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Fire Department retains original application and issues duplicate as Permit.
' (� (QCZ7�'Zr'�2Q��'LLl12CriLGJ2 f2�P�'�
� �el�a�IirnenCa��arre CC)9�a�urcea
APPLICATION and PERMIT I Fee:
for storage tank.removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
.t
Tank Owner Name (please print) 1 � �� X
r 1� / Signature ll-�p^pryng ra permrtJ
Address 7 Z 1.l..��l 11V�- . �G U�-t>V_v lL( �-+-- 1✓'Z-Ql C7:s-
Sheer GIy Stare Zip
Company Name Co. or Individual G o11D GZC�rz1K11 CC�bls� ;
P. Pt"
Address /r��l,' Address �� ��0��ZZ�Pf Mu \ _,±U D' i>b
f applying or perm') ` ` Signature(if applying for permit)
CI•Certified Other '1FC1'Certified O LSP# Other
• �07�! /
Tank Location -5 �%,� ! �V\� LU <,7'P-�
Stee_rA_dcress- - City —% _
Tank Capacity(gallons) n o Substance Last Stored �As ^1
nn �J
Tank Dimensions(diameter x length)
Remarks: C kA G- _k- \J f�X_ E-3-vWSE-�
Firm transporting waste �Zi1Gl. Q State Lic. #
Hazardous waste manifest# E.P.A.#
Approved tank disposal yard J n S �►4ATr Tank yard 3 ,nn
Type of inert gas TC- Tank yard address
City or Town ►�y � FDID# U ( 1 Z-Z, Permit# ff
Date of issue Date of expiration r �L
Dig safe approval number. 7- Z G(o j k 1 g a Toll Free Tel. Number-800-322-4844
l; a..t,T,f":a rS• Fr•.rr to II'%I tr14RAR Rr 6.Y _r0 rr
.zaraaaavra aa, i BbIL IL iYVb't`N• 6.Y61,L
Signature/Title of Officer granting permit HYANNIS
After removal(s) ("Consumptive Use"fuel oil tanks exempted)send Form FP-29OR signe ocal Fire bX6WWd;G2 .of the
State Fire Marshal, UST Regulatory Compliance Unit, P.O. Box 1025, Stow. 1775.� i
'International Fire Code Institute
FP-292(revised 4/9 )
Fire Department retains original application and issues duplicate as Permit-
l07
GL7:Yiy7LQ/�LLlJ2Cril�GlZ > 1� 6 „
APPLICATION and PERMIT Fee=
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
1
Tank Owner Name (please print) 0 nL X
�� gnw—p appryng for pamr r) _
Address .5 Z C> l luV-� lrF�l�s- . � U t>E-N ((z -�_
Street city State Zip
• • Y M • Y. .1 •T'T!�
Company Name �C'�Z'S L� I� --HS P�II�� t i i71� Co, or Individual 61---OLDGTLS�I�U
Prvu Pml
Address TS �,� L« ��1,'� � �1—�f�Y�`o''1 Address P ti Print\
f applying or perm') Signature(if applying for permit) V V '
CI•Certified Other 'fFCI*Certified 0 LSP;#// Other
Tank Location
_ Stoat Address city
Tank Capacity(gallons) 0 )O -- -Substance-Last Stored
Tank Dimensions (diameter x length)
Remarks: �kA6, lV V` k `. — �Lk'z�-'S4 Y�cu����
>t tM. . 1
Firm transporting wastef' 1Gt�L� � State Lic. #
Hazardous waste manifest# E.P.A.#
Approved tank disposal yard J Zaf Lk 7' Tank yard: Do ++3
Type of inert gas �Tc Tank yard address . t'� 1Z 1 `
City or Town W�U"t��t�� FDID# d�� Z�— Permit# �
Date of issue 40 Date of expiration ''L�f L(G
Dig safe approval number. -2 1 ' ✓ 1 Sat oll Freee�aTel.rYNuml:beyr- p8�00--3y22-4844�yr��t
n'Ji oti 9 rV ll'�! c"�!` E. 11 i1�P1Yrr
Signature/Title of Officer granting permit I VI 'DEPARTMENTh
Vi 1 11
C, ULD. EXT
After removal(s) ("Consumptive Use"fuel oil tanks exempted)send Form FP-29OR signe Local r�Mipa'r Tter edlfflce of the
State Fire Marshal, UST Regulatory Compliance Unit,_P:O-Box'1025,Stow, MA 01775.
'International Fire Code Institute �� Z� yv: 2 `J � �Q—
FP-292(revised 4/97)
f - -
rtre uepanmenL reiams onginai appucauun anu tssu— uuNnaa— as rcnntr.
" 9)96�,n6 olC 'riXe �— ✓cJoaixcz'a� rixe ��
APPLICATION and PERMIT Fee: 10,00
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
. ,
Tank Owner Name(please print) ` ol:- Y X
r Signalurs Id a-pp*r y[or pamup
Address 5 Z C`7 t�l l_�4V lids- . �� U��r�V'�Cr FT OZat
strew City State Zip
- . 1 H •Company Name Co. or Individual (T�1-0 G-MC..- Wn!K( C r sD:��
PMt Pmi
Address N! Address I 4�Z7�L \ ,}�yDSiUt�y
Prim fM q Pau n-
f applying or perm') ` '�{- Signature (if applying for permit) N\
CI'Certified Other 'iFCI'Certified 0 LSP# Other
17,111
--------------
�J---� --- —_
Tank Location -5 � �% za i= P'c L��1 Ems' rh F— 1 1`,t l f� A
� Slesrtidcreu `' Gry�
Tank Capacity(gallons) �� e)o 0 _Substance_Last Stored--- 4�8- S-6(---44 ,_Cc
Tank Dimensions(diameter x length) C� ` ��!?In�CJ 9C .
Remarks:
. . (.1 d I I I`-
,
Firm transporting waste State Lic. #
Hazardous waste manifest# E.P.A.It
Approved tank disposal yard -J �n S ��r� _' Tank yard# 190
Type of inert gas <--G Tank yard address .
City or Town �, �f ,s FDID# �� ZL— Permit# �
Date of issue � )? Date of expiration
Dig safe approval number. 7�r�z- 0� ✓ �� Safe Toll Free Tel. Number-800-322-4844
Signature/Title of Officer granting permit r't!�24t �fgt� aa�z�aAAxn. AA e
. JYWY YY. Y'i Y. YW Y rV Yy
bEPARTIly ENT
After removal(s) ("Consumptive Use"fuel oil tanks exempted)send Form FP-29OR signed by LQWjG0j%VaftenD oERffice of the
State Fire Marshal, UST Regulatory comnliance Unit,.2.0-Box-1025;Stow,-MA-01775: I�r 601
'International Fire Code Institute i, �Z —
__ n -r�A _ Q� �'R`i•�V \
FP-292(revised 4/97) �/
Make application to local Fire Department.
Fire Department retains original application and issues duplicate as Permit. .
_ f2V
APPLICATION and PERMIT Fee:
for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions
of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by:
• //
Tank Owner Name(please print) 91 of L- X
_ fYre demur- .
Address J-z-;Lb O Zlle 41JS ,AJe lr'RD v i c(e"i C, �� U za Q e .5,
Sneer Qr/ state Zia
l Company Name �e SS��',� ` Sjf//{�jd S Co.or Individual f-5eDJOC� C' 5�;�'U/C L.0 go
PrW
Address_�ysl�f%I�j 1!'/�/C y e PL-dllA,* Address /s &'V ltr'}2e l/ Ave /9'y d s-w
t�
Signature if applying for ermit) Signature(if applying for permit)
❑ IFCI'Certified Other ❑ IFCI•Certified ❑ LSP# Other
Tank Location
SteerAd*sss Giry '
Tank Capacity(gallons) ;ate V Substance Last Stored
Tank Dimensions(diameter x length)
Remarks-
Firm transporting waste State Lic.#
Hazardous waste manifest# E.P.A.#
Approved tank disposal yard ,v Tank yard#
Type of inert gas Tank yard address /► C' S S Ae-
Asa •
City or Town I N vS FDID# (. 2 Permit# V ��
Date of issue v�(�.�u Date of expiration u!rt Z�G Z
Dig safe approval number O O i oll Free Tel.Number-800-322-4844
Signature/Title of Officer granting permit ee u ru T
e
After removal(s) ("Consumptive Use"fuel oil tanks exempted)send Form FP-29OR sign oca9&WI6";ArRt8r6f of the
State Fire Marshal, UST Regulatory Compliance Unit, P.O.Box 1025, Stow,MA 01775. HYANNIS, MA 02601
'International Fire Code Institute
'P-292(revised 4197)
TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO. TAG NO.
ADDRESS OF TANK: _ 07 VILLAGE: V/d
Numbwr •tr��t
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : 4
OWNER NAME: PHONE: � 77/, Z-�~�/
INSTALLATION DATES BY:
INSTALLER ADDRESS: -CERT .NO.
*TANK LOCATION: ABOVE BELOW
(owso"InK TANK LOCATION WITH RGOPQCT TO nwl"DINO)
CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL
TESTING CERTIFICATION [PASS [ ] FAIL DATE
LEAK DETECTION [ --f CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION ( ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [I YES ( ] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. ( ] DATE
* PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
'•�T. _ti�.�.r,^. :. �. wrv',.r.a,�,•,,,,"..._,,..,,.__ ,....-'w,r.. . ..w--+r."<a^.-r•�,.rt};,.v.:-w:o*.:t'?'.-.�.r,`.�.at.,•-a=rar,r-F,'Als .,�c-ys,.P�R• �,,:�.,... ,-,-+- -....-r,.. -�--•,..ii'�'viG+.i
TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
s MAP- NO. PARCEL NO. TAG NO.
ADDRESS OF TANK: _ �77 VILLAGE:
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : Q
OWNER NAME: /"��� J�r7/'7I�J� ���r� / l/�,� PHONE: So 77/, Z
INSTALLATION DATE: BY:
INSTALLER ADDRESS: -CERT.NO.
*TANK LOCATION: ABOVE BELOW
(DOOR I aC TANK LOCATION WIT" RQOP@CT TO 7u I LSD i NO)
CAPACIfTY TYPE OF TANK AGE YRS . FUEL/CHEMICAL
TESTING CERTIFICATION [ V] PASS [ ] FAIL DATE
r
LEAK DETECTION . [ mil CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [ I YES . [ ] NO DATE
CONSERVATION [ ] 'CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
'i
TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION
T MAP" NO. PARCEL NO. TAG NO.
ADDRESS OF TANK: 77 �� ��/'��/ /^� J VILLAGE: _
Number
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) :
OWNER NAME: I 'rGi��J /7/`71 ���rJ�'/^J/'�i� / PHONE: J Jl- 77/'
INSTALLATION DATE: BY:
INSTALLER ADDRESS: 'CERT .NO.
*TANK LOCATION: ABOVE BELOW
(DCOOPi I OQ TANK LOCAT I ON W I TH "QOPQCT TO >U I LSD I NO)
CAPACITY TYPE OF TANK AGE YRS. FUEL/CHEMICAL
TESTING CERTIFICATION ^PASS [ ] FAIL DATE
LEAK DETECTION � CHECK IF N/A TYPE/BRAND
ZONE OF CONTRIBUTION [ ] YES [ .] NO DATE TO BE REMOVED
FIRE DEPT. PERMIT ISSUED [j YES [ ] NO DATE
CONSERVATION [ ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. [ ] DATE
PLEASE PROVIDE A SKETCH SHOWING THE .TANK LOCATION ON THE BACK OF THIS CARD
TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
MAP NO. PARCEL NO.
ADDRESS OF TANK: / / VlAit l o r- VILLAGE:
Numbmr wtr-�mt
MAILING ADDRESS ( IF DIFFERENT FROM ABOVE) : '"i-oo
C:2 '-?o
OWNER NAME: i7't r_. �ra, PHONE: ear!
I NSTALLAT ION DATE: 4 BY: utl r�lkti if
INSTALLER ADDRESS: CERT.NO.
STANK LOCATION: ...-
(DiYCRI•t TANK LOCATION WITH RKU"KCT TO RUiLDIN0)
CAPACITY .5CZ%' TYPE OF TANK ` %r.- �r AGE YRS.. FUEL/CHEMICAL rJf--L, 61
2
TESTING CERTIFICATION C ] PASS C ] FAIL DATE . iQ<1\lolv'Aj
LEAK DETECTION [ ]. CHECK IF N/A TYPE/BRAND ky;\i
ZONE OF CONTRIBUTION 1)4 YES C ] NO —I}A`-TE TO BE REM0 VIE D
FIRE DEPT. PERMIT ISSUED C YES C ] NO DATE
CONSERVATION C ] CHECK IF N/A DATE
BOARD OF HEALTH TAG NO. Cq5l ] DATE IX6 UA/'
a :� o
T
f1 Ht 1A t
� PLEASE PROVIDE SKETCH SHOWING THE TANK LOCATION ON THE . BACK OF THIS CARD
TOXIC AND HAZARpDO,,US MATERIALS REGIST TION FORM
NAME OF FIRM: J
� �"�3-0-��Q,t,, - r�_*y
K -
MAILING ADDRESS: �'�" �`'`""" gT O� �a /
TELEPHONE NUMBER: f- &l 7-
CONTACT PERSON:
Does your firm -store-any of-the -toxic o-r-hazar-dohs--mat-eri:als -1ist.ed_below_,_ .
either for sale or for your own use, in quantities totalling, at any time, more
than 50 gallons liquid volume or 25 pounds dry weight? YES NO
This form must be returned to the Board of Health regardless of a YES or NO
answer. Use the enclosed envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a
site other than your mailing address :
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS .MATERIALS
The Board of Health has determined that the following products exhibit toxic i
or hazardous characteristics and must be registered when stored in quantities
totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put
a check beside each product that you store:
Antifreeze (for gasline or coolant systems) Refrigerants
Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
Hydraulic fluid (including brake fluid) Photochemicals
Motor oils/waste oils ;p
Gasoline, Jet fuel Printing Ink
Wood preservatives
Diesel fuel , Kerosene, #2 heating oil (creosote)
Other petroleum products: grease, Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Degreasers for driveways & garages Leather dyes j
Battery acid. (electrolyte) ,Fertilizers (if stored i
Rustproofers
outdoors)
Car wash detergents PCB' s
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) Other products not listed
which you feel may be
Spot removers & cleaning flu4IdgZ C E I V E ® toxic or hazardous (please
(dry cleaners) HEALTH DEPT. list.l:.
Other cleaning solvents TOWN OF BARNSIA3LE
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 1 5 1981
Disinfectants
Road Salt (Halite)
J ,
TOWN OF BARNSTABLE
. BOAR ® OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION, SHEET
w
FIRM WIVIO
Y 0`5
ADDRESS r ,
Major types of materials: 1) 2) 3)
4) , 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 v/or # Remarks/RecommeT ions `
1. Indoor
. .a) separate, contained room
b . "} stored general work area
i) inadequate ventilation
ii),.:&I"or drains
iii) dequate fire protection
2. Outdoor
a) uncovered, exposed to weather rx
b) pervious surface/catch basins
III. Disposal "
A. Reclamation/Recycling unit
B. On-site disposal
1. Town sewer
2. Regular septic system
3. Separate holding tank
C. Off-site disposal
1. hauled by own firm
r
2. hired hauler
a) name of hauler
b) address or disposal site
Persons) Interviewe Ins ector _
- - - - - - - p —
- - '= — — — — — — — — — —
Date - - - — — — — — —
6 3 0- 8 1
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: S/�' - ��^ Board of Health
MAILING ADDRESS: A/ Wv04A-1,0 Town of Barnstable
TELEPHONE NUMBER: �.v `^ Q 61,4 P.O. Box 534
CONTACT PERSON:
Hyannis, MA 02601
����
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totallin 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 when stored '
lease put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants �rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, 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) 5 h
Other cleaning solvents WA 71:; amlq Z.
Bug and tar removers
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
i_
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
2.Printers
O satisfactory
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT I IN OUTI IN OUT #&gallons Age Test
ls:
Ga ine,Jet A)
Diesel, Kerose #2 (B)
/re'rV, or- ?7�_� e__
e waste C)
9Vn
s •s
ne motor oil (C)
trans issio draulic
SyntheXers
ganics:
degre
iscellaneous:
I
DISPOSAL'RECLAMATION REMARKS:
V1. Sanitary Sewage 2. ater Supply
Town Sewer Public
O On-site OPrivate
V3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
V 4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
�1�
5.Waste Transporter is45� eL0
Name of Hauler Destination Waste Product
zhAf-Tfq--V YES NO
�y�/ r, l z- ,4- oc
Da e erso Interviewed Inspect-or