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Home My WebLink About0425 BARNSTABLE ROAD - HAZMAT ,yam�r�rns-�a-bLe�(mod- �zm�-r C� fag- crl�- us' - -- % `� C/ �� -,. i IKE roh1 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 T BARMASS. . ` 200 Main Street• Hyannis, MA 02601 f639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT RFD MP'� Business Name: U41 Emirm Co.I I J Rik- A �T i Date: d l 6 Location/Mailing Address: ValArms Co. AK63kli Contact Name/Phone: ,6 d Inventory Total.Amount: «B0 MSDS: 4A License#: 11 Tier II : !v7 a Labeling: Spill Plan: 'M1 Oil/WaterSeparator: hoA Floor Drains: Emergency Numbers: Storage Areas/Tanks: sgdil Emergency/Containment Equipment: yr �'. Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Cry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) V 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 II �-- t � �� l E r `°F� Topti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B""MAP,% E 200 Main Street• Hyannis, MA 02601 i639 M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 AC Business Name: -T--J yn q�q Date:. 9`,'Lo Location/Mailing Address: QG rr s-kA- I- P. .,e Contact Name/Phone: d rr--;?"ll-4� L� Inventory Total Amount: C MSDS: �� License#: VV Tier II : A& Labelina: Pear t Spill Plan: Oil/Water Separator: Floor Drains: Emerc iencyNumbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: y D 1 VS W 1719 .T 9J Waste Product:t`A;s t Jlg bk 1C he»-',0-1?/ Date&Amount of Last Shipment/Frequency: 6'. s2..a Licensed Waste Hauler&Destination: I 'a I -,;1 y ' t It Other Waste Disposal Methods: /!14 LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils ��Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, t hydrochloric acid, other acids) ONS: C l `mot.►-+ s llw ORDERS: VV6 INFORMATION/RECOMMENDATIONS: S m4 f 14w i RA. Iv - • -&r Inspector: 0- Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p�ME TOk� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAR �LE.�` 200 Main Street• Hyannis, MA 02601 p t639.p�0 rEOM1 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: �—I ma Date: �7 7 Location/Mailing Addres : Sez> w 4-0o( Y a.n vi , Contact Name/Phone: IN Inventory Total Amount: 2S SDS: - - <AJN&A— �O,-< License#: � Tier II : o Labeling: ��a 1 ebeA� • Spill Plan: Oil/WaterSeparator: Floor Drains: a Emergency Numbers: Storage Areas/Tanks: (Dw A. a ;0+->1 Ja Emer enc /Containment i ment: cav,�1 W�GIee, s`' '�S -wb �S Waste Generator ID: WA Waste Product: Ser,e�S Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/ ECOMM DATIO S: JN tSSV� of Ce.c o�M OAS Inspector: , LeL i�l� P _ Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS v`°F� ►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 snRMASS .. ` 200 Main Street• Hyannis, MA 02601 1639..�prED MA+A,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT- Business Name: C- - ""� tZ""" Date-3- -8 0 Location/Mailing Address: IL qwiii G 2-6C Contact Name/Phone: M A<-, -- (r; qr :ti► �, _ 1_��y;t; 7 c/o' ib�6 Inventory Total Amount: /-SCM MSDS: G� I License#: Tier II : 10fs Labeling: Zeg� M�� I Spill Plan: `i Oil/Water Separator: � a Floor Drains: IV`y Emergency Numbers: `f Storage Areas/Tanks: Emergency/Containment Equipment: 5�; 11 k:4 e lA-8 61 ov a -J Waste Generator ID: Waste Product: Date&Amount of Last Shipm nt/Frequency:NTH 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 1/ Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils 1--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 V Car waxes and polishes L,� Wood preservatives(creosote) Asphalt&roofing tar i/-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) P/ Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS:_ ORDERS: INFORMATION/RECOMMENDATIONS: - C s Inspector:\� Facility Representative: X'� WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS I INE►oq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMSTABLE.9` 200 Main Street• Hyannis, MA 02601 'bp t67q.s�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT FFD MP'� Business Name: uk-k-O '1 d)� Date: / q Location/Mailing Address: i1 3 a Contact Name/Phone: O " Inventory Total Amount: Ob `��l t6 a SDS: P khe, License#: 765 CitO-3 Tier II : + Labeling: 9 Spill Plan: I/f-S Oil/WaterSeparator: WA Floor Drains: Emergency Numbers: laufAs Storage Areas/Tanks: Emergency/Containment Equipment: k . ' h 1 arm —rb Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze )% Dry cleaning fluids Automatic transmission fluid V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil i/" Disinfectants Q Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages V Pesticides Caulk/Grout insecticides, herbicides, rodenticides 1413 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 acquer thinners V Miscellaneous Combustible V� Paint&varnish removers, deglossers Leather dyes iscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes 2t✓ Other chlorinated hydrocarbons �! `r�1<G� Laundry soil &stain removers (including carbon tetrachloride) (including bleach) j�� Any other products with "poison labels' .f3c.1g, (including chloroform, formaldehyde, hydrochloric acid, other acids) ;(®© VIOLATIONS: ORDERS: INFORM TION/RECOMMENDATIONS: CA'fttlfAk rjo,06et/ Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °FIMErok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"",„RSB`E'�+` 200 Main Street• Hyannis, MA 02601 �prEO MA TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: (�G2Av�. �f°�-+-e_ �v to ` c,�' Date: Location/Mailing Address: 390 arts+•k10 an n is Contact Name/Phone: SO --190 of Inventory Total Amount: N 11-15' �1 SDS: g' -0r �r�' e' �'bSikLi ense#: 70S (sC7� Tierll : f ' Ik" Labelino: W46fll Plan: eS (PliS Oil/WaterSeparator: A Floor Drains: o Emergency Numbers: 5 Storage Areas/Tanks: A k�. arm vine S %v` J�crw 5t,,{2 444f+!) Emergency/Containment Equipment: +1 +� ++�'� So S'I C K. 6ffcet reo,%-+ a is+e' Waste Generator ID: w1 �P Waste Product: wA(sc reta,l o�Rvwayt Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: 26-s'F c. �S'�JS�' avvlR '. ; 0�0 a t- r.. �e� �o�O�l5�o5e+� 1 LIST OF TOXIC AND HAZARDOUS MATERIALS �vtk�! �V1VCK+wel -��rh+ 0\J4-e�L o 5 r, sa et NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hzrdous materiafuse, S,,w•vvle.r storage and disposal of 111 gallons or more requires a license from the Public Health Division. +eXcc ne Antifreeze Dry cleaning fluids &Xet Automatic transmission fluid Other cleaning solvents&spot removers OPT S-k� Engine and radiator flushes Bug and tar removers V\R"rf,, Hydraulic fluid (including brake fluid) '�j— 6 Windshield wash I$lk 1Q�3 Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners lyov Diesel fuel, kerosene, #2 heating oil Disinfectants y'bo 1 000 Miscellaneous petroleum products: 14111c0lb Road salts3Zx'o 4 q0`X?-J + "7"2-0 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: L W uw VAV1 0v1 C. I A 14-4 + ` INFORMATION/RECOMMENDATIO S: � 11 Inspector: I i Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p ISE► Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • en PM LE.MA $ 200 Main Street• Hyannis, MA 02601 039. iOrEDH,n+A, TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Qc -F c. J o6 L m-+ Date: !6 Location/Mailing Address: 310 y ,I I Z Contact Name/Phone: e r So 0 - 77 � Qv kke,( Inventory Total Amount: +�oe�o MSDS: License#: -1O� Tier II : ? o<< cSS • Labeling: c{k&A Spill Plan: yeS Oil/WaterSeparator: ►) Floor Drains: r&l Emergency Numbers: ye.S Storage Areas/Tanks: Emer enc /Containment E ui ment: d `� w 5orbw`ks ep c -� ve.<��( Waste Generator ID: 0A - 6, L gi> Waste Product: Date&Amount of Last S ipment/Frequency: •ev--�k't n! - -A-o Licensed Waste Hauler&Destination: ` "-'^ cv4v(t k s Ic a 4, Other Waste Disposal Methods: '5\n.,P 9 :j 4 eA<- 6Q,-,,Pr,s ,\ . LIST OF TOXIC AND HAZARDOUS MATERIALS J-Kv, `WI{IcA-'o►�`4 rc •�•ow 14- 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. A,Soofa.1 Antifreeze Dry cleaning fluids Automatic transmission fluid �� Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils 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: 7— 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 y/ Swimming pool chlorine Cove•��►v% �`'1,zr Paints, varnishes, stains, dyes Lye or caustic soda 5+Dry meoa1 cl�ey►•� Is Lacquer thinners �- Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes l s�og+ —�� 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: D erC c•1- o{ D� kA wt'c k o.( .�S Inspector: e- Facility Representative: �7 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- -------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- _^� WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. CIO 07/01/2016 � JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health C0 (% Town of Barnstable 11t111rc r Regulatory Services Richard V. Scah, Director MAM, Public Health Division B ALE s6 9. • e""wuss�"°� m�•m�nw� P 0 Thomas McKean, Director 1` °1` 200 Main Street, Hyannis,MA 02601 ( �� Office: 508-862-4644 Fax: -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 DULY 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 A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND.PARCEL NO. DATE 3D JCP FULL NAME OF.APPLICANT: S , O 10 Lo+ o- W ti ai4nm/ , NAME OF ESTABLISHMENT: Oden� S4-r4-e- J.c b `-� ADDRESS OF ESTABLISHMENT: (9 Q.y_ I� 5h-<e+ WyAt nm, MAILING ADDRESS(IF DIFFERENT): C&yr i0V�2 'P4V e ,. l`t iyw S l 0 U44-, o aSsa TELEPHONE NUMBER OF ESTABLISHMENT: _ EMAIL ADDRESS: ?ley MAS�G �� (,_, CP/►'►� SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE OF: CORPORATION NAME v PRESIDENT �Fp TRH IF PREPARED BY OUTSIDE PARTY: SIONATJURF.OF 8VPLICANT Name: Company Address Telephone#: Email: QApplication Forms\HAZZAPP Revl6.docx Page 1 of 2 IHE rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508a90-6304 • BARNSTAASBLE.g 200 Main Street• Hyannis, MA 02601 MAS" ,b,q a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MA'S Business Name: DCeavt, +�-I-e_ b Lo+ Date: Location/Mailing Address: 3 o 64rvisl-a.6/e- R.R a rli5 S208- 770-21W. Contact Name/Phone: Kar r-- a( e st, ,s ? �' no+ �44.ri Inventory Total Amount: - jZ 00 r 9000 b MSDS: 0vt 0,4 lC+d'� License#: (�� Tier II : o5 ibl 9of ��`o��K-C- Labeling: < a+l Spill Plan: +nee e e- Oil/WaterSeparator: Floor Drains: 00 Emergency Numbers: Storage Areas/Tanks: +�+� 't e5ke- Lzc a eon. Ilse Emergency/Containment Equipment: 5 11114 413 & 5 a v+ Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc : S vtk `j' Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ti 0,e c J SLA, by +0 W4ctN,o\ge. �.a a. LIST OF TOXIC AND HAZARDOUS MATERIALS / Co<Porn-e 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 Zdo r t0o Automatic transmission fluid o0 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) — Windshield wash Motor oils 4: Miscellaneous Corrosives %o -r to f Gasoline,jet fuel, aviation gas Cesspool cleaners �n� cl¢�tiwcs Diesel fuel, kerosene, #2 heating oil -;-So Disinfectants S.r yo k. Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages to•t�l o Pesticides: tso 10 +S•r4� CauIWG rout/oaC tt,74vc5 1 � insecticides, herbicides, rodenticides bb Battery acid (electrolyte)/batteries Photochemicals(Fixers) ��•�e. Rustproofers Photochemicals(Developer) ool A�,�` \�,�w� Car wash detergents Printing ink e i Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar ��,� ' Swimming pool chlorine ,poo\ w� 1 U14 Paints, varnishes, stains, dyes &" Lye or caustic soda Lacquer thinners loo Miscellaneous Combustible 4.Lero5ol5, 20 4ZO Paint&varnish removers, deglossers Leather dyes 100 Miscellaneous Flammables fo f� rt (Vojb Fertilizers (a00 t� Floor&furniture strippers tvl, PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) 1 0 \4a X5�0 Any other products with "poison labels" �20 (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: 6 oD eA%5L ORDERS: INFORMATION/RECOMMENDATIO S D_ vk\ c4 5 o bl, :5\'X'J io Qoo 60,3 ¢.SM:eat'krX :cj�w��ca.\�• Inspector: . Lava-112, Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS �IWE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 "ASS. 200 Main Street•Hyannis, MA 02601 1639. �i0rF0,�a+"�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: L2avl. 5� �-e, ,�pb �04 Date: Location/Mailing Address: j2- Q a A vt 1 n ,SvB-7 b-2.1 F,(,�, -,�l Contact Name/Phone: -C ► - eo r� SPA f4 av` , s 5 Tau soa Qi-f-sAo�b 11� Inventory Total Amount: � MSDS: JeS�D►ti��c.��lc'f`GLK�� License#: 70S Tier 11 : 0055ib)e- o./C Labelina: OK Spill Plan: Ye5 Oil/WaterSeparat�A Floor Drains: lyo Emergency Numbers: e5 Storage Areas/Tanks: R.P-h-,i I' Emergency/Containment Equipment: 1< -- s Waste Generator ID: Waste Product: Mi SC fzkxA\ Date&Amount of Last Shipment/Frequency: eor Licensed Waste Hauler&Destinati n: Other Waste Disposal Methods: QA5k-e- IS 1►, .1 -tic- i9445 45 `�Itt�C ors Were, a vL Joke-k4vo 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. 10 Antifreeze Dry cleaning fluids Automatic transmission fluid io Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils 7t, Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants �LO Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants I Degreasers for engines&garages 300 4� I�rSo6Pesticides: S Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) y Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar o°s I�- 2o16Swimming pool chlorine ® Sbo I b CaCto Paints, varnishes, stains, dyes Lye or caustic soda gbo 16 d,6k l of Lacquer thinners Z Miscellaneous Combustiblesh�k- Paint&varnish removers, de lossers 11 Leather dyes Miscellaneous Flammables (.r9�rak 4'�`I/ Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) Zg3 (including bleach) Any other products with "poison labels" s� -j2o/b (including chloroform,formaldehyde, - �` hydrochloric acid, other acids) VI TIONS: �sga I ff�v ORDERS: INFORMATION/RECOMMENDATIONS: lZ dtAw J fC4Xv Su ►e5 pr'I, b 1, C, a.) D' G o r Inspector: -GL.►2��2� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOWN OF BARNSTABL Date: 9 /30 113 I 0K_ TOXIC AND HAZARDOUS MATERIALS s FORM NAME OF BUSINESS: L-O+ BUSINESS LOCATION: JFo &trot 5+a_)o k, INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -7q0 - 2/ 6 L /2'hb ,00•C6 CONTACT PERSON: h& 6 o i s EMERGENCY CONTACT TELEPHONE NUMBER: 77/- '93(6 —3852 MSDS ON SITE? TYPE OF BUSINESS: lae4zLi 1 *5 - 6 r �c INFORMATION / RECOMMENDATIONS: 11GeKs _ AA5 Fir District: oi�Alytia Gvcrcwf h 4ekse- o r o2o13-2olt/ � Sp.11 �-,fs a��-- Kri Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) i Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) / 7 lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) 3 Caulk/Grout + Swimming pool chlorineC+,ab s) Battery acid (electrolyte)/Batteries Lye or caustic soda Z 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) 6lo Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes 5u,1wAy►klr�g Qoa Laundry soil &stain removers f b G (including bleach) OdQ �3 clvtG. Shock Spot removers&cleaning fluids f (dry cleaners) gvt,-�'t 'tv.292�ton s Other cleaning solvents Bug and tar removers aLoej Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials , Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Walbreen Eastern Co., Ine.i RITEAID STORE#10189 ...----------•----------------------•----•------••------•-•----------------------•----------------------------------•------------ 360 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 Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Walgreen Eastern Co., Inc.IRITEAID STORE#10189 360 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 �'�o�ce.wN� Ka��,n � as�i9 s - ; Town of Barnstable & �- THE Inspectional Services BARNSTABLE Op Tp� unwsrnel=_•czr5l:;l:conm•.namr � • Public Health Division WFSiF 41 5.159-20-�T3Fa4SJ E 41�1 0 :;i79-1014 575 BARNSTABLE, ' Thomas McKean Director - y MASS. ' G • 4'pr fc39. �a`o 200 Main Street, Hyannis,MA 02601 ' 10 Office: 508-862-4644 Fax: 508-790-6304 jat 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 DULY 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 Vet' *A late charize of$10.00 will be assessed if payment is not received by July 1st. dr l t�r}3 1. ASSESSOR'S MAP AND PARCEL NO. O� 2. IS THIS A PERMIT RENEWAL? V 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: vV 5. NAME OF ESTABLISHMENT: t /RITE AID#10189 360 BARNSTABLE ROAD 6. ADDRESS OF ESTABLISHMENT:; HYANNIS, MA 02601„ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: °taxlk6nserenPwals wal reens,com 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: _-taxlicenserenewals@walgreens.com SIGNATURE OF APPLICAN DATE MAY Z S 101Q • Q:\Application Forms\Haz Mat App Revised 09-10 8.docx Kayaynn De Los Santos License Specialist 847-315-3376 wS wl of& instable r. !te imtory ices C> Richard V. Scali,Director Public Health Division � C; BA1�NSTA��B ! bn1mzr "•w.r Thomas McKean,Director �t '`�� •`°� 200 Main Street,I•Iyannis,MA 0260-1 P+ (') ke: .508-862-4644 Tax: 508 790 C.304 APPLICATION FORPERMIT TO S1't)R& ND/UR UTILI� I-IAZARllOUS MAT ERIAT.S IN ACCORDANCE WITH THE TOWN OI BARN8TAt LF GENl3-RJkL ORDINANCE,CHA)"MR, 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER.THAN HOUSEHOLD QUANTITIES ARE REQUIR.T~D TO OBTAIN AN M,NUAI,PIiRMIT(RUNS JUL.Y Ist—.TUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: 50.00 ❑ CATEGORY 2 PERMIT 1 1 1 —499 Gallons: $125.00 ❑ 4 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 "'A Ittre.�littr�e of S1U'(IU �i+ill hest ai s8ecl i1 IIiIYl11C111 fS II(Sl t'(CCiV��I U�'.IUIt (SI.. F4 ch)( 1 1. ASSESSOR'S MAP AND PARCEL,NO. 328370 oaaa l 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: Kimberly Dascoli S. NAMF OF ESTABLISHMENT: DBA Rite Aid#10189 6. ADDRESS OF ESTABLISHMENT: 360 Barnstable Road, Hyannis, MA 02601-2920 7. MAILING ADDRESS(1F DIFFERENT FROM ABOVE: 300 Wilmot Road MS#3301 Deerfield, IL 60015 8. TELEPHONE NUMB.FR OF ESTABLISHMENT: , 508-771-6511 9, EMAIL ADDRESS: kim.dascoli@walgreen.com 10. SOLEOWNER:—__YES-__NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE.#Ole- ,�ORPORATION NAME Walgreen Eastern Co, PRESIDENT TREASURER CLERIC - I2. IF I'RI?.PARF,D BY OUTSIDI.PA.RTYr NAME: t'F;L.EPHONF#: COMPANY ADDRESS EMAIL: SIGNATURE Or APPL.ICANI1ffvmw I)A1'E wa U�rt',nk'•t1 1t t?9�t(ii1F ZRq., AI"1f1;7 r Tripp,Vanessa • From: De Los santos, Kay <kaylynn.delossantos@walgreens.com> Sent: Thursday,July 25, 2019 12:16 PM To: Tripp,Vanessa • Cc: Dascoli, Kimberly; Hora, Lisa Subject: BARNSTABLE HAZARD MAT renewal Attachments: (L)BARNSTABLE MA HAZARD MAT Local renewed 05.29.19(592854267).pdf Importance: High Good morning, There had been a little over payment of the:I:I;;; ,I,,;l„2;I;)_:\[;1'a:'renewals for stores: ,tea%'� ,� CMS,".%. ayyf 'r°a s�O,,,f�'�'""ci FIT' a "QNny �' - R 'µ sh M Celtlfl V0''�i/�ifiD�A` ilia. .;,s C�C�T�'SS e ` r., a i r�x ' d a: fQl}11 u ,$....kw'/.udla/ gswul .a .w o u a RITE AID 520 W MAIN ST. BARNSTABLE MA BARNSTABLE . _ ... #10190 360 ,F -RITE AID:, BARNSTABLE BARNSTABLE MA BARNSTABLE ° #10189 RD RITE AID 3848 FALMOUTH` BARNSTABLE MA BARNSTABLE ._ `1 .'..:- :":. #10192 RD • June 5" was the 1 st check received,which attached should be the initial application that was sent. • Then the 2"June 24", was the other application and check that was sent. - Kim , can you please attach (if available) the application and check that was sent to verify the checks that were sent. - If not,Vanessa please send a copy of all documents sent from Walgreen Co., so we can keep record. Since both payments have been processed, the renewal period is-covered for this year and upcoming. To avoid crossing this bridge again , License Administration usually does renewals for the stores for Rite Aid and Walgreens. Please let me know if there are any issues and concerns. Thank you, q"e a paw,(c dart'! Kaylynn Pe Los Santos License Specialist, License Administration walgreen CO. • 300 Wilmot Road, MS 3215 / PO Box 901 Deerfield, I L 60015 • 1 PHONE# (847)-315-3376 FAX# (847)-368-6525 *l will be out of the office on Fridays* • taxlicenserenewals@walgreens.com (Group email) CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! • • I • • 2 • Town of Barnstable O(lice:508-862-4644 Fax:508-790-6304 Regulatory Services Department aAMSTABLL Public Health Division 9 MA . Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $450.00 Name on check: Walgreens Business: Rite Aid #10190 Owner: CAMBRIDGE ASSOC I LP Address: 530 WEST MAIN STREET, Hyannis Note: "520 West Main Street";Category III Permit • • • • • � % Town of Barnstable Office:508-862-4644 0 Regulatory Services Department Fax:508-790-6304 snnrrsraei.e Public Health Division b' `�$' Thomas A.McKean,CHO 39,�• 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $450.00 Name on check: Walgreens Business: Rite Aid #10192 Owner: BROMLEY- COTUIT LLC Address: 3840 FALMOUTH ROAD/RTE 28, Marstons Mills Note: "3848 Falmouth Road"; Category III Permit • • • • Town of Barnstable office:508-862-4644 Regulatory Services Department Fax:508-790-6304 CA Public Health Division BAHNFfrAHLE MAM $ Thomas A.McKean,CHO 200 Main Street, Hyannis,MA 02601 Payment Receipt Hazardous Materials Payment received: $150,00(Check) on 6/5/2019 Permit number: 2019-2020 Check number: NT30-0011742370 Check amount: $45P.00 Name on check: Walgreens Business: Rite Aid #10189 Owner: DAVID T&PARKKA, DANIEL 3 TRS PORKKA Address: 363 BARNSTABLE ROAD, Hyannis Note: "360 Barnstable Road";Category III Permit • • • Town of Barnstable Office:508-862-4644 • Fax:Regulatory Services Department 508-790-6304 • enxxerAsce. = Public Health Division MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number: 0007193124 Check amount: $450,00 Name on check: Rite Aid Hdgtrs Corp. Business: Rite Aid #10192 Owner: BROMLEY- COTUIT LLC Address: 3840 FALMOUTH ROAD/RTE 28, Marstons Mills Note: Category III Permit • • op Town of Barnstable Office:508-862-4644 Regulatory Services Department Fax:508-790-6304 • i BAXNST BLZ : Public Health Division MAS& Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: 150.00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number: 0007193124 Check amount: $450.00 Name on check: Rite Aid Hdqtrs Corp. Business: Rite Aid #10190 Owner: GYMK REALTY INC Address: 515 WEST MAIN STREET, Hyannis Note: Category III Permit • • • Town of Barnstable Office:508-862-4644 Regulatory Services Department Fax:508-790-6304 EARNSTAaLE Public Health Division MASS. $ Thomas A.McKean,CHO 16 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $150.00 (Check) on 6/24/2019 Permit number: 2019-2020 Check number: 9007193124 Check amount: $450.00 Name on check: Rite Aid Hdgtrs Corp. Business: Rite Aid #10189 Owner: DAVID T& PARKKA, DANIEL 3 TRS PORKKA Address: 363 BARNSTABLE ROAD, Hyannis Note: Category III Permit I Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10189 360 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 t`'�' 1 bob �� -331 E 1 • To n�of Binstable egu atory ervlces Richard V. Scali,Director Public Health Division BARNSTABU i unnvareDIA Thomas McKean, Director m�es. 200 Plain Street,Hyannis,NIA.02601 Office: 508-862-4644 i''ax: 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 I 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: $1 " 00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: 150.0 *A late charge-of st0.A0 will lie assessed if pay ment is iiot r. vt l)v duly 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 328370 2. IS THIS A PERMIT RENEWAL? V 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: Kimberly Dascoli 5. NAME OF ESTABLISHMENT: DBA Rite Aid#10189 6. ADDRESS OF ESTABLISHMENT: 360 Barnstable Road, Hyannis,MA 02601-2920 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 300 Wilmot Road MS#3215 Deerfield, IL 60015 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-771-6511 9. EMAIL ADDRESS: kim.dascoli@walgreen.com 10. SOLEOWNER:—YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Walgreen Eastern Co., Inc. PRESIDENT Richard Ashworth,700 Tournament Drive North, Hawthron Woods IL 60047, 847-315-2500 - TREASURER Alan Nielsen, 1263 Williamsburg Ln., Crystal Lake, IL 60014,847-315-2500 CLERK N/A 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: (L i SIGNATURE OF APPLICANT V'-'DATE `'( ! • C;\t;sers.Decollik Ap;.iC)atniLocal\MicrosofllbVir.:!h�tal'e,nnnr+iv ICr+c1 t es7�'mx�nt.Ou+looklRNlljpv%]2NHAZ 1AT APP 201 7 P VIS M docx �z ti Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10189 360 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 06/30/2018 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 p� So 0h r--#-M6G� y� r Town of Barnstable ' oE°HF roy� . Regulatory Seivices Richard V, Seali,Director BARNSCAAt:I:,' ARNSTAB�E. Public Health Division �fOµptA idl(+;sa Thomas McKean,Director 200 Main Street,Hyannis,Iva 02601 4 Office: 508-862-4644 e,� Fax 508-790-6304 i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE_ HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS . - MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st-JUNE 30th), APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons; $50.00 O CATEGORY 2 PERMIT 111 —499 Gallons; $125.00 O l CATEGORY 3 PERMIT 500 or more Callous; $150.(}0 A:-lop,doeke-oi 1():0{1 will be Msca�dtl if liati ncrit,is'i of tt cc:ivccl bY.Ju13{1st,. ASSESSORS MAP AND PARCEL NO. 32.8370, DATE June 5, 2017 FULL NAME OF APPLICANT:, . David W. Crozier NAME OF ESTABLISHMENT:. Maxi Drug, INC./D.B,A, Rite Aid Store#10189 ADDRESS OF ESTABLISHMENT: 360 Barnstable Road, Hyannis, MA. 02601-2920 MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: 508 771-6511 EMAIL ADDRESS: EHS@riteaid.com SOLE OWNER:YYES_NO IF NO,NAME OF PARTNER FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME_ Rite Aid Corporation Attn: EHS.__30 Hunter Lane,Camp Hill,PA 1,7011 PRESIDENT, Kenneth Black,Office Addres$:_30 Hunter Lane,Camp Hill PA 17011 TREASURERw Snhrnatlar. 1 rPFCf � A 1?m 1 CLERKaPa j�lillerlff_ire Adrfea" I PA 17011.- IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email C:Vremp\HAZ4APPRcv16:docs Page I or Permit Store Amount Account# 10189 1140 $ 150.00 Vendor: Town of Barnstable 10190 1141 $ 150.00 Vendor#: 72080 10192 1139 $ 150.00 Date: 06/05/2017 Total $ 450.00 i �e Number Fee -1140 THE COMMONWEALTH OF MASSACHUSETTS $150.00 2 Town of Barnstable Board of Health This-is to Certify that MAXI DRUG INC✓RITEAID STORE#10189 360 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 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i 40, Town of Barnstable �'THE►� Regulatory Services ti Richard V. Scah, Director �>( ' '" MAE&"� ' Public Health Division � �� BARNSTABLE 1 639 10� �(_ s "m'�wwiiECDw°s°re nx�Mu Thomas McKean, Director `J 1639-2014 ��5 200 Main Street, Hyannis,MA 02601 "do 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 ❑ j CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 I) V's A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE WZ2 FULL NAME OF APPLICANT: -— --_ ----- - - - ------� NAME OF ESTABLISHMENT: MAXI DRUG INC./RITE AID # 10189 - _ - 360 Barnstable Road Hyannis, MA ADDRESS OF ESTABLISHMENT,- c MAILING ADDRESS(IF DIFFERENT): -- - TELEPHONE NUMBER OF ESTABLISHMENT: S O I EMAIL ADDRESS: &H S SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,X TELEPHONE#OF: CORPORATION NAME 30 Nv 1�A I?Ota PRESIDENT TREASURER ,., SGlncoe��d �,30 l3urtaS L-R,r�Q Cs+f..�L1��1��A �?A�� 71�•?!e� Z( 3� 1i1 CLERK�c�.n1¢,1 N.:1\•cr• . 3g gorc'rax L", - G..p N:u: � �yo u . '2 11•Z(4I- t(, 21033 - IF PREPARED BY OUTSIDE PARTY: SJANATUpf OF APPLICANT Name: Company Address Telephone#: Email: Q\Application Forms\HAZZAPP Rev16.docx Page 1 of 2 Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INC.IRITEAID STORE#10189 360 BARNSTABLE ROAD, HYANNIS, 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. 07/01/201 5J JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health s �E}4. �i Town of Barnstable �t Regulatory Services Richard V. Scali,Director B" MASS. ' Public Health Division 9� 1139. 10� RFD MP'1 a Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 328370 DATE June 4,2015 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT David Crozier NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10189 ADDRESS OF ESTABLISHMENT 360 Barnstable Road,Hyannis,MA 02601-2920 • TELEPHONE NUMBER 508-771-6511 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: 1W( PRESIDENT Kenneth Black, Office Address:?0 Hunter Lane, Camp Hill,PA 17011 1W TREASURER Matthew Schroeder,Office Address: 30 Hunter Lane, Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address: 30 Hunter Lane,Cardinale,Office Address: 30 Hunter Lane, CampHill,PA 17011PA 17011 2 IGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# L:\Re1Leg\HL\ENVIR0NMENTAL\East Coast States\MassachusettsUnvoices&PermitsVurisdictions\Town of Barnstable\10189 6.4.15.doc t N/03/2015 09: 17pm RITEA V 0190 5087753864 1131 Rage 02/02 " - Town of Barnstable Z Regulatory Services 10 1 Z Richard V. Sca)tit,]Director ,MASI � PutbIic Health Division Thomas McKean,Director 200 Plain Street, Hyannis, MA 02601 �Z�-O d Office; 50$-$62-4644 Wayne Miller,M.D. Fa: 508-,90-6304 Paul J.Carmiff,D_M.D, Jtuuchi Sawayanagi NOTICE sue; _ TO ALL BUSINESS OPERATORS WITH NALARDOUS MATERIALS IN BARNSTA.BLE 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 l — 2: 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the: Town of Bacrnsfable. MATT all of the above to this office on or before June 30, 2015. A late charge of$10,00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 10$: Hazardous Materials on the Town Website, www.town.barnstahle.ma.us , which.is located hider the E-Code section if you should have any questions or concerns. Q;'RLunaAHaz Mat Permit Letter.DDC r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department •AIti�S3Ti�OLE« Public Health Division MASS. � Thomas A. McKean,CHO tb�9 200 Main Street, Hyannis, MA 02601 `moo ram►+ . Payment Receipt (Hazardous Materials Payment received: $100.00 (Check) on 6/1 _15 Permit .- 7/2015 Permit number: 1140 lCheck number: 0006443080 Check amount: $300.00 Name on check: RITE AID HDQTRS. CORP. Business: MAXI DRUG INC./ RITE AID STORE #10189 ;Address: 363 BARNSTABLE ROAD, Hyannis • Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10189 360 BARNSTABLE ROAD, HYANNIS, 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 6/15/2015 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 s ' Town of Barnstable Regulatory Services Thomas F. Geiler,Director BARNS'1'ABLB. ' Public Health Division ib fo rrud" 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. 328370 DATE June 12,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug Inc./DBA Rite Aid Store#10189 ADDRESS OF ESTABLISHMENT 360 Barnstable Road Hyannis,MA 02601-2920 TELEPHONE NUMBER 508-771-6511 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address:30 Hunter Lane,Camp Hill,PA f0l1 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # �73 I RETAIL SAFETY MANITAL Store 10189: Rite Risk Management Department SPILL CONTINGENCY PLAN Maureen Lawrence Store Manager. Name 508 771-6511 :. Phone.# Guy Suffolettd: Dtstrict Manager Name 508 996=3549 Phone# Jeff Schares Regional Vice President Name 401 82172569> Phone Local Emergency Contacts DIAL: 91 508 775=1300 Fire Department Phone#, 508-775.0387: Police Phone# :< 508 771 1800 Hospital Phone#: Sill Response Procedures REQUIRED EQUIPMENT.... 1 Contact Store Management, 2 Put on gloves,goggles and apron, ❑'Chemical Cleanup Kit 3 Contain the spill with a mop or absorbent ❑ Apron,: materials, O Buckef 4 Cleanup the`spill,as directed, using generous; O'Mop amounts of water, ❑Water ` 5 Clean the area thoroughly; 6 Clean all safety equipment and;.rinse' out all absorbent materials that are reused JANUARY l i_2013 IQ7: Environmental Health&Safety Number Fee 1140 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that MAXI DRUG INCYRITE AID STORE#10189 360 BARNSTABLE ROAD, HYANNIS,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------- ------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 4/1/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health rs w s Town of Barnstable Regulatory Services Thomas F. Geiler,Director ` SM MA ' Public Health Division 9A %639. a9+" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 .y ASSESSORS MAP AND PARCEL NO. 328370 DATE March 20,2014 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Stephanie Caiati NAME OF ESTABLISHMENT Maxi Drug.Inc./DBA Rite Aid Store#10189 ADDRESS OF ESTABLISHMENT 360 Barnstable Road Hyannis,MA 02601-2920 TELEPHONE NUMBER 508-771-6511 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. 042960944 STATE OF INCORPORATION DE FULL NAME AND HOME ADDRESS OF: PRESIDENT Kenneth Black,Office Address:30 Hunter Lane,Camp Hill,PA 17011 TREASURER Matthew Schroeder,Office Address:30 Hunter Lane,Camp Hill,PA 17011 CLERK Gerald Cardinale,Office Address:30 Hunter Lane,Camp Hill,PA 1 1 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # v RETAIL SAFETY MANUAL Store 10189 Rite Aid = Risk Management Department i SPILL CONTINGENCY PLAN Maureen Lawrence Store Manager. Name 508-771-6511 Phone# Guy Suffoletto. District Manager Name 508-996-3549 Phone# Jeff Schares Regional Vice President Name: 401-821 2569; Phone# Local Emergency.Contacts. DIAL 911 Fire Department 508-775-1300 Phone#. 508-775-0387 Police Phone#' 800 Ph 508-771-1 Hospital one# Spill Response Procedures REQUIRED EQUIPMENT 1 Contact Store Management; 2 Put on gloves,goggles and apron; ❑ Chemical Cleanup Kit 3. Contain the spill with a mop or absorbent ❑ Apron materials; (] Bucket 4 Clean up the spill, as directed,using generous` 0'Mop amounts of water; 5 .Clean the area thoroughly; ❑ Water 6 Clean all safety equipment and rinse out all ;< absorbent materials that are reused. JANUARY l;2011 107 Environmental Health&Safety Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. .-••••••••••...••••••-••-••••••••••••...•••••••••••••-••-••••••...•••••....•••••••-••••-•••••••-••............................... 390 Barnstable Street, 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. I - --- ----------- --- ---------- ------ 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 is I Ocean 375 Commerce Park Road North Kingstown, RI 02852 June 25,2020 Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 RE: Ocean State Job Lot of Ilyannis,Inc Ocean State Job Lot#204 390 Barnstable Street Wannis,MA 02601 To Whom It May Concern: Please find enclosed Application for a Permit to Store and/or utilize Hazardous Materials, along with payment in the amount of One Hundred Fifty Dollars($150.00), Check#1002014931 for the lora n mentioned above. Once the heense has been issued,please send the original to my attention at the corporate office at 375 Commerce Park Road,North Kingstown,RI 02852. I will make a copy of the license for our corporate records and then send the original to the store for posting. r Should you need any additional information please do not hesitate to contact me at 401-443-9775 Monday-Friday 8.00am-430pm or you can email me at J.Fredette@osjtcom Thank you, ``)OKA Jean Fredette Licensing Coordinator Enclosures /USPS Town of Barnstable Inspectional Services BARNSTABI,E Public Health Division " "` '` s wr�er�s�. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE : f HAZARDOUS MATERIALS N, IN ACCORDANCE WITH THE TOWN.OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY J st—JUNE 30tn). 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 W& *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 328-070 2. IS THIS A PERMIT RENEWAL? X YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Ocean State Job Lot of Hyannis- Inc 5. NAME OF ESTABLISHMENT: Ocean State Job Lot#204 6. ADDRESS OF ESTABLISHMENT: 390 Barnstable Street,Hyannis,MA 02601 375 Commerce Park Road, 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: North Kingstown, R102852 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-790-2166 9. EMAIL ADDRESS: Permits wosjl cults - -- - 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: I!. FULL NAME,HOME ADIiRESS AND TELEPHONE#OF: CORPORATION NAME Vicean§tate Job Lot of Hyannis, Inc PRESIDENT Marc Perlman-Owner/President TREASURER John Conforti-Chief Executive Officer CLERK Jenn Fredette-Licensin2 Coordinator 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: LI E SIGNATURE OF APP CANT DAT — QA pplica6on Fonns\Haz Mat Appli Draft Jan2019.docx 1 Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis,Inc. 390 Barnstable Street, 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 I s:. . Town of Barnstable w Y Inspectional Services BAMSTABLE Public Health Division �PHsF�P`•�. 9 7 i '..�.,��" `"' W4}iC!6 PIGS•G�Ex'FLLF•K�3.R.StAtF • BARNSUBIX, ' Thomas McKean, Director s OrEc6� 200 Main Street, Hyannis,M.A. 02601 ` mod. Office: 508-862-4644 Fax: 508-790-6304 I� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 65 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 f 6 G *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 328-070 2. IS THIS A PERMIT RENEWAL? X YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Ocean State Job Lot of Hyannis, Inc. dba Ocean State Job Lot#204 5. NAME OF ESTABLISHMENT: Ocean State Job Lot#204 6. ADDRESS OF ESTABLISHMENT: 39O Barnstable Street, Hvg nni,; MA 09601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 375 Commerce Park Road, North Kingstown, RI 02852 8. TELEPHONE NUMBER OF ESTABLISHMENT: 508-790-2166 9. EMAIL ADDRESS: nPrmitcnncil rnm 10. SOLEOWNER: x YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ocean State Job I ot nf Hvanni5, Ind PRESIDENT Marc P rlman-Owner resident TREASURER John Conforti- hi f Financial Oft-er CLERK Jennifer Fredette-Licensing Coordinator 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE Go (a� � Q:\Application Forms\Haz Mat App Revised 09-10-18.docx 7ennifer Fredette Licensing Coordinator Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable S4reet; Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------ --------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable n . Barnstable Regulatory Services Department t Public Health Division $9� • a L1R[vsr4sLE, • 1 9�A ; 200 Main Street,Hyannis MA 02661 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE July 24, 2009 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Job Lot of Hyannis, Inc NAME OFESTABLISHMENT d/b/a Ocean State Job Lot # 204 ADDRESS OFESTABLISHMENT 390 Barnstable ?moo&treet, Hyannis, MA • TELEPHONE NUMBER ( 5 0 8) 7 9 0-21 6 6 SOLE OWNER: X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: , c) t IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO,`, w`515-0 7 9 819 71 —tea--- STATE OF INCORPORATION Rhode Island � �? 5 :21- !-n 1 FULL NAME AND HOME ADDRESS OF: � c jfi $j0W,YX CFO: John D. Conforti, CPA C:) ° TREASURER CLERK Elaine Gagne SIGNATURE OP XPPOCAI RESTRICTIONS: HOME ADDRESS HOME TELEPHONE # Q:\Hazmat\:Haz Mat Application2008.DOC Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i ' owr�of Bgnslabl.e egu atory ervices Richard V.• Scali,Director A. oFn+�rod � Public Health Division BUMBLE._ Y . PJPM4IMlEQ'.Y1EM T1WINi5nf8WGi S 1 .n1 _Y44ftt`.L.'6'Sa6ilF9l Thomas c can ector 200 Main Street,Hyannis,MA.02601 =R: Office: 508-862-4644 Fax: 508-790-6304sg APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE M HAZARDOUS MATERIAL IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st--DUNE 3 0th). 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 4' *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/rJSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Ocean State Job Lot of Hyannis, Inc. 5. NAME OF ESTABLISHMENT: d/b/a Ocean State Job Lot#204 f. ADDRESS OF ESTA2 1S- M-DENT: 390 Barnstable Street, Hyannis, MA 375 Commerce Park Road 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: North Kingstown, RI 02852 S. TELEPHONE NUMBER OF ESTABLISHMENT: 508-790-2166 9. EMAIL ADDRESS: permits@osjl.com 10, SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ocean State Jobbers, Inc. PRESIDENT John D Conforti CFO TREASURER CLERK Julie Amato, Flaralegal 401-2U5=- 2 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: SIGNATURE OF APPLIC 71 ATE 5/22/2018 Q;1Applioau�,t i�rmsUTAZMAT APP 2017 tL" sEL,docx x V 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 06/30/2019 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 r �� { 0 Vwofol B=sxable eg atory ervices �zIK*E ram, Richard V. Scah,Director o► d% Public Health Division BARNSTABLE PP MNSTMU-CEHMVNyE.CD�UR-W.M S w BAMErr"LE, i naasrors—.aS1E. -Wr SAMST a �@�� .J�'f+y ] Mass Thomas McKean, Director 1639-2014 l(/,�A/�+1I 200 Main Street, Hyannis,M.A 02601 575 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0 V,S . *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?)(--YES—NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT" 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 3 AC`r1 �Cj� QC�A� �,/Cr1n�S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: cc� 8. TELEPHONE NUMBER OF ESTABLISHMENT: U�— 9. EMAIL ADDRESS: Cx-\-E Gi),S CLu±nS=1v . C_CYy-) 10. SOLEOWNER:RYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME O( i�Cx A-�i'rr7 Su(Jpl�r, lrlC. PRESIDENT 6 R\c�,�1 sr-book Jc- 91 lnl'A GIB hlav Cyik- AM.,VA �6--1`1(0 TREASURER cL ` CLERK k` < 12. IF PREPARED BY OUTSIDE PARTY: NAME: LEPHONE#: • COMPANY ADDRESS EMAIL: _ SIGNATURE OF APPLICAN DATE Q:Wpplication FormsUiAZMAT APP �VI do Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, 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 Cf r. of Un TROestable egu stoervices rs r Richard V. Scali,Director (f� —n�, Public Health Division BARNSTABME 11rA -Thomas McKean Director 1639-2434 A� °r �a`� 230 Main Street,Hyannis,MA 02601 .c, ab/� ao Office: 508-862 4644 /9 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 I st—JUNE 3 0th). 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 late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Ocean State Job Lot of Hyannis, Inc. 5. NAME OF ESTABLISHMENT: d/b/a Ocean State Job Lot#204 6. ADDRESS OF ESTABLISHMENT: 390 Barnstable Street, Hyannis, MA 375 Commerce Park Road 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: North Kingstown, RI 02852 S. TELEPHONE NUMBER OF ESTABLISHMENT: 508-790-2166 9. EMAIL ADDRESS: permits a@osjl.com 10. SOLEOWNER: X YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ocean State Jobbers, Inc. PRESIDENT John D. Conforti, CFO TREASURER CLERK Julie Amato, Paralegal 401-295-2672 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS A EMAIL: • SIGNATURE OF APPLIC T °` t ATE 6/7/2017 Q:\Application FormA1HAZMAT APP 2017 RE ED. ocx Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------I---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------- 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 -� Town of Barnstable Barnstable Regulatory Services Depart.meu.t a639. Public Health Division MAM S 200 Main Street, Hyannis MA 02601 �� a M " 2007 Office: 508-8624644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CIA-) Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. �9—0 q 0 DATE 6-1 9-1 5 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Job Lot of Hyannis, Inc. NAME OF ESTABLISH1r7ENT Ocean State Job Lot #204 ADDRESS OFESTABLISHMENT 390 Barnstable Street, Hyannis, MA • TELEPHONE NUMIBER 5 0 8-7 9 0-21 6 6 SOLE OWNER:X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 5 5-0 7 9 8 9 71 STATE OF INCORPORATION Rhode Island FULL NAME AND HOME ADDRESS OF: XKRNMZW John D. Conforti CPA CFO TREASURER CLERK Elaine Gagne, Executive Assistant SIGNATN4OFA I,ICANT RESTRICTIONS: HOME ADDRESS i HOME TELEPHONE# JAinspection handouts\Haz Mat Application2008.DOC i x Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 • BMA 8 M Public Health Division v MASS. �$ Thomas A.MFKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $100.00 (Check) on 6/24/2015 Permit number: 705 Check number: 428780 Check amount: $100.00 Name on check: Ocean State Jobbers,Inc. & ,Affiliates i jBusiness: Ocean State Job Lot of Hyannis, Inc. 'Address: 390 Barnstable Road , Hyannis i I I • • Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, Hyannis, RI 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 i r� , c - t _ Town of Barnstable + Barnstable Regulatory Services Department Public Health Division i ABM i I MAS& g 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiier,Director FAX: 508-790-6304 Thomas A.McKean,Cli(-,% Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 7-2 9-1 4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Job Lot of Hyannis, Inc. NAME OFESTABLISHMENT Ocean State Job Lot #204 ADDRESS OFESTABLISHMENT 390 Barnstable Street, Hyannis, MA 'TELEPHONE NUMBER 5 0 8-7 9 0-21 6 6 90LE OWNER:X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NA AND HOME ADDRESS OF ALL ME Go RMITNEi&, ww/ 3J-rtt IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 5 5-0 7 9 8 9 71 STATE OF INCORPORATION Rhode Island FULL NAME AND HOME ADDRESS OF: John D. Conforti CPA CFO TREASURER CLERK Elaine Gagne, Executive Assistant SIGNATURE oy I PPLICA T RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Minspection handoutslHaz Mat AppGcation2008.DOC Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, 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 6/30/2013 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 f s Town of Barnstable pUTHE Regulatory Services Thomas F. Geiler,Director B"R''' `Z ' Public Health Division 9buss. eg i639 Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Job Lot of Hyannis, Inc. NAME OFESTABLISHMENT Ocean State Job Lot #204 ADDRESS OFESTABLISHN[ENT 390 Barnstable Street, Hyannis, MA TELEPHONE NUMBER-5 0 8-7 9 0-216 6 SOLE OWNER: X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.,-) 5 5-0 7 9 8 9 71 STATE OF INCORPORATION Rhode Island FULL NAME AND HOME ADDRESS OF: MIX John D. Conforti, CPA, CFO TREASURER CLERK Elaine Gagne, Executive Assistant j - SIMATWONIMICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc//wp/q Number Fee 188 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Rotary Collision Centers 345 Barnstble Rd., MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAULJ. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health ROTARY,COLLISION,CENTEROF•HYANNIS-, --t a , a,._.t. ;.d •k ^f fin„®Ml ,, :^'i i,.^'..6� " r"�'°�a. „ �. ; #0 1,su 7" y" ` L : � a aa@ a ., TOWN;OF.BARNSTABLE" .'; �,:.�a " Accountk# it ,y � � � � L� t s% r ' J'!g., 9�.Ya,y,l""ii'• +'.,1y - _ "! ^# f` far«,..c ;rW` ..� �. .,tl^ ..°`($ . "9 ,-,. .. - f!, ., ( mL Invoice No w�Yb ,"� ; Date -invoice'Amount Amount PaidDiscounts�TakenCreditsTaken �Net Amopuntt u t2007-2008 4 i s °g v 05/24/07� 100-00 100 00�1t` ff 0 00 y 0'00 100 00 i 7 2 � _ !r a, �, . � P n psi. ;--gar �B o:oo$ av m % �sp� a'. - _y s r � :4r �r• ° f4 �> `_E rg €l .wE�Ibf ak: Ae - --- -f4 b. g.ar, � 6fwb4 `4� #fs* t tee. E_,"�i?'' '.., M mow,y _ 9y 1 r i�r;° >`� a�1t ' Net.Check"; � act� 1��6d i �t r a { a ffia �' .,:', er•.� r. " £. 3a a..i5t '}, �w..€ `T'53` dc_? L . ' a 4 � , a:. II_. t M a � �. ♦� .$fie d� ,'8a� r�'e. fJ e.f? t.. eo i:,^ � 4 1 $ of �5t A-mo 1, or 4�:Y'�'" ar=a#5 r s � b aie Y�. Town of Barnstable - � 5 Regulatory Services U Thomas F.Geiler,Director BAWSUBLB. + Public Health Division NAM 9$ t63 9.� �,e�' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 5 h-3 07 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Janct+6h ?yR K Kg S R, NAME OF ESTABLISHMENT Rc4mry ADDRESS F ESTABLISHMENT3�;U arN S,Fuble �d• `J��1� s, MC- UZG a / < .TE-1;EPH0 E NUMBER Sv S 3 S&E OW 1--YES NO IF�PLIC�T IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL _ PA TNER5: s IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.Cffijolgaj STATE OF INCORPORATION YAN. FULL NAME AND HOME ADDRESS OF: PRESIDENT,Jona+6n Wgkje-c SR Z?,©Pv9 s+ OS-Irr✓1Ile, TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS ZS0 Pared st 65-fPr✓dlr, AA HOME TELEPHONE # S of-vzo- f'aG/ Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, 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 Town of Barnstable l� Barnstable Regulatory Services Department d �.. Public Health DivisionKAM ,erg 200 Main Street, Hyannis MA 02601 a # 2007 Office: 508-862A644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHi? Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 9-3 0-1 3 .A.PPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Job Lot of Hyannis, Inc. NAME OF ESTABLISHMENT Ocean State Job Lot #204 ADDRESS OFESTABLISHMENT 390 Barnstable Street, Hyannis, MA TELEPHONE NUMBER 5 0 8-7 9 0-216 6 SOLE OWNER:X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDEN T IFICATION NO. . 5 5-0 7 9 8 9 71 STATE OF INCORPORATION Rhode Island FULL NAME AND HOME ADDRESS OF: John D. Conforti CPA CFO TREASURER CLERK Elaine Gagne, Executive Assistant GNATURE OF P LIC N RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# ]inspection handouts\Haz Mat Application2008.DOC Number Fee 705 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. ��as) 390 Barnstable Street, 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 r 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 Town of Barnstable 1��//�� z r Regulatory Services Thomas F. Geiler,Director BA MAS& Public Health Division °i 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. DATE 5-2 9-0 7 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Ocean State Jobbers, Inc. NAME OF ESTABLISHMENT Ocean State Job Lot ADDRESS OF ESTABLISHMENT * 390 Barnstable St. , Hyannis, MA Q=�601 � r TELEPHONE NUMBER ( 5 0 8 ) 7 9 0-21 6 6 SOLE OWNER: YES X NO o IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS ALLC4 PARTNERS: c cn M IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0 5-0 3 7 3 7 9 3 STATE OF INCORPORATION RI FULL NAME AND HOME ADDRESS OF: PRESIDENT Marc Perlman, 375 Commerce Park Rd. , No. Kingstown,RI 02852 TREASURER Alan Perlman 375 Commerce Park Rd No. Kingstown,RI 02852 RUM _ , RI * Corporate Office 375 Commerce Park Road North Kingstown, RI 02852 oFAPPLICANT RESTRICTIONS: HOMErDRESSHOME E 9 Number Fee 0 705 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Ocean State Job Lot of Hyannis, Inc. 390 Barnstable Street, 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 rr i UL. 3.2008 12:38PM BARNSTABLE BOARD OF HEALTH NO.689 P.2/2 Town of Barnstable Regulatory Services Thomas F. Gefler,Director Public Health Division o " Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office; 508-862-4644 Pix: 508-790-6304 Appllcatlon Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 2-.7-O . APPLICATION FOR]PEMT TO STORE AND/OR YJ''J MIZE MORE THAN 111 GALLONS OF HAZARDOUJ .MATERIALS FULL NAME OF APPLICANT OL&a S-fza k J o t o, L-v-. e C- . (4-qci oei r`5 NAME OF ESTABLISHMENT- _j_ A IA Oc.ewn S4ev, . .l g6 L10f ADDRESS OFESTABLISHMENT . TELEPHONE NUMBER _ v 0 ® .6 6 ^' SOLE O"FIR: YES�NO , <j . N IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF''. L PARTNERS: -� ,vm vet ccvlc N . jCLA9 C _ I IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO,,'�- 6 7 STATE OF INCORPORATION FULL NAME AND DOME ADDRESS OF.- PRESIDENT av e-' v(v►�c� s�G C GFv wt. SYa OF.A PY,ic�,NTI RESTRICTIONS: HOME ADD SS ROME TELEPHONE# H®a.doc/wp(q _ �* F Scott y . 11 The sa lon i ` 379FWest Main Street Hyannis 1 M.A.02601 508-778-2829 ;,� ° kl g'may. °F THE T° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARM SS. o` 200 Main Street• Hyannis, MA 02601 1639. �'ptEDMP�6 `00 �TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I - Sao- opt, I Date: 3 231�7 Location/Mailing Address: 1 Wee,+ VVI 44 VL S` fl ,•h Y,15 Contact Name/Phone: 7 y0A — '7$ —2$Z1 (fall 15 Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals (Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS } °FIKE Tows Town of Barnstable Office:508-862-4644 Public Health Division Fax:508as0-6304 9 BARMAN`'E�,, 200 Main Street• Hyannis, MA 02601 ,6,q a, TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED MPS Business Name: Date: � . Location/Mailing Address: 3 � We S-I� �✓� � S� , � /� >1h 5 Contact Name/Phone: C-a+� J<e eX e SO 8 —'7-7 r, —2; Inventory Total Amount: SIDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other.Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture`strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" fit (including chloroform, formaldehyde, hydrochloric acid, other acids) ' VIOLATIONS: . .r ORDERS: r t INFORMATION/RECOMMENDATIONS .. i Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT;(CANARY COPY-BUSINESS' ` _ . . � . YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS.YOUR NAME-in town (which you must do by M.G.L.- it does-not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE: 7 31-p2U/7 Fill in please: YOUR NAME/S: APPLICANT'S - ::,�"`'�""'�' BUSINESS YOUR HOME ADDRESS: � ev/`S c n ✓'` S TELEPHONE # Home Telephone Number „•;W,;.;:rti+.::.nay;. E-MAIL: NAME OF CORPORATION: j v- re 55-er < u S NAME OF NEW BUSINESS TYPE OF BUSINESS C IS THIS A HOME OCCUPATION? . YES NO X— ADDRESS OF BUSINESS. . 12 ( ,4 / a MAP/PARCEL NUMBER 3 L�� [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses.required to legally operate your business in this town. 1. BUILDING COMMISSIONER', 'Q FIC P This individual has been i f6. any permit'e iremerits that pertain to this type of business. r. y Aut d Signat e** • COMMENTS: /t — 2. BOARD OF HEALTH This individual he een informed of the emit requirements that pertain to this type of business. MUST COMPLY WITH ALL.> Authorized Signature** HAZARDOUS MATERIALS.REGULATIONS; COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** 'COMMENTS: <r • Date:'? /61 l 26 i3" TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: e ' Prd �S �� / c� '►'c/ BUSINESS LOCATION: 6263. INVENTORY MAILING ADDRESS: d Sean: : TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 'p-m t a [ INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission luid 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 S U CS Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash `// /1 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's ignature Staff's Initials Date: / 2! //7 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: L:/4ki�-x BUSINESS LOCATION: 7 1 ` .h'VtA�vl�, 5T" r{y fj,�,, , `� INVENTORY MAILING ADDRESS: TOTAL UNT: TELEPHONE NUMBER: �I S� 210 7 9 Z CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: .P C-4�v INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires 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): S 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 Applic Staff's Initial nt's Signature �_ _... f YOU WISH :0 OPEN A BUSINESS? . _.. :: . us�ness eertificaGes cost$40:OO;;for 4;`:ears A business eet tt cate;;ONLY:REGISTERS YOUR NAME in town which oir FW Your:lntgrmaL,qn B ( Y, ) : .. - _ ( y MA st do b M GcL rt flees noEgive ou perrni�siontq operate j You must first obtain tli`e ne?cessary::signatures on this form at 200 MainSt, Hyannis;: y Y - 1s _FI 367>Main:'5t. H nni 1sA QZ.6:E7 t {Town Hall) and::: et the`Business Ce.rtficate'that i.s; Take,the:cocnpi:eted form totle Town Cf eric's.Office,, t . ,> :. ..Ya s, ;...:. g. required:by Iaw;c r:. DATE`L Fill in please 33.e1!«'KS'"trr P r- APPUCANTS . YOUR NAME/ `` BUSINESS :YOUR:.HOW AD RESS^� l 01, 1 K1 TELEPHNI* # Home::Telephone Number - � +.:naJk d4'7 pY1 t OR .E.IN #:: t:-MAILS / I .. Da •.... NAME OF CORPORATION i TYPI=OF BUSINESS NAME OF'NEW BUSINESS . ISsTHIS A:HOME;:OCCUPATIDN? ADDRES6 OF BUSINESS.. n _ �� MAP/PARCEL NUMBER -� j (Assessing], 1lVkien st rtlrl a;I�ew business there ire several tfaings you:mut d.in ortlerto;.kie in compGence with tihe rules anci;regufations of'the Town of 8 4. Barnstable This`fcirm is intended to assiall", in abtal: the infiacm$ an ynu::tttay need Y>�u:MUST GOT BQQ Main:St. - (cdriner of.Yarmouth Rd: &A?iain Streetj to make sure yeti haaVe-the appropriate.pormi s arttl liceri:ses recltirretl t o Legally operate your business in:t his town. 1. "BUIIi]ING Ci7Ml 189IONER' OFFICE This Individual has uep fo d pfarry per . r qu remeri�that;peml`aii to this type;of business utho Ized ign ure** co vI Au 2. BOARD OF HEALTH: iMpLY WITH ALt'; A This indiv dualhas beenanforrned f> erm requirements that,pertain<to this type m.business M US`'f HgZgRDOUS MATERIALS REGULATIONS A a Authorized Sign 4 CIDMMENTSW. 3. CONSUIVIER,AFFAIAS[LICEN0Wf AUTHDRITY): ind riduel has beensanforrned of the licensing requirements,t,.at pertatn to thlstype of business.:; zl Authorized Sfgriatuee* COMMENTS_ r� 1Z . y YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this format 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St.,. Hyannis, MA 02601, (Town Hall) and get the Business Certificate that is, required by law. DATE: 1 I, —1 Fill in please: APPLICANT'S YOUR NAME/S: z" N[j C( V►7 C J:'=!-`">�°j;';�•'.��". ;�•' ;��r.:' Q. BUSINESS YOUR HOME ADDRESS: f:<� ,�,"•titi �' 1 �t..:-:r ( - Loll C�� M c, Q �,� h, TELEPHONE # Home Telephone Number .i�'�JvJ3uc-� ,r.,.rv.r•>rr:•s;r,:�:•• ;? 0R E I N #: ` (�j I 0E-MAIL: NAME OF CORPORATION: e s sc. NAME OF-NEW BUSINESS -, TYPE OF BUSINESS E(/llhi / art) f c, L .�� v'J 15 THIS A HOME OCCUPATION? Y NO _ /� h ADDRESS OF BUSINESS.31c` 1.5 MAP/PARCEL NUMBER l— V' [Assessing) there are several thins you must do in order to be in compliance with the rules and regulations of the Town of a new business When starting n9 Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth in this town. Rd. & Main Street) to make sure you have the appro riate permits and licerises required to legally operate your business 1. BUILDING COMMISSIONE OF I ' e uiremerits that pertain to this e of business. been e fan I tYP This individual has P Y q . ut,kio ed S' at e e CD TS:74T, -/k,'FAIA V 2. BOARD OF HE .7T 's e of business. ei�tain to this Arize ed of the permit re uirements that type I This individu hasp P .. t4N3P�'�`�iHh1`Fff,R Aunature** HAZARDQUiAATEiIAL ''RG171r9tT1i5 COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: b/ZZ/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: fad ; �- BUSINESS LOCATION: 3 - " i to S .r h'L1 c�0 1q i S INVENTORY MAILING ADDRESS: (:> / TOTAL AMOUNT: TELEPHONE NUMBER: Sb '�R---3&0 - LQ3 !7 InCAIW CONTACT PERSON: dry �e-n &-r`cjt oZ EMERGENCY CONTACT TELEPHONE NUMBER: �� 9 2,(-g4,0gfa MSDS ON SITE? TYPE OF BUSINESS: ,L10 in /G h641 (- �— INFORMATION / RECOMMENDATIONS: - Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids o��t�rS .`�o "fUh�-.5 Ct��01� �(� t?z-- (dry cleaners) � � (0 o Z Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature taff's Initials