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HomeMy WebLinkAbout0792 MAIN STREET (OST.) - HAZMAT �'79cq /Mc 7 4U--L -t74?-ZOQal-- L jV TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 11-n _ f Mail To: NAME OF BUSINESS: ����/� f Board of Health MAILING ADDRESS: � --�77 MO— Town of Barnstable TELEPHONE NUMBER: �' So� (J O'D� P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities 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 store 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 ass Hyclraukc fluid (including brake fluid) Disinfectants 60�torrl� waste oils Road Salt (Halite) Gasoline,dgt fa& Refrigerants _ V Diesel fuel, kemsme, #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 f 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 t I _ .. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body shops 0 unsatisfactory- 4.Manufacturers COMPANY � � (see"Orders") 5.RetailFuel Stores to Suppliers ADDRESS �'1l�vyj.i7" � Z� lt��&ass' ! 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drurns Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test P Fuels: Gasoline et Fuel (A) C6 Diesel, Kerosene, #2 (B) (J . Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic (/ Synthetic Organics: degreasers Miscellaneous: DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer $Public Von-site OPrivate 3. Indoor Floor Drains YES NO 0 Holding tank: MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO—,K ORDERS: 0 Holding tank: MDC ° 0 Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (sT Interviewed Inspector ` Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 5 �� Board of Health MAILING ADDRESS: 7 Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON:'���i , c B %u ���� Hyannis, MA 02601 Does your firm store anNing, f the toxic or hazardous materials listed below, either for sale or for your own use, in quantities t 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 l 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 r TOWN OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY T vA,� S^B�'t�24� _' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 7ZE MAity aS�P- 0S 4'- Y7-'_'�&ass: 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 Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) Ilk,, new motor oil (C) lG�_f RXS transmission/hydraulic« Synthetic Organics: degreasers Miscellaneous: t7j;: ,b (� DISPOSAURECLAMATION REMARKS: )_ 1. Sanitary Sewage 2.Water Supply O Town Sewer ,dPublic *On-site OPrivate `�1� � 3. Indoor Floor Drains YES V NO Holding tank:MDC G' - O Catch basin/Dry well 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 a YES 1Nv 2. erson ( Interviewed Inspector ate MODE HUBBARD OIL COMPANY, INC. GASOLINE / DIESEL / MOTOR OILS / KEROSENE / FUEL OIL Brooks Road., P.O. Box 10, Hyannis, Massachusetts 02601 • 508-775-37�1 ti August 24, 1989 CommonWealth of Massachusetts i Department of Enviormental Protection -�0 Richard Pakard Lakeville Hospital �) Lakeville Ma 02347 V t ; v . -I, V Dear Mr. Packard: lu This letter is to inform you of the progress concerning they / . 4000 gal U/G tank at our station at 792 Main St. Osterville Ma. on August 22, 1989 we contracted with L.C.R. Services, Inc. of Centerville, Ma. to: 1 . Remove the tank on September 20, 1989. 2 . After removing the tank L.C.R. Services Inc.will test, render inert, clean a nd transport it to an approved facility. 3 . L.C.R. will then test the soil beneath the tank at seven locations, more if necessary. The testing device is known as a H.N.0 photo ionization detector. If further remedial action is needed we are prepared to do whatever is necessary to correct the problem. Please let me know if you have any questions concerning this matter. Sincerely Y urs, R F Latshaw cc: Charlotte Stiefel L.C.R Service LT. Wilcox r • Facility' No:-�1��, LOCATION• Q5TE RY!L1—k 5. . . .sir•. •. :• . . •. . , . WATER • TOPOGRAPH3C • '. . . AV D .Ate.' SEWER• ...•-.- LAND A CA *OAS tri� S• • .. *OAS _�-- i S(00 SQYT• '' s�Qee-r . Gi2pde. . • ••- .TES �� . ZONING • � �,.,' •�� S vDaNz O PR � ,QLOCK Z eAY �l�D!• � , , 6 •�::. i'• ,::•��l5 .,� :. � L, �;-1..�0 7- t. !� C6, COA; 1 ���cac.DEsti��•. T e ,�s s.o , •SST ' NEIGHBORHOOD :J •'' • •' 'f. •1✓o N • •('•D/�)/>> �I:i!�l I11�G:'''/ r���• /� r. ,. : J�.t••i OTHER EASEM.NT R•o.cv:� To Awl�or.uwG- Piesp�a*y•:ewe?eR . • •_ • ti• ••.! , � '.� is �.• .l•:�•<�:: �•'�,.:,:.• � •. •• +•, • , • •', .�♦ ••, ,', •:,.,•••:'•71i L' t7as++- anew..t:S •: t4 •f1 •;�• h .. , ' ..'r t �Z Yq • Volto *of • 6 cl YOGI �•:• WO op o ' .•••' •, 7� i • Q' J • • :' • •• • • •• •'i'• �f„ •:U,: • • •w•••j• •.••�• is •�' ,, • • • C•h : •,• f ':• .• '� • •: •• •• ,,': ,,•• .•'J�'' '••i•„• •ems•"'�•:• .'�,r r,t:t.•!• •f•�'• •• • ' • MAiN OPW BALANCE STAGE II VAPOR RECOVERY SYSTEM MANIFOLDED VAPOR RETURN LINES EXHIBIT II NOTE SERVICE STATION 3/4" GALVANIZED RISER BUILDING PIPE STUBBED EITHER TTT INSIDE DISPENSER. OR ON PUMP ISLAND. -- --- � .---- --� III 2" VAPOR `------- ---- --�. - - _ - -- -- -- -��`LINES 2" VAPOR - `� LINES SLOPE `\ ( 1/4" PER ,FOOT) 3" VAPOR LINE-f`S<O ` 3^ PIPE WITH VAPOR `� �`\ MAINTAIN 2' -0" CLEARANCE TIGHT *ADAPTOR . BETWEEN FILL PIPE AND (FOR STAGE I V/R). VAPOR RETURN PIPE TO TRUCK . RECOMMENDED FILL LINE -� - - - -- - . FLOAT CHECK VALVE FOR REG. REG. NEW PIPE INSTALLATIONS LEAD \. . UNL. PREM (WHERE PERMISSABLE) \ UNL. NOTE ( l ) VAPOR RETURN MAY BE COAXIAL WITH FILL LINE. C®M TM/OPW DI PO JAN. 1988 CINCINNATI, O. U.S.A. I LCR, INC. ENVIRONMENTAL CONTRACTORS Site Remediation • Site Assessment • Tank Services (508) 778-6002 Fax (508) 775-6646 August 30, 1989 Hubbard Oil Co. , Inc. Brooks Road Hyannis, MA 02601 Attn : Mr. Bob Latshaw RE: LCR No. 2433 Dear Bob: To confirm our telephone conversation of August 23, 1989, please be advised of the following. 1 . LCR, Inc. shall test the excavation of the 4, 000 gallon tank to be removed by our firm on September 20, 1989. An HNU-101 photo-ionization detector, calibrated with iso-butyl cal- gas, is to be used for the test. This test will be conducted by trained certified personnel. All results will be recorded and proper documentation forwarded to your attention. 2. We are also in receipt of your $1, 200. 00 deposit on this contract. We send our thanks to yourself and Bert Fournier for this opportunity to serve you. Sincerely, 1 Robert H ` Cox; Jr. Field Operations Manager RHC: klw cc: File Bayberry Square - 2C 1645 Route 28 Centerville, Massachusetts 02632 r - M001 HUBBARD OIL COMPANY, INC• GASOLINE / DIESEL / MOTOR OILS / KEROSENE / FUEL OIL Br ooks Road., P.O. Box 10, Hyannis, Massachusetts 02601 • 508-775-3711 August 24, 1989 CommonWealth of Massachusetts Department of. Enviormental Protection .Richard Pakard Lakeville Hospital 'Lakeville Ma 02347 Dear Mr. Packard: This letter is to inform you of the 79ogress conCeSt. rstervthe 4000 gal U/G tank at our station at 2 MainMa. On August 22, 1989 we contracted with L.C.R. Services, Inc. of Centerville, Ma. to: 1 . Remove the tank on September 20, 1989. 2. After removing the tank L.C.R. Services Inc-toll test, render inert, clean an approved facility. 3 . L.C.R. will then test the soil beneath the tank at seven locations, more if necessary. The testing device is known as a H.N.0 photo ionization detector. If further remedial action is needed we are prepared to do whatever is necessary to correct the problem. Please let me know if you have any questions concerning this matter. Sincere y Y urs, R F. Latshaw cc: Charlotte Stiefel L.C.R Service LT. Wilcox ATWOOD OIL COMPANY Div. of Fournier Petroleum inc. Brooks Road • P.O. Box 1238 • Hyannis, Massachusetts 02601 508-775-0081 The following is to inform you of our plans for the installation of the underground tanks at the site on route 130 .sandwich Ma. As discussed we plan to install fiberglass double wall tanks and lines. All tanks will be equipped with the following: manhole with a minimum_�capacity of 1 . A spill containment three gal lons in order to return product to the tanks. . g 2 . An over-fill prevention device; a) One device will auto- matically shut off flow into the tanks .when the tank is no more than 95% ful,l .b) A second device will alert. the individual delivering product when the tank is no more than 90% full . 3 . Continuous Leak. Detections roved interstitial o a) The double wall tanks will have an approved space monitor . b) An approved. in tank monitor installed and maintained by qualified employee. c) Monitoring for vapors in the soil through .the . use of a monitoring device. d) The station personel must keep records of the daily stick:; readings of all the tanks. . 4. Vapor recovery stage 2 lines will be installed from tanks to dispensors . Also, the dispensors will be equipped for conversion to stage 2 when required by law. ATWOOD OIL COMPANY Div. of Fournier Petroleum Inc. Brooks Road • P.O. Box. 1238 • Hyannis,. Massachusetts 02601 508-775-0081 5. An added safety feature is the automatic shut off equipment in the event a customer hits one of the dispensors. Also the supplier of the tanks guarantees them for 30 years. With all these precautions it is almost impossible to have a leak due to faulty equipment. Arthur, we do look forward to a very good relationship at the new station, as we presently have at your Wakeby Station. y Sincerely Yo rs, R F .Latshaw M1 III REPRESENTATIVE CUSTOMER LIST Army Corp. of Engineers Bank . of Boston Boston Project Corp. Cabot Corp. . Cape Cod Bank and Trust Cape Cod Five Bank Cape Cod National Seashore Coastal Engineering Energy Answers Corp. Town of Falmouth, Ma. Falmouth Marine Falmouth Coal Co. Falmouth National Bank Fields Point Development Corp. . General Electric H. V. Allen & Co. Inc. . Hall Oil CO. " Town of Harwich, Ma. Hubbard Oil InterContinental Developers, Inc. Land, Vest, Inc. May Institute Mobil Oil Nelson Oil Co. New England Aero Services Orleans Auto Supply Inc. Oyster Harbors Club Panton Plumbing & Heating . Plymouth Savings Bank P. S. Ideal Oil Co. Puritan. Clothing Real Estate Assoc. Regional Waste Services Inc. Carl F. Riedell & Son Plumbing Rogers and Marney Builders Town of Sandwich Sapphire Engineering United States Air National Guard United States Coast Guard U. S. Department of Commerce U. S. Oceanographic and Atmospheric Adminstration V&V Construction Woods Hole Historical Collection Woods Hole Oceanographic Institute Wright Jennings Oil Make Sure Your Investment Is Well s fill . , You may not be aware of the Our services cover a range of • Petrotite testing liabilities associated with property technologies from underground • Soil gas testing transfers in the state of Massachusetts. storage tank removal to biological • Removal and cleanup LCR,Inc.provides specialized remediation of pollution problems. Our.practical,economical straight consulting services to minimize Our site evaluation teams perform: forward approach will help you meet liabilities associated with underground Site Evaluations your regulatory obligations with a storage tanks,environmental site f When need assessments,oil and minimum of fuss. en gasoline spill • Soil contamination studies y g p • Remedial investigations assistance with your environmental remediation,and asbestos abatement. . Groundwater investigations problems call LCR,Inc. Groundwater and soil • Tank evaluations contamination rank high among . Waste disposal site investigations today's environmental problems. LCR's site evaluation teams identify Property Transfer Assessment such problems in a cost effective • Site audits manner.Whether you have property • Historical land review to sell,buy,finance,or insure,our staff • 2 1 E Site evaluations can help you with both technical and regulatory questions in a cost efficient, Fuel Tank Management and confidential manner. • Alarm retrofitting LCR, INC. (508)420,3365 is P.O.Box 765 .381 Old Falmouth Road,Unit 5 ENVIRONMENTAL CONTRACTORS 1645 Route 28 Bayberry Square-2C C Centerville,MA 02632 Because We .. May Be The Next Endangered .. Species I A 1, classified by the U.S.Government as maintaining a safe,healthy,home, Fuel Tank Maintenance The U.S.Government estimates a"special waste",responsible for environment,LCR,Inc.will work T over he of all underground storage thousands of cases of lung cancer and with you for all your environmental tanks are leaking,causing severe emphysema across the country.If your concerns.All it takes is a phone call. house was built between 1920 and damage to our environment and LCR, INC. substantial risk to public health. 1970 you should seriously think about � LCR,Inc. opublic you with purchasing an asbestos survey. ENVIRONMENTAL CONTRACTORS providesy LCR,Inc.will identify, 1645 Route 28 Bayberry Square-2C services ranging from in place fuel encapsulate,or remove asbestos from Centerville,MA 02632 tank testing to removal and cleanup of your home in a cost effective,efficient fuel tanks and spills in an efficient, manner.Asbestos is a health risk you professional,and confidential manner can't afford not to deal with. Asbestos Services Because we recognize the Asbestos has in recent years been responsibility we all have in b i V Y Y � � •�� �i'TPLI . �.�,'1r":-1°r�IT7T�,� 3—vTacxvi �.---t-� O satisfactory �.;2. Printers '�BOAF� U OF HEATH 3. Auto Body Shops 1,� unsatisfactory- 4. Manufacturers n (see"Orders") S. Retail Stores COMPANY ( � ,��nl)�/ , I�a �< I-� �� `t 6. Fuel Suppliers ADDRESS ( � ,� - ( s �r�? a`ur Class: 7. Miscellaneous /I A n� QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor Case lots Drums AbdveTanks Undetgrouad Tanks MAJOR MATERIALS IN UT IN OUT IN IOUT N & ggllonse rrest Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) _ ,f• �{ transmission/hydraulic 1 Synthetic Organics: degreasers �► v J i W scellsiicous: DISPOSAL RECLAMATION REW.RKS: ! Q 1. Sanitary Sewage 2. Water Supply l h/' ,- - - J C r/-�' YAk; OTown Sewer O'Public n y O.On-site V Private 3. Indoor Floor Drains: YES NO O Holding tank: MDCrr O Catch basin/Dry well C O On-site system �77� 4. Outdoor Surface drains:YES NO el Holdink• tank: MDC 77 Catch basin/Dry well OOn-site system ._ __�_ --r---•r- --- S. Waste Transporter i pit tr'� .. i� , Licensed? ,Nance of Hauler- ,,jlpstinati n l,1ste-"Product YES No u ei Person(s), Int.erviewe ndpector Date' T. T®VVIV ®F BARNSTABLE" BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM ADDRESSr gn , Major types of materials: 1) 44 2) ) . 4) 5) 6) 1 I. Description of material(s) use: - II. Storage (denote product by numbPliste ' above) A. Containers metal glass paper plastic cans,bottles,j ars drums,barrels r aboveground tanks 14 underground tanks bags,boxes open,loose,uncovered inadequate labelli B. Storage Facility ✓or # Remarks/Recommen(i:llions 1. Indoor r a) separate, contained room b} stored it general work area i) inadequate ventilation ii) floor drains ."41 1f, 11 f iii) inadequate fire protection 2. Outdoot. a uncovered , exposed to weather Bather y# , b) pervious surface/catch basins III. Disposal, A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system 3. Separate holding tank ` f C. Off-site disposal 1. hauled by own firm Aj 2. hired hauler a) name of hauler b) address or disposal site Persop(s) Interviewed — r Inspector > ►- - - - — — — — — — — — Date �' - - - - - - - - 6 30 81 OSTERVILLE HOUSE & GARDEN SHOP INC. 846 MAIN ST. OSTERVILLE, MASS 02655 December 11 , 1987 Town of Barnstable Board of Health John M. Kelly, Director 367 Main Street Hyannis, MA 02601 Dear Mr. Kelly: Reference is made to our letter of September 4th regarding the cleaning and removing of hazardous materials from our Bike & Mower operation located at 832 Main Street, Osterville. Please be advised that Clean Harbors of Braintree has completed the clean up and removal of said materials, and I have attached a copy of the manifest. I trust that the above will be satisfactory in complying with the state and local regulations concerning hazardous,,- wastes. Very truly yours, Carl Souza, Vice President Osterville House & Garden Shop Inc. CS/jl Enc. . o, COMMONWEALTH OF MASSACHUSETTS ,,^ DEPARTMENT OF.ENVIRONMENTAL QUALITY ENGINEERING DIVISION OF SOLID AND HAZARDOUS WASTE tf� One Winter Street `"- •� Boston, Massachusetts 02108 ,;, r % Please print or type.(Form designed for use on elite(1 2-pitch)typewriter.) UNIFORM HAZARDOUS 1.Ge rat US ER L�IDy� Manifest 2.Page 1 In formation in the shaded areas Document No. / WASTE MANIFEST of / is not required by Federal law. 3.Genera or's Nam end Mailing Address A '- s ,' %L:` i A State Manifest c t u 3 4.Generator's Phone( . 1 � ` h a> • ; J= 5.,Tra. porter 1,Company Nam) ` l 6. I S EPA ID N mber _ C St to ransx I p� � -• ,�f - '•�: ' ! .•I L/ 't /l}J Ul 7.Transporter 2 Company Name ;% 8. US EPA ID Number "D Transpoiter's Phone(.✓/ ) 5 j 9.Designated FaIcility Name and Spe Ad*ess 10. US EPA ID Number � �= ;'11 �/•'���c.:'= ��. +-�/� '"-�'7�!`i:C::. ,�F�Transporter_sPhoneC�;K rl �<1���:��'.:r � j 'T•G: t`te a"ili`'sD. `i, Nt RAio f ' H'Faclht Ph one( I. —C v 12.Containers 13. . 14. r I Ir j11.US DOT Description Including Proper Shipping Name,Hazard Class,and/D Number) Total Unit o.x{Waste •• No. Type Quantity WtNol D a' AI dc_ f u (} I I TOOR001 n G b' 4 Vl E Z C R c. g A 2 O Z c R d. €€a t V) J.Additional Descriptions for Materials Listed Above(include physical state and hazard code I =f K "Handling Codes for Wastes Listed Above ar d.a y Y , r*1 b. 15.Special Handling Instructions and Additional Information r*1 a z 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by M proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway Zl :^ according to applicable international and national government regulations. m If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable O rJ and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ- ;1 merit;OR,if I am a small quantity generator,1 have made a good faith effort to minimize my waste generation and select the best waste management method that is available to me and that I D can afford. Date D Printed?ypedName Signature Month Day Year 'A T 17.Transporter 1 Acknowledgement of Receipt of Materials Date ID R A Printed/TypedName Sig ture Month Day Year N J S P < 0 18.Tr n o er Ac ow dement of Receipt of Materials Date R T Printed/TypedName Signature Month Day Year E R .19.Discrepancy Indication Space F A C I L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. Date T Pr/nted/TypedName Signature Month Day Year '" I I I I I I Form Approved OMB No.2050-0039,Expires 9-30-88 EPA Form 8700-22(Rev.9-86)Previous editions are obsolete. COPY>6 : DESTINATION.STATE-MAILED BY GENE TOWN OF _BAR 1. Marine,Gas at ons, Fpa .r Q satisfactory 2. Printers BOARD 0 ►:. HEALTH 3. Auto Body Shops O unsatisfactory- 4. Manufacturers COMPANY (see"Orders") S. Retail Stores 6. Fuel Suppliers. ADDRESS glass: 7. Miscellaneous OwN �� () OIL QUANTITIES AND STORAGE (IN=indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetground Tanks IN JOUT I # ' j gellons Age rest? Gasoline, et Fuel . (A) �" �� Vg', i Diesel Kerosene, #2 (B) �1esc Hea, aste motor oil 100, new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous-V �1 SCUWXP— TAT. DISPOSAL REC ,ATION REW,,RKS: 1. Sanitary Sewage 2. Water Supply V OTown,Sewer Public OOn-site Private 3. Indoor Floor Drains: YES NO J —O O Holding tank: MDC O Catch basin/Dry well, DER , On-site system ••___�.. OILS 4. Outdoor Surface drains:YES NO (� fk,:d=ng tank: MDC a OCatch basin/Dry well AM , .Tx __•_� OOn-site system S. Waste Transporter Licensed? -- Destination msauAt Product L) YES NO 1 01 L' ;7 .V I o Tg� 12 23 81 P Pfson s) Inte v' a pector� D to F.P. 29-2 . ., The (90mmmtfn>'ttlth Drf . sStIt LIgP B t Department of Public Safety—Division of Fire Prevention t APPLICATION FOR PqQMIT FOR REMOVAL AND TRANSPORTATION TO APPROVED TANK YARD t o 19 ° C.82 S.40 M.G.L. ` To: HEAD OF FIRE DEPARTMENT DIG SAFE NUMBER r y2 / 1 Start Date y� a �Ov '� O�•�' In accordance wit;n the provisions of Chapter 148 G.L. as 4f r 5t Application is hereby t Section 38A Ali by Provided in n L Y made Y r "L1 �.K `.�' / Name OT verson,l-irm or orporation) 4 so�� Address For permission to remove and transport underground steel storage tank(s). from C'S TIC,v vt 14- _T_ Street address city or town v FDID# 0l q? G to approved Tank Yardl; State clearly type of inert gas used in steel storage tank y—T pe o� finer gas usitid Name of Person, Firm, Corporation disposing tank v ;'. 64 �bs. cv� K Date issu rejected �� 14'1 8 Date due y or expiration 19 ai i na r *�s 9 e oT PPP ica t - - — — — — — — — — _ _ _ _ _ s F operation for underground steel storage tank dismantling and storage. it saia tank and is not properly licensed or y p y permitted by a city and town, Board, Agency, Department for any of the above facility classification, an application cannot be considered. (2) Each tank yard shall comply with all the provisions of regulation and be approved by the marshal and endorsed by the head of the fire department after ; •.', an on-site inspection. P) No person at a tank yard shall accept a underground steel storage tank that in any way would be. used for reuse or resale purposes. zs 4) An person, transporting ( y p p g on a public way an underground steel storage tank that has been determined to be leaking to an approved tank yard, shall provide the head of the fire department with a receipt of the disposal location for said tank iprior to the issuance of a permit (on forms furnished by the marshall). Each approved tank dismantling yard will maintain a ledger listing all underground steel storage tanks received, a receipt of disposition thereof and ' ,le r at- t15 sow 1 l SS DZFAR= i Or UBLIC SAFE=Y ;,7:1 E FIRE' :5 3!i,L S COFY — I10. 1 MOWN OF BARNSTABLE COMPLIANCE: CLASSr ,1. Maripe,Gas, Station' ,Repair t '.O sat factory ` 2. Printers BOARD OF HEALTH 3. Auto Body Shops _ O unsatisfactory- 4. Manufacturers COMPANY U►.lscll (see"Orders") S. Retail Stores �`' _ 6. Fuel Suppliers ADDRESS �T �5� 'J� Class• 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks IN IDUT IIN IOUT IN 1OUT # q2llons A e Test? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) #1i Heavy Oils: 1 waste motor oil (C) `f. new motor oil (C) S'Jf- transmission/hydraulic ! � ZC Synthetic Organics: degreasers .t,�„ U -r Miscellaneous: DISPOSAL RECLAMATION - REW,RKS:--- m Z. Sanitary Sewage 2. Water Supply rl Town Sewer O Public �t .�;� ia_ r i�I' .�-0 C)�On-site Private -- ' _ t 3. lndoor Floor Drains: YES NO Holding tank: MDC — © �Catch basin/Dry well fOn-site system ti' 4. Outdoor Surface drains:YES NC �iHolcling tank: MDC Catch basin/Dry well Ll 0 On-site system ti,.� �c. -__'-��zr� "�--- S. Waste Transporter ' ` }� Licensed? Name of�Ha ler_ Destination Jjast''efftP,,roduct. 4� NO Person s) Interviewed Inspector Date m 91 / P i 4 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM AME OF FIRM: uv�'S -u MAILING ADDRESS: $3Z TELEPHONE NUMBER: 1�21Z71 �Z 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 1� . 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: 144 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: i0 Antifreeze (for gasline or coolant systems) d Refrigerants Automatic transmission fluid #0 Pesticides (insecticides, Engine and .Radi,ator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) go Photochemicals Motor oils/waste oils _hLo-- Printing Ink L,,' Gasoline, Jet fuel __,&6 Wood preservatives c/ Diesel fuel, Kerosene, #2 heating oil —� Other petroleum products: grease, (creosote) NO Swimming Pool chlorine lubricants )VP Lye or caustic soda Degreasers for engines and metal � Jewelry cleaners t Degreasers for driveways & garages ,Vt) Leather dyes_ Battery acid (electrolyte) � Fertilizers (if stored _� Rustproofers outdoors) __Ato_Car wash detergents V PCB" s Car waxes and polishes N Other chlorinated hydro- 0 Asphalt & roofing tar carbons, (inc.carbon #Paints, varnishes, stains, dyes tetrachloride) No Paint and lacquer thinners � Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, ife Floor & Furniture strippers hydrochloric acid, other Metal polishes acids ) _N Laundry soil & stain removers #0 Other products not listed (including bleach) which you feel may be A6_ Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners ) list) : Other cleaning solvents E - Bug and tar removers k v i Ho Household cleansers, oven cleanersALTH DEPT. _1YO Drain cleaners TOWN OF BARNSTABLE IVO Toilet cleaners — We Cesspool cleaners *a Disinfectants Ate Road Salt (Halite ) MAY 1 4 1981 I� FOW N OF BA R N STA BL E CO PLIANCE: CLASS: 1. Marine,Gas Stations,RFpai.r satisfactory 2. Printers IjA R D OF HEALTH 3. Auto Body Shops O unsatisfactory- 4. Manufacturers COMPANY (see"Orders") S. Retail Stores Fuel Suppliers ADDRESS $_72 Class:7, / 7. Miscellaneous QUAN7ITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots - Drums AboveTanks Undetground Tanks iIN IDUT IIN WUT IN UT # L7allons Aizerest? Fuels: _ a Gasoline, Jet Fuel (A) / , 3 - 3 e-oro E� Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic L Synthetic Organics: i degreasers af.aeY c Miscellaneous: j DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2. Wate Supply Own Sewer Public On-site Private 3. Indoor Floor Drains: YESP NO- 0 Holding tank: MDC arch basin/Dry well On-site system 4. Outdoor Surface drains:YES NO aHolding; tank: MDC ----- O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? N=e_ of Hauler Desti nat;on xa.9 Q Erod 1. RYA/ ®��i %�°`6f0� �D �//,Z .. _ _ T2 23 81tl Person(s) Interviewed Inspector Date - , . " TOWN OF B STABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,RFpai.r O satisfactory 2. Printers BOAR D OF -EA LT R 3: , Auto, Body Shops O unsatisfactory- 4. Manufacturers COMPANY .. (see"Orders") S. Retail Stores '" 6. Fuel Suppliers ADDRESS Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbdveTanks Undetground Tanks IN OUT IIN IOUT F IN IOUT # -gallonserest? Fuels: . Gasoline, Jet Fuel (A) / tj I Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers { Miscellaneous: 1 DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water u�pply VZ'S Sewer ublic77 ite Private O -- 3. Indoor Floor Drains: YES NO _ O Holding tank: MDC O Catch basin/Dry well On-site system O . j 4. Outdoor Surface drains:YES NO O Holding tank: MDC O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? Name of Hauler Destination „NjaSte Eroduct YFS1 No 2. Vj /, Person(s) Int.ervid --"�-- «� 32 23 81 ewe /Inspector Dafe TOWN OF BARNSTABLE COMPLIANCE: cL s z 14 Marine,Gas tations, Fpair O satisfactory 2 Printers BOARD OF HEALTH 3. Auto aBodyctu Shops Qunsatisfactory- 4. Manufacturers "� 5, Retail Stores COMP7�NY �� � ������ (see Orders ) �6. Fuel Suppliers ADDRESS ► f ! ! U`S~11% V Class: 7. Miscellaneous s � QUANTITIES AND STORAGE (Itv=indocrs; OUT=outdoors; MAJOR MA7ERIALS Case lots Drums AbdveTanks Underground Tanks IN UT IN 0 IN OUT # 211 n e s ? Fuels: Gasoline, Jet Fuel (A) `� 7- :G'ZaC7 �. Diesel, Kerosene, #2 (B) sgDJ., ) f Heavy Oils: waste motor oil (C) new motor oil (C) 3Q transmission/hydraulic Synthetic Organics: degreasers64 <4 �L�•��`'� f -4 Miscellaneous: I DISPOSAL RECLAMATION REW,RKS:. . 1'. Sanitary Sewage 2. Water Supply Town Sewer 0 Public On-site Private - 3. Indoor Floor Drains: YES NO Q Holding tank: MDC4 1_11. ,- - i 0[Catch basin/Dry well -On-site system .. Y'���C 4. Outdoor Surface drains:YES NC fff 0%H01ding tank: MDC O Catch basin/Dry well 0 On-site system ILL __�- ---------S. Waste Transporter Licensed? Name of Hauler_ Destinations Naste Product ' �i� � Person(s) Interviewed Q Inspector bate Lei