.. . r .� Make application to local Fire Der a. Fire Dep '� retains original application and is - pl kip APPLICATION and I? d for storage tank removal and transportation to approved tank disposal yard in a of M.G.L. Chapter 148, Section 38A, 527 CMR-9.00, application is hereby made rovisions P Tank Owner Name(please print) '5t*WATD N LLyA-L111 I S X _ enure g per, Address_ 3S SGub D� �,� � �N U1S �'�(f�-- 02,GD�meet CRY Sere ZIP • a IF-relfelm HOISTING LICENSE # Company Name tl f 1•A 9 r- (r::i-1 P o„„„,",e-sa; Co.or Individual Prim Address Address �nr P►1 A o l Co r Signature(if applying for permit) Signature(if applying for permit) ❑ IFCI Cert' ed er ❑ IFCI,Certiified ❑ LSP# Other Tank Location V4 Pte fZ E4vs. 1�K1� Nis i �/b steer adder COY # k,Capacity{gallons) L[ D Substance Last Stored, ` C•�5 Tank Di isnme ions(diameter x length) Remarks: Firm transporting waste , D t5P 5 qL -rF tFK�ol2ov�State Lic.# MA i Hazardous waste manifest#_011+ 1< o 4 ( E.P.A.# Approved tank disposal yard W.M. k Ft cn n Cre p Tank yard # n r t Type of inert gas O RY r c e= Tank yard address 33 ELrn d r ,-i-o,y g�c,� City or Town. FD1C# Oita- UnitH�s � # Date of issue i � Date of expiration / try � l't. cm Dig safe approval number. 1 9 9 $ S a v 3 0o gry� [D7ig-9afe Toll Free TelS,fyyuu�m 0088CA - r Signature/Title of Officer granting permit ZY. After removal(s)send Form FP-29OR signed by Local Fire Dept.to UST Regulatory C mpliance Unit,One Ashburton Place, Room 1310,Boston, MA 02108-1618. � �pom��zo�tsaeta,�t a�C��aaaa:c�ivaedla - �e��Caxtirrae�xt V'vXe Vea�ucces ��eauGius � Ccs - q5 z Notification for Removal or Closure of In Place Storage Tanks Regulated Under 527 CMR 9.00 Forward completed form,signed by local fire department,to:Mass. UST Compliance Unit, Dept- of lire Services,One Ashburton Place-Room 1310,Boston,MA 02108-1618 'include copies of FP-292, Fire Department PermitMR I to Received: / Disposal Yard Receipt(FP-291). HYANNIS FIRE DEPARTMENT Fire Dept. ID# 'Fire Department retains one copy of FP-290R) 95 HIGH SCHOOL RD. EXT Fire Dept. Sig. HYA i-his form is to be used for notification for removal of Underground Storage Tanks/ State Use Only Piping. , if a storage facility has USTs which are to remain in use, an entire amended FP-290 A. Facility Number (long form) must be filed. B. Date Entered 'Dote: "Facility street address"must include both a street number and a street name. C. Clerk's Initials Post office box numbers are not acceptable,and will cause a registration to be D. Comments atumed. If geographic location of facility is not provided,please indicate distance and Alirection from closest intersection, e.g., (facility at 199 North Street is located)400 . ards southeast of Commons Road(intersection). I. OWNERSHIP OF TANK(S) II. LOCATION OF TANK(S) :°caner Name(Corporation,Individual.Public Agency,or Other Entity) If known,give the geographic location of tanks by degrees,minuted,and seconds.Example:Lat.42,36.12 N Long.85,24, 17W y4n nj J en Latitude Longitude �c� hc� C►rc�e or':hest AtlCreas n A u1stance tit.__ _ closest-nt°ra°ction-(sas.not•-above) K rSec ,r Facility Name_or-Companysd .as-applipbfo---� Yticnblatn �S �'JL 0�601 3�� CFe,d' Pr ,QyP—' ° Zip c0tle Street Address(P.O.Box not_accembW}sw-rwn.above)_ �rrnS �I� yannt`i /� O n0/ ry Ctty State Epcod. -�Olr� 77�7775 B�.rv�S�b Phone Number(Include Area Code) Owner's Employer Federal 10 a County III. TANKS/PIPING REMOVE OR FILLED IN PLACE Tank Number Tank No-1— Tank No. Tank No. Tank No. Tank No. 1. Tank/Piping removed or filled in place (mark all that apply) A. Substance last stored B.Tank capacity gallons 000. ao C. Estimated date last used (mo./day/yr.) D. Estimated date of removal (mo./day/yr.) E.Tank was removed from ground F F. Tank was not removed from ground Tank was filled with inert material Describe material used: G.Piping was removed from ground H.Piping was not removed from ground I. Other, please specify 29OR(revised 11/96) 1 Tank Number(font.) Tank No.-Z— Tank No. Z nk Tank No. Tank No. 2. Tank closed in accordance With 527 CMR 9.170 XYes No C Yes -,No O Yes C No ❑ Yes C No C Y7-7—NoA. Evidence of leak detected Yes7-Yes C No C Yes C No ❑ Yes C No 'Yeo B. Mass, DEP notified C Yes Po =Yes :1 No O Yes C No 0 Yes C No `Yes C No 1. Mass. DEP tracking number �o 2.Agency or company performing contamination assessment I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents, and that based on my inquiry of those individuals immediately responsible for obtaining the informa- tion, I believe that the submitted information is true, accurate, and complete. Name and official title of owner or owners Signature: authorized representative (Print) Date: 3oR(revised 11/96) �arrrir,�to�z���r�j`�asuic�zuaet�`i - �e`zcLxCnre��' C�Pixvica� Lr ��ecuC�i�se �1 eat uli�ic d)"a' G� eyutlaCaw7 am� iut Notification for Storage Tanks Regulated Under 527 CMR 9. 9 9 00 . Forward completed form,signed by local fire department,to: Mass. UST Program,Dept - 9-0 - • of Fire Services, For removals include copies of FP-292 Fire Department Permit and both sides of Date Received: /6 -9--5 Registered Tank Disposal Yard Receipt (FP-291)! ire Dept. ID# O(Fire Department retains one co of FP-290 HYANhOS FIRE PREVENTION ire Dept. Sig. copy ) HYANNI A. New Facility(see instructions, fr1) (I B,Ame�ded95 HIGH;3CI�A%AVUF _ Lon- • INSTRUCTIONS: Form FP•290(Notification for Aboveground and Underground Storag Ion each location containing underground or aboveground storage tanks regulated under 527 CMR 9.00. If more than live tanks are owned at this location,photocopy the following pages and staple continuation sheets to the form. The FP-290 must be A. Facility Number completed in duplicate. Although the form may be photocopied,the facility owner or owners representative must sign each copy separately;photocopied signatures are not sufficient. Both copies of the FP-290 are to be forwarded to the local B. Date Entered fire department,who will cheek all information and certify the forms. The fire department will retain one copy of the FP- 290 for its records,and the facility owner shall be responsible for forwarding the other copy to the Dept of Fire C. Clerk's Initials Services at the address above. The local fire department will issue the permit portion of the FP-290;however,registration is not complete until the FP-290 is received and checked by the UST Regulatory Compliance Unit All questions on this form D. Comments are to be answered.Incomplete forms will be returned. 1-New Facilftlr means a tank or tanks located at a site where tanks have not been previously located. 2'Facillty street address•must include both a street number and a street name. Post office box numbers are not acceptable, and will cause a registration to be returned.If geographic location of facility is not provided,please indicate distance and direction from closest intersection,e.g., (facility at 199 North Street is located)400 yards southeast of Commons Road (intersection) /bv 110, TANK GENERAL INFORMATION Notification Required Excg0tlow(a)a farm or residential tank of 1,100 gallons or low capacity used for slitting motot Fire Prevention Forth FP-290 is to be used as Notification,Registration,and Permit for fuel for noncommercial purposes.or(b)a tan k used for storing healing oil for consumptive aboveground and underground storage tanks and tank facilities regulated under 527 use on the promises where dated are not requ ired to be registered under 627 CMR 9.00. Code e Massachusetts Regulations,maiNo regulated aboveground or underground Penalties-Anyownerwhoknowirglyfailstonotifyorsubmitsfalseinformationshallbesubject storage tank facility shag ( Installed,i maintained.replaced,substantially modified or to a civil penalty rat to exceed E25,000 for each tank for which notification is not given or for removed without a permit(FP-290)issued by the head of the local fire department The owner of any storage facility shall within seven working days notify the head of the "fib false information is submitted.(MGL Chapter 148,section 38H,527 CMR 9.00) local fire department and the Dept of Fue Services of any change in the name, Aboveground Storage Tanks address,or telephone number of the owner or operator of a storage facility subject to 527 CMR 9.00 requires the registration of any aboveground storage tank which meets the regulation by Chapter 148,Mass.General Law and by 527 CMR 9.00. following definition:a horizontal or vertical tank,equal to or less than 10.000 gallons Underground Storage Tanks capacity,that is intended for fixed installation without back fig above or below grade,and is Each owner at an underground tank first put into operation on or after Jan.1,1991. used for the storage of Hazardous Substances,Hazardous Wastes,or Flammable or shall,within thirty days after the tank is first put into operation,notify the Department of Combustible Liquids. Fire Services(the department)of the existence of such tank,specifying,to the extent Ex�pffonNl:Aboveground tanks of more than 10.000gallonscapacityregulatedby520CMR known,the owner of the tank,date of installation, capacity,type,location.and uses of 12.00(Requirements for the Installation of Tanks Containing Fluids Other Than Water in such tank.By no later than Jan.31,1991,each owner of an underground storage tank Excess of 10,000 Gallons)are not required to be registered under 527 CMR 9.00. that was in operation at any time after Jan.1,1974, regardless of whether or not such tank was removed from beneath the surface of the ground at any time,shall notify the rExce ptign g2:(a)a farm or residential tank of 1,100 gallons or less capacity used for storing department of the existence of such tank,specifying,to the extent known,the owner of motor fuel for noncommercial purposes, or (b) a tank used for storing heating ad for the tank,date of installation.capacity,type,and bcadon of the tank,and the type and consumptive use on the premises where stored are rat required to be registered under 527 quantity of substances stored in such tank,or which were stored in such tank before CMR 9.00. the tank ceased being in operation it the tank was removed from beneath the surface Pgnattlec:Any person who knowingly violates any rule or regulation made by the Board of Fire of the ground prior to the submittal of such notice to the departmenL Such notice shall Prevention Regulations shall,except as otherwise provided,be punished by a fine of not less also specify,to the extent known,the date the tank was removed from beneath the than one hundred dollars not more than one thousand dollars. (MGL,Chapter 148.section surface of the ground prior to the submittal of such notice to the department.The 108,and 527 CMR 9.00) operator of any tank that has no owner or whose owner cannot be definitely ascertained,shall notify the departmenbof the existence of such tank,specifying,to the Where to Notify?Two completed notification forms should be signed by both the tank owner extent known.any information relating to ownership of the tank,and date of and the local fire department.One copy will be retained by the rife department,and Me tank installation,capacity,type,and location of the tank,and the type and quantity of owner shalt send a separate copy to the address at the top of this page. substances stored in such tank,or which were stored in such tank before the tank When to Notify?1.Owners of storage tanks in use or that have been taken out of operation ceased being in operation it the tank was removed from beneath the surface of the must notify within thirty days. ground prior to the submittal of such notice to the department If the tank was abandoned beneath the surface of the ground prior to the submittal of such notice to Owners and Operators of Regulated Storage Tank Systems must maintain records the department,such notice shall also specify,to the extent known to the owner or certifying that all leek detection,Inventory control and tightness testing requirements operator,the date the tank was abandoned in the ground and all methods used to for the Regulated Storage Tank System are current These records must be readily stabilize the tank after the tank ceased being in operation_ -available for inspection. L OWNERSHIP OF TANKS) Ile LOCATION OF TANKS) Owner Name(Corporation,Individual,Public Agency,or Other En' ) If known,give the geographic location of tanks by degrees,minutes,and 1 t f \ seconds.Example:Lat.42,36, 12 N Long.85,24,17W TG to A� 3 �: �+ � Latitude Longitude StreetAddreaa J 0)3S%tJj Ow. • s' ,�LV A. if F C►'�� _ .intersection-(see-ins •2—k-H rl a opt s�e1'kton LelIVAKI Faa1Ry Name or Company_She_idemif r,-ass awficable State zip Code Street-Address P:O—Box not ac ceptable ceepabl•-see instructions 02) urxy sat•----`_Zip cad• hone N (InetWe Area Code) Owners Employer Federal l0 a yt • III. TYPE R I INDIAN LANDS Federal Government Commercial = Tanks are located on land within an Indian Reservation or�n State Government other and sale) other trust lands. D Private ❑ Tanks are owned b Loc�T Government y native American nation, tribe, or individu. (storage and use) V. TYPE OF FACILITY Select the Appropriate Facility Description:.(check all.that apply)% � , Gas Station Marina TruckingiTransport Petroleum Distributor Railroad ° Utilities Airport Federal-Military Residential Aircraft Owner Industrial Farm Vehicle Dealership Contractor Other(explain) CDvr�_ ry►��. VI. CONTACT PERSON IN CHARGE OF TANKS . Name:Gr,c 4.e, i vt, Address: A Phone Number(include area code): Job Title: v\ -� SC-vSJer Afi e. Horne:4 -3917 a AY_TnW%%'C PKA 0-ar.0 G 1 Business:� �7.r-77 �� VII. FINANCIAL RESPONSIBILITY ❑ I have met the financial responsibility requirements in accordance with 527 CMR 9.00. ------------- ----------- Check all that apply: r ❑ Self Insurance ❑ Guarantee ❑ Letter of Credit ❑ Commercial Insurance ( ❑ Surety Bond ❑ Trust Fund ❑ Risk Retention Group ( ❑ State Fund ❑ Other Method Allowed-Specify Vill. ENVIRONMENTAL SITE INFORMATION This information should be available from local health agent, conservation commission, or planning department. 1. Tank site located in wellhead protection area ❑Yes + 'No ❑ Unknown 2.Tank site located in surface drinking water supply protection area ❑Yes )(No O Unknown 3. Tank site located within 100 feet of a wetland ❑Yes/ANo o Unknown 4.Tank site located within 300 feet of a stream or water body (Yes 0 No ❑ Unknown DOL. UESCRIPTION.OF STORAGE TANKS AND PIPING (COMPLETE FOR EACH TANK AT THIS LOCATION) Tank Identification Number Tank No. Tank No. /4 Tank No. Tank No. Tank No.- 1.Tank status a.Tank mfes serial# (if known) b. Currently in Use Ab �� C c. Temporarily Out of Use(Start Date) 0 �� d. Permanently Out of Use C -7 0 F- _ e. Aboveground storage tank(AST)or O AST UST AST O UST ❑AST O UST ❑AST ❑ UST O AST O If Underground storage tank(UST) 2. Date of Installation (moJday/yr.) Al - - 7 1-9-71 3. Estimated Total Capacity(gallons) UGC FP-290(revised 11/961 Pa I 4Tank Id6ntification Number(cont.) k No.—j— Tank No.-9., T o. Alk Tank No. Tank No. 4. Substance Currently or Last Stored a. Gasoline CIO 13� Motor vehicle or other use •MV ^ Marina MV Marina a MV O Marina C/� MV Marina O MV E Marina F other other ❑other ❑other =other b. Diesel a 1 :1 �� Motor vehicle or other use O MV ❑Marina C: MV Marina ❑ MV C Marina O MV 0 Marina C MV =Marina C other other O other ❑other C other c. Kerosene d. Fuel Oil C� '"Consumptive Use'hanks need not be registered.. "Consumptive Use'fuel used exclusively for area heating and/or hot water. ' e. Waste Oil f. Other, Please specify i Hazardous Substance --� (other than 4a thru 4e above) CERCLA name and/or CAS number ' ---------- ---- ---- ----- ---- ----- ---- i Mixture of Substances i Please specify 5. Material of Construction-Tank(mark only one) Bare steel(includes asphalt, galvanized and epoxy coated) Cathodically protected steel Composite (steel with fiberglass) Fiberglass reinforced plastic (FRP) Concrete Unknown Other Please specify 6.Type of Construction-Tank (mark only one) Single walled Double walled Unknown Other Please specify Is tank lined? O Yes 14No u Yes ❑No C Yes ❑ No O Yes O No C Yes C No Does tank have excavation liner? O Yes O No O Yes ❑ No O Yes C No O Yes O No O Yes O No 1 •290(revised 11/96) Tank Idendiication Number(contim, Ah Tank No.__L_ Tank No. A an Tank No. Tank No. l 7. Material of Construction-Piping( ) Bare steel (includes asphalt, galvanized and epoxy coated) Cathodically protected steel Fiberglass reinforced plastic (FRP) Flexible Copper Unknown �� �� � � C❑ Other Please specify 8. Type of Construction-Piping(mark only one) Single walled �� � � � ❑❑ Double walled Unknown -Other �_� -� �� C❑ Please specify Has piping been repaired? G Yes ?QNo 01 Yes 0 No ^ Yes O No ❑Yes _71 No = Yes =No Is piping gravity feed? Yes No Yes G No ❑Yes ❑No ❑Yes ❑ No 2 Yes C No Date X. CERTIFICATION OF COMPLIANCE 1. Installation A. Installer certified by tank and piping manufacturers B. Installer certified or licensed by the �� ❑❑ � C�implementing agency C. Installation inspected by a registered engineer D. Installation inspected and approved by the implementing agency E. Manufacturers' installation checklists have been completed F. Another method allowed by 527 CMR 9.00. Please specify 2.Tank Leak Detection Tank Tank Tank Tank Tank (mark only one) A. Double-wall tank- Interstitial monitoring ❑ a ❑ ❑ ❑ B. Approved in-tank monitor ❑ ❑ ❑ ❑, ❑ C.Soil vapor monitoring (check one below) C Monthly O Continuous E. Inventory record-keeping and tank testing ® ❑ ❑ ❑ ❑ F. Other method allowed by 527 CMR 9.00. Please specfy !!! •290(revised 11/96) o��e Tank Identification Number(cont.) k No.� Tank No. 12, Ta Tank No. Tank No. 3. Piping Leak Detection (mark only one) Piping Piping Piping _ piping Piping A. Pressurized a. Interstitial space monitor ❑ ❑ ❑ ❑ ❑ b. Product line leak detector ❑ ❑ ❑ ❑ ❑ (mark all that apply below) Automatic flow restrictor' Automatic shut-off device' G Continuous alarm' Also requires annual test of device and piping tightness test or monthly vapor monitoring of soil. B. Suction: Check valve at tank only ❑ ❑ ❑ ❑ ❑ (Requires interstitial space monitor or line tightness test every three years) ❑ Interstitial space monitor ❑ Line tightness test C. Suction: Check valve at dispenser only ❑ ❑ ❑ El monitor required) ❑ D. Other method allowed by 527 CMR 9.00. Please specify 4. Date of last tightness test(tank&piping) 5. Gravity feed piping ❑ ❑ ❑ ❑ ME] 6. Spill containment and overfill protection Tank Tank Tank Tank Tank A. Spill containment device installed ❑ ❑ ❑ B. Overfill prevention device installed ❑ ❑ ❑ 7. Daily Inventory Control (mark only one) A. Manual gauging by stick and records ❑ ❑ reconciliation a X ❑ B. Mechanical tank gauge and records ❑ ❑ ❑ ❑ ❑ reconciliation C. Automatic gauging system ❑ ❑ ❑ ❑ ❑ 8. Cathodic Protection (if applicable) Tank Piping Tank Piping Tank Piping Tank Piping Tank Piping A. Sacrificial Anode Type ❑ ❑ ❑ ❑ ❑ Cl ❑ ❑ ❑ ❑ B. Impressed Current Type ❑ ❑ ❑ ❑ L--❑ ❑ ❑ ❑ El ❑ C. Date of Last Test 77 Certification of Compliance No.: X1. CERTIFICATION (Read and sign after completing all sections) NOTE:Both the copy being sent to the Dept of Public safety and the copy retained by the local fire department must be signed separately. A photocopied signature will not be accepted on either document I declare under penalty of perjury that I have personally examined and am familiar with the information submitted in this and all attached documents,and that based on my inquiry of those individuals immediately responsible for obtaining the information,I believe that the submitted information is true,accurate,and complete. Name and official title of owner or owner's authorized representative(Print) Signatu oate: cnxtn 4cts 4 I FP•290(revise 1 V96) �C�D y = z�y. 1/O TOWN OF BARNSTABLE - UNJSGR ND FUEL AND CHEMICAL ORAGE REGISTRATION' �ee MAP NO. PARCEL NO. k ADDRESS OF TANK: i lle I° Aye. V I LLAGE: gin I' MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : y��,�,.�,p, OWNER NAME: P r !dyvs 1L jorFi�c� ,(� SO4- PHONE: -�Cdi7-77,4�7- 72725- INSTALLATION DATE: " ��,-`� BY: tj INSTALLER ADDRESS: ��C� �`G �Cd� -CERT.NO. *TANK LOCATION: aCflOF4 aC TANK t-oo^frxoN W S TH mammas TO nu i l_D I NOAt CAPACITY �� TYPE OF TANK k:' AGE _L—YRS. FUEL/CHEMICAL o `c Co TESTING. CERTIFICATION C)Q PASS C ] FAIL DATE LEAK DETECTION C ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES C ] NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [��] YES C ] NO DATE CONSERVATION N CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ / �5�• ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD RN If TOWN OF BARNSTABLE - UN GD FUEL AND CHEMICAL61DRAGE REGISTRATION-- Ltt = .t ; ! MAP NO. PARCEL NO. ADDRESS .OF TANK: )�'u�lh�`� r , v—& ' VILLAGE: 17v n S ; � .f Number; < �stv .�! Ir ...•• H -'.._...':...- - -•• - ... MAILING ADDRESS ( IF DIFFERENT FROM ABOVE): / --» OWNER NAME: be r r;--Jrov�, a. C Do (0,(4• PHONE. _�c'��-77<- �� INSTALLATION DATES INSTALLER ADDRESS: S £��X t CERT.NO. *TANK LOCATION: �11&�V�':C vllo A Au � 'A-Arzl "i c vy--�. it!'"�-eAV*,2 r4,t g� 1� i ech j c ac cra z ac T.A'N K1 LOOAT i ON W I TN RcwPac V TO aU S LD 2 NO) / { CAPAC I TY �_� � TYPE' OF TANK F ar AGE •_ IiYRS FUEL/^CHEMICAL �70 t ; .(rx TESTING CERTIFICATION [)j PASS [ ] FAIL DATE LEAK DETECTION CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [,3) ES [ ] NO DATE TO BE REMOVED AFIRE DEPT. PERMIT ISSUED XT YES [ ] NO DATE t�• CONSERVATION [sue] CHECK IF N/A DATE ¢ v i BOARD OF HEALTH TAG NO. [ � �'% ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD TOWN OF BARNSTABLE - UN GROUND FUEL AND CHEMICAL ORAGE REGISTRATION--- MAP NO. PARCEL NO. t �J f , ADDRESS, OF TANK: ��5 c u'r e C31�- VILLAGE: `iu�;�t t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) OWNER NAME: ���P..f c. bv� { ���nyl, ., !�� .(of � PHONES ��,�'-�1��'� INSTALLATION DATE: INSTALLER ADDRESS: !1 i t G C� , ;CERT.140�. .: *TANK LOCATION: �I "ltl�:� 4r. ttv� - �:is _,.+ Cc*'rr tc. l ' 1 olv%.? +' aF'v/z�ac TANK' LOQAT I ON W I TH RGOPQOT� TO au Z LLD I NO CAPAC I TY 1 TYPE -OF TANK C k AGE YRS. FUE��L/CHEM I CALAI � PASS FAIL DATE TESTING-CERTIFICATION_ � C ��. C 7 . LEAK DETECTION F `3 CHECK IF N/A TYPE/BRAND," ZONE OF CONTR I BUT I'ON_--TT{,,J_ YES C- ] NO DATE-TO BE REMOVED FIRE DEPT. PERMIT ISSUED Cyr]' YES C ] NO DATE '" ` JV'� CONSERVATION C-31 CHECK IF N/A DATE BOARD OF HEALTH TAG NO. C l .�m ] DATE PLEASEPROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD i V1 ' t °FIME A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • MAPMBARBLE. ` 200 Main Street• Hyannis, MA 02601 �" �a,9•°�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT ffD MA'S Business Name: �� NC5a 4 A,,,,,,� Date: Location/Mailing Address: 3 S—Sc.,, e-r AVZ y4 nri+s Contact Name/Phone: ►�oQ. w� �l'l66 �'�' Inventory Total mount: 2 n �1�' H 0 0 j'Di Gedz 60 ►y-W DdGg�OV License#: o-, Tier II : 4 Labeling: 0 K Spill Plan: 15VIL Oil/Water Separator: b Floor Drains: qee75 +U Emergency Numbers: `2 Storage Areas/Tanks: J�ORM" tov& AA Emergency/Containment E ui nient: Z-(-u O-y\ T— Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 951J-A&av1 'tV_)n5 LIST OF TOXIC AND HAZARDOUS MATERIALS ! o v ( ,V A-A +v�y"ZVt�r�t J �yt f.� �a,1`�l►�g ��� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws f MA, hazardous aterial use, storage anddisposal of 111 gallons or more requires a license from the Public Health Division. V 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 s4l Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants VDegreasers for engines&garages Pesticides: Caulk/Grout ot^r ,vt S insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers p Photochemicals(Developer) W carte 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:: L tC 54 L �+ Go�CoG2� Cov�l.✓ �[�`E'TDIM- D r 4-, o,(-- q j /Q5 �A, S J6& I a 1 10 V-.A-4 +� 5 J&Sp$ G,�i* 4L"kfnspector. L AVIedl`e, oVt A,ru.t5 vv w o +v-V� !�kr ,. , Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BU INESS 1/��,�.1C1,.�p; `°F�►�rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. \\ MASS. 200 Main Street• Hyannis, MA 02601 039. '�EDMA�a`e TOXIC AND HAZARDOUS � MATERIALS INSPECTION REPORT Business Name: W2,So�� aK� yLt t2tice� er Date: Location/Mailing Address: 35 74V.P- l4 t-iVlis Contact Name/Phone: 5+Z1AP-V s , ck 1e� �P-xa)vLee y- Inventory Total Amount: e'LI� �� y y 0V MSDS: O 1 ot-v e License#: � Tier II : IJ o Labelina: Spill Plan: " L 1�►^% Oil/WaterSeparator: Floor Drains: `e -7%0u Emergency Numbers: c) Storage Areas/Tanks: i0va 4,1 h-;Gk&LV5 Emergency/Containment Eauipm nt: 6o .,5 ev., Waste Generator ID: 10 A Waste Product: Date&Amount of Last Sh pment/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. `I Antifreeze 4 Dry cleaning fluids Automatic transmission fluid `3 Other cleaning solvents&spot removers 3 Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils —�� Miscellaneous Corrosives 7-+ t 5' Gasoline,jet fuel, aviation gas cleaners Diesel fuel, kerosene, #2 heating oil DisinfectantsMiscellaneous petroleum products: ,Cesspool Road salts Son 110 grease, lubricants, gear oil Refrigerants Degreasers for engines&garages 3 Pesticides: i �2 9• Caulk/Grout/-%A1%,ts,-V s I-r i insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) o learwash detergents r��s� 3P Printing ink Car waxes and polishes Wood preservatives(creosote) +,7o Asphalt&roofing tar 0 k IoD Swimming pool chlorine zo- �2•S%�Y�o ' Paints, varnishes, stains, dyes Lye or caustic soda 1 001 y Lacquer thinners Miscellaneous Combustible 'L Paint&varnish removers, deglossers W. Leather dyes — Miscellaneous Flammables ZS Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers �-O (including carbon tetrachloride) (including bleach) ��(�-5k� Any other products with "poison labels" o S�r11p� (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: .e-r of m6b S 4 Inspector Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t� • INN rOk1 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 M Vq. 200 Main Street• Hyannis, MA 02601 �O�EDHa+°�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name:`r�- IQ,,-g°,A Av�� C�.e�-Fe<ev�C2 Cey.�e.t �+ S. Date: 7 Z / Location/Mailing Address: 35- 5e-- oL-e-Avs. , Nyev%His Contact Name/Phone: SoS-79-T-2- cfO Invento1y Total mount: 'A- DO 9A. MSDS: - ewl-ss License#: Tier[I : a Labeling: 6K r Spill Plan: Oil/Water Separator: t3 o Floor Drains: 717 �`�Emergency Numbers: �S Storage Areas/7anks: +e �-e N o-eur Emergency/Containment Equipment: � is 0A/A,4 \- Waste Generator ID: 0A I Waste Product: Date&Amount of Last Ship ment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 2 C�St Aov, i6tcl �.X- bDe",AV, ' o LIST OF TOXIC AND HAZARDOUS MATERIALS No wv�` o.( �\,�t o� �� �� �v..��n�or NOTE: Under the provisions of Ch. 111, Section 31, of the General Law of MA, hazardous m terial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid �— Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V 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: ,�99 II Inspector: ` L0.V� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �I TOWN OF BARN STAB LE Date:/�//6 / Is � TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 0604 tin vQge�tc,,n� a-� 9,/ah yj IS BUSINESS LOCATION: -Is' Ave- INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -s'��j - 7-75- 77-7s $ li, t- loo I b CONTACT PERSON: �� S'�-ey�vls �� .e.n g/•�-�e.�l EMERGENCY CONTACT TELEPHONE NUMBER: Sa -73 7-z3y o MSDS ON SITE? TYPE OF BUSINESS: �9&balk-4-4tLns av ,v oo Is + a I 7LS - INFORMATION / RECOMMEN ATIONS: ') tc.e,P_ Fire District: -'o �2 V A00" 20 ✓ ,* e 0ce. 0-11 skA-a I vu¢-t'S V4 t^� a,b.e,l-e-o - <tc.c-+(V s� b>15 ID a 6-1jP an fA A ^VrO %>5 4,5 0 1oK, •r A `r) g- t 11 co in e. avL s �ostcaQ ,..�,iI,,., Vets l�s. Waste Transportation: A Last shipment of hazardous waste: Name of Hauler: t 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 /2 (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 5' ,t. Swimming pool chlorine Battery acid (electrolyte)/Batteries l oo I b 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) S Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes ����,� (r'c�e>'tse.��D6� 15 C J�,�E�L / Laundry soil &stain removers 'f yJ (including bleach) Spot removers&cleaning fluids (dry cleaners) 6 p Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials IKEloN4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' 6A M..fR.LE. ' 200 Main Street• Hyannis, MA 02601 MASS. J1. prED MP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: (+ 0* c.C�DcY�'� I.CJ l�� Date: Location/Mailing Address: '3S _ O G yf- Contact Name/Phone: Inventory Total Amount: I I SDS: v _ License#: .,_ Tier II : U 6 Labelino: ' Spill Plan: O Oil/WaterSeparator: V Floor Dr ins: Emer ency Numbers: Storage AreaslTanks: P ` 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 JCar waxes and polishes Wood preservatives(creosote) Asphalt&roofin4 tar Pp V 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 20 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: i ORDERS: _ �' f an $ r, INFORMATION/RECOMMENDATIONS: Inspector: Facility Representativ WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS ts TO Town of Barnstable Office:508-862-4644 °^ Public Health Division Fax:508-790-6304 • BARMAN,%. • 200 Main Street• Hyannis, MA 02601 prFOMP+�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: k ifr Date: 6/I1/ Location/Mailing Address: v QAk niS Aubl Contact Name/Phone: /S0$-775-J7 5 Inventory Total Amount: " J 0 u SDS: iAP License#: 6 Tier ll : NO Labelino: fevttll Spill Plan: Oil/WaterSeparator: Floor Drains: No Emergency Numbers:te-�� Storage Areas/Tanks: PCOI Sl-► 6 2 hak room waakoust; rows Emergency/Containment Equipment: 2 Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: -b 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 j 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 V Paint&varnish removers, deglossers to Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes —V Other chlorinated hydrocarbons Laundry soil &stain removers j5 (including carbon tetrachloride) 10 (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDER'S: INFORMATION/RECOMMENDATIONS: O !i?commeArlf�ltms Inspect . Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAq L .�• 200 Main Street• Hyannis, MA 02601 �A 3639. �0 'FOrnn+" TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: kSA QIfO Date: 6t l o/ 14 Location/Mailing Address: ntcs Wfnslab le Contact Name/Phone: —7 7 7 7 7 Inventory Total Amount: '.$SDS: c License#: o 6 a, Tier[I : O Labeling: r.,1 l Spill Plan: NO Oil/WaterSeparator: Floor Drains: -d ® Emergency Numbers: _ hi Storage Areas/Tanks: ® J Emergency/Containment E ui m nt: P& S Waste Generator ID: Waste Product: WA Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods - hay, M ,l 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 I1vdraulic fluid (including brake fluid) Windshield wash ✓Motor oils Miscellaneous Corrosives E/Gasoline,jet fuel, aviation gas L4- t ® Cesspool cleaners Diesel fuel, kerosene, #2 heating oil V Disinfectants 10 Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: ✓ Caulk/Grout S 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 a.O Lye or caustic soda Lacquer thinners V' Miscellaneous Combustible Paint&varnish removers, deglossers,i Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons 40 Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acciidi,,other acids) VIOLATIONS: 0 Q r plan 0Q� 6 1 vfv� , D fn Lo th momy/, ORDERS: INFORMATION/RECOMMENDATIONS: t i r� 6ibo 110 Inspector: CIO' !'• ,o ®� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA MASS. ' 200 Main Street• Hyannis, MA 02601 et639. �0� _TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name. I µ I"- �roo g o( - o c Date: Location/Mailing Address: ,tic.. IS Contact Name/Phone: ,v, Y&o So - "1'7'79 a� 570$400 $-7y Inventory Total Amount: ^� 1"1'<1i-1 MSDS: 125 i' License#: °1 Tier[I : o Labeling: o o d Spill Plan: e- Oil/Water Separator: 011A Floor Drains: j o Emergency Numbers: S Storage AreaslTanks: Sao 1000 t.1 44Ls k,5-(,, CV14CLICZ 1 A coK.e-f1e:k,e S A-I "MW-o Emergency/ContainmentEquipment: 5 � o �� �j°taI "''� ms«� -1L`, nt Waste Generator ID: M 4Ct)QQJ-? el-1 I W ste Product: b I k¢-< Date&Amount of Last Shi ment/Fre ue c : v w y ► Ins Kg �'�o.ti Licensed Waste Hauler&Destination: CJ 0- Other Waste Disposal Methods: ,11 LIST OF TOXIC AND HAZARDOUS MATERIALS IV 0 NtiOL v,! NOTE: Under the provisions of Ch. 111, Section 31, of the eneral Law of MA, hazardous�naterial 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 Diesels, 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 t 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 v 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: �5 a15 ma . f3o V� Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE r°k� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BnRMA_BR 200 Main Street• Hyannis, MA 02601 t639• �0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT prFO MAC a Business Name: vii k.- ��oo�g fl� " v�f32 Date: 8 /� Location/Mailing Address: 31r 5c-oQ ve, QKn, Contact Name/Phone: eJ►v-,,Y000.4 B- -7 -7-77 � 2 Inventory Total A ount: MSDS: 4 License#: 1[0? Tier II : Qi o Labeling: 6-0,0A Spill Plan: ZS Oil/WaterSeparator: Floor Drains: o EmeMeocy Numbers: 2. Storage Areas/Tanks: ` o O&Y APAJ 1000 rig W[ ?I t Emergency/Containment Eq ipment: ,k Waste Generator ID: '7 I Waste Product- o t Date&Amount of Last Shipment/Frequency: S i< S© 1"' Licensed Waste Hauler&Destination: Cy Ll- v9 pq I.tfio.ti , Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NO NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous aterial 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 'L- 55 4�?-\A Wm-0,tom 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 --V 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 �L Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes 1 Miscellaneous Flammables Fertilizers d-kAft'< 6-1rPt 0wAX TA44_ 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 2 o „ I VL, AA-AA o s 5 u25 od PKt_5. Inspecto — )"t"u��.ki Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' Bi1RMA `� ' 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name-1 w1K- 8rVDVCS 6-E>W Date: 7 �3 l4 Location/Mailing Address: 3 S Sc uoQAv- Ave- a n h i.S Contact Name/Phone: i~;ev yo-j L^4 SoS - 7-7 -7-T 7 S Inventory Total Amount: ^' I k� MSDS: 0-6 License#: I o k Tier II : Labeling: Spill Plan: d Oil/WaterSeparator: N o I I Floor Drains: Na Emergency Numbers: es Storage Areas/Tanks: xot,4L 0\� 4- j',\--t e, tv, 'l�cov�ga.� Gov A\Vn "-� h rre\S oa� �vrs Emergency/Containment Equipment: ova 5 1 \' Waste Generator ID: SD 2�b b Waste Product: O\ ` , F, 1 yc<S Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: CAI Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS Oo ,MEt joy! ck&& h JW ��-.�e��a� 6 lack lkse�1� NOTE: Under the provisions of Ch. 111, Section 31, of the General La of MA, hazardous material use, (1012 1 (ts) 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 I 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: a c�2v.S.0 ens s4. 74 5 I\ . G a a CoYu qv� e Inspector: �• �--0.u /- Facility Representative:/n � WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS l TOWN OF BARNSTABLE Date: /v/91 / /3 :3:Zis + I&V'— TOXIC AND HAZARDOUS MATERIALS RER&STRAUGN FORM NAME OF BUSINESS: �01'� C&Q c-g.e_ BUSINESS LOCATION: 3S �Gu .l f�t/2•, >'7d�nn�s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 77 S-77 -7 !�' ti 17 a "A's CONTACT PERSON: - <&J,v, EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: o -f r Ye INFORMATION / REC MENDATIONS: '3 Masi eb�a, (tia a�d�,,s r&-Xc,.d Fire District: tI ' 8'e ot3-tot 2� J to Avt G S �I/� Caw�-� avL t P-ArttS 3�D /a�b�1 b 1 %06-< �&e, ¢Ay nt.3 D a oLe i ' I°f teeom✓k e�r�� Q r+nll�zr QC_���SQL, air a .1 1Ad_S t,t��5 Ma-Fe.( .a�g`�na]t' .art. y10 1o►�i�l V� Crc wcca aro! lj: 8 I Waste . JyIV�b8Sb26g-7 1 Last shipment of hazardous waste: Z Name of Hauler: C K, ©, 1 Destination: K ©, 1,21 L A Waste Product: I_A,s}t.D,l t �, 1+er5 Licensed . a No IMADc�2_� 3?7? 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 6S Motor Oils Pesticides (�•cc.soli&s{IIq.,,�S� LYot NEW to MUSED 5:e.- 56 (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 /p Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine A,< Battery acid (electrolyte)/Batteries(S) Lye or caustic soda Rustproofers Miscellaneous Combustible 1 Car wash detergents Leather dyes 1 Car waxes and polishes 9-7 Fertilizers AIS lb gol,lZs Asphalt& roofing tar PCB's y� Paints, varnishes, stains, dyes of sol s 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_� TOWN OF BARNSTABLE Ordinance or Regulation BAR -W 6049 WARNING NOTICE Name of Offender/Managerwt� Yw� Address of Offender MV/MB Reg. # Village/State/Zip A� ,,t^ Business Name Win BrooKS CTO Cc ur5e ,� :a am/pm;�-o Cn 125- 202) Business Address 39 SCLx!�v Me i /�t?� t �1 t Signature of Enforcing Officer Village/State/Zip 000t) t5/Ac' lOX_oi Location of Offense TW M i,lrcws 01f Course H e{kW) d'I Ws' Enforcing Dept/Division Offense Y fU 1CAlon D� +Own cb& low' l t'ce oS_ c ,fi� conTi ate g Plan ) �� Facts �( i� 'r oyar t5 Sioclnq < M ani� 7` oo gallons 0; AU'z &2S i'Yl�.t�f( a) WI4°I� t _F W.r hCQ0Sina. SUbr4 app),"rr�I'Cj) Je2 * 13 We 1�C2 *o f e- I) . tl#� This will serve only as a}warning. At this 1ime 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 6049 WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip r Business Name 1�T WJ'a 8r CJOK C rjr5f .) • am/)m�� on 05125- 20�2 Business Address 3 SC ye— {{j� SI( ` s —8ignature.of Enforcing Officer Village/State/Zip OLW65/Ack/02601 . J Location of Offense TwIn B(-Q)I<5 6_011 (OU(se �"VFsI~on Enforcing Dept/Division ViUIUlion ( +own Cb& Imo- � � �iC�tl�� oi)) oo 4In e j on .Offense � � � Facts b0'5;1WOw#1e( {5 r}l ftl c,,n� 7 cxo ga16s c) a?ar ar Air)Ae w � P r oer ��Ct'��it3�. %6 4� apohlrAlo , ee * I D 104 to *ors JUKE' � This will serve-only as afwarning. 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 & ADDRESS ~' LOCATION ' Dunfey's Hyannis Hotel 35 Scudder Ave. , Hyannis c/o John A. Drew (Owner of land) (West End Circle) 749 Main St. , Hyannis, MA 02604 BOOK. & PAGE - DATE GRANTED AMOUNT STORED 135/146 - Oct. 1.5, 1979 1 ,000 gals underground ' DATE PAID 10 T7-79 FEB 22, •fry d TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS P VILLAGE 5�4.0--f LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL _ A (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. /112_'_ 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS