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Home My WebLink About0445 WEST MAIN STREET - HAZMAT q ' r °F1Me r°k ' Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 BARMA�BLE. ' 200 Main Street• Hyannis, MA 02601 "rFOM 0',O� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: d t Date: 7 Location/Mailing Address: u2 m 'A Contact Name/Phone: O Inventory Total Amount: SDS: On I License#: Tier II : Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers:Te-S Storage Areas;/Tanks- Emergency/Containment Equipment: ` Waste Generator ID: Waste Produ : 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) indshield wash Motor oils Miscellaneous Corrosives�o 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 f r engines&garages Pesticides: Caulk/Grout� t 1000 insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) stproofers Photochemicals(Developer) Car wash detergents Printing ink qwaxes and polishes Wood preservatives(creosote) Paints, halt&roofing tar Swimming pool chlorine varnishes, stains, dyes Lye or caustic soda quer thinners V Miscellaneous Combustible nt&varnish removers, deglossers Leather dyes cellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) 7 Uo (including bleach) Any other products with "poison labels" aco.'9 rat t✓ (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------- ------------------------ -- -------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 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 s, Town of Barnstable Inspectional Services BAR- STABLE �QS.511E hL_� -:. �usrne:=_.te+rE:r.:L.;onirt.wrurcr Public Health DivisionNus 9snxx s- Thomas McKean, Director c � 200 Main Street, Hyannis,MA 02601y Office: 508-862-4644 : Fax: 508-790-6304 �w. APPLICATION FOR PERMIT TO STORE AND/OR U11LIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: - $125.00 ❑. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0 VS11- C41 *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?X . YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPL CATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QU TITIEtS, ((225 G LONS)? YES ,NO. 4. FULL NAME OF APPLICANT D G/ 5. NAME OF ESTABLISHMENT: LA 6. ADDRESS OF ESTABLISHMENT: ' 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF STABLISHMENT: 9. EMAIL ADDRESS: I�Cd 10. SOLEOWNER: YES kNO IF NO,4ME OF PARTNER: Alv -z-t 11. FULL NAME,HOME ADD SS, EL PHONE#OF: CORPORATION NAME G. PRESIDENT 10 Alw,) m TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL:_ • SIGNATURE OF A PPLIC T DATE Q:\Application Forms\Haz Mat App Rev sed 09-10- . o Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis, MA Is Hereby Granted a License . For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 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 I IowtA of Bynsxable eg atory ervices Richard V. Scah, Director Public Health Division BARNSTABLE = ��ABY. ' Thomas McKean, Director 'Rw 0Ma o-WWWRWVLE Mnas — -- — -- -- —i639 10 -- —— -- ArED�a 2 00v an—S treet,Hyan-- s-,1VA"02G 01- 30�— ---- --' —— — Office: 508-862-4644 D/ Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE c 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 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 9 V.S *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: 5. NAME OF ESTABLISHMENT: U 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �A) 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS}AND TELEPHONE#OF: CORPORATION NAME PRESIDENT �,75 TREASURER CLERK �L 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T DATE JS / Q:\Application Forms\HAZMAT APP 2017 b� r Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 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 TRowr of Unstable eg atoervlces Richard V. Scali,Director Public Health Division BABSTABLE us r r eartrusrw • xre;viur•coutr•"r++i •AMSfABLE. Thomas McKean, Director 16 9 20 4w""""ST&` ArF ,�e`� 200 Main Street,Hyannis,MA 02601 4..h Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). � APPLICATION FEES CATEGORY 1 PERMIT 26— i 10 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 9 Ups *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QU TITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: U �� U Z ' 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF STABLIS.HMENT: �56 77S-4/0 L 9. EMAIL ADDRESS: 1A 10. SOLEOWNER: YES NO IF NO,NAME OF TNER: 11. FULL NAME,HOME ADDRESS,AND TE PH NE#OF: CORPORATION N / PRESIDENT TREASURER �L�-[� /IAA_ ��- CLERK 7 12. IF PREPARED BY OUTSIDE PARTY: • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T �TE Q:\Application FormSUiAZMAT APP 201 °FIKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMs��E. • 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED MPS A Business Name: Clegf,-e,l 5op,014 Date: S 2Z t Location/Mailing Address: `I4 S S4r IM4,I A ( a,h,n►s Contact Name/Phone: a.-ecV e ,S"Og -'77S G 1 d 0 Inventory Total Amount: ev$Ck �ro MSDS: ��`�- 4ye�`�a�o�L License#: 13 b Tier II : N p ` Labeling: 4ec % Spill Plan: OK, Ko Oil/WaterSeparator: J�I�Ac Floor Drains: AD Emergency Numbers: . -le-y Storage Areas/Tanks: C i,% Sg&1 Emergency/Containment Equipm nt: Waste Generator ID: - �� Waste Product: IA Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: L Other Waste Disposal Methods: 5 a�f VIS4, �nG�ar .�'S w }a- to11e4 ,An. q,-4- �� er�'1�t-,0�-- LIST OF TOXIC AND HAZARDOUS MATERIALS �o Vkq.10� a,,. .g �� •�vc �k�t� i AAV 4►e S��•}�y 1��5� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws o MA, hazardous mat na use, l storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: oS `I D ('VS teal V ` INFORMATION/RECOMMENDATIONS: o ` Sv\C.S oC (�i?.C.o.n^ ,mvt� Inspecto� LQ1e— FacilitY Representative: resentative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health a s This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 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 Regulatory Services ti Richard V. Scali, Director ��AB Public Health Division BARNSTABLE 16gq w"nso"sews �nuEDws°ewnsnsF y A Thomas McKean, Director 16�� ° 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Ci? APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 3 0th). 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 Julyy 1st. ASSESSORS MAP AND PARCEL NO. DATE 7 FULL NAME OF APPLICANT: , NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: O`1✓/(� % ` SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADD S LEPH NE#OF: CORPORATION N O PRESIDENTA TREASURER CLERK e • IF PREPARED BY OUTSIDE PARTY: SIG Name: Company Address Telephone#: Email: I` Q:\Applicarion Forms\HAZZAPP Rev I6.docx Page 1 of 2 1 ` V �\ Number Fee vL 136 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., 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 q�� ` Town of Barnstable Regulatory Services Richard V. Scali, Director MASS. , ' Public Health Division 9qj i639. �FDMP'�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.0.0 I" $ , ogq,aa3 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 U U' NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PART �1Gtiu6b _B /ley C� t&&D IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: / PRESIDENT A/ajf ea ��/� - sue.�ye TREASURER CLERK I-Lt • S16KA F T RESTRICTIONS: HOME ADDRE HOME TELEPHONE# CAcache\Temporary Internet Fi1es\0LKD3\HA7-APP ReQ015.DOC `°FT ►ogti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMASS. .g 200 Main Street• Hyannis, MA 02601 039. �ArEOMP+�`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: w Date: Location/Mailing Address: Y e k MA,.-- aKYJ I S Contact Name/Phone: Laecya S'8 - 7-7 - &100 cto? Inventory Total Amount: 'kJ k-k 4�a�t;t-s MSDS: 041%v<v y,IODJ%.UJ License#: 13 b Tier II : �.yY� Labeling: Tt,�6%� Spill Plan: yAo\)Izz-ar4 Oil/Water Separator: �► Floor Drains: 0 a Emergency Numbers: 6W Storage Areas/Tanks: 4J i (-t ti - Av 1 a-C VS a j �cI%AA- Emergency/Containment Equigmen : o .e- Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: A\k)( V,— 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 7.Do Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers -F'I�F��omtcl-cats Hydraulic fluid (including brake fluid) Windshield wash dto�n s r5 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: K0 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" �V k20 vo 1, �; g� (including chloroform, formaldehyde, Z57`�(.k`1 X�; �Z'o hydrochloric acid, other acids) CNIX {{'I- 4V@ 16 3�'x -Loo A 30 lu,c >a 5Ak� g c VIOLATIONS:- Y-S: ORDERS: INFORMATION/RECOMMENDATIONS: v Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS nG r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 &1RMT,R. .A • 200 Main Street• Hyannis, MA 02601 �OrfDrnn+"�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C- 0,A1�,r �0 3 1 S Ao v Date: Location/Mailing Address: is. Contact Name/Phone: Lar�.� I.t'oodQ��t,roQ� wtar 5- $-775-6/00 Inventory Total Amount 3ofl a � �Qo {�� MSDS: o��(r-��P A��I License#: 135� Tier II : MIA Labeling: lrwV.1et,,Je-- Spill Plan: Oil/WaterSeparator: tilk Floor Drains: t3o Emergency Numbers: O� Storage Areas/Tanks: S,/QOIy AocX Emergency/Containment, E ui ment: < Waste Generator ID: A Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: �tn�► � 'I So .� .S�n�.Okt 16t,ty..40 S ,>A,/Itkge LIST OF TOXIC AND HAZARDOUS MATERIALS o �lc� o l c,�c.v�,LS ko \AVewAa� 5IvV-e-�a� �ng�i°( NOTE: Under the provisions of Ch. 111 Section 31 of the General Laws of MA hazardous milterial use t2I � 3 storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes' Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, degossers Leather dyes Miscellaneous Flammables Fertilizers �— Floor&furniture strippers t Pox'", PCB's Metal polishes U004-<3 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: p %5SJ4-5 e1, Inspector: U,�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: TOWN OF BARNSTABL S ,ate TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: CJoj+I-e,< S,� BUSINESS LOCATION: q 46� INVENTORY MAILING ADDRESS: -54Au— TOTAL AMOUNT- TELEPHONE NUMBER: . 6—N —-77,<-- 6 100 270 r JlOpt5 CONTACT PERSON: La oo <, EMERGENCY CONTACT TEL PHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: --�Iao rolo -5 yes INFORMATION / RECOMMEND IONS: TDistrict: v avx -re4t,'Y o v v5&ble, o� " et VI V1 15 Waste Transportation: A)1A Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) 10 Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel O Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) p Other cleaning solvents�'loo�t0e4.(,Cs Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials kj Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. 445 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------ ------------------------------ ---------------1_------------------ ------ --------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------- -------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------- ---------------------- WAYNE MILLER,M.D.,CHAIRMAN _PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town ®f Barnstable Barnstable 'THE Regulatory Services Department N-AmaicaGrly • Public Health Division ] RA"SrASM 9$ 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Ceder,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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C/o it�+ ,1� �a. NAME OF ESTABLISHMENT /� ADDRESS OF ESTABLISHMENT f1�� I,C1 • TELEPHONE NUMBER — �D SOLE OWNER: YES :� IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS ( F ALLY PARTNERS CW x , .O' IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. - j 7 STATE OF INCORPORATION / �✓ M FULL NAME AND O ADD SS OF: 1/ PRESIDENT TREASURER od CLERK • F APPLIC RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Q:\Hazmat\Haz Mat Application2008.DOC •3 t 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. i For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page • QAflazmaftHaz Mat Application2008.DOC