HomeMy WebLinkAbout0614 IYANNOUGH ROAD/RTE132 - HAZMAT _ _
�2
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $5o.00
Town of Barnstable
Board of Health
This is to Certify that Hyannis Host Inn
.......--------------------------------------------------------------------------------------------------------------------------
614 Iyannough Road, Hyannis, MA
.-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
Is Hereby Granted a License
For: Storing or Handling 26 - 110 gallons of Hazardous Materials.
------------- ------------------------------------------------------------------------------------------------------------------------------------------------------
Restrictions:
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,
and expires 06/30/2021 unless sooner suspended or revoked.
----------------------------------------
JOHN NORMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2020 PAUL J.CANNIFF,D.M.D.
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
f
Town of Barnstable
sue Inspectional Services BARNSTABLE
4^ l Lti STABLE•tENiEtVILtE•CONR•YY41v415
M;1M. is WlS•05-'RAU-Win 0?RNs lE
Public Health Division 63JL'�4
BAMSTABLF Thomas McKean, DirectorMAIWL
{
200 Main Street, Hyannis,MA 02601 '
Office: 508-862-4644 Fax: 508-790-6304 G
x:
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ,
HAZARDOUS MATERIALS r}L
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 �/v
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 NJ
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10 00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO.
V
4. FULL NAME OF APPLICANT: haA 1 Pic—,1
5. NAME OF ESTABLISHMENT: ,"N
6. ADDRESS OF ESTABLISHMENT: U�A Rle l "" MANNIS 1A A
WW.1
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS:
10. SOLEOWNER: . YES�NO IF NO,NAME OF PARTNER: P�1 V pM l.,
11. FULL NAME,HOME ADDRESS,AN Iq TELEPHO E#OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANTWAD,�.Pa DATE (0 0nn\ '(lN "
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
�- monLtk� LO;oo
IHE r°k� Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
C BARMA�BLE.$' 200 Main Street• Hyannis, MA 02601
,6M TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rFDMP�a i1
Business Name: mf),' R6� inn Date: 77111 !q
Location/Mailing Addr ss:
Contact Name/Phone:�S 'Ir -gAID
Inventory Total Amount: J,7 SDS: Oe5 License#: Q70
Tier II : Labelina: rl Spill Plan: 0��
Oil/WaterSeparator: Floor Drains: Emergency Numbers: ue�
Storage Areas/Tanks: (60tr1
Emergency/Containment Equipme t: LS,` �i�'tl�trd. S aro
Waste Generator ID: Waste Product: IG
C�11� '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) � mdshield wash
Motor oils ✓ Miscellaneous Corrosivesl0
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 wimming 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 0 (including carbon tetrachloride)
(including bleach) 3 Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: Dd tfCQMM a+ ;5 ti111
Inspector:
*Facility Representative:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $50.00
Town of Barnstable
Board of Health
This is to Certify Hyannis that t Inn
s Host
614Iyannough Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 110 gallons of Hazardous Materials.
------------------------------------ ----------------------------------------- ----------------------------------- -----------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2020 unless sooner suspended or revoked.
--------------------------------------
PAUL J.CANNIFF,D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI, M.D.
07/01/2019 JUNICHI SAWAYANAGI
THOMAS A. MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable Am A
Inspectional Services BARNSTABLE _+..
N SwTC'ciBMiLL�J�'U.fQ�9hn�imE "�mf
Public Health Division So Y 04
911APN ABLE.! Thomas McKean, Director
`1iAr16 ;�e.`0 200 Main Street, Hyannis, MA 02601
all,
Office: 508-862-4644 Fax: 508-790-6304 ° ?
65
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 Xvs 1 f4 4g-o ills
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.
1. ASSESSOR'S MAP AND PARCEL NO.
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 STORAGEIUSE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: �� H pail
5. NAME OF ESTABLISHMENT:
6. ADDRESS OF ESTABLISHMENT:WN - u A N NO O l N)41'-1ARMLMh
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: C—II"
8. TELEPHONE NUMBER OF ESTABLISHMENT: nog'—11
9. EMAIL ADDRESS: CM
10. SOLEOWNER: YESVNO IF NO,NAME OF PARTNER: KUM
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME'
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT tfR. DATE��
Q:\Application Fonns�Haz Mat App Revised 09-10-18.docx
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $so.00
Town of Barnstable
Board of Health
This is to Certify that Hyannis Host Inn
614Iyannough Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 110 gallons of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2019 unless sooner suspended or revoked.
----------------------------------------
PAUL J.CANNIFF,D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2018 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN, R.S.,CHO
Director of Public Health
' o of Barnstable
Veg, atory ervices
Richard V. Scali,
'THEDirector
Public Health Division BARNSTABLE
• �BrABLE. r Thomas McKean Director ""�°A""�'°�"2014
MASS ) 1639Z014
-- - - -- -v� 1639 - - ' - - p_j- - ---- --�`' -- -
ArEO r 6 200 Main Streef,I-ipannts-1VIA 02601--- --- - ——
�«r
Office: 508-862-4644 Fax: 508-790-6304 _.
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth).
APPLICATION FEES
CATEGORY-1-PERMIT 26— 110 Gallons: -$ 50,00 -: ;VS
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.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
FULL NAME OF APPLICANT: M OIA kTCL U b6A �RW� IS "691W�
�. NAME OF ESTABLISHMENT:
6. ADDRESS OF ESTABLISHMENT:
7. MAILING ADDRESS OF DIFFERENT FROM ABOVE l n
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS:
10. SOLEOWNER: YES V NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS, TELEPHO #OF:
CORPORATION NAME�I,CK MCI— - lu�1(- 1?)a ojlfiwtlS
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
. NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL: ,
SIGNATURE OF APPLICANT&tM DATE 5'9 l"4` Ig
Q:\Application Forms\HAZMAT APP 2017 REVISED.docx
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $50.00
Town of Barnstable
Board of Health
This is to Certify that Hyannis Host Inn
614Iyannough Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 110 gallons of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2018 unless sooner suspended or revoked.
----------------------------------------
PAUL J.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
ti
i
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $5o.00
Town of Barnstable
Board of Health
This is to Certify that Hyannis Host Inn
614 Iyannough Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 100 gallons of Hazardous Materials.
------------------------------------------------------------------------------------------------ -- ----------------:--------------------------------------------
-------------------------------------------------------- --------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2018 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
�CIO . a �
• Tow of Unstable
TRegaatory Services
Richard V. Scali, Director
BIKE Tp��
• Public Health Division BARNSTAB11
Y f 9PNYSr4tllE•iFNrENYILLG•CONR•NYnF1:15'
• YARNgrABLE• r Thomas McKean, Director 1 3r9-201gresr ea.xsr at
v MASS g
0399 `0 200 Main Street, Hyannis, MA 02601 00
r�
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ,
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). �-7 Aq/ -d-�K
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.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
'• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT O C 1- UC 6bQ oMhw IS 00S
5. NAME OF ESTABLISHMENT: ACE
6. ADDRESS OF ESTABLISHMENT:(9) �yP jNAC`" Rb- MANN.1S ; HA
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: a2
9. EMAIL ADDRESS: M(Zll� NUTW@lcCUYI
10. SOLEOWNER: YES`V NO IF NO,NAME OF PARTNER: A LW N-A PQ R E L-
11. FULL NAME,HOME ADDRESS,AND TELEPHONE# F:
CORPORATION
PRESIDENT N 1
TREASURER
CLERK KI
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICAN DATE �` Z° I�'
Q:Wpplication Forms\HAZMAT APP 2017 REVIS i
Op91B rp Town of Barnstable Office:508-862-4644
c Fax:508-790-6304
Public Health Division
l{: BpRMA�LE.g` 200 Main Street• Hyannis, MA 02601
\\ t639. O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: av+,n 5 os l- n.^ Date:
Location/Mailing Address: 1c4 ak&t 4,o Ea.tl V%-c.Contact Name/Phone: $'off - "7-7Y- A"?f a f--av- - nt,.2X.0-1 r"
Inventory Total mount: 14qa•� MSDS: N o - 5 ��5�S License#: J `� �� t
Tier II : o l Labelin4: bK Spill Plan: o
Oi[/Water Separator: Floor Drains: y e-!5 - Emergency Numbers: `
Storage Areas/Tanks: J ka.<Ak, c
Emergency/Containment Equipment:
Waste Generator ID: Waste Product:
Date&Amount of LastEment/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 1 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 o ��
grease, lubricants, gear oil lwl�— Refrigerants ti
Degreasers for engines&garages p\\�'� I Pesticides: 1
\b Caulk/Grout 1a0t ,,..s•vc.,M, rA V-- a\'"� insecticides, herbicides, rodenticides
Battery acid electrolyte)/batteries $el Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
k\o 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) (o Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: b erg o�.
cb
5ake�•wl5 ���ehx, 1S �cr1v���(� ' Inspecto . a �
Facility Representative:
WHITE COP -HEALTH DEPARTMENT/CANARY COPY- BUSINESS
Number Fee
1270 THE COMMONWEALTH OF MASSACHUSETTS $50.00
Town of Barnstable
Board of Health
This is to Certify that Hyannis Host Inn
614Iyannough Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 100 gallons of Hazardous Materials.
---------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------ ----
This license is granted in conformity with the Statutes and ordinances relating there to, and
and expires 06/30/2017 unless sooner suspended or revoked.
----------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
C 6 PAUL J.CANNIFF,D.M.D.
® 07/01/2016 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Ot
w� -
w
Town of Barnstable
` • Regulatory Services
Richard V. Scali, Director
��ABM BARNSTABLE
MAM Public Health Division W
1639 �ws'eu�ins r
Thomas McKean, Director 16J9 °" 1''
3�g cr) .
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304 m
r�
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS
MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN
ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 �
a
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 /0
FULL NAME OF APPLICANT: hc,-T PA-Te L'
NAME OF ESTABLISHMENT: 0 1�A �S MS T 'T N 1�1
ADDRESS OF ESTABLISHMENT:U T ti�1 11 1" I A 0%0�
MAILING ADDRESS(IF DIFFERENT): / J
TELEPHONE NUMBER OF ESTABLISHMENT:
EMAIL ADDRESS:
SOLE OWNER: YES�NO IF NO,NAME OF PARTNER: N QPE D kg 2AM"
FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME Mr�TA WC�TFL LL,C�
PRESIDENT
TREASURER
CLERK
IF PREPARED BY OUTSIDE PARTY:
SI T F APPLICANT Name:
Company Address
Telephone#:
Email:
Q: Application Fonns\HAZZAPP Revl6.docx Page 1 of
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TOWN:- OF 'BARNSTABLE BAR-W 5170
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip
"". �:r�0 � 9
Business Name '�'i yi Ft 1;, Q; ,t. ►� (am/pm,, on lot 20
_
Business Address n✓1 yt-)1h `!
t Signature of-'Enforcing Officer
Village/State/Zip ��))
Location of Offense oyL ok
k� p Enforcing Dept{/Division
Offense V+ tdt,+ 1r'vt J 10;- (e-, : t� �'cAG uS s t�iP Cf..i`haK J� ����MS of
� 1
Facts 11ti ' +N�� t��n tJ+ vim-` V� +dC Iie-eo .�e.- . v54 A4,rop
This will serve only as a warning! At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
.� .-...r.. .,r.»r`... ,.-r w^,+`-..•^ti.ti,. °,e1..t..+,evr..r^+ti �-w -.+.+.+-.-•s.—.y..,,...,;,.,a..�..+....-r..,.-ra..a...-,.,,-.,,.,.,. ..�,+s�"-v^'."^y""•"R�++..Y _ ....-�...._ ,...-+. �..-..r
TOWN OF BARNSTABLE BAR-w ',17
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager ►t F 'R. f
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name .�o a1 am/pm, on b 1 20 /
Business Addressa--
r J, . Signature of-'Enforcing Officer
Village/State/Zip 111
Location of Offense Jjvf;oor
Enforcing Dept/Division
Offense Vt ' • „�x,t = � - � . .�f rrtA"e At �� ;• ��'' `� ', ��
Facts ,;{ r�r t/r. ir {, � ''. i,)# � �3"t i `sly , E ' vii'i
r
This will serve only as a warning.' At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER 'GOLD-ENFORCING DEPT.