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Home My WebLink About0333 BARNSTABLE ROAD - HAZMAT 333 `�a.006 Av- eOGd- t .t 4D °F1HE l°y Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAN,% E ` 200 Main Street• Hyannis, MA 02601 039. �prF�MP TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT t� Business Name: 6 r Date: 6l Location/Mailing Address: Contact Name/Phone: �it;Q%-`71" Inventory Total Amount: ®0 MSDS: p (License#: Tier II IV® _ Labelino:_ Spill Plan: Oil/Water Separator:_ Floor Drains: d Emergency Numbers: v Storage Areas/Tanks: U d Emergency/Containment Equipment: k4b al Waste Generator ID: Waste Product: P, Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: velq l` et , 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 VAutomatic transmission fluid V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils VIMiscellaneous 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 tl Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: V Inspec 46r: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS i INE*oq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA M' q E. ' 200 Main Street• Hyannis, MA 02601 1639. prFDMP+p`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C A-PC-n6 JTiy? SO OV-71 Date:.P. Location/Mailing Address: C Contact Name/Phone: C k 5,09r-� Inventory Total Amount: :7 !�C-ro SDS: 6vY ,4.e License#: )�� Tier II : wo Labelina: Q&+ri, I v Spill Plan: Oil/WaterSeparator: IVA Floor Drains: 9Vn Emergency Numbers: Ye Storage Areas/Tanks: Emergency/Containment Equipment: 5`60) i-' -Cbu� Waste Generator ID: Waste Product:LVQ S�el 6, Qie`un 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 il"�`Dry cleaning fluids r/ Automatic transmission fluid 0 .er 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, ii -i hydrochloric acid, other acids) �1 P q.}-t P P Ct L d -Y,y�en,T�-�.� S e yy., ORDERS: INFORMATION RECOMMENDATIONS: see aim Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °FTNEIok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMT E,A_%. A 200 Main Street• Hyannis, MA 02601 p'EOMA'� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: CAunS 3 Date: Location/Mailing Address: Contact Name/Phone: k8- 9 -V S6 Inventory Total Amount: 11 SDS: Of) License#: ��- Tier II : Nr) Labelino: W% Spill Plan: - Eb Jeht Oi[/Water Separator: N 0 Floor Drains: rl O Emergency Numbers: WZ� Storage Areas/Tanks: -� _n � ' 1 l Emergency/Containment E ui ment: Waste Generator ID: Waste Product: /V ` Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Ec gy') (!4V. t)f>7 ( f c)t'Srlr� 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 a s 'other cleaning solvents&spot removers 1r Engine and radiator flushes ✓ Bug and tar removers Hydraulic fluid (including brake fluid)1_6 Windshield wash Motor oils'q D Miscellaneous Corrosives wo Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants 5a' Degreasers for engines&garages Pesticides: aulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries I o 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: m0.,llnVeA4DN,5d INFORMATI N/RECOMMENDATIONS: `r ` r ` n iS Inspect Facility Representative: �..' WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS vT. °FINE roN Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMARSBLE.g• 200 Main Street• Hyannis, MA 02601 A t6 p M �0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 Ay Business Name: uff Date: 1' Location/Mailing Address: 3 Contact Name/Phone: _Qd 9--179 -T l,g Inventory Total Amount: 11�JrDO SDS: Of)Ilh1 License#: Tier II : Nr) Labeling: r6cW Spill Plan: - ® Ieht Oil/Water Separator: NO Floor Drains: N O Emergency Numbers: KZ�S Storage Areas/Tanks: k-,a�f, Emergency/Containment E ui ment: ' Waste Generator ID: Waste Product: rtfum /Wake oil Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: t pf) PAU;II(-o() ( f cx's�1r i Other Waste Disposal Methods: �J 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 a 6 'Other cleaning solvents,&spot removers 1r Engine and radiator flushes ✓ Bug and tar removers Hydraulic fluid (including brake fluidh,d Windshield wash Motor oils"4 D Miscellaneous Corrosives 00 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: aulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Z c) 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: moo l io "gUfAiDN 1;.51 INFORMATI N/RECOMMENDATIONS: `�[ [��:n�U �t r a1i`41) Inspect Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS IH rE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABLE, ` ,MASS, � 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Or12A vas AAo So Date: Location/Mailin Address: 333 ��lv. l e. fR It�{ q,V%VJ 15 ►Contact Name/Phone: c-Iz- -e v��c�v.. c -178-75:51G X 23 Inventory Total mount: MSDS: ley -4 1+-4�jc A6 License#: (O'L C4 3 Tier II : 00 Labeling: Spill Plan: yens` Oil/WaterSeparator: Floor Drains: 0 o Emergency Numbers: Storage Areas/Janks: 156 elo l wAyk.e- b. I , off,-rVJ->,C. Seal oyS,ti.t\�c� cow�aT�s Emergency/Containment Equipment: r 4 S ok,s 4- &-i L labl a- Waste Generator ID: V D 62 Waste Product: Wask�- o< < . 6A" Gong Date&Amount of Last Shipment/Frequency: bAA c0-0m, ov%e.-e� OL Wge,�t- Licensed Waste Hauler&Destination: V,e 51vt.t-o- 2.oi y 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 vHydraulic fluid (including brake fluid) Windshield wash Motor oils * wt.5ke- 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: IN ORMATION/RECOMMENDATIONS: C&Du .1\ 1�c. -! -Lh a��dL , a o ( � 5 i•k 1 Inspector: 0.o-e11�e, l Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. --------------------------------------- g WAYNE MILLER,M.D.,CHAIRMAN \ PAUL J.CANNIFF, D.M.D. 07/01/2016 AWAYANAGI c Is JUNI H THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Pi r Town of Barnstable rw,ti Regulatory Services °^ Richard V. Scali,Director MAS& Public Health Division BAMSTABLL 1639 a10� eawus o s K � �wsi�nxsoa y Thomas McKean, Director 7639-2019 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304' t 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 I PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT Ill —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallo 150.0 V•s A late char a of$10.00 will be assessed if a of received by July 1st. ASSESSORS MAP AND PARCEL NO. .5/7e,/ DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT:. Orleans Auto 3uWy Inc 803 t amsta tb a 00ad ADDRESS OF ESTABLISHMENT: Hyannis, MA. 02601 MAILING ADDRESS(IF DIFFERENT): �flL TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: SOLE OWNER: YES NO IF NO,NAME OF PARTNER: '�— FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME - PRESIDENT TREASURER CLERK y rIF PREPARED BY OUTSIDE PARTY: 'SIG U F P ANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev 16.docx Page 1 of 2 °pI►1E►ok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA1-9. 200 Main Street• Hyannis, MA 02601 " .b59. M 6. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 PS Business Name: era5 Aofo. Sop0 i Date: �3 / Location/Mailing Address: 333 i4,1'esAK15 Contact Name/Phone: gko f- 1 ,ck¢r ' 4', 4'n 42R-778-7 Sb 2 3 Inventory Total Amount: ^�) aI MSDS: `I 2-g- o"�-�I�w License#: �� Tier II : Drfy�bl e. 1�Z„Giay Labeling: waSEcoK Spill Plan: 'tom o5f Oil/WaterSeparator: A)[A Floor Drains: NQ Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: QlQ;rSZ� * &k�-AV fts XAk �o r 511 Waste Generator ID: AV &n Waste roduct: WA6 L o,L Date&Amount of Last Shipment/Frequency: 1 c a > ,< ►vt- rV r Licensed Waste Hauler&Destination: Vi 1 Other Waste Disposal Methods: d•I z c Coce s �'��,�,�� a c- (7 y f;o Od t G LIST OF TOXIC AND HAZARDOUS MATERIALS L vv`a G1o< NOTE: Under the provisions of Ch. 111, Section 31, of the eneral 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 SS�a�}� dtr� - — 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-v-ewes 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- sv Sv I��S ��G• d1�v�ta1,�R.� o �I� vL`�i v�G it v(�. �A �esf wo,sfi� M4vi -S- + s �!i,pla ( , La��Ilc� Co►M�I� k&,s 3 b-2'14' S I) M4(W-�� 1 g o�el t Inspector: wa5.l.e Qos l ��k Qc e�V i y v� I��►"� Cmf�- Facility Representative: w� WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °Ft r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARNSTABL. 200 Main Street• Hyannis, MA 02601 =:N TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT - Or�ea n.6 �`TvT o S,,001 Date:y Business Name: _ _ , Location/Mailing Address• 93 r •c a v►n, Contact Name/Phone: i C-6 r f Wit, 'I a' I-- SoB 78-7951 u Z 3 �c- eKkcn mac,! Inventory Total Amount: - K00'7-OCO a) MSDS: yes License#: I$�- Tierll : I Labelina: 25 Spill Plan: D1� Oil/WaterSeparator: iR Floor Drains: b Ewerr9-en-cy Numbers: 0V Storage Areas/Tanks: _5 Emergency/Containment E ui ment: 5OA,(4 o%k 41kr4- Waste Generator ID: I I Waste Product: z v� Date&Amount of Last Shipment/FrequencX: Licensed Waste Hauler&Destination: 0,yyk�a&4 w�a'lti. ,.a 1A 1 Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS tv 0 L�\k%"J e, I w `Kv�+w`�t7�-J SIvC-e-- A K4,&,An ov-- NOTE: Under the provisions of Ch. 111, Section 31, of the General Law&of MA, hazardous material use, �X storage and disposal of 111 gallons or more requires a license from the Public Health Division. �t�r'�s Antifreeze Dry cleaning fluids `l 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 0 0 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 PCBs 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: INF RMATION/RECOMMENDATIONS: r t i s . Inspector: 2 Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: // 13 TOWN OF BARNSTABLE5oo- TOXIC AND HAZARDOUS MATERIALS REGMUMUM FORM NAME OF BUSINESS: OrIt yt6 4.4o :5,, BUSINESS LOCATION: '333 I��rng'�aao1� f' a� INVENTORY MAILING ADDRESS: 5ctyvL� TOTAL AMOUNT: TELEPHONE NUMBER: _,So0--770 --795-j, x Z3 CONTACT PERSON: RIC-44.(� i,r�ja��GS EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: AL40 u,(+5 r•,C al I yes INFORMATION / RECOMMEN ATIONS: /lea C��mvn�N�,o►c� a,'d' Fir District: Waste Transportation: Last shipment of hazardous waste: &-2-e03 Name of Hauler: CvvL 0, Destination: More has AX4-ie- 4(6,t co/1qe-r-t�o� Waste Product: kA5,+z o, Licensed? Yes No bo+ra-re-ly L 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 IUa ✓vta or c4�`n� ivc lnvenjo S/rl60— �q The Board of Health and the Public Health Division have determined that the following products exhibit toxic or *1 hazardous characteristics and must be registered regardless of volume. Obse ed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED .� Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)IBatteries 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) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials i • • w� Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply .-------------------------------------------------------------------------------------------------------------------------------- 333 Barnstable Rd., 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 : Jun. 10. 2020 9:43AM ORLEANS AUTO SUPPLY No. 7466 P. 1 ✓ `` Town of Barnstable AM Inspectional Services BpA.�RNNiASTApBpLE ryy5�15 YA1i'OR(MUt�TV�@ fy Public Health Division 1639-701• �' .wru+erne+a F Thomas McKean,DirectorNAM 5N}l1J .en 200 Main Street,Hyannis,MA 02601 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 sc—JUNE 30th), APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ v5.r CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late charge of$10 00 will be assessed if ygment 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/MSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: S 1 _ Gen,10f. �6m /� < LJ 5. NAME OF ESTABLISHMENT: C -E�5 PrLft 6. ADDRESS OF ESTABLISHMENT: =, /� BQrr� h�e Rcd �� 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: L e��s@ Or� S a SUIPI� • CG'`r1 10. SOLEOWNER: /YES—NO IF NO,NAME OF PARTNER: 11♦ FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME ' -Jne Q � '�' 2q°lq ild�foo� " Y � PRESIDENT & t TREASURER << CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: �1 C TELEPHONE#: 5�-� 5co COMPANY ADDRESS EMAIL: c mr saw SIGNATURE OF APPLICANT DATE O Z� Q\Applioation FormsWaz Mat Appli Draft Jan201 , x Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., 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 4 Town of Barnstable Inspectional Services BARNSTABLE OF THE) ` �fzo?o�u w5;=e o Public Health Division 3629-2M ` v Thomas McKean,Director b�prEo �a`0� 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERNUT 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 PERNIIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERNUT 111 -499 Gallons: $125.00 "❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V l nCt CAA *A late charge of$10.00 will be assessed if payment is not received by July 1st. d iOb 1. ASSESSOR'S MAP AND PARCEL NO. J i 0 � H O 2. IS THLS A PERMIT RENEWAL?ZYES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZON-ING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO, 4. FULL NAME OF APPLICANT: pC�' C G 5. NA.ME OFESTABLISHMENT: 0oeGnS 6. ADDRESS OF ESTABLISHMENT: J� �5 �►� �oc�C� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: � -�-7? 9. EMAIL ADDRESS: SryrAGr-Qber-�'s &-IeQnS0,t� t/ C C-y 10. SOLEOWNER:X-YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER 1 CLERK 12, IF PREPARED BY OUTSIDE PARTY: NAME:'-�non TELEPHONE#: COMPANY ADDRESS - EMAIL:Cs Y,GcCn (c7 a-(-&-s(s �y.can • SIGNATURE OF APPLICANT �" DATE Q I ()) QAApplicarion FormsViaz Mat App Revised 09-I 8.docx Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health ' ow1�of Unstable egu atoervlces oFt►+e r Richard V. Scah, Director Public Health Division E*: : L,E a.ru5BARNEEABLE. Thomas McKean, Director :nsroot 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 _ !� Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 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 Z VS• *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 310 I LAC) 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: 5. NAME OF ESTABLISHMENT: Od ans A..r„ 6. ADDRESS OF ESTABLISHMENT: 333.Bamstable Road Hyannie MA. 02601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: .- 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50�3 118 _7 9 5(o 9. EMAIL ADDRESS: ae-4 � QA%z f 10. SOLEOWNER:X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT ,�4��ra�.� iA,I4,A TREASURER CLERK c{ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE 6 Q:\Appfication Forms\HAZMAT APP 2017 REVI 0 'U Fee Number 182 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i i � I Town of Barnstable Regulatory Services . �� Richard V. Scan,Director Public Health Division Z Thomas McKean,Director ' h� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Faz`-508-790-6304 Application F e:$100.00 rq ASSESSORS MAP AND PARCEL NO. r DATE : APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Orleans Auto Supply, Inc. 333 Barnstable oad NAME OF ESTABLISHMENT Hyannis, MA. 02601 • ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER 7 g'-7cIS G SOLE OWNER: /YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION �SS FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • SIGNATURE OF AOLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# � Mcache\Temporary Intemet Files\0LKD31HAZ.APP Rev2015DOC rq� Town of Barnstable Office: 508-862-4644 '�. Fax: 508-790-6304 Regulatory Services Department ;. BARNn"LK Public Health Division p MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt :Hazardous Materials Payment received: $100.00 (Check) on 6/26/2015 ;Check number: 7620 Check amount: $100.00 Name on check: Orleans Auto Supply, Inc. ;Business: Orleans Auto Supply, Inc. Owner: FAIRBANKS FEBRUARY LLC ;Address: 333 BARNSTABLE ROAD, Hyannis i I,. Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------- ------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r, Town of Barnstable °F�HEti Regulatory Services Richard V. Scali, Director BARNSTAMASS. # Public Health Division 039.Arfor9'�° 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.3�0YO DATE 6130 / APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 0 2L�4116 ,4 V7-0 Sc�4�'40 NAME OF ESTABLISHMENT 2 2 ADDRESS OF ESTABLISHMENT 33 AA cr/ TELEPHONE ER SOLE OWNER. YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NOO STATE OF INCORPORATION c s4c fuS�/7-is I i FULL NAME AND HOME ADDRESS OF: IPICC-1 PRESIDENT .� / Icy0'1 6414 3Aa��S%� I 6 �U� ��e TREASURER a CLERK ` -ram51 SIGN RE OF APPLICANT RESTRICTIONS: OME ADDRESS y HOME TELEPHONE# ,S0 9-N m— 7 6 Q:\AppficationFormsU-1AZAPP.D0C , 1 MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills,etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven(7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health.Division 200 Main Street Hyannis,_MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also; please fax us a copy of your contingency plan(to handle hazardous waste spills, etc). In.addition, please mail the required fee:amount of$100.00. Please make the check payable to: Town of Barnstable. The check m in-house be mailed to the address listed above. Allow u to four days for in house processing. p Y p g For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Pane Q:\Application Forms\HAZAPP.DOC Hazardous Material Spill Control I. Scope II. Purpose III. ApplicabilitX IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste —Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: 1 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. 2 C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations ` Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. 3 f B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. _ 4 APPENDIX A Form 1 — Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. I 2. Determine all potential causes of the incident with descriptions. 5 f 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 6 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must be taken to prevent future occurrences. Determine responsible person(s)for corrective action, e.g. policy revision, etc. with a timetable for completion. 7 ' Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 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 6/30/2014 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 Towm of Barn-stable . Regulatory SenlccS Thom Y Gaflex,Dir2djor 3AR-NE AN4 , Public'' He;alffi Division ision a,�� T�033sCKET j Dir2D3 2 n0 lye Stri, Hyamis,lv�A 02 b01 ' F= 50�-�90-b3D� V111��: 508-SS.7-4-b4� Applicafan Fee: ifl .D(3 go ASS�SSflRS A�AND PA_.R=NO, DAZE APP-1 ITCATIOI t FOR PEp�II Tn STnR-E AND/IOR U= 1 fl IF1- 111 GAZLnN,,; OF T Ak ARDQUS MATERL LS L NAB OF APFiIC_ TT N9, of EST-,�-B17S� 933 ADDRESS OF EST_,k=zg�f ENT n T HO-�NO Im r s��E owe: YES NO . APPI_JCA_NT I5 A PAI�T11 �1�'� ' ATI�HoNa A_.DDRESS OF AL L PARTNERS: ,I I A271JCAi?�Elk C-ORP0RA'=ON: F=- RAT S PATE OF IN CORPORATIOt T � S SC%f✓5��/"� — All L A-ME AND HOtNE ADDRESS OF: e PRISmENT J P--)C q P1'pwaks �5r C�� SlGI(AillAE OF�P�idCAl�IT PASC : Ho ADDRE � = TaO- HoE T��Ho .44 t } Hazardous Material'Spill Control I. Scope - II. Purpose III. A licabili pp i IV. Definitions 4 V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written'to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. A112licabil4 All departments, employees;,customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste—Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per,310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. } A., Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: 1 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area: 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it'in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE-as any contaminated item used in the spill clean-up has been handled. > 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. . 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the,contarnination away. 3. Notify the Operations Manager that a small spill has occurred. t 4. Ask the Operations Manager for medical assistance for the person(s) affected,by the spill,if needed,. 5. Remain at the door of the area to ekplain.to the First Responders the quantity and location of the spill:_ 2 C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall cleanup the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the sP ill clean-u P shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List fora specific hazardous material. The guideline for this policy is 100 milliliters (ML) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close'.the doors to the area 3. Prevent others from entering the area.. 4. Notify the Operations Manager that'a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify,the Controller and President. 5. Remain at the door_of the room to explain to the First Responders the quantity and location of the spill. 3 B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste. Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous.Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. S. 4 APPENDIX A Form 1 —Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. g Describe the incident. Include tasks or operations being performed at the time of the incident. p List the chemical or physical agent(s) involved. 2. Determine all potential causes of the incident with descriptions. 5 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 6 I r 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine-if similar incidents have occurred in the past. 10. Describe what actions must betaken.to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision,etc. with a timetable for completion. 7 - fl Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 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 6/30/2011 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CA_NNIFF,D.M.D_. 6/30/2010 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health M- r Town of Barnstable oF1HE To,, Regulatory Services ti Thomas F. Geiler, Director • + BA MASS. _ ]Public Health Division y hiASS. a 1639. `gym pTFDMA�A 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. / 0 DATE (� s APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 1_ e_-AVS AC176 StIAOL_� SjVC- NAME OF ESTABLISHMENT Ao-0a SL/Agc-5 ADDRESS OF ESTABLISHMENT 333 R/1111J-57_40(J /2� k74vr_16 0-d-1-cal • TELEPHONE NUMBER ��`�-V- C> SOLE OWNER: ES NO IF APPLICANT IS,A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF.AZL r PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NOVY STATE OF INCORPORATION I e P 55h S FULL NAME AND HOME ADDRESS OF: 'I / PRESIDENT j IC 'AtOAoukS, v�• 91 MIC-6 ( we TREASURER CLERK • SICNATUU O L.-ANT RESTRICTIONS: ME ADDRESS HOME TELEPHONE # 0d4f — '7C.7(o D Haz.doc,k�P/q r MAIL-IN REQUESTS Please mail the completed application form to the address below. [n 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. 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. • i For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page • Hazardous Material Spill Control I. Scope II. Purpose III. Applicability • IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting L • I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material • Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste—Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do • the following: 1 L • 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. • B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. • 2 f • C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be .laced into an area for safekeeping. P P g VI. Reportable Spills • Reportable spills are defined as hazardous material p preleases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the • quantity and location of the spill. 3 • B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Rel2orting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. • 4 • APPENDIX A Form 1 — Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible fbr Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. • 2. Determine all potential causes of the incident with descriptions. • 5 • 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. • 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 6 + A 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must betaken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. • 7 Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., 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. 7/1/2007 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health I RECEIVED FROM co ADDRESS 3 , �' i = ._� o 4 ❑FOR RENT ❑FOR x S a - s v a s 4 - _ 'a • • • . AMT.OF' h rillilm *a ACCOUNT CASH G r �, �: _ AMT.PAID CHECK k`� K 3- BALANCE MONEY i x ,r y DUE ORDER ' BY" " .r �. r Town of Barnstable Y oFz Regulatory Services Thomas F. Geiler,Director l MRNSMLE, Public Health Division Thomas McKean,Director J 4 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 56-790 04 Application Fee: $100.00 set N ASSESSORS MAP AND PARCEL NO. -7j 0 - 3 O DATE U J ramn APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 012-L4W-S Is UPPL`> C NAME OF ESTABLISHMENT 04L e /'JS 14V6 C-., ADDRESS OF ESTABLISHMENT 333 ��f►�5'%R/�C1� '�C �/ `� °`��S �� TELEPHONE NUMBER �oir- 71- �f L SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0/ STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT J R)CIW-->-�. fff/�,3Aav45 TREASURER / `' CLERK /I P SIGNA OF APPLICANT RESTRICTIONS:. H ADDRESS -S` r/sii2�Iic HOME TELEPHONE# Sod-V.14 L7L � 4e 3o v Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $100.0o Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 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 June 30, 2009 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health a 1 Town of Barnstable . Barnstable THWE Regulatory Services Department :IIARNSI'ABLE. Public Health Division I �m r 9� 639 � 200 Main Street,Hyannis MA 02601 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. 3 1,o - / 7 0 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN I11 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT OX&-� IU S NAME OF ESTABLISHMENT J ADDRESS OF ESTABLISHMENT 3.33 91V/VSTA1SC-1-- TELEPHONE NUMBER SaJ' ?71- -)S 5 L SOLE OWNER: YES /NO Cpe'10614 - N IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS O ALLY PARTNERS: , 1 - c!r p � z �/ "ncn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. /- STATE OF INCORPORATION /&SSAC11 yS4%"T� FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER ✓ Cie' �.4/2�•o.�.cs ��. S Sc�•)! ,� ' cisr :rim; CLERK rC/�A/(� T��ti .�2.. .Sc/ src J SIGNAT OF APP RESTRICTIONS: HADDRESS s .SC�'� � �• OSi f��/� / I HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC 5 Hazardous Material Spill Control I. Scope II. Purpose III. Applicability IV. Incidental Spills of Hazardous Materials V. Reportable Spills VI. Reporting J I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Incidental Spills of Hazardous Materials All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. i 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. f D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. V. Reportable Spills A. Spill Response 1. Notify a--'I other personnel in the affected area. 2. All personnel exit the area and close the e doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VI Reporting Notification o cation of reportable hazard ous dous material spills shall be reported by the Operations Manager. I w . APPENDIX A Form 1 — Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. 2. Determine all potential causes of the incident with descriptions. 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must be taken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 Barnstable Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. lv -- ------------- --- ----------------------------------------------- ------- - - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ i = This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2013 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health tr 1 I Town of Barnstable �tIH*E Regulatory Services Thomas F. Geller, Director '" MASS. ; Public Health Division 9^ 13 ,deg' . p 139. °i 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. c3& / YO DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 0/2 51)Aa NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 333 � SCX � /�I y,9�uNlS /Y G�G� TELEPHONE NUMBER SOLE OWNER: /YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.0 -10-79/ STATE OF INCORPORATION /� SSAe, USES FULL NAME AND HOME ADDRESS OF: PRESIDENT :J`'-ICAA,2S A1P3"<S ik 9l Wick �oS,� Glfiq y l ,�Nimedic(� U2� �— i TREASURER CLERK i SIGNATURE OF P CANT RESTRICTIONS: HOME ADDRESS I Cl//L Sf Ay C )iaz , HOME TELEPHONE# Haz.doc/wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. 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. 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. For further assistance on any item above, call (508) 862-4644 i i i f Hazardous Material Spill Control I. Scope II. Purpose III. Applicability IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste—Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: 1 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment_(PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. 2 C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. 3 B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. 4 APPENDIX A Form 1 — Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. 2. Determine all potential causes of the incident with descriptions. 5 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 6 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must be taken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. 7 Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 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 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health y Town of Barnstable Regulatory Services S 1 00.0D ti Thomas F. Geiler, Director BAM ASS.� ' Public Health Division 9� 1639. ,fig' RFD 39. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 3jQ /�"o DATE V APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT OK—L6A�VS PTO S t,.alk L7 -::ZU C , NAME OF ESTABLISHMENT QALf ADDRESS OF ESTABLISHMENT A�NSi.4/3C x �Z� //'9N��S, TELEPHONE NUMBER SOLE OWNER: /YES NO CD IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALLY -n PARTNERS: `` N �py teyy 3 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION /7)4-5S#Cf-us✓��'i� FULL NAME AND HOME ADDRESS OF: / a— PRESIDENT 2) i� r_s �. o'll /�� (ruas-Zpv TREASURER CLERK /SIGNATURE f ICANT RESTRICTIONS: H ADDRESS 9�(�V1L✓JS� U/9`� ��'% /�-L`/�� HOME TELEPHONE# Haz.doc/wp/q MATT-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. 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. 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. For further assistance on any item above, call (508) 862-4644 Town of Barnstable oFIKE ta,. Regulatory Services " Thomas F. Geiler,Director t �� LE, Public Health Division ArF 639. 6. Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 - 2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2011. A late charge of$10.00 will be assessed if payment is not received by July 8, 2011. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DOC Hazardous Material Spill Control I. Scope II. Purpose III. ApplicabilitX IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting I I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply;Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material Hazardous material is defined in 49 CFR, Department"of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste —Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: f 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. j D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. APPENDIX A Form 1 —Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. 2. Determine all potential causes of the incident with descriptions. 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must be taken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. Hazardous Material Spill Control I. Scope II. Purpose III. Applicability IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. Applicability All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste—Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: 1 1. Notify all other personnel in the affected room to evacuate including yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. 2 C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. 3 B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts.Oil and Hazardous Material List shall be reported by the Operations Manager. 4 APPENDIX A Form 1 —Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. 2. Determine all potential causes of the incident with descriptions. 5 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 6 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must betaken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. 7 Number Fee 182 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Orleans Auto Supply 333 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 C - Town of Barnstable Barnstable THE 4� 1T Regulatory Services Department AHMeiica ,. a i,�uisrAei.E, Public Health Division 9MASS. 200 Main Street,Hyannis MA 02601 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.3W A /0 DATE �7 a/ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME.OF APPLICANT �KL�= -� 4, !/60 SUMU l NAME OF ESTABLISHMENT n Lf m ADDRESS OF ESTABLISHMENT 3 33 /� • TELEPHONE NUMB R SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. t � STATE OF INCORPORATION /llf1SS�C�fivS, �� S ' FULL NAME AND HOME ADDRESS OF: PRESIDENT jticPO'!� agAN�s .iK cj� !t� Crdc�S GUA�j TREASURER CLERK SIGi1`A c� �/U-3 RESTRICTIONS: E ADDRESS /1 use y�u'f62tJ�a-4 HOME TELEPHONE# $a - yd 8 7 G 0�3� Q:\Hazmat\Haz Mat Application2003-DOC , • Hazardous Material Spill Control I. Scope II. Purpose III. Applicability IV. Definitions V. Incidental Spills of Hazardous Materials VI. Reportable Spills VII. Reporting a . • I. Scope This policy is prepared in accordance with Orleans Auto Supply, Inc. Plans, Policies and Standard Operating Guidelines. II. Purpose Orleans Auto Supply, Inc. is committed to provide a safe environment for customers, vendors and employees of the company who need to work with and around hazardous materials and to those areas of the company which may be affected by presence of such materials. The management of hazardous material spills is crucial to that goal. This policy is written to provide the overall requirements for the management of hazardous material spills in all laboratories, work spaces, facilities, and other property of Orleans Auto Supply, Inc. III. A1212licabilily All departments, employees, customers, vendors and visitors at Orleans Auto Supply, Inc. IV. Definitions Hazardous Material • Hazardous material is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA). Hazardous Waste—Hazardous waste is defined in 49 CFR, Department of Transportation (DOT), and 29 CFR, Occupational Safety and Health Administration (OSHA), 40 CFR Environmental Protection Agency (EPA) and 310 CMR 30, Massachusetts Department of Environmental Protection (DEP). V. Incidental Spills of Hazardous Materials Incidental spills are defined as hazardous material releases into a room which does not exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. All chemical spills shall be reported to the Operators Manager who then shall notify the Controller and President. A. Local Clean-up of Spill If no person has been contaminated by the spill and the spill is localized do the following: • 1 1. Notify all other personnel in the affected room to evacuate includin • y P g yourself. Have someone notify the Operations Manager. Keep other people out of the area. 2. When assistance arrives, determine if the spill can be cleaned using towels, sand, speedydry, etc. Do not reenter the area alone. Use proper personnel protection equipment (PPE) such as gloves and eye protection. 3. Clean up the spill and place the spill clean-up items into a labeled hazardous waste container and place it in a secure area. 4. Remove any contaminated PPE and immediately wash hands, etc. Dispose of the contaminated PPE as any contaminated item used in the spill clean-up has been handled. 5. The incident shall be reported to the Operations Manager on Form 1, Appendix A by the manager responsible for that area. • B. Need for First Response Personnel If any person has been contaminated by the spill, especially eyes and skin, you must ask for First Response Personnel. 1. Notify all other personnel in the affected area to evacuate, exit the area and close the doors to the area. 2. Assist the contaminated person(s) to a safe eyewash or drench shower station to wash the contamination away. 3. Notify the Operations Manager that a small spill has occurred. 4. Ask the Operations Manager for medical assistance for the person(s) affected by the spill, if needed. 5. Remain at the door of the area to explain to the First Responders the quantity and location of the spill. • 2 • C. Spill Remediation 1. The First Responders shall evaluate the spill quantity and location for feasibility of complete Remediation. 2. The First Responders shall clean up the spill using approved spill clean- up kits, personal protection equipment, etc. 3. The incident shall be reported to the Operations Manager, Form 1, Appendix A by the person responsible for the area and the First Responders. D. Handling of the Hazardous Waste 1. All items used in the spill clean-up shall be placed into a suitable container and labeled with the appropriate hazardous waste information. 2. The container shall be placed into an area for safekeeping. • VI. Reportable Spills Reportable spills are defined as hazardous material releases into a room which do equal or exceed the Reportable Quantity (RQ) per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List for a specific hazardous material. The guideline for this policy is 100 milliliters (mL) or greater. A. Spill Response 1. Notify all other personnel in the affected area. 2. All personnel exit the area and close the doors to the area 3. Prevent others from entering the area. 4. Notify the Operations Manager that a large spill has occurred. Tell the Operations Manager the name of the chemical spilled. The Operations Manager will notify the Controller and President. 5. Remain at the door of the room to explain to the First Responders the quantity and location of the spill. • 3 • w B. Spill Remediation The incident shall be reported to the Operations Manager on Form 1, Appendix A by the person responsible for the area. C. Handling of the Hazardous Waste Handling of the hazardous waste shall be accomplished in accordance with the Orleans Auto Supply, Inc. Hazardous Waste Management Policy. VII Reporting Notification of reportable hazardous material spills per 310 CMR Subpart P, Massachusetts Oil and Hazardous Material List shall be reported by the Operations Manager. • 4 • APPENDIX A Form 1 —Incident Report Location of Incident: Date of Incident: Time Incident Reported Type of Incident: Hazardous Condition: Name of Person Responsible for Investigation Follow-up: Name of Investigation Team Members: 1. Describe the incident. Include tasks or operations being performed at the time of the incident. List the chemical or physical agent(s) involved. • 2. Determine all potential causes of the incident with descriptions. 3. Describe any injuries, illnesses, or exposures which may have occurred 4. Describe what PPE was used and which hazard controls were operating at the time of the incident. 5. Describe any Health and Safety Policies which may apply too the incident including emergency response and first aid. Determine if policies were followed prior to the incident. 6. Determine when the last training was performed concerning these policies. 7. Determine if training was received by person(s) involved in the incident. 8. Determine how the incident could have been prevented. 9. Determine if similar incidents have occurred in the past. 10. Describe what actions must be taken to prevent future occurrences. Determine responsible person(s) for corrective action, e.g. policy revision, etc. with a timetable for completion. •