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0530 WEST MAIN STREET - HAZMAT (2)
- �A CtZsC`n aJ� ---- - f� Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Walgreen Eastern Co., Inc../RITE AID #10190 .-------------------------------------------------------------------------------------------------------------------------------- 520 WEST MAIN STREET, HYANNIS, ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 °F IKE►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 e"";a `� ' 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'�e Business Name: Rk. qj� HO 190 Date:, 611ali9 Location/Mailing Address: fin/ . t ' ° .M ce�i Contact Name/Phone: '(9�(' ` d �9 ^J �S Cal Inventory Total Amount: 00 SDS: i h License#: Tier II : Nu Labeling: Labeling: / akl Spill Plan: C4 U Oil/WaterSeparator: NIA Floor Drains: 0 Emergency Numbers: ' C Storage Areas/Tanks: abet. 1,.0 CO( C Lcct Emergency/Containment Equipment: Vrl,cajr ka os Waste Generator ID: Waste Product: rt�'*l re 6m Date&Amount of Last Shi ment/Fre uen : Licensed Waste Hauler&Destination: � i V� Sao 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 V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash 1,0 Motor oils (D v Miscellaneous Corrosives Gasoline,jel fuel, aviation gas Cesspool cleaners Miesel fuel, kerosene, #2 heating oil --V—,--Disinfectants/Cj iscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides 10 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 V Laundry soil&stain removers `�� (including carbon tetrachloride) (including bleach) a d Any other products with "poison labels" � 1 Ov� q o (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/R COMMENDATIONS: ✓ nO o M S i n y Inspector: Facility Representative: _ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 1 `pt114 �p Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. ` 9 MASS. g 200 Main Street• Hyannis, MA 02601 039. �prED MP+6. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �<t' -r- A,ot, ei It` 1 o 19 n Date: � /$ Location/Mailing Address: 520 Zs+ 4-%•-t 5`4' Q N Y1 I S Contact Name/Phone: S05- -1 7 5-- q21 1 c k -e,d, ,NAG e Inventory TotallAAmo�unt: 7 S� SDS:�g V� `I "0Ol iv-p—Cv rp License#: I y I Tier II : N u Labeling e a� wks `2.-ors Spill Plan: ZS Oil/WaterSeparator: NJA Floor Drains: o Emergency Numbers: ye-S Storage AreasfTanks: W klb- e6 CUfZe%, 0`Z,&vNi1�e 4- C,1?cL Emergency/Containment Equipment: C< Ix S Waste Generator ID: N A(, OD D�L 14 Waste Product: Date&Amount of Last Shipment/Frequency: 1 1,4 1-7 3 X r 3-S I�o Licensed Waste Hauler&Destination: ct-r oars 2, 5N 1 l 2 Z' S v.N1e.. Other Waste Disposal Methods: A' LIST OF TOXIC AND HAZARDOUS MATERIALS 'V° �^'�` ,° �"�� '`' N 1�� �y 61%Ace.. (�5� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous matell use, I ks ' 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: e4-tD y%kays,% s M .ee-10 1-2vL ,,,,art, -e-41 S 1 A v S u Arc" -2�, tVt 0 y Q.QiS Y�Vvo v��G� Q�f�C. Inspector: a V vJ�r� I�.I a��'�e. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°Ft►�►o, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASSS.. • 200 Main Street• Hyannis, MA 02601 1639. �'0'FDrnn+"�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 44e,Business Name: A J J �'�"a�e. �l D 14 DI Date: Location/MailingAddress: S2o �l�es•� Mott, S� Contact Name/Phone: V��- '7-7 ' I 1 �QV< Fola� Inventory TotalAmount: - 5�•C.Vw'r�- MSDS: ale* k%�"<Oc'w License#: < <N t C"i' : a Labeling: WwSt�" °' ° '""'` `wo Tier II ���ce� Spill Plan: yc g Oil/WaterSeparator: Floor Drains: too Emergency Numbers: %lk5 Storage Areas/Tanks: i Co,ti t C �c�! �n� u.C�.v6 W&,,,,k2 -b-K e<V4, Emergency/Containment Equipment: 3 ,ll % W A�, g a Q Waste Generator ID: 0ool-I -I 2 Waste Product: A I Date&Amount of Last Shipment/Frequency: b 04,,-I<-< Licensed Waste Hauler&Destination: _e�eaw ar�oo`r s e S It�� W Other Waste Disposal Methods: , LIST OF TOXIC AND HAZARDOUS MATERIALS N o VAOL, O'e [.�c��^�'y� �v� NOTE: Under the provisions of Ch. 111, Section 31, of the Gineral Laws of WIA, hazardous materialy 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: INFO5MATION/RECOMMENDATIONS: CO.<' IS mac` dVC. k 2VIA G� S'�D C OVA., !e uS�5� ,n 15S y2`S C2GO,M oc S Inspector: �� Facility Representative: �4 q-, WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I `°Ft rowti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 a""MA�,K 200 Main Street• Hyannis, MA 02601 �1°rEDMA+p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: z i Location/Mailing Address: S20 es 4 iv%- 1Jqr,��5 Contact Name/Phone: a tic S'f e(2 dH ' Inventory Total Amount: &.e-�, v YL MSDS: 72 ,* "Y1 wvjf-�License#. ( I Tier II : _No Labelina: � e s ��S� rCI"a' Spill Plan: Oil/WaterSeparator:_ 014 Floor Drains: d Emergency Numbers: 2 Storage Areas/Tanks: I-20141 C.-K+AJKA.r-f;- c 4 fAl l 11AS441,15 JA)A 01%4f-.d1 a ref•4,I d4ee )0* Emergency/Containment Equipment: �� �/�-�� w SoV�Vv+ �-� G ok Waste Generator ID: U10r)0 I Waste Product: Mi t G�tcal 04 - Date&Amount of Last Shipment/Frequency: i 2 i 'Z S 110 IxtZimmo , Licensed Waste Hauler&Destination: Q Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS ��II c��k ��"� Caro �c� o.l te��Sfi'�` °►� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RE OMMENDATIONS: vL- I Ca, .ram W Go t A. -P- oW, <-0 o Ue- o�< C rn Inspector: LctJ'e-� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 3/ Jy/ /v TOWN OF BARNSTABLE w � w=„S G�;o ,,i, V� TOXIC AND HAZARDOUS MATERIALS ORM NAME OF BUSINESS: KA,_ AJ 30 //,Wft�* BUSINESS LOCATION: S2o (Jes•1 Mg,j,& C:�A- , wa vin Is INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: I 15-o S 2 CONTACT PERSON: IV aVlc J car EMERGENCY CONTACT TELEPHONE UMBER: MSDS ON SITE? TYPE OF BUSINESS: q c i�-I-a� s o� e •��k� c�,� o INFORMATION / RECOMMEN ATIONS:�Jowo, q �CAx, \At Flre District: + Waste Transportation: Last shipment of hazardous waste: t 30113 Name of Hauler: ER Destination: o,k aste Product: M�S�� �� �C1c�W\ o ,� ' Licensed es No Mt S L Qq<�.Gy Waske. ►5 l'tc�v�s po<�t ��� � ee a — G +1,�, aw o owJ v�o NOTE: Udder the provisions of Ch. 1 1, Section 31, of the/ enera cws of MA, hazardou material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) 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 I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials � l 2 TOWN OF BARNSTABLE Date: `�l TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 121`�GQQA/o(a*- /D190 T�E-Q(S7P_ Ti6-M BUSINESS LOCATION: ,Jdn 10,pjj- /ykm S eer annis, !1'l4 D;�t-ol INVENTORY MAILING ADDRESS: _ :�o #3tp -,, /ane_ 11T 17011 011 TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: S O�i�s-li& /��ki��G i Jlre�r 644 EMERGENCY CONTACT TELEPHONE NUMBER: 7/7 9 7S 8Zy3 MSDS ON SITE? TYPE OF BUSINESS: 2e�l j�l�tc rw�G-c•-I INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Alel 1/f-Aic% Last shipment of hazardous waste: a �3IJS Name of Hauler: T 16K*-9c 4 ne. Destination: ✓ Waste Product: 7� otd api"i r//Ilirefj_/A- jM_icensed Yes) No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) !/ Miscellaneous Corrosive NEW ❑ USED N Cesspool cleaners I/ Automatic transmission fluid ✓ Disinfectants Engine and radiator flushes ,/ Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ✓ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas N Photochemicals (Fixers) /} Diesel Fuel, kerosene, #2 heating oil A41A ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil A ❑ NEW ❑ USED t/ Degreasers for engines and metal e/ 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 A1114Leather dyes Car waxes and polishes /vIA Fertilizers A/1A Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, A11A Lacquer thinners N A (including carbon tetrachloride) A ❑ 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) a/ Other cleaning solvents 1/ Bug and tar removers Windshield washU2 2�L) WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appli nt's Signature Staff's Initials 3 . 'TOWN OF BA:RNSTABLE Date: /2`�/ TOXIC-AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Rrk Aid--2!t /0/QO �'( C9� BUSINESS LOCATION: J'20 llinj� X it Sf'Qef )- yann%si AM Da�or INVENTORY MAILING ADDRESS: _ �� �./one, (la.,T 1 17011 TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: /��.�-,iP �g�ii l I re ch,- ed4J EMERGENCY CONTACT TELEPHONE NUMBER: 7/ -7 9 7S P,413 MSDS ON SITE? TYPE OF BUSINESS: �e l ��1G Y✓tnF C.A-` INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Mese ye.Ak./<- Last shipment of hazardous waste: ,1311S Name of Hauler: 66 A/nAh ecg /-b►e. Destination: ;66- r� Waste Product: 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 L-/ Antifreeze (for gasoline or coolant systems) ✓ Miscellaneous Corrosive ` NEW ❑ USED AJIA Cesspool cleaners,.., ` Automatic transmission fluid ►/ Disinfectants Engine and radiator flushes i/ Road salts(,Halite)z Hydraulic-fluid-,(including-brake fluid)_ Refrigerants-`-: ; Motor Oils Pesticides NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas /V Photochemicals (Fixers) IVIA A Diesel Fuel, kerosene, #2 heating oil A J ❑ NEW ❑ USED Miscellaneous petroleum products: grease, I—VIA, Photochemicals (Developer) lubricants, gear oil f} ❑ NEW ❑ USED Degreasers for engines and metal t/ Printing ink Degreasers for driveways &garages aj4 Wood preservatives (creosote) Caulk/Grout ✓ Swimming pool chlorine Battery acid (electrolyte)/Batteries ,/ Lye or caustic soda aA Rustproofers ✓ Miscellaneous Combustible ✓ Car wash detergents A Leather dyes ✓ Car waxes and polishes /v f A Fertilizers n/ A Asphalt& roofing tar PCB's If- ✓ Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners N (including carbon tetrachloride) Any other products with "poison labels /A ❑ NEW ❑ USED ✓ (including chloroform, formaldehyde, N A - 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 Appli6a�nt's Signature Staff's Initials µ Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Walgreen Eastern Co., Inc.✓RITEAID #10190 520 WEST MAIN STREET, HYANNIS, Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of BarnstableiI➢mu�" SHE Inspectional Services BARNSTA LE Tp _ C - Public Health Division VSTC%nP 5.,9'rL tS 3NntiJ v • ��{{557J7niaW BARi4s ABLE, ' �9U 4 9 $ Thomas McKean, Director r; q7 1639. 200 Main Street, Hyannis,MA 02601 ,.. Office: 508-862-4644 Fax: 508-790-6304 '' I� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE p ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 '5 1Q� *A late charize of$10.00 will be assessed if payment is not received by July 1st. NT30-00l►. 1. ASSESSOR'S MAP AND PARCEL NO. 42 t 2. IS THIS A PERMIT RENEWAL? v YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: &44yi )reell ��L.���r 5. NAME OF ESTABLISHMENT: -RITE AID#10190 i, 520 WEST MAIN STREET 6. ADDRESS OF ESTABLISHMENT: HYANNIS, MA 02601 L _ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: - -- — - - — -- P.O. Box 901 8. TELEPHONE NUMBER OF ESTABLISHMENT: Deerfield, IL 60015 9. EMAIL ADDRESS: taxlicensererr. r — - - taxlicenserenewals@walgreens.com 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE 9 OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: --taxlicenserenewals@walgreens.com • APPLIC • DATE MAY Z SIGNATURE OF 9 Q:\Application Forms\Haz Mat App Revise109-1 ,-18.d cx aylynn De Los Santos License Specialist 847-315-3376 p"vn, of B. instable . ei.l atory �t•vices Richard V. Scali,Director + •n�. 1k1I�ft.A(,. Public Health Division BAR "ABLE 11^"Ala$�t�t Thomas McKean,Director 200 Main Srre.cL,I Iyarmis,MA 02601 �♦.r. / Offic:c: 508-862 1644 t'aa: ..908-790-6304 AI'I'UC'ATION FOR PERrylIT TO STORE AINVO'R IITILI7T: HAZARDOUS MATERIALS 1N ACCORI)A:NfiL 4V'I fH ('I lE'1'CJWN 0I BARNSTA13Ll^6'BN',2'%L ORDINANCE,CHAPTER 108, H.AZAIWOU&M 1TERl.A;L.S,ALL'BUSRd1 SSPS THAT HA.NDLE,GR STORE HAZARDOUS MATERIALS(aREA mit:,'TIiAN HOV4561.101.1)QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS,IULY lst—.fUNE 30(h). APPLICATION FEES CATEGORY I PERMIT 26— 1 10 15allons: $ 50.00 ❑ CATEGORY 2 PFRMIT 11 l —499 Gallons; S''125.00 ❑ _Iq CATEGORY 3 PERMIT 500 or more Gallons: $150.00 4di �rllntechstr�eoC$11}.(III.�� ll heassetised it'Iativtnttit i5 nr�l received h1� luly ls1 © ,I( �� 1. ASSESSOR'S MAP AND PARCEL NO, 269013 2, IS THIS A PERMIT RF.NEWAL? V YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OP' GREATER THAN IIOUSIEIIOLD QUANTITIES(25 GALLONS)?`YES NO. 4. FULL NAME OF APPLICANT: Kimberly Dascoli S. NAME OIL ESTABLISHMENT: DBA Rite Aid#10190 6. ADDRESS OF LSTABLISI mENT: 520 West Main Street, Hyannis, MA 02601-3576 7. MAILING ADDRESS(IF DIk'FERENT FROM A13O111i,: 300 Wilmot Road MS#3301 Deerfield, IL 60015 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50€-77"21:1 9. EMAIL ADDRESS: kim,dascoll@Walgreen.com 10. SOLEOWNER: __VES__`NO IF NO,NAME OF PARTNER: 11, BULL NANIE,HOME ADDRESS,AND TELEPHONE 4 OF: ,;ORPORATION NAME Walgreen Eastern Co. PRESIDENT TREASURER CLERK 12. IF PREPARED 13Y OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL! � SIGNATURE OF APPLICANT tlsi.r i)::e•iill.rU l„ <�I.P.I i c:illt.Ir.rn. iHl'•,'ri .c!',i n,c�.lttl E lle'lt'tkggnLCTGt'tiQk!(1AQflqpj I—l�—diiG'%''�W:11 A IT_2.111 1!LVIS'I=.)::r•. t Tripp,Vanessa From: De Los Santos, Kay <kaylynn.delossantos@walgreens.com> • Sent: Thursday, July 25, 2019 12:16 PM To: Tripp,Vanessa Cc: Dascoli, Kimberly; Hora, Lisa Subject: BARNSTABLE HAZARD MAT renewal Attachments: (L)BARNSTABLE MA HAZARD MAT Local renewed 05.29.19(592854267).pdf Importance: High Good morning, There had been a little over payment of the }:..1 ,,;\.1Z.I,).._.`s[A].'renewals for stores: ' - t - ionf 11t d res 1�1 Ci i . ®4fntY �. �:s' :s, - ,v -"` ,.G„u? .�,....s 14 RITE AID 520 W MAIN ST BARNSTABLE MA BARNSTABLE #10190 RITE AID 360 i 1 b3 ._ BARNSTABLE BARNSTABLE MA ' BARNSTABLE #10189 RD. RITE AID 3848 FALMOUTH 19c�4;-._� M 4: #1019� BARNSTABLE A BARNSTABLE •June 5`h was the 1st check received,which attached should be the initial application that was sent. Then the 2nd June 24`h, was the other application and check that was sent. - Kim , can you please attach (if available) the application and check that was sent to verify the checks that were sent. - If not,Vanessa please send a copy of all documents sent from Walgreen Co., so we can keep record. Since both payments have been processed, the renewal period is covered for this year and upcoming. To avoid crossing this bridge again ,License Administration usually does renewals for the stores for Rite Aid and Walgreens. Please let me know if there are any issues and concerns. Thank you, q"e a or w*¢ ,- dace/ Kaylynn De Los Santos License Specialist, License Administration Walgreen CO. ,300 Wilmot Road, MS 3215 / PO Box 901 Deerfield, IL60015 1 I , PHONE # (847)-315-3376 FAX# (847)-368-6525 *1 will be out of the office on Fridays* • p e R'up moll taxlicenserenewals@walgreens.com (Group email) CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! • • 2 Town of Barnstable Ofiice:508-862-4644 �{. Regulatory Services Department Fad:508-790-6304 HARNgrABM Public Health Division 'p MASS. g Thomas A. McKean,CHO 1o59.�e`� 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $450.00 Name on check: Walgreens Business: Rite Aid #10190 Owner: CAMBRIDGE ASSOC I LP Address: 530 WEST MAIN STREET, Hyannis Note: "520 West Main Street";Category III Permit • rq Town of Barnstable Office:508-862-4644 o* Regulatory Services Department Fax:508-790-6304 ,�„a Public Health Division MASS Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150,00 (Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $450.00 Name on check: Walgreens Business: Rite Aid #10192 Owner: BROMLEY- COTUIT LLC Address: 3840 FALMOUTH ROAD/RTE 28,Marstons Mills Note: "3848 Falmouth Road"; Category III Permit I • oF 'O Town of Barnstable Office:508-862-4644 Regulatory Services Department Fax:508-790-6304 anKysrAai.E Public Health Division MAS& $ Thomas A.McKean,CHO 200 Main Street, Hyannis,MA 02601 Payment Receipt Hazardous Materials Payment received: $150,00(Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $450.00 Name on check: Walgreens Business: Rite Aid #10'189 Owner: DAVID T&PARKKA, DANIEL]TRS PORKKA Address: 363 BARNSTABLE ROAD, Hyannis Note: "360 Barnstable Read";Category III Permit • • �z++� Town of Barnstable Office:508-862-4644 • 0 Regulatory Services Department Fax:508-790-6304 t =anxeterwsi.e, Public Health Division • MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number: 0007193124 Check amount: $450.00 Name on check: Rite Aid Hdgtrs Corte Business: Rite Aid #10192 Owner: BROMLEY- COTUIT LLC Address: 3840 FALMOUTH ROAD/RTE 28, Marstons Mills Note: Category III Permit • • Town of Barnstable office:508-862-4644 • , ' Regulatory Services Department Fax:508-790-6304 • Public Health Division eAR.wsT�et.e. MASK. Thomas A.McKean,CHO 163.is � 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number; 0007193124 Check amount; $450,00 Name on check: Rite Aid Hdqtrs Corp. Business: Rite Aid #10190 Owner; GYMK REALTY INC Address: 515 WEST MAIN STREET, Hyannis Note: Category III Permit • I� • n rays Town of Barnstable Office:508-862-4644 Regulatory Services Department Fax:508-790-6304 BARN$TASLE Public Health Division MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: 15 .00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number: 0007193124 Check amount: $450.00 Name on check: Rite Aid Hldgtrs Corn. Business: Rite Aid #10189 Owner: DAVID T&PARKKA, DANIEL 3 TRS PORKKA Address: 363 BARNSTABLE ROAD, Hyannis Note: Category III Permit • Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUGINC./RITE AID #10190 520 WEST MAIN STREET, HYANNIS, 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 'k p� �Aso �►�� 1 T&wr>l of B ns table egu atory ervices Richard V. Scali,Director Public Health Division BARNSTABLE 9 HAf M ALM Thomas McKean,Director - AAA 200 Main Street,Hyomnis,MA 02601 Office: 508-862-4644 Fax: 508-7 90-6304 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 AN-NUAL PERMIT(RUNS JULY 1st-JUKE 30t1i). + APPLICATION FEES CATEGORY 1 PERMIT 26-- I I O Gallons: $ 50-MO ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $1 - 0 ❑ CATEGORY 3 PERMIT 500 or more Gallons: 150.00 (o-5'1� *A late ch u•4ge of$10.00 Quill he assessed i1'jiayment is not rec. ec w.fa1V ISt. 1. ASSESSOR'S MAP AND PARCEL NO. 269013 2. IS THIS A PERMIT RENEWAL? V YES 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 THAN HOUSEHOLD QUANTITIES(25 GALLONS)?`YES NO. 4. FULL NAME OF APPLICANT: Kimberly Dascoli 5. NAME OF ESTABLISHMENT: DBA Rite Aid#10190 6. ADDRESS OF ESTABLISHMENT: 520 West Main Street, Hyannis, MA 02601-3576 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 300 Wilmot Road MS#3215 Deerfield, IL 60015 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-9211 9. EMAIL ADDRESS: kim.dascoli@walgreen.com I 10. SO.LEOWNER:—YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: ,,ORPORATION NAME Walgreen Eastern Co., Inc. PRESIDENT Richard Ashworth 70 Tournament Drive North Hawthron Woods IL 60047 847-315-2500 TREASURER Alan Nielsen, 1263 WillamsburgLn. Crystal Lake, IL 60014, 847-315-2500 CLERK N/A 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE- I C:'�UserslDecolliklAp��nataiLical\b(i4'rpc��illWi�tlrnv,c'Tmu9�an tri i,allat tblaSlCooninni,C).nlioklOMO(1i�F".Sf-,�Zi12 '�'APP ZU17 R1�V15EC)doc� r� Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCY RITE AID #10190 520 WEST MAIN STREET, HYANNIS, Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health TZn To'-N.4 LTOZ � IUZI alA�*CO.P C i t4 0 Town of Barnstable o Regulatory Services Richard V. Scali, Director A ku UA$NaPAIIL£; Public Health Division �.i639 10�.: 4.`i1r"9it`Iir 1rt'44sus{ FO NVPt - so va,r Thomas McKean,Director 200 Main Street,Hyannis,ALA 02601 Office: 508-862-4644 � Pax: 508-790-630,I 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 i ANNUAL PERMIT(RUNS JULY 1st-JUNE 30tli), i APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons; $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499,Gallons; $125.00 ❑ CATEGORY 3 PERMIT 500 or moreGallons: $150.00 N u A lute chitrge of$I::OOf1.wUl he_assessed tfi.��iyment s'��iot.i�ecetved bv:Ji,ly Yst:: ASSESSORS MAP AND PARCEL NO, 269013 DATE June 5,2017 FULL NAME OF APPLICANT: David W,Crozier NAME OF ESTABLISHMENT: Maxi Drug, INC./D,B,A. Rite Aid Store#10190 ADDRESS OF ESTABLISHMENT: 520 West Main Street, Hyannis, MA. 02601-3576 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER.OF ESTABLISHMENT: 508-775-9211 EHS EMAIL ADDRESS:. rlteaid,com. @ SOLE OWNER A YES^NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Rite Aid Corporation Attn:EHS 30 Hunter:Lane,Camp Hill,,.PA 17011 PRESIDENT Kenneth Black Office Address:30 Hunter.Lane Camp Hill:PA.17011 TREASURER_ti61jha 7Fl11 CLERK Daniel millet 0WIce Address ;30Aunt�p;Camp Hill PA 17011 IF PREPARED BY OUTSIDE PARTY: Sh VURE' F APPLICANT Name: <-. - Company Address : �.a ,Telephone#: }` Email:- �; C:V1'entp\HA7.7.APP ReyWdocx Page I or2 Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INC./RITE AID #10190 520 WEST MAIN STREET, HYANNIS, 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. --------------------------------------- Q WAYNE MILLER,M.D.,CHAIRMAN \T PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health :N Town of Barnstable °OHE ram, Regulatory Services P� 1' • y °� Richard V. Scali, Director * BARNSTABLE, y MASS. g Public Health Division 1619• 'OrFn Mo`�°i Thomas McKean, Director z 200 Main Street, Hyannis, MA 02601 r; Office: 508-862-4644 Fax: 508-790-639'4 s Application Fee: $4eC-.W isoPd ASSESSORS=PARCEL NO. 269013 DATE June 1, 2016 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT David Crozier NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store# 10190 ADDRESS OF ESTABLISHMENT 520 West Main.Street, Hyannis, MA 02601-3576 TELEPHONE NUMBER 508-775-9211 SOLE OWNER: YES . NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 1F APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black, Office Address: 30 Hunter Lane, Camp Hill PA. 17011 TREASURER Matthew Schroeder, Office Address: 30 Hunter Lane, Camp Hill PA. 17011 CLERK Daniel Miller, Office Address: 30 Hunter Lane, Camp Hill, PA. 17011 GNAT[ RE OF APPLICANT • RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# L:\Re1Leg\HL\ENVIR0NMENTAL\East Coast States\Massachusetts\Invoices & Pennits\Hazardous Waste\2016\2016 Applications\Town of Barnstable\10 190 Application.doc MAIL-IN REQUESTS • Please mail the completed application form to the address below. 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. 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 _f • L:\Re1Leg\HL\ENVIR0NMENTAL\East Coast States\Massachusetts\Invoices & PeimitMazardous Waste\2016\2016 Applications\Town of Barnstable\10190 Application.doc f , r Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-7 90-6304 Public Health Division HIARN MAC: Thomas A.McKean,CHO '¢ 9' e` 200 Main Street, Hyannis, MA 02601 Fo Payment Receipt ;Hazardous Materials Payment received: $150.00 (Check) on 6/7/2016 Permit number: 1141 !Check number: 0006649086 Check amount: $300.00 Name on check: Rite Aid HDQTRS. Corp ,Business: MAXI DRUG INC./ RITE AID #10190 Address: 520 WEST MAIN STREET, Hyannis i 1 I � ------ _.__._ --.......... ...- -.-. ........... �._.._ ....... ..- -- - --- ....... - - ---......1 • • Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INC./RITE AID #10190 520 WEST MAIN STREET, HYANNIS, 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 a Y Town of Barnstable Fz Regulatory Services - o g Y • � Richard V. Scali,Director '"MAS& ' Public Health Division iOrE1 rr9. 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. 269013 DATE June 4,2015 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT David Crozier ' NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10190 • ADDRESS OF ESTABLISHMENT 520 West Main Street,Hyannis,MA 02601-3576 TELEPHONE NUMBER 508-775-9211 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black, Office Address: 30 Hunter Lane, Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address: 30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address: 30 Hunter Lane,Camp Hill,PA 17011 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# L:\Re1L.eg\HL\ENVIR0NMENTAL\East Coast States\Massachusetts\hivoices&PermitsVurisdictions\Town of Barnstable\10190 6.4.15.doc �V r Town of Barnstable Office: sob-g62-4644 Fax: 508-790-6304 Regulatory Services Department ' Public Health Division . + Ehltht M' Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015 Permit number: 1141 i ,Check number: 0006443080 Check amount: $300.00 Name on check: RITE AID HDQTRS. CORP. ;Business: MAXI DRUG INC./ RITE AID #10190 Address: 520 WEST MAIN STREET, Hyannis Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS 100.0o Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCY RITE AID #10190 520 WEST MAIN STREET, HYANNIS, 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 6/15/2015 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 Regulatory Services Thomas F. Geiler,Director AS& Public Health Division Cl' c Ord" _ Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 269013 DATE June 12,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10190 ADDRESS OF ESTABLISHMENT 520 west Main Street, Hyannis,MA 02601-3576 TELEPHONE NUMBER 508-775-921`1 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office.Address:30 Hunter Lane,Camp Hill,PA 17011 i SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # RETAIL .:SAFE. T'Y 11�IANIJAL Store .0190 Rite. Aid Risk Management Department SPILL CONTINGENCY PLAN Nancy Mulcahy Store Manager Name 508 7757921 Phone# Guy Suffoletto District Manager Name 5089963549 ::Phone.;# Jeff Schares Regional Vice President Name 40;1 821=2569 Phone Local Emergency Contacts DIAL: 91 50.8 775-1300 F!re Department Phone# 508 775=0387 Police Phone# 508 77 f 1800 Hospital Phone# _ .. Suill'Response Procedures REQUIRED EQUIPMENT 1 Contact Store Management, 2 Put on gloves,goggles and apron, ❑.Chemical Cleanup Kit 3 Contain the,spill with a mop or absorbent ❑;Apron; materials, 0 Buckef 4 Clean up the'spi. as directed, using generous Mop amounts of water, 5 Clean the area thoroughly, ❑ Water . 6 Clean'all safety equipment and„rinse out all :'absorbent materials that are reused ]ANUARY 1 2013 1Q7: Environmental Health&Safety Number Fee 1141 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID #10190 520 WEST MAIN STREET, HYANNIS,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 4/1/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 7 Town of Barnstable Regulatory Services Thomas F. Geiler,Director ' `� Public Health Division eciwc+" 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. 269013 DATE March 20,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10190 ADDRESS OF ESTABLISHMENT 520 west Main Street, Hyannis,MA 02601-3576 TELEPHONE NUMBER 508-775-9211 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.042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Ca ill,PA 17011 CLERK Gerald Cardinale,Office Address:30 Hunter Lane,Camp Hill,PA 17 11 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# r i RETAIL SAFETY MANUAL ..Store 10190 Rite Aid Risk Management Department SPILL CONTINGENCY PLAN Nanc Mulcah Store Manager y y Name 508-775-9214 Phone# Guy Suffoletto District Manager Name 508-996-3549' Phone# Jeff Schares Regional Vice President Name 401-821-2569 Phone# Local Emergency Contacts DIAL 911 r Fire Department. 508-775-1300 Phone#. 508-775-0387: Police. Phone #; 508 771-1800 Hospital Phone#:' Spill Response Procedures p p REQUIRED EQUIPMENT, 1 Contact Store Management, 2. Put on gloves;goggles and apron; ❑Chemical Cleanup Kit 3. Contain the spill with a mop or absorbent O:Apron;; materials, Ll Bucket 4 Clean up the spill,as directed; using generous • ` 0 Mop amounts of water; 5 Clean the area thoroughly, ❑ Water • 6. Clean all safety equipment and rinse out all absorbent materials that are reused- `W'j" JANUARY.I;2013 107; Environmental Health&Safety INE TokY Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"",„ss`E�, 200 Main Street• Hyannis, MA 02601 2639. �ArFDMAll TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT (fi t ,n,tI Business Name: w R► wC #1oIa 0 Date: 07 V aOAD Location/Mailing Addres . _ L/- mallo PC) q0I Crer ,60, iS Contact Name/Phone: Inventory Total Amount: 00 SDS: eS License#: IN Tier II Labeling: Spill Plan: gef Oil/Water Separator: O/A Floor Drains: Emergency Numbers: �J ovs— Storage Areas/Tanks: Emergency/Containment Equipment: ` Waste Generator ID: 6 Waste Product: aOPoo � v( f Date&Amount of Last Shipment/Frequency: `� G Licensed Waste Hauler&Destination: `( lt►'li'/4 Other Waste Disposal Methods: L{ 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. Antifreezery cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) indshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas esspool 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: 00 �2(- C'iI� T��at 4L1 Ae Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS L