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0515 WEST MAIN STREET - HAZMAT
�a�� �l�`S F�re.t c� �,-�- N-�z,��' a�R - �I - - - - - ---- - - IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMSATQl- {,, 200 Main Street• Hyannis, MA 02601 039. �prFOMP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: X v ` 6 4 S Q�es Date: 2 3 ,P-6 Location/Mailing Address: W a► +V s 0 J1 n`V Contact Name/Phone:.. u��z���yFr- !2 Inventory Total Amount: MSDS: ` !s License#: r Tier II : 9 1 Aw Labeling: 6C Spill Plan: CyS Oil/WaterSeparator: 4V �'�" Floor Drains: Emergency Numbers: Storage Areas/Tanks: Siy S ice ` Emergency/Containment Equipment: 'a _ - cn" 412--dm Waste Generator ID: ha V 0 '775 7M Waste Product: 61 Date&Amount of Last Shipment/Frequency: �' , ��, &F Licensed Waste Hauler&Destination: �✓P [3►' - i r �e h, "+ 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 i Other cleaning solvents&spot removers � Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 10 Windshield wash 7 S 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, deglosserA, Leather dyes i Miscellaneous Flammables a °' 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) C� VIOLATIONS: V I-t C 1 e T� ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: C Facility Representative: P WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS +.i Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. SI S 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 =t owr of Unstable eg atory ervices Richard V. Scali,Director r� �LLW�GPublic Health Division E*7, , HEZ •COYUIT•HYa.t:liBARNWABLE, 14:it Pa:.niTSo!EMassThomas McKean, Director 0341639• �• prED MA+a 200 Main Street, Hyannis,MA 02601 M^3 m..7 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). � _a(579 APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 f S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize 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: G xe c u,"w 4-�q I Q 1 L. 5. NAME OF ESTABLISHMENT: axe o C l w /q-u 1'i9 6. ADDRESS OF ESTABLISHMENT: �/5 ��5Cl I�1 S�• 4.1+s 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 6`I V 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND T LEPH N #O CORPORATION�v AME e +v o �( ta -Met PRESIDENT Ve SS ( P f u U jr-0 - TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\HAZMAT APP 2017 REVISED. cx Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. .-------------------------------------------------------------------------------------------------------------------------------- 515 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 t . r` Town of Barnstable �. n Inspectional Services BARNSTABLE • ,+LWjiMJS NWtLLS 0 MLLCeTTR BaWVM15T4&-E Public Health Division 6 �19 BARNSTABLF. Thomas McKean, Director i639. �w 200 Main Street, Hyannis,MA 02601 ;r P.-, Office: 508-862-4644 Fax: 508-790-6304 k 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 I st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 - CATEGORY 2 PERMIT _L11 —499 Gallons: $125.00 vs-r 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. 1909 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? l/ 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: Oe t U.S Se 5. NAME OF ESTABLISHMENT: 6xe-Q�`v.4 AA, 6 SQ ie S 6. ADDRESS.OF ESTABLISHMENT: J S`JJ ` 'S 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: C C 8. TELEPHONE NUMBER OF ESTABLISHMENT: SO�6 S e J J 9. EMAIL ADDRESS: AA e 0vk 10. SOLEOWNER: /YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF CORPORATIW NAME e&c `wl "4 t )u I • PRESIDENT he '/��S"r TREASURER 3 eel CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS _ AIL: SIGNATURE OF APPLICANT DATE - �Application Forms\Haz Mat Appli Draft J Q: an2019.d Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. SI S 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 { 1 Town of Barnstable Inspectional Services BARNSTABLE o� Public Health Division HARNW'ABLE. Y Thomas McKean, DirectorMASK 039. � '°reo N,or s 200 Main Street, Hyannis,MA 02601 ; Office: 508-862-4644 Fax: 508-79'0-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE k 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 3� V Pd CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by.Jules 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: o . 5. NAME OF ESTABLISHMENT: e C"*UC S(A)f S �^C- 6. ADDRESS OF ESTABLISHMENT: 6'15` SAAU 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: J`• © $ 9. EMAIL ADDRESS: 10. SOLEOWNER: !/YES_No IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: / CORPORATION NAME G C _ '. 0 g` PRESIDENT TREASURER S c< � CLERK �C.�.w,e 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\l-laz Mat App Revised 09-10-1 Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. 515 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 ' owr of Brnsxable eg atory e r v I c e s of t"e Richard V. Scali, Director Public Health Division MMSTABLE ` MRNSTA2LE.f&REgVILLF.C TUR.W.W5 i ��AB Thomas McKean, Director MAR50SM'�i�a a< NS.� " Mass. g �.. ►63p �� --200 Main"Street,-Hyannis,-MA 02601--- --__-------.-- p 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 J9 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. 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: 5. NAME OF ESTABLISHMENT: `-�/`e w ` kxQ 6. ADDRESS OF ESTABLISHMENT: VS-" Q�d- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: �7 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: N "" 'y uk 6 q �^�� 1 C8 10. SOLEOWNER:X. NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEP ONE#OF: CORPORATION NAME e S a AA CC"e-. PRESIDENT // TREASURER 9 CLERK i 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE ����ol Q\Application FormsV AZMAT APP 2017 REVISED.docx ra Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. 515 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 Regulatory Services ti \ Richard V. Scali, Director EAMSrABMPublic Health Division �`�' BARNSTABLE ti Thomas McKean, Director V 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 1st-DUNE 3Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 i� 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. DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: C n� ADDRESS OF ESTABLISHMENT: NA O O MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: �e.e h��9.U` �� fd Im a; SOLE OWNER: 4-(YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME -q&Qor 130c- PRESIDENT C P Z24 o6ja'- TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: . I SIGNATUj3E OVOLICANT Name: Company Address Telephone#: Email: Q\Application Forms\HAZZAPP Rev I6.docx Page I of 2 s. } °p IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"RM �. ' 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 7116116 Business Name: EXect..�+,ve. 'Av' ni5-.tf-g Date: Location/Mailing_Address: i S 65-I Contact Name/Phone: E:e-&- - o�5s�.� - 't S- �3 1¢-k. Ell,S Invento1y Total Amount: �`� ��S'3i��a) MSDS: YeS License#: ( I 8y -- �• Tier II : o Labeling: Spill Plan: 2 S Oil/Water Separator: NIA Floor Drains: Emergency Numbers: Storage Areas/Tanks: 2 0 OL was}e- cl, Emer enc /Containment Equipment: d- X 6 ,l\ Waste Generator ID: o o-,l i 1 aste Product: o Date&Amount of Last Shipment/Frequency: v 1%40,54-k 9 c,\A-,) 6kKx-e- w�J owu 5 P 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. 10 Antifreeze Ill Dry cleaning fluids 2 Automatic transmission fluid 2- �— Other cleaning solvents&spot removers t Engine and radiator flushes ,,�\ Bug and tar removers Hydraulic fluid (including brake fluid) �kti Windshield wash L Motor oils �1 kti k 2,1S wa5}i Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil �_ Disinfectants 1 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 l Paint&varnish removers, deglossers Leather dyes 1 Miscellaneous Flammables I 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/ ECOMMEN TIONS: 115 P-X }fie- o �G2vt b+r 45A P. 1 S 2 f W1 Inspector. r Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p IKE roN1 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMST�BLE.9` 200 Main Street• Hyannis, MA 02601 �'prEDMP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT I V,2/iS— Business Name: eGJ+���— o e 3 Date: Location/Mailing Address: SIS' 2 ,,.e, $-{ ¢.�+�,s Contact Name/Phone: eoc ovsse. Invento1y Total Amount: tio A'' 11; License# Tier II : w Labeling: Spill Plan: sk Oil/WaterSeparator: Floor Drains: Emergency Numbers: +1 Storage Areas/Tanks: al WhS f, D Emergency/Containment Eq lament: �504ZVkA5 -V 6 A111 $4A- aVa �00 Waste Generator ID: NuI'lro VC ,h��( wtkh6V Waste Product: 4 Date&Amount of Last Shipment/Fr quency: I)O 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 8 Dry cleaning fluids 3 Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers �j Hydraulic fluid (including brake fluid) 3 Windshield wash L4 t I 25� Motor oils $1�LSo 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: ?- C V, 0,KO ve a o t.� w � Inspector: 1 1 1V Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable °ptHE T Regulatory Services Richard V. Scali, Director Y Y =" MASS.`� ` Public Health Division QED N►P'�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. �` /b DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 6 (� NAME OF ESTABLISHMENT P c �' ADDRESS OF ESTABLISHMENT 117-1 ,�21" 411 a--rin4"S 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._ � STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT Q&X L Z131 IV 11lr TREASURER � P CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# S-o t/;2 C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP ReQMDOC Number Fee 1184 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. 515 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 owv,s GX�G`���� �v✓loGp /� Date:V 1�,3 �, TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: KXF(07)✓e_ Auto � SALes-,7'iVc- BUSINESS LOCATION: .r/5�e�/rsf"�YIAIh�Sf, ffYANNiSr1VV OZ6a/ INVENTORY MAILING ADDRESS: lS We_&t 1#4iH .5f. W-41Y 1S.,1V14 "So / TOTAL AMOUNT: TELEPHONE NUMBER: ,ry g- '77.5 /3 S 5 CONTACT PERSON: &e-oRfre A. Yoosse:F EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Aj -o RaeAi2 INFORMATION/RECOMMENDATIONS: Fire District: HYAt IS Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum v Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive NEW 04 USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) I/ 1� Hydraulic fluid (including brake fluid) S Refrigerants ®O Motor Oils Pesticides ANEW "SED (insecticides, herbicides, rodenticides) Photochemicals (Fixers) � o Gasoline, Jet fuel,Aviation gas q Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ ICED 7=_ Photochemicals (Djdeloper) Miscellaneous petroleum products: grease, .- �1 -°' lubricants, gear oil ❑ ❑NEW IAED w Degreasers for engines and metal Printing inky Degreasers for driveways&garages Wood preservatives ( reosote),,,j Caulk/Grout Swimming pool chlorie Battery acid (electrolyte)/Batteries Lye or caustic soda rs Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) W 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 (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS App ant's Signature Staff's Initial Date: /Z/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS RE=STfVMM FORM NAME OF BUSINESS: V -o ge,04l BUSINESS LOCATION: s l,�esf al•ti y.1 vi47s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: _109-7-1 S- 13 SS ^- :;L-74/ � CONTACT PERSON: 7 elf— C- O i S EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: �v�o ./►-ta►v��-<�a�c� g �-epa �� yes INFORMATION / RECOMMENDATIONS: Sp►lI Q/an �s Dosf�, , �2 Fire District: ora 1 4. 2 (:JeAkt ,: d ►4 r"-CCo �tyenrr► S Waste Trai : ,MNI.Sb"775�1 355' Last shipment of hazardous waste: 3 Z1 13 Name of Hauler: Destination: 2 Waste Product: I,A54.o, o, / Licensed . es No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum (0 Anti reeze (for gasoline or coolant systems) Miscellaneous Corrosive NEW I'D ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 7Nr Oils / Pesticides 4 oa EW I o B USED 25oq d AsT (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) Z 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 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 (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials IKE rok, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ` LE MASS ' 200 Main Street• Hyannis, MA 02601 �'DTFOMa+ � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT IC>/2I2/1L/ Business Name: o4,ve-- . v ,2S Date: Location/Mailing Address: S'i 2S f- M.A T. Contact Name/Phone: n Inventory Total Amount: '"'"'3 4- MSDS: ell� License#: Tier II : Labeling: &'va-A Spill Plan: o�E Oil/WaterSeparator: Floor Drains: o Emergency Numbers: Storage Areas/Tanks: 0 4 d A A14-T tO © 1 OVA- ,Vt.e� Emergency/Containment E ui ment: � 111 %X,} td1\400KA 5oh-�� DkA5 . Waste Generator ID: W,11 e!w Waste Product: o• —S �J `7+X Date&Amount of Last Shipmen Frequency: Licensed Waste Hauler&Destination: c0wks9rA-9.X W,1,� oo-,-1 0014 Cy-- 5, 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. to 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 10 25'p 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/RECOMMENDATIO S: cA, b 30 ZS ;, o "CM4 q tj-,ot�-. �5k W• . M0.gS�t��-Yo( N.Q. Inspecto . -tin Facility Representative WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS i Number Fee 1183 THE COMMONWEALTH OF MASSACHUSETTS 100 Town of Barnstable Board of Health This is to Certify that EXECUTIVE AUTO & SALES, INC. 515 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 pFtHE rpw Regulatory Services Richard V. Scali, Director * aaxxsras�. MASS. g Public Health Division t639• ♦0 '°rEnru►'�° 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.^Y9 O 0 / DATE /0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �2� _ e -5 — NAME OF ESTABLISHMENT axe c.6�V`u e (:,:�Cx'Q ADDRESS OF ESTABLISHMENT 3'I% W� I"�G't tit �� '�M/K i S TELEPHONE NUMBER 3'0 5 " 13 6-,!� SOLE OWNER: J,,�S NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OFALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. q4.-y 6 y4 g - STATE OF INCORPORATION Ij A SS FULL NAME XND PRESIDENT HOME ADDRESS OF: y31 G',i b&&hd 11 ost 4 U; le TREASURER S� CLERK SIGNATURE OF APPLICANT ° RESTRICTIONS: HOME ADDRESS %3� � c�►�c5�c�.,c� �� HOME TELEPHONE# i J:\HAZAPP.DOC SPILL CONTINGENCY PLAN Emergency Coordinator, Name: &4)-ta �Mkss Address: y31 '5-Fan6cPcA,*,A- CQM - Daytime Phone: jr©9 - 7 7 5- -7/ 1 Evening Phone: Fire Department: 5 0 2 -3 2 5- 1 -S o o 0 -2 7 S= ,?U 3 Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: C ! N o 1 t - Phone: !Q 1 °-3 t}I - 8 o -7 y Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. �- � Number Fee 160 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Jack Ellis Foreign Auto SI S 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 6/30/2014 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 f• tU i OWE 0-1 Barnstable Rego atory Se vic-eS *, nay Y GeLex,DirBdua Public Hea1-f. Dion MeKL-an,Directox 2-001M3S m Stz4 F_ya js,MA 02601 Appjicafcn Fee: V OCAC r_SSySSO7S �LLP A PACL 1T0 q mod/ ��Ty , TPLIO TIO FOR PE l TO STORE /OR III GA NS Off' ��-RD-0US �A�� of APP7ICA�T �SC.� , 07 EST_�BT rgxE � CK .a=RZSS OF EST ABLUKEMG-�iT Jam/ soles o =: �So H APPI�CA N T IS A PAB�, + A��HOiYSE ADD SS 0y AID i 223: LF API'IIICA `IS A- CORFP:)CATION: Flu 'T IDEI I'ITF`ICATION NO. STATE OF LEI CORPOAA=+» NAla AND HOB��DRZSS OF, ID RES=�1' T e r ES'�=0INS: Foy, ADDRESS �Sv pl���l�DK�����-r�fc,a✓5/'I,I��J�r d� HOME �EFHO ���= 7 3®5v i Number Fee 160 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Jack Ellis Foreign Auto 515 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.CANNIFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI — THOMAS A._MCKEAN, R.S.,CHO Director of Public Health Number Fee 160 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Jack Ellis Foreign Auto SI S 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 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Barnstable Regulatory Services Department o��T Public Health Division 9A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT /1 D N NAME OF ESTABLISHMENT (J/Lc k 'r—:7LLI3 ADDRESS OF ESTABLISHMENT 5 7; • TELEPHONE NUMBER j p S- r2 1 S-5 SOLE OWNER: ✓YES NO t IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS O ALL�- PARTNERS: cx z } C CD CD i IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK NATURE OF APPLICANT. • RESTRICTIONS: HOME AD SS7,qp Ole) Fy N►o 6rstov5`/j%/S /1'a► HOME TELEPHONE# SOS-y�S- P7 30 5' D dd Q:\Flazmat\Haz itilat ApP lication2008.DOC Number Fee N 160 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health C This is to Certify that Jack Ellis Foreign Auto SI S 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 June 30, 2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health a r Town of Barnstable Barnstable 'TKEr° Regulatory Services Department o ;erisaC-i Public Health Division RAMSrABM 639. � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 '�6) e-9� ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT k S . ®1'-P f.P A) , )-b0 ADDRESS OF ESTABLISHMENT /5— -,77` jk rt� , 1 _ c TELEPHONE NUMBER - <I SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALINE' PARTNERS: rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK NATURE OF APPLICANT/ fJ RESTRICTIONS: HOME SSA HOME TELEPHONE# '1"�I5�7 �✓l` i /'l ► l/ r Q:\Hazmat\Haz Mat Application2008.DOC f o Number Fee 160 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Jack Ellis Foreign.Auto 515 West Main St., 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 June 30, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAULJ. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health r Town of Barnstable Regulatory Services Thomas F. Geiler,Director S MAXNSTABLE, MAS& Public Health Division � 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. 6 ! — O JDATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Q. A r-k 5 o V 5 k NAME OF ESTABLISHMENT L L JS Fj) -ne i ,t/ A 14 f 49 ADDRESS OF ESTABLISHMENT y7- /'7 0-/ �, i . �y>•��,5��®'I TELEPHONE NUMBER .5 5-5-- SOLE OWNER: 6/'-YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: N Cl) 23 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. G% STATE OF INCORPORATION CDm FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLIC��A��NT / RESTRICTIONS: HOME RESS 7,q0 old F lm a A HOME TELEPHONE# SOS' /�g�93os Number Fee 160 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of.Barnstable Board of Health This is to Certify that Jack Ellis Foreign Auto SI S West Main St., 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 June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 24, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r Town of Barnstable °FIME T° Regulatory Services °. Thomas F. Geiler,Director AAP MRNSTARLE. * • • • • ass. Public Health Division � i639. ,fig' rED 39. A Thomas McKean,Director A 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 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT L�)Ae-JGy,o L g L C 1 S 5 r NAME OF ESTABLISHMENT JAIL k F L is f t�r.Q,sL A ,&e4 to ADDRESS OF ESTABLISHMENT �/S West 57' 100, ,. TELEPHONE NUMBER 17 9_5_� SOLE OWNER: &'-fis NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALLi PARTNERS: K� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK / SIGNATURE OF APPLICANT A RESTRICTIONS: HOMEADDRESS 7irP all FA1,.,oy-rh �r�" '1ar3�®:Hlfk HOME TELEPHONE# .37�'7- 04-7- r7 D� Q:\Application Forms\HAZAPP.DOC " } MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven(7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page w_ Q:\Application Forms\HAZAPP.DOC Town of Barnstable pp1HE Tp Regulatory Services v ti Thomas F. Geiler, Director • : BA MASS. a• Public Health Division .� MASS. �p t639. ,gym ATEDMA 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 6 0 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ( j��/�CSdA/ LL�IS SIQ NAME OF ESTABLISHMENT jTAC/k ,to r w P 9 N Atl fa Re ph-1 r- ADDRESS OF ESTABLISHMENT • TELEPHONE NUMBER ®S 17 7-'�". ,S SOLE OWNER: 1/YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: rp �,, IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. - STATE OF INCORPORATION Et Y� FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNA OF APPLICANT .RESTRICTIONS: HOME DDRESS rf SD old F/M pt4h4, `7A'rgrAiA4N;Ns,/98 ° HOME TELEPHONE # L/a_ eg- Haz.docA%P/q 4 n+ F ( � Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Jack Ellis Foreign Auto Fax: — Corp Name: Mailing Address Location: 515 West Main Street,Hyannis Street: 515 West Main Street e, mappar: City: Hyannis v v Contact: .Jack State: Ma .3'Q 1OL( Telephone: '(508)775-1355 Zip: 02601. C � Emergency: (508)428-7305 Person Interviewed: Business Contact Letter Date: 5/28/2004 Category: Inventory Site Visit Date: 6/1/2004 5 Type: Follow Up/Inspection Date: public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir ---- - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ............._.... REMARKS: 6/2/98-Parts washer lid was closed. No antifreeze compliance: changes-just top offs. MV5087751355. 2 hydraulic lifts. Cyne rag Satisfactory service. Shop floor swept clean-outside yard was clean+organized. Oxylacetylene for hot work. No thing allowed down drains per owner. NAPA trades batteries. ORDER: Obtain Material Safety Data Sheets for all products. Request from suppliers and keep file or clipboard. 1 3 , Z57 Cl 4', �j ti Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑d gty's>25 lbs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more descripfon: gtyr. ,� �unitof measu"re antifreeze(for gasoline or coolant systems) 4cases ______.._...._..._._.__......_.._._.._..-----..__........__._.___._......_.._._.._..............___.....__._..___......_._..._..__.__.._....__......_.___.._._.__._.._..._._._.__.......___.._.._...._.....__.... automatic transmission fluid 1cases hydraulic fluids(including break fluid) 1cases motor oil 55gallons _._ ..___._.__.._..._.._._................._...._ __.......__..__....___...._._.......___._._........_.__......._....__..._......_._....__.._....___.._.._... misc.petroleum products:grease,lubricants 30 pounds car wash detergents _ 1units car waxes and polishes 1cans ____ paint,varnishes,stains,dyes 2cans Waste Transporter Fire District: lG%� Last HW Shipment Date: O Ll Waste Hauler Licensed: ,t. COPY TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: 4-0 - F cm /4wk� BUSINESS LOCATION: S .MAILINGADDRESS: INVENTORY TELEPHONE NUMBER: �08 `775— /35•S TOTAL AMOUNT- CONTACT PERSON: EWS a dw —7 / EMERGENCY CONTACT TELEPHONE NUMBER: Fti�E D(STRIC TYPE OF BUSINESS: /4-& �o k'e-ect c,. OTHER INFORMATION: sM 505' oo 5if?" ecz-t- aCIAGLrr i o► a I• W aus mask-�c:'al s aste Transportation: Name of Hauler: di/ Destination: Waste Product: LC7i/ Licensed? es No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners Iq�.NEW USED Cesspool cleaners 3. U Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt(Halite) Hydraulic fluid (including brake fluid) Refrigerants ✓ Motor oils Pesticides NEW taA USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED .Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways& garages Wood preservatives (creosote) l5' A Battery acid (electrolyte), 'ems Swimming pool chlorine Rustproofers Lye or caustic soda ooA Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes O� Asphalt& roofing tar Fertilizers. Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride)- Paint&varnish removers, deglossers An other roducts with " Paint brush cleaners y P poison° labels Floor.&furniture strippers (including chloroform;formaldehyde,. hydrochloric acid, other acids) Metal polishes Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers &cleaning fluids MiSC.: �d . (dry cleaners) _ � �aA Other cleaning solvents Bug and tar removers �! .- TOWN OF BARNSTABLE .5�RPLIANCE: CLASS: 1.Marine,Gas Stations,Repair �sa,i�sfactory 2.Printers BOARD Oy HEAJT 3.Auto Body Shops {�Yo , -1V !P O unsatisfactory- 4.Manufacturers COMPANY �4 A-�,�i. z i (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS .rl—1 6[i' f�1.�1�1J!S Y- Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) 4vacA- al Diesel,Kerosene, #2 (B) Heavy Oils: C✓' �7= � �' waste motor oil (C) new motor oil (C) •gip J1Z<•�,9 s� �► transmission/hydraulic d Synthetic Organics: degreasers Miscel aneous: ., 4A, fi i' ti I DISPOSAIJRECLAMATIO REMARKS: 1. nitary Sewage 2.W%ter Supply (Town Sewer (ublic 0 On-site OPrivate 3. Indoor Floor Drains YESJNO/19 �7 Holding tank:MDCJ' ' 0 Catch basin/Dry well 117 'J 0 On-site system A(Aw 4. Outdoor Surface drains:YES N0J/ ORDERS: 0 Holding tank:MDC 0 Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product NO 2. e s) nterviewed Inspector Da TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �. Mail To: NAME OF BUSINESS: :124; T`� �9.�rw"` 1�anxr�� ��'` Board of Health MAILING ADDRESSL,,t a �IRr� u1 �►' - �`►ti Town of Barnstable TELEPHONE NUMBER: 7 7g��'".� ! ., 1 O. Box 534 CONTACT PERSON: ` } l " �,�i; 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 quan ' les 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 or hazardous characteristics and must be registered w i . Please put a check beside each product that you store: v Antifreeze (for gasoline or coolant systems) Drain cleaners !� Automatic transmission fluid .41 Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste ils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business ' TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: /A A [— re7Al ONTO MAILING ADDRESS: •�/-� !N PS l TELEPHONE NUMBER: 77✓` /�,�✓� CONTACT PERSON: �� C Does-your- f rm� _store any of the toxic or- hazardous materials- l sted.'b-elow_, 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. areRstored 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 stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put t� a check beside each.product that you store: 8 � Antifreeze (for gasline or coolant systems) Refrigerants �Rr,�.cp— Automatic transmission fluid Pesticides (insecticidest 8e.--k= Engine and .Radiator flushes herbicides,rodenticides) Hydraulic fluid (including rake fluff Photochemicals f�® Motor oils/waste oils --- j�� Printing Ink Gasoline, Je fue t S � Diesel fuel erose #2 heating oil Wood preservatives '? — 1 g (creosote) Other petroleum products: grease, lubricants Lye or caustic soda Swimming Pool chlorine Degreasers- for engines and metal Jewelry cleaners I i Degreasers .for driveways & garages Leather dyes d� Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) JagaaB¢—^ Car wash detergents PCB IS Car waxes and polishes Other chlorinated hydro- Asphalt & 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 (including bleach) R E C ° + Other products not listed Spot removers & cleaning flue which you feel may be S P g �ALTH DEPT. toxic or hazardous (please (dry cleaners) TOWN OF BARNSTABLE list)"F Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners SUN 2 4 JQC.4 Cesspool cleaners Disinfectants Road Salt (Halite) • TOWN OF BARNSTABLE' BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM r ADDRESS Major types of materials: 1) 2 3) a) - S) 6) I: Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/Recommen( ions 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains i-ii), inadequate fire protection 2. Outdoor a) uncovereA, exposed to weather b) pervious surface/cat N4 basins ' I 1I' Disposal= M A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer ; 2. Regular septic system 3. Separate holding tank C. Off-site disposal r 1. hauled by own firm ' 2, hired hauler , R a) name of hauler b) address or disposal site Persc.n(s) Interviewed � _ Inspector ,i_ _ _ _ _ Q — ct�f Date r/D ���� - - — — — — — — 6 30 82 - - -�. � - - - - - - - - - -rowrv-oF-BARNS BLS ` ��:�:r�;��G: �. satisfacto !` .•. 2. Printers BOARD OF H EA L H n' • }- ' 3. . Auto aody shops unsatisfactory 4. Manufacturers see"Orders" S. Retail Stores COMPANY '�' ��' -" -'� =' { "" ` �' ' ( ) 6. Fuel Suppliers ' _ ,�,, f' > .� ; 7 Miscellaneous ADDRESS �' ______ Class• 1-TI-64 flL QUANTITIES AND STORAGE (I indoors; OUT=outdoor Case lots Drums AboveTanks Undetgro.und Tanks MAJOR MATERIALS IN 'r IN I fi gellons a rest Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene,D!F B) Heavy Oils: : .. . .. - � waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics:.• ' degreasers Miscellaneous. / DISPUSAL REC TIUN REME.RKS: 1. Sanitary Sewage 2. Water Supply Town Sewer y --• opublic v� '�� � ' 3� 0 On-site Private ,- . •3. Indoor Floor Drains: YES NO 4 Holding tank: MDCL T - , OCatch basin/Dry well OR _._._»....._.... _.._� _ . 0 On-site system � -----•--_..._. 4. Outdoor Surface drains:•Y.ES _NO� Q Holdink• tank: MUC O Catch basin/Dry well - 0 On-site system F . Licensed? S. Waste Transporter ler �Petinat�on_ ,(�(t1ctR Product, ' 114 bf 4e� lov Person(s) -Interviewe Inspector. Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPE�yNY _ _� �i �� - (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous Nf` QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots 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 0 Kp� waste motor oil (C) C —- �.r 1� new motor oil (C) transmission/hydraulic Synthetic Organics degreasers Miscellaneous: , 141 DISPOSAIJRECLAMATI0N REMARKS: / ra C C—' 1 1. Sanitary Sewage 2.Water Supply � �, !_+ 1� X "®Town Sewer O-Publ�c� f' I,~s'` t--/ O�� _ �A A k V P l� 7 O On-site OPrrvate / 3. Indoor Floor Drains YES X NO � .. O Holding tank:MDC O Catch basin/Dry well a O On-site system 4. Outdoor Surface drai ns/YES NO`% ,ORDERS: O Holding tank: MDC / O Catch basin/Dry well f O On-site system/ 5. Waste TransporterName of Hauler ! i Destination + YES NO u- r ,.✓ Person (s) Interviewed Inspector' - / Date, ` !��.� r . ���� �' '�.� �� �, _M= 1 `�.-.. `J `�_ �e�, �� Af�