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0127 AIRPORT ROAD - HAZMAT
a7 a, y� zee r�l� �1 I _ _ INE*oq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9B"M�s�e.g 200 Main Street• Hyannis, MA 02601 �p'FOmoll& TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 4 Business Name: A r a4 Date: / 1 Location/Mailing Addre s: 1,� o Contact Name/Phone: 3OI-77-6 - 0316 Inventory Total Amount: �SDa9 SDS: S License#: �D Tier II : Labelin L Spill Plan: tfeS Oil/WaterSeparator: Floor Drains: Emergency Numbers: T Q- Storage Areas/Tanks: 50 Pb a C' f pfnw,ze� Emergency/Containment E ui ent: i It `d tkglr [Date& aste Generator ID: Waste Product: Amount of Last Shipment/Frequency: icensed Waste Hauler&Destination: ther Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils „ Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products.. Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables 04 A 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/NCOMMENDATIONS: 6ak WA (0 rrlu - Inspec Facility Representative:' WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 Y BAR^ARqBLE.g' 200 Main Street• Hyannis, MA 02601 �ArEO MP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Ai S E�t.s-' Date: � 30 !g Location/MailingAddress: I�-1 +r Contact Name/Phone: ,ro$-'7'7 -031 -77 - 8-1-6K 37 Inventory Total Amount: `J SDS: License#: I© Tier II : N o Labeling: O-K Spill Plan: 3 Oil/WaterSeparator: Floor Drains: No enc Numbers: Ye-5 StorageAreasrranks: o <o �-2. S kooks �Z Vmer eXA. W CI I wse,�S Emer enc /Containment E ui ment: k ZV 4Cva, k ovv N aW 5 k — Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS N ° vv'-a 10 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materill 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: < < + C< �rX� ION Inspector:-- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS. • 200 Main Street• Hyannis, MA 02601 1639. �A'FOMP+a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A f r a 1 to S+ Date: Location/Mailin Addr s : 17- 1 A l r aA- yqj, a v►,�i S Contact Name/Phone: a-e- I +o-1 -JD9-7-T8-031 '77y- $ -6 3 Inventory Total Amount: Q jAA+36W�`��� SDS: ZS License#: Io (`+3 Tier II : v Labeling: Spill Plan: va.e- a Oil/WaterSeparator: tl� Floor Drains: tJ Emergency Numbers: Yc 5 Storage Areas/ranks: 5VO a,1 P -A ST Emer enc /ContainmentE ui ment:22�11 Waste Generator ID: Waste Product: t)o m- Date&Amount of Last Shipment/Frequency: 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 -rVC100 igj-k-� bop 1b 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 I 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" 16%) IAC"IIZV-41 (including chloroform,formaldehyde, scvRo�Qtn�a hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFO MATION/RECOMMENDATIONS: ,A- \ as avtN o C k o c� a_ d t SSJ� 01 co NVA. , Inspector:— LQ41-e— Facility Representative: i•i1u�� . WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r� Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health s This is to Certify that Airgas East 12 7 Airport Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health e Town of Barnstable Regulatory Services C_ Richard V. Scah, Director Z MASK M ` Public Health Division BARNSTABLE � s639 `0� Ks'�"ems ` F+ Thomas McKean,Director 16575 a> 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 V'1 . co APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE �Q Iz2� (O II T— FULL NAME M OF APPLICANT: i 16d 1—p Yvt CY-1 �1 NAME OF ESTABLISHMENT: A ADDRESS OF ESTABLISHMENT: ' ci A} r?p 4 iZ Q1 �)a eny tf / G MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 503 -7 -1 n EMAIL ADDRESS: t C�a.e,, , �i d►'1 e r N� A j�c�G S �0 SOLE OWNER: YES ✓NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE F APPLJYANT Name: Company Address Telephone#: Email: Q\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127Airport 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 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 it > „ Town of Barnstable ' Regulatory Services • Richard V. Scan,Director R° ASS ` Public Health Division 16 9. 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 0"20/ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT I'J NAME OF ESTABLISHMENT _A, 1 R G A S US A L L C_ • ADDRESS OF ESTABLISHMENT _—I TELEPHONE NUMBER rag ,-7 7 8 - d 136 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION ))eA � t FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK M A ishGFR`y yA ichC,Q P IMM • IGNATURE F APPLICANT RESTRICTIONS: HOME ADDRESS g ��eMo�n� s� 1aUVA6r 611 S G HOME TELEPHONE# gtEfP,- `1-i A- WR`1 -643 7 Mcache\Temporary lmemet Files\0LKD3U ZAPP Rev2015.DOC I IK TE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE. MASS. g. 200 Main Street• Hyannis, MA 02601 1639. '0lE0 M & TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A,r is q Date: �SyS Location/Mailing Address: 1 l 0 4nr'1 Contact Name/Phone: AA,c-k4 I Inventory Total Amount: OS Y';6o�u09k MSDS: t 5 License#: Tier II : N. Labeling: 6 Spill Plan: F—yA-Cv^.4-%eti fL.\A . Oil/WaterSeparator: Floor Drains: 14, v Emergency Numbers:� 1 Storage Areas/Tanks: O q a.� v a+ Emergency/Containment Equf pmenit: n�-` �r e►,�cd�i< k o e�rw,�� evv Waste Generator ID: aste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: A, LIST OF TOXIC AND HAZARDOUS MATERIALS f"v WA- ° Gkkdcv,� 1 V- \hvtti?< NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materi�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" sflc�ti� rc�av�, (including chloroform, formaldehyde, 3 boo$ �ac��C.���Vu- hydrochloric acid, other acids) VIOLATION ORDERS: INFORMATION/RECOMMENDATION : Mi. s10 11. Vn Inspector: �12�l� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS oa.+cc. Michael Pimgntel Branch Manager Northeast Region Air9as USA,LLC 127 Airport Road Airgas. Hyannis,MA 02601 Office:508-778-0316 Fax:508-778-1922 GASES,WELDING&SAFETY PRODUCTS Cell:774-487-6437 Email:michael.pimentel®airgas.com j Airgas.com IKE fOkti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAR& 200 Main Street• Hyannis, MA 02601 iOtFDnnn+"� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ,r�CAS EA S lI Date: ►7 Location/Mailing Address: IZ`1 A, C4 AVIV1iS Contact Name/Phone: t, �,So•ti 5bb-' 7 b-0311, ce11 Soo- 7y2-734 1 Inventory Total Amount:3 bo��kg �fa MSDS: y2S License#: 1 v `� `c`A`9 Tier 11 : No Labelin4: C91-9& Spill Plan: � Oil/WaterSeparator: N Floor Drains: 40 Emergency Numbers: es Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID:0A Waste Product: Date&Amount of Last Shipment/Frequency: 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 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 X +ox��5 \ Fertilizers Floor&furniture strippers (10"f0-c'; S/ PCB's Metal polishes 1 Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" 3 b00 cjk kt4 y6,, (including chloroform,formaldehyde, 5-00 Gal pcoDAwe- hydrochloric acid, other acids) VIOLATIONS: 11 1 ORDERS: INFORMATION/RECOMMENDATIONS: Z(-m, AS-e-xo .r a ru. 5.re- K2L eA o- u) A- dC4 a Inspector� Z Facility Representative: ` WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS L Date: TOWN OF BARNSTABLE.-r-a TOXIC AND HAZARDOUS MATERIALS RE0tST990MU FORM NAME OF BUSINESS: ,r a s BUSINESS LOCATION: t r������-3 � �rin, S INVENTORY MAILING ADDRESS: S,cr� TOTAL AMOUNT: TELEPHONE NUMBER: 5-0 g -77 9 -03/(o A, s t-3600 ff`� CONTACT PERSON: ea,tis o•�- EMERGENCY CONTACT TELEPHONE NUMBER: ccl/So$-7Y2.-73�'1 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOM,M'E)N Tl0hN : ��/��s�'f�,n.�-� �a�c�ovs Fire District: V�11wes M1 S It e��— `� LJU4ie ✓ ,5,D5 �I AA-<- to, Inar oOaQs Waste Transportation: IVIA Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 1111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, (kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) ,g Miscellaneous. Flammables va,r%ooe 0,-1 Other products not listed which you feel Floor&furniture strippers f<a,e&C*s may be toxic or hazardous(please list), Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) I5 . .by Ff F3 � � �cfetck-- Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials M Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: A 1& AS ee--�� Business Location: / � i�1l3�T 1 , Ar✓ JJ RA o�Io�/ Mailing Address: As A6a✓t Telephone Number: Jr0,-PI$ 03/6 Contact Person: Je/tAJ A,56A.J Emergency Contact Telephone Number:,) 36AJ du.' 3®� �Z Type of Business: SR-&- oT Ci AT&-, klezz)iN G giln'ti&s f/J,0 SAG�-ry�r�ecsiorr��� HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts,gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc �?Ai VA-AJi t.'TAI LS C*Ott Po u j ►, l -ZS 4ALLWE ¢oA'� E Mt5c Vll�-tDrruf� p c'J 11 ouc�c� �p t3 if&-L+E :RAMRML [' J f$A-uoos ova:fx GA0S � TVi� s S F?ezErJa xsi- ,4 ntA �G-I�g/ei Dew LL6�SS B/Ua= �j�-'Ld.ocs Woa2K be�Lxu /0 �o®Ci.y o�J oor000'f -PRoVA0G 6,6,-S 5 00 Pouk)b S A66vS��N; 1>67V _&cor-r 7T ra V clo 3T'mA$C - 1 - Misc. Combustibles Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount:--,- 75-6*We/S t�j- n 7011-,M S -,:J .3 S y10 Hazardous Materials License Posted es No Contingency Plan Posted?49 No Fire District: I-lyl Wq/>S Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes NALorbent Material Available? Yes N Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site? es No Hard Copy Computer Access Hazardous Waste Handling / Hazardous Waste Generator Identification Number: _ &IA Type(s) of hazardous waste product(s): Date of last hazardous waste shipment,type of waste and quantity: Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes No If hazardous waste is stored out of doors is it covered from the elements? Yes No Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor? Yes No - 2 - v FLOOR DRAINS (Chapter 381) Town Sewer Account Number: A1/4 Sc-Pnc-AS eun-T 3 /-t oo 3 Indoor floor drains: Yes (9 If yes,circle one,does it discharge to a: holding tank dry well on site septic. Outdoor surface drains: Yes No If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes No Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? es No If yes,is it protected from the elements? Yes No If yes,how? Is it on a foundation larger in size than the tank? es No COMMENTS/RECOMMENDATIONS/CORRECTIVE ACTIONS Date: Public Health Inspector: Facility Representative: - 3 - is Additional Inspection Notes May 12, 2011 Air Gas East 127 Airport Road Hyannis, MA Cynthia Martin, PHD Jean Jason, Facility Representative All gases, except propane, are packaged(i.e. sold in cylinders that are pre-filled at an off site facility). Pick up and delivery of prepackaged gases is conducted on Tuesdays and Thursdays. These gases are oxygen, helium, nitrogen, acetylene, argon, carbon dioxide compressed air, propylene and argon mixes. Propane gas is the only gas that is stored in bulk. A five-hundred pound above ground tank is used to fill smaller cylinders for customers on an as need basis. The propane bulk tank is out side in a fenced and locked pen. Packaged gases are stored indoors it a concrete room equipped with vents, fans, explosion proof lighting and a fire wall. The fire wall is to separate acetylene (flammable) from oxygen(oxidizer). This room is located at the end of the building and is accessed by a garage door on the Airport Road(front) side of the building. The facility also consists of a welding supply and safety equipment retail store and receiving area with a work bench. The receiving area is located in the rear of the retail store. The facility was very well organized, and clean. Safety precautions in the way of signs, emergency procedures,phone numbers, and MSDS were visible and accessible. Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Airgas USA LLC 127Airport Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------ -------..---------- - ----------------------------------------- ------------------------------------- - ------------------------------- -------------------------- - ----------------------------------------------- ------- ------------------------- --------- - ------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r I ✓ i` Town of Barnstable , Inspectional Services BARNSTABLE arnic�aeni�:�c�miF°�-s a%'n*=i.e r•, Public Health Division =E3Z9-2Q14 * lARNSTABLE. ` �JU r 9 MASK $ Thomas McKean, Director `l'Atfo�39�.�p 200 Main Street, Hyannis,MA 02601 M. Office: 508-862-4644 Fax: 508-790-6304 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 I st—JUNE 3 Oth). APPLICATION FEES _ CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ _v CATEGORY 2-PERMIT' 1'11=499 Gallons: - $125.00- - -El- CATEGORY 3 PERMIT 500 or more Gallons: $150.00 9V *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?_,,Z YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:-DA'R l .,4) alb Al A U F Z 5. NAME OF ESTABLISHMENT: ,A�R(.,6S, Lye A L L C- 6. ADDRESS OF ESTABLISHMENT: 19, A-IP Poul P i H UAIA-TS M h Og (aQ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 5 0 J. 9. EMAIL ADDRESS: AAA LG A) F 2-6P AZA kA!S,C 064 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE - G / 3 19 Q:\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Airgas East 12 7 Airport Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Vowegulatoryof B nsxable ervices Richard V. Scali,Director ' Public Health Division BARNSTA-iffy rt 3ARNbTABLE. s ru�asm�vus�+x��r sr�aeF M49& Thomas McKean, Director 1639-2014 1639-- —--200 Main Street,-Hyannis,NIA--02601--- --- - --- - - — ---- r,.� Office: 508-862-4644 Fax: 508-790-6304 -e APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE Cry HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26-- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0 V,S . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL'9 _LZ�i S—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: 5. NAME OF ESTABLISHMENT: Alga 1,AS US A L L C- 6. ADDRESS OF ESTABLISHMENT: I;M 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: S D - 77<6—05 l!J 9. EMAIL ADDRESS:� 1 ', 10. SOLEOWNER: YES NO W NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE it: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q: �Application FormsViAZMAT APP 2017 REV& ED.docx Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127Airport Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------- --------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Office: 508-862-4644 Fax:508-790-6304 Regulatory Services Department Public Health Division w anxrtsrast:�, • t son UAW: �$ Thomas A.McKean,CHO ibg9� a� Hyannis, MA 02601` 200 Main Street, �a�t Payment Receipt (Hazardous Materials Payment received: $160.00 (Check) on 8/9/2017 Permit number: 1074 (Check number: 02001961888 Check amount: $160.00 Name on check: Airgas Business: Airgas East ;Address: 127 AIRPORT ROAD, Hyannis i ;Note: $150 + $10 late fee/ 2017-2018 Category III Permit __.._ -- _...... . --. ........... -- — ------ -. 1 Towel of Barnstable Barnstable y�* Regulatory Services - R Public Health Division 1 1 s Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 2007 Office: 508-862-4644 Fax: 508-790-6304 July 25,2017 RE: HAZARDOUS MATERIALS NOTICE i Our records currently show that your business is not permitted by the Board of Health to store and/or utilize hazardous materials due to a non-payment of permit. Your permit expired on June ` 30,2017. A$10 late fee has been assessed. Your hazardous materials permit application must be completed within(14)fourteen days of receiving this notice.Failure to comply will result in additional fees. APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $50.00 (+$101ate fee) CATS ORY 2 PERMIT 111 —499 Gallons: �12 �+ O late feeCATEGORY 3 PE or more Ga lons: late fee) Should you need additional application, they are available online(see instructions below). If you have any questions or concerns,please contact Timothy Lavelle,Public health hazardous Materials Specialist,or Vanessa Sousa, Public Health Division Assistant,at 508-862-4644. FOR HAZARDOUS MATERIALS APPLICATION ONLINE; www.town.barnstable.ma.us. Go to Health Division page by looking in the Department Menu. On the Health home page,under Health Resources,select Applications&Forms,and then click on Hazardous Materials Permit Application. Sincerely, 1 1 Thomas Mclean Public Health Agent t [F F F It t QAHazmaA2017-TL1Haz Mat Notice 2017.docx { 1 . . _ y IB lo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE. • 200 Main Street•Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: c•a�s Date: 7 f I r ro Location/Mailing Addres 7---7 IS Contact Name/Phone: Z e CCa-. <'oww -7 5- 307 Inventory Total Amount: 4v$94,1 MSDS: °wl'Ku- aze-sS License#: /V Tier II : A6 Labelina: 9K Spill Plan: Oil/WaterSeparator: /l) Floor Drains: o Emergency Numbers: Storage Areas/Tanks: o ru�"s 'ttn 111e,1.V- or elect OS Emer enc /Containmen ui ment: a- S ✓K aCc� 5 c� K I Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 'v�V�CMJt�r S�K� I�s'f'�1•t5ylar`, NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazarddus 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: No Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date:�Jl Z<1 I TOWN OF BARN STAB TOXIC AND HAZARDOUS MATERIALS -*N FORM NAME OF BUSINESS: 6-6,9 BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 19,E TOTAL AMOUNT: TELEPHONE NUMBER: D +7 3 _ - 11 l Q CONTACT PERSON: �,�,�e t�c,. (17(OOVl�, EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: aL61 / , Cwle5 v INFORMATION / RECOMMENDATIONS: Fire District: rho t9,, PV kf61 0-CIA-0 3 ort, ► a — /WiKo-f' ►5 0,M,0jA*5 on < (�o�ticL�o1 Waste Transportation: A)A Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes 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) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's p Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 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 17T Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127Airport Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 11/20/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health .y C C�) Town of Ir° tad 3 B ble amnsta e. of T uato Service� ., ep artih .y 9 ;200',ivla>31 Street,Hyannis VI�102,601; a � 2�007 t Office: 'Sa8 8G2 464 Tfiomas F,Geler Director FAX: SO8-79.0 b3Q4: Thomas A.'i�_icKean,GHO: q r � 3 App.l catigo fee $100.00 r ASSESSORS lYIE1F AID PARCEL NO. DRATE } APPLICATION �OR PE I'T TO •S`T`ORE AND/0 UTILIZ TM ORE T H tAIILONS Of �IAZAI2 30�JS I1!IA7CER ALS FULL NAlYIE OF , PLICANT. NAME:OF.FSTAB ;ISHAIENT 2ESS OF EST, BLI8I3IVIENT h2' 7. Aw. fe • s 'TELEPHONE NU ER ,S^C� d.3 /6p F SOLE YES' 4 } 4 IF APPLICANT TS' ' I'ATNE �7LL NAIVZE.Aa�iD I�C) IE ADDRESS`Ok'A I — RAI�TNERS:: a 1 S , s IF_APPLICANT IS C!D tPORATION. FEI)FRAL IDtN•TIFI,`CATION STATE OF dNCO. ,<OItAION` FULL NAMM 'AND HO ADDRESS OFi RR.ESIDENT 7b 07, TREASCT 7 CL R I ._.. r t 3 'RF OF,APPLICA.NT. z sTRICTIONS: xo . ADDRESss.�' r1✓� /i =`,�� .�' J;linspecuonhaindoutslt3az at.�pplwataori2�Q8:U0G� j a s ! 9 t i t } MAIL-TN REQUESTS` tlO o heaedssel �1soncudeacopy #Pleasem4, co w o your<.contingency<p an"(to,handle,hazardous waste spills, etc) Tn addit on pl,'ease include the-required-fee of -I00 Make check�payable to: Town of Barnstablee ow tune for in"house:processin &. Our'mailing address.is;: a t Town of..Barnstable Public Health Division. 2001V—.Sfreet, ° )RYannis,MA.02 03. f { FOR.FAXED'RMOVESTS: O"-fax number is ( 0$)"790-b304. Flease fax a completeel application f6rm., ;Also, please fax us:a.cop of"your".ctintirigency plau.(t 'handle Hazardous waste spills, etc.)' In' addition, piease ma the.requixed fee of$l OQ Please make the check payable to Town of Barnstable. The heck must'be mailed to the address listed above Allow time fof`in- house processing.: i l I + � r E � � For lien'assistance o'n any'itein above, call (50"8 $62-4644 ,Back to.Main>Pubiic'Healti ;Division Page. l � t {{ t 3 t i { i i f I 3 , { t S t J linspect ion.han louts111az M F Applica#'ion2QO8 DOC i i r� Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Airgas East 12 7 Airport Road, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable THE Tph� Regulatory Services o J Richard V. Scali, Director 9$" MASS. Public I alth Division Thomas' cKean, Director 200 Main Streg Hyannis, MA 02601 Office: 508-862-4644 "r .,.,,u. Fax: 508-790-6304 Applicatioty,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 A41VS1054 — NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER F _ 7 7S 3/(; SOLE OWNER: YES ONO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION j. -,—+3 � 2Z V? STATE OF INCORPORATION FULL NAME AND HOME ADDRESS'OF: PRESIDENT TREASURER CLERK ATURE OF APPLI NT RESTRICTIONS: HOME ADDRESS? `fiav�� S� �f�� /`/17 0�-7�y HOME TELEPHONE# 8-G 7 J:VHAZAPP.DOC f Airgas USA, LLC—North Division 6055 Rockside Woods Blvd,Independence,OH 44131 Headquarter Contact Information: Address: Airgas USA, LLC—North Division 6055 Rockside Woods Blvd Independence, OH 44131-2337 Phone: 216-642-6600 Fax: 216-642-6697 Website: www.air 7a� s.com Company Information: Tax ID # 56-0732648 Classification: Corporation State of Incorporation: Delaware Duns # 07-835-9644 SIC # 5084 NAICS #423830 Stock Symbol: ARG Business Established: 1984 Years in Business: 28 Type of Business: Resale—Medical, Industrial, Specialty Gases, Safety Products, and Hardgoods, such as welding equipment and supplies. Officers: President-North Division: Shaun Powers CFO- North Division: Dave Brown Remit-to Address: Airgas USA, LLC PO Box 802576 Chicago, IL 60680-2576 Banking/ACH Information: Bank routing# 031000053 Bank account# 8606074318 Bank name: PNC Bank Email address for remittance: agl.eft.paymentsgair a File Format: CTX Bank Contact: Kathy Fisher Phone: 856-489-2783 Fax: 877-421-2622 Email: Katherine.fisherna,pnc.com Bank Address:PNC Bank 1600 Market Street 19`h Floor Philadelphia, PA 19103 Important Contacts: Accounts Receivable/Cash Apps: Donna Albertson, Phone: 216-642-6784, Fax: 216-642-6622, Email: donna.albertsongair ag s.com Additional Info: We accept PO's electronically, via fax, and via US mail Our terms: Net 30 days Shipping terms: FOB Shipping Point 0 s Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127Airport Road, Hyannis,MA 02601 Is Hereby Granted a License �p FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -- ------------------------------------------------------------------------------------------------------------ --------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2013 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i • Town of Barnstable �p(NE gyp Regulatory Services Thomas F. GeiYer,Director MAW. Public Health Division n,ud' Thomas McKean, Director 200 Ivfa-in Street, Hyannis, MA 02601 Office: 508-862-464 Fax: 508-790-6304 Application Fee: $100.00 -7 .ASSESSORS MAP AND PARCEL NO. DATE U APPLICATION FOR PERK UT TO STORE ANDIOR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERULS FULL NAME OF APPLICANT U NAME OF EST kl3LI:SF1NWNT • ADDRESS OF ESTABLISHMENT TF,LEPU'ONE-NUMBER-- SOLE ONVNER: _ 1`ES NO_�_ _._ __..___ IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: (4 o? S � � fat-7 IF ,,VPI..ICANT IS A CORPORATION• FEDERAL IDENTIFICATION NO. STATE Off'MOR.POR.AT.I.ON / FULL NAME AND HOME A ftESS OF.- PRESIDENT fioo . J I TREASURER tl-fazi jMt7IMI) CLERK --4-414 .._.._...._......_._ .....r._.«.... .- . ....._. .. SIGNAT F kPPLJCA.N7 _ RESTRICTIONS: HOME ADDRESS HOINJE TELEPHONE# Haz.aodwphl i T Town. of Barnstable Regulatory Services Thomas F. Geiler, Director • RARNwreer s, DUB& Public MOM. Division '�En�nrt" Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J, Canniff,D.M.D. Junicbi sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERI,A-LS IN BA.RNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to ?remit a fee, of$1.00.00.i.f one,-hundred and eleven .111) gallons or more of hazardous mat erials are i s„t�orec , ttanspoited, uti] d; and/or,disposed ofat a_iz� particular site. ; STEPS 1 -2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Towrt of Ba�•n. able. MAJL all of the above to this office on or before June+30, 2012. A late charge of$1.0.00 will be assessed if payment is not received by July 6, 2012. Please feel ,frog to view the above Code, Chapter 108: Hazardous Materials on the 1 owz� Web't tivwtiv.town.bai nstable.n�t�.�is , which is located under,the E-,Cade f sec`tzorz if you shotilci have �any_questions car c of cerns:, r� *. 0 Of QAHazmaAFH Mat Permit Letter.DOC Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127Airport Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------- ------------------------------------------------------- ----------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health C s iv. oo Town of Barnstable Regulatory Services Thomas F. Geller,Director r • MRM MAW"M& = Public Health Division i679 �� p�.+ Thomas McKean.,Director 200 Main Street, Hyannis, M,A. 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 UTELIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS r L FXJLL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT /YJ: PV/7"fi:-'a ga ��TELEPHONE NUMBER 031 _ _ v e C SOLE OWNER: YES . _ O „ IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL =• PARTNERS: i ,. 7 t� rn IF APPLICANT IS,A,CORPORATIO : FEDERAL IDENTIFICATION NO. Up 19 3SS STATE OF INCORPORATION FULL R SSIDEENT HOMEAmop) TREASURER /� -- != C QCLERK P &- l t i'1 (il I ram`/ U /� • SI NAtUU OF APPLICANT RESTRICTIONS: HOME ADDRESS _ HOME TELEPHONE# {dat.doc/wp/q Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127AirportRoad, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI ..THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 e� Town of Barnstable • THE Tj Regulatory Services Thomas F. Geiler, Director �^ MASS. � ` Public Health. Division MASS. 699 Thomas )McKean, Director ATFD M�� 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 SWORE AND/OR UTILIZE MORE THAN I I I GALLONS OF HAZARDOUS MATERIALS FULI,NAME OF APPLICANT NAME OF ESTABLISHMENT Arm's F S ADDRESS OF ESTABLISHMEN"I' TELEPHONE NUMBER V �� SOLE OWNER: YES X NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: = '� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. a STATE OF INCORPORATION FULL NAME AND HOM9 AD RE PRESIDENT _ Yt? ;9'6k TREASUIIRER CLERK SIGN T RE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.dodu•p-y Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127 Airport Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D:M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health I C� I Tows. of Barnstable YHk � Regulatory Services Thomas F. Geller,Director 9AUMW8 rase e. 4 HAS&, Public Healtb Division Tbomas McKean,Director 200 Main Street, Hyannis, MA. 02601 Office: 508,862 4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Cannif;D.M.D. Junichi sawayanagi NOTICE { TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to.remiit-a,:fee of$100:00.if One.=huiadi'ed and eleven:() 11) gallons or more of hazardous materials are stored,,transported, utrlized, and/or disposed of at a' particular site. R Z..n � co C> STEPS 1 — 2 3: w; - 1. Please complete the attached application forzn 2. Include a copy of your contingency plan (to handle hazardous waste ` ' 513 spills, etc.) G � 3. - Subnut the fee of$100.00 payable to the: .Towiz of,Barnstable. , MAIL all of the above to this office on or before June 30, 2009. A late charge of$10.00 will be assessed if payment is not received by July 1, 2009. Upon :receipt of the fee and a completed application form, an inspection may be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A, permit will be issued once the application, contingency plan and check are received. Please_Yfeel. flee to-view the..above Code; Chapter. 109: Hazardous Materials on the Town.Website, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:\1fazrnat\Haz Mat Permit LcucrDOC t I�� Town of Barnstable Barnstable a� Regulatory Services Department A%40fticaMy y�- Public Health mvisron IBM 200 Main Street, Hyarmis MA 02601 2007 Office: 50M62-4644 Thomas F.Geller,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE .A.PPLICATION FOR PERMIT TO STORE ANWOR UTILIZE MORE THAN I I I GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT !-Mt)'rH--e NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT I RI Irc,20= (Z5A V . RYa4QW 5 , 01�, TELEPHONE NUMBER 0 (o SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 1F APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION FIC;ATION Ni:.®ia 1416 S�55 STATE OF INCORPORATION VG l�ixgF�Q� .FULL;NAME AND HOW ADDRESS OF: PRESIDENT "I I Q MAO1:!fl TREASURER :YbE MCCAU ; _-- CLERK +�, (zCh jJQ �vtr— " ` S1C.NATURE p�QPk'L[C,A RESTRICTIONS: HOME,ADDRESS HOME TEtf,FPRONE# Q:1Hazmat'}Jaz hfat Appll'C4(ioi12008j)C)C: Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 1` Town of Barnstable Board of Health This is to Certify that Airgas East 127 Airport Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health a r� i Town of Barnstable Barnstable Regulatory Services Department MAKINCR x Public Health Division r ��,�. • �. 200 Main Street,I�yazi<zus MA 02601 e(# �a�c�a,�l 2007 a- Office: 508 862�644 `� ®� 7 j/�� Thomas F.Gailu,)5irector FAX 508-790.630a `T' (V Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL.NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT 6%IZ& 5 _E kS'T X�J G ADDRESS OF ESTABLISHMENT I X-1 AIR—Po 2-r (Z ? 6 WA IS, tAy'\ QX60 i TELEPHONE NUMBER `SOg ~T)S- b SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS 01 ALL N PARTNERS: a a- � w � IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 6 _N STATE OF INCORPORATION v2LAVV'A(Z+er ^i FULL NAME AND HOME ADDRESS OF: PRESIDENT F ZE g-< TREASURER $tg r A CLERK M'm RJEAA &-4 < 5 IGNATutf OF APP CANT RESTRICTIONS; HOME ADDRESS ROME'TELEPHONE# QA1i8zmsAHaz Mat.Application2008.DOC w Number Fee 1074 THE COMMONWEALTH OF MASSACHUSETTS $o.00 Town of Barnstable Board of Health This is to Certify that Airgas East 127 Airport Road, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable r Regulatory Services d Thomas.F. Geller,Director Public Health Division " Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Appl-Maffon-Fee-.$100.00 ASSESSORS MAP AND PARCELNO. DATE APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT " ri Ni®-"k�! i2`►��; NAME OF ESTABLISHMENT A-1)'L6-41- 3 E A-S ADDRESS OF ESTABLISHMENT b1l A}8,126—C r TELEPHONE NUMBER 509 --7 0 5/6 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL ,. — PARTNERS: � u .� rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NJ`D — `Z STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT t-tZcD r���►�i�Y TREASURER i a tz►z`( C-4 c iz izy CLERK . SZa;A SIGNA OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# &6- ;4-j H=dWwp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also.include a copy of your contingency plan(to handle hazardous waste spills, etc). In addition,please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven(7)working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call(508) 862-4644 7►+i.�"�..;;:. ..r-., . �„ t.a.4'. _. .. - �.. _ ..'° '� ,.,�.t..�.<.�v.+�.,,;�1-i'?,+�x .i`� ��,'��, •�.+`�,�;a�' .+tl..�- ,� � ,a 4:r - Date: J/ If/ 0 7 1 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: � as �r BUSINESS LOCATION: 121 A-Il PLM+ �Odd , HV411211S INVENTORY MAILING ADDRESS: \k It TOTAL AMOUNT- TELEPHONE NUMBER: �US 77f 031le _di)a 1Imr CONTACT PERSON: J_/a w A . Ja5m , I�K"A nck W a bpi er EMERGENCY CONTACT TELEPHONENUMBED- 5Dg " G�` MSDS ON SITE? J J17to TYPE OF BUSINESS: l n V� 01 � IIG j' tit I PA 'S bl6 �l mq v bfiA t yt G h�tZd rd o us ' INFORMATION/RECO9�MENDATIONS: Fire District: MilerlAl6 Pam L+ M 07- K• f�/'QI Wear hrai95 s7u f V I Akl. h(aADr)i5 "Vp,n,lX of tw k etiva, w ova 04 t� Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: r Destination: Waste Product: _ Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials 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) Misc. 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 Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) -NEW USED -Any other products-With "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) j Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash rr WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE BAR-w 4762 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager r4 vt. 115 0A - Address of Offender MV/MB Reg.# Village/State/Zip Business Name 4++C '11+ 5 �,<.� - 1C'.0D(n/pm, on 14q 20 )q Business Address 2"? { t Signature of E�nfbrcing Officer Village/State/Zip A o�Z60 1 Location of Offense t Enforcing Dept/Division Offense 4-a. �u�-�• t� � n + vt. #�1 � ti es 1` r,AP---'+rt t S L i/.evl! 1K Facts Ct C G ca ►!c �)+'C'Sl� _ �!cCyl��rrc�y�� rat 1+'7 , (^ , 114+l`'>4 C 'Ytt����1 y This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE B _W 1E ' # Ordinance or Regulation , WARNING NOTICE + Name of Offender/Manager J Y "' Address of Offender MV/MB Reg.# Village/State/Zip Business Name am ; am/pm, on 20_ Business Address Signature .of Enforcing Officer Village/State/Zip Location of Offense _ s ' Enforcing Dept/Division Offense ' ' �� t- �, j . ' �� "� f r, Facts f 'a ?+1 t 1f`* tk r '7 This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.