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DEPARTMENT Revis [.1::: 9 2 2 Hyannis Fire Department Report Form >s'»»;;»ss .;... If E Date Alarm ArrivalIn Service ident # "00046.0 005/ 18/96 Day ISaturday � 17.28 17.31 17.50 Fire7 SITUATION FOUND ACTION TAKEN ;:::: ::;::; MUTUAL AID B Spill, Leak w/ No Ign 4 1 >'<' Remove Hazard FIXED PROPERTY USE (CCCUPANCY) : IGNITION FACTOR C Paved Public Street <.>'.9 6 2 '' NO FIRE 0 0 OCORRECT ADDRESS ZIP CODE CENSUS TRACT D 50 SEA STREET 02601 60 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. CARLINO JOSHUA OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE F 12 TOWN OF BARNSTABLE MAIN STREET HYANNIS MA 508 790-6200 G 13 METHOD OF ALARM CO. DIST. PERSONNEL ........... ENG RESP. ........... AERIALS RESP. ; ;:s;3 © RESP. 0. 1 SHIFT HAZ MAT PRESENT? Y TANK. RESP. OTHER RESP. 0 TEL-1300 NO. SUBSTANCE 12 7 0 1270 SPEC. EQUIP. USED? O 20 FIRE OTHER SERVICE «< 0 zzf 0 <># E 0 >< 0 0 O 11 MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LASS TOTAL INS. CLAIM PD 0. 0 0 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 JIF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX AREA OF EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION MATERIAL FORM TYPE © IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT EXTENT OF DAMAGE Flame ... Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE N :.. OPLj E Material generating FORM TYP ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date ERIC FARRENKOPF CAPTAIN 5/ 1 8/9 6 0 Comments for this incident have been printed on an additional comments page. Comments for Incident: 96 . 000460 Exposure: 00 Date: 5/18/96 RECEIVED A CALL FROM URANO'S RESTURANT FOR A MOTORCYCLE THAT HAD LEFT THE AREA AND SPILLED SOME GASOLINE ON THE ROAD. RESPONSE:CAR 812 ON AN INVESTIGATION. UPON ARRIVAL FOUND BARNSTABLE POLICE OFFICER JOHN YORK ON LOCATION OF A PAST MOTORCYCLE ACCIDENT.THE MOTORCYCLE HAD HIT THE STONE WALL OF URANO'S AND TORN OPEN THE OIL FILL PIPE AND SPILLED APPROX. 1/2 OT OF OIL ON THE SIDE WALK. THE OPERATOR OF THE MOTORCYCLE JOSHUA CARLINO 10 CARROL LANE WEST HARWICH, MA. HAD TAKEN THE MOTORCYCLE TO A HOUSE ON OAKNECK ROAD. COVERED THE OIL SPILL WITH SAND. CAR 812 TO OTS 1750 ERIC FARRENKOPF CAPTAIN 05/18/96 BARNSTABLE POLICE CASE # 96013042 MASSACHUSETTS FIRE INCIDENT REPORT �. F11.77_ Revised ti ^1 jl.. # .0.:.1;,9..L:,2.,.::. DEPARH annis Fire De artment Report Form li' Ex Date Alarm jArrivaiIn Service » : ::3> : I id)t� 970443 Fire 005/ 1 3%/97 Day ITuesday01 : 28 01 :30 01 :59 TUATION FOUND ACTION TAKEN MUTUAL AID Spill, Leak w/ No Ign 4 1 Remove Hazard FIXED PROPERTY USE (OCCUPANCY) IGNITION FACTOR C Paved Public Street "9 6 2 is NCtE - OCORRECT ADDRESS ZIP CODE CENSUS TRACT D 182 SEA ST. 0 2 6 0 1 60 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. NO OCC F 12 OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE G 1.3 METHOD OF ALARM CO DIST O PERSONNEL ENG RESP. AERIALS RESP. 6 ; H RESP. M _... .. 4 SHIFT HAZ MAT PRESENT? TANK. RESP. OTHER RESP. D 0 0 ..........: -T Radio NO. SUBSTANCE 0 0 1 JISPEC. EQUIP. USED? O2 SERVICE A 0 TF.: OTHER T.;INJURIES O A. 0 O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS _ __.... TOTAL INS. CLAIM PD 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL N0. IN IGNITION O COMPLEX AREA OF EQUIP INVOLVED IN IGN ORIGIN © FORM OF HEAT IGNITION MATERIAL FORM TYPE IGNITED OMETHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE EXTINGUISHMENT a EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE N P O Material generating FORM TYPE no most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date ROGER CADRIN LIEUTENANT 5/ 1 3 / 9 7 • Comments for this incident have been printed on an additional comments page. Comments for Incident: 97 970443 Exposure: 00 Date: 5/13/97 RESPONDED TO A MVA FOR AN OIL SPILL IN THE ROADWAY. WE REMOVED THE SPILL OF APROX 40TS OF OIL USEING SPEEDI DRY. THEN LEFT A COAT OF SPEEDI DRY ON THE ROAD. E ALSO DISCONNECTED THE BATTERY OF THE CAR INVOLVED IN THE ACCIDENT. AFTER REMOVING THE HAZARDS E-826 RET TO OTS. • MASSACHUSETTS FIRE INCIDENT REPORT <>DEPARTMENT Revised .r *FIXE'DPROPERTY g22"'' Hyannis Fire Department - Report Fore' If Date Alarm Arrival jInService 265 Fire 001 2/1 1 /95 Day IMondayEE 09:52 09 :52 10:20 ACTION TAKEN ;.:.:: MUTUAL AID pi Ign .'.4 1 Remove Hazard Recv'd 1 USE (OCCUPANCY) IGNITION FACTOR C Paved Public Street :::9 6 2 NO FIRE >0 0 OCORRECT ADDRESS ZIP CODE CENSUS TRACT D SEA AND SOUTH ST 1 02601 000060 O11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. F 12 OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE G 13 METHOD OF ALARM CO. DIST. PERSONNEL ENG RESP. AERIALS RESP. 3 © RESP. 0:. SHIFT HAZ MAT PRESENT? TANK. RESP. OTHER RESP. B 2:.: Telephone (Direct) NO. ALA RMS SUBSTANCE 0 0 O: SPEC. EQUIP. USED? O 20 FIRE SERVICE » 0 0 >' OTHER Q> ; O MOBILE PROPERTY TYPE VEHICLE STOLEN? * ESTIMATED TOTAL INSURANCE CO. h� DOLLAR LOSS r1 TOTAL INS. CLAIM PD • 0 0 0 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. yEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX AREA OF EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION MATERIAL FORM TYPE © << IGNITED ....... METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT Lj Li EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE OP N O Material generating FOFM TYPE ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date DEAN L. MELANSON LIEUTENANT 1 2/ 1 1 /9 5 • Comments for this incident have been printed on an additional comments page.. r Comments for Incident: 95 001265 Exposure: 00 Date: 12/11/95 FIRE tLARM REC'D A REPORT OF A MVA AT THIS LOCATION AND DISPACTHED R-827. UPON R-827'S ARRIVAL THEY NOTE fi VTI-FREZZE AND TRANSMISSION OIL ON THE GROUND UNDER ONE OF THE VEHICLES AND THEY REQUESTED AN OONGINE TO THE SCENE. I WAS IN E-822,WITH FF'S CLOUGH AND JONES, RETURNING FROM ALARM#1264 AND ESPONDED DIRECT.ONCE ON SCENE WE COVERD A SMALL ANTIFRETIE AND OIL SPILL ALONG THE GUTTER WITH SPEEDY RY FROM THE WREAKER.WE THEN STOOD BY FOR THE REMOVAL OF THE SECOND VEHICLE(BLAKC BERRETA MA REG 628-25C WHICH WAS UP ON THE SEA ST STONE WALL OF URANO'S RESTAURANT.THIS VEHICLE WAS REMOVED WITHOUT PROBLEM OR LEAK AND WE RETURNED TO QUARTERS.C.O.M.M.PROVIDED A MUTAL AID RESCUE FOR PT CARE. LT. DEAN L. MELANSON 11-DEG-95 t S� MASMCHUSETTS FIRE INCIDENT REPORT O 10 ':. ...... « DEPARTMENT Revise 0 2 2............ Hyannis Fire Department Report Form . ' If Fx4 I Date Alarm jArriva In Service nciNTION 0788 Fire 008/ 13/96 Day ITuesday111 :17 11 :22 11 :35 OUND ,,.......... ACTION TAKEN ::::........::::. MUTUAL AID B Spill, Leak w/ No Ign "4 1 Remove Hazard FIXED PROPERTY USE (OCCUPANCY) IGNITION FACTOR C 0 Paved Public Street 9 6 2 ' NO FIRE `> OCORRECT ADDRESS ZIP CODE CENSUS TRACT D SEA STREET 1 02601 60 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. N/A F 12 OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE TOWN OF BARNSTABLE MAIN STREET HYANNIS MA CO. DIST. PERSONNEL ENG RESP. ............ AERIALS RESP. G 13 METHOD OF ALARM 3 © RESP. 0 SHIFT HAZ MAT PRESENT? TANK. RESP. JOTHER RESP. A TEL-B P D NO. SUBSTANCE 0 0 1 > SPEC. EQUIP. USED? O 2 o FIRE SERVICE O »»• O > > OTHER 0 O '... 0 F F O MOBILE PROPERTY TYPE VEHICLE STOLEN? ter, ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. CLAIM PD 0 0 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 30 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. 410 IN IGNITION O COMPLEX AREA OF •• ..EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION MATERIAL FORM TYPE © >? IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT # ..... L] Ll EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE OP Material generating FORM TYPE no Material smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS IOfficer in Charge: Date ERIC FARRENKOPF CAPTAIN 8/ 1 3/9 6 Comments for this incident have been printed on an additional comments page. Iments for Incident: 96 000788 Exposure: 00 Date: 8/13/96 RECEIVED A CALL FROM THE BARNSTABLE POLICE FOR A WASH DOWN AT AN MVA IN FRONT OF 167 SEA STREET. RESPONSE:ENGINE 822 CAPT E.FARRENKOPF,F/Fs OBERLANDER,REX. UPON ARRIVAL HAD AN APPROX 2 GALLON SPILL IN THE ROAD WAY,OF GASOLINE FROM A VEHICLE THAT HAD HIT A ELECTRIC POLE. THE VEHICLE WAS ON THE TOW TRUCK AND HAD STOPPED LEAKING. JANSOL THE AREA AND WASHED IT DOWN. ENGINE 822 TO OTS 1135 ERIC FARRENKOPF,CAPTAIN 08/13/96 • • s Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number j Pursuant to 310 CMR 40.1000(Subpart J) a - 21596 IL 'i For sites with multiple RTNs,enter the Primary RTN above. A. SITE LOCATION: 1. Site Name/Location Aid: INO LOCATION AID 2. Street Address: 1293 SEA ST 3. City/Town: HYANNIS 4. ZIP Code: 1026010000 5. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site. ❑ a. Tier IA b. Tier I ❑ c. Tier IC d. Tier II 6. If a Tier I Permit has been issued,provide Permit Number: B. THIS FORM IS BEING USED TO: (check all that apply) 1. List Submittal Date of RAO Statement(if previously submitted): mm/dd/yyyy ❑✓ 2: Submit a Response Action Outcome(RAO)Statement Fla. Check here if this RAO Statement covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here. b. Provide additional Release Tracking Number(s) ❑ _ ❑ _ covered by this RAO Statement. 3. Submit a Revised Response Action Outcome Statement a. Check here if this Revised RAO Statement covers additional Release Tracking Numbers(RTNs),not listed on the RAO Statement or previously submitted Revised RAO Statements. RTNs that have been previously linked to a Tier Classified Primary RTN do not need to be listed here. b. Provide additional Release Tracking Number(s) ❑ _ ❑ _ covered by this RAO Statement. 4. Submit a Response Action Outcome Partial(RAO-P)Statement Check above box,if any Response Actions remain to be taken to address conditions associated with this disposal site having the Primary RTN listed in the header section of this transmittal form. This RAO Statement will record only an RAO-Partial Statement for that RTN. A final RAO Statement will need to be submitted that references all RAO-Partial Statements and,if applicable,covers any remaining conditions not covered by the RAO-Partial Statements. Also,specify if you are an Eligible Person or Tenant pursuant to M.G.L.c.21 E s.2,and have no further obligation to conduct response actions on the remaining portion(s)of the disposal site: ❑ a. Eligible Person n b. Eligible Tenant ® 5. Submit an optional Phase I Completion Statement supporting an RAO Statement Fi6. Submit a Periodic Review Opinion evaluating the status of a Temporary Solution for a Class C-1 RAO Statement,as specified in 310 CMR 40.1051 (Section F is optional) 7. Submit a Retraction of a previously submitted Response Action Outcome Statement(Sections E&F are not required) (All sections of this transmittal form must be filled out unless otherwise noted above) Revised:02/28/2006 Page 1 of 7 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number Pursuant to 310 CMR 40.1000(Subpart J) = 21596 C. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply;for volumes,list cumulative amounts) 1. Assessment and/or Monitoring Only 2. Temporary Covers or Caps 3. Deployment of Absorbent or Containment Materials 4. Treatment of Water Supplies ❑✓ 5. Structure Venting System 6. Engineered Barrier ® 7. Product or NAPL Recovery 8. Fencing and Sign Posting 9. Groundwater Treatment Systems 10. Soil Vapor Extraction 11. Bioremediation ❑ 12. Air Sparging 13. Monitored Natural Attenuation ❑ 14. In-situ Chemical Oxidation L]✓ 15. Removal of Contaminated Soils Q a. Re-use, Recycling or Treatment ❑ i.On Site Estimated volume in cubic yards Q ii.Off Site Estimated volume in cubic yards 25 iia.Facility Name: AGGREGATE INDUSTRIES Town: SOUTH DENNIS State: MA iib.Facility Name: Town: State: iii.Describe: LICENSED ASPHALT BATCH FACILITY b. Landfill ❑ I.Cover Estimated volume in cubic yards Facility Name: Town: State: ii. Disposal Estimated volume in cubic yards Facility Name: Town: State: 16. Removal of Drums; Tanks or Containers: a. Describe Quantity and Amount: b. Facility Name: Town: State: c. Facility Name: Town: State: 17. Removal of Other Contaminated Media: a.Specify Type and Volume: b.Facility Name: Town: State: c. Facility Name: Town: State: Revised:02/28/2006 Page 2 of 7 r L! Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number Pursuant to 310 CMR 40.1000(Subpart J) - 21596 C. DESCRIPTION OF RESPONSE ACTIONS(cont.): (check all that apply;for volumes,list cumulative amounts) ✓Q 18. Other Response Actions: Describe: INSTALLATION AND SAMPLING OF MONITORING WELLS 19. Use of Innovative Technologies: Describe: D.SITE USE: 1. Are the response actions that are the subject of this submittal associated with the redevelopment, reuse or the major expansion of the current use of property(ies)impacted by the presence of oil and/or hazardous materials? ❑ a. Yes Z b.No ® c.Don't know 2. Is the property a vacant or under-utilized commercial or industrial property("a brownfield property")? a. Yes �✓ b.No c.Don't know 3. Will funds from a state or federal brownfield incentive program be used on one or more of the property(ies)within the disposal site? ❑ a. Yes Q✓ b.No c.Don't know If Yes, identify program(s): 4. Has a Covenant Not to Sue been obtained or sought? Qa. Yes Q b.No c.Don't know 5. Check all applicable categories that apply to the person making this submittal: ® a. Redevelopment Agency or Authority ® b. Community Development Corporation ® c. Economic Development and Industrial Corporation d. Private Developer ❑ e.Fiduciary f. Secured Lender g. Municipality h.Potential Buyer(non-owner) Q✓ i.Other, describe: TRUSTEE TO TRUST This data will be used by MassDEP for information purposes only,and does not represent or create any legal commitment, obligation or liability on the part of the party or person providing this data to MassDEP. E. RESPONSE ACTION OUTCOME CLASS: Specify the Class of Response Action Outcome that applies to the disposal site,or site of the Threat of Release. Select ONLYone Class. 1. Class A-1 RAO: Specify one of the following: EJ a. Contamination has been reduced to background levels. b. A Threat of Release has been eliminated. ❑✓ 2. Class A-2 RAO: You MUST provide justification that reducing contamination to or approaching background levels is infeasible. ❑ 3. Class A-3 RAO: You MUST provide an implemented Activity and Use Limitation(AUL)and justification that reducing contamination to or approaching background levels is infeasible. 4. Class A-4 RAO: You MUST provide an implemented AUL, justification that reducing contamination to or approaching background levels is infeasible,and justification that reducing contamination to less than Upper Concentration Limits (UCLs)15 feet below ground surface or below an Engineered Barrier is infeasible. If the Permanent Solution relies upon an Engineered Barrier,you must provide or have previously provided a Phase III Remedial Action Plan thatjustifies the selection of the Engineered Barrier. Revised:02/28/2006 Page 3 of 7 i Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 L71- RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number Pursuant to 310 CMR 40.1000(Subpart J) - 21596 E. RESPONSE ACTION OUTCOME CLASS(cunt.): 5. Class B-1 RAO: Specify one of the following: El a. Contamination is consistent with background levels Elb. Contamination is NOT consistent with background levels. 6. Class B-2 RAO: You MUST provide an implemented AUL. 7. Class B-3 RAO: You MUST provide an implemented AUL and justification that reducing contamination to less than Upper Concentration Limits(UCLs)15 feet below ground surface is infeasible. Fi 8. Class C-1 RAO: You must submit a plan as specified at 310 CMR 40.0861(2)(h). Indicate type of ongoing response actions. a. Active Remedial System b. Active Remedial Monitoring Program c.None d. Other Specify, 9. Class C-2 RAO: You must hold a valid Tier I Permit or Tier II Classification to continue response actions toward a Permanent Solution. F. RESPONSE ACTION OUTCOME INFORMATION: 1. Specify the Risk Characterization Method(s)used to achieve the RAO described above: 0 a. Method 1 0 b.Method 2 n c.Method 3 d. Method Not Applicable-Contamination reduced to or consistent with background,or Threat of Release abated 2.Specify all Soil Category(ies)applicable. More than one Soil Category may apply at a Site. Be sure to check off all APPLICABLE categories: a. S-1/GW-1 d.S-2/GW-1 g.S-3/GW-1 El b. S-1/GW-2 ne.S-2/GW-2 h.S-3/GW-2 0 c. S-1/GW-3 R f. S-2/GW-3 Z i. S-3/GW-3 3. Specify all Groundwater Category(ies)impacted. A site may impact more than one Groundwater Category. Be sure to check off all IMPACTED categories: a. GW-1 b. GW-2 n c.GW-3 Z d.No Groundwater Impacted Specify remediation conducted: Q✓ a.Check here if soil remediation was conducted. b.Check here if groundwater remediation was conducted. 5.Specify whether the analytical data used to support the Response Action Outcome was generated pursuant to the Department's Compendium of Analytical Methods(CAM)and 310 CMR 40.1056: ✓® a. CAM used to support all analytical data. b.CAM used to support some of the analytical data. c.CAM not used. 6.Check here to certify that the Class A,B or C Response Action Outcome includes a Data Usability Assessment and Data Representativeness Evaluation pursuant to 310 CMR 40.1056. 7. Estimate the number of acres this RAO Statement applies to: 0.1 Revised: 02/28/2006 Page 4 of 7 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number - 21596 Pursuant to 310 CMR 40.1000(Subpart J) G. LSP SIGNATURE AND STAMP: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1), (ii)the applicable provisions of 309 CMR 4.02(2)and(3),and 309 CMR4.03(2),and (iii)the provisions of 309 CMR 4.03(3),to the best of my knowledge,information and belief, > if Section B indicates that either an RAO Statement,Phase I Completion Statement and/or Periodic Review Opinion is being provided,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,and(iii)comply(ies)with the identified provisions of all orders,permits,and approvals identified in this submittal. I am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false,inaccurate or materially incomplete. 1. LSP#: 14303 2. First Name: JDAVID C 3. Last Name: BENNETT 4. Telephone:15088961706 5. Ext.:1 6. FAX: 7. Signature: David C Bennett of btas�` 8. Date: 12/23/2008 mm/dd/yyyy 9.LSP Stamp: c �. Ele_otronic Seal H. PERSON MAIdNG SUBMITTAL: 1. Check all that apply: 11 a.change in contact name b.change of address Q c. change in the person undertaking response actions 2. Name of Organization:ILOLA J FUCCILLO INVESTMENT TRUST 3. Contact First Name: LOLA J 4. Last Name: IFUCCILLO 5. Street: 12424 CROWE RIDGE ROAD 6.Title:ITRUSTEE TO TRUST WINCHESTER 40391-0000 7. City/Town: 8. State: 9. ZIP Code: 10. Telephone: 859-842-4845 11.Ext.: 12. FAX: Revised:02/28/2006 Page 5 of 7 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number L71 Pursuant to 310 CMR 40.1000(Subpart J) F - 21596 I. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON MAFdNG SUBMITTAL: 1. RP or PRP ® a. Owner in b. Operator ❑ c. Generator ® d. Transporter ®e. Other RP or PRP Specify: TRUSTEE TO TRUST ❑ 2. Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) ❑ 3. Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) ❑ 4. Any Other Person Making Submittal Specify Relationship: J. REQUIRED ATTACHMENT AND SUBMITTALS: 1. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s) ❑ and/or approval(s)issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. ❑ 2. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of an RAO Statement that relies on the public way/rail right-of-way exemption from the requirements of an AUL. ❑ 3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the submittal of a RAO Statement with instructions on how to obtain a full copy of the report. 4. Check here to certify,that documentation is attached specifying the location of the Site,or the location and boundaries of ❑✓ the Disposal Site subject to this RAO Statement. If submitting an RAO Statement for a PORTION of a Disposal Site, you must document the location and boundaries for both the portion subject to this submittal and,to the extent defined,the entire Disposal Site. 5. Check here to certify that,pursuant to 310 CMR 40.1406,notice was provided to the owner(s)of each property within the ✓0 disposal site boundaries,or notice was not required because the disposal site boundaries are limited to property owned by the party conducting response actions.(check all that apply) ❑ a. Notice was provided prior to,or concurrent with the submittal of a Phase II Completion Statement to the Department. ❑ b. Notice was provided prior to,or concurrent with the submittal of this RAO Statement to the Department. ❑✓ c. Notice not required. d. Total number of property owners notified,if applicable: 6. Check here if required to submit one or more AULs. You must submit an AUL Transmittal Form(BWSC113)and a ❑ copy of each implemented AUL related to this RAO Statement. Specify the type of AUL(s)below: (required for Class A-3,A-4,B-2,B-3 RAO Statements) ❑ a. Notice of Activity and Use Limitation b. Number of Notices submitted: ❑ c. Grant of Environmental Restriction d. Number of Grants submitted: ❑ 7. If an RAO Compliance Fee is required for any of the RTNs listed on this transmittal form,check here to certify that an RAO Compliance Fee was submitted to DEP, P.O.Box 4062, Boston, MA 02211. ❑ 8. Check here if any non-updatable information provided on this form is incorrect,e.g.Site Address/Location Aid. Send corrections to the DEP Regional Office. ❑✓ 9. Check hereto certify that the LSP Opinion containing the material facts,data,and other information is attached. Revised:02/28/2006 Page 6 of 7 r— Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC104 RESPONSE ACTION OUTCOME (RAO) STATEMENT Release Tracking Number Pursuant to 310 CMR 40.1000(Subpart J) F - 21596 K. CERTIFICATION OF PERSON MAKING SUBMITTAL: 1.1, ,attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal, including any and all documents accompanying this transmittal form,(ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii) that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made am/is aware that there are significant penalties,including,but not limited to, possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. 2 By. Lola J Fuccillo . Title: TRUSTEE TO TRUST Signature 4. For: LOLA J FUCCILLO INVESTMENT TRUST 5. Date: 12/23/2008 (Name of person or entity recorded in Section H) mm/dd/yyyy ❑ 6. Check here if the address of the person providing certification is different from address recorded in Section H. 7. Street: 8. City/Town: 9. State: 10. ZIP Code: 11. Telephone: 12.Ext.: 13. FAX: YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO$10,000 PER BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Date Stamp(DEP USE ONLY:) Received by DEP on 12/23/2008 5:43:22 PM Revised:02/28/2006 Page 7 of 7 r eDEP -MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Username:DAVIDBENNETT My eDEP I Forms ui My Profile ii 6 Help` Receipt Forms Attach Files Signature Receipt Summaryleceipt print rpcept_ Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP"to see a list of your transactions. DEP Transaction ID: 218717 Date and Time Submitted: 12/23/2008 5:43:22 PM Other Email : Form Name: BWSC 104 RAO Transmittal Form RTN: 4-21596 Location:NO LOCATION AID Address: 293 SEA ST,HYANNIS, 026010000 Person Making Submittal LOLA J FUCCILLO INVESTMENT TRUST LOLA J FUCCILLO 2424 CROWE RIDGE ROAD WINCHESTER,KY 40391-0000 LSP LSP#: 4303 LSP Name: DAVID C BENNETT Person Making Certification LOLA J FUCCILLO INVESTMENT TRUST Lola J Fuccillo Ancillary Document Uploaded/Mailed BWSC-104 Ques.132-RAO Report-Uploaded (RAMC-RAOA2 upload report.pd£pdD My eDEP MassDEP Home I Contact I Feedba I Tour I Privacy Polic MassDEP's Online Filing System ver.8.2.2.0© 2008 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 12/23/2008 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number � _ 21596 TRANSMITTAL FORM Pursuant to 310 CMR 40.0444-0446(Subpart D) A. SITE LOCATION: O LOCATION"AID - 1. Site Name/Location Aid: 'N - - - a -- 2. Street Address: 293 SEA,ST 3. City/Town: HYANNIS 4. ZIP Code: _026010000 _ 5. UTM Coordinates: a. UTM N: 14610673 b. UTM E: 1392518 ® 6. Check here if a Tier Classification Submittal has been provided to DEP for this disposal site. ❑ a. Tier IA ❑ b. Tier IB ❑ c. Tier IC ❑ d. Tier II 7. If a Tier I Permit has been issued,provide Permit Number: B.THIS FORM IS BEING USED TO: (check all that apply) 1. List Submittal Date of Initial RAM Plan(if previously submitted): 10/24/2008 (mm/dd/yyyy) ❑ 2. Submit an Initial Release Abatement Measure(RAM)Plan. a. Check here if the RAM is being conducted as part of the construction of a permanent structure.If checked,you must ❑ specify what type of permanent structure is to be erected in or in the immediate vicinity of the area where the RAM is to be conducted. b.Specify type of permanent structure: (check all that apply) ❑ i.School ❑ ii. Residential ❑ iii.Commercial ❑ iv. Industrial ❑ v.Other Specify: ❑ 3. Submit a Modified RAM Plan of a previously submitted RAM Plan. ❑ 4. Submit a RAM Status Report. ® 5. Submit a Remedial Monitoring Report.(This report can only be submitted through eDEP,concurrent with a RAM Status Report.) a.Type of Report:(check one) ❑ i. Initial Report ❑ ii. Interim Report ❑ iii. Final Report b. Number of Remedial Systems and/or Monitoring Programs: A separate BWSC106A, RAM Remedial Monitoring Report, must be filled out for each Remedial System and/or Monitoring Program addressed by this transmittal form. Q 6. Submit a RAM Completion Statement. ❑ 7. Submit a Revised RAM Completion Statement. 8. Provide Additional RTNs: ❑ a. Check here if this RAM Submittal covers additional Release Tracking Numbers (RTNs). RTNs that have been previously linked to a Primary Tier Classified RTN do not need to be listed here. This section is intended to allow a RAM to cover more than one unclassified RTN and not show permanent linkage to a Primary Tier Classified RTN. b. Provide the additional Release Tracking Number(s) ❑ _ ❑ _ covered by this RAM Submittal. I (All sections of this transmittal form must be filled out unless otherwise noted above) Revised: 2/16/2005 Page 1 of 6 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number ;TRANSMITTAL FORM - 21596 Pursuant to 310 CMR 40.0444-0446(Subpart D) C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT RAM: 1. Identify Media Impacted and Receptors Affected: (check all that apply) ❑ a. Air Q b. Basement ❑ c. Critical Exposure Pathway ❑ d. Groundwater 0 e. Residence ❑ f. Paved Surface ❑ g.Private Well ❑ h. Public Water Supply ❑ i. School ® j. Sediments ✓❑ k. Soil ❑ I. Storm Drain ® m. Surface Water ❑ n. Unknown ❑ o. Wetland ❑ p. zone 2 ❑ q. Others Specify: 2. Identify all sources of the(Release or Threat of Release,if known: (check all that apply) ❑ a. Above-ground Storage Tank(AST) ❑ b. BoaWessel ❑ c. Drums ❑ d.Fuel Tank ❑ e. Pipe/Hose/Line ❑ f. Tanker Truck ❑ g. Transformer ❑ h. Under-ground Storage Tank(UST) ❑ i. Vehicle 0 j. Others Specify: PARTIALLY BURIED FUEL OIL TANK IN CRAWL SPACE 3. Identify Oils and Hazardous Materials Released: (check all that apply) Z a. Oils ❑ b. Chlorinated Solvents ❑ c.Heavy Metals ❑ d. Others Specify: D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply,for volumes list cumulative amounts) ❑ 1. Assessment and/or Monitoring Only ❑ 2. Temporary Covers or Caps ❑ 3. Deployment of Absorbent or Containment Materials ® 4. Temporary Water Supplies Q5. Structure Venting System ❑ 6. Temporary Evacuation or Relocation of Residents ❑ 7. Product or NAPL Recovery ❑ 8. Fencing and Sign Posting ❑ 9. Groundwater Treatment Systems ❑ 10. Soil Vapor Extraction ❑ 11. Bioremediation ❑ 12. Air Sparging I Revised: 2/16/2005 Page 2 of 6 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 'RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number TRANSMITTAL FORM - 21596 Pursuant to 310 CMR 40.0444-0446(Subpart D) D. DESCRIPTION OF RESPONSE ACTIONS(cont.): (check all that apply,for volumes list cumulative amounts) Q✓ 13. Excavation of Contaminated Soils Z a. Re-use,Recycling or Treatment i.On Site Estimated volume in cubic yards © ii.Off Site Estimated volume in cubic yards 25 iia.Receiving Facility: AGGREGATE INDUSTRIES Town: SOUTH DENNIS State: MA iib.Receiving Facility: Town: State: iii.Describe: LICENSED ASPHALT BATCH FACILITY b. Store !.On Site Estimated volume in cubic yards ii.Off Site Estimated volume in cubic yards iia.Receiving Facility: Town: State: iib. Receiving Facility: Town: State: FJ c. Landfill i.Cover Estimated volume in cubic yards Receiving Facility: Town: State: ii. Disposal Estimated volume in cubic yards Receiving Facility: Town: State: 14. Removal of Drums,Tanks or Containers: a. Describe Quantity and Amount: b. Receiving Facility: Town: State: c. Receiving Facility: Town: State: 15. Removal of Other Contaminated Media: a.Specify Type and Volume: b.Receiving Facility: Town: State: c.Receiving Facility: Town: State: 16. Other Response Actions: Describe: INSTALLATION AND SAMPLING OF MONITORING WELLS 17. Use of Innovative Technologies: Describe: Revised: 2/16/2005 Page 3 of 6 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number !TRANSMITTAL FORM - 21596 Pursuant to 310 CMR 40.0444-0446(Subpart D) E. LSP SIGNATURE AND STAMP: attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1), (ii)the applicable provisions of 309 CMR 4.02(2)and(3),and 309 CMR 4.03(2),and (iii)the provisions of 309 CMR 4.03(3),to the best of my knowledge,information and belief, > if Section B of this form indicates that a Release Abatement Measure Plan is being submitted,the response action(s)that is (are)the subject of this submittal(i)has(have)been developed in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(iii)comply(ies)with the identified provisions of all orders, permits,and approvals identified in this submittal; > if Section S of this form indicates that a Release Abatement Measure Status Report and/or Remedial Monitoring Report is being submitted,the response action(s)that is(are)the subject of this submittal(i)is(are)being implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(iii) comply(ies)with the identified provisions of all orders,permits,and approvals identified in this submittal; > if Section S of this form indicates that a Release Abatement Measure Completion Statement is being submitted,the response action(s)that is(are)the subject of this submittal(i)has(have)been developed and implemented in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000,(ii)is(are)appropriate and reasonable to accomplish the purposes of such response action(s)as set forth in the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(iii)comply(ies) with the identified provisions of all orders,permits,and approvals identified in this submittal: I am aware that significant penalties may result, including,but not limited to, possible fines and imprisonment, if I submit information which I know to be false,inaccurate or materially incomplete. 1. LSP#: 4303 2. First Name: I D"ID C 3. Last Name: BENNETT 4. Telephone: 5088961706 5. Ext.: 6. FAX: 7. Signature: David C Bennett s��th of Mase 8. Date: 12/23/2008 r $� 9.LSP Stamp: a g (mm/dd/yyyy) Elea--NO w Seal z Revised: 2/16/2005 Page 4 of 6 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number TRANSMITTAL FORM ] - 2159s Pursuant to 310 CMR 40.0444-0446(Subpart D) F. PERSON UNDERTA UNG RAM: 1. Check all that apply: ® a.change in contact name b.change of address ❑✓ c. change in the person undertaking response actions 2. Name of Organization: JLOLA J FUCCILLO INVESTMENT TRUST 3. Contact First Name: JLOLA J 4. Last Name: IFUCCILLO 5. Street: 12424 CROWE RIDGE ROAD 6.Title:ITRUSTEE TO TRUST 7. Cityrrown: WINCHESTER 8. State: 9 ZIP Code: 403910000 10. Telephone: 18598424845 11.Ext.: 12. FAX: G. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAI KING RAM: �✓ 1. RP or PRP ® a. Owner ® b. Operator ® c. Generator ® d. Transporter Q✓ e. Other RP or PRP Specify: TRUSTEE TO TRUST 2. Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E,s.2) 3. Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) 4. Any Other Person Undertaking RAM Specify Relationship: H.REQUIRED ATTACHMENT AND SUBMITTALS: 1.Check here if any Remediation Waste,generated as a result of this RAM,will be stored,treated,managed,recycled or ® reused at the site following submission of the RAM Completion Statement. You m ust submit a Phase IV Remedy Implementation Plan along with the appropriate transmittal form(BWSC108). 2. Check here if the Response Action(s)on which this opinion is based,if any,are(were)subject to any order(s),permit(s) ® and/or approval(s)issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions thereof. 3. Check here to certify that the Chief Municipal Officer and the Local Board of Health have been notified of the implementation of a Release Abatement Measure. Fi 4. Check here if any non-updatable information provided on this form is incorrect,e.g.Release Address/Location Aid. Send corrections to the DEP Regional Office. 5. If a RAM Compliance Fee is required for this RAM,check here to certify that a RAM Compliance Fee was submitted to DEP,P.O.Box 4062,Boston,MA 02211. �✓ 6. Check hereto certify that the LSP Opinion containing the material facts,data,and other information is attached. Revised: 2/16/2005 Page 5 of 6 I Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC106 L I RELEASE ABATEMENT MEASURE (RAM) Release Tracking Number TRANSMITTAL FORM - 21596 Pursuant to 310 CMR 40.0444-0446(Subpart D) I. CERTIFICATION OF PERSON UNDERTAKING RAM: 1. I,LOLA J FUCCILLO I ,attest under the pains and penalties of perjury(i)that I have personally examined and am familiar with the information contained in this submittal, including any and all documents accompanying this transmittal form, (ii)that,based on my inquiry of those individuals immediately responsible for obtaining the information,the material information contained in this submittal is,to the best of my knowledge and belief,true,accurate and complete,and(iii) that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. I/the person or entity on whose behalf this submittal is made am/is aware that there are significant penalties,including, but not limited to, possible fines and imprisonment,for willfully submitting false,inaccurate,or incomplete information. 2. By. Lola J Fuccillo 3. Title: TRUSTEE TO TRUST Signature 4. For: LOLA J FUCCILLO INVESTMENT TRUST 5. Date: 12/23/2008 (Name of person or entity recorded in Section F) (mm/dd/yyyy) ® 6. Check here if the address of the person providing certification is different from address recorded in Section F. 7. Street: 8. City/Town: 9. State: 10. ZIP Code: 11. Telephone: 12.Ext.: 13. FAX: YOU ARE SUBJECT TO AN ANNUAL COMPLIANCE ASSURANCE FEE OF UP TO$10,000 PER BILLABLE YEAR FOR THIS DISPOSAL SITE. YOU MUST LEGIBLY COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Date Stamp(DEP USE ONLY:) Received by DEP on 12/23/2008 5:44:33 PM Revised: 2/16/2005 Page 6 of 6 eDEP -MassDEP'J OnlineFiling System Page 1 of 1 MassDEP Home i Contact i Feedback i Tour i Privacy Policy MassDEP's Online Filing System Username:DAVIDBENNETT My eDEPI Forms m; My Profile v; Help; Receipt ^--- ----�71 ®--S Forms Attach.Fles Signature Receipt Summaryleceipt _print receipt , Exit Your submission is complete.Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 218715 Date and Time Submitted: 12/23/2008 5:44:33 PM Other Email : Form Name: BWSC 106 RAM Transmittal Form RTN: 4-21596 Location:NO LOCATION AID Address: 293 SEA ST, HYANNIS, 026010000 Person Making Submittal LOLA J FUCCILLO INVESTMENT TRUST LOLA J FUCCILLO 2424 CROWE RIDGE ROAD WINCHESTER, KY 403910000 LSP LSP#: 4303 LSP Name: DAVID C BENNETT Person Making Certification LOLA J FUCCILLO INVESTMENT TRUST LOLA J FUCCILLO LOLA J FUCCILLO INVESTMENT TRUST LOLA J FUCCILLO Ancillary Document Uploaded/Mailed BWSC-106 Sec.B Q.6 -RAM Completion Report-Uploaded(RAMC-RAOA2 upload report.pdf pdo My eDEP MassDEP Home I Contact I Feedback I Tour PriVBcV Policy_ MassDEP's Online Filing System ver.8.2.2.0© 2008 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 12/23/2008 • SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the "RETURN TO"Space on t4l everse vide. Failure to do this will prevent this card from being returned to you.The return receipt fee will provide ou the name of the arson delivered to and the date of delivery.For additionaltees the following services are an a e. onsu t postmaster or s Ti—e—ana c ec t ox es for additional service(s) requested. f 1. Show to whom delivered,date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number P 017 005 917 Urano Saragoni Type of Service: c/o Kitchen Chef d/b/a Chef Urano Registered ❑ Insured 50 Sea Street Certified ❑ coo Express Mail ❑ Return Receipt Hyalmis Ma. 02601 for Merchandise Always obtain signature of addressee or agent and DATE DELIVERED. 5.,Signature - dress 8. Addressee's Address (ONLY if X .t 1 requested and fee paid) 6. Signature — Agent X 7. Date of Delivery f/�h� PS Form 3811,Mar. 1988 * U.S.G.P.O. 1988-212-865 DOMESTIC RETURN RECEIPT UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name,address and ZIP Code In the space below. • Complete items 1,2,3,and 4 on the Laaaaaaaas reverse. O revee. • Attach to front of article If space permits, otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested"adjacent to number. RETURN Print Sender's name, address, and ZIP Code in the space below. TO BOARD OF HEALTH BOX 534 I HYANNIS MA. 02601 I I I P 017 D05 917 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to Urano Saragoni Street and No. 50 Sea Street P.O.,State and ZIP Cod"Hyannis Ma. 02601 Postage 2.00 Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered Ln Return Receipt showing to whom, Date,and Address of Delivery m j TOTAL Postage and Fees S 2.00 o" � Postmark or Date 3/$/89 M E 0 U. N a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space per- mits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. i U.S.G.P.O.1987-197-722 �PyoFTHE po�yo TOWN OF BARNSTABLE OFFICE OF e,»sT,►�� �A06. BOARD OF HEALTH M 1639. ` 367 MAIN STREET QMA`f HYANNIS, MASS. 02601 March 8 , 1989 Mr. . Urano Saragoni c/o Kitchen Chef d/b/a Chef Urano's 50 Sea Street Hyannis , MA 02601 Re: Underground Fuel Storage 71ystems Dear Mr. Saragoni : You are now required by -;he "Health Regulation Regarding Fuel and Chemical Storage Systems" published in the December 17 , 1987 issue of the Barnstable Patriot, to register your underground tanks with the Board of Health. Please complete the enclosed Registration cards . Include any evidence of the date of purchase and installation, a copy of the permit from the Fire Chief, and a sketch map showing the location of such tanks on the property. Upon entire completion of the Registration cards , you will be issued brass valve tags by the Board of Health . These valve tags shall be picked up by you or your representative at the Health Department located in the Barnstable Town Hall . The tags shall then be attached to the filler pipe/cap of the underground tanks . Please return completed Registration cards to : Town of Barnstable Health Department, P. U. Box 534 , Hyannis , MA 02601 , as soon as possible . You are required -to comply with this regulation by March 22, 1989. If you have any questions , please telephone 508 (775-1120 , extension 182) Donna Miorandi or myself during office hours . Office hours are Monday through Friday from 8 : 30-9 : 30 a.m . and 12 : 45-2 : 00 p.m . . V��ry Truly Your , czst 0, Wk Thomas A. McKean Director of Public Health