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HomeMy WebLinkAbout0058 WILLOW AVENUE - HAZMAT Iluc� e 3a 1 - 0 f0-7 4 Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel ...------------------------------------------------------------------------------------------------------------------------------ 58 Willow Ave, Hyannis, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town Of Barnstable Inspectional Services STABLE Public Health Division dV-x914 Thomas McKean,Director NAM 200 Main Street, Hytinnis,MA 02601 Office: 508-862-4644 Fax; 508.790-6304 APPLICATION FOR PERMIT TO STORE ANDIOR 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 1ULY Ist—JUNE 30th). . APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT" 111 —499 Gallons: $125.00 � ���' � CATEGORY 3 PERMIT' 500 or more Gallons: $150.00 *A late charge of$10.00 will be assessed if pa my ent is not received by July 1st. V40•0`0 1. ASSESSOR'S MAP AND PARCEL NO. z Z -0 z,, 7 Z 2. IS THIS A PERMIT RENEWAL."�YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)" YES NO. 4. FULL NAME OF APPLICANT: - - f • 5. NAME OF ESTABLISHMENT: ac, f-v 6. ADDRESS OF ESTABLISHMENT: lam/ L 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �6 (/�% /—OOl// (zGiF��' -�`` 9. EMAIL ADDRESS: > 0 10. SOLEOWNER: YES NO IF NO,NAME OF TNER: 1 L FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME K�.et_ 14a l-e PRESIDENT ' TREASURER S CLERK °''- g 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE %d2e�__ CJ Q:'\Apptication Fonnfflax Mat App Revised M-10-1&docx Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, 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 i Town of Barnstable X�o��.��� .►� Inspectional Services BARNSTABLE oF row Public Health Division 6 2(it BARNSTABLE, + Thomas McKean Director 9 MASS. ) .:..,-. 4',,rFn3+a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 5&790-6304 :c. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE r HAZARDOUS MATERIALS - j 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 ❑ F *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. O 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIIESS (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: „ /12 6. ADDRESS OF ESTABLISHMENT: (tJ i2A 4212- n 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: /c 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Q' e 10. SOLEOWNF,R: YES NO IF NO, NAME OF PARTNER: 10. SOLEOWNERA 11. FULL NAME, HOME AD SS,AN TEL P . O. E # OF: ^G CORPORATION NAME t Ur C, (�'" 771— �p PRESIDENT �s 16-3 Cip 3p TREASU R /h ,4`3 CLE &M-a— /d 3 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICA DATE c Q:\Application Dorms\Haz Mat App Revised 09-10- 0 Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ,. P Tow of Unstable Regulatoervices t"e Richard V. Scali, Director of *� Public Health Division BARNSTABLE BA ffrABM ' Thomas McKean, Director ♦ W1q$TOX$MIL'S-OSfENVLE.WEST&1'nNSiM:E aMASS. - ♦� —— -200 Main Street,Hyannis;MA 02601-- Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26-110 Gallons: --$ 50.00 ❑ - CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 X VIS . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?4 YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25/GALLO/NS)? YES NO. ME .- 4. FULL NA OF APPLICANT: ��l�f�/Y�`j,�� //7 L 5. NAME OF ESTABLISHMENT: 1C klc el�!/lrkll /2IC . 6. ADDRESS OF ESTABLISHMENT:d-pe , . 0a. ` 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: &'TT- 7 71— 114 O/ 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULCORPLORATION N1AE ADD ME �RF ,AD ell0 .FjP/ONE# OF: .�7� G, PRESIDEN t. = a i� ss/,ll/ TREASURER 44 e r- s S Qr1 �a i- /7? 3 y 9 CLERK h./ /n e-. -- S e ss 6 r!V-e.� �� n t s G'r U L6 l r SS 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC T ATE Q Upplication Formsk HAZMAT APP 2017 RE docx pf IKE�Oy, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS .. • 200 Main Street• Hyannis, MA 02601 16 39 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Tf0 PS D Business Name: C4.¢Z comic �"��k 1a k -(1?ewtoy&A <yiee5, Date: Location/Mailing Address: .J o,. v-e— , Contact Name/Phone: �R�w�o-c Sl^avg ttLSs y o& - -7-7 1- Ooo / Inventory Total Amount:� !0 , SIDS: e"����^-�- �cc�s S License#: Tier 11 : _A)o yoo9� Labeling: OK Spill Plan: Off'- /G,1it os�nG�GS Oil/WaterSeparator: M Floor Drains: A16 Emergency Numbers: '8 5 Storage Areas/Tanks: 3-2;5&0ct vd fagk-frvelcs Je<.c+ovt, s,*-, 2'7�-was+e o,!Asf, 2 Emergency/Containment Equipment: Sorbc.* o c l+s lk-trvcke, Waste Generator ID: /Vly!rg>&"7-7$ 92(o WastJ Product: 01 I Date&Amount of Last Shi ment/Fre uenc : 1 SD qa ) 2/5.2 f l-1 ti ix Jw. o . Licensed Waste Hauler&Destination: o n (J'tu �,l (o• —7 Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS/1/o ram)�r C�i�`+n-�,C- ,r� ►►tv� "may �kc c_ l&.5 f /H gAc�-f o►L, NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, I 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 4� 06-S}-e- 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: Ke 't at.-(' q,a S e Vt` a 5 i z- o e Le Je-KI ei--Ofy 19 INFORMATION/RECOMMENDATIONS: MAAA4 q4-5:) GLV OL, 1 o,..- JOL64 rVPACS r✓l avt I �e5 k 40 �l�A.�� o��-�"• Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, 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 TRpwrl�of B nstable p �� egu ato1 ervlces Richard V. Scali,Director . � Public Health Division STABLE '4' IEvtRNB'M84�, q i°i'^ns'x its rr-e'�a rFwr v.. Thomas McKean,Director .a � 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 c �q—cR O (/ 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 11 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 1st 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? >< YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF '. GREATER THANMOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: �(,cJ k 04 ord�G l / C 5. NAME OF ESTABLISHMENT:_�k` &G{/"Ghc.G� l/)C 6. ADDRESS OF ESTABLISHMENT: V, —p C j/<l0 y`f✓Q 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 77 7 9. EMAIL ADDRESS: v 10. SOLEOWNER:-)�—YES_NO IF NO, NAME OF PARTNER:'—'' 11. FULL NAME,HOME ADDRESS,A , TEL PHONE#OF: CORPORATION NAME cl� � C�c 6'0 7l, PRESIDENT 02�3 TREASURERVJ,oes Gc �3 seer �r Q 3 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: Y SIGNATURE OF APPLI DATE 7a i�a o C:\Users\Decollik\AppData\Local\Microsoft\Window m rary In net Files\Content.Outlook\BMQD49H2\ AZMAT APP 2017 REVISED.docx IKEA Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE.�` 200 Main Street• Hyannis, MA 02601 039. �prfD MA'�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C tP&= e-6,4 Ev- e-I a.kk / ,-&10 /aJ ga-y-viee,s Date: Location/Mailing Address: 415 0. 1IoLJ A Contact Name/Phone: R ,e— v 5228-771 --000l Inventory Total Amount: ti f7(9 MSDS: i c.�-c., OVA Kv License#: 0 Tier II : _ Labeling: Coo Spill Plan: 04< Oil/WaterSepara or: N Floor Drains: NO Emergency Numbers: �5 Storage Areas/Tanks: - o a 1 , ot Emergency/Containment ui ent: 5o 13'L 41 A CV VVL t elYK / Waste Generator ID: &A V 5-6Q5 Waste Product: ci ( ��`t'e's'K 3 � Date&Amount of Last Shipment/Frequency: qO6 9A,4 ti wt d_ Licensed Waste Hauler&Destination: 34-1-1 M,Vt- ,M 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. 5 Antifreeze 5 Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid Jincluding brake fluid) Windshield wash Motor oils 2-51&A bvr,AtAs q 2iv w a.�� Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners 3 Diesel fuel, kerosene, #2 heating oil 3 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 I 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" a ) ��� +��cS Qce �v�s t rn•<<t-}c (including chloroform, formaldehyde, Jam'2ho0 9 hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: No CL'OICL(.Lt-UAtl (ct.lo' , ti� I SS A D Insp ecto . � J� ire t,0yol-t oI , . Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, 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 h C/e �i � �� I�� �I - w Town of Barnstable • �t '�,. Regulatory Services ti Richard V. Scali,Director ` *& ?A"Bn"�"'�"� Public Health Division63q 0 Thomas McKean, Director � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �p t?1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 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 • A late charge of$10.00 will.be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: y.I ADDRESS OF ESTABLISHMENT:�� b MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT:,c,7Z)M) (MlrD�&-74AM-4- EMAIL ADDRESS: 0-awCnj& '@M! SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS, TELE ION OF: CORPORATION NAME / PRESIDENT TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: S T- E OF APPLICANT Name: Company Address Telephone #: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 Q, `p v Number- Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, 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 a� • • i Town of Barnstable f e a y��oFn�E t� Regulatory Services Richard V. Scali, Director MASS.• �` Public Health Division 1639• �� 1639 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 3 DATE UD APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OFESTABLISHMMNT7aa,chy-mol- ,/g�-Nib)y(bo I ADDRESS OF ESTABLISHMENT &OU0 I • TELEPHONE NUMBER s �Ial. SOLE OWNER:4�6ES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: I, IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION A' FULL NAME AND HOME ADDRESS OF: PRESIDENT Uh � T ► �• Q .r I�ll`ll�„ dG�� TREASURER CLERK -----� • IGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP ReQ015.DOC I"HE lok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' B"RM� 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUSMATERIALS INSPECTION REPORT Business Name: C0.p4?- Cori t--le-f ,tilt 1"(//e-,vlava.\ 5ct�,�2 Date: Location/Mailing Address: 1 6 I v-L aK,t,5 0,ll o f Contact Name/Phone: Inventory Total Amount: ^'31,ck MSDS: �` t� �'� License#: O t� Tier II : N o Labelino: 6004 Spill Plan: DK Oil/WaterSeparator: tJA Floor Drains: O Emergency Numbers: ye: Storage Areas/Tanks: 5 a, vi c. o,l Emergency/Containment Equipment: Waste Generator ID: 001-7 Waste Product: y2, Date&Amount of Last Shipment/Frequency: 020 110 4 a►low 042). Licensed Waste Hauler&Destination: w.�q > AA\jahvg I)cce.+Q©,� 1 o Ir�,✓�ft 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) V Windshield wash ► Motor oils S k 2,7,5' 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 7— Battery acid (electrolyte)/batteries I 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 'S Lye or caustic soda Lacquer thinners v 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: ac- c avt o v . ,IC e i" ZLk,p. , t,0ok. Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------- ------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health L f ca Town of Barnstable of1HE Regulatory Services °- Thomas F. Geiler,Director 3 3 9A° MASS. Public Health Division �7 i639• 1� a?�nnsi Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4-644 F= 50&790-6304 Application Fee: $100.00 ASSESSORS AND PARCEL NO.L 0 ATE at APPLICATION FOR PERNffT TO STORE AND/OR TTTI= MORE THAT 111 GALLONS OF HAZARDOUS MATERIALS F=NANID OF APPLICANT �. -NANH OF ESTABLISHlySENT ADDRESS OF ESTABL SHE [whobm TELEPHONE NTTYIDER L SOLE OWNER: YES NO IF APPLICANT IS A PARTNEFSHIP,YULL NAME AND HOMI ADDRESS OF ALL PARTNERS: IF APPLICANNT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION 1 YU LL NA IE�D HO D S OF: PRESIDE TREASURER CI,F,RK SI A OF APPLICANT RESTRICTIONS: HOAU ADDRESS HOSE TELEPHONE# xa7-doc/wpiq i June 17, 2013 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come inspect and clean up site Please let me know if you need any further information. I can be reached at 508-771-0001. Sincerely, SL James F. Shaughnessy President i y Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel I Elm St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and =\ and expires 6/30/2013 unless sooner suspended or revoked. �J ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services ti Thomas F. Geiler,Director MASS. $ Public Health Division i65 4• iOTfa Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ARASSESSORS MAP AND PARCEL NO. ATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT' jVC f"' Y(ha ADDRESS OF ESTABLISHMENT � LL C TELEPHONE NUMBER SOLE OWNER: S NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALLY PARTNERS: ,E �- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. VJ 9*: STATE OF INCORPORATION ' FULL NAME-� ADDRESS OF: PRESIDENT- 1m2u TREASURER CLERK i SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q June 28, 2012 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come inspect and clean up site Please let me know if you need any further information. I can be reached at 508-771-0001. Sincerely, James F.Shaughnessy President __ I Town of Barnstable °FtHE lqr, Regulatory Services Thomas F. Geiler, Director MAW: �0� Public Health Division 1639 Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS 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 - 3: 1. Please complete the attached application form Clark). 2. Include a copy of your contingency plan (to handle hazaste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town ofBarn MAIL all of the above to this office on or before June 30, 2012. A late charge of$10.00 will be assessed if payment is not received by July 6, 2012. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DOC Pr w Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 1 Elm St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------- -- f This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2012 unless sooner suspended or revoked. W CX WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable 3100 p THE Tq�, Regulatory Services - ti Thomas F. Geiler, Director x"R'' S&MA LE, ' Public Health Division 1639. . iOrF Mai°' Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 It Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. ATE OCO 130) 1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT MW5,�U �C� NAME OF ESTABLISHMENT 2aKK'Chijrih1iQ 1 ADDRESS OF ESTABLISHMENT 2 inllu ftaw TELEPHONE NUM 3ER fm- SOLE OWNER:Z�YES NO a C) IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF,- LL PARTNERS: CD IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. l Q U-7 STATE OF INCORPORATION I ► t R FULL NAME HO , O : y� }�D PRESIDENT TREASURER CLERK SiGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q lv June 17, 2011 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public.Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come inspect and clean up site Please let me know if you need any further information. I can be reached at 508-771-0001. Sincerely, James F. Shaughnessy President Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 1 Elm St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR.MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D._ _ 6/30/2010 JUNICHI SAWAYANAGI THOMAS_A. MCKEAN,R.S.,CHO Director of Public Health rr . . r— Town of Barnstable oFIME ram, Regulatory Services ` ti P Thomas F. Geiler, Director BARNSTABLE, " MASS. a Public Health Division 9� 039. ,gym AlFDMA�A' Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE C6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C �l . NAME OF ESTABLISHMENT - ADDRESS OF ESTABLISHMENT LUD • )Iya��apmw- TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS:OF ALL }_ PARTNERS: x:.e r7j ax" IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION STATE OF INCORPORATION FULL NAME AND HOME PRESIDENT TREASURER CLERK 0 '4IGNATrRE OF APPLICANT RESTRICTIONS: HOME ADDRESSS �QI� HOME TELEPHONE Haz.doc/wp/q June 28, 2010 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come inspect and clean up site Please let me know if you need any further information. I can be reached at 508-771-0001. Sincerely, James F. Shaughnessy President CAPE COD FUEL EXPLANATION AMOUNT 10805 A DIVISION OF ZAKK CHURCHILL,INC: 53-13/110 MA 58 WILLOW AVE. 84600 HYANNIS,MA 02601-5236 y PH.508-771-0001 _ o ), = PAY V IX-1/�— DOLLARS] AMOUNT OF — CHECK DATE TO HE ORDER OF a DESCRIPTION HUMRER M ieouk 1 M)"UMDIlp � o _ Bank of America — ACH R/T 011000138 - AUTHORIZED SIGNATURE 1:0 1 500.0-1381: 0094 200 7L, 28 Slim Number Fee 1019 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Fuel 58 Willow Ave, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable C °F1HE Tq,,� Regulatory Services Richard V. Scali, Director B" MASS.` Public Health Division 9Q 163- �0� O'°lE039. ° 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. DATE1:9, 14 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMEN;44K".XU _ 1 ADDRESS OF ESTABLISHMENT �2 W' V p VV� TELEPHONE NUNi R ffx�Rl /Zn)K SOLE OWNER• YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A.CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME H D SS OF: PRESIDEN TREASURER CLERK S1&4TURE O PPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q\Application Fonns\HAZAPP.DOC June 17, 2014 Zakk Churchill, Inc D/b/a Cape C.O.D. Fuel 58 Willow Avenue Hyannis, MA 02601 Town of Barnstable Regulatory Services Department Public Health Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern: Our contingency plan to handle hazardous waste materials is as follows: • Attempt to contain spill • Warn others in surrounding areas of potential danger • Contact and inform proper authorities of situation • Contact Clean Harbors to come inspect and clean up site Please let me know if you need any further information. I can be reached at 508-771-0001. Sincerely, James F. Shaughnessy President a Town of Barnstable ��FtHE Tqy� Regulatory Services yP °" Richard V. Scali, Director Public Health Division �En►�'�' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS 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 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. v s office n r before June 30 2014. A late MAIL all of the above to this i o o J , charge of$10.00 will be assessed if payment is not received by July 30, 2014. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the. Town Website, www.town.barnstable.ma.us , which is located under the E-Co section if you should have any questions or concerns. QAHazmat\Haz Mat Pennit Letter.DOC TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF B!JSINESS: - f Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: t5 P.O. Box 534 1 Hyannis, MA 02601 CONTACT PERSON: 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 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 Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid --L,,--Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) L_­*'�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) ji Other cleaning solvents Svc- . Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD F HEALTH satisfactory s:Printersdy 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) MAJ OR MATES Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) ' transmission/hydraulic Synthetic Organics: degreasers I DISPOSAL/RECLAMATION REMARKS: 1. anitary Sewage 2. ater Supply Town 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 ORDER O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed?' YES NO 1. 2. Az Person (s) Interviewed Inspector Date 'TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 1} A Y iy NAME OF FIRM: C NASE LAttN�RY L'ivG (�� N G fie Q MAILING ADDRESS: „Zg Li ��` a •,, AuE. 11yAAJA/1 S ca.Gd/ TELEPHONE NUMBER: 7 �a'- o SG 7 CONTACT PERSON: p . 6 m o A,c o v R TT Does. your -firm--store-any-.of=t-iie -toxic or hazardous_materials__1isted .be.low_, 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 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 Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing .Ink Gasoline, Jet fuel Wood preservatives j Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Degreasers for engines and metal Lye or caustic soda i Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCBs 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 /r chloroform, formaldehyde, Floor & Furniture strippers' hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluid7s toxic or hazardous (please (dry cleaners) A, C E IV E HEALTH DEPT. list) Other cleaning solvents TOWN OF BARNSIABLE Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 4 1981 ' Disinfectants Road Salt (Halite) -TOWN --OF BARNSTABL'E- BOARD OF HEALTH CO OL OF TOXIC AND HAZARDOUS MATERIALS .- INSPECTION SHEET FIRM 6X_ ADDRESS ' Maj-or-types_--of-materialsr 1) 6 2) 3) 4) 5) 6) I, Description of material(s) use: II. Storage (denote product by number listed above) A. Containers a .glas paper plastic cans,bottles,jars G p .r drums,barrels aboveground tanks underground tank ,, bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/RecommeTIC I"Lions 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains- -' iii).-inadequate==firer-pro tect ion_ 2:'-Outdoor-- a) uncovered, exposed- to:weather b) pervious surface/each basins Al.- ` �• - 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 2. hired hauler a) name of hauler b) address r isposal s' e Person(s), Interviewed — — — — — — — — - - — — — — Inspecto, _ _ - - - - - - - - - - Date 6 30 81 — - - — — — — — — — — — ,.�v/�►r; C OF . I-ILAL'1"I-I 0satisfactory •. 2. minters 3. Auto ,rody Slrvps /il t unsatisfactory- 4. ' F1anu(getttrers COf•frAnr 1t ,� .L1�1� � �_(� (see"Orders") S. Retal•1 Stores ADDRESS .• ��� �-j' 6. rue: Suppliers � G�'v1� i ClasssT 7. FIIsc llanevus . ' {� QUANTITIES AND SYORAGE (1N-indoors; OU1'-outdo fUIJUR FUl7ERIALS Case lots Drums Abdve7'arrks Underground Tanks Fu. ls. IN )U{' _-- W 1 A 6 ¢ellvns age, I' Casvilne, Jet rue: (A) Diesel, Kerosene, AZ Heavy Oils! — — waste motor oil . (C) new motor oil (C) _ transmisslon/11ydraullc —� Synthetic Organics! N — degressers , 1. SanitarySewage REFVRKS! 6a 2. Water Supply '�.��_ � \�•� _ t 1 �' � � �� � t ;� �. Town Sewer public On-site -_ rrlvate �_ 3. Indoor rivor Drains YES NU_ Q Holding tank!, MDC O Catch basin/Dry well OOn-site system - 4. Outdoor Surface drains:l'ES NO IluldlnL• tank: MUC O Catch basin/Dry well Oun-site system Waste Transporter "'- -Name of llU1R1r- �L Llcensedl 1► - � 1L �1n' erson s) f nt:er -EHc• --- i�'1�, r .l) i '� C ���' ���._ tor Date P • i_ , M, A Y>� � 1 .." -3"'''agy".'+ "SatY.JP � +E,.p;.>4 + k+ atH�'t 'r. �c�^ $ 4C 4A• ` ea.`� x{' 1 TOWN OFF � NAME OF OFFS t .. =: � sr� BARNSTABLE .� a ; r UJ'+ 1 O `CONTACT ° CISIN fdO � DDR�� -��: •r. _ AESS.O OATE OFMOLA�TION- ►' & sc� w c TI E OF 1Ma.11TAat,&,p.: TFC�'�1.' 7� S""Y+,r"eb^•, y,, S.S "'K` �• M 3k•.""d "^fg ^a ' �'r"�'� Fa tAld•` ;�� "� �. s=�'.a.: ��,�as.�` r. r '�^ �. ," '���.�''��Ez-- .., - YOU HAVE BEE BSERVED_ VIOLATING ' x, h. ..,� BY� .s•.-� 1�. . '' ,� ' - _ a.�"";. } regu_ta :W E xNOTIO WS . J IQN26x rtup (Pla viola A+ § ,.FINE AMOUNT:"` i H Y AC N a t r iz fi .: #arat �' y tfp , r r+- a —r M us �r BYLAW OR,ma c E D E UECEI OF ITA ON' * �E ULATI��^'•, �' l` ��Y �Q; �,• . �J �x y,;. A � ar ", u. E (a, BADGE NUMBER " '' .'' p�:a= .r r 8nature of enforcing person)yk• raay w t r, '� 's. YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD T�O Sg pH5 A7 ER ' f r# z.•�` � k d�r.r Q{i)_-You may elect to pay the above fine either by appearr nhi � + M,! _ x'�sayt+fg"t "CLERK-MAGISTRATE DistrictCoun n8 in Person between 8:30 A M.and 4:30?MMonday.tlirough F i ';.I «t_�w. r��*_� � aF•; r the Clerk-magistrate WITHIN TWENTY�2 pq S OF T►EE DATE OF Table H S NO NOTICE 7his will o'rate as a final di a days excepted'before THEY ?:s pound,Main Street,Barpstable,MA02630,orbymailingachedc moneyorderorpostalnoteto' Y > '(2):"If you desire to contest this matter inanoncriminalProceeding,.youmaydoso disposition of gimirtalrecord a Judge or Clerk-Magistrate will operate as a final di by making a written regLestto the above CLERK-MAGSTAATE fora heermg.A unal r inat i n, y. r (3►. ff you fail t0 sposition•wah no resuhingaiminal record;Provided any fi pay the above fine orto appear as spetified'e aiminal complaint may be issued against uz i°HEREBY ELECT the first option above confess to the offense charged,and ahclose-payme by that officer is paid wrthrn the hmespecdred r! r r'•,J `. S 'itaure ;St ynt m the•�amo ME q r j' BBC : '�� a r TOWN OF . BAR I Q NAME OF OFFENDERS CITATION �-T 1 ION NO.: D11R . BARNSTABLE Q CONTACT: - DATE OF VIOLATION: - . v`°F. E rOw ADDRESS OF E DE 1 TIME OF VIO TION: .CITY: STATE: ZIP: a BARNS7ABLE. + w 9� MSS. �0m S.S.# ,„ .<t' G -:°' TA E.OF BIRT �.. x __. 1 prFDNA�., LU YOU HAVE BEEN OBSERVED VIOLATING: I Vim, z ,{� / (specify bylaw or"regulation) � NOTICE OF BY: " /�! r ems- ", . ./ W (act constitute vwlation)'' 'LOU VIOLATION AT, CHA� Lmqn( / ` /� 'F FINE AMOUNT: ��� OF TOWN (placalbf violation) Q BYLAW OR I HEPEBY ACVNQ�/LEDGEEECEIPT OF CITATION: ~ �,1j/� �vJj J / ' � f�jy k�j (signature of off ndgr) w Uj REGULATION BY. �`Ni{\VI BADGE NUMBER G)w W (signature of enforcing person) cn w YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER. J (1) You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:30 P.M.,Monday through Friday,legal holidays excepted,before: THE a CLERK-MAGISTRATE,District Court Department,First Barnstable Division,Court Compound,Main Street,Barnstable,MA 02630,or by mailing a check,moneyorder or postal note to the Clerk-Magistrate WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.This will operate as a final disposition of the matter,with no resulting criminal record. (2) If you desire to contest this matter in a noncriminal proceeding,you may do so by making a written request to the above CLERK-MAGISTRATE for a hearing.A determination by a Judge or Clerk-Magistrate will operate as a final disposition,with no resulting criminal record,provided any fine imposed by that officer is paid within the time specified. (3) If you fail to pay the above fine or to appear as specified,a criminal complaint maybe issued against you. I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature t rBA WN OF - . Y BA9950 �NAME OF OFFENDER: CITATION NO.:RNSTABLE ' 6 CONTACT: —� ����a .DATE OF VIOLATION: p //)6 °F 1HE rO�Lt ADDRESS FjOF,j�.END R. ` 1� TIME OF VIOLATION: " yWP O r t CITY: �f� STATEA ffi ZIP: UO(O U I a RAWNSTnaI.e. - O vonss.' m S.S. ee/J! }i A��yD,ATrE�.Oi�yF t�RTH: ,/ J� [ /�'}�/ +/� �,�r W °pr,t63q.eye /Y r+I.✓'lV7WL.3... W/Y�! ti.4�W71. /r//V (,/^t .7'_ Z E Mp+ YOU HAVE BEEN OBSERVED VIOLATING: LU (specify bylaw or regulation) NOTICE OF BY: VIOLATION / !#{f�!`_ / T)��►( j J (act constituting violation) N �...J f� t�J t� I!,�hfJ f _ � � ��j o AT: FINE AMOUNT: ^✓ a� W OF TOWN ',&ace of violation) ` Q BYLAW OR I HEREBY ACKNOWLEDGE RECEIPT OF CITATION: >"* (signature of offender) LU W REGULATION BY:—(�/ ��l !t„ ll/)�F� V�'//"'1(/ BADGE NUMBER ° L' W signature of enforcing person) Q YOU HAVE THE F91LOW)N 'ALTERNATIVES WITH REGAL TO-OfSPOSITION OF THIS MATTER. a (1) You may; leo p y the above fine, hems appearing in person between 8:30 A.M.and 4:30 P.M.,Monday through Friday,legal holidays excepted,before: THE CLERK-MAGISTR T DistrietCourtDe FirstBarnstableDivision,CourtCompound,MainStreet,Barnstable,MA 02630,or by mailing a check,money order or postal note to the Clerk-Magistr#e WITHIN NE,(2-1)DAYS OF THE DATE OF THIS NOTICE.This will operate as a final disposition of the matter,with no resulting criminal record. (2) If you de tthismat vina noncriminal proceeding,you may dosoby making a written request to the above CLERK-MAGISTRATE for a hearing.A determination bya Judge or Clerk- agjstrate wil ope{at as a final disposition,with no resulting criminal record,provided any fine imposed by that officer is paid within the time specified. (3) If you fa to pay the a e fine or}o appear as specified,'a criminal complaint may be issued against you. I HEREBY EL .ttEtIrst op ti�live,confess to the offense charged,and enclose payment in the amount of$ Signature \\✓/ TO." DONNA MIORANDI-HEALTH DEPARTMENT SUBJECT: BYLAW CITATIONS THE FOLLOWING CITATIONS REMAIN UNPAID AND ARE BEING SENT 1-0 COURT FOR COMPLAINT. COULD I PLEASE HAVE YOUR REPORTS ON THESE VIOLATIONS BY I AM IN THE OFFICE OF WEIGHTS & MEASURES SCHOOL ADMINISTRATION BUILDING ' THANK YOU, � ANN HlGGINS 19501 CHASE LAUNDRY 19502 CHASE LAUNDRY � 19503 CHASE LAUNDRY