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0082 WILLOW AVENUE - HAZMAT
�a W►MCO Ave., nn is Fir c +C)tno(row 4 IKE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSIABLE. MASS, y, 200 Main Street• Hyannis, MA 02601 ,b59. M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT jED P'�� Business Name: V j demfA Date: Location/Mailing Address: a- W 1/ w U "i1 &ngqw Contact Name/Phone: ``Sow m l-%o o Inventory Total Amount: 111-44q SDS: License#: Tier II : Labelin a d Spill Plan: Oil/WaterSeparator: NA Floor Drains: Emer enc Numbers: Storage Areas/Tanks: - 5 11 coolplV (6 C . Emergency/Containment E ui ment: , - fd&tO 52i'll kifl` aste Generator ID: Waste Product: R - h �t 6 Date&Amount of Last Shipment/FrequencX: 4 Licensed Waste Hauler&Destination: AI aik-oYLCA!( Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 66 moor >✓ ;►1 f1V 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 v Dry cleaning fluids 5-6 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 v Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOM NDATIONS: a b5o r- 1 -6 Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that \ Centerville Cleaners Emilios Rigas 82 Willow Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �'A r Town of Barnstable o Inspectional Services BARNSTABLE F THE Tp�� wvWCr ur;.s"0.'Fr u=-'-i . Public Health Division -,���< 9&4mN �ABLE,$ Thomas McKean, Director '--A NLA1639. Argo N,p.�a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE > ; HAZARDOUS MATERIALS D`` 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 x Vt 6h CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 1 *A late charge of$10.00 will be assessed if payment is not received by JuLy 1st. 1. ASSESSOR'S MAP AND PARCEL NO. a ` 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: C M% L-\O S' 1�t-\ 5. NAME OF ESTABLISHMENT: C.APC CioTA -ATLE b&/A cs.=A,-je)FJrtLLC- c:LEAAk-;VL� 6. ADDRESS OF ESTABLISHMENT: 97- w 1 LL0 w A V , l-(YAfvM 5 04 A o Z 6 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S®g - 7 71 `S S O 9. EMAIL ADDRESS: 10. SOLEOWNER: YES 7C NO IF NO,NAME OF PARTNER: gNgST O,S I q V-AC- - 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME LAME C.Lo'rk C-Ay& 6/NA C-CAITOE .i Ldc- PRESIDENT TREASURER �A N �SC AS C�fit t CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat App Revised 09-10-18.docx `pF� TOk� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA M.T%BLE. 200 Main Street• Hyannis, MA 02601 T MASS. �). .6N1 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT tF0 MA'S Business Name: CeK-�e�y 4e- �.� �� Date: Location/Mailing Address: y4 v,vl 1 S Contact Name/Phone: 6VVk, J i D i e-S -7 Do" ac o.e,e tc- Inventory Total Amount: SDS: License#: ea 3 l Tier II : NO Labeling: Spill Plan: Oil/WaterSeparator: k) A Floor Drains: D Emergency Numbers: G Storage Areas/Tanks: no' I - yr•,o a 1 2 c.1-44K�v Emergency/Containment Eq uii ment: wrist-s� Vw 117.�ti� 5 va.. w - ' Waste Generator ID: (-3D o5-i-51 Waste Product: E C. o -114-k" 5 0"J1 t- Date&Amount of Last Shi ment/Fre ue c : 'ItteA6 2&0 16 w Licensed Waste Hauler&Destination: vV" 1, V6 e, e. rl 4a tr s o 1 Other Waste Disposal Methods: c)`e\po tt, LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, �aYS storage and disposal of 111 gallons or more requires a license from the Public Health Division. I Antifreeze IS tie Dry cleaning fluids *17 ,"`� ��?3a—4-e- t e. Automatic transmission fluid 10 Other cleaning solvents&spot removers c64 3�8 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 rav,,,V^o,1\.,� Diesel fuel, kerosene, #2 heating oil l Disinfectants I 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&roofingi 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 /kt0 Other chlorinated hydrocarbons J!; Laundry soil &stain removers S �� (including carbon tetrachloride) (including bleach) ,Fyokb50 Any other products with "poison labels" (including chloroform, formaldehyde, 100 hydrochloric acid, other acids) VIOLATIONS: ORDERS: 019i 0.1V- oe a �o ��- S v 2 �� D w v t,�aae< � '-�1cS INFORMATION/RECOMMENDATIONS- �LW ' c0VV D� C �IVII I � 12�.v�c,c�iK ` v►ti�c a1 < -�� d �J�S�� to aLk--%A.A—. / Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners-Emilios Rigas 82 Willow Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health E` • • • r Ieg,o of Unstable atory ervices Richard V. Scali, Director oFi"e ra,,_ Public Health Division BAMSTABIE � BAMI eABl.E. : Thomas McKean, Director 160 9p 0 4� MASS. $ 57 QED MPr s 200 Math-St reef,-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 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26-• 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 VS 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. 1-2-1 - 010 2. IS THIS A PERMIT RENEWAL?)�' YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: CAQC C-LO%14 CA -e-C J ��/A CC-A'-tC--Nz-V1 t.i.E C.L yeL" 5. NAME OF ESTABLISHMENT: (fr--N1 C--�!-v k\.`.0 CJ-C-Ati E�A 6. ADDRESS OF ESTABLISHMENT: Q2- (,V l(_(_Q�/,v A 1/, NyA Pk/l� OA A D?f O/ 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 509 - -77I , S Sp( 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ckpr- C_LpT4 r,4�2L ���la �'i E`u l t t_ C!.kA tiF�R PRESIDENT r d \ Cry, TREASURER�,r�S CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN — DATE A 1 QAApplication Forms\HAZMAT APP 2017 REVISED.docx Number Fee \ 831 THE COMMONWEALTH OF MASSACHUSETTS $125.00 r, Town of Barnstable Board of Health This is to Certify that Centerville Cleaners-Emilios Rigas 82 Willow Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ------------------------------- -------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health TROvvn% t Unstable rvceseg atoervices Richard V. Scah,Director # � Public Health Division BARNS TABU. BmmsrABLE. Y4NilU`S NL'5•639-LfF•Yl:5tP6cryiT - ass. Thomas McKean Director 139-2014 +� 200 Main Street,Hyannis, MA 02601 �77g Office: 508-862-4644 c20 7—o"2`0 Fax: 508-790-63 4 X APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER,-f08, 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 0 V- 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. �11V-C.E1-- 1.t) 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: E M l O S �, 5. NAME OF ESTABLISHMENT: GAS'U (-1-o-i 4 c-MR-C b I13I q 6. ADDRESS OF ESTABLISHMENT: 9'1- Wi I i C)V,• qN f k'Ir1MLi1 , A o-7,60 1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: �� 't'1 I -S S-O o 9. EMAIL ADDRESS: Ge�v\�e�W XT CO M 10. SOLEOWNER: YES?NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME i vyC-. PRESIDENT TREASURER ►�F1/f}S i w►�t �1 \C� CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT - . DATE 6 1-2-1. /11 Q:\Application Forms\I-IAZMAT APP 2017 REVISED.docx °FINE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE`E ' 200 Main Street• Hyannis, MA 02601 Fo � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Ce0,+-e'CVt 0e- c lle t v r5 Date: Location/Mailing Address: SZ Q,l I o t.> A V�& v►ri r 5 Contact Name/Phone: 15o sO - 7'7/ - SS/o!� a� �iGc�✓�cK- Inventory Total Amount: A 4, MSDS: es License#: 3 1 Tier I[ : AIJA Labeling: 46- aX�ksaJ} Spill Plan: S Oil/WaterSeparator: 6 _ Floor Drains: tJ Emergency Numbers: �-Ie-S _ StorageAreas/Tanks: 4�`f L P_A►��►ui v►cQGk�ybGy/2 , 3 I5�4211Sga��r�"ti5 Emer en /Containmen Equipment: I v v y o� I v,,-X cl a ri(s. Waste Generator ID: G 3 DODD 3 4 Waste Product: Date&Amount of Last Shipment/Frequency: '5 1 /(0 30 Qc-f ,2 D 16 ^--e VM Z Mo5 . Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. �X Antifreeze 1��°` 13O Dry cleaning fluids Automatic transmission fluid )O Other cleaning solvents&spot removers oJ� 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 L Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers /.FF-\ ? r (including carbon tetrachloride) (including bleach) �,t // Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: qO, � •t•ee_qZ, INFORMATION RECOMMENDATIONS: 0. �Y. 1 4 1 0(* Z � �.L W It ��t,�'L►1,�So! KS�-w �a a l l C l�w<<e q S . Inspector:— 1 Facility Representative: - WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable 'Board of Health This is to Certify that Centerville Cleaners-Erailios Rigas 82 Willow Avenue, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO _ Director of Public Health �� I Town of Barnstable Regulatory Services ti Richard V. Scali,Director ' KAS& Public Health Division B S LE P a6;9 Nuvnns"m�"a° AN' nrte."annae F QED uu+° Thomas McKean,Director U' 1639- U, �g 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 oa� Fax: 50 90-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZ�' ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 Eln'�' 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. 3<-7-0-10 DATE 6//��(� FULL NAME OF APPLICANT: C gVC Lc y-ili G- V Z-- fyG NAME OF ESTABLISHMENT: A/VC S� ADDRESS OF ESTABLISHMENT: S2 W11-1,0 w Mz. M,4 0ZL01 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 09 — '771—S S: O D EMAIL ADDRESS: goo) ' SOLE OWNER: YESJZNO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME c;A'1k-- cu7-11Y �iLr-- h.A5h9 c��-���cvrct;✓ c1-ER PRESIDENT E w% TREASURER AtiA S,A S i A !i Ls-A S CLERK IF PREPARED BY OUTSIDE PARTY: SIGNA-TUMWICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev 16.docx Page 1 of 2 Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners-Ernilios Rigas .-------------------------------------------------------------------------------------------------------------------------------- 82 Willow Avenue, Hyannis, MA ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Vi r 71 Town of Barnstable Inspectional Services BARNSTABL,E O(1 w..N.Ta '-an'iF Ln -COW-hyANN15 Public Health Division "'S ""'� '39-20 `����"� p 163�(9y-�3014 r 1 �� 1 Thomas McKean,Director a q CO 200 Main Street, Hyannis,MA 02601 Fo� y r:a 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 DULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 w G(�I( e vw CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ 2-ceR *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3GLn M C) 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: EM\ 5. NAME OF ESTABLISHMENT: C-0G C-LOT14 GP P-C- 'tA/A C-L/L i cw✓i+.1_c C-L&-A�-SV,3 6. ADDRESS OF ESTABLISHMENT: 8Z WILLOW, AV kyR1�N�S �� p2E, 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �O`8` `7 -7 I - 5900 9. EMAIL ADDRESS: CeA4e- N1 00• C_b M 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME CP1VE c,LoTH g-AVxE 1 a'k- p(�/A GE NrC-R-V 1 U-e C F-AAC-V-S PRESIDENT TREASURER �.S�t ASi A �ICsA� CLERK • 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT — DATE 06 I©yl zo zee Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners 82 Willow Avenue, 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 i PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI / THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ..r Town of Barnstable f °pTME l Regulatory Services Richard V. Scali, Director 3 HARMASS.NS"H Public Health Division 1639. ° 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:-,Li-3VT 010 DATE ro //1 L t APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT E M 1 L NAl1MIE OF ESTABLISHMENT CAPE CLOTH CARE, INC. d/b/a Centerville Cleaners ADDRESS.OF ESTABLISHMENT i c°� ��lrnel�th Rd ,-�Init 2 �� 3 Fa TELEPHONE NUMBER Centerville, MA 02632 5,o. q-T _ Oa SOLE OWNER: YES- ?C NO IF APPLICANT IS A PARTNERSHIP, FULL NADI AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O Ll 3L( 7LJ 9 . STATE OF INCORPORATION M, FULL NAME AND HOME ADDRESS OF: PRESIDENT C M k Uk a � �-i 6,+ ,> 20 G LJ_ I ►-f t-b C.4-_-�-,&Pjv► tl t 01_jo_Z TREASURER 4k/v R�-,rNS, A N$4 M C-: CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS _'v>AN E A,,., ADO L/C HOME TELEPHONE# SV 9 - -1`7 Sr O-Y3 C� Q:1AppGcation FormsViAZAPP.DOC ' Town of Barnstable Barnstable 4z Regulatory Services Department ., Public Health DivisionSARNWAIISM 9 t1Ass.i6gQ. 200 Main Street, Hyannis MA 02601 �p �. rffl �n 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS 1 FULL NAME OF APPLICANT NAME OF ESTABLISHMENT A ADDRESS OF ESTABLISHMENT �� W t LLp t� q V k�Jati�c,S ik a?lO0 TELEPHONE NUMBER -!�()C 7 7 K SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: t�7 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. L 'Vjmoi9 STATE OF INCORPORATION 'S - p FULL NAME AND HOME ADDRESS OF: PRESIDENT tP1 t. o t( W• KEC-►►N(," T-- V) - b6 o7,S3� TREASURER RN&STASL A SAME N CLERK P rn SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS*- ,.SAn6-- A's A'%DV& HOME TELEPHONE # 5-og Q:\Hazmat\Haz Mat Application2008.DOC i Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of. Health This is to Certify that Centerville Cleaners-Emilios Rigas 82 Willow Avenue, 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 y d. Town of Barnstable °FTFIE rok, Regulatory Services Richard V. Scali, Director BAMSTAY *Y • MASS. p�0g Public Health Division039. k En nu►� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 mA Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE � «n f' % o APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ` �, OS NAME OF ESTABLISHMENT ��� �( �I I {� Df Gt ap f • ADDRESS OF ESTABLISHMENT -2 1 () A V e H�rin n\ -� TELEPHONE NUMBER 5 o 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. ` - �1 0 2 0-i-C! STATE OF INCORPORATION C SSC-kC\r\ R S FULL NAME AND HOME ADDRESS OF: PRESIDENT C t i 0 21a,32 TREASURER C CLERK • SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C:\cache\Temporary Intemet Fi1es\0LKD3\I-IAZAPP ReQ015.DOC IKE►oNti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA.RA 200 Main Street• Hyannis, MA 02601 t639.�ptFDMP+a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Re��� Business Name: C2vte,ly�(fie_ a �r Date: Location/Mailing Address: 2 Qi II—i vim. 4hn i Contact Name/Phone: E'm, I i vs IQ�g k s �08- 77l- SS'C>D 1)ajii &e,Qvenevt Inventory Total Amount: A� MSDS: Mxa A05�w-t :AWF- License#: �3 Tier II : No Labelina: Spill Plan: Oil/WaterSeparator: hti A Floor Drains: Nv Emergence Numbers: ��25 ' etorage Areas/Tanks: '3-3c 4&( -rk5 c� fie,� Oalle�5�of w�st� �6AC ) ►�� �?cv %e, , t vie}s ��,,eEmer enc /Containment E ui ment: va.C�a�Ytow la.a.©�n l �Cc ae �'" y` �k� 4/ Waste Generator ID: A4 C,3o06v 513 Q aste Product: 4•54'e �R�. �-tetl'a) G ' Date&Amount of Last Shi ment/Freauency: 2- v--K-v-5, Z�1 ev2-ry 3 wton9E�n S Licensed Waste Hauler&Destination: 'cj 4<ler-w- reK- ©H Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze 44lNz0 1 be Dry cleaning fluids 1019 1 QERLt k we-st Automatic transmission fluid 30 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 Av PCB's Metal polishes w\ Other chlorinated hydrocarbons O Laundry soil &stain removers Li S (including carbon tetrachloride) (including bleach) �4\ Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: OR ERS: INFORMATION/RECOMMENDATIONS: e, i qr e-e of 1 h -,--A K.►tom 0' Inspector b t� lopd,& t S K I �`v— �g�a�Jl��11At9�l �cor-Arty of1gQ 'ka"o , Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °.IKE►, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMS�LE,� 200 Main Street• Hyannis, MA 02601 Fo39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: vl ����112 r'ea►�c Date: ( /e iq Location/Mailing Address: 2 0,1Io,,) Ave— a.i.A, s Contact Name/Phone: C m d l o s VZ OAs S --771 - s scx3 InventorkTotal Amount: 4_1,16"'2oy 4, MSDS: Ye-5 License#: 83� Tier II : N o ` Labeling: 0 Swill Plan: yeS Oil/WaterSeparator: N Floor Drains: Emergency Numbers: YES Storage Areas/Tanks: 8 Emergency/Containment Equipment: Waste Generator ID: Waste Product: PEKL Date&Amount of Last Shipment/Frequency: 1-1 1 y 4 2a Ib Licensed Waste Hauler&Destination: a (2e v&- cox Ql-( 20 ER-I LI 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, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: y.7C�Cr�4l� dttv�2 �� C1 o y, rr7 C A A ��VQ oC a`N`-}S �r o a ovL, Inspector: • ` d"\W\ '(i Facility Representative: C t WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS 1 Date: 616 / 13 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS N FORM NAME OF BUSINESS: aW449r6J le- (2jeivLO-1-6 BUSINESS LOCATION: 0Z INVENTORY MAILING ADDRESS: -krte— TOTAL AMOUNT: TELEPHONE NUMBER: �6 0b T 7V7 1 - .S6-O 0 -4- I`7q ,fl CONTACT PERSON: v►^+ 1. o . 91 OL6 EMERGENCY CONTACT TELEPHON NUMBER: MSDS ON SITE? TYPE OF BUSINESS: * Iwri r �s INFORMATION / RECOM ENDATIONS: to f4,ItAfAL5 4es1415 Fire District: tIUyt6& i S n1D+ CQ(Te,4-- S +o .fie. L4jcQa�"e�. how � n���P�� l�YQw y►1 S a Gw�et � x�'►�wv�be-c s �te� r..ka � ��� �.-�� Waste Transportation: Last shipment of hazardous waste: 6 41s 13 Name of Hauler: ' 2W 1 b5 ~6, Destination: 6 tr-z"�awl-, Waste Product: 0a,J+,e- Licensed . es No _1RjbooS40o,?oY7 A; g 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 fo Laundry soil &stain removers( j1'ax) (including bleach) ,�� )qo Qrwo r a g4jj.,40 Spot removers&cleaning fluids 1-7 (dry cleaners) 1 Other cleaning solvents Pcv�(- Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners 82 Willow Avenue, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health R� I Town of Barnstable Barnstable Im r ti Regulatory Services Department o ;ericaC"i Ii LE Public Health Division A MA&& , ' 9� 639 � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 7�—�) 2,-1: oK) DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C tv\ ) L\ O �'r S NAME OF ESTABLISHMENT C-C-- A-i C. V--V 1 Ll,C L&C f tiC� ADDRESS OF ESTABLISHMENT W 1 (—L- -w P(/ 14"1OA//N1 TELEPHONE NUMBER '�-C� — 7 7 O P7 � N SOLE OWNER:/x\ YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS-OF AL9 PARTNERS: N as 3> J P IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.O 4-3u O101 q STATE OF INCORPORATION S FULL NAME AND HOME ADDRESS OF: .PRESIDENT (=M 1 Q oS @,16-t\S q 2, lit/,MC—E►A/&4fouSC- �-?j �•_SANcS�glut mq o2s 37 TREASURER A&✓OkS I4\St A 1�Lt C,-►q*> CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC t J1 Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners 82 Willow Avenue,.MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS-------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 C ASSESSORS MAP AND PARCEL NO. DATE - u > APPLICATION FOR PERMIT TO STORE AND/OR UTILIA MOU THAN 111 GALLONS OF HAZARDOUS MATERIAL N co 1r � FULL NAME OF APPLICANT r.kPqVC= e l.Orlt C-A z -C NAME OF ESTABLISHMENT 1D P 6 I N CC—jv t C�Z—V i LLL CLCAMepX ADDRESS OF ESTABLISHMENT 32 W i Ll ow 8V• (-i-(AdVA/1, M#� Ou'a l TELEPHONE NUMBER ®� e 7 S so 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. Doi-34fOW-79 STATE OF INCORPORATION ►Pr S ' FULL NAME AND HOME ADDRESS OF: PRESIDENT 4—!:m to c, L12 ►v9 ��C"l I�v�-H�usEr �- �r���ct�ic if �M►�SS TREASURER h^,AyT As i A V—\&A> N-1 E o-ZS3�1 CLERK SIGNATURE OF APPLICAMb RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# $OK-6�:5 q7)-A �� _ Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners 82 Willow Avenue, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING Ill GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. June 27, 2006 PAUL J. CANNIFF,D.M.D. -�- THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Akan' art Regulatory Services �'Z,/ ' ,. Thomas F. Geiler,Director . Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 ax:.508-790-6304 . Application Fee: $100.00 h��7 ASSESSORS MAP AND PARCEL NO. DATE 6 0 6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME-OF APPLICANT 11- \ O k�:, NAME OF ESTABLISHMENT GAg7 C-LO t N GAV_.E/D cc-PA C-tw I Uj_ ADDRESS OF ESTABLISHMENT 9Z W►.LLO W A V, R Y A A-l"r�-` ttA(k D.Z6 1 TELEPHONE NUMBER S O'9 - 77 S S O O SOLE OwNER:4YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: �'1 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.oLl -3 ' 02 b q STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT E M ! Lt C) > V-16-A-> L1 Z TREASURER AN r�JT A S t fN V-J (rA � CLERK SIGNATURE OF APPLICANT Z w, OA CE 1 r A,G-R OUSC—: RESTRICTIONS: HOTME ADDRESS C SJqtit l '04 .0-A 62S3" HOME TELEPHONE.# Haz.anc wp,1q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. Allow five to seven (7)working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 I� FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in- house processing. For further assistance on any item above call "508 862-4644 Back to Main Public Health Division Page r" Number Fee 831 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Centerville Cleaners 82 Willow Avenue, 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 Y I � Town of Barnstable RegahtorY Services Thomas F. Geaier,Dirutor a BAMMIAM7, Public Health Division MASS. 9 1611). 1 11). 1 Thomas McKean,Dirzeto • 200 Main Ste-4 Hya=Lis,MA 02601 F= 508-790-6304 O,Ecx: 508-862-4644 Appficaficn Fes: 1fl0.D0 ASSESSORS ASAP AN7�PARCEL NO. �� " C37 O DATE A-PPLICATION FOR PERMIT TO STORE AND/OR MORE TF- AN 111 G_ALInNQ n-F TT A 7ARD0US MATERLkLS _ �,� i ��® `� FULL NA-ME OF APPLICANT ,NAINUO-FESTA3LISBMENT �� -�o C��►� � ADDRESS OF ESTA131, L' L'1'I i `a A V • T 'T_,T+_,�PHONE iNO?Y'IBZR SOLE OWNER: YES NO ]F APPLICANT IS A PARS =,FULL ALA AND HoNa ADDRESS OF ALL PARTNERS. IF APPLICANT IS A CORPORATION: FEDERAL D)E,-TIFICATION NO. 09 3LtQ�� °C � STATE OF IN CORPORATION ra. rn ULL NA a AND HOt + ADDRESS OF: PRESID= 5 6-LLn i T TRIASZ7,71, RtiAS1%ASiA 2Q SIQtAT OF A"T T"ANI' .� F�STRICTIONS: HOME ADDRESS L7 C� i HOI�T=EOtNE# S _ i r WILLOW ST. SHELL & TIRE, INC. + COMPLETE AUTO SERVICE FOREIGN AND DOMESTIC SNOW PLOWING 381 CAMP & YARMOUTH ST. (508) 775-9899 HYANNIS, MA 02601 4 Y P M_ .� �, z �� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: ST SAEUL t i,Ct- Minc. Board of Health MAILING ADDRESS: -3A I C84v\j? ST Ilya, nn;s , nIL oa(0o ( Town of Barnstable TELEPHONE NUMBER: (508�) qe)q q 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 our own use, in u titles totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry Y q 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-store Please put a check beside each product that you store: V Antifreeze gasoline asoline or coolantsY stems) Drain cleaners ( Automatic transmission fluid Toilet cleaners Engine and radiator flushes I Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants VDiesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners)- Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business s �,.�"'�3.r u'Gr',-•+ws' .�' �,.,. 'T�N+.,r.. �'49,•e�vr„5 e's+�&d,..�s ,�.��,,��r"••�� ,� ;q ,�:.r_.n. __ ^* ,�: � _ TOWN OF BARNSTABLE s COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers �- BOARD OF HEALTH �® satisfactory 3.Auto Body Shops ! f'� .T era Q unsatisfactory- 4.Manufacturers COMPANY r f 4 1.0N -r, .g` r,C�- `far-,."c," (see"Orders"). 5.Retail Stores +'� 6.Fuel Suppliers ADDRESS 14' 40A 4 04 orM of -IV, (,''183S• 7.Miscellaneous +'Y �y`� QUJANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel,(A)"- aY 0'* Diesel;Kerosene;#2(B) Heavy Oils: waste�motor oil (C) new motor oil(C) A transmission/hydraulic Synthetic Organics: degrea sera Miscellaneous:✓ `a r �- , DISPOSA,IMECLAMATION, REMARKS: C 'I. Sanitary Sewage 2. Water Supply 4 ,1119 O Town Sewer QPublic" 41 ( l' �O'On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDCc Tel u O Catch basin/Dry well picl 0 4 -A-11 4 1 F O On-site system ; 4. Outdoor Surface drains:YES 'NO 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 2. A Person(s) Interviewed Inspector Date Tz RM 7t. A AM—Aft!ft 7 . ..... . .......... 4f. TZ1JD. -in le -Tem r> TO& f-0 foe) nl' a7e G . fo ie :Flu ie 4di cry - "t.., Ot fi ,JAI z 'Z ._Z7 ....... 47 qe'-- -:N- Av **.1tar TOWN OF BARNSTABLE BOARD OF HEALTH CONT OL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM A ` ADDRESS: Major types of materials: 1) IJ 2) 3) 4) 5) 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 A At - his # open,loose,uncovered inadequate labelling B. Storage Facility �/or # Remarks/Recommendations 1. Indoor a) separato, contained room b) stored in general work area i) inadequate ventilation ii) floor drains 124 , iii) inadequate fire protection 2. Outdoor •- a) uncovered, exposed to weather .. b) pervious surface/catch basins III. Disposal p 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 or disposal site Person(s) Interviewed _ _ _ — ,� _ , _ — Inspectox Date _ _ k —