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HomeMy WebLinkAbout0208 BARNSTABLE ROAD - HAZMAT ;.oa C. � a 1i l 6 o .. Norm Blasi Z-7 IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS ... ` 200 Main Street• Hyannis, MA 02601 0 S9 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 P'� Business Name: ' Go(oW Date: 3�3 Location/Mailing Address: Contact Name/Phone: c'S -77) q9% Inventory Total Amount: <Soo MSDS: gk-Onitkt- Wl ;n License#: 107 6 Tier II : Labeling: V5 „ Spill Plan: Oil/WaterSeparator: h A Floor Drains: C) Emergency Numbers: 4� Storage Areas/Tanks: S 1c Emergency/Containment Equipment: Waste Generator ID: Waste Product: N I 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) p 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" A�,1 ts11e5 (including chloroform, formaldehyde, �+ hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION RECOMMENDATIONS: flo re(A)MMenAWbAS Inspect Z tu Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS r• • !l y1 Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that A+Flooring Solutions ................................................................................................................................. 206 Barnstable Road, Hyannis, MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 'n `C Public Health Division 4 1639-]01 1 BAMMBLF, Thomas McKean, Director 'ate 200 Main Street, Hyannis, MA 02601 � Office: 508-862-4644 Fax: 508-790-6304 T. :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 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 . Pot chi *A late charge of$10.00 will be assessed if payment is not received by July 1st. LtZr S 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? 1/ 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: YIe1 GCL►' [ lI tLL 5. NAME OF ESTABLISHMENT: AtR 0 n 6. ADDRESS OF ESTABLISHMENT: 2010 ` d. 1-4uw,0511, o � 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: ,p, / 8. TELEPHONE NUMBER OF ESTABLISHMENT: ,5 0 a 1-7` ~ Z q D 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHO E(#O CORPORATION NAME '�' !1 PRESIDENT -1�' TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 61� f Q:\Application Fonns\Haz Mat Appli Draft Jan20l9.docx 1 Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that A+HARDWOOD FLOOR SOLUTIONS 206 Barnstable Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------- ---------------- ---------------------------- - --- -------- ------ .------------------------------------- ----- --------- ------------------------ ------ ------- -------------------------------- -- ------------------------------------------------------------- --------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------- -------- ----------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services rBAeT" 'THE ofrower LE Public Health Division fiAAM1Sii.>,cFKFK;1`llflbCO^iR•!c:!;t:i Q� y.ti,=-iiw'.IS•.i::Eii'!J..:.•.Y i'P.d.:{.>.t5':.: 16 9 BARN MASe ,$ Thomas McKean, Director n- 4'ArF1639. 200 Main Street, Hyannis,MA 02601 "y pWa; Office: 508-862-4644 Fax: 508-790-6 304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 't 1N 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: $150.00 V$r©��� *A late charge of$10.00 will be assessed if payment is not received by July 1st. t 1. ASSESSOR'S MAP AND PARCEL NO. &�0, 01 Cq-- 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 MATERIALSXORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? �/ YES NO. 4. FULL NAME OF APPLICANT: 1 5. NAME OF ESTABLISHMENT: C26T � r l n 6. ADDRESS OF ESTABLISHMENT: 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 it OF: CORPORATION NAME n' v28o1 PRESIDENT TREASURER - 92 CLERK CJRL t.F sfc� t 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICAN DATE Q:\Application Forms\Ha2 Mat App Revised 09-10-18.docx Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that A+HARD WOOD FLOOR SOLUTIONS 206 Barnstable 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 TRowr of BVnsxable eg atory Services THE Richard V. Scali, Director � Public Health Division PTIA mmu t BARNWAHLE. r Thomas McKean Director 1 1639-2014 -- -- — -- — -a639•- PIED�p -- —-2001VIairi Street,Hyannis-1VIA 02Ci01--- ------- ------ — -- -------- __ 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 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 x 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. 37 l.blZ- 2. IS THIS A PERMIT RENEWAL? VYES_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: :l�l 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 20� V fj e� yjj, U t�lA-�1w)PA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: ®�`"I'� I '4 a-D 9. EMAIL ADDRESS: ) 6 10. SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT -5 -3-43& TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 5I Z QApplication Forms\I-IAZMAT APP 2017 REVISED.docx Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that A+HARDWOOD FLOOR SOLUTIONS 206 Barnstable Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 600 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 6Z:T H-j LT i 61 Nfif TRow1u->�of Unstable eg atory ervlces t� Richard V. Scah, Director � r� Public Health Division BARNSTABLE r w WtH5Tli8lk••lYfECY1liE.COIUrt•Nfs Y.IS BARNgrABLE. - Thomas McKean, Director 1639-204a'sle.."srae ArED 3>`� 200 Main Street,Hyannis,MA 02601 575 Office: 508-862-464-4 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ,GPI 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? ✓ 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)?_AYES NO.. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. DADDRE OF E DTABLISH NT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: sos'-I l i- 9. EMAIL ADDRESS: 'r 0(: i? i n `& S 10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT 414 (0A TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS MAIL: SIGNATURE OF APPLICANT21 DATE Q:VWpplication Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Hardwood Floor Supply 206 Barnstable Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------- -------------------------------------------------------------------------- ---------------- ----------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Barnstable o40% Regulatory Services Department , A>$-Americacft • � Public Health Division t v 1 39� 200 Main Street, Hyannis MA 02601 ATFo r�xA. 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. DATE APPLICATION FOR PERMIT TO.STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT CAA L L Si Mdam, . NAME OF ESTABLISHMENT C °v COS r—Lo,0 ij S ADDRESS OF ESTABLISHMENT �L V 6 d 4'kK S' te_; 4.m • TELEPHONE NUMBER ,?f- 7 f- &O-fO SOLE OWNER: J( YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS Of ALL PARTNERS: ..� t IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. to STATE OF INCORPORATION fin, -S-r FULL NAME AND HOME ADDRESS OF: PRESIDENT Cb4t U qM l e_ (o C-i X1,94 L-441C TREASURER CLERK SIGNATURE OTTPPLICANT • RESTRICTIONS: HOME ADDRESS G t`�7� I 4tti C�°� M✓v^ HOME TELEPHONE # f-D P-1127-qj Q:\Hazmat\Haz Mat Application2008.DOC i } APE COD HA UPPLY, INC. 503 s 508-771-4290 206 BARNSTABLE RD. bie HYANNIS,MA 02601-2930 DATE v 53-13/I8 MA 8436 PAY TO THE t.-may ,;�j CA,� 6��S P44 I $ (o 0 / v '` e ORDER OF - e J1 n i�L I� 4 lJ I7 rJ�: L�i DOLLARS u `e BankofAmerica ' ACH RJ 011000138 FOR �V� wr u'000 50 30 1:0 1 1000 L 3a': 00460a 7 L L L L III' Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Hardwood Floor Supply 206 Barnstable'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 Town of Barnstable Barnstable I"ETti Regulatory Services Department p� aieaC i • Public Health Division I BAMSrABLE, NAS& 200 Main Street, Hyannis MA 02601 ArfO MA'S A 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. DATE G d10i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT CAq L (-10M 'CN NAME OF ESTABLISHMENT 900 WSW OWFL00,39"tY ADDRESS OF ESTABLISHMENT 204 AsSir MA 02601 TELEPHONE NUMBER 'a�'" SOLE OWNER: YES V NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: S Aav IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. C05 STATE OF INCORPORATION r•l AS_S FULL NAME AND HOME ADDRESS OF: PRESIDENT CAI,L, jjr,M/Ce, 6 4-W0 4 L4 r-vte�,:W<e- `h 6 6A'VY TREASURER 04 AO -"1140 01 11J' CLERK 4e4 a M" 1 o+ dJ Q vi v t1 m tz d/ SI NA URE OF APPLICANT RESTRICTIONS: HOME ADDRESS `6 LIP' 1 L• 4te r�oxc4lArs HOME TELEPHONE# g"v f 7 QAHazmat\Haz Mat Application2008.DOC Town of Barnstable V@O (Up Regulatory Services W y�P Thomas F. Geiler, Director a �P Public Health Division �33 i°F�or 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 ' 7 - APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ��V�YI lQ( r.-t S.,�p Ccc� ; C NAME OF ESTABLISHMENT 01 rn".. ADDRESS OF ESTABLISHMENT aUb TELEPHONE NUMBER SOLE OWNER: V YES NO i IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: J: t ` IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ON - ati-1 cyW3 STATE OF INCORPORATION ./L1,4 FULL NAME AND HOME ADDRESS OF: PRESIDENT 3 y nn2S �} s�n�\�/' , 6- mco ST /t)C/T"— rn� TREASURER Lct (•r" _6 CLERK -j ' &— e. SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS C t,�,lNL HOME TELEPHONE # xaz.aoc,'wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). 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 copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). 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 Back to Main Public Health Division Page Number Fee 633 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Town Paint Supply 206 Barnstable 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 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 24, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health P-. 1 �r Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Hardwood Floor Supply 206 Barnstable 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 30, 2008 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/20/2007 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health t Town of Barnstable OWE, Regulatory Services Thomas F. Geiler,Director BAP.NsrABLE, D' Public Health Division 9Q t639 `�vt v�E1639. 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. 2�' ��� DATE 7 ` APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C41Z L CIF M k NAME OF ESTABLISHMENT CAN FLOOR 8 9P Y d �, 206.13ARNSTABLE RD g ADDRESS OF ESTABLISHMENT HYANNLS,MA 02661 [ c._ TELEPHONE NUMBER :J J SOLE OWNER: YES ' NO N �► IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: �' m CAL L4411t 1 Lt W-4 L4�LE Fet4erm-14-1-.M*f- a `yx IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. a:05 306y�6 STATE OF INCORPORATION M FULL NAME AND HOME ADDRESS OF: PRESIDENT ,C4kL �-;v4tc.e 6 `,Ndf Ltd.' r-'GSr09-ca- k%f4,rr TREASURE ; l 5 Y#ew S',"Ot 6 MV140 V) Sva�&V A 4SS CLERK I-?'e-! 3 AIL Al v M V-V71 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 6 L/ ir024-b HOME TELEPHONE# Number Fee 1076 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Hardwood Floor Supply 206 Barnstable Road, Myannis,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. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town ®f Barnstable Barnstable Regulatory Services Department AN-AmiwicaCf ' Public Health DIVISIOIl • aARNMBL& KAS& 200 Main Street, Hyannis MA 02601 1639. a ° 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. DATE 7 f f h 6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT If�,f G&-. NAME OF ESTABLISHMENT CL2?f eQP tVf 'UPPI I/V ADDRESS OF ESTABLISHMENT > L GI//'�S �OII _. _ - "A TELEPHONE NUMBER / �ak) 7 7-/- 4V SOLE OWNER: YES VINO w O IF APPLICANT IS A PARTNERSHIP,FULL NAME AND-HOME ADDRESS OF ALIT PARTNERS: a tom, IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D �C� r�6� STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF:p PRESIDENT RC frK G6 oCIS 4/&#fJ N IX. CPU J&e y M,4 a /7/ TREASURER 0 / .� 4?)� CLERK SIGNATURE O APPLICANT RESTRICTIONS: HOME ADDRESS A.2 +MRl4t4 OrMY17YZ4 all 00171 HOME TELEPHONE# J:\inspection handouts\Haz Mat Application2008.DOC °FtHETti Town of Barnstable + BA MASS. : Inspectional Services 9 ASS. . i639� ♦� A'FD 39 lk Public Health Division Thomas McKean,Director 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 A+ Flooring Solutions 2-27-20 del COP Hello, As discussed this is the letter that has all the information you need to comply with the regulations. Things that need to be fixed are as follows: 1. Contingency plan needs to be posted 2. Spill plan needs to be posted 3. SDS sheets must be on property PLEASE HAVE THESE THINGS FIXED ASAP,AS I WILL BE BACK THE WEEK OF MARCH 23RD If you need anything at all please call me.Thanks for your cooperation I have enclosed my business card with contact information C. Gus Johnson Hazardous Materials Specialist ,NE►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM�BLE.�` 200 Main Street• Hyannis, MA 02601 059. ArEDMP+a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: F)at,-t� Sal Dater Location/Mailing Address: d ©fo Qv-v►s LU,- Q. Contact Name/Phone: G rm -q-� Z A ., Qg-- 5-:a 3 Q 4 '-3 Inventory Total Amount: fob O -14�00rl S MSDS: License#: t 0 Tier II : l\/1,A b� 6S Labeling: Spill Plan: Oil/Water Separator: IV VA Floor Drains: JV 0 Emergency Numbers: Storage Areas/Tanks: 9IIv, cam,Je,;1 T c, s ►�- Emergency/Containment Equipment: ..Sw S,,n� )/ S_o; f1 6�4 Waste Generator ID: Waste Product: dVtn,.-c-' 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 11'1 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: f C WJ64GFeut- , a d�-%— Z,,\e 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 L,,"- Miscellaneo, s 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, pp hydrochloric acid, other acids) VIOLATIONS: 'TO 3 ��plP 1`s � �� e` `� ��o� 0 a e o% P1 cf, Tc,IP®EJT ORDERS: S7"C� +4 } 6rfw, ICI' Cjr Safi ' ' ,�Ci INFORMATION/RECOMMENDATIONS: Inspector: C" fad Facility Representative:!�,z 0—�a-I WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS 0t1HE*off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ` R""M IL& ` 200 Main Street• Hyannis, MA 02601 w9. v+"�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A' Ss 1,4,4D s Date: g `� Location/Mailing Address: ZoSF• IBa�+tis}a�b1� 12 anvt� Contact Name/Phone: mo_ 04 ao- Inventory Total Amount: `f�fl—qs��b MSDS: eer - 4&<k License#: Tier II : 0,0w o Labeling: WOe-li Spill Plan: ye,7 - Oil/WaterSeparator: Floor Drains: N O Em�rgency Numbers: 91 Storage Areas/Tanks: 9 14,1 by tea-_V a{ o�, "«S Emer enc /Containment ui ment: V } : � w- — a, o c, 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 I W(C(t lrc- I v., a� a tax.- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, azardouenal use, t KI) 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 N%D� Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil V Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants VDegreasers for engines&garages Pesticides: Caulk/Grout I 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 J 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 J Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: IN FORMAT ION/RE COMMEND ATIONS: Cow%w-t-cc b>,12 v4et, er �- DMi5kb `Cov 4_t�Gk 5k<ick%&6 J1,,D. ctdL ti3g. � �� 5� 5 k �V�al�i gvf� .� �n�-t Inspector: �-e-- GWt 1 t.c5 ) D�J �,> L:e . (�J�Cvvk t5 , EpC<<iv 5 ') �tn`1 p1�pG ��e 5, Facility Representative: 1 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. 9` 200 Main Street• Hyannis, MA 02601 p t6 M A�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MPS Business Name: �i fi �"14906 So)-J}•ok s Date: Location/Mailing Address: oti 5 Contact Name/Phone: rmaye r a K s2pq-S2 - 38 F/eof,M r-CtV-/ Invento Total Amount: �� GoAa b MSDS: / / License#:!076 Tier II : o Labelina: Otks Spill Plan: OK — 01 Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Ai ^44,y, cm w+a+%AXs Emergency/Containment Equipment: 14a5 6 h i II cJ egKvJ +evc 61 }e- ewe '%/acS Jo 46 Waste Generator ID: A Waste Product: Date&Amount of Last-RAipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: Q LIST OF TOXIC AND HAZARDOUS MATERIALS I Vte, -'VL I1AVeYVk°'r I`L, 0% ` �i.,r CvL`' NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA hazardous material use, qt f5 storage and disposal of 111 gallons or more requires a license from the Public Health Division. AN "e ���'s„p�/+ems Antifreeze Dry cleaning fluids 4400+I e0 Automatic transmission fluid bO Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Me-4%> l Hydraulic fluid (including brake fluid) Windshield wash i v- c4cte{-e- eeot KI 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: 6Aw �) Caulk/Grout/ 5%vt s 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 13 o Paints, varnishes, stains, dyes�C04; Lye or caustic soda Lacquer thinners ��w5 Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes 000 Miscellaneous Flammables Pot� r&1r q,-s Fertilizers _ '30 Floor&furniture strippers k`wt's�S PCB's Metal polishes yoo-tboa 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: (24rft� c.k ea-., KSR-A v%A9.00-05 %VVV C> alp. VV.04XJfa•,wI I,n eGti otn., v�.c._1 ORDERS: k a r . INFORMATION/RECOMMENDATIONS: okS o--V �4 ��Ja}e! �S S v vl. _moo �- ctf QoS��l. Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS F °p IKE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS . . 200 Main Street• Hyannis, MA 02601 ,a,q.A TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MPy Business Name: P "o-C, ev Date: /S Location/Mailing Address: Contact Name/Phone: ra Inventory Total Amount:316600\\v MSDS: to k VdA+4 License#: -4 Tier II : 0 Labelina: ® Spill Plan: # Oil/WaterSeparator: MA. Floor Drains: Emergency Numbers: _ Storage Areas/Tanks: h 1A C&oL\ka Z t Emergency/Containment quipment: �"I\ aiw 'S ,I1 �' t �c Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc : 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 2?j 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: X`pt7 Road salts grease, lubricants, gear oil 9� Refrigerants Degreasers for engines&garages ke oo Pesticides: i'a 1b�13� aulk/Grout ,c� s,�g 5 q " insecticides, herbicides, rodenticides Battery acid (lectrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine t�jSy Paints, varnishes, stains, dyes AI*,'�f+tit Lye or caustic soda Lacquer thinners -aka%VUS Miscellaneous Combustible Paint&varnish removers, deglossers x Leather dyes 401D Miscellaneous Flammables �oly'�.�,a"`' Fertilizers 30 Floor&furniture strippers v PCB's Metal polishes '~ �x 5 y�y n� 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: 0 aw 4A INFO AT ON/RECOMMENDATIONS: Inspector: ' L^vt ii-L, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date: ./ Z?-/ /.3 TOWN OF BARN STABLE TOXIC AND HAZARDOUS MATERIALS R FORM NAME OF BUSINESS: Ca -G Ca� aro�woo� �'/aor S� BUSINESS LOCATION: 2 -s INVENTORY MAILING ADDRESS: .54m e- TOTAL AMOUNT- TELEPHONE NUMBER: -5'08 -'77 ► - t{2 9 D t 7Z q c, I CONTACT PERSON: A:+,_,- L, V EMERGENCY CONTACT TELEPHONE NUMBER: b t 7-2b S 608 S MSDS ON SITE? TYPE OF BUSINESS: Tor C&0_t K-g s�L4P/y 'de s INFORMATION / RECOMMENDATIONS. lf4�,.4 be_e'nse gK�spj 11 Fire District: 1l411 ,K,&-CVLc./ A f/�lavlrt�S 'a bSo��ocx,-E� �r� a vas I at.b le. Ova S,'I'e.. E�rS.�v�<.1 dQ►l►�D h oy.�- nv wt�7c,,rS �o T -C o s+.¢..Q y d�►o,� Waste Transportation: 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) i Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) I 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 13�(o Paints, varnishes, stains, dyes s 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) �pp Miscellaneous. Flammables felA= %#1-15+ 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 ���.- Date: << / 1� /t 3 TOWN OF BARNSTABLE 5,;, .,, TOXIC AND HAZARDOUS MATERIALS REOSTRABON FORM NAME OF BUSINESS: F�� U -C-J, C-0 BUSINESS LOCATION: 2 �v�,c.,l V ,k —1 INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 0?9 -"1'l CONTACT PERSON: 9vy a, w EMERGENCY CONTACT TELEPHONE NUMBER: 022 6,Z3 q $?2 cll MSDS ON SITE? TYPE OF BUSINESS: < < ,&-A cleAtum,_4 e. INFORMATION / RECO ENDATIONS: all ow 1 t 4-0 5wF Fir District: �(�l,p COv.�r��vwc S t�dao. �n—vw�Aw �4.� . K� GLSN)S t a►�h Waste Transportation: N 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) I Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants I 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) 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) 1, Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials t, YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is required by law. na3 fi DATE: 3 Fill in please: �k3! ur APPLICANT'S YOUR NAME/S; BUSINESS YOUR HOME ADDRESS: r�,F P r 3 YJw? 9h- �t TELEPHONE # Home Telephone Number ram$ a tl a Q V' NAME OF:CORPORATION NAME OF NEW BUSINESS ex m '� TYPE OF BUSINESS �: (=l cx 'r+� Wp 1,�- IS THIS A HOME'OCCUPATION? i/ YES 'NO ADDRESS OF BUSINESS:: o S MAP/PARCEL NUMBER ©� [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual ha bee ormed of the permit requirements that pertain to this type of business. MUST'wOMPL'1fTWITH ALL Iwl(� I4 ARDOUS MATERIALS REGLILATIN!^, Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(L�IICENSI AUTHORITY) This individual has beeli inf d` f he licensing.requirements that pertain to this type of business. . Ay:hori ed unatt &* 1 n COMMENTS: "0 OI�C Q..�. _�j� / 11. V�'U� JL� �� �7 . - �. I �2��Date:l Z0� TOWN OF �ARNSTA�LE its-rg�iayi - o- aAf TOXIC AND HAZARDOUS MATERIALS ON-SITE DiVIAMQW NAME OF BUSINESS: ki- on ' BUSINESS LOCATION: INVENTORY MAILING ADDRESS: A s_04 y. TOTAL AMOUNT: TELEPHONE NUMBER: Q -, --, 1 _ t y sco CONTACT PERSON: 7�► h�4� EMERGENCY CONTACT TELEPHONE NUMBER: 5Z32f_-6_s_6 MSDS ON SITE? TYPE OF BUSINESS: Rpj�n t j sate-c jFIewri eq / 0166pi`,`T s�ppj_ INFORMATION/RECOMMENDATIONS: �},� r�9�,w a� fh � c�►�'( �ir�.=. Fire District: q so i wi 3943CA4 C.441frg2rc LQ A s I .-S - --�t�6 - . u 1 Rio c3 '�+ Waste Transportation: d,4 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 Glued Cemew-f; F(cgrhw?et b1 c, Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda As Pad,,reNiotsstq1,05 Arj O Rustproofers 2 Miscellaneous Combustible r'iowr�g4�„gs, Car wash detergents ` Leather dyes 1rCe q�u°rt�rs �F Car waxes and polishes Fertilizers ThiS fcfiaL o"s in&i11of) BNCiJs Asphalt& roofing tar PCB's AC RempIAdr-r 1s iq floor I Geffen andl gwArrt Paints, varnishes, stains, dyes � � Other chlorinated hydrocarbons, m ma b �n�a�nerd Lacquer thinners Fla k° (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables N-18 5 Other products not listed which you feel Floor&furniture strippers "s op may be toxic or hazardous (please list): Metal polishes n %Ar CdV1 i'_Jn r n OM PA 1 80 Laundry soil &stain removers (including bleach) r - 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