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0411 BARNSTABLE ROAD - HAZMAT
a-v-%Y7 vv Number Fee 1342 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CVS Pharmacy #10852 .-------------------------------------------------------------------------------------------------------------------------------- 411 Barnstable Road, Hyannis, ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable AAA.• W.& Inspectional Services BARNSTABLE �FT1iE TQ`. n;rnsTnee•c>n�nvn _cenrr•rrrrns Public Health Division 2014 BNSTB_F ff '` 1639-2014 N 5rrAABLE. = Thomas McKean, Director ; pr 1639 .��D 200 Main Street, Hyannis, MA 02601 f MP'� C.. Office: 508-862-4644 Fax: 508-790-6304 w. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE �r HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, ` HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V A- *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. • St(�ph@n1s Cadorette 4. FULL NAME OF APPLICANT: Conrdinat6r 5. NAME OF ESTABLISHMENT: �V 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: l CVS/pharmacy 8. TELEPHONE NUMBER OF ESTABLISHMENT: :J" J n.ne CVS Drive Mail Code 1160 9. EMAIL ADDRESS: nonpharmacvpermits@cvshealth.com Woonsocket, RI 02895 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS E , AIL: 0 . SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx I i IToq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MASS.LE.$` 200 Main Street• Hyannis, MA 02601 pfEDMP'�0. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: S i u 'e-1= ±f- 10195- D1 Date: Location/Mailing Address: y 11 G i,.,,, ,` t6)P YZ qr!!T�n d'tp.4 GI Contact Name/Phone: S02t-:? 1- Inventory Total Amount: > ��� SDS: License#: 1 Tier II : NO Labelina: eeku.• f Spill Plan: vv�__ Oil/WaterSeparator: Floor Drains: wo Emergency Numbers:Storage AreaslTanks: AN .,z inrefl i�-r cs,n 5 k- vod I+-- Ca.} ..,s m ne" t Emergency/Containment Equipment: _ 2�r� A-a3 —SC.- t Waste Generator ID: n)I% ° Jo610%-5 sa'S Waste Product: Scj,as Date&Amount of Last I Shipment/Frequency: m Licensed Waste Hauler&Destination: "t c VVV Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oiler isinfectants Miscellaneous petroleum products: i/ Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages _L,,-' 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: � eku Virg. �,J da ("�Apo c,✓►e ORDERS: INFORMATION/RECOMMENDATIONS: VOWS fcv) — YV`P�i —6y "'ZCV Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKErok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMAN Le.$ 200 Main Street• Hyannis, MA 02601 'bP t639. MP A`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 Business Name:- - CA (t 0 Date: IWO Location/Mailing Address:\ 6 i WGO Contact Name/Phone: !0(?'771-9753 Inventory Total Amount: SDS: 3E- onti he. License#: 13 y? Tier II 0 _ Labeling ff.) %( Spill Plan: (A e Oil/WaterSeparator: Floor Drains: N O Emergency Numbers: Storage Areas/Tanks: Stfl'oh J Emergency/Containment E ui ment: 5Q PfAd q ri Waste Generator ID: nM0W16Zk5 Waste Product: I16n (T d lit ij,6 So l,`tW Date&Amount of Last Shipment/Frequency: r= 0 N-e-�- Licensed Waste Hauler&Destination: O iC Q1I) / - e. G b i O l y Other Waste Disposal Methods: S�fr;_r QC LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil — Disinfectants 3 o 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 ye or caustic soda Lacquer thinners 7 Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons V Laundry soil &stain removers qa CC,+60 (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: .INFORMATION/RECOMMENDATIONS: _ t r MCLI(e- StXr, e MPCar) det 0 5 ►n Inspector: Facility Representative: e WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p THE Tp� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9Bna A�`E'� 200 Main Street• Hyannis, MA 02601 4'`lE0►w+' TOXIC AND HAZARDOU5 MATERIALS INSPECTION REPORT Business Name: CASA K ate: l / 9 _ Location/Mailing Address: f 11 0 W 0 Contact Name/Phone: ' -771-41b::y Inventory Total Amount: SDS: License#: I3� Tier II : N Labeling: rt.fi I Spill Plan: � Oil/WaterSeparator: Floor Drains: 40 Emergency Numbers: Storage Areas/Tanks: mergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: I� 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. An Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: . ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: _ WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS pQ�ME rOk, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9B"MARS. ' 200 Main Street• Hyannis, MA 02601 .67q.MA'S p�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT tF0 Business Name: °N 5 �o Date: ( g Location/Mailing Address: I 1 _i �atav"k5 Contact Name/Phone: 1411 . 1_1)0�4<0&-r 5-6 0 'b t 4-1 3 Inventory Total Amount: Soy °�1 SDS:CVS oK� e '��1 �K�5 �Ke, License#: -� Tier II : 1�rn Labeling: 00-16�� 1V t7y�. Spill Plan: y2S Oil/WaterSeparator: OJA Floor Drains: 'It6 - VD�ob,AEmergency Numbers: �aske, e5 Storage Areas/Tanks: AZ'-ak {' k ,66 de- b�vtS Ssa� S're1 ti.w�Us45ke. Emergency/Containment Equipment: b s q So��Gy1�C otn 5 ti Waste Generator ID: L l0 2 Waste Product: WX4 Date&Amount of Last Shipment/Frequency: 12 2,t S 0. usvwl l-/ 44e Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �I Xe ce��t� I Q61'mAcy Ivl\/ZV+O<y S' NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, q%c- storage and disposal of 111 gallons or more requires a license from the Public Health Division. Jevt�oty SSG Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDE a S" ovS G� a C A S i G2bt l5 C� t 2 o �►.� CLA koo6-� 1 S INFORMA ION/RECOMMENDATION : o o tS15v4 o-<' Inspector:-', Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1342 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CVS Pharmacy #10852 411 Barnstable Road, Hyannis, 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 t 1 Town of Barnstable Inspectional Services BARN TABLE wnnwsrne.=•rzarai;;i•cm.im+..wm= Public Health Division °_'�,u�:,9 2014 • BARNSTABLE, � Thomas McKean, Director 4',rev 50 200 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 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 5�VSi c( Ci�14� *A late charge of$10.00 will be assessed if payment is not received by July 1st. � (6cr4— 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: CVS PHARMACY#10852 411 BARNSTABLE ROAD MA 02601 • 6. ADDRESS OF ESTABLISHMENT: � HYANNIS, k Cv.spP armacy - - One CV5 Drive 7. MAIILING ADDRESS (IF DIFFERENT FROM ABOVE: — -Mail Code 115^ woonsoc e , 8. TELEPHONE NUMBER OF ESTABLISHMENT: c'��S -• 9. EMAIL ADDRESS: nonpharmacypermits@cvshealth.com 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK SEE ATTA%ClncLj 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT E Q:1Application Forms\Haz Mat App Revised 09-10-18.docx I� Number Fee 1342 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CVS Pharmacy #10852 411 Barnstable Road, Hyannis, Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ---------------------------------------------- -------------- ------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. -------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f ti Ion of Barnstable eatory ervices t"e Richard V. Scali, Director � Public Health Division BARNSTABLE BARNgrABLE. : Thomas McKean, Director ""�°"S"'�i�a o<� �'� - - -- -- b ' AS&- ,•� -- -- - —- - 3�� ArEo s 2 0 Main Street-I-Ipannis-1VIA 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 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ � '' CATEGORY 3 PERMIT 500 or more Gallons: $150.00 R v,S A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? LOYES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 1 CVS PHARMACY#10852 411 BARNSTABLE ROAD - ` 6. ADDRESS OF ESTABLISHMEN+ HYANNIS MA 02601 one CVarmacy One S Drive Mali Code 1160 ' 7. MAILING ADDRESS 02895-J 8. TELEPHONE NUMBER OF ESTABLISHMENT: .50 s_1�11) l- 49 Z3 9. EMAIL ADDRESS: 14- 10. SOLEOWNER�YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Nr=z� L nc_ PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: A) I A TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC __C ` SATE l` /l Q:\Application Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1342 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CVS Pharmacy #10852 414 - ----- — — ---- 411 Barnstable Road, Hyannis, CA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials__ — V �1 ---------------------------------------------------------------------------------------------------------------- --- ---------------- ------------------------------------------------- ----------------------------------- ----- 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 ' oww�. of Bxrlstable egulatory ervices Richard V. Scali,Director i f • Public Health. Division BA& NSTABLE f is� ?a►.r��str�ar. KAM Thomas McKean,Director .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—TUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 el CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Jltp *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES X 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)? X YES NO. 4. FULL NAME OF APPLICANT: CVS Pharmacy, Inc 5. NAME OF ESTABLISHMENT: CVS Pharmacy#10852 6. ADDRESS OF ESTABLISHMENT: 411 Barnstable Rd, Hyannis, MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 1 CVS Dr. MC1160 Woonsocket,'RI 02895 8. TELEPHONE NUMBER OF ESTABLISHMENT: (508)771-4753 9. EMAIL ADDRESS: Dianne.Durand@CVSHealth.com 10. SOLEOWNER: X YES NO IF NO, NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND.TELEPHONE#OF:-- - CORPORATION NAME CVS Pharmacy, Inc: 1 CVS Dr. MC1160 Woonsocket, RI 02895 PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: �E4a4o alit/�� SIGNATURE OF APPLICANT DATE C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.dom pd, gas d nL of Brnstable VevAatory Services � . Richard V. Scah, Director Public Health Division BI AN TABL Thomas McKean,Director .,,,d `3 - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 `f APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ®. CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by Jules 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES X 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)? X YES NO. 4. FULL NAME OF APPLICANT: CVS Pharmacy, Inc 5. NAME OF ESTABLISHMENT: CVS Pharmacy#10852 6. ADDRESS OF ESTABLISHMENT: 411 Barnstable Rd, Hyannis, MA 02601 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 1 CVS Dr. MC1160 Woonsocket, RI 02895 8. TELEPHONE NUMBER OF ESTABLISHMENT: (508)771-4753 9. EMAIL ADDRESS: Dianne.Durand@CVSHealth.com 41 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME CVS Pharmacy, Inc: 1 CVS Dr. MC1160 Woonsocket, RI 02895 PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\BMQD49H2\HAZMAT APP 2017 REVISED.docx r Date: ► 1-7 / 1 y TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS R FORM NAME OF BUSINESS: -T�r%C4 Pevt6k,e, i�z4o�s BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -77 / -o y5p < 11 I yk CONTACT PERSON: �av►ie wtiag EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: Z4'rucac, c-erl s INFORMATION / RECOMMENDATIONS: A4r;r om4.s Fire District: t �� IA)A S Q t IJ00 . a V1..-¢Xe a n— �D y °l�c�o�,ti `�-0 IA)4-'b w 1 S V e,5 o ,I 1 6" o f a -s tiJS Waste Transportation: 66 Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's 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) &e- 0144-C u r k ©r4fs to f-eJ V7 '2— Spot removers &cleaning fluids (dry cleaners)�KG G U I c -c. �4sLn4 Other cleaning solvents A' I I Bug and tar removers �o I IG /"D �/�11�2, ASY I IS (� Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signatur Staff's Initials IRE►o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMAT-R- .A 200 Main Street• Hyannis, MA 02601 " ,639 a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MPy /� ,n Business Name: fit+' / PeKgk-e- ►°f�vt--�-a.�5 Date: Location/Mailing Address: qts a,,r- 6+ e— YU7. 9Vfon i Contact Name/Phone: v% 5 O - -7-7 1 —D O t: �< a 'Invento Total A oun "9ttc- License#: Tier II AM Labeling: e akx-41 Spill Plan: Oil/WaterSeparator: IVIA Floor Drains: AJ& 7mergency Numbers: Storage Areas/Tanks: ow si-��a •M�x�4iMov s Emer enc /Containme t E ui ment: Waste Generator ID: at 4.— Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 1/ Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 0 -G 5 1 .2 S a K y .se V-,J1 C-e I La u-11�nspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 1 TOWN OP BARNSTABLE VA /Q �,lE � �� UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS W�}LAl IP9 ASSESSORS MAP N0. 31/ �3 860 f. /� / PARCEL N0. ADDRESS 411 j3,Q�lrYS7'��L£ AGY VILLAGE NAME;-..?• �� /QIf� Ce .Z',v� CONTACT PERSON /JIB � �'� 1-YAlG-4 Aee. PHONE NUMBER LOCATION OF TANKS: CAPACITY: .TYPE OF FUEL AGE: TYPE: LEAK OR CHEMICAL: , ye L ION . AA 'Er . /y7ftDATE OF PURCHASE OF. EACH: 1. 2. 3. 4. 5. DATE OF: FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: cS/y �� �/� �s PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING TIIE LOCATION OF TANKS ON THE BACK OF THIS CARD. �•� ;��, r ` , ��� X �. - _ z i k{n 1 TTT 9 4 bate f. TO MAINTAIN AN CXiSTINWNIW UNDERGROUND SfORAGC FACILITY In accordance With the provisions of 527CMR9.24 this. permit to maintain ar existing/crew underground storage facility is granted to: tocat.ior of prioperty. Street a res� Owner of property: �.�-'��_�.��. Full nQme of person, firm or corporation Rrstrict,ions: Fee Paid.$/AZ__ _ (M.O.L.A. Ghapt. 148 Sec OA) f _ _ note ! azure of Head of Fire Dept. or pointed des ee (0brrier's Copy to be pustt�d at the st,.or�ige facility with F.P.290 Part 3) �w@ J � . v. . ems... a i�1 t y4 �b•'��i,����} a k -,y.� t y. -. .. �� it e ;„ ,�y. 0., .: ,,.r .tv t yy.,ty+#> �• +�.{� 'n�'+,zt ';:. r t`!°'1"'', +ti S r t �3 �0 tobi ti bs 8 $�._ ! +,,�'rp, & 5 - ray l� iv '°A •'». * F��t i 4, =r �.:.,}w `" 9'. .., iy '`a. " ru taf'r 'r'il �"r s a f 3t t j I 1 tSTATtc US 'ON `fct il�iit t +` rs 1 • ,. 4 µ ..t .. is \i?j' t:C� f K C'E L f 1. :t E;Ky �? t� �I i' CC t71kC2 a1•id. 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('.trt!t.Lle'l tIA0vakilx V'Itr, ,twold, bt ent tL• .hti adtFt„ ta,it ,."`.tad 1.I uht;a,3rtitTticfinitudipg rftttncctcd ondergntund piping)is 10f,t7r pwn at 0w top lit thn page in;vitht'nralh III,r1.,anJ Sanict>,.imrvle,,arcuntt6goundi;tnk„twiny`1.ga,ohnr ++t�l Whit" tirtl�dwlulrl'w,,nt)2 indii,itnsttulIerli,_jw,wide` .titfblride,utiunligmil+ 1tx°iati(t! F tlMntt t,itrt'1.1•'ck+,.+t,ni,rluNgti JaE,k,m uKt+rth.etta-ttt h,a tt taktil mit its oltcrati n nrtt1,t.tnu;ely t 1974 t," rilY to tht yt...mil nw,t wi3\ h• I-V'hia Twit, %if F'Nelnttrd! la nLs Tbrnatcd tram tht' yrnund art•riot'11blect to Nijk X.lt.f: 7.dt,%rwv,t4h,i ttu, unz,t rt,t+.sd,to. nauut,nu,n, Oiler iirnk,L vrludcti tfopt•itouhCauitn in^ } E 1 d tyy t,ink•.uv, t .L:,i) k9 tti k .fa!niw+t,iJcrn..dt,Yrt.idl !(?lpflutt,iuicv.catrr,u ttwil?tit .tolItyloir9nflutI -_ly3tt+ irto,t ttotily�tuttiit:utdati,+tl t,!iatgutk(h,•tank.-inetru,t,^ ' • • -: ?,!t u n .aru„f, I „?, t KnAlits' Arty outlet Who knowlnyl)(lit.to"tit)or,tul>rnit.flEu tn(trr'mitic;ti .half ht tub rrt io m nett pirritlly nut 6 rketr4 U6.6m fw"tkrh t►nu tell eihich 3.,cl,rlt taf,k�, fill lcrih3n not gicrn trr for uhtch(stun hifommlan i tub"lltt'd. S�._ w a 3 uY,,..'sY�rr?',rr�` .':«•.'.z�. � ,•. aa;..,..� - .�,_ _><",.....-..., _s,.- .". ..ri k. .tun c:. ai.._.:.t1.:.-„C. iu .,a ,w ._._a$3_..ei-uk�i•.'1Fk r��c3i.: ' i tr r� #�`tit't ttt`tt!'�Fit s fnrrFt rrtmt b rt�rYr lrfid Ito ,Pit s.cT= >.xn tF t, Y 4,€!"; tt .i� �q J',_ x aiCftl,yititit .rat-..r.st7zttj t.i.t4,$� .+zcl„t.italyT Htlltt it#twiti PaC`("P{iSl {{C \�'Kr1Cll t•t1t 54 t' tt iht =tMsr��S71 ia11T1tt tP'} rib. ` +r`1 Et a Y 13itt\44ri't}; d.',.,I .tr,r ,tif!.uflt't i4 L+r,Itltitrrrtt/7r11}ttCt 6rtr€.;li.; i1C1Tt r .. . 11 tir14't:`(f- t xe bwnzt F t tr. Ct,tt G=h, tr-d v+ t l F'utt,.r huamV iOf Oltecr f nillyt 1+Sumo itS`yvGttG,. .ttel.n t,. .{,ra Y t ! f/,,y�� �j ,��,ry�,� (/,''T�y �r a<T yi-* F.3�y,� L.,L[ ' L. .Sr'' Fat,11;y ., ,.Ut (" r.sk,. y t' f,N'"eJc'!it t•t!!` Street Addross - r _ 11 " Coup S1tuCtA.tti9}tansQf.Silit, .e;,,J ., rolllliat•it, �t i� - _ Cis ;StAto _ ZIP Gpde Courtly Ara ode PIi 3ne Number. City{haYerctst} Sotto ZIP f•ucta Type of btand'r (t4fark all that ajPly[El ) r Indit."B}p ►J,:)rh i r!!Ft&tr`tF tyi194�51 t 5 � F7rivtttt3 or Current Staid or t oCat Gov't corporate humtJdr.ut zit:1 uistit3t.n lut,t),htfTim a r�1 f'"1 F ockral Gov't � bwnirrship lijnka a�tots �Z a! 1, jtte,•'Aboo Ctr,n ., L=.J L�J EcarrFYer t.J (GSA fti itity I-D ('to unceflairc- {otsat,ort a}�w V.Jlaa,11.,rt 1.. .It 9k)44'.s e 3 Name(It surge r,+,S xi on t,rn 'k t)nx here )� ,JobTltle .` Area Code Phturio'FFtimbet k' � '' s - .w ,? .+w+«i,4..i---_; n ',-.. ._r.-'��.�.:,:-.•,,...,t1. Y '.m..tasE. xt_.. tip. Mark box here tartly if this is art amended ctr:,tsltseq;Ytiftt notification for ihls Itx-000 f it rt• +Yr '.iF ;fir.,iyr� ,.a t e ,".' t 3 ,R ty yet ,r7 '• t"�°'9. t 1 `•ti.., w .,, P- � - ., x�,ti _`, ( _ ., , ► ,,, .t1 t;. 1 k.t:t' �13 1 !_ �:;.; !'' t. ill tlr e t t r �dtttiy Li,de"f poiidl y o, kw that l ha'�e�;ii wn,r y exarnirtod and aria farniliar with thi! inn oimation , rtbtrltft�d�tn this and al. attacha3d c c,c tltr'tur�t�, arid tl }it Ctrs•`3 on it}�i(tyr ir�,r�{Its Sstr��ntfitridtia�ls-;mmodiataay rf spo Sihlr.,11or6bt,iir irtt�t�e it7fortrtatirJfl. khr lrve that the . siubnlitted information is true,accurate,and'completei t. uti-i;iL rti: cS.,i,ti{).ft{a YY I'1L`9r(,i?,.QY1.18t'5 aUihOrle-(i t€.rs`YkJSr'f llattVll -C� 84t!r `/ Da OJI rled , a• s �++ .�x' ,•IM• /,�� .S,'?v'MT a t`a"'t in"€,R. � " ._ C.C_ s - ^.'�-"-c"-"'�'$`-c•,�"�-"�--,�-s•,-.-....'-i„r^.'r".� i•"'3rn,.,-��. 1E4[: *. -,- sw- -�='�, 3- .'v, + �,-u--*� - _�"� ir, ,x..4-.t,�,!e,t ',s_'A-�-�tAC�".+"" � � _ �t P+ ^t, e�•� h I' "�"^ra „1 M' q...�� 6,� tocr+lion(from so-dicin fl)--: . ,. Psopo,No _ ... .I• �' .off ii 'tl+) ►� �l;i� l} si.'�I�, }' „I!'.i �;� wr�i � >'1 � h`--k� ilfT�t ��t{� rti.. TU,tK rit-(e fj,ABC-123),or . Tank No.�_ Tank No- Tank No. Tank No. Twill. No. lkrt}flrarily/'4.S.ic)rrcd`irc;tif<ttlttlNfstnll�r f�8�].,1,2�3.,.j 1.Status of Taint (Mark:atl 0181 dp,pty.pf}1 C4arresrtly fr�.Use r[ *. f 7Nt1 ilXrJfiif rfy i)(lt Utit Sf?' 4,. ! —'D F',;rrr, r+iyntlyt�utcitJse ��� L. �c; _ Sfor rytfl utto.LlS('after 5 818b (_= F._D 1 --1 2.>~stlrrtrite,i Acte{Ytxars} 3KE.stitn<'atesi fut.tt Capacity(Gallons) �t.,tlrpterlill at co,nstmeliori Steel _ (Mark crte ) { ._I I"sbur IaS5 fIelntofcod Plastic , Unknown pow• -...-...� _.b: Wyk-.,�aYz�r-`�k:Ly':.ef+F-: _'^n' 11".. .. _� .i :a ^_ T- _ Other,Please Specify � _ 5:Internal Protection Cathodic Protection (Mork an that opp"Y T) +letiar t,ining lv,g.•epoxy tesins) C_-D None Unknown E C-1 1= ED w Other,Pleepe Spvcify Exti real Ptutectit Ca+J�txirt;Prtltttion <.� a • L. ._ C_.�f Cr :(tUfark all Rmt app+Y Z ` �Ej'&fnted(bp,aspha iic) ;l [ (c7D ",.±"�'-r`+'"' �_ P_, '''~t *Sftli -�''fll5- `�"f^YtB� s x - �'.;"".... i, l��?*,-�- y-' _-•- , * ;�-__..._-.y1 _�-i: EM r Unkntowr, Other.PleAe Specity 7,Piping f3artt 5t�1 �w ;� � y� �—.-� C 7 � f-�:� �,�r ,. tt tt _ I �-^�- Galvarm-140d`,AeCl ,n_ �: _1t ! . 1 rr.. 'f rh-=-^r I fb0j]`il, `f1fi9rttur,,t;i Mastic t .--n��r [_'_ i callioda-allyProtected [ _ .t I '_D 1_-_ :3 Unknown _W Otltr,r PletaS6 Specify _ 1n Great-A Utax1 ity t yVolume (tilortc;:ltt trvtbppiy1811 ° b,. Pttrok:um _, ___ tlresl E : :J C_._.:D [�___l (.:�_.� Cxi vl,rtG(r tudirrC d:l .;la al tit,nd%) C. °1 C�. _ Used 0;1 c t-tarard6uis Sul 0anca 4..6•l:•'lfl-Af Cf+ •rrt„�i Ahsira�t�nrVt"£r 01 - ---_..-- rdia,l L „ Dlif t-tt,h $S d. Unknown C _D E=11 9-Additional Informallon(tortanks pormanently . , taken out of service) ._ `-stirrtrtited daW last user) (mo%yr) remaining {gal.} b,Estmioied qu,intily of substance - « c. 1-0-or k box(A if tank was filled with.inert material i (rag sand concrete) l l~ C—KA _ H - �- - Pt+nP:2 JIM'S PUMP & TANK SERVICE P*0. Box 224 -a HARWICH, MASSACHUSETTS 02645 N 2 2089 Phone 432.4216 DATE • May 21,1985 TO CUSTOMER ORDER NO. A.F. German Co. Snc, 411 Barnstable Rd. SALESPERSON Hyannis, Mass. 02601 VIA I • , 1 I 1 TERMS: °QUANTITY - a--* SCRIPTION A O NT' ' ,.., .fir. .,..�...,... ' .; ..,.:,..�.�.. • 5/14/85 Prepare to test tanks, excivate fill, remove 4" of water from tank. Labor 6 Hrs. 10 00 5/18/85 Kent - Moore test 1,000 gallon fuel tank. 300 00 Install vent & fill, back fill. Labor 3 -Hrs. 51 00 453 00 ORIGINAL I zn ..r-O-� G•• •••�• r.e W Sr�i+� C n {TTA�N^K TO TEST CAPACITY. /•�/ S fir' t Ne...,r C...aer Lt i7 d� waserr rA.n...+.er l /)y,��'_ ...wrglhorr:u.r �1 L a C!^ �7(i /rCI^ 1.raw a.,m a m T_Cmty r _ C�cnvrw.w0 Ow . wP.Wd wmr TSTT •...r t.a. S••S•coo."OETEAMINING TArx CAPACrrV' _ i oars FILL-UP FOR TEST �«s TeaG...n. b r•ra ri.6t�r w.N..o.q ? Beci wsr Ebaole - brrar.Fr►w rr A rle.s-ncx aEFORE AMO AFTER EACH COMPARTMENT DROP OR EACH METERED DELIVERY QUANTITY Preemeor in hA tsr Iw b SPECIAL CONDMONS AND PROCEDURES TO TEST THIS TANK VAPOR RECOVERY SYSTEM 5«.rwrr r.uw.•seem"Ch—ores•rq Hove vooeun n wp(261 - `SWOs I - r wm ti W.r mvn..Wr Weis a trot.:uv..on _I L,r(y e.rrq ft~rem LVLLT some o. . TEMPERATURENOLUME.FACTDR(al TO TEST THIS TANK (6i71 4M.4216 - - - b low wrw?`;_Corowl_ 'F Pmow r Tar F FRW.Prmro on l�w2 f Emeese Orsge I.a (. =oft Pb'f inroq.of.�.d.r1 OMA .7 Nrr )Ilvi'S PUMP 3 TANK SERVICE` .n. FEATURING UNITaa00t1E TESTIM6 EQUIP. - • .. "a slummy in aerr.orr d ararore tar �e.tart eJrfr�N ml.rrt Y rrt(16 or 17) r.aerr.a p..rd P.0.Box 224 P� - pE CetAst _ NAIPWRCN,MA 02645 Caytr..7 r r. Vora. This is d..rra.yr rtiPA low Row Omar r a tart Prow r.br(a). A0i OF TEA P.a®anEE - ssm ."tat t• - �E®a LET NI.tE .� Ly: own ail GL R FIM W O1a� tl01 mmm . Comm ft.trr I.r.r. A.r. ws .e I ILa6 itlaia d..�a w r� rr" T..s rr td n 4 at0.(List t.a i aatw. r..r r . I RR.r- kl•bi- rrr..err w I Y.Stf d rr i rti<I r I r.a ar.ss Art twom a... p _ Ea.as Lr r ■W.Iw.err .. �W foray,I-) //// .alq-.aRT1 Sltsrlr. f�J � f'c t1 Or J'�c u i ' i ( 1 p G-• i r3o GF( ri I.p 0 ,14 4 �{'I F Icy! ,, r JD i� 0�': U a�-r ; •�:) "`07 d v p4y .o40 ,U i I I 44 ,n4 e i..Gl / / � ;4 '3�� .�. D u i{TJl• ir:D` 60 ,0360 <" i ''i I.l• 601. D �v '�vl���'�'D.- 3fo �( b .v,� 44= ') 2 I p i t I I p j . TANKS] 21 FUEL 'STORAGE TANK "RECORDS ] HELP [ ] FOR PARCEL NBR: 3111 0331 ] ] MAIN ACTION I] Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ ] [ 11 [ 1031 [0101701 [B ] Test ] Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - [ l [ l [ l [ l [ l [0414921 [ ] [ ] Fuel Reason Capacity Constr Status Leak-Det Cath-Det [FO] [B ] [ 10001 [SS] [N ] [Y] [ ] Additional Details [ATLANTIC-HY FIRE. l -------------------------------------------------------------------------------- Action Tank Nbr Tag Nbr Installed Location ----Notification Dates----- [ l [ l [ l [ ] [ ] Test ] Rem ] ---- Test --- --Abandoned-- -- Removed -- -- Variance - Fuel Reason Capacity Constr Status Leak-Det Cath-Det [ ] [ ] [ l [ l [ l [ ] [ ] Additional Details [ ] -------------------------------------------------------------------------------- Cancel [ ] END OF DATA NEXT SCREEN [HMENU] ACTION [ ] PARCEL NBR [ ] [ ] [ ] ] TANK NBR [ ] [ l A;tkt- So�.w�vS 3 �1 - 3� TOWN OF BARNSTABLE g 0 UNDERGRCUND FUEL AND CHEMICAL STORAGE SYSTEMS � GL� NAME""' ' ADDRESS Ln�?Z- VILLAGE �3 LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMIC L 1� (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. T ,� 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED tii DID NOT PASS r _ t � ..n.•^r.� ''*MG'^�s ♦:�M_-,w�....y r +. M. .��.-rl.n.1. _ P M r w �'-Ouve �L- EL 'HO1MES.,,. �� I4rb /0'E _ - 01 1174 �� I a b.mw :ten.. .�. o u.0 Sr•...tr� Gn I Saw G.o of Ta, TANK TO TEST CAP.CtTY Nwwu)C.MCIT I�v �/ uP.C+H ceun n.Y/M •L�[� _ Tra M.I1yl�'.Chin - n t>a Grant j Gravy— I.t—boua a to I—Grady T Carr�p.nv Enpaavrq D.0 Cnru woo+ae a,a TSTr ta.n uc t..w. i Sw S.cnon"D ETERMIHiNC TANK CAPACITY- Ogres _ FILL-UP FOR TEST rsCk Flttobgt Tew G.ke to 1k Ill - titters m sea wev r soaa t " boon F.Y.up tD M P l'iaypry IlnadT . PVI up STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR EACH METERED DEUVERY OUANTITY - Tank OW — •� / .-.['.l Proouet in lull tart(up w fJa ppel 70C} SPECIAL CONOMOINS AND PROCEDURES TO TEST THIS"TANK VAPOR RECOVERY SYSTEM 5«wunuY rcttora nOOOC.OraCIMGb Dhow.w nxao aooaun irl log(261 _ _ .saw I - r Water In um I "On water bob n UrA t:uftbon I— - t_ `. _) Ck*Itl e.ng tttlte.rint LVLLT >'�gergp O TEMPERATURENDLUME.FACTOR(1)TO TEST THIS TANK (6171 t324216 h logo Wi1ow?G Cal O Z_•F-Prttpp a Tst_'F Fi,p PrpopQ aSn=_ F Exoeato"DwW I•or-I . ThenesFSa.tof roe"ttlw ooNtlbt q-� "_'F CSplbr par in range of o mqt JIM'S PUMP h TANK SERVICE` gv. FEATURING KOf MOM TESTING EQUIP. 4 �i Cuw+tT in mcfbeira o1 tgrrrbb fa► oftin _large b arm brat - ft*Ew1k(16 or ET) is.bbt0 product _ per*F 619 Joe CHASE HIIRYMICYL YA 02615 n LI[_ L - w O D(" l - � 6.w "Teat IS oungs,Per'P cm Dig"Par IF in as v , eMV6 Per aft Malt " PARP cm Carom m t otmvoM pmm& boar(h InveamUS OF TETI PIACEPM T• ROE OFISOE�(� HQfiE Cam- * CRA R .ACMI ATED i re tBtn 1011 iL. Ki F{L�¢1 PACK IOiA7fl aA1110 6E Urt . UmomP Iwr plead i.awbw !y ur rate .. t(lE ram A tint&I t own so tau0 •bra -iniark 40of.e(-1 ! awes Crr.dua wrr w tar d bfaaw um main Cat(um No" ► i �� I L.—• k1•NI Wb.a ans W"6 of fat i ttdd( bprra0 �rrr kmw Aft. 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Jµ•,+°. > +a_ a 5✓-: 4 r8:. sa ✓ '?: a tK} Ss�c' • F' ` ' w..a -�r•.r 5 s, _rt Barnstable,Road - ' ,`2 t 1_.,v rr'F^' " `° $ +� yairiis Ma:"0260I +y'f` .., ,���, 4' k,+ fib"+f"',r et<f T t e�,•4i.-+r� )�'�,w i t"t.:: . A�+_ � } t"',� t + �•!} �s" �S r;'+ a 'q,"+,�i`t r,i f y,}t ,<r .s ty r�J + ,r��. � ,,� t .+, , r��. a��.• .r; `5� ^r �'° � .. a� .D �,afi� t,a r,� :1 t s' s a w� f^ w • A a.- t a I .t - h*�+'•., -rk. rt ? s Re t{ o r3underground fuel..tanksslocaied at Northwest CoFner'of your building ''� • at 411;-Barnstable Road wi�yannis •� � . ' + � Y 's '., r'. f� ry '` k + f' � rW ;�.. C��, 3,u+{ t y -F ! '3 � � •_ .iT � �,.'�,r 7 L:, 1-'^ i .i.. �,y,as' yd. '�'' M�` r /' }< fq., S{ ',, !Y •t.' r y' b +�r 4 y,-.>< ♦{ ',� '3- .Y it'+ ;r�, r� i t', .. r ,f .. y r t o r r,is st n '> t ,• 3,hi� '� -a% Iv`' +�u�n t 1 at yt'�f ,, f•. ! Y t r ..,y cAt r H e r:. �, '�t q t � +a Dear;Sir M , i. -I,b�S Ir .' } y +ai<tl. $�Yt ? a >.1' , ..`� *,Y .[ S -�Y r� t f •`A b)*•� .+ t c,3 �'1 y.ry${ A F�✓r -� ;•a.. }'' '� �+ "yi.�' ?Y •�r �rJr� n"'?S, 1. '"r �.• ; tJA.c.,' � 4"�� `�✓, ra} �tv°� „p a.4� y.�� J ,, Qur�records indicate ;that your 1 000 11 f 1 ` a '. ,�•.y: l- Ri ga on ue •oil tank located on`-your propertyy `k T "at 4.11,ft- stable'Road"'Hgannie to;be fifteen years of ages + ' s?i'� "-- � � � � -I � �r T•+ ,t r , ✓�` :Town--'regulations,,•requi a all-tanks`°-fifteen ye$frs of�a e, ottolder,' '.toy=�be tests"d�`uain sI{,I� Kent Moors Pressures Test or if the tank' is a pty, 'a 5••P..S1 Ate 1Piesaur' Test- ° a �4 �`ytb.n• .✓:+ _ ,!•- .., !, #.. ..yr s.; .. - tiyr t t k4. ' f P * £ i .. r•{, .+f+ �, }b _t a S+•+' a ,�, E�R „�� ti ti r• y °ected`t `.hav' ��,�•-•� �•', ,�+�3 �x?= � ��"" t .';•�iti }a;� .;� • ��r � > •�-� >:,� `Your are 'dir Q_ e-your tank,�te'sted by;,Uune 1 1455 ,�•PlJease"'sabm'it testing : s ',mot- I i r results andtChetr:iliterpietation to this officeaprior to•June 1,49$5..i 1 �'"'t>t,. �t :;�" o { "u .* s' y _a *t;r r:.`1 Er �^ ..a�r» b y,w,i• :•i '+ " r � r T...., w '� i�, } rt •-.;fit < �' ' ';� f �'; y- .1, �+. S •• 'i t Ft t r: a� �+• r,r, :•r r v,rt di ♦, ailiirae'to'do sp;could rosult,: n legal a-tion and the penalty of a�fineE Bach separate r: ' r1day'svfaiIure:tofcomplywith'an orde`r'shall conetitute:a separate violation., '} -� d> s ,w a ,. ✓ �X,T+ r ,4 i r ♦. •,. .• - k9 1 s;. { s ., n You inay<r"equest a hearing=tefore'the Board of Health if written,,pit lon requesting -same is received within-seven Malays of-receipt of this ocdei i•.... y, 1,`t'. ..C Y -✓ 1 a'"r. 3 ^;�+1, 'M i + 1 1« a',•S " 1 iV ,<.;,` ar i a .•. �{ y Xt �+'• r. -+ t' + +r YT .. i.:•'. Pot :your convenience;.twe :have�'enclosed a'listing of campunies motto perfarin`' this; r r;' K �t r ti w x { •� t" kkV �.'testing.}tY'ou,mayrutilize anyk�pther',concerns,qualified to,'perform°thlsftesting; ,( 'Y fir ..a ,= d.ry;.d. A x at 1 t i• w'1, ?•+a:Y'` 'T4+ Y 's Z .Fr..s ' .+° a t.Y, •` -Axt'l yy 't,' , z .++•a. 7�:Very..trulyryours,y ��,c, -_,s +�t��'f a�° ' t%°,1S �'.Ar �, •, �`1�,. + r �+ c " ...4"1,�"^,t+t•.yG .'i ^4._� ..f., r L#' q„r aa.4. r ,y',.,f t *, 'g '"`'t ° 4y r M+,a gip° 7} ..+fit ''. N .. rj a tx 6A'4L .iy t+ • ;' Yk: G a+.'.Ji ti S•� a '� � t ?.• as� .� v�q+a J + S• ! '1 t ` .{ r F_- r rr !f y. i� _ 4 'Y,•' 9 "tY'd y = L yC'•-' I � Y ) {.. .� + y�}6 1 '• ( ,'� �..,7y r ...rs• 15 O""-.'+T o� k,' F '..vlf 'r...4 F,. � Maq A{ § •(f." ; i ' 13 ;•� ; f,John'�My'Kelly .. 't,.-" ��;3,�E .-.�Y r .w rz�;a� ��y���y.:a1�� �t r ,5 ,;M1;,4'' + ,rt f J�yti a ,,� a ,._ + �'�rti'' '� ' .. i _Health ya >-. `,`Director,of Publ c =v y};. t j, , =1�* ' t• ' i° 'per S S ".,.�* �• {'�'c"'},,F •;tp.. t„f a ,fii <a ti,�t ; b:, i + +.°i y.+. ••+ rr .,+� q+. 4 r^ *: {i "t; r�1.'° a r 1 t 1 r for i� y Y'^:% y ,.+rf ,-Ja - * -SP,r� .F ti' �' S+' N G ft s '1,1 y J+;- ♦ ` ��', j•� pv^ 'Robert L Childs,yChairman +_ .. ✓:., J * ,} e. U„s y'•L• •5,. {'aya.•r } ;Ann"Jane Eshbaugh . F&rrish, U"D. `et �'.,:3'a '�, t a s +yr,.c t� k• c t• + ,,ti; `" r ;f �..,* ► p Sp.. p. 7 •`j` t t s_ �. s'4• a�, . a y +*y n i t h t L z yr ft •. r BOARD OP*,HEA iL'1 •4''^46ti 1�`P -tp'i T r �.}'sa Y1`+.ti r ' i t" i + t, :'m }r 'A.•,? y }fya fi ta.t '�`4 • .TOWN OF:BARNSTABtiB W `� r r•' _ ',` s G' ;; �''�+_ �4' ♦ r.. a: -; y ',,^? 'i2 S .! 't' r t ' '� l''.'i £ ,� t' .[ t r Xw r!, , '��?fit+• t9ars ;rC -" A Frt -'�t'n., r. + -art- a : �,i ha` a _+ y jas� 1.r a•71,r vP� } 1J' / t !1 E t' 1 kj. rr. l� '$ +y• 1i-JMIt/m MI , C� r S •rt "t °' -i �•:? t . _ rC� •�. y ,ry r� f�.+ .j� �: JR., a `^i �• x!'.r'„enC1, 2 tRt+" �•rk t >,q, •*:� 15 r •eJ', `,; {a,t� iA+,� ,.t iw- ..t t.ti• ra, ^r,. • ,..�, � 3 �+,' i Y t - ✓s. �.. F r M +r -.: r7' �; t i 4.'a ht rs ' Y� -:. •t-, - ; '+ ,t'� y-r+ sit - .�`'S" . n b: i *,!�+:�, � y.. A t � K.°Tr',y � _:�� r`�w. � ,.,,J �� > ;, '{,i ,. n.'F Ly ,,>� kr y,� �••l• a++.t.:,� :.� .7� ,t; le, ! i , f . 3 �; t 5• _ r.b�`. -.S' � .. y 'a ° {� r- � E � t .✓ .,+.a'' i t.� - .". .r a. ° .'•`. t t f�.f. t Z s_ � a .t:. ,..r C ���y„`.* � ,fr•c...r ,t a' M�F ..�4,'r+ a. � r•rt'�Z.a� " � j i .t.'S, ,5�••'r` 'a�; ia�'.•K}�~ St` Y i°w r-'lr: ... {° • . ,�• ' 4 i 4� � i . t TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: y Town of Barnstable TELEPHONE NUMBER: /©e P.O. Box 534 CONTACT PERSON: ,�/�/� /� �d Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quanti les totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES y NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: n/ ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered v rrir� Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners LZ. Automatic transmission fluid Toilet cleaners fX// Engine and radiator flushes Cesspool cleaners V Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline,JQMWI Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) 6,-' Degreasers for driveways & garages Printing ink c/ Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) �✓ Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLEe)MPLJANCE: CLASS: 1.Marine,Gas Stations,Repair tisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ,� O unsatisfactory- 4.Manufacturers COMPANYA. C' rr (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS C1agS; 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test ge'f Fuels: Gasoline,-J* Fa@ ; _)z— C Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transfiii§sion/hyd� raulic Synthetic Org s �j� , degreasers Miscellane us: 4' v . - �- & ram`` DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 144 O Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES NO --z O Holding tank:MDC O Catch basin/Dry well r O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well COS O On-site system 5.Waste Transporter i • of Hauler Destination Waste ProductLicensed? 4", R., YES INO 2. 1 Person ( ) Interviewed Inspector Date t TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM / V/ NAME OF FIRM: A. F. German Co. , Inc., MAILING ADDRESS: !+1Z1_'Barnstdb19 Up , Hyannis, Mass. 02601. TELEPHONE NUMBER: 775-1005 CONTACT PERSON: Lester Bishop Dues-your-firm -store any of` the=tox -c-ur--hazardous materials .listed=hel:ow,. _ either for sale or for your own use, in quantities totalling, at any- time, more than 50 gallons liquid volume or 25 pounds dry weight? YES L/' NO This form must be returned to the Board of Health regardless of a YES or NO answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS .MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put check beside each product that you store: Antifreeze (for Refrigerants asline or coolant systems) Refri g Y g, Automatic transmission fluid w Pesticides (insecticides, Engine and Radiator flushes herbicides, rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink i Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil Other petroleum products: grease , (creosote) Swimming Pool chlorine 7lubricants Lye or caustic soda / Degreasers for engines and metal Jewelry cleaners #)Rustproofers egreasers for driveways & garagesLeather dyes attery acid (electrolyte) Fertilizers (if stored outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning f �� .- (dry cleaners ) C EI toxic or hazardous (please Other cleaning solvents T HEALTH DENS listl;� TOWN 0� QARNSTABLE Bug and tar removers Household cleansers, oven cleaners .Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 5 1981 Disinfectants Road Salt (Halite) t ' TOWN OF BARNSTABLE BOARD OF HEALTH �. CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM f ADDRESS >., ': ✓! fi;"�� Major types of materials: 1) r / 4) ,; S) I 6) 71- - I. Description of materials) use: II. Storage (denote product by number listed above) /(} A. Containers metal glass paper )vlastic cans,bottles,jars j 1 , ; , �f 1" F. drums,barrels / -F ' ; aboveground tanks underground tanks ' �f bags,boxes % ��' n✓, open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/Recommen(�t .ions j 1. Indoor —" a) separate, contained room ' b) stored in general work area ✓� �+ i) inadequate ventilation f.. ii) floor drains iii) inadequate fire protection I/ 2. Outdoor , a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system ! 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site s / f Person(s) Interviewed fIn ector — . — — — — — — — — Date /+ - 6 30 81 O.W N OF BA R N STA B L E COMPLIANCE: CLASS 1. Marine,Gas Stations,Repai.r 2 ._..Printers BOA � � C ^ �.T.H' Q satisfactory 3. . Auto Body Shops -- -- D GA. , , Qunsatisfactory- 4. Manufacturers (see"Orders' ) S. Retail Stores COMPANY 6. Fuel Suppliers ` . di�,9,'tr�t� Class: 7. Miscellaneous ADDRESS l � �R "'.�Y� c. # i - -�_ QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors; Case lots Drums AboveTanks Underground Tanks MAJOR MATERIALS IN IDUT IN [OUT IN OUT # iz2llonsAve rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) d Y-4 transmission/hydraulic Synthetic Organics: 1 degreasers f - Miscellane us: , DISPO&AL RECLAMATION REWORKS: r 1. Sani ary Sewage 2. Water Supply ". `• �. t _a., r:z S r own Sewer Public Arok _` C� �-x2,.• _ �<l On-site Private 3. .Indoor Floor Drains: YES 'NO O Holding tank MDC 74 O Catch basin/Dry well On-site system a •-- _ / f 4.' Outdoor Surface drains:YES NO _ O Holdding• tank: MDC OCatch basin/Dry well ------ OOn-site system S. Waste Transporter Licensed? Declination '•�` �1; �:r! �� I'if� try' ...Gem. � G r � �J ' Xf Person s) Int.erviewed •11 Inspector ate �_ 01 i