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0365 WEST MAIN STREET - HAZMAT
'e 7 °F THE T°k� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 7isnnMASS. $ 200 Main Street• Hyannis, MA 02601 ,e,q a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MPy Business Name: tr C. Date: Ar� Location/Mailing Address: 10157 i Contact Name/Phone: Inventory Total Amount: MSDS: � License#: Tier II : No Labeling: eS Spill Plan: _ Oil/WaterSeparator: Floor Drains: O Emergency Numbers: _ Storage Areas/7anks: ` — Emergency/Containment Equipment: i Waste Generator ID: Waste Product: t/ 01 ti Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: S Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) ° Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar �Swimming pool chlorine Paints, varnishes, stains, dyes `ye 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: INFOR ATION/RECO MENDATIONS: CeCOMAWAW fh?, Inspector: Facility Representative: �t's WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °F� ►oy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MA.fq LE. • 200 Main Street• Hyannis, MA 02601 plFDMP��`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: OU_Aie, � Co. Date: 7FI Q� Location/Mailing Address: k t! in S� Contact Name/Phone: SD t -775 -'NI 4 Inventory Total Amount: --300 SIDS: AP-5 online, License#: �l y Tier II : Labeling: 1 Spill Plan: Oil/WaterSeparator: Floor Drains: NO Emergency Numbers: Storage Areas/Tanks: icei Emerc iency/Containment Equipment: tl 1144-K I ckbSDI` Waste Generator ID: Waste Product: Vf as O$' Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: WUt 0;I fP er. Cup, 66 ) S, Gyfn LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners VDiesel 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 V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: P Cdl' A Wa `JA Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `�.IKE To - Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMASS. 200 Main Street• Hyannis, MA 02601 1619. �prEDMn+e�m TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Ayt r(ltoe 90 6 0S,Y-d- 0-0• Date: Location/Mailing Address: 36S rt).es+ ,MAi, S+,;_�ycrtn, 1 Contact Name/Phone: r16 wce Ko,pge w. 509> -7?,5,-3`f S14 �`'3 I Ily Inventory Total Amount: MSDS: 2 5 � n License#: � Tier II : N 0 Labeling: a w\110va Spill Plan: Ye 5 Oil/Water Separator: Floor Drains: Emergency Numbers: ��S Storage Areas/Tanks: VW ta.v4_V,5 , �.�� ow b,ke, Emer enc /Containment Equipment: 5v",--N\ Waste Generator ID: ce, i -4 aste Product: O t S o ( Lug Date&Amount of Last Shipm nt/Frequencx: o av� ��! z,o, Licensed Waste Hauler&Destination: '- y 0-q Other Waste Disposal Methods: JoLle 11 u t- tEv ,t-,w vs a. C., 8' LIST OF TOXIC AND HAZARDOUS MATERIALS No via- or cltia`�' - NOTE: Under the provisions of Ch. 111, Section 31, of the Lneral LavA of MA, hazardous material use, ` storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) 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: 6)Sul ,A S �'���&S ORDERS: a.�he.�s a cril v� �� �� V1-�-• INFORMATION/RECOM NDATIONS: Inspector: t [.�-2_- Facility Representative: CC WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN STREET, 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 - r Town of Barnstable Regulatory Services • `� Richard V. Scali,Director �r MAS& Public Health Division n,u 2 ` D Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 r Office: 508-862-4644 i_'y Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 2 q--0 q F DATE U. �4 S APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS �1� 1\kam 4 . YLO FULL NAME OF APPLICANT Anchor OL),-+b��l Co ; Inc. . NAME OF ESTABLISHMENT A echo' Co', ) yi c . ADDRESS OF ESTABLISHMENT VJ� S 4 Q� S he� , WA ALS 'v 4 TELEPHONE NUMBER " SOLE OWNER: /YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O 2g521 D�} STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: N� PRESIDENT W i I 2 �d NWI&jNW� TREAS R CLERK SIGNATURE OF APPLI ANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# 5OZ-3W-ZC6i(o Mmche\Temporary Intemet Files\OLKD3IHAZAPP Rev2015.D0C IKKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' B""MASS. . • 200 Main Street• Hyannis, MA 02601 �°rFOMn+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: AK dA of OA 4 C&, Date: Location/Mailing Address: A l w a H vii s Contact Name/Phone: _C_�Ko,oD.e= �a Inventory Total Amount: A-3� MSDS: I 2,5 License#: kIy, Tier II : 00 Labeling: a t&6\cowk4„u(s Spill Plan: e-4 Oil/WaterSeparator: N 4k Floor Drains: Emergency Numbers: ', 5 Storage Areas/Tanks: W oAI)r �'4,0ko-0-',0v6Ak1-2 Emergency/Containment Equipment: 6 5 A Xo1 A\ 5 Ao--aw,V6 I AOA -V-'sXe- n Waste Generator ID: Waste Product: n%` , 10zd(v4-> CP)�ec"t�o�dC y Date&Amount of Last Shi ment/Fre uenc 1 Licensed Waste Hauler&Destination: o t r tomqe. o t AD Other Waste Disposal Methods: G, �& 0,1 �Kv,�9 uk- 'of k LIST OF TOXIC AND HAZARDOUS MATERIALS 90 YA&. a�ah�,(. Ilot I Kvf-wAo.4y owLe..- las-J- m5 pe-4 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) 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"acciids) VIOLATIONS: ' v�C . ORDERS: o�r o INFORMATION/RECOMMENDATI NS: vt al Ky-<- C (Lac OmAe-0 t l �'Ca�s t oQa1L/ Qva�ct,� rz(,el r)Inspector: I ,��a��1le, No [o,nFy���< A %vv4—Cs, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: / 17 TOWN OF BARNSTABLE 75r ,o,,%— TOXIC AND HAZARDOUS MATERIALS REAWRAPIGN FORM NAME OF BUSINESS: 44C.61- rZC,�, —rim BUSINESS LOCATION: 3&5- ltJz t Ma►►,- S+ , !/A jYI)s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -5-00 - 775 3`fSz{- 1,3(8 9g(l�� CONTACT PERSON: CItAl Ko ),eK— EMERGENCY CONTACT T LEPH NE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ye 5 INFORMATION / RECOMMENDATIONS: '/OC6 � Fire District : 00-S►i� z/ y1/ S VVk -A w0.ake C"&%V-t.fS de.,.,.- U j kc45 AM -'�46, wkke- uo-- 4e �.a�.Jov5ke. t 10c-c-�� Cot�ec--I-eeJ 1�Co,w Waste Transportation: 0el� -4ra►tseor4 -l-o /gca.l Last shipment of hazardous waste: Name of Hauler: b,�s.,►cg�s�,r,s0ar,`I►,�,Few Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) a Pesticides y Refrigerants a1Dx%2- {3�-le 66 rj,,;Llo Motor Oils �//x��� M 01 NEW Q1, Li USED 10 (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) �2- lubricants, gear oil ,Ske k` ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine p Battery acid (electrolyte)/Batteries 31 k� Lye or caustic soda Rustproofers /�, Miscellaneous Combustible Zy2 tZ Car wash detergents l Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar y PCB's 1�{ Paints, varnishes, stains, dyes 1° Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes %Cvh,ka,klk Laundry soil &stain removers (including bleach) _ po� Okv-,- AJ Sv�^►, A- uiov40 Spot removers &cleaning fluids (dry cleaners) &�` W� Delh►,�'����► -�,o�, i0 Other cleaning solvents 10 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TL R 5. Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. ..------------------------------------------------------------------------------------------------------------------------------- 365 West Main 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 Y Town of Barnstable Inspectional Services BARNSTABLE • • M�iaMA MMus 0,7M -VIP can sm I Public Health Division 1639-2014 4. Thomas McKean, Director , 039. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 .Fax 508 790'6304 �:. yr.c. v,yi.•..i 1... : - .. .•r� t5 F � �� 3 \.,�'R. ' F ." '� APPLICATION'FOR PERMIT TO STORE AND%ORUTILIZE `G - HAZARDOUS MATERIALS Cr. 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 rV*rptCh CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 a O,;-+A *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: W1111am hjh d ' I 5. NAME OF ESTABLISHMENT: Aymr 6. ADDRESS OF ESTABLISHMENT: U} ` 4 S D Ztt o 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 66s' I r n` `l 5y 9. EMAIL ADDRESS: 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS AND TELEPHONE#OF: CORPORATIO N ME - n PRESIDENT % �G PTREAS R l CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS / EMAIL: SIGNATURE OF APPLICAN / DATE Q:Vlpplication FormsWaz Mat Appli Draft Jan20l9.docx Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN 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 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNSTABLE Public Health Division xsas 7nx< w:, " Thomas McKean, Director KAM •639. � Ar��p 200 Main Street,Hyannis, MA 02601 y. Office: 508-862-4644 Fax: 508-790=6304 �w APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 [l CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 j 1l,j i p Chk=W CATEGORY 3 PERMIT 500 or more Gallons: $150.00 CJ ` � OcJ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. A G q - o q? 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: W MI CIM A • k p p pai 5. NAME OF ESTABLISHMENT: knabo r Oti+boc rrl Co . i n t 6. ADDRESS OF ESTABLISHMENT: (.a 4 'Da�r'l #' t.9 Q_Y1j11 S NA ®V,()j 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 0Xi(--"ipr ouA-kjyctxr� (f i'itarak:. L 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Afibh Qu±bpatd PRESIDENT a l Q.. TREASURER w i11 . CLERK � _ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS _ EMAIL: -41 SIGNATURE OF APPLICANT DATE Q:1Application Forms\Haz Mat App Revised 09-10-18.docx r �L? Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN 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 � �towr� of Barnstable ?:?aoc /o?S K:Y# eg atory ervices Richard V. Scali, Director �t Public Health Division BARNSTABLE f • MNS"M-CEHf ALLE•CDTtM-WMIS BARNSPABM = Thomas McKean, Director ""�°�""�1° o;°`��""S""F --200 Main Street,Hyarinis�NL 02601--- ------—-- 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 I PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 x 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. O�,b 9 0 9f 2. IS THIS A PERMIT RENEWAL? V"'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 QUANNTITIES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: /�/ �p - 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: d OW17 gaLl'ais 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: V ) 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND ELEPHO #OF: CORPORATION AME PRESIDENT KAwfbd WIT TREAS R CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS 1 EMAIL: • SIGNATURE OF APPLICAN CU DATE Q:VWpplication FormsV AZMAT APP 2017 REVISED.docx Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN 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 OZJON'd LTAZ Ci4pr 1619 Town, of Unstable Regulatoervices Richard V. Scali,Director - of�►�r �� • �` 'o„ Public Health. Division BARNSTABLE Z WNSP�lE•iENIFAu1LLE-CMff-W-AS 0 BLAB . ' Thomas McKean,Director .ans•us F.es 1639¢`2034'S ea:,rtat 1639. 200 Main Street Hyannis,MA 02601 �g Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS l 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 ✓•S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? " YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: hchor- O(,f -boaj d bI 6 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: S WP,4 /I m o s t 1'M 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: C�mc �roQ�htl �0 Gl, ex��. Cf�ri� 10. SOLEOWNER: "S NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION NAME �r PRESIDENT 1RILk TREASURER M I(�o CLERK 12. IF PREPARED BY OUTS E PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application FormsViAZMAT APP 2017 REVISED. cx Yf Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN 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 Town of Barnstable ri �t Regulatory Services ti Richard V. Scali, Director B" MAS& Public Health Division BLS LE Thomas McKean, Director 16 �° 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508&0-6304 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 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 ❑. A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP.AND PARCEL NO. O 9 9 DATE G-Z /G FULL NAME OF APPLICANT: A////ajr7 eo a aj NAME OF ESTABLISHMENT: C'hOr 0�,UJ-fjpx In L ADDRESS OF ESTABLISHMENT: c��J� ,� p A/a hrl/1 d z"'nz MAILING ADDRESS(IF DIFFERENT): SaM_e-- TELEPHONE NUMBER OF ESTABLISHMENT: EMAILADDRESS: ��Gtrlck.or SOLE OWNER: ✓YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Anchor PRESIDENT j�2�� TREASURER L qj CLERK_ (�&gAk;� J 4 J&y A#! - q. IF PREPARED BY OUTSIDE PARTY: SIGN RE OF AP ICANT Name: Company Address : Telephone #: Email: - Q:\Application Fonms\HAZZAPP Rev16.docx Page 1 of 2 f c+� r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department eattlyrAes. '* Public Health Division MAss. Thomas A.McKean,CHO sbss ` 200 Main Street, Hyannis, MA 02601 Eb 1 Payment Receipt 'Hazardous Materials Payment received: $125.00 (Check) on 6/7/2016 Permit number: 1147 .Check number: 19184 Check amount: $125.00 Name on check: Anchor Outboard Company, Inc. 'Business: ANCHOR OUTBOARD CO., INC. Owner: RICHARD L ESTATE OF :Address: 365 WEST MAIN STREET, Hyannis d3 Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN STREET, HYANNIS,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING, 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------- - ---------------------------------------------------------------------------------------------------- --------------------------------- ------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 4/16/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health - Town of Barnstable -. Barnstable Regulatory Services Department ' �- Public Health Division 1 i � M ; i6M 200 Main Street, Hyannis MA 02601 2007 I Office: 508-862-4644 I Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.021A-Qq2 DATE i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT A// /// ko/ aal-) NAME OF ESTABLISHMENT Z(L Jhwr (1 (X6 I ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER U Z)?" 77-5- J 4454 SOLE OWNER: /YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.Qit-2,45Zi09 STATE OF INCORPORATION M� FULL NAME AND H_O ADDRESS OF: t � � /�0�� PRESIDENT `1 •. ,r) _ , � O ,'-k I� NIA l &qy TREAS R V� Ar V-i, -Zy U0� CLERK I �' ZSCjiM SIGNATURE OF APPLICANT 24 alx=p� RESTRICTIONS: HOME ADDRESS iM6u-C--)tYV- P cW HOME TELEPHONE# 56a--1,90 - 2.01(a J:linspection handouts\Haz Mat Application2008.DOC SPILL CONTINGENCY PLAN Emergency Coordinator, Name: i m Address: WAiOj 144 Daytime Phone: �09 775-93 6,-4 Evening Phone: 602�- 3&©-Zd 16 Fire Department: l iyannls Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: Phone: Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). was , o„' + v+�� U CUACK S e vae,. roLt4 S NEW oe 4- r � 7 1 z Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. Sm .I/ bpi//f -�o & �0),ea' %-P 1ar9, spi//f - wl// Cam// 911 �Lv con fvi Are 6 W-e J Number Fee 1147 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that ANCHOR OUTBOARD CO., INC. 365 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable °pIHE,p Regulatory Services Richard V. Scali, Director '"R'AS& ` Public Health Division gj 039• ♦� iOrEo " Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. A 9491 DATE f6 -/O-/4/ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT (�/I II lAr» K b fD EIII NAME OF ESTABLISHMENT 0/ oupbalrd N 47& ADDRESS OF ESTABLISHMENT �%�UJt yIIP�� /Matha TELEPHONE NUMBER CO 9' f 15-3LI J' q SOLE OWNER: AYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION. HA FULL NAME AND HOME ADDRESS OF: AA PRESIDENT J A M 0 ,Q TREAS R h w CLERK ' I -1Qj �tR1ILli ' 7- SIGNXTUF&QrF APPLICANT RESTRICTIONS: HOME ADDRESS?N��M'l nZt HOME TELEPHONE# Q\Application Forms\HAZAPP.DOC SPIT i 1--h"IICENCY PLAN Emergency Coordinator, Name: tgm a klnaga _z __-- Address: _ Daytime Phone: 6V Evening Phone: : $• 3 -�pfte Fire Department: f/?is Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Mauler: Name: Phone: Building diagrm. indicating hazaMous materiaVwaste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicabl_e), wwd r! ate NEW �4j Actions to be taken to.control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground:. 81"a'a UP lary� 3PI11r cui// p7a"!/ q11 "o e'm fit �'1me 6tvt TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM M ' _ NAME OF BUSINESS: �/U'4�ia� �' - MAILING ADDRESS: r���� ��� ����� - = - stable TELEPHONE NUMBER: ��Q�) `7'7� -3�%5 L/ Box 534 CONTACT PERSON: �-�- 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 1/ 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 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 1� Hydraulic fluid (including brake fluid) Disinfectants 'Moils/ Road Salt (Halite) -r---r 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 `/* TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,.Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops /{ / O unsatisfactory- 4.Manufacturers COMPANY_/71UG y 0!n J "R (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ,Y"-hl In Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATER& S Case lots Drums 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) 2 t16 V t Ap§m ssaon/hydraulic Synthetic Organics: degreasers Miscellaneous: a tl � rol MIS'POSAURECIAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer &Public O On-site OPrivate 3. Indoor Floor Drains YES 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 y Name of Hauler Destination Waste Product YES NO 1. �- 2. yl Person(s) Interviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 3.Printers Body Shops O unsatisfactory- 4.Manufacturers COMPANY .��P�y�� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous ' QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATER S Drums Above Tanks Underground Tanks 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 ai m C.. Miscellaneous: EV Ld=;;� Ile- DI POSAUREC I AMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES 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. Person(s) Interviewed Inspector Date TOWN OF BARN_TIT L- _ l'Uh1YLIf1P1i:C: " � •�• •. . ... 2. Printers �� satisfactory. , � 3. Auto P,ody Shops BOARD FH �' ctor - 4.• Manufacturers unsatisfa� 0 y �, 5. Retail Stores 0i (see Orders ) 6. Fuel Suppliers COMPANY t� pp ADDRESS a' ' Class: 7. Miscellaneous UAN7ITIES AND STORAGE IN=indoors; OUT=outdoor Case lots Drums Abdvel'anks Undetgrouad Tanks MAJOR MATERIALS IN IN QU p & gimons- e C si Fuels: I Gasoline, Jet Fuel (A) Diesel, Kerosene, 02 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: . degreasers Miscellaneous: - ' I DISPOSAL RECLAMATCION REW"RKS: 1. Sanitary Sewage 2, Water Supply T own Sewer Public - 0 On-site /Q Private •3. Indoor Floor Drains: YES O Holding tank: MDC OCatch basin/Dry well »�...�_.._..._. ______.......M.... ...___ 0 On-site system 4. Outdoor Surface drains:YES NO ' Q Halding• tank: MbC OCatch basin/Dry well �.-------- --- - 0 On-site system 5. Waste Transporter Licensed? In Name of Hauler n ctinatinn Tj q4 Me u23e� rson(s) In rvie a Inspector, Date - + 4 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: .aa Board of Health MAILING ADDRESS: c3&6 /V /nhJ0 Si ► TI Y6,%ii/J Town of Barnstable TELEPHONE NUMBER: ��� '75 _ `a I'.O: Box 534 CONTACT PERSON y,� 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 totalli , at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NC 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 when storey ^{ 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 _V 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, yi il Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) f Floor & furniture strippers Any other products with "Poison" labels Metal polishes J (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) ' {d Other cleaning solvents r y Bug and tar removers'~ r Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business 1 TOWN OF BARNSTABLEkOMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY j- 4� Z 1AV (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS _4'_ /A&AZ -5Y Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATE Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: G et Fuel(A) t5 Diesel, Kerosene, #2 (B) Heavy Oils: V ;r was a motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: I �rRyl� 1.44 � DISPOSAL/RECLAMATION REMARKS: 1.�anitary Sewage 2. Water Supply Town Sewer Public O On-site OPrivate o � 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES - N0,, ORDERS: Q Holding tank:MDG O Catch basin/Dry well O On-site system 4 5.Waste Transporter Name of Hauler Destination Waste Product YES No - 2. Pe`r� (s) Interviewed Inspector Date