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WN OF BARNSTABLE — UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION
OWNER AND INSTALLER INFORMATION
ADDRESS:, /-/)/,q"i/S MAP 'NO. I PARCEL NO.
OWNER NAME: /�XfI�.A ' taBSl ,�C�-r ' /917 ILLAGE: 4y°r�'t-JA)I f-
INSTALLATION DATE:
v ..
TA IN"IFORMAT I O
LOCATION OF TANK: W N`TL I' -
CAPACITY J L TYPE l f.... AGE 4A Y4•FUEL/CHEMICAL �j�•
TESTING CERTIFICATION C ] BASS C I FAIL DATE
LEAK. DETECTION C ] CHECK IF N/A TYPE/BRAND
ZONE OF CCINTRIBUTION C ] YES C\.] NO,TS DAlE TO BE REMOVED
FIRE DEPT. PERMIT I SSIEDs .,C . ]t YES ' -.] NO DATE
CONSERVATION E ] CHECK IF N/A DATE i
`BOARD OF HEALTH TAG NO. [ > ]C ]C ]C ] DATE
r
' PLEASE .PROVIDE. A .SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD
I DI
RICHARD P. MORSE, JR.
Attorney at Law
161 Main Street
P.O.Box 117
Yarmouth Port,Massachusetts 02675
617-362-1144
May 31, 1988
Ms. Donna Miorandi
Town of Barnstable
Board of Health
367 Main Street
Hyannis, MA 02601
Re: 296 Winter Street, Hyannis, Massachusetts
Dear Donna:
Enclosed herewith please find my Underground Tank Registration form.
Would you kindly send me, at your earliest convenience, a brass valve tag to attach
to the filler pipe.
Please also forward to me information regarding having the tank removed.
I believe I have the correct Map and Parcel number indicated on the form.
- -Would-you be so kind as to make sure that I do and make sure that I am in a Zone
of Contribution.
Thank you for your cooperation.
Very truly yours,
Richard P. Morse, Jr.
RPM,jr:js
Enclosure
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: } - � Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: °- ' / yl d/ P.O. Box 534
CONTACT PERSON: o Hyannis, MA 02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totallli g, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO 1/
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 Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
Paint brush cleaners (inc. carbon tetrachloride)
Floor & furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
Laundry soil & stain removers hydrochloric acid, other acids)
(including bleach) Other products not listed which you feel may
Spot removers & cleaning fluids be toxic or hazardous (please list):
(dry cleaners) _
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTHsatisfactory 3.Au Body Shops
/► O unsatisfactory- 4.Manufacturers
a �p '7'' �f4 zejU (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS ;?Z lhji,,t17 Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
ls:
ine,Je (A)
iesel, Ker # B)
waste WuotsaWi:W�
ew motor oil(C)
tran'sm siodydraulic
Synth4ser
rganics:
degr
Miscellaneous:
DISPOSALIRECI A�M�ATION REMARKS:
V
V1. Sanitary Sewage 2. Water Supply
V Town Sewer Public
0 On-site SPrivate
b^3. Indoor Floor Drains YES NO
OHoldin tank:MD C
O Catch basin/Dry well
0 On-site system
tA. Outdoor Surface drains:YESALNO ORDERS:
0 Holding tank:MDC
15 Catch basin/Dry well
On-site system
VA 5.Waste Transporter
Name of Hauler Destination Waste Product Licensed?i
YES I No
V' 2.
Person(s) Interviewed Inspec or D