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Home My WebLink About0111 AIRPORT ROAD - HAZMAT 41 K-- 1ffq2-M)q-r- i Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that LEWIS& WELDONCUSTOMKITCHENS ................................................................................................................................. 111 AIRPORT ROAD, 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 i Town of Barnstable Inspectional Services BARNSTABLE Oart"sraeic•tcnhht •centrrranws lJ�r Public Health Division ` ""� °639-201��g" ��" K � 14 ' &MW9rABLF, s Thomas McKean, Director 0 39.t s` 200 Main Street, Hyannis,MA 02601 e i Office: 508-862-4644 Fax: 508-790-6304 w} r,. X 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 O CATEGORY"2 PERMIT 111 —499 Gallons: $125.00 �j V5� d G�1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El —9 0(o *A late charge of$10.00 will be assessed if payment is not received by July 1st. fJ 1. ASSESSOR'S MAP AND PARCEL NO. ��7 '?A1S_C6, 1, 013 2. IS THIS A PERMIT RENEWAL? YYES_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 I• QUANTITIES (25 GALLONS)? YES NO.4. FULL NAME OF APPLICANT:. ,C- a rep G(% Li. 4A Vr .-ft— 5. NAME OF ESTABLISHMENT: + k/aldcv, Lt.'o-sitm 6. ADDRESS OF ESTABLISHMENT:. j i I Ai[�PD(L d- 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: C I-1 (V(L t 0?9 & 1•S 10. SOLEOWNER: )( YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ,L ; s k)e,( urn C6,Jov" KJAuk,ein,( PRESIDENT Ci jgj_eJA cc` w i,+A vT a. TREASURER CLERK M,tc /►ovr �t_ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: h SIGNATURE OF APPLICANT DATE h d Q:\Application Forms\Haz Mat Appli Draft Jan20 .d Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that LEWIS& WELDON CUSTOM KITCHENS 111 AIRPORT ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------------------------- ------ ---------------------------------------- ---------------------------------------------------------------------------------- ------------------------------ ---- ----- --------------------------------------------------------- ---------------------- --- -------------t- ---------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06130/2020 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 Town of Barnstable p , , Inspectional Services BgN-8 LE OpTME�'r Public Health Division xrs"restui�.�e>.�`'ru=0n :6,9-z0=<. ASTABLE, ' Thomas McKean Director $ Otf039. Mp�p�O 200 Main Street, Hyannis, MA 02601 �'. -ri Office: 508-862-4644 Fax: 50.-Cl 90-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE r 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 RVSI- d c�Yt 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. ?jNitC�. 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 STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: S. NAME OF ESTABLISHMENT: -f. U-CAd, 4 K ors 6. ADDRESS OF ESTABLISHMENT: ��I �4I"`" 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: OLV.,rdi & ICIs,i) ,. Gdo- 10. SOLEOWNER: x YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHON ,#OF: CORPORATION NAME i eLj Is 6u-t Pr PRESIDENT • 4(ew , R- — A.— TREASURERe- CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: '"- _ / TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC r DATE /f 1 Q:Wpplication Forms\Haz Mat App Revised 09-10-1 ocy `pp THE TOk4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 Y BARMAR-S. ` 200 Main Street• Hyannis, MA 02601 1659. �A'FDMP TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 5�2°/A9 Business Name: Lewis LJ-e-I.Q o w Date: Location/Mailing Address: If I A,� oak N aKN t Contact Name/Phone: 1�w,- Wa151.. 5<og -77 -.15---757 J InventoU TotalAmount: 'L �< SDS: ee✓ License#: Tier II M17 Labelina: Spill Plan: OK Oil/Water Separator: Floor Drains: ® Emergency Numbers: a� Storage Are 6K q R X<o.U- ►n7&/ L , G Emer enc /Containment E u ment: 6 P.o I I lep O t Waste Generator ID: Waste Product: Dai < Date&Amount of Last Shi ment/Fre uenc : 1 A-- 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. 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 f r e gines&garages Pesticides: �i insecticides, herbicides, rodenticides Caulk/Grout 2010 Battery acid (electrolyte)/batteries / Photochemicals(Fixers) Rustproofers 11�� Photochemicals(Developer) Car wash detergents A0�kD Printing ink Car waxes and polishes Lk Wood preservatives(creosote) Asphalt&roofing tar 10)< Swimming pool chlorine Paints, varnishes, stains dyes -CO. S Lye or caustic soda Lacquer thinners�f,- �o\®eve ��-<,�c� Miscellaneous Combustible Paint&varnish removers, deglosNrs LDS"'' 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: INFORMADOW RECOMMENDATIONS: J `P-, a 1 11A; I t' Inspector-- LQ Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p IKE* Town of Barnstable Office:508-862-4W Public Health Division Fax:508-790-6304 • BARMASS . . ' 200 Main Street• Hyannis, MA 02601 1639. TOXIC,AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Lewis S 0&1 A&x- Date: Location/Mailing Address: %l -v P,-4- ' kQ 1-�•!a hr .S Contact Name/Phone: —Inventory Total Amount. �" I�b el f MSDS: G License#: 1 �3 Tier II : o l Labeling: a" Spill Plan: S Oil/Water Separator: Floor Drains: N1D Emergency Numbers: Storage Areas/Tanks: A,1 �� vPd-3 04t.r-Ww►mac.. `S 00 \0,� 1 S Emergency/Containment E ui ment: k ` W 0A, 50 r 0%4.. 5 �- Waste Generator ID: 0 7"l Waste Product: Date&Amount of Last Shipment/Frequency: 1 I 1 P- V! Licensed Waste Hauler&Destination: v- Other Waste Disposal Methods: Ar LIST OF TOXIC AND HAZARDOUS MATERIALS I ° V�Mk ad t NOTE: Under the provisions of Ch. 111, Section 31, of the aneral 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: v Inspector: L0. 1`� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS TC roy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAR ,$ 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Lewi-s 5 LJP-1 atov%- C�-4+.V.- K-4C1.-.Vk-S Date: Location/Mailing Address: t t i A i )PQ 1 AAVNi 5 Contact Name/Phone: 7-1,'v%&- Lt)/&l 5W,- 5-0 o -7713- n S-7 Inventory Total Amount: ti 160 q MSDS: eS License#: l t`}3 Tier II : Labeling: '�oo Spill Plan: 2 Oil/WaterSeparator: Floor Drains: ISJ o Emergency Numbers: 2 StorageAreas/Tanks: J- S Emergency/Containment Equipment: '11 So,< 5 0 f-A-f. Waste Generator ID: D Waste Product: &Nh -Q ; u�as e� Date&Amount of Last Shipment/Frequency: N)Q PSCAL VD S k x Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS No dh4,\°l &VAb �v� \v.J2hko �iK[,� 1e%s-� NOTE: Under the provisions of Ch. 111, Section 31, of the General La s of MA, hazardous aterial 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: NO 5 Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: 3 / 2 / T TOWN OF BARNSTABLE `o,� TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: k-14 Ir 4bv�- L1L1Tovv1, �� 5 BUSINESS LOCATION: it INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: Sflgj --7 —15-1"-'-7 O jeflejt45 CONTACT PERSON: \w, Wk\51� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: co-� alo- , 4 7Z INFORMATION / RECOMMENDATIONS: ko m ,, < -Y k-e- Fire District: r=QA G �➢: . l2 t31 3 Waste T er +en: +��1�� Last shipment of hazardous waste. r�ns� 57 p Name of Hauler: A0J 01 �Q�.oVeS Destination: bate, o 00<s �rz Waste Product: o %c. -J� Licensed? es No 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) 12- Caulk/Grout✓1.., 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, 10 b Lacquer thinners ✓ (including carbon tetrachloride) � Any other products with "poison" labels C�NEW►t) USED S� (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that LEWIS& WELDONCUSTOMKITCHENS 111 AIRPORT ROAD, 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 lowl B%e "x ,, le 8C� eg atory ervices �t Richard V. Scali,Director Public Health Division BARNSTABLE �Ml t swarvsrnars = Thomas McKean,Director """�°�""gib;-0 44� 5T"�� Mass $ Po7 200 Main Street,Hyannis,MA 02601 -r 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V.S , 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. enAP 91 7,%t c6 L a 0 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: �( A('"G,L L j 4*ri Jfl- 5. NAME OF ESTABLISHMENT: ),eccl l-I 1- (Je(GCO� 1. �`ri►y►► �j i�i � 6. ADDRESS OF ESTABLISHMENT: I I I 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: Ci k Ad o?,a e MS iJ ` C O 10. SOLEOWNER: ./ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME kew i S fi cf thn C'AJ PRESIDENT C W.,n tc= w Uk -, A TREASURER 00 n 4E- CLERK M AC-c /1® -�- 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE I3 Q:\Application Forms\HAZMAT APP 2017 REVISE L Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that LEWIS & WELDON CUSTOM KITCHENS 111 AIRPORT ROAD, 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 ZZ_TOWd L TQZ 61 Nfif Tow1�, of Unstable-Regulatoervices �c7O Richard V. Scali,Director J� mot . Public Health Division BARNSTABLE • BnRN9i„etf••l+i(F41LLE•[ONR•HTt:15 BARNEMABLE. r Thomas McKean)Director NF . 5ML - T: ry, 4 LLE•WSI P4 XiTGBF ASS. � i639-2024 ATfGµple�0 200 Main Street, Hyannis,MA 02601377� Office: 508-862-4644 �6 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. map AN �)Aitcc%L 0 iS 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 STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANN�TI(IES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 17 5. NAME OF ESTABLISHMENT: �C e�J S W y►U'!J►n ✓ r % 1 6. ADDRESS OF ESTABLISHMENT: l (12i0(�'Li 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: SO •5 � .. 9. EMAIL ADDRESS: k*gx 01d, (I Al - Cam 10. SOLEOWNER: %YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME 4 eti l S v PcActa, & sT-. PRESIDENT- G j&rgg f,,- jjA&T - TREASURER /V6 kcf in601M t CLERK M i kO Noon- 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 6 i Q:\Appfication Forms\HAZMAT APP 2017 REVISED. ocx Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that LEWIS& WELDON CUSTOM KITCHENS 111 AIRPORT ROAD, 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 e Town of Barnstable • �t '°�ti Regulatory Services , Richard V. Scali, Director "' MASS. Public Health Division BARNSTABLE 16 9. 0� BARX-M VJLS-OSERT.•CDNR•HTAIi75 � NiASOR5 g115.OSfERV:LLE•W3TBMRS�B 3 1 Thomas McKean,Director 1639-2014 377� 200 Main Street, Hyannis,MA 02601ti Office: 508-862-4644 Fax: 508-790-63 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 109; 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 ❑ 11// 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 b My 1st. ASSESSORS MAP AND PARCEL9N � �`' ®J!�' DATE FULL NA OF APPLICANT: C- E ME A P- NAME OF ESTABLISHMENT: Al eul i � W L(jcv\. C'C•skj' ADDRESS OF ESTABLISHMENT: y// /9,(LQ0 -7 qo Ac9L . MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: C 61 ( .2g (J 1 SiL< C~ SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT Gln L Oc. 1}A,tii JeC. TREASURER Jfrk[; A)am e_ CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATII Name: Company Address Telephone#: Email: Q:\Applicarion Forms\HAZZAPP Rev 16.doex Page 1 of 2 pf' > Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 HA"nAftt Public Health Division Thomas A.McKean,CHO A` 200 Main Street, Hyannis, MA 02601 ffl ' Payment Receipt ;Hazardous Materials Payment received: $125.00 (Check) on 6/9/2016 Permit number: 1143 I ,Check number: 6365 Check amount: $125.00 Name on check: Lewis&Weldon Custom Cabinetry, i LLC t Business: LEWIS&WELDON CUSTOM KITCHENS Owner: KENNETH G TR 1 ;Address: 111 AIRPORT ROAD, Hyannis i It I _...... ._ ........ .......... _... __.... _. .................. ._. _... ................. ._._. ........._. ......._... .. ....__....._; s Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that LEWIS & WELDON CUSTOM KITCHENS 111 AIRPORT ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ f�This license is granted in conformity with the Statutes and ordinances relating there to, and � and expires 06/30/2016 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health rod, Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 n Regulatory Services Department • snt nat�; Public Health Division MASS.st` z `$ Thomas A. McKean,CHO ` 200 Main Street, Hyannis, MA 02601 Payment Receipt :Hazardous Materials Payment received: '100.00 (Check) on 8/24/2015 Permit number: 1143 :Check number: 5624 Check amount: $100.00 Name on check: Lewis &Weldon Custom Cabinetry, LLC ;Business: LEWIS &WELDON CUSTOM KITCHENS Owner: KENNETH G TR :Address: 111 AIRPORT ROAD, Hyannis i • I Number Fee 1143 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that LEWIS & WELDON CUSTOM KITCHENS Ill AIRPORT ROAD, 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 FM Town of Barnstable °f1NE r Regulatory Services ti Richard V. Scali Director MASS.LE. Public Health Division 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 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C. utclk A- NAME OF ESTABLISHMENT + P,(cXot-, r-(,&sA,, 0-c�e,4 ADDRESS OF ESTABLISHMENT Po+ C" TELEPHONE NUMBER SOLE OWNER: V YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 900ca 1?3026 l STATE OF INCORPORATION �lS FULL NAME AND HOME ADDRESS OF: PRESIDENT l( e61zC'J*C-Dk- • �r9irVh1T,0i/�� ,TREASURER CLERK ' N RE OF APPLICANT RESTRICTIONS: HOME ADDRESS l jDd14G►*Z- Via, . W. HOME TELEPHONE # ,SbW-?6 Y- .s Q\Application Forms AZAPP.DOC f LEWIS &WELDON CUSTOM KITCHENS 1 CAGINETRY COUNTERTOPS •TIE Spill Prevention & Response Plan 1 1 i :Lewis & Weldon Custom Kitchens j I I I Airport Road I Hyannis, Ma 02601 508-778-5757 Spill Prevention: Ensure all hazardous substances are properly labeled. Store dispense and/or ! use hazardous substances in a way that prevents release. Provided secondary containers when storing hazardous substances in bulk quantities (<55g1). Maintain good j housekeeping practices for all chemical materials at the facility. 1 Spill Containment: j The general spill response procedure at this facility is to stop the source of the spill; contain any spill material, .and.clean up the spill timely to prevent accidental injury or other damage from occurring. Because of the low potential for spills occurring at this facility the most likely spills to occur are small or incidental spills. Small spills will be contained by site personnel if they are able to do.so without risking injury. Spill kits are marked and located at the spray booth area. Ensure spill clean up materials are properly characterized before disposal. a Emergency Procedures: 1 • 3 Immediately call,911 in the event of injury, fire or potential fire, spill of a hazardous substance that gives rise to an emergency situation,or release of a hazardous substance to the environment(i.e. ground; surface water, floor drains or storm water drains). • If a hazardous substance spill has been release to soil, surface water or drains the following;notifications must be performed: Contact: Chuck Hart- Partner #508-778-575.7 or 508-364-4875 Don.Richereek—VP of Operations # 508-778-5757 or 508-292-5659 Fire Department #911 or Local 508-778-1300 Autobody Solvent Recovery Corp 800-oil4ank/EPA#MV5087785757 D:EP Spill Hotline # 888-424-8802 I 111 Airport Road, Hyannis,MA.02601 508-778-5757• Fax 508-77875111 •www.lewisandweldonkitchens.com tt �: Town of Barnstable ] �V r Regulatory Services Thomas F. Geiler,Director BA `� ' Public Health Division • i639 �� 39 Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C h u C k i1i 0 A(LIT TO— NAME OF ESTABLISHMENT aC e cu i.S A- w edc(vn n S ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SD k ' ?e- 's/"s 7- 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.2002.33-26I STATE OF INCORPORATION 0"I 4 j FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK VU SIG TUBE OF APPLICANT RESTRICTIONS: HOME ADDR �SS P ERGMtt-*bQ,. 1nJ,Qaty � HOME TELEPHONE# Of�• r� LEWIS &WELDON CUSTOM KITCHENS CABINETRY • COUNTERTOPS •TILE Spill Prevention & Response Plan Lewis & Weldon Custom Kitchens 111 Airport Road Hyannis, Ma 02601 508-778-5757 Spill Prevention: Ensure ail hazardous substances are properly labeled. Store dispense and/or use hazardous substances in a way that prevents release. Provided secondary containers when storing hazardous substances in bulk quantities (<55gl). Maintain good housekeeping practices for all chemical materials at the facility. Spill Containment: The general spill response procedure at this facility is to stop the source of the spill, contain any spill material, and clean up the spill timely to prevent accidental injury or other damage from occurring. Because of the low potential for spills occurring at this facility the most likely spills to occur are small or incidental spills. Small spills will be contained by site personnel if they are able to do so without risking injury. Spill kits are marked and located at the spray booth area. Ensure spill clean up materials are properly characterized before disposal. Emergency Procedures: • Immediately call 911 in the event of injury, fire or potential fire, spill of a hazardous substance that gives rise to an emergency situation, or release of a hazardous substance to the environment (i.e. ground, surface water, floor drains or storm water drains). • If a hazardous substance spill has been release to soil, surface water or drains the following notifications must be performed: Contact: Chuck Hart—Partner # 508-778-5757 or 508-364-4875 Don Richcreek VP of Operations # 508-778-5757 or 508-292-5659 Fire Department # 911 or Local 508-778-1300 Autobody Solvent Recovery Corp 800-oil-tank/EPA# MV5087785757 DEP Spill Hot Line # 888-424-8802 111 Airport Road,Hyannis, MA.02601 508-778-5757•Fax 508-778-5111 •www.lewisandweldonkitchens.com W -a TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:5!:. -L._L ,5z4r® 1W4ehgA°o �� Board of Health MAILING ADDRESS: �l �'{� "T` ' �`� Town of Barnstable TELEPHONE NUMBER: �� y' P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: C�65.S -r ��a�✓� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalli , 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 i - d t. 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, var stars-, 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 4 TOWN OF BARNSTABLE MPLlANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH - Satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMP ��.� f�/��✓ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /1!649 e Class: 7.Miscellaneous A' .e-QUANTITIES AND TORAGE (IN=indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drunis Above Tanks Underground Tanks IN OUT I IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: how waste motor oil ast (C) new motor oil (C) 146 transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: -161(_ ` DISPOSAI✓RELLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply 4z& O Town Sewer APublic Von-site OPrivate 3. Indoor Floor Drains YES N0 _ O Holding tank:MDC 0 Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product �. YES NO er on (s) n ewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 6'V Board of Health MAILING ADDRESS: ��' � Town of Barnstable TELEPHONE NUMBER: 7�7a — .72��- z 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: - L LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) 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 a 'w—r.%t..r..,. s..,+.r...ti.._..�-••t,+r.. ...r -.q,.- f- TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM + 44;�� Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: 10 I" 5�va o'l' Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: ^7wo Hyannis, MA 02601 CONTACT PERSON: A� 44AVA IV,* a. 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: ADDR€SS: CA24." . . TE`I_E-N- NE: Ct LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product,that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including.brake fluid) 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 Y 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-Healifi�Department/ Canary Copy-Business , rV.N 1 1 �. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM +�- 5/18/81 �iVAME OF FIRM: Terkelsen Machine Company MAILING ADDRESS: 111 Airport Road TELEPHONE NUMBER: 775-6229 CONTACT PERSON: George C. Terkelsen 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 X 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 Diesel fuel , Kerosene, #2 heating oil ' (creosote) Other petroleum products: grease,lubricants Swimming Pool chlorine Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproof ers outdoors) Car wash detergents PCB' s 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 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 fluids toxic or hazardous (please (dry cleaners) E C E I \/ E ® list) Other cleaning solvents Bug and tar removers HEALTH DEPT. Household cleansers, oven clew°n1eVsBARNSTABLE Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants 198� Road Salt (Halite ) MAY 2 0 V r, v TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM r' --�i'1�e-6 .' Ael'ae Co. ADDRESS .` p -r-?r 5 Major types of materials: 1) 01 a N 2) Jq �50q,3) 4) 5) s V 6) I. Description of material(s) use: I 6 V II. Storage (denote product by number listed abo e) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling a .. B. Storage Facility ✓or # Remarks/Recommeri;� .i.ons 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather 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 C. Off-site disposal 1. hauled by own firm 2, hired hauler a) name of hauler CVA6ie O _ ®va�— b) address or disposal site P rQa Oil Persons) Interview _ Ins ector - - - - - - - - - - - - P -47r - - — - - Date - - - - 6 30 81 Vr •---r�H--iN5 .-' I ' raj -- - -• ----.. . . 4 BOARD - OF HCALT'I-1 -satisfactory 2. Printers• Dody Q unsatisfactory- 3. Auto actu Shops -� � 4. ' Manufacturers COMPANY / {� �� ,r�r;f'l�i� j (see"Orders") S. Reta).1 Stores 6. Fuel Supl•llers ADDRESS -y _j // J,1 Class: 7. Miscellaneous I. ��.�� QUANl'I IES AND S70RAGE (IN-indoors; OUl•=outdoo VJ MAJOR FIA7ERIALS 1 ' Case lots Drums AboveTanks Undetground Tanks IN )U1 1 N OLrr I II 6 gallons e t Fuels: Gasoline, Jet Fuel (A) alipsel. Kerosene, 12 (B) Heavy oils: — ----� waste motor ail (C) 1 -A new new motor oil (C) �" transmission/hydraulic Synthetic Organics: ' degreasers 1 F . _ 1 . Miscellaneous: a U1S� POSAL/Imc . JjTIUN FtEr1l.RK5: 1. Sanitary Sewage 2. Water Supply 0 Town Sewer Public \,0 On-site private - 3. 'Indoor Floor brains: YES NO k HnMing tanks. MUC • '/.k � O Catch basin/Dry well Un-site system — i � 4. Outdoor Surface drains:YES NCr- 0 Huldin . tank: MUC l O Catch basin/Dry well _ On-site system �• -____� __._ S. Waste Transporter r Licensed? Name of Hauler- _11cs-17InatInn Wlste Product c� NU 1. u Li ei sons' nt�ery r w '�� - / f 41nsPddt'or� f Uate 1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: L �� - Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: %w s S _Tei kelse,%� 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_2� 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: 1 \ 1 Sri R,roRr 2opsegn TELEPHONE: S0 $- ')7 5— (.22 1 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) 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.. 'w -r ""•y`"��, tree♦_ . .r.+,+u..r:N-.r....+,. ,rw• • 4_!7 .• a TOWN. OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair - ' satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops O unsatisfactory- 4.Manufacturers qi � COMPANY" W k�'� o-o axis &,h IAte t (see" Orders ) 5.Retail Stores 6.Fuel Suppliers ADDRESS /I/ A-Y,004—Rr9 +'� 0,A'l lass: 7.Miscellaneous r QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MANOR MATERIALS Case lots Druins Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) r new motor oil(C) y transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer ®Public fO On-site OPrivate 3. Indoor Floor Drains YES NO ,I O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES . NO .f ORDERS: 'r E O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste.Transporter m• of Hauler Destination Waste Product YES NO ur.rw—4 .s ' f/4.1 r' � � "/ Q_fit► 2. r �� Ile Person(s) Interviewed Inspector `" � Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS 4 Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 7 Q V P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: c tA vim- (Z—\L-) A` i o L 4 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities total ' g, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NC 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 i 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 *� -Qw waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, vawAsh - es Fertilizers (if stored outdoors) V Paint & lacquer thinners PCB's Paint & varnish removers, deAkwmen 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 fluid'' be toxic or hazardous (please list): (dry cleaners) _l�Iy-� �. ;- 5-b L„ r V Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business I i TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. nters BOARD OF HEALTH satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores COMPANY �� `� 6.Fuel Suppliers ADDRESS lass' `✓�`- 7 1 7.Miscellaneous I Q TITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (13) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers iscel neous: 4_42:&"--" w� 17 G_ l s tl � s DISPOSAURECLAMATION REMARKS: - P 1. Sanitary Sewage 2. Water Supply ` O Town Sewer OPublic 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 N01,/ 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. Person.(s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: JAMES E. W10MART Y MAILING ADDRESS: III AIRPORT ROAD U Isjoy TELEPHONE NUMBER: HYANNIS, CIA 02601 �`7 CONTACT PERSON: Does your firm. store any of the toxic or hazardous-materials-l -s-t-ed`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 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 --- Gasoline Jet fuel Printing Ink Diesel fuel, Kerosene, #2 heating oil Wood preservatives(creosote) Other petroleum products: grease, lubricants Swimming Pool chlorine Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar Paints, varnishes, stains, dyes carbons, (inc.carbon tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners 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 flui-ds (dry cleaners) tt C C E e V E ® toxic or hazardous (please Other cleaning solvents HEALTH DEPT. 1is01 Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 8 1981 Disinfectants Road Salt (Halite)