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0380 WEST MAIN STREET - HAZMAT
�gb I�t�9-�-$' �1c��t 5�., a,���`S 1 IMFrpk� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAS,1, ' 200 Main Street• Hyannis, MA 02601 �prEOMP��`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 05�6 3 Business Name: C6 Date: 5` 00a 0� Location/Mailing Address: �So W tAQA f;0 Contact Name/Phone: SOS Inventor)) Total Amount: i5g MSDS: 25 License#: 3 Tier II : NO Labeling: Spill Plan: Oil/Water Separator: NLA Floor Drains: _ Emergency Numbers: Storage Areas/Tanks: SWV P6006fr- I a1�Cd F enc /Containment E ui ent: Z eGenerator ID: Waste Product: &Amount of Last Shipment/Frequency: sed Waste Hauler&Destination: Waste Disposal Methods: D�1 LIST OF TOXIC AND HAZARDOUS MATERIALS AO Ck o h V e o q NOTE: Under the provisions of Ch. 111, Section 31, of the G eral 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 acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Vryc Inspector:4ka - Facility Representative: .WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FTHE T°k Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA�BLE.g` 200 Main Street• Hyannis, MA 02601 059. PrFOMP+p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 9 Business Name: cNAN �Ctrkns Date: Location/Mailing Address: J 3811 weaS Contact Name/Phone: S6 'j-ti — S103 Inventory Total Amo-unt: C MSDS: License#: �3y, Tier II : _ Labeling: Spill Plan: Oil/WaterSeparator: , Floor Dr ins: NO Emergency Numbers: Storage AreaslTanks: fiu'VA I W 2 Emergency/Containment Equipment. 0& iw Waste Generator ID: 13 Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticidp 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 4Leather dyes Miscellaneous Flammables V Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: a �,e ; n f gkwus o INFORMATION/RECOMMENDATI NS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden ................................................................................................................................. 380 West Main St., Hyannis, MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. .................................................................................................................................................................... Restrictions: ....................................................................................................................................................•............... This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of rsarnstaDiC mm Inspectional Services BARNSTABLE nr,>a;raec-eEnhw�.Conimrr ms n,ura+s H:us•osF..zvn.ie•rss eaaxsrnes Public Health Division 1 fig° snnnsr�ars Thomas McKean,Director ED 5 �� 200 Main Street, Hyannis,MA 02601 f Fax: 508-790-6304 Office: 508-862-4644 ;., APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, t. 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 El CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 lam, *A late charge of$10 00 will be assessed if payment is not received by Jul v 1. ASSESSOR'S MAP AND PARCEL NO. o �� 2. IS THIS A PERMIT RENEWAL?�S_—NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMITR VAL FOR HAZARDOUS MATS,INDICATE ERIALS S STORAGE/USE OF THER BUSINESS HAS ZONINGBUII,DIN GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: b fwtL U �� � 5. NAME OF ESTABLISHMENT: !7 b B /' C1—a "�P�'I it7C i 6. ADDRESS OF ESTABLISHMENT. - 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 6 / S ✓���� 9. EMAIL ADDRESS: T()LC-�� , dell , C� 10. SOLEOWNER: YES_ O IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT JOcet TREASURER -. CLERK 12. IF PREPARED BY OUTSIDE PARTY: TELEPHONE#: NAME: COMPANY ADDRESS EMAIL: I SIGNATURE OF APPLICANT" PPLICAN DATE Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx • o� ? Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 .� Regulatory Services Department Public Health Division Mass. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Hazardous Materials Payment received: $150.00 (Check) on 7/8/2020 Permit number: FY 2020 i 1 Check number: 042791 Check amount: 150.00 Name on check: Hyannis Country Garden.. Inc i Business: Hyannis Country Garden .Owner: RICHARD W]R TR GRIFFITH I jAddress: 380 WEST MAIN STREET, Hyannis j • CAI�,c� ►-��'d a(�P • Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 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 JUNtCHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health F a1 . • L r Town of Barnstable MWE Inspectional Services *1& EZxYi=Public Health Division •m BARNSrABLE, 9 $ Thomas McKean, Director r> 200 Main Street, Hyannis, MA 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 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 19 u!;r�uh " *A late charge of$10.00 will be assessed if payment is not received by Jules /-p 1. ASSESSOR'S MAP AND PARCEL NO. � 4e-1 —0 6 a' 2. IS THIS A PERMIT RENEWAL?X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS()? YES NO. 4. FULL NAME OF APPLICANT: 1k J lT , I0 5. NAME OF ESTABLISHMENT: j b[ p�(� (jnz- 6. ADDRESS OF ESTABLISHMENT: go 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: ` M3 9. EMAIL ADDRESS: . 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION NAME ; PRESIDENT TREASURER CLERK J 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT ATE " A I Q:\Application Forms\Haz Mat App Revised 09-10-1 ocx IKE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAR .$! 200 Main Street• Hyannis, MA 02601 "rfDMA�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: MLa orn ca�dYa! Gra(&n Date: Location/Mailing Address: S160 e4 Aa,n Contact Name/Phone: 5nfs 77-- Inventory Total Amount. "'500 SDS: ^ on License#: 137 Tier II : Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers:-- Storage Areas/Tanks: 5 Emergency/Containment ui ment: I Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: NIA Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS /�6 MO�o r L�J i h �h NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous aterial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 4Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants ✓ , / Degreasers for engines&garages ,Refrigerants V ioo 10� 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 6,10 Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °pIKET°k Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. MAGM. 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4.14A15 C&%.2 !� �Yarc Date: S l8 1(0 Location/Mailing Ad ress: 380 I.�eb a�+� Sk t� a�ri S Contact Name/Phone: ,N�.cl��l r �JuSQv. 1�ccs�o,n. Sob-'1'rS 8703 �y�,p-�1tih, Srley �K - E«...� Ne.lso Invento Total mount: A.- +?vD 4-!�5 ws MSDS: �(e5- 0w %%tC,0440 S License#:—3 Tier II : a Labelino: f4•k#-� k 00%" Spill Plan: OLD Oil/WaterSeparator: M O Floor Drains: Y�6- "W-w•¢-r gmergency Numbers: yes Storage Areas/Tanks: u e - 0%-Ad>" Emergency/ContainmentEquipment. a60 % c�eu y• -� Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: t1he, Va.24 w&5V•c. cEJka. Gov, haj (45 �e � LIST OF TOXIC AND HAZARDOUS MATERIALS I o h V. l�vzvvv I NOTE: Under the provisions of Ch. 111, Section 31, of the neral Laws of MA, hazardoulmaterial 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 �l Diesel fuel, kerosene, #2 heating oily; Disinfectants Miscellaneous petroleum products: 40P Road salts grease, lubricants, gear oil a�- 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 e> Swimming pool chlorine �— Paints, varnishes, stains, dyes �,60A ;�-1 Lye or caustic soda ✓ Lacquer thinners b� �' I 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) J Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 0 v g-c cL b e Lca,J WV4`^ k 0.t S. �L ��Inspector: ay.¢._ ¢� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Fee Number THE COMMONWEALTH OF MASSACHUSETTS 137 $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 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. 9. --------------------------------------- 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 cf PCf q3 s Town of Barnstable • FOIE Regulatory Services Richard V. Scali,Director �STABM BARNSTABLE MASS. �. 1G3T 6ARNS40li•@llFRifl •mN.R•4YNC.t3 9/�.� �0 NRRSTQYS gtS•OStFilY•LLE•PfBT BMNSR3tE V �fDMA'�a Thomas McKean Director 1639-2014 F+ 200 Main Street, Hyannis,MA 02601 z Office: 508-862-4644 Fax: 508-790-6304 t?1 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 A--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. C�&9 5,Z DATE 6 -a 7 I(� FULL NAME OF APPLICANT: /T ��5 UGC fY ✓G{ NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 5-0 8 ` EMAIL ADDRESS: L y(-6 e , SOLE OWNER: YES O IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 4/W 4a PRESIDENT Y-6ee,k vi 7),jrf!2!:j TREASURER 1)� p'Ae l e�j CLERK IF PREPARED BY O T IDE PARTY: • SIGNATURE OF APPLICANT Name: Company Add ss . Telephone#: Email: Q:�Application Fonns\HAZZAPP Rev 16.docx Page 1 of 2 r Office: 0 - -4 � Town of Barnstable O e 5 8 86244 6 Public Health Division Fax:508-790-6304 • BARMASS. 200 Main Street• Hyannis, MA 02601 "f1639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: gvlh 15 C-."A Y Ga< 14 - Date: Location/Mailing Address: 380 s a i K 4 hA Is Contact Name/Phone: a sus f`estovt. So - 7� '- 8-7d3 U' # � aq Inventory Total Amount:/ MSDS: Licerfs Ne#,e.: Tie : b 1� +06 l so - ��v. • Labelino: -'a( ; k&�\ go,�v Spill Plan: 5 Oil/WaterSeparator: Floor Drains: Emergency Numbers: Y S Storage Areas/Tanks: O&LbkkA A a irz,( c.ak&, Emer enc /Containment ui m6nt: 1 Waste Generator ID: 01A Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: /J LIST OF TOXIC AND HAZARDOUS MATERIALS — 64Ee, ���a��^c-D�- eW�t`� 41 I'd ScDw� �VaI 1 JJg1 Sov.� NOTE: Under the provisions of Ch. 111 Section 31 of the General Laws of MA hazardol 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 V Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda 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) J Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: ¢ e (AA4 & p — Ao al t Inspector: / Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Page 1 of 1 Lavelle, Timothy From: Craig [craign@countrygarden.com] Sent: Tuesday, February 17, 2015 10:25 AM To: Lavelle, Timothy Subject: fertilizer and pesticide estimates Hi Tim, I have put together some numbers based on what our highest inventories would be from March-June. After our peak season,we would have significantly lower amounts on hand. 40 tons Granular Fertilizers (Includes 5 tons of fertilizer mixed with pesticide such as"Weed & Feeds") 75 Gallons Liquid Fertilizers 6 Tons Granular Pesticides 500 Gallons Liquid Pesticides Let me know if there is anything else you need. Craig Nelson Purchasing Manager Hyannis Country Garden 508-775-8703 0 2/17/2015 h a�� i�s � � �-�� TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip Business Name am/pm, on 20_ Business Address_ Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense Facts 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. T TOWN OF BARNSTABLE BAR-W )""`''° Ordinance or Regulation WARNING NOTICE Name of Offender/Manager � �° ,. Address of Offender MV/MB Reg.# Village/State/Zip / Business Name T ; ,+ "` 4<.. '' ' am/pm, on 20 Business Address +� • '�+ Y" 1 �-� �-^- Signature ,of Enforcing Officer Village/State/Zip d�" / t + tW " Location of Offense J F V' r Enforcing Dept/Division Offensej, Facts 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. SEN •ER: COMPLETE THIS SECTION • • ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig t e item 4 if Restricted Delivery is desired. ❑Agent o. Print your name and address on the reverse X. ❑Addressee I so that we can return the card to you. B. c ived d Name) FDajtjecf Delivery lieAttach this card to the back of the mailpiece, or on the front if space permits. l 11. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No Hyannis Country Garden I ` 380 West Main Street Hyannis, MA 02601 3. Service Type 12�'Certified Mail® ❑Wority Mail Express' ❑Registered LIG Return Receipt for Merchandise — F ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I i 7 015+`06 4 0 0005 8 4$9; 7,9k9 (Transfer from service labeg f PS Form 3811,July 2g13 Domestic Return Receipt UNITED STATBSf A First-Class Mail Postage&Fees Paid USPS Permit No.G-10 5 L Sender:• 'Aease print your name,address, and ZIP+4®in this box* Town of Barnstable Health Division 200 Main Street Hyannis,MA 02601 0111VII, All, , ram+ � D Maw Ern W Ir rO Certified Mail Fee 43 $ H YA F�ctra Services 8 Fees(check box,add fee as appropriate) � ❑Return Receipt(hardtop» $ 'Y CO 3 ❑Return Receipt(electronic) $ r ttP6stmark 2/r p ❑Certified Mail Restricted Delivery $ Here O ❑Adult Signature Required $ []Adult Signature Restricted Delivery$ Postage I O _a $ p Total Postage and FeesLrI $ -- — I SeDfr Hyannis Country Garden , "_____________ C3 sseajj 380 West Main Street Hyannis, MA 02601 ;-------------- I Certified Mail service provides the following berYatits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipients retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. -Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified ■Insurance coverage is notavaliable for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retaiq. of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark If you would like a postmark on ■For an additional fee,and witha proper this Certified Mail receipt,please present your endorsement on the mailplece,you may request Certified Mail item at a Post Office-for the following services: postmarking.If you don't need a postmark on this -.Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion- of delivery(including the recipient's signature), of this label,affix it to the magpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. .:` electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 TOWN OF BARNSTABLE, Date: )-'/ TOXIC AND HAZARDOUS MATERIALS REZ4&T1UVIVN FORM NAME OF BUSINESS: 44Vacvlybls C--,0K+rV BUSINESS LOCATION: /390 0-0-5k ,Ma►,,t., H I cY►,n, S INVENTORY MAILING ADDRESS: Sa vt a TOTAL AMOUNT: TELEPHONE NUMBER: og — 775 — 8703 400 aI rxl DOD It CONTACT PERSON: M, ac-I 4 5054►1. Pit 5fo ►� EMERGENCY CONTACT TELEPHONE NUMBER: 1?,6h!e. 6Yr•► d�- MSDS ON SITE? Avg -7-76�308� TYPE OF BUSINESS: crY' .� Sv � �'��'ai 0 ��-or� yc5 -aAt/kAl— INFORMATION / RE C MMENDATIONS: Fire District: C o vt,�",vt, nc ��w a v\ a S ,� �� 2�-� Inc vt�. vvvt� � !'✓!✓17 5 2) N a�Q..e, s �I I c���� a-�.Qra�►S as �.�, us 1,.�s-� 3) .Do n L V10 Sao r e.9,-444i) ket V;A005 k or�Pfod�+�C`5) Waste Transportation: A1 A Last shipment of hazardous waste: Name of Hauler: f4%1 wwgt-e-,kssvot-'e-o-Ao �JDestination: Waste Product: l�ti�AI�,&6 15 s�l�=- oolny B(4ed�Licensed? Yes No -Ad '54, ►o,c. mr I)rt<- o4�osa-1 NOTE: Under the provisions of Ch. 111, Section 31, of the eneral 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 ,?00f4,/ Pesticides ❑ NEW ❑ USED /o4 /6 (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes you Lao ff, 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 Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers v� (I" (including bleach) V l etc, Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 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 l } '•-' ``' `c Vofow1� B nsxable Pd egi latory�ervices Richard V. Scali,Director 1NE Tp� u " "' o n �9���2 l� ublic Health -iM&` n BARN LE '�'/`� `� Y • NMsrf LE.CFMErtVILLF.�fUR.HYRHHIS �+� # • PUFSTONS H¢3.OSlErtY.LLE•YfdT B;.i.NSfA¢:E z BARNsrABLE. - Thomas McKean, Director 1630-2014 9� .MASS. .-- - fig -- - ---- --p, - -- ''rEnrYw'�" __ Z00 Maui Sf�eet;Hyannis; Office: 508-862-4644 Fax: 508-790-6304 V APPLIC ON FOR PERMIT TO ST AND/OR UTILIZE ? TERIALS <y n� IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1st—JUNE 3 Oth). 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 W.S . pTP *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?-t 1 LS_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAT. HOUSEHOLD-QUANTITIES--(25-GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: /1&,Aire.S .:s a i gA 6. ADDRESS OF ESTABLISHMENT: ZA)GS k tM 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: _ M � 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME AD DRESS,AND TELEPHONE# OF: CORPORATION NAME ' PRESIDENT TREASURER At - J1FF— F' CLERK 00 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN , .DATE Q:\Application FormSUHAZNIAT APP 2017 REVIS docx Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 West Main St., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 'Lop r��ii��, of Unstable P CAd$� Zb ogulatoervices Richard V. Scali,DirectoroA.� o� Public Health Division BARNSTABLE enansrrn ••�rrsYluF•coTurt•xra.r.$ ^I R51[X5 F�5•L51.YVILLE•Yt3f P4?tliTtuc BARNSTABLE, Thomas McKean,Director 1639-2014 6 9 200 Main Street, Hyannis,MA 02601 �g fA MPS 94 �7 Office: 508-862-4644 Fax: 508-790-6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE _ HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER TO8, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS fszi 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 ❑. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 /C �,S . b--[P *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: Vt 1 5. NAME OF ESTABLISHMENT: 1A 6. ADDRESS OF ESTABLISHMENT: $aAn MA- (4© ( 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 570,9 �7�_-�1703 9. EMAIL ADDRESS:'r 6(�?i �i✓1 �'Y - t1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 4,nij w PRESIDENT V1 TREASURER i f5 V CLERK Jam, T ^ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE ITi'1�I 1 Q:\Application Forms\HAZMAT APP 2017 REVISE ocx Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 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 9 *. 1�4 iY- Town of Barnstable oFtHE r�; Regulatory Services Richard V. Scali,Director IT BAMSTABLE, : Public Health Division v 9 MASS. ArEp Mpg a Thomas McKean,;Director f E�.79 i 200 Main Street, Hyannis, MA 02601 Fax: 508-790-6304 � Office: �508-862-4644 Application Fee: $100.00 �ci- DAT / G ASSESSORS "AND PARCEL NO. 1 r lC 3 E APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS ' FULL NAME OF APPLICANT NAME OF ESTAB LISHMENT , ADDRESS OF ESTABLISHMENT HONE NUMBER _ TELEPHONE ..� 77 SOLE OWNER: YES O IF APPLICANT IS A PAR SHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: --- IF APPLICANT I CORP072ATIO, EDERAL IDENTIFICATION NO. 7� q� g STATE OF INCO FULL NAME HOME AD DRESS OF: PRESIDENT -CSC-e,( TREASURER •` CLERK • /Irt nA tc SIGNATLAE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE#62hS dla3-y Y0 MHAZAPP.DOC ,'' '/T ( C/e ,,n l O { A,. Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 a Regulatory Services Department • � Public Health Division �$ ranss. Thomas A.McKean,CHO say 200 Main Street Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $110.00 (Check) on 9/16/2015 ,,Check number: 93422 Check amount: $110.00 Name on check: Hyannis Country Garden, Inc. 3 !Business: Hyannis Country Garden Owner: HENRY A&ANNE I DIPRETE !Address: 373 WEST MAIN STREET, Hyannis i Note: $100 + $10 late fee i i Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------I------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i Town of Barnstable Regulatory Services Thomas F. GeEer,D3PE�DP } Public Health Dl�ion p 3.�a Thomas McKean,Director 2D0 Main St e-tt, Hyannis,MA 02601 Fes: 50$-790-6304 OEca: 508462-4644 AppflC21jon Fee: $100.D0 0 " DATE ASSESSORS iSAF AND PARCEL GT NO. d ��PPLICATION FOR PERMIT TO STORE A /�R U'T MERE � 113 GALLO�T� OF HAZARDOUS MATERIALS FULL NA -9 OF APPLICANT -: NAAIE OF ESTABT 791MXNr ADDRESS OF EST_ABL18131VET IT �' TI=H ONE NU ER Z> SOLE 0WN=: YES�NO IF APPLICANT IS A PAR =� NAB AND HOME ADDRESS OF ALL PAR : / !J , L /G� `Z a /� �%l f4- 0� j . � � e. o ar.7 7 ttv o �a-- L �< ^ O 0^]�\ e�ems$ -r 4 IF APPLICANT 35 A CORPORATION: FEDER AT ERICA ON NO. STATE of IN CORPORATION S F:=NAB AND H01E ADDRESS OF: PRESIDENT u©rl � - t � -- tl`t�"' CLE�3K a i F,0YUCANT HoA E ADDRESS S' ICTIONS: „A.1 EON j + { HONFE # - F-=doc/wp/q MALL-IN REQUESTS Please mail the completed application form to tine address below. In addition, please include the Teqau'ed fen amount. Make check payable to: Town of Barnstable. Our nailing address is: Town of Barnstable Public Health Division 200 fain Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fa;number is (508) 790-63d4. Please fax a completed application fog.. In addition, you must a'1 i' o n.s. the rz�ured fee amount (se,, fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. For further assistance on any item above, call (508). 862-4,644 I I i II i i i ��V O ��F:R�C/ joENNETT ENVIRONMENTAL AsSOCIATEs9 NC. LICENSED SITE PROFESSIONALS 6 ENVIRONMENTAL SCIENTISTS & GEOLOGISTS 6 ENGINEERS 1573 Main Street-P.O. Box 1743, Brewster, MA 02631 508-896-1706 Fax 508-896-5109 6 www.bennett-ea.com June 21, 2013 Mr. John Duffley 380 West Main Street Hyannis, MA 02601 RE: QUALIFICATIONS PACKAGE BENNETT ENVIRONMENTAL ASSOCIATES, INC. Dear Mr. Duffley, Under cover of this letter, I am providing you with a BENNETT ENVIRONMENTAL ASSOCIATES, INC. (BEA) Qualifications Package;. as specifically related to the cleanup of oil and hazardous materials (OHM). BEA features a 24-hour emergency response mobile unit which is able to respond to a release of OHM within 2 hours anywhere on the Cape. This trailer is outfitted with equipment and supplies commonly needed to implement preliminary :remedial response actions for containment and stabilization of release conditions to help mitigate environmental impacts. Additionally, we warehouse supplies and specialty equipment at our Brewster offices and have an established network of qualified contractors to lend any assistance that may be deemed appropriate on your project. In addition, BEA has a diverse and qualified staff of engineering and environmental professionals that can assist in all areas of planning, design, permitting and construction. Please feel free to contact me directly to further discuss our professional services and.qualifications. Thank you for your consideration. Very truly yours, BENNETT ENVIRONMENTAL ASSOCIATES, INC. Kara Ris Business Manager Encl: Qualifications Package Company Brochure (www.bennett-ea.com) EMERGENCY SPILL RESPONSE WASTE SITE CLEANUP O SITE ASSESSMENT PERMITTING SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE b WASTEWATER TREATMENT,OPERATION&MAINTENANCE sZIAR9 ,: r Ah �� $c �`„ a k�a3`��; ,�,�.•�s'x'w"r rr' �'r,'�w�+.�'" rrs��'1£y�i��t3;� Y '� ' �" - r • BENNETT ENVIRONMENTAL ASSOC►IATES, IN IMM8.89G.170G BENNETT ENVIRONMENTAL ASSOCIATES, INC. (BEA), the Cape's leading- remedial response service company,is proud to present our newly acquired Emergency Response Unit trailer. This 24-hour mobile unit is able to respond to a release of oil and/or hazardous materials within 2 hours on the Cape,serving an overwhelming need for a quicker response time as compared to off-Cape companies. Our trailer is outfitted with a generator, lighting, fuel transfer pump, DOT drums, absorbents, booms, and ventilation fans, as well as various hand and power tools and personal protective equipment. We also have a warehouse inventory of skid-mounted soil and groundwater treatment systems ready for immediate application. Please consider BEA for your emergency spill response or other environmental needs. Log onto www.bennett-ea.com or call 508-896-1706 "the one call that does it all." Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS $10o.00 Town of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 West Main St., 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 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER, M.D., CHAIRMAN PAUL J.CANNIF_F, D.M.D. 6/30/201 o JUNICHI SAWAYANAGI — — -- ------__ THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable �ofIMEA Regulatory Services Thomas F. Geder, Director • : BA ASS. LE. MASS. * Public Health Division 9 MASS. O 1639. oArFoMP�A 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. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN I II GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT v NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT • TELEPHONE NUMBER SOLE OWNER: 'YES NO IF APPLICAN IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: M t l d5 wrR/ CIF AFPLICANTIS A CORPORATION: FEDERAL IDENTIFICATION NO. �'STATE OF INCORPORATION FULL NAME AND HOME DRESS OF: PRESIDEN t qA +�V; ' TREASURER q243� jN��., CLERK . ' o �Jjt)� Al S IA� TU R/0F/0fPPL ICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Haz.dod%%P/q HAZARDOUS WASTE SPILLS CONTINGENCY PLAN Hyannis Country Garden June 26, 2008 I. Emergency Contact Information Police; 911 or 508-775-0387 Fire: 911 or 508-775-1300 Operations Manager: John Duffley 508-775-8703 Facilities Supervisor: Richard Griffith 508-775-7737 j Loud Fuel: 508-457-0097 • 2. MSDS located in electrical room (back building) 3. Spill Kit : Speedy dry located in electrical room 4. Fire extinguishers: Electrical Room (back building) And in aquatics display room MATERIAL SAFETY DATA SHEEN' • Dyed Diesel Fuel 1. CHEMICAL PRODUCT and COMPANY INFORMATION EMERGENCY TELEPHONE NUMBER(24 hrs): CHEMTREC($00)424-9300 COMPANY CONTACT(business hours): 600-686.7222 Global Companies LLC Water Mill Center 800 South St. Waltham,MA 02454.9161 SYNONYMS:Dyed Diesel Fuel;Off Road Diesel;Tax Exempt Diesel See Section 16 for abbreviations and acronyms. 2. COMPOSITION and INFORMATION ON INGREDIENTS CONCENTRATION INGREDIENT NAME EXPOSURE LIMITS PERCENT BY WEIGHT Diesel Fuel OSHA PEL-TVWA:5 mg/m,as mineral oil mist loci CAS NUMBER:68476-3»-6 ACGIH TLV TWA:1997 NOIC.100 mg/m skin,A3 Naphthalene OSHA PEL,10 ppm Typically<0.01 CAS NUMBER:91-20-3 ACGIH TLV-TWA,STEL;10/15 ppm,A4 Contains Red Dye 5 11ppn, A complex mixture of hydrocarbons%vith carbon numbers in the range C9 and higher. S. HAZARDS IDENTIFICATION EMERGENCY OVERVIEW CAUTION( OSHA/NFPA COMBUSTIBLE LIQUID-SLIGHT TO MODERATE IRRITANT-EFFECTS CENTRAL NERVOUS SYSTEM-HARMFUL OR FATAL IF SWALLOWED Moderate fire hazard.Avoid breathing vapors or mists,May cause diz4iness and drowsiness.May cause moderate eye irritaton and skin irritation(rash). Long-term,repeated exposure may cause skin cancer If irgestee,do NOT induce vomiting,as this may cause chemical pneumonia(fluid in the lungs). EYES Contact with liquid or vapor may cause mild irritation. SKIN May cause skin irritation with prolonged or repeated contact.Practically non-toxic if absorbed following acute (single)exposure.Liquid may be absorbed through the skin in toxic amounts if large areas of skin are repeatedly exposed. INGESTION The maier health threat of ingestion occurs from the danger of aspiration(breathing)of liquid drops into the lungs, particularly from vomiting.Aspiration may result in chemical pneumonia(fluid in the lungs),severe lung damage, respiratory faihire and even death.Ingestion may cause gastrointestinal disturbances,including irritation,nausea, vomiting and diarrhea,and central nervous system(brain)effects similar to alcohol intoxication, in severe cases, tremors,convulsions,loss of consciousness,coma,respiratory arrest,and death may occur. INHALATION Excessive exposure may cause irritations to the nose,ehroat,lungs and respiratory tract.Central nervous system ;brain)effects may include headache,dizziness,loss of balance and coordination,unconsciousness,coma, respiratory!allure,and death. WARNING,the burning of any hydrocarbon as a fuel in an area without adequate ventilation may result in hazardous teveis of combustion products,Including carton monoxide,and inadequate oxygen levels,which may cause unconsciousness,suffocation,and death. Page 1 of 6 Revision 34/13/06 EA) • d , MATERIAL SAFETY DATA SHEET -- Dyed Diesel Fuel CHRONIC EFFECTS and CARCINOGENICITY Similar products produced skin cancer and systemic toxicity in laboratory animals following repeated applications. The significance of these results to human exposures has not been determined—see Section 11 Toxicological Information. ,ARC classifies whole diesel fuel exhaust particulates as probably carcinogenic to humans(Group 2A). NIOSH regards whole diesel fuel exhaust particulates as a potential cause of occupational lung cancer based on animal studies and limited evidence in humans, MEDICAL CONDITIONS AGGRAVATED BY EXPOSURE irritation from skin exposure may aggravate existing open wounds,skier disorders,and dermatitis(rash), 4. FIRST AID MEASURES EYES In case of contact with eyes,immediately flush with clean,low-pressure water for at least 15 min.Hold eyelids Open to ensure adequate Flushing.Seek medical attention. SKIN Remove contaminated clothing.Wash contaminated areas thoroughly with soap and water or waterless hand cleanser.Obtain medical attention if irritation or redness develops. INGESTION DO NOT INDUCE VOMITING.Do not give liquids.Obtain immediate medical attention.If spontaneous vomiting occurs,loan victim forward to reduce the risk of aspiration.Monitor for breathing difficulties. Small amounts of material,which enter the mouth,should be rirtsed out until the taste is dissipated. INHALATION 'Remove.person to fresh air.If person is not breathing provide artifl:�al respiration.If necessary,provide additional oxygen once breathing is restored if trained to do so.Seek medical attention immediately, 5, FIRE FIGHTING MEASURES FLAMMABLE PROPERTIES: FLASH POINT: >125 o F(>52 o C)minimum PNICC AUTOIGNITION POINT: 494 c F(257 o C) • OSHArNFPA FLAMMABILITY CLASS' 2(COMBUSTIBLE) LOWER EXPLOSIVE LIMIT(%): 016 UPPER EXPLOSIVE LIMIT(%); 7.5 FIRE AND EXPLOSION HAZARDS Vapors may be ignited rapidly when exposed to heat,spark,open flame or other source of ignition.When mixed with air and exposed to an ignition source,flammable vapors can burn in the open or explode in confined spaces. Being heavier than air,vapors may travel long distances to an ignition source and flashback.Runoff to sewer may cause fire or explosion hazard, EXTINGUISHING MEDIA SMALL FIRES:Any extinguisher suitable for Class B fires,dry chemical,CO2,water spray,fire fighting foam,or Halon. LAP.GE FIRES;Water spray,fog or fire fighting foam,Water may be ineffacCve for fighting the fire,but may be used to cool fire-exposed containers, FIRE FIGHTING INSTRUCTIONS Small fires in the incipient(beginning)stage may typically be exting.uishad using handheld portable fire extinguishers and other fire fighting equipment.Firefighting activities that may rssult in potential exposure to high heat,smoke or toxic by-products of combustion should require N10514/MSHA-approved pressure demand self• contained breathing apparatus with full face piece and full protective clothing.Isolate area around container involved in fire.Cool tanks,shells,and containers exposed to fire and excessive heat with water,Fcr massive fires the use of unmanned hose holders or monitor nozzles may be advantageous to further minimize personnel exposure.Major fires may require withdrawal,allowing the tank to bum.Large storage tank fires typically require specially trolned personnel and equipment to extinguish the Ire,often including the need for properly applied fire fighting foam. Page 2 of 6 Revision 3/13106 E,AJ .�� MATERIAL SAFETY DATA SKEET • Dyed Diesel Fuel 6. ACCIDENTAL RELEASE!MEASURES ACTIVATE FACILITY'S SPCC,SPILL CONTINGENCY OR EMERGENCY RESPONSE PLAN. Evacuate nonessential personnel and remove or secure all ignition sources.Consider wind direction;stay upwind and uphill,if possible. Evaluate the direction of product travel,diking,sewers,etc,to confirm spill areas. Do not touch or walk-through spilleo material. Spills may infiltrate subsurface soil and groundwater;professional assistance may be necessary to determine the extent of subsurface impact. Carefully contain and stop the source of the spill,if safe to do so.Protect bodies of water by diking,absorbents,or absorbent boom,if possible.Do not flush down sewer or drainage systems,unless system is designed and permitted to handle such material,The use of fire fighting foam may be useful in certain situations tc reduce vapors.The proper use of water spray may effectively disperse product vapors or the liquid itself,preventing contact with ignition sources or areas/equipment that require protection, Take up with dry earth,sand or other non-combustible,inert oil absorbing materials.Carefully shovel,scoop or sweep up into a waste container with clean,non-sparking tools for recizrnation or disposal.Response and clean-up crews must be properly trained and must ubli:ee proper protective equipment(see Section 8), Local and f or Federal notification may be required if this material is released to the environment(see Section 15 for additional information). 7. HANDLING and STORAGE HANDLING PRECAUTIONS Handle as a combustible liquid.Keep away from heat,sparks,and open flame!Electrical equipment should be approved for classified area.Bond and ground containers during product transfer to reduce the possibility of static-initiated fire or explosion. Special slow[cad procedures for"switch loading"must be followed to avoid the static Ignition hazard ti.at can exist when higher flash point material(such as fuel oil)is loaded into tanks previously containing low flash point products (such as this product)-see API Pub cation 2003;'Protection Against Ignitions Arising Out Of Static,Lightning and Stray Currents. STORAGE PRECAUTIONS Keep away from flame,sparks,excessive temperatures and open flame.Use approved vented containers. Keep containers closed and clearly labeled. Label all secondary containers that this material is transferred into with the chemical name and associated hazard(s),Empty product containers or vessels may contain explosive • vapors.Do not pressurize,cut,heat,weld or expose such containers to sources of ignition: Store in a well-ventilated area.Protect containers from damage and vehicular traffic. Post"No Smoking'signs in product storage areas. This storage area should comply with NFPA 30"Flammable and Cornbustib[e Liquid Code".Avoid storage near incompatible materials.The cleaning of tanks previously containing this product should: follow API Recommended Practice(RP)2013"Cleaning Mobile Tanks In Flammable and Combustibie Liqu'd Service"and API RP 2016"Cleaning Petroleum Storage Tanks". WORKJHYGIENIC PRACTICES Emergency eye wash capability should be available in the near proximity to operations presenting a potential splash exposure.Use good personal hygiene practices.Avoid repeated and/or prolonged skin exposure. Wash hands before eating,drinking,smoking,or using toilet facilitiles.Do not use as a cleaning solvent on the skin,. Do not use solvents or harsh abrasive skin cleaners for washing this product from exposed skin areas.Waterless hand cleaners are.effective.Promptly remove contaminated clothing Gnd launder before reuse.Use care when laundering to prevent the formation of flammable vapors which could ignite via washer cr dryer.Consider the need to discard contaminated leather shoes and gloves. 8. EXPOSURE CONTROLS and PERSONAL PROTECTION ENGINEERING CONTROLS Use adequate ventilation to keep vapor concentrations of this product below oc-nupational exposure and flammability limits,particularly in confined spaces. EYEIFACE PROTECTION Safety glasses or goggles are recommended where there is a possibility of splashing or spraying. SKIN PROTECTION Gloves constructed of nitriie,neoprene,or PVC are recommended.Chemical protective clothing such as of El, DuPont TyChemS,$aranex(D or equivalent recommended based on degree of exposure.Nots,The resistance of specific material may vary from product to product as well as with degree of exposure.Consult manufacturer specifications for further information. Page 3 of 6 Revision 3/13,106 FA1 • MATERIAL SAFETY DATA$MEET • Dyed Diesel Fuel RESPIRATORY PROTECTION A NIOSHIMSHA-approved air-purifying respirator with organic vapor cartridges or canister may be permissible under certain circumstances where airborne concentrations are or may be expected to exceed exposure limits or for odor or irritation.Protection provided by air-purifying respirators is limited.Refer to OSHA 29 CFR 1910.134, ANSI Z88.2-1992,NIOSH Respirator Decision Logic,and the manufacturer for additional guidance on respiratory Protection selection. Use a positive pressure,air-supplied respirator if there is a potential for uncontrolled release,exposure levels are not kr:own,in oxygen-de=icient atmospheres,or any other circumstance where an air-purifying respirator may not provide adequate protection. 9. PHYSICAI,and CHEMCAL PROPERTIES APPEARANCE Red Dyed liquid ODOR Mild,petroleum distillate odor BASIC PHYSICAL PROPERTIES BOILING MANGE: 320 to 690 o F(160 to 365 o C) VAPOR PRESSURE' 0.009 psis,@ 70 o F(21 o C) VAPOR CENS(TY(air=1), a 1.0 SPECIFIC GRAVITY(H20=1): 0.83 to 0.86 @ 60 o F(188 p C) PERCENT VOLATILE$: 100% EVAPORATION RATE: Slow,varies with conditions SOLUBILITY(H20): Negligible 10. STABILITY and REACTIVITY STABILITY:Stable.Hazardous polymerization will not occur, CONDITIONS TO AVOID,and INCOMPATIBLE MATERIALS Avoid high temperatures,open flames,sparks,welding.smoking and other ignition sources.Keep away • from strong acids and oxidizers;Vton S;Fluorel HAZARDOUS DECOMPOSITION PRODUCTS Carbon monoxide,carbon dioxide and non-combusted hydrocarbons(smoke). 11. TOXICOLOGICAL PROPERTIES ACUTE TOXICITY Acute dermal LD50(rabbits):>$mUkg Acute oral L050(rats);9 mUkg Primary dermal irritation:extremely irritating(rabbits)Draize eye irritation;non-irritating(rabbits) Guinea pig sensitization:negative CHRONIC EFFECTS AND CARCINOGENICITY Carcinogenic:OSHA:NO IARC:NO N'TP;NO ACGIH: '997 NOIC:A3 Studies have shown that similar products produce skin tumors in laboratory animals following repeated applieadons without washing or removal.The significance of this finding to hurnan exposure has not been determined.Other studies with active skin carcinogens have shown that washing the anirnal's skin with soap and water between applications reduced tumor formation. MUTAGENICITY(genetic affects) This material has been positive in a mutageniciiy study. 12. ECOLOGICAL INFORMATION Keep out of sewers,drainage areas,and waterways.Repert spills and releases,as appliwt le,under Federal and State regulations.(See Section 15 for additional information). 13, DISPOSAL CONSIDERATIONS Consult federal,state and local waste regulations to determine appropriate disposal options. Page 4 of 6 Revision 3113/06 EAJ 96(27i299t FRI 19:j4 FAX 59V 457 6259 LAUD FUEL 1�046iQ07 i �r MATERIAL SAFETY DATA SHEET • Dyed Diesel Fuel 14. TRANSPORTATION INFORMATION PROPER SHIPPING NAME: Dyed Diesel Fuel HAZARD CLASS and PACKING GROUP: 3,PG lit DOT IDENTIFICATION NUMBER: NA 1993 DOT SHIPPING LABEL; None IRS REQUIREMENTS Dyed Fuel Product,Non-Taxable Use Only,Penalty for Taxable Use EMERGENCY RESPONSE GUIDEBOOK GUIDE NUMBER: 128 is, REGULATORY INFORMATION U.S.FEDERAL,STATE,and LOCAL REGULATORY INFORMAT16N This product and its constituents fimLed herein are or,the EPA T SCA Inventory_Any spin or uncontrol,ed release of this product,including any substantial threat of release,may be subject to federal,state ardlor lord reporting requirements.This product and/or its constituents may also be subjeci to other regulations at the state and/or local level.Consult those regulations applicable to your facility/operation. RCRA Information If disposed,this product would be considered a hazardous waste under RCRA with an EPA waste code of D001 for the characteristic of ignidbility. CLEAN WATER ACT(OIL:PILLS) Any spill or release of this product to"navigable waters"(essentially any surface water,ineludin@ certain ko-e°lands) or adjoining shorelines sufficient to cause a visible sheen or deposit of a sludge or emulsion must be reported immediately to the National Response Center(1-e00-424-8802)or,if not practical,the U,S,Coast Guard with follow-up to the National Response Center,as required by U.S.Federal Law.Also contact appropriate state and local Mulatory agencies as required. CERCLA SECTION 103 wd SARA SECTION 304(RELEASE TO THE ENVIRONMENT) The CERCLA definition of hazardous substances contains a"petroleum exclusian"clause which exerrpts crude oil, refined,and unrefined petroleum products and any indigenous cernponents of such.However,other federal reporting requirements(e.g.,SARA Section 304 as well as the Clean Water Act if the spill occurs on mavigal:la waters)may still apply. • SARA SECTION 3111312-14AZARD CLASSES ACUTE HEALTH CHRONIC HEALTH FIRE SUDDEN RELEASE of PRESSURE REACTIVE X X X SARA SECTION 313.SUPPLIER NOTIFICATION This product may contain listed chemicals below the de minims levels which therefore are not subject to the supplier notification requirements of Section 313 of the Emergency Planning and Community Right-To-Know Act (EPCRA)of 198o and of 40 CFR 372. If you may be required to report releases of chemicals listed in 40 CFR 372.28,you may contact Amerada Hess Corporate Safety if you require additional information regarding this product.However,Poiycyciic Aromatic Compounds(PACs)are coincidentally manufactured from the canbusticn of various fuel oils and other petroleum products. Under SARA Section 313,the de minims exemption has been eliminated for PACs and other listed persistent bio-accumulative and toxic chemicals(PBTS). Refer to EPA guidance for additional reporting information EPA NOTIFICATION(OIL SPILLS) If the there is a discharge of more than 1,00Cwgallons of oil into or upon navigable waters of the United States,or if it is the second spill event of 42 gallons or more of oil into water within a twelve(12)month period,a written report must be submitted to the Regional Administrator of the EPA within sixty days of the event. -CANADIAN REGULATORY INFORMATION(WHMIS) Class B, Division 3(Combustible Liquid)and Class D,Division 2,Sub&lsion S(Toxic by other means) • Pale 5 of 6 Revision 3113/t35 EAJ 04/27/2008 IFRI 14:93 FAX 508 457 $289 LOUD FUEL U007/007 f J �. MATERIAL SAFETY DATA SHEET • Dyed Diesel Fuel is. OTHER INFORMATION NFPAS HAZARD RATING HEALTH: 0 Negligible FIRE: 2 Moderate REACTIVITY: 0 Negligible HMIS&HAZARD RATING HEALTH: 1`Slight FIRE: 2 Moderate REACTIVITY: 0 Negligible `Chronic ABBREVIATIONS: AP=Approximately <=Less than >-Greater than N/A=Not Applicable N/D c:Not Determined ppm=parts per million ACRONYMS_: ACGIH American Conference of Governmental OSHA U.S.Occupational Safety 8,Health Industrial Hygienists Administration API American Petroleum Institute PEL Permissible Exposure Limit(OSHA) AIHA American Industrial Hygiene JRCRA Resource Conservation and Recovery Association Act CERCLA Comprehensive Emergency Response, REL Recommended Exposure Limit Compensation,and Liability Act (NIOSH) ANSI American National Standards Institute SARA Superfund Amendments and DOT U.S.Department of Transportation Reauthorization Act of IUIS 711le III EPA U.S.Environmental Protection Agency SCBA Self-Contained breathing Apparatus HMIS Hazardous Materials Information SPCC Spill Prevention,Control,and System Countermeasures (ARC International Agency For Research On STEL Short-Term Exposure Limit(generally Cancer 15 minutes) MSHA Mine Safety and Health Administration TLV Threshold Limit Value(ACGIH) NFPA National Fire Protection Association TSCA Toxic Substanoas Control Act NIQSH National Institute of Occupational Safety TWA Time Weighted Average(8 hr.) and Health NOIC Note of Intended Change WEEL Workplace Environmental Exposure Level(AIHA) NTP National Toxicology Program WHMIS Canadian Workplace Hazardous Materials Information System OPA Oil Pollution Act of 1990 DISCLAIMER OF_EXPRESSED AND IMPLIED WARRANTIES Information presented herein has been oompifed from sources considered to be dependably.,and is accurate and reliable to the best of our knowledge and belief,but is not guaranteed to be so.Since conditions of use are beyond our control,we make no warranties,expressed or implied,except those that may be contained in our written contract of sale or acknowledgment. Vendor assumes no responsibility for injury to vendee or third persons proximately caused by the material if reasonable safety procedures are not adhered to as stipulated in the data sheet.Additionally,vendor assumes no responsibility for injury to vendee or third persons proximately caused by abnormal use of the material,even if reasonable safety procedures are followed. Furthermore,vendee assumes the risk in their use of the material. • Pave 6 of 6 Fervision 3113/46 EAJ r a r r x' MASSACHUSETTS FIRE INCIDENT REPORT DEPARTMENT Revised 0MUATI.N 0 1 9 2 2 H annis Fire De artment ReportForm lie ... If Ex Date AlarmArrival In Service Y400463 Fire 005/21 /97 Wednesda � 10 .53 10:58 11 :21 UND ACTION TAKEN MUTUAL AID Spill, Leak w/ No Ign 4 1 Remove Hazard ' FIXED PROPERTY USE (OCCUPANCY) IGNITION FACTOR C Public Service Station 5 7 1 OCORRECT ADDRESS ZIP CODE CENSUS TRACT 381 YARMOUTH ROAD 0 2 6 0 1 20 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. SPRAGE, BILL 508 775-9899 O/S OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE F 12 WILLOW STREET SHELL 381 YARMOUTH ROAD 508 775-9899 CO. DIST. © PERSONNEL ENG RESP. AERIALS RESP. 013 METHOD OF ALARM 1 RESP. 0 1 SHIFT HAZ MAT PRESENT? TANK. RESP. OTHER RESP. 0 D 0 Telephone (Direct) NO. ALN RMSSUBSTANCE 0 0 11 SPEC. EQUIP. USED? O 20 FIRE TNJT FS -INJURIES FATAT,TTTF.S RESCUES. SERVICE 0 > < 0 >> OTHER 0 > 0> > 0 O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. CLAIM PD • 0 0 0 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 4 O IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION OCOMPLEX iAREA OF EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION ----'' MATERIAL FORM TYPE © IGNITED METHOD OF LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE O EXTINGUISHMENT L.I l EXTENT OF DAMAGE Flame ......... Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE N >:: OP 0 Material generating FORM TYPE ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date FARRENKOPF, C. CAPTAIN 5/ 2 1 /9 7 Comments for this incident have been printed on an additional comments page. - Comments for Incident: 97 000463 Exposure: 00 Date: 5/21/97 DRIVER FOR CAPE COD AMBULANCE CALLED TO REPORT A FUEL SPILL[ABOUT TWO(2)GALLONS]AT 381 YARMOUTH ROAD WILLOW STREET SHELL. *ARRIVING ON SCENE, FUELING AREA,WE FOUND A SMALL SPILL OF ABOUT ONE{1}GALLON ON A CEMENT PAD. WITH SOLVENT AND SPEEDY DRY WE REMOVED THIS HAZARD. OPERATOR OF WILLOW STREET SHELL TOLD US THAT WHILE THE AMBULANCE DRIVER WAS FUELING HE ACCIDENTLY SPILLED THIS SMALL AMOUNT OF GASOLINE. SHELL PERSONNELWERE GOING TO TAKE CARE OF IT THEMSELVES BUT THEY ENDED UP HAVING WORDS. CAPE COD AMBULANCE. WILLOW STREET SHELL 381 CAMP & YARMOUTH ROADS. 508-775-9899. FF. HOLIGAN, LT. CADRIN. WEATHER CONDITION: PARTLY CLOUDY,COOL,WIND OUT OF THE NORTHWEST ABOUT 3 MPH ,T 600 F. FARRENKOPF, C. CAPT. 05/21/97 • i MCHUSETTS FIRE INCIDENT REPORT O 1 . DEPARTMENT Revised Form YAP 922 Hyannis Fire Department Report If Ex Date Alarm Arrival In Service Inc # .000619 006/ 17/94 Day lFriday18.34 18.40 19:22 Fire6 UATION FOUND :. ACTION TAKEN M77� MUTUAL AID B Spill, Leak w/ No Ign 4 1 Remove Hazard "4 FIXED PROPERTY USE (OCCUPANCY) ::> IGNITION FACTOR C Public Service Station >5 7 1 NO FIRE '::<:0 0 >::: ..................... OCORRECT ADDRESS ZIP CODE CENSUS TRACT 380 WEST MAIN ST 02601 000050 O 11 OCCUPANT NAME (LAST, FIRST, MI) PHONE ROOM or APT. TELE CUMBERLAND FARMS 508 790-0227 E, 12 OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE G 13 METHOD OF ALARM CO. DIST. PERSONNEL ENG RESP. AERIALS RESP. 3 © RESP. a 0 SHIFT HAZ MAT PRESENT? TANK. RESP. OTHER RESP. :........... B 0 1 Telephone (Direct) NO. ALARMq SUBSTANCE 0 0 0? SPEC. EQUIP. USED? O 271RE �,7iT�T � OTHER ERVICE C F �Ii1BOF FL O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS. CLAIM PD 0 <"' I o 0 30 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION O COMPLEX JAREA OF EQUIP INVOLVED IN IGN. ORIGIN FORM OF HEAT IGNITION '<: MATERIAL FORM TYPE © « IGNITED ................... ....... METHOD OF LEVEL OF ORIGIN u................. Number of Stories CONSTRUCTION TYPE O EXTINGUISHMENT 0 1 EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE op Material generating FORM TYPE no most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date DEAN L. MELANSON LIEUTENANT 6/ 1 7/9 4 Comments for this incident have been printed on an additional comments page. Cq,mi tints for Incident: 94 000619 Exposure: 00 Date: 6/17/94 FIRE ALARM REC'D A CALL FROM A EMPLOYEE OF COUNTRY GARDENS ON WEST MAIN ST WHO REPORTED SMELLING GASOLINE AT APPROX. 1700 OUT AT THE WEST MAIN ST EMTRANCE.SHE WENT BACK OUT TO CLOSE THE GATE AND ;OULD STILL SMELL IT AND THOUGHT THE FD SHOULD INVESTIGATE.SHE ALSO METIONED SEEING LIQUID ON THE GROUND ACROSS THE STREET AT THE CUMBERLAND FARMS SELF SERVE GAS STATION. I RESPONDED IN E-822 WITH FF'S MONETTE AND GRANDAW.UPON OUR ARRIVAL WE TWO SMALL GASOLINE SPILLS (COMBINED TOTAL EST.5 GALLONS)ON THE WEST SIDE REAR PUMP AREA.WE APPLIED JAN-SOLV AND WATER TO REMOVE ANY POSSIBLE HAZARD. I DISSCUSSED THE PROBLEM WITH THE STORE MANAGER(MS.RAEDA MARZUQ)WHO WAS UNAWARE OF THE SITUATION.SHE STATED SHE SAW PEOPLE FROM THE BOAT DEALER NEXT DOOR(KAWASAKI, YAMAHA&MARINE OF CAPE COD,405 MAIN ST)FUELING BOATS AT THESE PUMPS APPROX. 1.5 HOURS AGO AND THAT THEY WERE"WASHING DOWN"THE BOATS WHILE THEY FUELED THEM. I WENT NEXT DOOR AND FOUND THE BUSINESS SECURE FOR THE EVENING.WHILE CHECKING THE PROPERTY I OBSERVED A BOAT(A WHITE AND GREEN PROLINE LETTERED"BOOMERANG"AND NUMBERED 230)ON A TRAILER INSIDE THE REAR"MARINE SERVICE AREA"OF THE BOAT DEALERSHIP.THIS BOAT HAD A GARDEN HOSE RUNNING INTO A GUNWALE OPENING THAT I ASSUMED WAS A BILGE VENT.A VERY SMALL AMOUNT OF WHAT APPEARED TO BE A PETROLEUM AND WATER MIXTURE WAS DRIPPING OUT OF THE STERN BILGE SRAIN ONTO A PIECE OF CARDBOARD.FROM OUTSIDE THE FENCED IN AREA WE COULD SMELL A ODOR OF GASOLINE.I REQUESTED FPO,LT HUBLER TO THE SCENE TO WITNESS AND PHOTOGRAPH THE SCENE SO THAT HE COULD PROPERLY FOLLOW-UP ON THE SITUATION. HE ARRIVED AND TOOK PHOTOS FOR FOLLOW-UP. I ALSO MADE LT HUBLER AWARE THAT THE CASHIER AT THE CUMBERLAND FARMS DOES NOT HAVE A CLEAR VIEW OF THE PUMPS WHERE THIS SPILL OCCURED DUE TO DISPLAYS IN THE STORE AND NO EXTERIOR MIRRORS. WHEN LT. HURLER WAS ALL SET WE RETURNED TO QUARTERS. LT. DEAN L. MELANSON 17-JUN-94 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: / S - MAILING ADDRESS: C� Li ` � ���� � TELEPHONE NUMBER: CONTACT PERSON: Does your firm store--any, of: the=:toxi_c, or hazardous materials. 1i..sted-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 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 it or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid'volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasline or coolant systems)_y,Refrigerants Automatic transmission fluid V' Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda : Degreasers for engines and metal Jewelry cleaners i Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored ! ' Rustproof ers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- ! Asp'zalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners ) R EC E IV E ® list) Other cleaning solvents HEALTH DEPT. _ Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants JUN `� 1981 Road Salt (Halite)