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HomeMy WebLinkAbout0091 BARNSTABLE ROAD - HAZMAT (1nn►S TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: � }litrsa' /20 /�r9Tt7 /?�'�i.� T�-c Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 21-00-73 P.O. Box 534 CONTACT PERSON: a7-02. Z),6^4V 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 qua tities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when store Please put acheck beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners )YO Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) ✓Disinfectants Motor oils/waste oils Road Salt (Halite) f Gasoline, +- Refrigerants #2 heating oil Pesticides (insecticides, herbicides, t✓ 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, 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) AE s7b^,r Alex-- 340Z'V- e7/ Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2•Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores / 6.Fuel Suppliers ADDRESS Class: 6 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATE SCase lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: 70 y Gasoline, Teel(� Di"e un ",#2 (B) 2�6 / Heavy Oils: r/ waste motor oil (C) !� new motor oil (C) g °1,✓�a �/ Id�S !/ transmission/hydraulic <S �/ Synthetic Organics: degreasers Miscellaneous: d"7,A" , DISPOSALIRECLAMATION REMARKS: f 1. S nitary Sewage 2.Water Supply Town Sewer (*Public O On-site OPrivate B71.t � 3. Indoor Floor Drains YES _j/ NO O Holding tank: MDC-2L, PLe O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC I O Catch basin/Dry well O On-site system / 5.Waste TransporterA!Z ` � - Na,me of Hauler Destination Waste Product i. ®, I � YES NO 2. Perg'o'n (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM V 0 Mail To: NAME OF BUSINESS: WdILIQIId Lt" Pl-,, �'��", ��c Board of Health MAILING ADDRESS: C/1 ;LLti-fP2t' As Town of Barnstable TELEPHONE NUMBER: 7 21-01'2 R P.O. Box 534 CONTACT PERSON: f r Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES ''� NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when 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 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations_,_Repair O satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops - unsatisfactory- 4.Manufacturers Pi / \ (see"Orders") 5.Retail Stores COMPANY Ti 1�!{ ./ ��:i 1�f �1!/ _J 6.Fuel Suppliers ADDRESS ���� �� �� !.���-� Class: .7-Miscellaneous E Iyjl'P1�J 4' QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MA MAJOR T R SUnderground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy_Oils...-------" waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: a c -0 Ukoll C,a DISPOSAURECLAMATION REMARKS: p},� _ /�' l� 1. Sanitary Sewage 2. Water Supply I ' � � 1 111 /� / 1�LC i J ®,Town Sewer OPublic 0 On-site OPrivate 3. Indoor Floor Drains YES-NOV O Holding tank:MDC O Catch basin/Dry well ,.. O On-site system ��1"O s �a � � > 'ki #,")Mlr 4. Outdoor Surface drains:YES _ NO ORDERS: O Holding tank: MDC `O Catch basin/Dry well /O On-site system 5. Waste Transporter --� Name of Hauler Destination Waste Product 1. /v( /�1 �/ _ �l_�1C �l ) ! i �n t ` ,1!� �>f r� J/ N0 2. Person (s) Interviewed-- Inspector Date i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Z—' g Town of Barnstable TELEPHONE NUMBER: —�o8' ?oe'I P.O. Box 534 CONTACT PERSON: Usn /10c. of 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 Jc:�_ 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) !!� Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN 01= BARN TABLE COMPLIANCE: CLASS; 1. tlar .ne,Gas,;Stattons,Repai.r a 2. Printers ��' HEALTH Q satisfactory%t, 3, Aputo Body:Shops - tTMRD` � , Q unsatisfactory= ` 4. hanufacturers COMPANY kWAI —`11. AI !mil 0 PODY (see"Orders") S. Retail Stores 6. Fuel Suppliers ADDRESS � � �"/���.LJL� _ � Class: ' 7. MiseeIIaneous- QUANTITIES AND STORAGE (IN=indoors, OUT-outdoor. MAJOR FUITBRIALS • Case-lots Drums AbaveTanks Undetgrohnd Tanks ttL �� 1ti_ 4liL gallons 9M [W Fuels: • Gasoline, Jet Fuel (A) Diesel, Kerosene, 12 (B) Heavy Oils: ,- waste motor oil - (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers •Miscellaneous: i PIRAtr � y �I,�NN�I� • • r DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply Town Sewer Public iL_f31aS no�uffi i 1 � O On-site Q Private ,C�1'1 ,- / �1 � / _ / d= /� 3. Indoor Floor Drains: YES NO „ �"' "J I nt. �( � '✓ '��/1'�� �`NP,K/ �t.C ° Q Holding tank: MDC w ` V Catch basin/Dry well On-site system V 2 ` 4. Outdoor Surface drains:YES NO� Q 11oldinl; tank. MD41 � p1 Q Catch basin/Dry well ��" OOn-site systems S. Waste Transporter Licensed? Alm"f_llauler l�stinatinn Waste Product YFS NO erson 's Interviewed Inspector /Date` I TOWN OF BARNSTABLE ,COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH p satisfactory 2.Printers 3.Auto Body Shops r �� : 0 unsatisfactory- 4.Manufacturers COMPANY - . . /�. �� 1. r ,L �C 1 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7..Miscellaneous y I IV D. QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) i Diesel, Kerosene, #2 (B) Heavy-Oils---� waste motor oil (C) new motor oil (C)_ r . i transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: c� _l C, G e t�,:e DISPOSATJRECLAMATION REMARKS:, / 7A) rA L.,La 1. Sanitary Sewage 2. Water Supply / � �O Town Sewer q),Public a /O On-site QPrivate 3. Indoor Floor Drains YES NO '.,Holding tank: MDC O Catch basin/Dry well U � . — UM-�E' O On-site system /UGC'VC 9 7A r l r—P 4. Outdoor Surface drains:YES NO ORDERS: c 1 O Holding tank: MDC I �'l/ 1 ( � it rr O Catch basin/Dry well O On-site system - 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Interviewed Inspector Date L TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH , O satisfactory 3.Auto Body Shops / r b, unsatisfactory- 4.Manufacturers COMPANY. +. �� 1 /:; l� (see"Orders") 5.Retail Stores ,�- / / L r 6.Fuel Suppliers ADDRESS /2: 2.!i'a I,�� `11-5� /�l'.Class; 7-Miscellaneous y f/////,QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIALSUnderground Tanks IN OUT IN OUT IN OUT #&gallons Age Test -Fuels Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) y � Heavy Oils:`� 11.4- 1 waste motor oil (C � s new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: o DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2�Water Supply O,Town Sewer yO,Public On-site OPrivate I0 � ) / , .�`1 3. Indoor Floor Drains _ YES �_ NO 1 / l O Holding tank: // O Catch basin/Dry well tT » ( 1 �� I U�lL �- #/� ��( a-t Pl O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC (� O Catch basin/Dry well �( 6 r O On-site system - � �y A r ff)lr fi j J�u( ° 5. Waste Transporter y , 1 ` `nizY Name of Hauler Destination Waste Product rNO 2. Person (s) Interviewed Inspector Date INE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMARq ' 200 Main Street• Hyannis, MA 02601 �ArEOMP+�`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: t A, (1P. !c Date: Location/Mailing Address: 1 0� d Contact Name/Phone: Sg;t4 �} � U to Inventory Total Amount:?it j MSDS:Y G s License#: Tier II : fVc) Labeling: Spill Plan: -J Oil/WaterSeparator: 1V' I A Floor Drains: Emergency Numbers: yL%S Storage Areas/Tanks -�s�a}ram \k)M` , Oe 1 Emergency/Containment Equipment: q,, &P6 Daw Waste Generator ID: m V Serf ��l DDT Waste Product: 0 i Date&Amount of Last Shipment/Frequency: 1 - _aQ S 0) . w, & r, Licensed Waste Hauler&Destination: WC 0 ee,,.� 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. I/ 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 ,i/ 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 ___,J-ye 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: (�RB�RS: l✓ l'y 63 )antics Ta ►at INFORMATION/RECOMMENDATIONS: C'l ew,— P�1 iJva QTL S Inspector: Facility Representative:�-- WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS i `°F�►�►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS .. g• 200 Main Street• Hyannis, MA 02601 �prE039. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ���� a 6e,v Date: I-7 Location/Mailing Address: I ate✓►Si'AP bLe- RX 14YaVVA Contact Name/Phone: a, AlA" — D --7003 Inventory Total Amount. OSDS: ��lI aa���'aS�j License#: 1 2-0%( C'1 Tier II : v Labeling: Spill Plan:VQ� Oil/WaterSeparator: Floor Drains: o Emergency Numbers: �: Storage Areas/Tanks: 2—" kj �c.)•M a s. k„�-e. Emergenc /Containment E ui ment: Waste Generator ID: O -7'7 I U v13 73 Waste Product: b I Date&Amount of Last Shi ment/Fre ue745kz<�,, : limit, Licensed Waste Hauler&Destination: I L ,nLo I 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 5 Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 3 12 Windshield wash 12 bS Motor oils 5Sw�5ke,.:► �p (-Y 55`;) 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 I 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 v <Q-AA-S Wk l o s OVA -, . `MS�s Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I °p IKE Tok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA-RS E ` 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO MP'� Business Name: c,aI{- itT�o Cz�-�-ef Date: Location/Mailing Address: 91 I9a%'vX6V4ol . 0.r\VX, s Contact Name/Phone: 5t,X A k V $ -2 D --7Do3 Inventory Total Amount: "K10 MSDS: 'LS License#:" I D�> Tier II : Labeling: r4 0,9 Spill Plan: to es Oil/WaterSeparator: Floor Drains: INJo Emergency Numbers: ye,S Storage Areas/Tanks: -, ¢.v,1 I �ftWtj- Emergency/ContainmentEaui6ment: oy` 5,4� Waste Generator ID: /Avg-0%-1-7 loot S Waste Product: Date&Amount of Last Shipment/Frequency: /7-/18/I , n 2-3 X -0 4 Licensed Waste Hauler&Destination: CY, ©, 1 VA 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. '1 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 ►Sa-5'o vS&i kL 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: 6„ 4, bd` 1 V.ri k .11 5 ` Now ,V- D S 5 1 ok- 'P`C,-\k-- Inspector: qa Facility Representative 21 ZZ WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS TC To Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMAR!R 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT QED MP'� Business Name: Qu4-14 c, f Date: Location/Mailing Address: If &-ryt,5qt6te- Q„✓I r Contact Name/Phone: S 8 Inventory Total Amount. Ilk 9CJ MSDS: 5 License#: Tier II : o Labeling: oo Spill Plan: N Oil/Water Separator:_3 A Floor Drains: v Emergency Numbers: et Storage Area t <0"w,- l o, k 2 Emergency/Containment Equipment: i ee A Waste Generator ID: -77 1,563723Waste Product: of Date&Amount of Last Shipment/Frequency: 2 1 S I o .c I ^-,5-�6 x Licensed Waste Hauler&Destination: 01264z�+t r' /.114co)K-! Pl— 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 V✓ 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/REC MMENDATION 4, f Q-C� 6Q JA ti U-JR , l Inspector: 1�-- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS INVENTORY WE HAVE TO KEEP LL THE A TIME: 1) 1- 2 CASES OF 5W 30 OIL OR MORE 2) OIL FILTERS - 6 OF EACH 3) 1 GALLONS OF BRAKE FLUID 4) 1 GALLONS OF POWER STEERING FLUID 5) 1 ROLL OF BRAKE LINE - 3 DIFFERENT SIZES : 3/16 ; % ; 5/16 WITH FITTINGS 6) 6 QTS OF SYNTHETHIC OIL 7) 6 WASHER FLUID 8) 3 GREEN COOLANTS AND 3 RED COOLANTS 9) 2 GALLONS OF GEAR OIL 10) KEEP 2 BATTERIES FOR POST OFFICE TRUCKS 11) WIPER BLADES - 6 OF ALL SIZES HOSE CLAMS AND LIGHT BULBS HAVE TO BE FULL ALL THE TIME °p VIE A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RaRMAR%. e• 200 Main Street• Hyannis, MA 02601 t6396 6TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFc ten+ Business Name: Date: 6 q 1 Location/Mailing Address: i 84.E-A " anv�\6 Contact Name/Phone: Sc,,d Inventory Total Amount: 60 t SS%)44A!a--0K MSDS: e✓6 License#: IJ Tier II : o Labeling: Spill Plan: Oil/WaterSeparator: o Floor Drains: 0 Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: ;,& Waste Generator ID: NJ� b` 7-1106 3 Waste Product: t06L5� o< Date&Amount of Last Shipment/Frequency: "5-0 fa ' 1 11- ,ko. Licensed Waste Hauler&Destination: �� •1 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. 6 Antifreeze (I Dry cleaning fluids l Automatic transmission fluid I Other cleaning solvents&spot removers Engine and radiator flushes � i Bug and tar removers 6 Hydraulic fluid (including brake fluid) 1 _�f Windshield wash St3 2'I : 1* ,Motor oils 2S 2-SS10 kr-)*0�$Ae1 a Miscellaneous Corrosives Gasoline,jet feel, 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 to Battery acid (electrolyte)/batteries 3k� 1 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 l 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: NFORMATION/RECOMMENDATIONS: 400V-k-4-V-k<e4- o v cV) 10 It1 o, - w d0114 1rV1V1 2-1L Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS THE T° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 + BARNSTABLE. 9 MASS, q 200 Main Street• Hyannis, MA 02601 ,639. M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT RFD P'� Business Name: Date: Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: 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 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �oFtrok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA MASS. ' 200 Main Street• Hyannis, MA 02601 1639. Y MASS. g. �A'FOMP+p`� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/Water Separator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: 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 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals (Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's a 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: Inspector: s Facility Representative: WHITE COPY- HEALTH DEPARTMENT 1 CANARY COPY BUSINESS r <il; 111� � �� 1 `oFtNE)oy Town of Barnstable Office:508-862-4644 ~� Public Health Division Fax:508-790-6304 • BARMS�LE.g' 200 Main Street• Hyannis, MA 02601 MA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 000d Date: Location/Mailing Address: an� Contact Name/Phone: 1 k -4'k. o - o- 7o0 Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: 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 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE T° —. Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98^"MA�B`E�,' 200 Main Street• Hyannis, MA 02601 1639. �'rFor�o+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4•/ �jf. �ow�P r ta�r)a n�. ,4c ) Date: Location/Mailing Address: qf ��✓stdhi�. 1/Z ', J-i<J��✓� 5 Contact Name/Phone: ✓ f Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: 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 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 r 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: Inspector: Facility Representative: F WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS t • Number Fee 1206 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Quality Auto Center .-------------------------------------------------------------------------------------------------------------------------------- 91 Barnstable 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 Town of Barnstable Inspectional Services BARNSTABLE Public Health Division WaSNN5 X15.639 LL%•:S B?UNBT BLE -` 1639-2014 1. BAF.N M 1 Thomas McKean, Director { p 39. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 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 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ t�1 If- CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 �V CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?X 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: 5. NAME OF ESTABLISHMENT: " 6. ADDRESS OF ESTABLISHMENT: 9z 26 eC 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 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 IL: SIG NATURE OF APPLICANT DATE Q:\Application Forms\flaz Mat Appli Draft Jan201 . ocx s Number Fee 1206 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Quality Auto Center 91 Barnstable Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. _ 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r r Town of Barnstable Inspectional Services BARN TABLE �F SHE IY1. WYSTCri NE�.S�Os:'wr i°'�i3r:�u'",T-.r�e Public Health Division t9-z14 9BARNMBr.E.$ Thomas McKean, Director q'ATEo�3,,�o�a`0 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 a.•3 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE it 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 x\/-<x L F CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ r 343 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. �3�7i �,�lV 2. IS THIS A PERMIT RENEWAL? X,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: 5. NAME OF ESTABLISHMENT: . 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 10�� 9. EMAIL ADDRESS: o/-o ax&e-e� Coy 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 Q:\Applica6on Forms\Haz Mat App Revised 09-104 . ocx • • • -40 r� Number Fee 1206 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Quality Auto Center 91 Barnstable 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 S V0wegu'AatoryVrv1cesof Bnslable a� Richard V. Scali,Director Public Health Division BARNSTABLE � enaxse •cuu+�+nut•mrtnr•!rcuxss r BMWsTABL 1 Thomas McKean, Director ° .�1639_04� 5"°rFc 059. A a`0� 200 Main Street, Hyannis,M 02601 575 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 KV.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. 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)?117 YES NO. 4. FULL NAME OF APPLICANT: SXrJ I Y ' a 5. NAME OF ESTABLISHMENT: u a ( 6 Ar-L I n c 6. ADDRESS OF ESTABLISHMENT: p-d' Yy�I mA-- f 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: <C /1 w S. TELEPHONE NUMBER OF ESTABLISHMENT: 50 8 — 771 00 53 9. EMAIL ADDRESS: `Ca 10. SOLEOWNER: YES NO IF U,NAME OF PARTNE10 11. FULL NAME,HOME ADD SS,ANP ELErom # CORPORATION ANTE t C PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS MAIL: p SIGNATURE OF APPLICANT ATE 5 h Q:.Application Forms\HAZMAT APP 2017 REVISED.docx i >w3 Number Fee 1206 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Quality Auto Center 91 Barnstable 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.CANNIrF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health la.gc�iK� ow of B stable egunlatory Services Richard V. Scali, Director " Public Health Division BARNSTABLE 9PR:•:SinIfLE•3xiERviLLE•CONR•HYN:1:15 :eyfi BARNSTABLE, * Thomas McKean, Director PR5S5MLL5.63'9- 014 b i0ren s``� 200 Main Street, Hyannis,MA 02601 �� t) 020 D l Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS N°' 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-=1-10-Gallons: $ 50.00 '� CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ I" *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? 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: ,r/pl�/e,/ 5. NAME OF ESTABLISHMENT: ,t/ 1� � 6. ADDRESS OF ESTABLISHMENT: AaRAWC 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME z2 PRESIDENT /',I/�Q/• �,�' ��7�,�Y�eS � l/F �/ .!/lY �Q�'9'j TREASURER -9.4.0 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE_ Z7,-��Z QAApplication Forms\HAZMAT APP 2017 REVI a7 _ Number Fee 1206 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Quality Auto Center 91 Barnstable Road, Hyannis, MA Is Hereby Granted a License For- Storing or Handling 26 - 100 gallons of Hazardous Materials. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health I t" Town of Barnstable 'THE►� Regulatory Services ti Richard V. Scali,Director MAR&"S`"B Public Health Division BARNSTABLE 1639 �0� `n`� w.xs"sar"sMr s N4enFxs"rs �''�en►�''° Thomas McKean, Director �\ 16377�4 _ 200 Main Street, Hyannis,MA 02601 r� Office: 508-862-4644 Fax: 508-790-6301& W 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 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 S 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 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: // ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 7l��, EMAIL ADDRESS: SOLE OWNER: YES�O IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: • SIGNATURE Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev16.doex Page I of 2 Fee 1206Number THE COMMONWEALTH OF MASSACHUSETTS $s0.00 s Town of Barnstable Board of Health This is to Certify that Quality Auto Center 91 Barnstable Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons 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. 02/29/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f _ . Town of Barnstable • oF'WE►o Regulatory Services ~o Richard V. Scali, Director `" MAS& �' ` Public Health Division BARNSTABIHSTA , . A 1639• A�O� WNS'0 5 M lS pO5TE0.Y!lE�W3T E0.i Thomas McKean, Director 1639-2014 r 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-659 r 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 �L' 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 NO3��- 0­2/ DATE �G FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: _144dX M ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): - TELEPHONE NUMBER OF ESTABLISHMENT: �f^9 -��2 a/O,R2 EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE #OF: CORPORATION NAME PRESIDENT TREASURER 2 M.r CLERK IF PREPARED BY OUTSIDE PARTY: • SIGNATU ICA Name: Company Address Telephone #: s Email: Q:\Application Forms\HAZZAPP Rev16.docx Page 1 of 2 dp't 7 Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department t Public Health Division Lt Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Hazardous Materials Payment received: $50.00 (Check) on 2/29/2016 ;Check number: 2182 Check amount: $50.00 Name on check: Quality Auto Center, Inc. Business: Quality Auto Center Owner: SAID S&SYLVIA DIMOVA ALHARTHY ,Address: 91 BARNSTABLE ROAD, Hyannis Note: Category I __ ......... • Number Fee 34 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable - Board of Health This is to Certify that Barnstable Rd. Auto Repair Inc. 91 Barnstable Rd., 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 V • Town of Barnstable. Barnstable �k"CTi Regulatory Services Department °� AH-Americat�"1y • AS Public Health Division 200 Main Street, Hyannis MA 02601 pl�'b AAA's�', m 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. �� ? r'i DA TE f APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Barnnt2hha Rnn Auto Relpair ADDRESS OF ESTABLISHMENT 91 Barnstable Road Hyannis, ]VI TELEPHONE NUMBER �`�/ ^ co 1 SOLE OWNER: ES NO c� c IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES F AL PARTNERS: -a •• w -� M IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O r, -9�? STATE OF INCORPORATION ' FULL NAME AND HOME ADDRESS OF: PRESIDENT /ooP'4` • %-)e9*-Or ( 7 Ju 0-.9 S�3 Gr✓ /� Pam—_ �r/I�y�S�J � � ���1/ TREASURER S 41-n 1- ' CLERK. S".- GNATURE OF AP PLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Q:\Hazmat\Haz Mat Application2008.DOC TOWN OF BARNSTABLE BAR-W 3394 Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager e,.4 0 ) Address of Offender MV/MB Reg.# Village/State/Zip )L-4 7)x e Business Name (: on -7- -2 0,",� Business Address Signat-dre,6`f,\tnf`brciHg Officer Village/State/Zip Location of Offense OFcl) iie 4""_4 6 Kt, P"P 4- En'forcin'g Dept/Division Offense 'j ,_) Facts ? A Olt) 4A CY 1.) f -- A4 &,� Alf#?,2 im-A P 14 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. i 04-Jan-06 Town of Barnstable Page No: 1 List of Underground Storage Tanks Inside Zones of Contribution which are over 19 years old As of: 1/5/2006 Fire Tank Tag Tank Installed Tank District Owners Name/Address Map/Parcel No. No. Permit Fuel Date Age Loc ZOC BA HAYES,G HOWARD TR 254015 01 00966 Y G 1/4/1986 20 B y ISLAND SUN NOMINEE TRUST DRAWER W HYANNIS MA 02601 BA HAYES,G HOWARD TR 254015 02 00965 Y D 1/4/1986 20 B y ISLAND SUN NOMINEE TRUST DRAWER W HYANNIS MA 02601 BA CAPE COD AGGREGATES CORP 295004001 02 00040 Y G 10/1/1985 20 B y P0 BOX 96 HYANNIS MA 02601 BA CAPE COD AGGREGATES CORP 295004001 01 00039 Y D 10/1/1985 20 B y P0 BOX 96 HYANNIS MA 02601 CO TIBBETTS,PAUL F&SUSAN M 121048 01 00547 N FO 1/1/1970 36 B y 58 POPLAR DRIVE OSTERVILLE MA 02655 CO HAROOTUNIAN,PHYLLIS 121141002 01 00784 D 1/1/1979 27 B y 15 THIS WAY OSTERVILLE MA 02655 CO BARNSTABLE,TOWN OF(MUN) 126004 01 00675 Y FO 12/16/1976 : 29 B y 367 MAIN STREET HYANNIS MA 02601 CT VALENTE,DENNIS B&JANICE 024050 01 00183 Y D 5/1/1971 34 B y C/O PLYMOUTH MORTGAGE CO PO BOX 1007 BOSTON MA 02205 HY MOTIVA ENTERPRISES LLC 269003 01 00886 Y G 1/1/1979 27 B y 1100 LOUISIANA AVE HOUSTON TX 77002 --77 VY . a[U T-i 04-Jan-06 Town of Barnstable Page No: 2 List of Underground Storage Tanks Inside Zones of Contribution which are over 19 years old As of: 1/5/2006 Fire Tank Tag Tank Installed Tank District Owners Name/Address Map/Parcel No. No. Permit Fuel Date Age Loc ZOC <HY~ MOTIVA ENTERPRISES LLC 269003 02 00887 Y G 1/1/1979 27 f B y 1100 LOUISIANA AVE �� p �-�^1 HOUSTON TX 77002 t/Im r(�J HY MOTIVA ENTERPRISES LLC •269003 03 00888 Y G 1/1/1979 27 ? B y 1100 LOUISIANA AVE HOUSTON TX 77002 /'HY V S H REALTY INC 269116 1 01 00863 Y D 1/l/1982 24 ' B y 777 DEDHAM ST V0990 CANTON MA 02021 /HY V S H REALTY INC 269116N 02 00864 Y G 1/1/1982 24:. B y t t v vv 777 DEDHAM ST V0990 CANTON MA 02021 HY V S H REALTY INC 269116 } 03 00865 Y G 1/1/1982 32�1,' B y 777 DEDHAM ST V0990 CANTON MA 02021 fHY V S H REALTY INC 269116 04 00866 Y G 1/1/1982 24 B y 777 DEDHAM ST V0990 CANTON MA 02021 HY CUMBERLAND FARMS INC 273083 7 05 00857 Y G 1/l/1981 '25 B y I--, 777 DEDHAM ST V 1284 I I J �j. z CANTON MA 02021 "HY/ BARNSTABLE,TOWN OF(MUN) 274031 03 00000 Y W 1/l/1981 "'25 ° B y 367 MAIN STREET (� HYANNIS MA 02601 �" " V 1 Nov li V5 f� fHY BARNSTABLE,TOWN OF(MUN) 274031 02 00147 Y D 4/13/1981 "24 B y 367 MAIN STREET HYANNIS MA 02601 04-Jan-06 Town of Barnstable Page No: 3 List of Underground Storage Tanks Inside Zones of Contribution which are over 19 years old As of: 1/5/2006 Fire Tank Tag Tank Installed Tank District Owners Name/Address Map/Parcel No. No. Permit Fuel Date Age Loc ZOC HY BARNSTABLE,TOWN OF(MUN) 274031 ' 01 00146 Y G 4/13/1981 24 B y 367 MAIN STREET I HYANNIS MA 02601 r ,-HY MOTIVA ENTERPRISES LLC 311017 06 00000 N 1/1/1986 20 B y 1100 LOUISIANA AVE HOUSTON TX 77002 HY MOTIVA ENTERPRISES LLC 311017 07 00000 N WO 1/1/1986 `20 B y 1100 LOUISIANA AVE ` HOUSTON TX 77002 HY AVIS RENT A CAR 311022003 01 00638 Y G 10/25/1985 20 B y TAX DEPT I 900 OLD COUNTRY ROADvrF GARDEN CITY NY 11530 SHY AVIS RENT A CAR 311022003 7 02 00000 Y G 8/1/1981 24 1 B y TAX DEPT 900 OLD COUNTRY ROAD GARDEN CITY NY 11530 HY GINSBERG,ARNOLD 311043 , 02 00909 Y G 1/1/1986 20 B y P 0 BOX 727 tv CAMBRIDGE MA 02139 HY ' GRIFFIN,JAMES T&JEAN M TRS 311104 01 00799 Y G 8/1/1984 •21 J B y %BARNSTABLE MUNICIPAL AIR 480 BARNSTABLE RD,2ND FLR �N HYANNIS MA 02601 (�/ (/ K IX1•d J/ �HY GRIFFIN,JAMES T&JEAN M TRS , 311104 02 00800 Y G 8/1/1984 ,21 ! B y %BARNSTABLE MUNICIPAL AIR 480 BARNSTABLE RD,2ND FLR HYANNIS MA 02601 1 HY US PROPERTY MANAGEMENT C 327026 02 00968 Y G 6/18/1981 'L 24 B y %DEMERS,PETER PO BOX 875 W BARNSTABLE MA 02668 04-Jan-06 Town of Barnstable Page No: 4 List of Underground Storage Tanks Inside Zones of Contribution which are over 19 years old As of: 1/5/2006 Fire Tank Tag Tank Tank District Owners Name/Address Map/Parcel, No. N Installed o. Permit Fuel Date Age Loc ZOC �HY. US PROPERTY MANAGEMENT C 327026 03 00969 Y G 6/18/1981 24 B y %DEMERS,PETER PO BOX 875 W BARNSTABLE MA 02668 HY BARNSTABLE,TOWN OF(ARP) 329003 06 01266 Y D 12/19/1985 20 B y BARNSTABLE MUNICIPAL AIRPO 480 BARNSTABLE RD 2ND FL --y HYANNIS MA 02601 HY SYKES,BERNARD G 329011 01 00924 Y G 1/1/1979 , 27 B y CAPEFJ,IGHT—L-�D 110 MARY DUNN WAY HYANNIS MA 02601 -HY SYKES,BERNARD G 329011 02 00923 Y G 1/1/1979 e27 B y CA 110 MARY DUNN WAY HYANNIS MA 02601 HY SCUDDER,FREDERIC F 2ND& 344080002 4 00000 Y FO 1/l/1975 31 B y SCUDDER,RICHARD M&ROBER 22 CHANNEL POINT RD HYANNIS MA 02601 HY SCUDDER,FREDERIC F 2ND& 344080002 05 00000 Y FO I/l/1975 31 B y SCUDDER,RICHARD M&ROBER 22 CHANNEL POINT RD HYANNIS MA 02601 �'HY SCUDDER,FREDERIC F 2ND& 344080002 06 00000 Y FO I/l/1975 ,31 B y SCUDDER,RICHARD M&ROBER 22 CHANNEL POINT RD �� POOP HYANNIS MA 02601 HY SCUDDER,FREDERIC F 2ND& 344080002 2 00000 Y FO 1/l/1975 31 B y SCUDDER,RICHARD M&ROBER 22 CHANNEL POINT RD HYANNIS MA 02601 HY SCUDDER,FREDERIC F 2ND& 344080002 03 00000 Y FO I/l/1975 31 B y SCUDDER,RICHARD M&ROBER 22 CHANNEL POINT RD HYANNIS MA 02601 04-Jan-06 Town of Barnstable Page No: 5 List of Underground Storage Tanks Inside Zones of Contribution which are over 19 years old As of: 1/5/2006 Fire Tank Tag Tank Installed Tank District Owners Name/Address Map/Parcel — No. No. Permit Fuel Date Age Loc ZOC HY MOTIVA ENTERPRISES LLC 345009 03 00885 Y G I/l/1970 - 36 B Y 1100 LOUISIANA AVE qr HOUSTON TX 77002 f HY MOTIVA ENTERPRISES LLC 345009 02 00884 Y G 1/1/1970 36 B Y 1100 LOUISIANA AVE HOUSTON TX 77002 r F THE t �''tio, TOWN OF BARNSTABLE Date: .......... _ -• LICENSE APPLICATION ❑ New Application • STABLE, * '`Renewal v 4 039.SS. ,eg 200 Main Street Os Hyannis,MA 02601 ❑ Transfer UQ, 508-862-4674 ❑ Other NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES f Name of applicant/corporation: 1?fiH.f 3c c�"_.._AO._...._ OJ4..70_... Z Okll._.... _ ..__._......_.......__...._...... Home phone#: 6 ...... _ _.... Address of applicanUcorpo ration:...-�3 . /...._._ c _:.._.._.._^+?_._..._..__�?�^�' i __..______...__... ' Business phone#: -vv ........... -.._.........._..._.__..._._.........._..._._._._...._......................_.._.........................._......._.._............._................._..........__.............................._.._.._....._.............................................................-............._......-............--........ _._._...__...-- _L y. D/B/A (�f !`?_5=r=��.._ _ >°......_1Utr�.Ll. _(.t._ ..._. ._ �1 JY _....._........._............_........._..._.... Business phone#: - .."_..-'�.._�i^Oo 3 ..- --....__.. Business location: .._.S./-...._I3.ft.�. .-..S.�.c _ '! - .F/- rry�1�_....._-fyi._...-.___G._? �a........._.....-------------- - Business mailing address: ..__._._SAj''s'____._._.___._ Local business address: Local mailing address: _...-....._..........................._........ LICENSE TYPE: CLR.ts.. - -_........ x!. V...........O ..`...�'1........................................................... Annual �- Seasonal .............. .. . HOURS OF OPERATION: . '..=. ._/ _.._F...._ _.' _ ..fFID Nameof manager: -/O� �-......__.. ............. ..............._...._...._..._...._........_......._................................................._...................... e Local mailing address: ...-..u..a .......&'2 .............dv. s�r�j- .t......^�...... d....f.........:..................................................... i. Managers Permanent mailing address: Y90 l'j _X �2! . / . ..�..._......_. _!'�............_._......._....__._..._.__.._ ._ "._._......-.. --- ......__......._....._.__..._..._.._.._._...__.... Manager's home phone#: f.vF..._... 1 - 6.f_.........._.. Business phone#: S'2J,F:-_ . ./..-..a 3'_.__...... ......___............... _ Nameof property owner: ......._4..._l'.,...�^..y/� ^_/'!...._�Ar74G.#r^ ?.........tea............................................_.............._...._............................................................._......._...........................................-............_......._....................... ASSESSOR'S MAP/PARCEL#: MAP '�?. - ' PARCEL O.Z ................:............ List any flammable substance or hazardous waste used in business(specify): Applicants must contact the Building Commissioner's office, (508) 862-4038, the Board of Health office, (508) 862-4644, and the appropriate Fire District office to schedule inspections. Signature of applicant ..................................................................................................................................................................................................................................................... REAL ESTATE TAXES PAID IN FULL ( t�C.��Jti Town usly PAYMENT AGREEMENT IN EFFECT ON IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES NO INSPECTORS APPROVAL Capacity set by Building Division................... Building/Zoning............_................_................................._......._........................................ Date ..............................._................_.........._............... Board of Health.........................................:................................................_...._......_._.... Date ....._.............._.............__..._..._..................... Wire ....................................................._........._...._.... Date ......................................................_......_....-....... Plumbing ._.................-.................._.................................................._......Date ._............................................................._......_... ... Gas .....__............................................................... Date .............................................................................. Fire District ........................................................................_... Date ..._...._............._..............._..........._....__............_ Comments: White-Licensing Authority Canary-Health Division Gold-Building Commissioner Pink-Fire Department TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS -N ft4iz�-or N E Karcalidis Lefteri ( e") C t S044-'�S7fti-6 ADDRESS Barnstable Rd. & Louis St. VILLAGE Hyannis LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL Left of B u i 1 di nq T otii g, St 4,nnn r1a_sol.i.nP _ _Steel Give same information for any additional ( 1 on reverse side of card) DATE OF PURCHASE OF EACH: 1. 6-1 5-81 2. 6-1 5-R 1 3. 6-1 55-81 4. DATE OF FIRE DEPARTMENT PERMIT: A`ti-1 53-R 1 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS p /9=- h&It it�V 'tit EI&Wd COMPANY, U.S.A. 6 CANAL ROAD•PELHAM MANOR,NEW YORK 10803 MARKETING DEPARTMENT NORTHEASTERN REGION CONSTRUCTION & MAINTENANCE CENTER January 14 , 1931 Exxon Station ;;0256 Barnstable Rd . & Louis St. Town of Barnstable Board of Ap eais Town Halfilo, South l'treet JV Hyannas, Mass. 02601 Attention: Mr . Richard Bay, Chairman Gentlemen: In accordance-with the- Barnstable -Health- Regulation To Prevent Leaking Of Underground Fuel And Chemical Storage Systems, a recent tank system tightness test of petroleum storage tanks at subject location was undertaken, utilizing the Kent-Moore hydrostatic test method . One 4000 gallon tank exceeded the allowable test limit of . 05 gallon per hour apparent product loss in the first phase of testing , indicating a question concerning the tightness of that system. Rather than proceed with further testing steps , the tank was opened for visual inspection. No substantive corrosion damage was present . However , a loose fitting at the top of the tank holding the suction piping was determined to be the cause of loss of hydro- static pressure during the test. This was corrected . Since the tank was now open, it was decided to line the inner surface with an epoxy coating , utilizing a process commonly used in our industry for tank repair , and approved by the Massachusetts State Fire Marshal. (File No. 78-18-1 , August 18 , 1977) for general use throughout the Commonwealth. The lining was used in this instance not to correct a defect, but to provide a safeguard against future corrosion deterioration, while it was economically feasible to do so. While we are satisfied that this tank system is now tight, following repair of the loose fitting , it is our intention to retest the system to confirm this , and, at this writing , plan to do so when weather conditions permit. A DIVISION OF EXXON CORPORATION C� 2 - The purpose of this letter is to request approval to return this tank to normal storage service upon completion of final testing , rather than suffer its removal . It is our contention that the apparent lack of system tightness resulted from a mechanical problem, corrected by routine maintenance procedures, rather than from a system defect. No hazard to the surrounding environ- ment exists; the removal of the tank would create an unwarranted expense , and be a serious interruption of the dealer ' s business activities. Your early consideration of our request will be appreciated. Very truly yours , , 7 You Jr . ADY: ri File : Location file cc : Hyannis Fire Dept. 95 School St. Extension Hyannis, Mass . 02601 Attn: Chief Farrenkopf Board of Health Town Hall South Street Hyannis, Mass. 02601 Attn : Mr . John Kelley TOWN OF BARNSTABLE P f• OFFICE OF i BAH MAS& E, : BOARD OF HEALTH .� AB& p� 1639. `�� 367 MAIN STREET 0 MAX A HYANNIS, MASS. 02601 August 11, 1980 Manager Exxon Station 0256 Barnstable Rd. & Louis St. Hyannis, Ma. Dear S ' e r Sir: The information you returned to us indicated the age of your underground fuel tanks as being thirty years old for three of them and twenty-three years old for the other. You must have these tanks tested using the Kent-Moore Pressure Test by November 20, 1980. Please submit testing results and their interpretation to this office prior to November 20, 1980. In addition, this test must be performed annually and the re- sults sent to this office. For your convenience, we have enclosed a listing of companies who perform this testing. You may also utilize any other con- cerns qualified to perform this testing. Very truly yours, 44hn M. Kelly irector of Pub�icealth JMK/mm encl. 1 ,3. f Yt I � - . u� � d .. • • � • .. i r y¢- ds. 7 J_ �F_ � d Mr. Lefteri4 Karocalds , '♦ ' ,. 26 "Chestnut St, e a. - r V a t r . E • ♦ • n } ' _ J • d i _BKa rizstab1a RQad Louis St. Fi an as.. i, ' •• - - .`• r� da 4`• t B - � �:1.,f >r�, �� � a� s � ., - r�d "" � gar-Y LOCAzIOE, KA4G�1L7.MS, Ie ft:eri. Barnstable Ind, & Louis Si —s' 26 Cher twat L. Hyannis Ii rannis, -`pass. y BOO K X1) m, : T(li�EiJ 3�i?laU January 3I 37/276 Yf1Z °ch 61 1-9511) 77/63 March 14, i957 Total - 1.2,Doo DATE PAID 1973 - 11�rch 27 Y) `1 .S 19 51974 FEB 2 71980 NAP 1975 MAR 8 1.? A PIT ], 1 e r'"• Name SvnWbr,Owns or Owta AdUros No.and Strwt(s) Clh State On.of Test l.: I'' 15. TANK TO TEST 16. CAPACITY From ; :.. _. . 0 Station Chart " Y c�w capacity rt most saturate , G Tank Manufacturer's Chart ` Nominal Capacity-9 � eepaeity cha available r s Identity y tbn Gallons Gallons Company Engineering Data Is there doubt as to True Capacity 7 ® 7 , �' e5H Charts supplied with TSTT ss••••�� _..._..`._•�._.,-. ____ and and Grad. See Section-DETERMINING TANK CAPACITY" Other br a ra ® 0 17. FILL-UP FOR TEST Stick reading* , C to X in. Gallons Total in Tank C� ® Stick Water Bottom + , before Fill-up Q's _ Inventory to%in. Gallons • 1 Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY L O Product In full tank(up to fill pipe) ! ^ r, �/ , Tank Diameter � O 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK 0L;>;j0�Cp y Sae manual saations applicable.Check below and record procedure in log(26). V n CO R j Water In tank High water table In tank excavation Line(s)being tested El Vapor recovery systems Stage I Stage II do Q Z N m . 19. TANK MEASUREMENTS FOR 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK TSTT.ASSEMBLY Inventory Top 'F Center_'F Bottom_'F On Truck_'F, Expected Change'ails 0 `Bottom of tank to Grade'. D •• 22. Thermal-Sensor reading after circulation ! 'F 0 - Assemble tubing+30'for 4'L.................. digits Nurest +24-for 3-L �7nC ....... ` 1 LJ • _ .Z ` """"" 23. Digits per'F In range of expected change , Total tubing to assemble (Approximate)......... digit ` n24. CL; X . rJc�O I., Q. gallons _ 20. total quantity coefficient of expansion for volume change in this tank •Tank top to grade'.................. .... full tank(17) for involved product per'F Extend hose on Test Elbow B'or more.• 25. c This is mbelow tank top.............................. volume change per'F(24) Digits per'F in test Volume change Dor digit. fast N) Range(25) Compute to 3 decimal places. factor(a) 'If Fill pipe extends above grade,use top of fill. 26. 30. HYDROSTATIC 31. VOLUME MEASUREMENTS 34. TEMPERATURE COMPENSATION 38•NET VOLUME 39 ACCUMULATED LOG OF TEST PROCEDURES PRESSURE CHANGES CONTROL (V) RECORD TO .001 GAL. USE FACTOR (a) ........ EACH READING CHANGE 27. 28. 29. Standpipe heel 32. Product in 3$, Product 35. 36. 37. TempelIlure I At High level record Record details of setting U In Inches Change Computation Adjnlmant total and deflection Date 9 P Read Graduda Replaced(-) Thermal Higher + (e) ■ is)� Volume Minus Time and running test.(Use full ing Beginning level to Sensor Lower- Expansion+ Expansion(+)or I At low level compute (24 hr.) length of line if needed.) No. of which Below After Product Reading (c) Contraction- Contraction(-) I change per hour Reading Restored Reading Reading Recovered(+) (r) - (t) (NFPA criteria) JJ O971 CS or. �t�����1�It�iiiL•� . • i�'.lt��, ir'flll�ll�IR�:! _.• � .� I r • l�Gf1��A r l I WPWANA RM IrFmcla MI��I���I��I�I�I MI��I®��I�_®ill �INMI��®le��l�! INNMI Ell �I�I 14. OyC . Name of Supplier.Owner or Dealer Address No,and Streets) ( Clry v State Date of Test 15. TANK TO TEST 16. CAPACITY From • - � Station Chart. - �(, By most accurate Q C`: L ' Nominal Capacity ��� �S capacity chart available �^� Tank Manufacturer's Chart q identity by position Gallons Gallons Company Engineering Data /` S/J s there doubt as to rue Capacity?""i r i T i ❑ Charts supplied with TSTT Brand and Grade See Section"DETERMINING TANK CAPACITY" "'" ❑ Other ® d 17. FILL-UP FOR TEST Stick readings a - to%in. Gallons Total in Tank f f) Cj Stick Water Bottom befwe Fill=up U v Inventory to%In. Gallons Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY �Z Product in full tank(up to fill pipe) Tank Diameter 0, 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK ,V n See manual sections applicable.Check below and record procedure in log(26). �! p 0 i' ❑ plater in tank ❑ High water table in tank excavation ❑ Line(s)being tasted ❑ Vapor recovery systems ❑ Stage I ❑ Stage II Co Z i P C/3 .t \r M 19. TANK MEASUREMENTS FOR 21. TEMPERATURE/VOLUME FACTOR (a)TO TEST THIS TANK TSTT ASSEMBLY Inventory Top—'F Center_-F Bottom_'F On Truck_'F Expected Change . Bottom of tank to Grade'....................... D 22. Thermal-Sensor reading after circulation C �` �, �-� ~ -F n Assemble tubing+30'for 4'L.................. digits 1 Nearest p _ +24'for 3'L................. 23. Digits per'F in range of expected change 4 Z Total tubing to assemble (Approximate)......... digits _ .20. total quantity coefficient of expansion for volume change in this tank 0 full tank(17) for involved product per'F DTank top to grade'............................. e � � Z Extend hose on Test Elbow B'or more 25. 2. �`. + 3 t r C• `' This is A . below tank top............................ volume change per'F(24) Digits per'F in test Volume change per digit. test to N "' Range(25) Compute to 3 ducimal places, factor(a) O W 'If Fill pipe extends above grade,use top of fill. • 26. LOG Of TEST PROCEDURES 30. HYDROSTATIC 31. VOLUME MEASUREMENTS 34. TEMPERATURE COMPENSATION 38.NET VOLUME! 39. ACCUMULATED PRESSURE CHANGES CONTROL IV) RECORD TO .001 GAL. USE FACTOR (a) ........ EACH REAUING i CHANGE 27. 28. 29. Standpipe level 32. 33. 35. 36. 37. Tempetaiuta At High Level record Record details of:elfin u Product in Product o p total and Jelleclion in Inches chance Computation fvmo Mint Date 9 D Read. Graduate Replaced(—) Thermal Higher ♦ (c) + p) � Votrme Minus Time and running test. (Use full ing Beginning l.r.l to Sensor (24 hr.) length of line if needed.) No. g g Lower — E,pansion + Eepans.en I•)at At low level compuls of which Before Ahat Product Reading W Contraction — Cen114WOG(-I change per he Reading Restored Reading Reading Recovered fv)-•(1) ( (NFPA cngrtii) • t - 01 � — I i i•• rl .. 1. I�'.1, `� n�'\ ~' 1 `00 t I I• r ` ! ? r f ���?,C.� Lj 1 - 1 6 �110 Jl- � I •I ft Form 77.1000 t (J 21103.31541 Data Chart fror Tank Syste,11, Tightness Tester USING KENT-MOORE CORPORATION TANK TIGFITNESS TESTER MODEL 1000 Copyright Knnt•Mooro Corporation 1977 PLrA$F, Fntf+T 1. OWNER PtocertY I]' �, f,l�/)c'A��n/'s /�/�i�il/S%��'��c= .Pc��.o y�r�i�iic />>is• N me Add,. Reotesentatire T.:ednOM Tank(s) c - Name ��• Addrett Reoresentauve Tef•pnone 2. OPERATOR �, f' 1/ /7Gc�ccU/ e Teleonorie Name AddreH 3. REASON FOR — TEST (Exolam Fully) r 1 4. WHO REQUESTED LC�'C��t �l Neme Title Comoanv or Affdianorl Oats TEST AND WHEN T".onens A.i•7rn11 5. WHO IS PAYING Tine T•i•onone FOR THIS TEST? Comoanr.Agency or Indlvidull Potion Ayl^onatnp State Zip Bithnq Ada,.%$ G vtJ�� Attention of: Onter fig. Omer Inairyr eons Identity by Drrecuon i Capacity I Brand/Suooher I Grade I Approx.Age j SteeftFiberglass 6. TANK(S) INVOLVED I 1 Sf�'yn c0 Till%. CLZ' Location I Cover Fills ' Vents Siphones Pumps L i 7. INSTALLATION f /1U7 �"/ I �' �C� i / yC5 DATA Svcuon.denote. Norm iris es env.—, I Conaete.5lace Too. I Size.Tdefin lot..'Jroo I i Pear of station.etc. '_arts,etc. Icoes.Aenote Fills I Site.Feanilowed I which to has I \hap d anOwn B. UiJOERGrlOUNO is the water over the tank? NVATER Depth to the lvater table �t Yes Tanks to be filled hr. Date Arranged by 9. FILL* UP .,.me Teieo^one ARRANGEMENTS Extra product to"too off"and run TSTT. How and who to provide? Consider NO lead. Terminal or other contact 'or notice or mouiry Teuonone Comwnr - Neme. 10. CONTRACTOR. <<° C L t ' J ev ,MECHANICS. dnv other contractor involved .f,�t:-i� �tr r.c,=l c.�l•,I r,r�t-:� Jc�i��c .Ej z<<,�:c� 11. OTHER. c lritU c.,> oeit e- INFORI.IATION OR REMARKS Accitrenal m'orctatjon on any rem%above.O:fictais or others to be advised whin testing is in progress or completed.Visitors or ecservers present pun;test etc. Tess were made on the above tank systems in accordance with test procedures ptescribed for Kent-Moore Tank Srsterns Togntr.ess Tester Model :CCO as eetade0 on attached test charts with resvtts as tafollows:12. TEST RESULTS I Tank Ieent,hcatton i Tich: Leakage Indicate i Date Te :rd yc✓J C,. I • This is to cert:fv that these tank systems:were tested on :he ea:e(s)shown.Those indicated as 7^meet the criteria rs:ati•s^ed by the Vat oral 13. CEATIF CaT10N Fire Pro:ecaon Association Pa +:et:9. s� .4 it Irat• 'Tesunq Ccntnc:or o Co-suna. By. S.:181.1e • i mac ks��J _ __ >- • Ser.0 No of Telter lee nnic.ant A"iesf • .ram _ _ ,I .r��. .►"v _'..f'7`;�•- �..s i'�=.�•s.•i•. 'Y,C � '4•.�. ..+,;I' tiw�rC""'-o 'JAY..'-•.r• .I,� �• mot:f _ r �_ L21 /0 e: 39ZJL)Cf,1�/73 165 A t:•"r Nome of Supplier.Owner or Dealer Address No.and Street($) City Sul• D•r•or tnl From TANK TO TEST 16. CAPACITY ��G�� station chart • y�v By most accurate Tank Manufacturer's Chart Tt c)Iti - Nominal Capacity r capacity chart available `J identity by position. Gallons Gallons Company Engineering Dale fZ Is there doubt as to True Capacity? Charts supplied with TSTT O fl Brand and Grade See Section"DETERMINING TANK CAPACITY" Olher O E - r Stick ic adings 17. FILL-UP FOR TEST to x in. Gallons Tout in Tank C O Stick Water Bottom (n CD Stick Q before Fill•up to SS In. Gallons z t Fill up. STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY OUANTITY J • o V+ Diameter Tank o Product In lull tank(up to fill pipe) 0 0 N U 18. SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK v c' See manual sections applicable.Check below and record procedure In log(26). � D v n Lfno(s)being tested Vapor ' Cb 7C O r recovery systems Stage I Stailts. Water in lank High water table in tank excavation � Po CD O N Z N mm 19. TANK MEASUREMENTS FOR 21. TEMPERATURE/VOLUME FACTOR (a) TO TEST THIS TANK -1 TSTT ASSEMBLY Inventory Top__.F Center 'F _ Bottom_'f On Truck 'F Expected Change da Bottom of tank to Grade'....................... 'F • 22• Thormal•Sensor reading after circulation 0 Assemble tubing♦ 30'for 4'L..... _ digits Nearest O ♦ 24'for 3'L................. 23. Digits per 'F in range of expected change Digits Z Total tubing to assemblo (Approximate) ........ � v o �� 3 �' K '24. (/' X . non 6 1_ gallons n (Olaf quantity coefficient of expansion for volume change to this tank _ 20. lull tank(17) for Involved product per 'F Tank top to grade ............................. '. /n (� /��. (/. This is - test Extend hose on Test Elbow 6'or more 25. volume change per 'F(24) Digits per 'f in teal Volume chanpo Poi digit, factor(•) tD below tank tOP.................... Rango(25) Compute to 3 decimal Places- to . N) w 'If Fill pipe extends above 0redo,use top of fill. 26, 30. HYDROSTATIC 31. VOLUME MIASURIMENTS 34. /EMP(RATURE COMPENSATION 3&!hlT VOLUME 39. _ PRESSURE CHANGH ACCUh1ULA/E0 lOG Of IEST PROCEDURES CONTROL (V) RECORD 10 .001 GAL. USE [ACTOR (s) .... EACH READING CHANGE //ht F S -/l:'-J 5' c`r z'� -!` 27. 28. 29. Slandpipe Level 32. 33. 35. 36. 37. TeTpereture At High Level record plod In ►coducl Chen a Con ulblion A[uelmenl In Inches 0 0 r IeUI end delbrlwe Date Record details of S¢llin u Reed• endued nepbeed(—) lhermel 9 D Iliphn • (cl • lei • Vol.w,r Mmue Time Find runningtest. Use lull in Senior ( 0 Beginning level to lower — [,Pension lrDent.en(.)of At low level ton.D01e (21 hr. length of line if needed.) N0• e1 which Before Alter Product ItPedrnp (c) Confliction— Com-action(—) things per hvr e [�� �s Reeding Restated Reeding Reading Recovered(t) (.)— (1) I (Nt!A uiterie) n //� cv V/� Tc-C� �'Fi� �.ut-3 C;' � %IP;. e r! LC (I L 12 c eV I %o C. "'L NiZ- G ;�, 0 ��t /5% ��jc e.' ' %V ti I t2 V c Ic i� it v S c9, D ILI r ��7 ► cl r� �•c't;�c'L L1�5 . 25 Xi- , C. LIS ''Aeoe • tj � � rZ • � F L • I ZED' s2 Ea • N". j a ILIS-70, 26. 30. HYDROSTATIC TEST PROCEDURES PRESSURE 31. VOLUME MEASUREMENTS 34. TEMPERATURE COMPENSATION 38•N VOLUME 39' ACCUMULATED LOG OF, CHtl ANGES CONTROL IV) RECORD 10 .001 GAL. USE IAC10R (e) .�,�r./ EACH REAOING CHANGE 27. •l l 28. 'J 29. Sundpipe Level 32. Product In 33• Product 35. 36. 37. !.' "in' a'Yle At Nrph Level record In Inches Change Computation Adlurlmonl total and tollectrea Retold details of settin u Graduate Replaced(—) Date 9 P read. Thermal Il ipher ♦ (c) • (a) - Volume Minus Time and running test.(Use full Ing Beginning I Level to Senior Lower — ($pennon o Lapana.oa(a)or At low It'll compute (24 Itr.) length of line if needed.) No. 01 which Before Allot Product Reading (c) Contraction — Contraction(—) theoge pat hour 17/p Reading Restated Reading Reding Recovered(e) l•l— hl (Ni PAcnutu), S2.3 o ' : Sl zY ) Z 25- qq ro 3:c 2' 2 2 26 0,6 v' 2( 1\ koy a V IN --- R TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER:' 7�� ��� y P.O. Box 534 CONTACT PERSON: �/C- cv lg.r �� 0 � l,, 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 NOS 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-. 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 X'_ Other chlorinated hydrocarbons, Paint brush cleaners .J(iqc.-earben-tetfaeh1 rode) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, C Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may X 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 ,1 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD OF HEALTH satisfactory 3.2.Auto Body Shops to unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS •'� Class' 7 7.Miscellaneous 2-10*WANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MATER S Case lots1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 04 DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply Li1� G / O Town Sewer Public f�On-site Private 3. Indoor Floor Drains YES-NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. _�*o Person ) Interviewed Inspector Date J TOWN ' or BAR NSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,14pai.r Q satisfactory 2. Printers t1MR D OF HEALTH 3. (luto P.ody Shops ¢ Q unsatisfactory- 4. lanufacturers COMPANY ��, TT� t IAb� (see"Orders") S. Retail Stores �I ,p 6. Fuel Suppliers r ADDRRES& , 711.4; 7 r 1 � Class: 7. Miscellaneous-ARR L&W QUANTITIES AND STORAGE (IN=Indoors; OUT-outdoor. 1IAJOR MATERIALS- Case lots Drums AbUveTanks UndetgroGad Tanks igallons &M EW Fuels: • Gasoline, Jet Fuel (A) Diesel, Kerosene, 02 (B) , Heavy Oils: ,- waste motor oil - (C) new motor oil (C) transmission/hydraulic Synthetl.c Organics: degreasers •Miscellaneous: C,� A N �.U6A r15 ISPOSAL RECI. MAT ON REM US:' 1. Sanitary Sewage 2. Water Supply Town Sewer ��i Public011 _ y� On-site Q Private 3. Indoor Floor Drains: YES NO Q Holding tank: MDC Catch basin/Dry well On-site system , 4. Outdoor Surface drains:YESI NO O IloldinL tank: MDC . OCatch basin/Dry well ____--- OOn-site system S. Waste Transporter Licensed? _Ham of Uau1D.r;. , ! nstina ion Wagta Produc (ES _NQ_ Person(s) Interviewed Inspector. -Date ---OWN-OF-BAR RWM, BL �s , ` O satisfactory a. 2. printers ��-BOARD OF HEALTH � tlt� 3. Auto Body Shops_ Qunsatisfactory- 4.' Manufacturers r I — (see"Orders") S. Retail Stores COMPANY t t+ '�� 6. Fuel Suppliers ADDRESS Class: 7. Miscellaneous QUANTITIES AND S70RAGE.(IN=indoors; OUT=outdoor U A Case lots Drums AbdveTanks Undetgtouad Tanks MAJOR MA79RIALS IN IN IgLrr IN 1 6 gallonse f ! Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, f2 (B) Heavy Oils: waste motor oil (C) •new motor oil (C) transmission/hydraulic Synthetic Organics: - degreasers It AU Miscellaneous: r . W J" A,' A K! yam b-2-1- - DISPOSAL CLAN'�A'T.ION REW,RKS: ftE 1. Sanitary Sewage 2. Water Supply OTown Sewer CYPublic _ OOn-site O Private •3: Indoor Floor Drains: YES- NO O Holding tank: MDC OCatch basin/Dry well ._.._._._..._. __._._...._...... . ._� 0 On-site system 4. Outdoor Surface drains:YES NO- 0 Holding- tank: MUC OCatch basin/Dry well _ _----- -- - O On-site system S. Waste Transporter Licensed? nPstinatinn Jq,1Sta Produce - ' 7. u Person .,.Int.ervi i spector Date -TOWN OF BARNSTABLE BOAR ® OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM �__/, _ ✓ c ,��r ADDRESS /1 � f � Major types of materials: 1) 2) 3} f�f,�%. 4) 5) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility Vor # Remarks/RecommeTw, .i_ons 1. Indoor —' a) separate, contained room b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection f�. f, 2. Outdoors. , a) uncovered, exposed to weather t�^ 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 �,-' r` 1, hauled by own firm ,r 2, hired hauler ; a) name of hauler b) address or disposal site e f, Perso.n(s) Interviewe&\, _t—. _ _ — — — — — — Inspector - - — — — — — — — — o 4 t:' � Date '11 A,jf ,� - - -, - - - - - - - - - - 6 30 81 /� U t / �'