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0001 SOUTH STREET - HAZMAT
so ai� -,-� . IY ,o ��` Number Fee 1291 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Anchor Inn ................................................................................................................................. I South Street, 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 :1 Town of Barnstable Inspectional Services BARNSTABLE Public Health Divisionz.K �, ur.srit.::t.• it s:.vo-i:. IE)9.711t. • • • l • BARrWABL&PAAM Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 1N 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 Ist—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑, CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 'c P 01 4 1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Cl ChV *A late charge of$10.00 will be assessed if Rayment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. -3 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 G LL/ONS)? YES NO. • 4. FULL NAME OF APPLICANT: /971�MS d C�� �/r(/ Opt 4 '• — I D�� 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 2 c� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 90 T 777` 0J S_/ 9. EMAIL ADDRESS: t7x-f X AVC46 itj om 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD, SS,AND TY QLEPHONE#O CORPORATION NAME M-s l 0 JAy,- • 60�'8✓ PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 1012-��D� Q:Wpplication Forms\Haz Mat App Revised 09-l0 . ocx i • • Number Fee 1291 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Anchor Inn I South Street, 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 of Bnsxable /� , oleo& loengatoryVervjces of t"e Richard V. Scah, Director " Public Health Division BARNS LE CAB Thomas McKeanALAS& , Director 1639_20,4 --200 Main Street,--Hyann s;lVlA-02601---- - - _,-_-- --75- --- -.-- - -- - Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 V,S. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 34�'-J(Vb l J 2. IS THIS A PERMIT RENEWAL?_ZYES_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 HOUSEHOL UANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: /S�4yC Gv��s2vZG�r501771U 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: `7-)5, 9. EMAIL ADDRESS: - 11 Ir-D q,,41VC4-�O1L41114 CO& 10. SOLEOWNER: YES (�O IF NO,NAME OF PARTNER:6�4, 'S- ilj,- M AJ 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: } SIGNATURE OF APPLIC DATE Q:Application Forms\HAZMAT APP 2017 VISE c Number Fee 1291 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Anchor Inn I South Street, Hyannis, HA 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.GUAD_AGNOLI_,_M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health ' Town of Barnstable �ME Inspectional Services BARNSTABLE �p TO Public Health Division 161071 'r'9 X 11 + BARMASS.LE, ' Thomas McKean, Director 9q'Ar16 �e.`0� 200 Main Street, Hyannis, MA 02601 t 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, ATE HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS 1<26 GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). �� APPLICATION FEES \ CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ 'jCATEGORY 2 PERMIT 111 —499 Gallons: $125.00 pir v6T— 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. 3,2 0�1/ J 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 HOUSEHOL UANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: / 5. NAME OF ESTABLISHMENT: t'FrJ / 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: � � 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5Z $'� ✓S / 9. EMAIL ADDRESS: W/&eA .11c - -01tiy, C-00-1 �"n 10. SOLEOWNER: YES " NO IF NO,NAME OF PARTNER:-5�` ��/�/� /��N 11. FULL NAME, HOME ADDRESS, AND TELEPHONE # OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PART NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: . *SIGNATURE OF APPLICA DATE Q:\Application Forms\Haz Mat App Revise 09-10 8. cx Number Fee 1291 THE COMMONWEALTH _OF MASSACHUSETTS $125.00 Town of Barnstable Board. of Health This is to Certify that Anchor Inn— - I South Street, 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 06/30/2018 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 17Aflz-f slo'4 Y r f owwl�, of B nstable p TR gulatory Services BIKE T Richard V. Scali,Director Public Health Division BARNSTABLEP v PPRRSI:.6lk••xiJ;tltLLG•CONR•HYnFRIS 4 d • , ?IFRS�.PS HCS•(51ciVILfE•tllSf P4:MSi4P1 • MAS& • Thomas McKean Director 1639-2014 M fo 39. e`� 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 �"� C Fax: 508-790-6304-o X APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 6 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 I V's b CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ pep *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`nl� / V& �- 5. NAME OF ESTABLISHMENT: L%f►�ZJ� 6. ADDRESS OF ESTABLISHMENT: 5�2k JO Ali,A S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: ��- 8. TELEPHONE NUMBER OF ESTABLISHMENT: -1757' 6,357 9. EMAIL ADDRESS: �iVf (/afl�(�17/�NreO�l 10. SOLEOWNER: YES t1NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: ` SIGNATURE OF APPLIC DATE �Application Forms\HAZMAT APP 2017 cx Q: .d1 Number Fee 1291 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Anchor Inn ` 1 South Street, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. ------------------------------ -- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 7 Town of Barnstable Regulatory Services Richard V. Scali, Director Public Health Division BARNSTABLE PCRNSRBtE•COlIERV[LLE•9Mf•MMWS$ s 16g9. ♦0 wuv+a nws.o�amu.wsr e.rxsr� '1J Thomas McKean,Director 139-2014 200 Main Street, Hyannis,MA 02601 v Office: 508-862-4644 /- Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 "1 rale, 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 PARCE O. / DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: 44 ADDRESS OF ESTABLISHMENT: ��✓ ��r -S MAILING ADDRESS(IF DIFFERENT): �i J TELEPHONE NUMBER OF ESTABLISHMENT: g 7 EMAIL ADDRESS:_g �- ^) �� - �'���, ® SOLE OWNER: YES V`NO IF NO,NAME OF PARTNER: � `J/ VAj FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER XjCLE IF PREPARED BY OUTSIDE PARTY: TU (O�F APPLICANT Name: Company Address Telephone#: Email: Q:1Application FormS\HAZZAPP Revl6.docx Page I oft TOWN OF BARNSTABLE BAR-W 917 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �'! �s er tip. ,; ��+. Address of Offender MV/MB Reg.# Village/State/Zip Business Name A �N c „ { e- pm, on 1 ` 20 1 > Business Address 00e- � y`�„ ^.✓-- �` Signature o`f�Enforcing Officer Village/State/Zip f� �/4 0►l t; . >r ) '/)/ Location of Offense ✓l �rs{ Enforcing Dept/Division Offense ( `}' •t, , a r (l` - ftf 401 � Facts 11A- 1,,e Ae't1;4- E' ua� llta�,rvL This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR—W cz17 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip Business Name 'l . Lj J 1 +' am/pm, on 20 t1- Business Address r .,,r '" 41, - Signature of Enforcing Officer Village/State/Zip {t ., i j -!. Location of Offense Enforcing Dept/Division Offense l#r., r �.y�^ �. a• . (t h e- — . Facts �y yrf.w- � ' 3�F 'J �+ �, .✓� ) � 'r. r .a r This will serve only as a warning. At thus 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-ORDJREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. NAME OF OFFENDER BAR 78727 �J't°O ,✓ 5'r vW TOWN OF ADDRESS OF OFFENDER ✓lam �- o BARNSTABLE CITY,STATE,ZIP COD 1 / plF yKE IQ MV/MDAEGISTRATfbN NUMBER OFFENSE • ld��'i NAN\STARIE. .639., o v�, �, t, �,-�'e� ,, K s o y9. � TIME D DATE OF VIOLAT LOCATIO OF VIOLATION LU Z NOTICE OF o ( •M M.)ON / 21 .20 H e �l SIGN UBE NFOR I ON ENFORCING D�/ BADGE NO. CD 0 OF TOWN I HEREBY ACKN L DGE RECEIPT CITATION XLU ORDINANCE 'Unable to obtain Si atur often er. THE ONCRIMINA INE FOR THIS OFFENSE IS S 7� Date mailed ( 'd w OR YOU HAVE THE FOLLOWI ALTER A IVES WITH REG D TO DISPOSI ON OF THIS M ER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL d DISPOSITION WITH NO RESULTING CRI NAL RECORD. to REGULATION (1)You may elect to pay the above fine,a er by appearing in person bet. 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LLJ before:The Barnstable Clerk,200 Main Stre Hyannis,MA 02601,or ailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-0NE(2 FTHIS NOTICE. d R(2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREEETT 9ARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 2/days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF Of FENDER _ BAR 78727 TOWN OF ADDRESS OF OFFENDER Vt �r ^ � � BARNSTABLE � D CITY,STATE,ZIP CODE dI IH6►qf, MV/ E(RR/EGISTRA ON NUMBER OFFENSE ` t - J y f `� .�jI f I1Afl1 679•A Se1.E. ' , 1 fit ►IJ b i�,, �C',I� �P.�.. "t?..! W .r..L��1 �i�f� � i� _ 41�ao1"a a \eg Vl 1- O TIME JD DATE OF VIOLA�A, LO OF VIOLATION i Z LU NOTICE OF (A. /P.M N f 1 41 20 bo ,11A4 r ,f-- SIGN TUR NFO ON FO CI G D PT. / BADGE NO. C VIOLATION .. L L�--- P 1 . OF TOWN I H,ERERY ACKN;f6A'I- D E CEIPT OF�CI T X a ORDINANCE � Unable to obtain signatu of offender,. ' ~ HE�bNCRIMINAL FINE FOR THIS OFFENSE IS i '',1,o o W Date mailed )f �' u, OR YOU HAVE THE FOLLOWIdG ALTE NATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINA RECORD. LU REGULATION 1 you ma eCD lect to a the above fine,either b earin inperson twain 0 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, Q ( 1 Y pay X.an 9 9 Y 9 Y 9 Y P w before:The Barnstable Clerk 200 Main Street,Hyannis,M„026A.1;of�y mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE.OFTHIS NOTICE. a WIf you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST U NSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or N you fall to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OFFENDER DDAD 78727 : pn TOWN OF ADDRESS OF OFFENDER BARNSTABLE CITY,STATE,ZIP COD YVI v pf(HE►qr, MVI GISTRATION NUMBER HAN ASRT Ik:. f J NsIA OFFENSE 8 tb e. rC� ;z 9 ,/a: o ►ED 5 MFt 0�C j/ Ae4 `1 r 0 . LLI f ., 14.)1 V-f J 1)! e-eg oje, . I > TIME AND DATE OF VIOLAT LOCATIO VIOLATION W NOTICE OF Q ,� ,"(A.�/ P.M.) N {t t f 2 ,y . 1ti SIGN URE f-0RC G- i ON ENFO CIS / 1,, BADGE NO. UJI VIOLATION OF TOWN ~ I HEREBY ACKNOW DGE R CEIPT OF CI ION X a ORDINANCE Unable to obtain si nature a- ll,, -ry�,�' Date mailed ! 11? 1 ! THE CRIMINAL FINE FOR THIS OFFENSE IS S JJ J d 4 w OR YOU HAVE THE FOLLOWIN6 ALTEAATIV ITH REGARD TO D ITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL w Cn REGULATION 1 You ma elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holida s excepted, Q O Y pay Y nn 9 P Y 9 Y• 9 Y P w i before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, J Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL (2)If you desire to contest this matter in a noncriminal proceeding,yyou ma,do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OFFENDER BAR 7 8 7 2 6 TOWN OF ADDRESS OF OFFENDER or v'r.t. I. �',r�/l tL BARNSTABLE CITY,STATE,ZIP CODE pIF IN> MV/M EGISTAATION NUMBER OFFENSE `• ItAN\STARI.F.. t \\ F� Muss. S to i. c t3vt. L' d) t�f ' ?.. `>•N " f"C`6,4k 14 f '�Y+c't 12 i�r a ECM►+ fi13t�1+15 �T G y^, �+at� vv(�Y , �•.V r� t� tiL�f �d_ t�� 1Lz /Ct')��1P > TIME ANODATE OF VIOLATI 4 'MC)If OF VIOLATI W NOTICE OF 11 oo (A.W .4.)ON i 1 ,20 ) SIGNATURE OF EN C1NG - / E ING DEPT. BADGE NO. W VIOLATION , e w /. '�, CD OF TOWN o �H REBY ACKNOWL G RECEIPT I TI / a ORDINANCE „Unable to obAtund . �TF�E"NONCRIMINAL FI E FOR THIS OFFENSE IS i ©c�Date mailedWOR YOU HAVE THE FOLWITH REGARD TO-0ISPOSITION OF THIS MATT .EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH RECORD-� W REGULATION 1 You may elect to a the above One,either earin in arson between 8: M.and 4:0oMonda through Friday,legal holidays excepted, Q () Y pay P 9 Y 9 P W before:The Barnstable Clerk,200 Main Street,H nm , 1 orb eck,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21 YBAYS OF THE DA OTICE. d 2 If you desire to contest this matter in a noncriminal Drocee mg you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RRNSTABLE DIVISION,COURT COMPOUND,MAIN STRE 9 yARNSYABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature s s .NAME OF OFFENDER BAR77 TOWN OF ADDRESS OF OFFENDER + o e_tit BARNSTABLE CITY.STATE,ZIP CODE 4 ` 1!# s �t11E iq,- MVI MR REGISTflATItlN NUMBER OFFENSEt rn : ) NAX\Il'AXII:, a /•+ ', r .s'b Ike uAss. �. L'� � v t3✓�. f;` t r '.i. --..�" -Car.'"w°„ 9.��? - `•f a^-�+.J <'`t' Fy^. :. ,.:' a [O MIKt r'� t 0.`,J. r '1 P C4 7 7.I! tf.)✓ .. .� ']..F?C 1 a°t :-,,� .e)� .T 1.- S./F':,� ,,'r � (`4 !� W Ct r 4 /S{' v i f TIME ANY PATE OF VIOLATION. p,g r LOCATION OF VIOLATI 2.I NOTICE OF �.,4 acti A.M P. .)ON f� J l ;, ;��I 9 `' �w j��a�� � �{ SIGNATURE OF EIFORCI rEl N �F �� ENFORCIN DEPT. BADGE NO. y VIOLATION �,,. ,�` �,,, �r e144 �� o OF 70WNfk HEREBY ACKNOWr` RECIEIPT T\k N • CL ORDINANCE Unable to obtain Big tur of`tee offender. "' d � THE NO,NCRIMI INE FOR THIS OFFENSE IS i ,• cr a� �'I j Date mailed / w! OR YOU HAVE THE FOLLOWIN ALTE VES WITH REGARD TO DISPOSITION OF ER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO.RESULTING C AL RECORD:- W,'i REGULATION (1)you may elect to pay the above tine,ei rin i etw 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before:The Barnstable Clerk,200 Main Stree, annis, 02601,or ailing a check,money order or postal note to Barnstable Clerk,P.o Box 2430, _t Hyannis,MA 02601,WITHIN TWENTY-0NE(21) &8 F THIS NOTICE. d �2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST i ARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET BARNSTABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature TO OFFENDER: Failure to obey this notice within 21 days Place after the date of violation may result in a Stamp criminal complaint being issued. DO NOT Here MAIL CASH. Post Office will not deliver without-stamp i MAIL TO: BARNSTABLE CLERK P.O. BOX 2430 HYANNIS, MA' 02601-2430 M . Er CO . OFFICIAL Us �� S CO Postage $ ru Certified Fee C Postmark O Return Receipt Fee Here Q (Endorsement Required) C3 Restricted Delivery Fee t3 (Endorsement Required) r-q 0 Total Postage&Fees $ rq Sent To Sheet,Apt-No IJt L / or PO Box No. crry,crate,ztP+4 OG�(Ob/ jj A15 :1 Certified Mail Provides: ■ A mailing receipt a A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: m Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. o Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery'. n If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for,postmarking. If a postmark on,the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 KI owl 4 Town of Barnstable a Health Division 200 Main Street Hyannis,MA 02601 ,F 7012 1010 0000 2847 8193 Anchor-In Hotel Attn: George Simpson One South Street Hyannis, MA 02601 1 i� SENDER: COMPLETE GOMPLETE THIS,5ECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delive■ Attach this card to the back of the mailpiece, ry or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No n 17 c SIMP(56-0 on I 3. Service Type Certified Mail® ❑Priority Mail Express" ❑Registered Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. 7012 1010 0000 2847 8193 i PS Form 3811,July 2013 Domestic Return Receipt i NAME OF OFFENDER 6r ,9 BAR R 78727 ,.. - TOWN OF ADDRESS OF OFFENDER 9 +^ BARNSTABLE CITY,STATE,ZIP COD 14 y�r Al A d,ISE 1 I MV/MBrREGISTFIATION NUMBER OFFENSE • HAN\�l'API.L:. I�639. lA. � �Q� �""J)., �f•,>!/.^' ���� � �����l '��? �. '��h �f .+°` Lii MASS S F bh. '� �'� i� - 4.++ � Q 'f' 'S✓• f �,!' � &1 t� dy` �1 '� ���+rt7 a to tAnr►�� ! p E C J Vf G Mr'ag >11 TIME AND DATE OF VIOLATION ° LOCATIf0��,.OF VIOLATION r,.�-• W ; NOTICE OF fA,° ,, I,IA.M)/.P.M.)ON t / * f 20 'f r A. A., K SIGN TUBE, �NFORCI,G SONdf ENFORCI D PT. ` BADGE NO. W VIOLATION ..��"'` t ,. x '���? ;{7a.= "' I' o I' OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION XLU ORDINANCE .ET Unable to obtain signature of offender. 57-� < Date mailed f► rid t'_; THE NONCRIMINAL FINE FOR THIS OFFENSE IS S f r e>0 W OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL Cl- DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W Cn REGULATION 1 You may elect to a the above fine,either b appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, LU Q before:The Barnstable Clerk,200 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS TABLE,MA 02630,Attn:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the t hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature y I TO OFFENDER: Failure to obey this notice within 21 days Place after the date of violation may result in a Stamp criminal complaint being issued. DO NOT Here } MAIL CASH. Post Office lwill not deliver i without stamp I i I i I 1 I; I �I MAIL TO: i BARNSTABLE CLERK P.O. BOX 2430 HYANNIS, NIA 02601-2430 i HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 RICHARD R. FARRENKOPF Cyr BUSINESS: 775-1300 S CHIEF wope Oetectvzd Save .eived EMERGENCY: 775-2323 DATE �— I�►��g TO x c n 1 5ot�h 1'4ydrtnlb m� Gzt.DO� In accordance with 527CMR 9 .21 1 b( ) (below] the following tank (s) ; Vo•,� Located at `�ovac�t ` Mtn <<awl, yTacP ��nde� a \obb.t Have been approved to be abandoned in place. The tank (s) have been properly cleaned by ; LCr2 "Tack $yv1ct5-7tmc y� _ 381 c.1d �a1,n+ou�h�cl Y�c�vng tllg YYI� VZl9� and have been filled with an approved inert material of; r'1Q��n `aanc� Each step in the process has been inspected and was found to be in compliance with the code. �.�. ��a�l-• 1�1se.\any..` �K����.,-�-Io.� 6����c For; Richard R. Farrenkopf , Chief Hyannis Fire Department CC. Town of Barnstable Board of Health t Q2 'Talc 5xrutcag 3$t oto 'V;;;A ��l, ledmdC Y►Gjml��j 527CMR 9 . 21 (l) if the owner decides to abandon a lank which is either located under a building and. cannot be removed from the ground without first removing the building or which is so located that it caiulot be removed from the ground without endangering the structural integrity of another tank, the owner shall promptly notify the head of the local fire department of this condition. After verification that such condition so exists, the owner shall have all product removed from the tank, by hand pump if necessary, tinder the direction of the head of the fire department, and shall have the tank filled with a concrete slurry mix or any other inert material approved by the Marshal for this purpose. 1 HYANNIS FIRE DEPARTMENT 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 RICHARD R. FARRENKOPF S` ohe Oeteamm Save .eived BUSINESS: 775-1300 CHIEF FIRE PREVENTION INSPECTION REPORT EMERGENCY: 775-2323 PROPERTY OCCUPIED BY: if1C�1c��. r,yy PHONE:�)9S-Q-SS'7 LOCATION : Ivti h 151 - BUSINESS OWNER : Fg E 'PF,,i +(� �ng PHONE:�1Z�3 (� BUILDING OWNER : „ % ti PHONE: TYPE OF BUILDING CONSTRUCTION 5arn� HEATING SYSTEM : !�dr SPRINKLER SYSTEM YES TYPE: PSI : / F.D. CONNECTION LOCATION SHUT-OFF: SERVICE CO PHONE FIRE ALARM SYSTEM ES NO PANEL LOCATION: SERVICE CO : E PHONE :LM?-,,r U6 AUTO/SUPPRESSION SYST M YES 0 LAST INSP. : SERVICE CO PHONE FLAMABLE STORAGE YES 0 KEY BOX YES 0 LOCATION: POWER c-z � 1rQ sc ICY4- 1z HYDRANTS 1) (2) (3) SPECIAL HAZARDS VIOLATIONS CORRECTION DATE FIRE DEPT. IN Tol (I . \ DATE: Z- 3' 65 OCCUPANT 1jf1 PHONE: EMERGENCY .PHON NUMB S �7)- o Z S5 1 PHONE: 77 - 29 LY 2 PHONE: 77i- 03�.2, ----- - 3 PHONE: 1 k'Ui:lf f. !'. U. 4Un-2-U9-9a0003 - -__ 041 TautututuuettiO of filaaaadjuatts DEPARTMENT OF PUBLIC SAFETY — DIVISION OF FIRE PREVENTION 1010 COMMONWEALTH AVENUE, BOSTON 1939 (Dale) APPLICATION '-FOR PERMIT To: HEAD OF FIRE DEPARTMENT Hc. 5nn15 City or Town In accordance with the provisions of Chapter 148, G.L. as provided in Sec.5--,-, cM 2 �I application is hereby made for permission to 111 Qn &hi�lnd0necl I ,00y q��llpn Z�UeI O(� State clearly c)nd r-dvnd iQnL tof+h- �d �t�J►ded ICE rank purpose for ks n U r� )a LA Jh l C h C,(p5 2 4z y) which permit _L�C)is+ be `P,I('ed S,.c)H-h 0 Or) f P-}P_ 51(.)( f`�l()G is requested Res-trictivri5: - at _ &n Gh Oc- Inn at (Give location by street cmd no., or describe in such a manner as to provide adequate identilloatiou of locotioo) Date issued---rej n I 19Fq By (Signature of ic�rt Date of expiration J a Y-1 -2 5 19 H Fee $ 10 (Paid l)ue iTlip Tilutmiume tO of Mttuuttr! ttsa u DEPARTMENT OF PUBLIC SAFETY — DIVISION OF FIRE PREVEN TION 1010. COMMONWEALTH AVENUE, BOSTON HwDnni, I/ 1819FR (City or Town) (Date) PERMIT In accordance with the provisions of Chapter 148, G.L, as provided it, 5 ZI-1 CIS P- q this permit is granted to Name --LC P' I a n Ic.. 5)e rU I ez-5 (Full name of person,firm or corporation granted permit) to_ �r ll art alOarnci()ned ( 100o State clearly u)rt-h San d . Qr-n Li)dam.d 5 a t d -}-a n� I- purpose for - _ which permit s-4ruc+v r a( ° u o r-t n r�h t h c�s� n Ic. is granted �� e I e . (3 r+h n Ue--� -,5+U M i Restrictions: at _-- anchor 1 nn ! Sn()+h � Puann 15 (Give location by street and no., or describe in such mane r as to provide adequate identification of location) Fee Paid $ 10 _ �C art t,l-(2' S a� ZS (Slgnatu of official granting permit) This permit will expire 19�� L-P U -\,La(T+)nn C1 rIL (Title) of i88M� SP S DEPARTMENT OF PUBLIC SAFETY—DIVISION OF FIRE PREVENTION PERMIT 2 V- 19�� Date TO MAINTAIN AN EXISTING/NEW UNDERGROUND STORAGE FACILITY r £ In accordance with the provisions of 527CMR9.24 this permit to maintain an existing/new underground storage facility is granted to: Location of property: Street address Owner of property ��7►' �a�f f��l' Full name of person, firm or corporation n Restrictions: _ Doo 1 412. O O /ea;z Fee Paid:$/Qo (M.G.L.A. Chapt. 148 Sec. 1 A) Form F.P. 290 Part a This permit will expire 19 Date Sig et r of Head o F' a Dept. or appol ed ignee (Owner's Copy to .be posted at the storage facility with F.P.290 Part 3) hM ' 1 Notification for Underground Storage Tanks eis`e K7:. r:T a4 <uK P ""€' :) 79 G;FIRE DEPT. FIRE DEPT. 'STATE USE ONLY CERTIFICATION I.D.Number Copy to be*certified by local fire department and: . POSTED AT• STORAGE FAC I L I TY ( Date Received dENERAL INFORMATION Notification is required by Federal law for all underground tanks that have been 1., A. pipeline facilities(including gathering lines) regulated under the Natural (has used to store regulated substances since January 1,1974,that are in the ground as of ! `,Pipeline SafetyAct of 1968,or the Hazardous Liquid Pipeline Safcq Act of 1979.or May 8,1986,or that are brought into rise after May 9,1986.The information requested which is an intrastate pipeline facility regulated under State laws: is required by Section 9002 of the Resource Conservation and Recovery Act,(RCRA), ! 5.surface impoundments.pits,ponds,or lagoons: as amended. " 6.storm'water or waste water collection sNstems: The primary purpose of this notification program is to locate and evaluate under- 7,flow-through process tanks: s It is •• 8.Iiquidtrapsorassociatedgatheringlinesdirecth related to oil orgasproductionand ground tanks that store or have stored petroleum or hazardous substance expected that the information you provide will be based on reasonably available :", 4 g"thering operations: records,or,in the absence of such records,your knowledge,belief,or recollection. 9. storage tanks situated in an underground area (such as a basement. cellar. mineworking.drift,shaft•or tunnel)if the storage tank is situated upon or above the Who Must Notify?'Section 9002 of RCRA,as amended, requires that, unless surface of the floor. exempted,owners of underground tanks that store regulated substances must notify designated State or local agencies of the existence of their tanks.Owner means— What Substances Are Covered? The notification requirements apply to under- (a) in the case of an underground storage tank in use on November 8, 1984.or i ground storage tanks that contain regulated substances.This includes any substance brought into use after that date,any person who owns an underground storage tank ..defined as hazardous in'section 101 (14) of the Comprehensive Emironmental used for the storage,use.or dispensing of regulated substances,and I Response,Compensation and Liability Act of 1980(C'ERCI.A),with the exception of (b) in the case of any underground storage tank in use before November 8, 1984W those substances regulated as hazardous wasic under Subtitle C of RCRA. It also but no longer in.use on that date.any person who owned such tank immediately before includes petroleum.e.g..crude oil or any fraction thereof which is liquid at standard the discontinuation of its use. conditions of temperature and pressure(60 degrees Fahrenheit and 14.7 pounds per What Tanks Are Included? Underground storage tank is defined as any one or square inch absolute). combination of tanks that(1)is used to contain an accumulation of"regulated sub- Where To Notify? Completed notification forms should be sent to the address stances."and(2)whose volume(including connected underground piping)is lVi or i .given at the top of this page. more beneath the ground.Some examples are underground tanks storing:►.gasoline. used oil,or diesel fuel.and 2.industrial solvents.pesticides,herbicides or fumigants. When To Notify? 1.Owners of underground storage tanks in use or that have been taken out of operation after.lanuary 1. 1974.but still in the ground,must notify by What Tanks Are Excluded? Tanks removed from the ground are not subject to Mav 8.1986.2.Owners who bring underground storage tanks into use after May I3. notification.Other tanks excluded I'rom notification are: .:'198G.must notify within 30 days of bringing the tanks into use. 1.farm or residential tanks of 1.100 gallons or less capacity used for storing motor fuel for noncommercial purposes: Penalties: Any owner who knowingly fails to notify or submits false information 2.tanks used for storing heating oil for consumptive use on the premises w hcrestorcd; ,shall be subject to a civil penally not to exceed$10,000 for each tank for which 3.septic tanks: notification is not given or for which false information is submitted. INSTRUCTIONS Please type or print in ink all items except"signature"in Section V.This form must by completed for, f i: Indicate number of each location containing underground storage tanks.If more than 5 tanks are owned at this location.,' ' i continuation sheets photocopy the reverse side,and staple continuation sheets to this form. ? i attached 1.OWNERSHIP OF • • OF Owner Name(Corp ``Li__on,Individual,Public Agency,or Other Entity) _ i tt.(Ii same as Section 1,mark box here❑) �( Y Ar,-&22` i Facility Name or Company Site Identifier,as applicable Street Address zv Co y I Str t Add r sg or Sta�Joad,as applicable e;,0 I; 5 l Of State 0,0 ZIPC. ode Can 1 / .° Area Code i Phone Number t i .• City(nearest) State ZIP Code firm 42-T -%5.33 3 ' • �� Type ofOwner)(Mar*all that apply®) I Current ❑ State or Local Gov't i Private or Indicate Mark box here if tank(s) Corporate number of are located on land within ❑ ❑ Former I ❑ Federal Gov't ? ❑ Ownership tanks at this an Indian reservation or f t (GSA facility I.D.no. uncertain location I ; on other Indian trust lands CONTACT •N AT TANK LOCATION 14Name(If same as Section I, ark box here ❑) i ; .=•.: .M Job Title l Area Code Phone Number ' 6n 7715--o4f IV.TYPE OF NOTIFICATION i ❑ Mark box here only if this is an amended or subsequent notification for this location. CERTIFICATIONV. I certify under penalty of law 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. 5 k:. .T,i , ;•r.,, .'r Name and official title of owner or owner's authorized representative{ Sig at r DatSigned+�� eft /itl�74 CONTINUE ON REVERSE SIDE Form F.P. 290 Part 3 Pagel �" " t k -.`s �'"�+� " � r �: c ��1i Ft•.�-';; r ,,';--� v ,�t;..,�•ht€N\:� -.s+'1�� ,.�,t ° ;�l Owner Name(from Section 1) Location(from Section 11)'.' Page No. of Pages V1.DESCRfPTION OF UNDERGROUND STORAGE TANKS(Complete foreach tank at this location.) Tank Identification No.(e.g.,ABC-123),or ' Y Tank No. Tank No..; ,Tank No. Tank No. Tank No. Arbitrarily Assigned Sequential Number(e.g.,1,2,3...) 1.Status of Tank :3'; s Currently in (Mark all that apply®) Use Temporarily Out of Use [Q t,, ,,x,L�,.;. Q • Q C] Permanently Out of Use Brought into Use after 5/8/86. 2.Estimated Age(Years) p 3.Estimated Total Capacity(Gallons) N p 4.Material of Construction(Mar Steel E] Q LQ Q Q ts one®) . Concrete Fiberglass Reinforced Plastic Unknown ` Other,Please Specify S.Internal Protection(Mark all that apply®) Cathodic Protection Interior Lining(e.g.,epoxy resins) Q Q Q Q Q { None Unknown ® Q Q Q Other,Please Specify 6.External Protection Cathodic Protection (Marts all that apply®) ' Painted(e.g.,asphaltic) ' Fiberglass Reinforced Plastic Coated ' None Q _' Q +' " .Q 0 0 1 x f l Unknown a :* - - � , - i t ♦ E.r;lam '.g,V'R .GM��. k�i. +1 - - - .1 + n. Other,Please Specify 7.Piping , r : , Bare Steel (Mark all that apply®) .. . Galvanized Steel", �\[:W-] Fiberglass Reinforced Plastic Q Q Q Q Q CathodicalryProtected' •Q Q] Q Q `„C�; Unknown Q Q Q Q Q Other,Please Specify " 8.Substance Currently or Last Stored a. Empty ` In Greatest Quantity by Volume `.�= ; C� - • Q Q Q (Mark al/that apply®). b. Petroleum I ~ Diesel Kerosene Gasoline(including alcohol blends) Used Oil Other,Please Specify ' c. Hazardous Substance Please Indicate Name of Principal CERCLA SubstanceOR :=—T— ti - r., ..,yam. T•-.-. - ., Chemical Abstract Service(CAS)No. " Mark box IN if tank stores a mixture of substances �{ d. Unknown », 9.Additional Information(for tanks permanently r, ; , 1;'1w, ;..,•p,;,, ,�i:., ., , taken out of service) , -• , a. Estimated date last used(mo/yr) fie'/ b. Estimated quantity of substance remaining(gal.) �' c. Mark box®if-tank was filled with inerfmatarial r �' s; .`;; (e.g.,sand,concrete) _) •<) C] Page 2 F TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. BOARD OF HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY id— (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 4-'. Class: 7.Miscellaneous QUANTITIES ANDS ORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: Mkt. Zoe- r Q DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply "I, Town Sewer IS Public /O On-site OPrivate 3. Indoor Floor Drains YES-Y—NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. 7rers.o (s) Interviewed —�� Inspector'o Date .. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:_ 2 -�� �0 Board of Health MAILING ADDRESS: 5001% ST 2V_ // Town of Barnstable TELEPHONE NUMBER: 7 -5-- 63577 P.O. Box 534 CONTACT PERSON: m - Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO K This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS �^ The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered v Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business