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Home My WebLink About0625 WEST MAIN STREET - HAZMAT — — - O'l to i 1 Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Star Market#4595 .-------------------------------------------------------------------------------------------------------------------------------- 625 WEST MAIN STREET, HYANNIS,AZ .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BAMSTABLE ��T�(] ry.:rasru,:i s:�nrut.rr mrccx• r Public Health Division �= •' ':Oi•''.`'.ucsn:e[e - !6-9-Zol• � Thomas McKean Director. MASS, S ' '� ►` 200 Main Street,Hyannis,INIA 02601 c ry Officc: 508-862-4644 Fax: 508-790-6304 r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH T14E 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 l 1-1 —499 Gallons. $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 � *A late charge of$10.00 will be assessed if payment is not received by July l st. 1. ASSESSOR'S MAP AND PARCEL NO. 248-079 to 248-192 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: Shaw's Supermarkets, Inc. 5. NAME OF ESTABLISHMENT: SHAW'S#4595 6. ADDRESS OF ESTABLISHMENT: 625 W Main St Hyannis MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: PO Box 29096, MS-6531 oenix, AZ 85M8-9096 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-3421 NASC.Tax@safeway.com 9. EMAIL ADDRESS: 10. SOLEOWNER: YES X NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Shaw's Supermarkets, Inc. PRESIDENT See attached TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE, OF APPLICANT DATE � Q � Q:AApplication Formslllaz Mat Appli Draft Jan2019.doe, h Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Star Market#4595 625 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------- --------------- --------------------------------------------------------- ----------------------- --------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. -------------------- -----...----------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. _ 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health r l � Town of Barnstable Inspectional Services BARNSTABI,E 1. • CF THE `7[w- an�wsme�•anT�SS��.�.L-wah•xra�r- aM31C.'b pN..•03'FFlu!i?A9FK:.NP Public Health Division ::il9-=t4 BARNWABU, Thomas McKean, Director 1659. p`0 200 Main Street, Hyannis,MA 02601 n X. 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-NNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 x"�� *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 248-076-00B 2. IS THIS A PERMIT RENEWAL? V YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Star Markets Company, Inc. 5. NAME OF ESTABLISHMENT: Star Market#4595 6. ADDRESS OF ESTABLISHMENT: 625 W. Main Street, Hyannis, MA 02601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: PO Box 20, Dept. 9938819, Boise, ID 83726 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-3421 9. EMAIL ADDRESS: s4595c90@shaws.com 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: 208-395-6200 CORPORATION NAME Albertsons Companies, 250 E. Parkcenter Blvd., Boise, ID 83706 PRESIDENT &CEO Vivek Sankaran VP TREASURER_ Gary Morton :C-$ Sr. Environmental Compliance Manager, Erica Fransen 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE May 29, 2019 Q:1Application FormsUHaz Mat App Revised 09-10-18.docx Erica Fransen i c Town of Barnstable Inspectional Services • " MAM ' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 10, 2019 NOTICE HAZARDOUS MATERIALS RENEWALS All businesses that handle and/or store hazardous materials greater than household quantities are required to obtain an annual permit with the Public Health Division. Your current permit to store and/or utilize hazardous materials will expire on June 303 2019. The fees are outlined below based on Category. A $10 late fee will be assessed if payment is received after July lst APPLICATION FEES CATEGORY 1 PERIVIIT 26— 110. Gallons: $50.00 • CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V Star Market#4595 If you have any questions or concerns, please contact Public Health Division at 508-862-4644. Thank you. Sincerely, ��ascKean, R.S., CHO Agent of the Board of Health QAHazmatWotice Letter for Renewals 2019-2020.docx } c J i Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------- --------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health QV,-# bX3q-ra2-- � wLoegilatory%Xervlcesof Bnstable x Richard V. Scah,Director Public Health Division BARNSTABLE � • ASAA9.MASS. ; Thomas McKean,Director 1639-2014 ' 1639. 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—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 -Pf V S . *A late charge of$10.00 will be assessed if payment is not received by JulYIst 1. ASSESSOR'S MAP AND PARCEL NO. 248-076-00B 2. IS THIS A PERMIT RENEWAL? ❑✓ YES,NO. IF YES,SIB 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: Star Markets Company, Inc. 5. NAME OF ESTABLISHMENT: Star Market#4595 6. ADDRESS OF ESTABLISHMENT: 625 W. Main Street, Hyannis, MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: PO Box 20, Dept. 81014, Boise, ID 83726 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-3421 9. EMAIL ADDRESS: s4595c90@shaws.com 10. SOLEOWNER: W]YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,4E ADDRESS,AND TELEPHONE#OF: 208-395-6200 CORPORATION NAME New Albertsons, Inc.,250 E. Parkcenter Blvd., Boise, ID 83706 Shaws PRESIDENT Paul Gossett VP TREASURER Gary Morton CORK Sr. Environmental Compliance Manager, Erica Fransen 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE May 21,2018 Q:1Appiicaiion FomiMAZMAT APP 2017 REVISED.docx Erica Fransen Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health C.A fir. �'+�� y• I o (a4-z 'TRown�of Bqrnstable egu atory 3ervices Richard V. Scali, Director " Public Health Division BARNSTABLE i BABNSrABM '' asysz,.uaa nzx ru mrcr.r3xn:, 9 MAss Thomas McKean,Director us1�820A 1659. 200 Main Street,Hyannis,MA 02601 P Office: 508-862-4644 a0-7-aO76 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑✓ vs. ✓❑*A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 248-076-00B 2. IS THIS A PERMIT RENEWAL? ❑� YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Star Markets Company, Inc. 5. NAME OF ESTABLISHMENT: Star Market#7595 6. ADDRESS OF ESTABLISHMENT• 625 W. Main Street, Hyannis, MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: PO Box 20, Dept. 81014, Boise, ID 83726 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-3421 9. EMAIL ADDRESS: s07595.dir@shaws.com 10. SOLEOWNER: 7 YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,]ROM19 ADDRESS,AND TELEPHONE#OF: 208-395-6200 CORPORATION NAME New Albertsons, Inc., 250 E. Parkcenter Blvd., Boise, ID 83706 Shaws PRESIDENT Paul Gossett NAI VP TREASURER Gary Morton CORK Sr. Environmental Compliance Manager, Erica Fransen 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT �� DATE August 1, 2017 • C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx Erica Fransen Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 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 tj f f Town of Barnstable Regulatory Services g Y • Thomas F. Geiler,Director °ARMA`S.M • Public Health Division '639• At� 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. 248-076-OOB DATE June 11, 2015 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Shaw's Supermarkets, Inc. NAME OF ESTABLISHMENT Star#7595 • ADDRESS OF ESTABLISHME ain Street, Hyannis, MA 02601 TELEPHONE NUMBER 508-775-3421 SOLE OWNER:W1YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 043243710 STATE OF INCORPORATION Massachusetts Mailing FULL NAME AND ICE ADDRESS OF: PO Box 20, Dept. 81014, Boise, ID 83726 PRESIDENT Justin Dye, COO TREASURER Mike Bessent CiruERKENVIRONMENTAL COMPLIANCE MA R Eri Fransen iDoug Kasefang, Dir. Environmental Affairs i S NATURE OF APPLICANT RESTRICTIONS: Mailing 00ME ADDRESS Same as above Office #OME TELEPHONE# 208-395-4793 erica.fransen@albertsons.com Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department • l BARNSTAFILK' ; Public Health Division MASS. Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015 Check number: 01153080 Check amount: $200.00 Name on check: Albertsons ,Business: Shaw's Supermarkets, INC Owner: TRT HYANNIS LLC !Address: 625 WEST MAIN STREET, Hyannis E i Note: Star #7595 i • Town of Barnstable Regulatory Services Richard V. Scali, Director tOjq. A� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02.601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul I Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS JUN 112015 WITH HAZARDOUS MATERIALS 5q� IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and • to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2: 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the: Town ofBarnstable. MAIL all of the above to this office on or before June 30, 2015. A late charge of$10.00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www,town.bamstable.ma.us , which.is located under the E-Code section if, you should have any questions or concerns. QAHa=naAHaz Mat Pernut Letter.DOC 60 39dd 13ANVW�NIS T80V899809T 0Z:00 STOZ/60/90 7zo Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 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 06/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 03/31/2015 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable a Regulatory Services Thomas F. Geiler,Director , Public Health Division Fn Nuc+"1639. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-10,6304 Application Fee: $100.00 ? ASSESSORS MAP AND PARCEL NO. 295-019-XF1 DATE March 24, 2015 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Shaw's Supermarkets, Inc. NAME OF ESTABLISHMENT Shaw's #7598 ADDRESS OF ESTABLISHMENT 1070 lyannough Road, Hyannis, MA 02601 TELEPHONE NUMBER 508-775-7611 SOLE OWNER:FV YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IFF� APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 043243710.�!1 S STATE OF INCORPORATION Massachusetts Mailing FULL NAME AND IMMF ADDRESS OF: PO Box 20, Dept. 81014, Boise, ID 83726 PRESIDENT Justin Dye, COO TREASURER Mike Bessent CLERK Erica Fransen, Environmental Compliance Mqr. erica.fransen@albertsons.com SIGNATURE OF APPLICANT RESTRICTIONS: Mailing HOMW,ADDRESS Same as above Office *OMC TELEPHONE # 208-395-4793 Op THE�p Town of Barnstable i Public Health Division BARNSTABLE. 200 Main Street - + ,� y+;q' j U.S.POSTAGE;'PITNEY BOWES -! C MASS. Hyannis,MA 02601 . b. i e r:• .� ti.+ F +� ZIP 02601 $ ®®D.�Fqq 8o 02 1VN 0001383424 MAR. 30. 2015, .n h . *N �� t j= �. Albertons's - Shaws/Star �' . Environmental Compliance Mgr-Erica Fransen PO Box 20 Dept. 81014 - I Boise, ID 83726 i. r l 3�3 d T � — Office: 508-862-4644 %Fo� Town of Barnstable Fax: 508-790-6304 .� Regulatory Services Department BARN"I'AULE. Public Health Division �+tAss• 0 Thomas A.McKean,CHO 200 Main Street,Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 3/30/2015 Permit number: 1155 Check number: 01135447 Check amount: $200.00 Name on check: Albertsons' Business: STAR#7595 Owner: Albertsons' Supermarkets Address: 625 W. Main Street, Hyannis Note: Star is a subsidary of Shaws who is owned by Albertsons. �J /P3y rJ Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 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. 5/1/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health lOwn 0I Daylinitiluir . BarnstaDl-e Regulatory Services -Department d AR o Public Health ]Division r WAjW 200 Main Street, Hya=is MA 02601 16 2007 Office; 508-862-4644 Thomas F.Oeiler,Director EAX: 508-790-6304 Thomas-A,McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL,NO. 248-076-OOB DATE May 1, 2014 APPI_,ICATION FOR PERMIT TO STORE.AND/OR LJTILIZF MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME.OF APPLICANT Shaw's Supermarkets, Inc. NAME OF ESTABLISHMENT Star 7595 ADDRESS OF ESTABLISHMENT 625 W Main Street, Hyannis, MA 02601 TELEPHONE NUMBPR 508-775-3421 SOLE OWNER.MYES NO IF APPLICANT IS A PARTNERSHIP',FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION; FEDERAL IDENTIFICATION NO, 043243710 STATE OF INCORPORATION Massachusetts Mailing FULL NAME AND XffX ADDRESS OF: PO Box 20, Dept. 72405, Boise, ID 83726 PRESIDENT James Rice TREASURER . CLERK Erica Fransen, Environmental Compliance Manager SIGNATURE OF APPLICANT" RESTRICTIONS: Mailing IWO= ADDRESS same as above Work tMX TELEPHONE# 208-395-4793 Minspccfion handoutsan Mat Application20000C Z0 �hd� l��i�ldl^l�id1S TE0b895809t 58�b0 bZOZ/6Z/b0 I 'y°FIKE r°H� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA.B% 200 Main Street• Hyannis, MA 02601 �A 039.A M �0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED P'� Business Name: 56r Date: n A Location/Mailing Address: 6.rkSM } Contact Name/Phone: M-77; - Inventory Total Amount: "�500 SDS: onlihe License.#: Tier II : ICI Labelina: Spill Plan: Oil/WaterSeparator: N/ l Floor Drains: VC) Emergency Numbers: Storage AreaslTanks: ch n Slord a C ins Emergency/Containment Equipment: &_ 5 6r q, Waste Generator ID: /WR Waste Product: VoTrieN, -.flaprva��R� cam Date&Amount of Last Shi ment/Fre uenc : i Cng n Licensed Waste Hauler&Destination: O SA i6h Z Other Waste Disposal Methods: Tlef 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 d 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) a Windshield wash V Motor oilsMiscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil V 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) �/ ar 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) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION RECOMMENDATIONS: Q fl - d. urkip, Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS IME r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' B"BMSTAB`E.g 200 Main Street• Hyannis, MA 02601 ,639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MPS Business Name: c' Date: Location/Mailing Address: 1 ` 1� Contact Name/Phone: t Inventory Total Amount: SIDS: License#: Tier II : Labelina: J e- ' Spill Plan: Oi I/Water Separator: Floor Drains: IIJ W Emergency Numbers: z ' Storage Areas/Tanks: CQ N Emer enc /Containment E ui ment: r Waste Generator ID: 9 77S Lig, Waste Product: —��;s �LILI�Y�LAc Date&Amount of Last Shipment/Frequency: �J �J Licensed Waste Hauler&Destination: 012%ea 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 an disposal of 111 gallons or more requires a license from the Public Health Division. t✓ Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers ZO Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) V— Windshield wash V Motor oils lS V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants V Miscellaneous petroleum products: Road salts grease, lubricants, gear oil V 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 ,Asphalt 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) �'� 3 30 Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: ` `() Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p IKE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B`",„�`E�, 200 Main Street• Hyannis, MA 02601 f6 0 39• ?Eon+" TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 54-kl a-r1ee+ Date: `f Location/Mailing Address: 62.E Wesk ,>^ '5 a,4 Contact Name/Phone: 5kbcc �� w+ - S}QK a, cur Sob-77�-3 2 t CCWfaCJ1 : tJI,.e-Ly KCk J¢wV \eh 0.�.ow� Inventory Total Amount: MSDS: License#: 1 ss Tier II : o Labeling: Spill Plan: Cl� Oil/WaterSeparator: Floor Drains: � Emergenc Numbers: A ►�CE45 Storage Areas/Tanks: �- Cb�n�atttptS r4� 1D wbcll�. Emergency/Containment Equipment: 'A ' w• K, Sv�l w Q c�I ,11 wt le. IP. aa,forc��a4.�1" Waste Generator ID: 't7 �{ l Waste Product: v%l i, •�e, (a�tic6Vr Date&Amount of Last Shipment/Frequency: Z� j to ( A-2 Licensed Waste Hauler&Destination: Q bl�� E�J, ScJ• or \� tout �� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers 4v Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners cro5 �� 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: t7 u \ CD V'O'C a 4 11A- vim, vim¢ v 5a O-c t tti 0X25. INFO ATION/RECOM E NS:al tOktk 46L, ,Ow\0 tic t� uK 9I&V1 C01,1V111Kt--- E.r,«. �lavt4evl p8_3?5 q-719nspector:" ` L Facility Representative: P11 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IL Number Fee 1155 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that STAR #7595 625 WEST MAIN STREET, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. --------------------------------- 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 ,ate toy Regulatory Services Richard V. Scali,Director 79�0 Public Health Division low MABB � \Thomas McKean,Director �/ �200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Q 1Q Fax: 508-79M04 APPLICATION FOR PERMIT TO STOREAND/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 1TERMIT 26- 110 Gallons: $50.00 . ❑ CATEGORY 2 PERMIT 111 --499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00l i A late cliarge of$10 00 will be assessed if paytnent is not received by July1st. ASSESSORS MAP AND PARCEL NO. 248-076-00B DATE June 23, 2016 FULL NAME OF APPLICANT: Shaw's Supermarkets, Inc. l NAME OF ESTABLISHMENT: Star Market#7595 ! ! ADDRESS OF ESTABLISHMENT: 625 W. Main Street, Hyannis, MA 02601 MAILING ADDRESS(IF DII+'FERENT): PO Box 20, Dept. 81014, Boise, ID 83726 TELEPHONE NUMBER OF ESTABLISHMENT: 508-775-3421 . EMAIL ADDRESS: s07595.dir@shaws.com SOLE OWNER: P11YES_NO IF NO,NAME OF PARTNER: ; , FULL NAME,HEADDRESS AND TELEPHONE#on 208-395-6200 CORPORATION NAME New dlbertsons, Inc., 250 E. Parkcenter Blvd., Boise, ID 83706 PRFSF PRINCIPAL OFFICER Jim Perkins. COO TREASURER Gary Morton VP G]6ERK-- SR. ENVIRONMENTAL,COMPLIANCE MANAGER Erica Fransen IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address : Erica Fransen Telephone#: Email: QAApplication FormAHAZZAPP Rev:6.doox Page I of °Ftro Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMSf�BLE.�` 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �+ezv r Date: Location/Mailing Address: 4. 2s a1K anAIS Contact Name/Phone: o -717 - 4-2-1 L rkcl ace wtw- n for r-oM �or� 6VK2A\e-!F/'r Invento TotalAmount:kJ�>' MSDS: 3C CAR "k- License#: 1163 -!�Oi n Tier II : 0A Labeling: Ol000e Spill Plan: eS BOA 3 Oil/Water Separator: Floor Drains: �o Emergency Numbers: `*/e,5 Storage Areas/Tanks: iVt V, C e t.?- oXLS o c\A4 -0-1 all label b Emergency/Containment Equipment: II le, PJ So�t,r6 t Q Waste Generator ID: tA4508-1-153 L'2I Waste Product: Date&Amount of Last Shi ment/Fre uenc : 1 o r A--(,,D I)D 2 r Licensed Waste Hauler&Destination: Z{•G Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes 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, nn hydrochloric acid, other acids) VIOLATIONS: \M\V VkI, P-)e- ORDERS: I-W-0 k9-&c v5 c kZ<\AS 1 n QA-( INF RMATION/RECOMMENDATIONS: eA- `\a �c,< CO X Cow L . d o< <QZ0 X g t, Inspector 0p pr /�6go 61& ItioJ9�-1 Uf %V� e1µ�\c a( 5tecn4t �q�• Facility Representative: 0 WHITE COPY-/HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: Y /0,"/ Iq TOWN OF BARNSTABLE s `t,,v%— �9 TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: -'A-a<- MaAz,-t 7 IIli�IIo„� BUSINESS LOCATION: 25' We-A IMAjv. ' � , --Avws INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: 5"0$ 1' 4o Ve- C,,,j k CONTACT PERSON: (�Zyy\kf- I-. v� kA, 12)D C�n��c1.�\\ .3r�c �a�,� 5-1nn NIA <�,rece�vZ� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: u A1�orv�— INFORMATION / RECOMMENDATIONS: ' s J-, c 0% - 1 V-A- Fi're District: ,} t/ a�n 5 0 A. 4ik� K�Cri �x �I c` 1!11 ^ 6%& S A}t—�otaa kn tynA;, v ovt ►�2J AA xlrwk v5 ida5�z,area,o14vt! jAevg be-,vL o Ak a k,5vSQ� LAf..A.v%Arf�kJv&ks e,4P w Waste . _mgSDco7`76'34-2 1 Last shipment of hazardous waste: 15 14 Name of Hauler: Destination: ��,a✓L, pol.s,y� zx�r� Waste Product: .,Parx.aocrb4,ytA License No cook tol�� 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 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/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials L TOWN OF tARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 0 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: ---07 Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons A estge T Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers i Miscellaneous: U II DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply own Sewer '*�ublic /O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO V' ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. WIMIAAI , AAA10A t rson ( } Inte ewe Inspect& Date y TOXIC-ANID HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: CA ei: Wits!bg RAF-60a I_ Board of Health MAILING ADDRESS: 60 \/rse dAia HYAi4tii-s, MAss. Town of Barnstable TELEPHONE NUMBER: 5'09,:- 779"`f jYY P.O. Box 534 CONTACT PERSON: �AAY �.�(�lcN 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 totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES 'DIES NO _ i'Cpi 0A * s)ram. 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 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) f/ 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) 1/ Wood preservatives (creosote) Rustproofers t,/ Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners VAsphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) bl Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, f/ 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) d/ Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business