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0790 IYANNOUGH ROAD/RTE132 - HAZMAT
`7aD �{q-Rnuo 12cad-�*7,�*T INE►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 �EARMASS. EI.E.g! 200 Main Street• Hyannis, MA 02601 \A 039.p�0 'FDMP� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: I Date: Location/Mailing Address: C ` Contact Name/Phone: - 75 V Inventory Total Amount: �_ MSDS: C: 11 M 001 License#:-�q Tier II : Labelina: Spill Plan: Oil/Water Separator: Flojor Drains: k Emergency Numbers: UQk Storage Areas/Tanks: V� �� �� S Emergency/Containment Equipmen . WA ` A VAL k4iS Waste Generator ID: l ��d��� ,L1 Waste Product: Mi M Date&Amount of Last Shi ment/Fre uenc : a C� E@7! Licensed Waste Hauler&Destination: 1 � d Vi Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS na In NOTE: Under the provisions of Ch. 111, Section 31, of the eral Law04MA, 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: bb co AF Ats Viviv Inspe Facility Represe tative: AA It V WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty #1026 ................................................................................................................................. 790 Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. .................................................................................................................................................................... Restrictions: .........................................................................................................•--...--------.......------------------......------------.. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health • Town of Bamstable Inspectional Services BARNSTABLE Public Health Division "`"rma .r•"''M ' 1 1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 862-4044 Fax: 508-790.6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE H A Z A T?11eVS!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)st—JUNE 30th), APPLICATION FEES CATEGORY 1 PERMIT 26-110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 O CATEGORY 3 PERMIT 500 or tngre Gallons: $150.00 1V;✓ni f( chK�t(p25�a" °A late charge ofS10.00 will be assessed if pa%ttlrnt is not received by July 1st. l_ --- r Cl 1. ASSESSOR'S MAP AND PARCEL NO. �� I 1 --� 2. IS THIS A PERMIT RENEWAL?_)�,YES__._NO. IF YES,-,KrP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIE;S-�((22,5 GALLONS)? _YES, NO. • 4. FULL NAME OF APPLICANT: U G-1 l 5. NAME OF ESTABLISHMENT: I )tTl-1 5. OF ESTABLISHMENT: -7q( 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 11 8. TELEPHONE NUMBER OF ESTABLIS:'..!ENT: -73 9. EMA,IL ADDRESS: .•Litvwty r,it: iiG it iiv,i:AT..E OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE 0 OF: C(A&ORAriii:Nftjvi: �WC' �l mE l ,. c�(; PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE N: COMPANY ADDRESS EMAIL: SIGNATURE OF APPC.I -'1-l,tt.,._:_,i}ATE 2,_/2_L1 Q,V4Vj1culat FarmAHU Met ApplI Deft 1rt201Q,Qocca.tt • Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL 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 4"..a Town of Barnstable -.M. Inspectional Services BARNS LE Public Health Division �-: WAAL A Thomas McKean,Director 200 IvEda Street,Hyannis,MA 02601 wr Office: 508-8624644 F= 508-790-6304 APPLICATION FOR PERMIT TO STO AND/OR UTILIZE HAZMWOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE CHAPTER HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES 3ULY 1st-IUATE 30th), ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS APP CATEGORY I PE LRMITTI26N FIEI0 Gallons: $50.00 CATEGORY 2 PERMIT I I I -499 Gallons: $125.00 QQ CATEGORY 3 PERMIT 500or More Gallons: $150.00 jguSl- 'Alate charge of 10.00 will be assessed i a ent is not received b Ja1 1st. Pd 0 L ASSESSOR'S MAP AND PARCEL NO. j Q '� . 2. IS THIS A PERMIT RENEWAL,? YES NO. IF YES,SKIP QUESTION 3. . 3. FOR ALL NEW PELT APPPLICATIONS,INDICATE WHETHER BUSYNESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: U � 5. NAME OF ESTABLISHMENT: b 6. ADDRESS OF ESTABLISHMENT: _ Q..._n P'ti 0�Q(� A � CA h n t C ... . �s 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: :l o g (e rn n a a e o 1 S. TELEPHONE NUMBER OF ESTABLISHMENT: r o u , L L top�C) Z U — , --- 9. EMAIL ADDRESS: Q \ I e U 10. SOLEOWNER: YES—NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS AND LEPH NE#OF: CORPORATION NAME PRESIDENT t _.. \ll l� 5 tC Q G TREASURER -� Q 4 Y O CLERK _ Z1 Q 12. IF PREPARED BY OUTSIDE PARTY: NAME: COMPANY ADDRESS TELEPHONE#: EMAIL: SIGNATURE OF APPLICANT, DATE ,/ Q 1Appilcuioa Fomu1H®z Mai App Revised 09-10-1 B dacx Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL 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 of B nslable �Von"glaatoryVmces Richard d V. Scah,Director QPublic Health Divisio BARNSTABLE' sexxsrnsr,�, �U.? . y $ Thomas McKean,Director K� r, °rFo r aim 200 Main Street,Hyannis,MA 02601 1639-2034 Office: 508-862-4644 �� APPLICATION FOR PERMIT TO STORE AND/OR UTIL Fax:UTILIZE H�508-790-6304a�a 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 ❑ e--*k CATEGORY 3 PERMIT 500 or more Gallons: $150.001/., *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. , ( o G 2. IS THIS A PERMIT RENEWAL?Y--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. 4. FULL NAME OF APPLICANT: U 5. NAME OF ESTABLISHMENT: \ 6. ADDRESS OF ESTABLISHMENT: .1, r\ rw i1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: l U 0 0 Oct S. TELEPHONE NUMBER OF ESTABLISHMENT:, hro `l � l0 0 U 9. EMAIL ADDRESS: A-e- ` 1 S - v ` CCJ rYl 10. SOLEOWNER:-Y—YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME U ( _ U v (� \� B 110 PRESIDENT � � � �O � TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: • NAME' TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:1Application Forms\HAZMAT APP 2017 REVISE —�j 1�b '' II r 1 Number Fee 1219 THE .COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL — 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 wr0 of Unstable egulato ,rvlces t r Richard V. Scali,Director � Public Health Division BABSTABLE q EFRHSf.1CL•=HilFVlt •CONIi•11'N.;:IS 410' BARNSTABLE, - Thomas McKean) Director '"_'.'.3"' "'='" •'s` " MAS& y. -639-20-4 1 9`�pr16 39. e`er 200 Main Street, Hyannis,MA 02601 ao��-�oeg Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE i HAZARDOUS MATERIALS rnT 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 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 o V S *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. .3 A ICE - 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. ri 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: e 5. NAME OF ESTABLISHMENT: Vo'�a w2bj `Q a 6. ADDRESS OF ESTABLISHMENT: :z an !,:-()N Q�na - �--�� �CP ,C,OI 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:%O 7 o LL- . TELEPHONE NUMBER OF ESTABLISHMENT: ��`� ���� 9. EMAIL ADDRESS: 10. SOLEOWNER: ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME k OCAD P e PRESIDENT TREASURER -%q CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 4 U Q:\Application Forms\HAZMAT APP 2017 REVIS x i Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS . $1so.00 Town of Barnstable Board of Health 4-� This is to Certify that Ulta Beauty 790Iyannough Road, Hyannis, IL 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 Town of Barnstable Regulatory Services ti Richard V. Scali, Director ' BAR AS& Public Health Division :r57:,l ftl�Al 16gy. Thomas McKean,Director ,y 200 Main Street, Hyannis,MA 02601 Vy�%4l'q� Office: 508-862-4644 (b Fax: 508-790-6304 Q 1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 Y15 A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: U M& d alon hs►iefics ¢-Ffa"Aee , T pzC. NAME OF ESTABLISHMENT:- k-6, ti-a kj:�j " ��OC`e A l Oaf ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): /22AtiMTM TELEPHONE NUMBER OF ESTABLISHMENT: (o3t�- o" '�$I��COrp• JP�-' 7 7��3� ��� EMAIL ADDRESS: Sire l ie ens�na @ Lc(fa .COrn SOLE OWNER: YES /NO IF NO,NAME'OF PARTNER: N14 FULL NAME,HOME ADDRESS,AND TEL PHONE#OF: CORPORATION NAME_U I'It1 dalon, CO3rn 7Cs d r-oc 1 nC• PRESIDENT ft(Ll b1 PA R TREASURE -I,U),e6 f' CLERK • IF PREPARED BY OUTSIDE PARTY: S N ft APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 `°FtTok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RnRMA�BLE.g! 200 Main Street• Hyannis, MA 02601 i6j9 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT fF0 MA'S I Business Name: 'Me, Otgv+ Sfo,c,,e. 102-fo Date: 2 q Location/Mailing Address: D an�o� �- n►q, S a /; Contact Name/Phone: wtt �/ �o - '775-3 0�0 c� InventoryTotal Amount: IV O� 1�G lk, MSDS: /e S License Tier II : MIA Labelino: Ire-+4-1 ( Spill Plan:orc tom- fr'QIK1*1 Oil/Water Separator: tJ1A Floor Drains: Emergency Numbers: D Storage Areas/Tanks: AZT4-1 /,00< 4- s-,>Pp/y --OarAu., Emergency/Containment E ui ment: Waste Generator ID: AY& Waste Product: Date&Amount of Last Shipment/Frequency: ovK- re-t-Yn5 Licensed Waste Hauler&Destination: -1A ba.e- o SJ "c -f o l I ac.JS Other Waste Disposal Methods: 'J " "- 2 k LIST OF TOXIC AND HAZARDOUS MATERIALS cSSQ2 2Tt d� �✓�Of S " �C�2lQll b t / 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. t vl(vCv,.v,+�c� t nS Antifreeze Dry cleaning fluids -Qe�v�vCO� 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: et OVI, && dog dofA 2- -�—n ►` '� 1 ,1, v� I iLN�J 1�v'e�T 1 y1 O�1�1 -� B1lti . Inspector: a,A Facility Representative: V WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS —' Message Page 1 of 3 Lavelle, Timothy From: Hojnicki, Jeremy Uhojnicki@ulta.com] Sent: Thursday, March 24, 2016 12:01 PM To: Lavelle, Timothy Subject: RE: Ulta Beauty chemical classification form Tim, Attached is a revised Hazardous Materials Inventory Form for the Ulta Beauty store located in Hyannis, Massachusetts. I included estimated gallons of oxidizers/organic products and cleaners/solvents. Please advise if this is acceptable. If so, I can complete the Application for Permit to Store And/Or Utlize Hazardous Materials. I apologize for the delay in getting this information to you. I appreciate all of your assistance. Thank you, Jeremy JEREMY HOJNICKI MANAGER, COMPLIANCE Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhojnicki(d�ulta.com ulta.com Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: Hojnicki, Jeremy Sent: Thursday, March 17, 2016 1:56 PM To: 'Lavelle, Timothy' Cc: Lentz, Christopher Subject: RE: Ulta Beauty chemical classification form Dear Tim, Thank you for speaking with me this morning. The clarification on the Town of Barnstable hazardous materials requirements that you provided was very helpful. Per your request, attached are two documents which should provide your office with the hazardous materials inventory information for the Ulta store located at 790 lyannough Road in Hyannis, MA. The first document is a list of products by SKU (store keeping units) and the associated hazardous materials classification. This information was provided to Ulta by Ulta's environmental vendor 3E. The second document is a chemical classification form which lists some of the types of products that are considered hazardous materials by volume, Ulta has provided this form to other jurisdictions. As you are probably aware, in the retail industry product lines and product numbers are ever changing and exact numbers of products and product volumes are difficult to accurately determine. Nevertheless, we hope this provides your office with the type of inventory information that you are looking for. Ulta will be completing the Application for Permit to Store and/or Utilize Hazardous Materials and we will send the form along with the application fees to your attention., Please feel free to contact me if you have any questions. Best regards, Jeremy ` JEREMY HOJNICKI MANAGER, COMPLIANCE 4/13/2016 E Message Page 2 of 3 Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhoinickita'�ulta.com ulta.com j Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.rm From: Lavelle,Timothy [mailto:Timothy.Lavelle@town.barnstable.ma.us] Sent: Thursday, March 10, 2016 9:36 AM To: Hojnicki, Jeremy Subject: RE: Ulta Beauty chemical classification form Hi Jeremy, Thanks for contacting me. I am usually only in the office for phone calls between 8:30 and about 10:00 AM EST, then out in field doing inspections. Please call any day when you're available, except Mondays. Thanks. Timothy Lavelle Hazardous Materials Specialist Town of Barnstable Public Health Division 200 Main St, Hyannis, MA 02601 508-862-4645 tim.lavelle(a)town.barnstable.ma.us -----Original Message----- From: Hojnicki, Jeremy [mailto:ihojnicki@ulta.com] Sent: Wednesday, March 09, 2016 10:34 AM To: Lavelle, Timothy Subject: RE: Ulta Beauty chemical classification form Dear Tim, I was given your contact information from Ulta's Loss Prevention Department. I understand that you have some follow up questions from your visit to the Ulta store located at 790 lyannough Road. I think I might be better equipped to provide you the information that you are looking for. I was also given a copy of the Town of Barnstable Application for Permit To Store And/Or Utlize Hazardous Materials. I would like to make sure that you and your office have all the information that you need for Ulta to complete the application. Are available for a quick phone call today to discuss what you are looking for from Ulta? I am available today between 11am and 2pm, between 3-4pm and also at 5pm (times in EST). Please let me if any of those times work for you or, if not, when you might be available for a call tomorrow or Friday. Thank you, Jeremy JEREMY HOJNICKI MANAGER, COMPLIANCE Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.296.1552 jhojnicki(cDulta.com j ulta.com Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.7M 4/13/2016 ULTA BEAUTY HAZARDOUS MATERIALS INVENTORY COMMON CHEMICAL QUANT LOCATION NAME NAME FORM STORED (storage&use) JUSTIFICATION ACETONE NAIL POLISH REMOVER ACETONE LIQ. 3 GAL. SALES FLOOR MSDS NON-ACETONE NAIL POLISH ETHYL ACETATE LIQ. 3 GAL. SALES FLOOR MSDS REMOVER BUTYL ACETATE LIQ. NAIL POLISH TOULENE LIQ. 14 GAL. SALES FLOOR MSDS ETHYL ACETATE LIQ. SALES FLOOR 90% FRAGRANCE ETHYL LIQ. 54 GAL. STOCKROOM MSDS ALCOHOL 10% SALES FLOOR 90% AEROSAL HAIRSPRAY ETHYL AER SAL N/A STOCKROOM MSDS ALCOHOL 2� 2 4 /b L4a A l 10% OXIDIZERS&ORGANIC PRODUCTS HYDROGEN PEROXIDE LIQ 5 GAL. STOCKROOM 50% MSDS SALES FLOOR 50% CLEANERS& SOLVENTS CORRISVE ACID LIQ. 3 GAL. STOCKROOM MSDS CORRISVE BASES ad Company Name: ULTA BEAUTY# 1026 Company Address: 790 lyannough Road Pagel 1 ,Hyannis, MA 02601 I L� l of L WT,-,Lw vk1T ll-rl' t zo = p Ir 4 l -t- t v k 2 = I SS �9 GlcrVL-�vow�, �Jvoa tf7Dk 3- CL �I Message Page 1 of 4 Lavelle, Timothy To: 1026,Store Subject: RE: From Ulta beauty- Fw: 1026 Fw:`Ulta Beauty chemical classification form -----Original Message----- From: 1026,St-Dre [mailto:Store1026@ulta.com] Sent: Thursday, February 25, 2016 10:14 AM To: Lavelle,Timothy Subject: From Ulta beauty - Fw: 1026 Fw: Ulta Beauty chemical classification form Importance: High STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA CUIta Beauty 00 R on Blvd. Suite 120 o ingbrook, IL 60440 W 508,775.3840 store 1026 a)ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.TM From: Francies, Bayyinah --�� C����fi� �B�'t' 3I� Ib� S�L� 1�� �� �►�t- +0UC' Sent: Friday, February 12, 2016 3:51 PM w To: 1026,Store;,Egan,Joseph; Covington, Donna /A, pp d Subject: RE: 1026 Fw: Ulta Beauty chemical classification form y IV�Ge� �Sfta�l",o►1= — III ie. -fit ►► '►"`�1��� 5 `P Hi Jen- 11 e-evt5-� I spoke to Tracey Anzar she advised that we should use the attached hopefully this will suffice. Thanks, Bay BAYYINAH FRANCIES RISK CLAIMS SPECIALIST Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 630.378.7178 C 708.261.2661 bfrancies@ulta.coml ulta.com l Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: 1026,Store 3/4/2016 I� ' Message Page 2 of 4 Sent: Wednesday, February 10, 2016 10:09 AM To: Francies, Bayyinah; Egan, Joseph; Covington, Donna Subject: 1026 Fw: Ulta Beauty chemical classification form Hi Bay- Joe Egan suggested I email you for help with the information the town of Barnstable is asking for. I am not sure if we have documentation for these products. Please advise and,Thank you in advance. Jen - GM STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store 1026 a(� ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY. ALL IN ONE PLACE.TM From: Lavelle,Timothy<Timothy.Lavelle@town.barnstable.ma.us> Sent:Wednesday, February 10, 2016 9:48 AM To: 1026,Store Subject: RE: Ulta Beauty chemical classification form Thanks, Jen. This is a good start. Don't you sell a lot of cosmetics though?Also, hair coloring would be a big category. Are you in all this week? I'll stop by when I get a chance. Thanks again, Tim -----Original Message----- From: 1026,Store [ma i Ito:Store 1026@ulta.com], Sent: Tuesday, February 09, 2016 3:35 PM To: Lavelle, Timothy Subject: Ulta Beauty chemical classification form Hi Tim - Attached, please find a chemical classification form. This is what they sent me when I inquired - if it's not the correct info -just let me know and we can do a count. Thanks so much - Jen GM STORE 1026 HYANNIS, MA - CAPE TOWN PLAZA 3 3/4/2016 ' -'Message Page 3 of 4 Ulta Beauty 1000 Remington Blvd. Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store 1026Co-,ulta.com ulta.com Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: Egan,Joseph Sent:Thursday, February 4, 2016 8:57 PM To: 1026,Store Cc:Covington, Donna Subject: RE: 1026 board of health question Hi Jen Attached is what I believe the inspector is looking for. Please share this with him. Let me know if there are any other requests. Thanks Joe JOE EGAN AREA LOSS PREVENTION MANAGER Ulta Beauty 1000 Remington Blvd Bolingbrook, IL 60446 C 508-930-8975 JEcianOWlta.Com I ulta.com Ulta Salon, Cosmetics & Fragrance, Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM From: 1026,Store Sent: Thursday, February 04, 2016 12:04 PM To: Egan, Joseph Subject: 1026 board of health question Hi Joe - Tim Lavelle the town of Barnstable health inspector was here today- he was inquiring about toxic materials on hand. He was wondering if ULTA has some sort of list of items and estimated quantities on hand. If we don't he would need to do.a walk through and estimate amounts of flammables, combustibles, corrosives and toxics. I am not sure where to begin - so I figured you could lead me in the right direction! 3/4/2016 r-Message Page 4 of 4 Thanks - Jen STORE 1026 HYANNIS, MA -CAPE TOWN PLAZA Ulta Beauty 1000 Remington Blvd, Suite 120 Bolingbrook, IL 60440 W 508.775.3840 store1026()ulta.com I ulta.com I Ulta Inc. ALL THINGS BEAUTY.ALL IN ONE PLACE.TM 3/4/2016 CHEMICAL CLASSIFICATION FORM ,F- COMMON CHEMICAL % QUANT QUANT IN LOCATION HAZ NAME NAME COMP CAS# FORM STORED USE(opeiciosed) (stomge&use) CLASSES JUSTIFICATION ACETONE NAIL POLISH REMOVER ACETONE 99% 67-64-1 LIQ. 3 GAL. 0 SALES FLOOR FLIB,IRR,OHH MSDS NON-ACETONE NAIL POLISH ETHYL ACETATE 45% 141-78-6 LIQ. 3 GAL. 0 SALES FLOOR FLIB,IRR,OHH MSDS REMOVER BUTYL ACETATE 35% 123-86-4 LIQ. FLIB,IRR NAIL POLISH TOULENE 20% 108-88-3 LIQ. 14 GAL. 0 SALES FLOOR SENS MSDS ETHYL ACETATE 15% 141-78-6 LIQ. FLIB,IRR,OHH SALES FLOOR 90% FLIB, FRAGRANCE ETHYL 25%to 64-17-5 LIQ. 54 GAL. 0 STOCKROOM IRR, MSDS ALCOHOL 92% 10% OHH SALES FLOOR 90% LEVEL 2&3 AEROSAL HAIRSPRAY ETHYL 22% 64-17-5 AEROSAL 1117 LBS 0 STOCKROOM IRR,OHH MSDS ALCOHOL /4_ 10% Company Name: ULTA BEAUTY STORE#1026 CAPE TOWN PLAZA Company Address: 790 IYANNOUGH ROAD Pagel of 1 HYANNIS,MA 02601 pFTHETph Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMBT�RLE.9` 200 Main Street• Hyannis, MA 02601 i639.MP'�p`000 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT TFD Business Name: 014,5. Beam Date: Location/Mailing Address: 7qO onft() 1000 kmih. " n B 61a "iMe 120 Contact Name/Phone: 630 -a 10 a 9$1q Inventory Total Amount: J ICI MSDS: Lkes License#: 214 Tier II AID Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Aid Emergency Numbers: Storage Areas/Tanks: da Emergency/Containment E ui m t: Qwc(�� Waste Generator ID: AA A A 6005 11 HSl Waste Product: Date&Amount of Last Shipment/Frequency: 111241 a0a O 15 (At S Licensed Waste Hauler&Destination: U liG Eny.5NSk,/+iS 1 P!'0✓lr,yn CP. Ri Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS iNOTE: 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 4 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: AO iTW7-1qWAAd09( 4 AiS Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. MASS. fir. 200 Main Street• Hyannis, MA 02601 'OTEDMP+a,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o I Date: Location/Mailing Address: 000 ReA,,11440A ` Contact Name/Phone: Inventory Total Amount: ��� MSDS: L— ` License#: 4 Tier II : Labeling: Aes Spill Plan: �Q Oil/Water Separator: VA Floor Drains: Emergency Numbers: c ] Storage Areas/Tanks: ` Emergency/Containment Equipment: 4 aste Generator ID: M.kp Waste-Product: Date&Amount of Last Shi ment/Fre uen : t� 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 �r 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: ak Ins or: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 eA M�`E 200 Main Street• Hyannis, MA 02601 0lE0Mn+a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Q Date: Q14/ Location/Mailing Address: AD P, ziyyJL11V10 loco D & 17, Contact Name/Phone: 6 — 4314 Inventory Total Amount: SDS: t C..a License#: �� �"3 Tier II : Un Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emer enc Numbers: Storage Area � e, cnw�nws �( Emergency/Containment Equipment: ` Waste Generator ID: M�wj-16%4® Waste Product: (t4i)1-n,5 Date&Amount of Last Shi ment/Fre uenc . Licensed Waste Hauler&Destination: ►C. YiJ6L6 Other Waste Disposal Methods: A-04a Iy l 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) ---------�indshield wash Motor oils V 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 V Miscellaneous Combustible aint&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: J=rt'_comM 48,1 (MS Qi iS el,`✓ )e Inspector: —A6 Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°F�►+E rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' MA.q ' 200 Main Street• Hyannis, MA 02601 prFDMP'�a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: V 14", 19,9q.0� =0--/0 2 G Date: z Location/Mailing Address: 7 O y 0, V1 t-, a n t i Contact Name/Phone: - '7'7 -3F3 D bb ; - a t+," W4 Inventory Total mount: 0 a 1 S�DS: �6- C,4)y, License#: a o �ak 3 Tier II : La eb lin : lct-A&,1- tJ�e--7 9?0 Spill Plan: ON<,-t 'r4-1K-1 Oil/WaterSeparator: Floor Drains: Emergency Numbers: OY� l Storage Areas/Tanks: VLUAM \01" Q4t<Ak6 Emergency/Containment Equipment: 5 0r V�t.k t t- s 1 mv\- 5 4 -e, Waste Generator ID: J D°b,1-5 D Waste Product: AthL M Y Date&Amount of Last Shi ment/Fre uenc : 2 110 3 4 "1 ve,,<�,e-e-1 -3 E Qco owe Licensed Waste Hauler&Destination: 1 v\ '5 oc-Yti.1�w� Other Waste Disposal Methods: Vo Ira.m :5 <J-zQ S YKOA� LIST OF TOXIC AND HAZARDOUS MATERIALS N 0 v.n w o-< \,A NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of M"A, hazardous materia 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 �M�ie' Hydraulic fluid (including brake fluid) 45 Windshield wash �G�e� �s� �'y' e }� Motor oils Miscellaneous Corrosives Q�oor 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/RECOMM NDATIONS: MLIP- viuvti oA, IbS e.v� W 0.JGN ado\2 0� v�._ �a c, �Ge�S . Inspector:—l' L`LV^e-lIl`-e— Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I ��1�,..v,� ,ry�1.C,��' ` ,fir.�tx '�' • �� S Co I� • ' `°F�►�r°,�� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE. 200 Main Street• Hyannis, MA 02601 ,b,q. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'�a Business Name: ` 16,-1"--) Date: 3 7 r 1 Location/Mailing Address: -7610 3.�. wv.o.�ail.� yav�haS Contact Name/Phone: Sow -7 10 _ 4- 19 8 B. ybv 0.�� InventoryTotal Amount: S SDS: - k ay �bl e. License#: �. Tier II : o La eb lin �e�o 1 wo taa5�e G<2A Spill Plan: M I p 1A Oil/WaterSeparator: Floor Drains: o Emergency Numbers: 0 il Storage AreaslTanks: ct,q A,, 9 a l G„�,�4-a�ti.�,lg „ti }��� G1-eA-, 0 S� Emergency/Containment E ui me t: .e�a�� +�`r�� ..ham a 41^ h. �wk- s� o.1ICt s Waste Generator ID: (IA `�0'�'` �`S �a4 5c<-\I, ?� 1 as e Product: s r,n Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: C ,,aw e.,n m,r- LIST OF TOXIC AND HAZARDOUS ATERIALSc vk&W a'(e.5 V., 5 0v1 a.Re. � 5 wv s5 ,e � oe,c,. 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 Xro. r4%%Ct14 Fertilizers Floor&furniture strippers o�� k r� PCB's Metal polishes �' Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" C05 c5 Z fi 3 (including chloroform, formaldehyde, ,nay I 01�Sh. I -6�+' 1 hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: C VK F.25 1L e,7__CvwiyV.. 1A ati.ZIV Gees 5 0 5 < OSIA A I k,e D - u. (�V k,� -�-C¢�'�.aL4t o vw Qov� dQo�..M-dQ�©-'vl • ��' ,PY�� E-a V a-,-!y 5 au v ct vt,'�`� Inspector: 1 , biy4J lei (g 11�'ateyt�e 1�I Facility Representative: C t lxx_ 1 Vt V�►v� Tv )4¢Ll l`^- � - -m+ _,(— WHITE 1 COPY-HEALTH DEPP RTMENT/CANARY CO Y-B SINESS .>,G✓�[L�5 ���� - � �¢�� X• �PteS kA �Qtbecaw�5 45 1u6+Je ,C, � r+�Z0/41. A °FI��o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 sne A�LE. ' 200 Main Street• Hyannis, MA 02601 ArFOMP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: --Ive. ae-1 OLZ Date: Location/Mailing Address: -7 t4y4kp4ts Contact Name/Phone: Slog - 7 - L I�, e k. JX( r K61y Coivie,5 Inventory Total Am unt�5ls> MSDS: N° qe-«55 License#:T'g\�) Tier II : Labelina: Spill Plan: 1a Oil/WaterSeparator: Floor Drains: 90 Emergency Numbers: Storage Areas/Tanks: 9w Imo/ © 4--Ii)e-- 0-d%&ka\\A.� e Co5vw -,gS Aa.� �01�5�� VeyvAvve-S: Q � Emergency/Containment E i ment: Waste Generator ID: tQ1 v Waste Product: M% t- a,AJ o , i- Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: C�Cc Zan v k�� v V,,e CcaS`.. 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, `Ma Qw�oJv�SlCova�ue�c� oq etD�j _��L`5� hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION RECOM MEN DATI NS: VA-AA9 k— C I v �CA\vL\rJ, I C f R��Cbwlwt� � � a.,� Inspector L Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �y °Ft►+E►ok Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ena A�LE.$ 200 Main Street• Hyannis, MA 02601 ArFOMA+A,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: IV o') Date: 1 Location/Mailing Address: 51v av&vLo fin, Z Contact Name/Phone: C n o 7 Inventory Total Amount: << q C, MSDS: 'AA1 0`04A1i,,.., License#: /J Tier II : NIN Labeling: — Spill Plan: — Oil/WaterSeparat r: NIA Floor Drains: — Emergency Numbers: Storage Areasi7anks: — Emergency/Containment Equipment: Waste Generator ID: tQ A - M q< 6.x Waste Product: Date&Amount of Last hipmen 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: CCOJk /5,,7p0b-0 ,u<}S < eA 5 L, C',evtwv-- e-r -PA1$c- C,O S►Ad.L�C�e-S 4 5 9A I ¢'Jv)AO'- t -s 010 2 19er,44,1,14, - o 44.I Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS • Number Fee 1219 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify tha Ulta Beauty 790Iyannough Road, Hyannis, IL Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, an and expires 06/30/2016 unless sooner suspended or revoke ------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 04/11/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health 1 a loan Town of Barnstable ' o+<T KIE� Regulatory.Services Richard V. Scah, Director i ' MASS. ' ' Public Health Division D k,4S- ABLE �. 6>0.Y5-P31E-CC 051RV.E•E- iT--rti':AI$ �^ ZB39• 10 MMF095 M:LS•GSTER�`.LLE•WEST 3A:Ji5TABLE F� Thomas McKean Director '6'9_Z°1° - � fag � 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 lob W APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. 3 ) ®q DATE t J )6 FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: V I A 'S Q A y�j ADDRESS OF ESTABLISHMENT: 'jq0 13 dj NrN&US , R043 , O y a r%i S (')A O�6 o I MAILING ADDRESS (IF DIFFERENT): S,0-- 111> � o�k L 6Q�tjU TELEPHONE NUMBER OF ESTABLISHMENT: 3'�' q J O " y� 14 EMAIL ADDRESS: `\ ►"�� n� J 1 y SOLE OWNER: V YES_NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME o� PRESIDENT TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SI ATU IE APPLICANT Name: Wal Company Address Telephone#: Email: Q:\Application Fonns\ IAZZAPP Rev I6.docx Page 1 of 2 Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- --------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health —.t,_..,....�......, .,..,�.,..��wo....a Fay Iw.au is uU I tcwtvt:u uy JUIy lU,LVAJ. • Please feel free to view the above Code,Chapter 108:Hazardous Materials on the Town Website,www.lown.barnstable.ma us,which.is located under the E-Code section if you should have any questions or concerns. Q:\Hvm AMaz Mat Permit 1,ata.DOC Town of Barnstable Regulatory Services Richard V.Scali,Director "'R'F`A01Y.f Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Offim 508-862-4644 - Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS Al"AND PARCEL NO. DATE lY�l�j ``.f t APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OH RAL.ARRD11OUS MATERIALS FULL NAME OF APPLICANT W NAME OF ESTABLISHMENT ADDRESS OF ESTABLISE A/E�N�TK.�7��/�1(.A, �7I I LAr a. tjt-t-;ni C Jo t1 AV- ( VA i Ht Y d S V01Z TELEPHONE NUMIER SOLE OWNER: YESVNO. IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNER: See.. a� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 0 Z-C'✓b� STATE OF INCORPORATION ,NCI FULL NAME AND HOME ADDRESS OF: PRESIDF,NT TREASURER CLERIC . �' Tax Analyst GNATURE OF APPLICANT RESTRICTIONS: I I o A u A D D R E s s 1 5 3 3 3, Pc L 82-1134, No-Wwao- D+& 7 HOME TELEPHONE# -`73`J�l CA—h Wempomy Intamm F8es101.XD7\h1AZA1'P kw2015110C T/T'd S6£2982Lb8T6:01 WM906L80ST 1-l'U3H iSMUe:wnJd 8£:10 ST02-eT-NM ELECTED OFFICERS OF KMART CORPORATION • FEIN 38-0729500 3333 BEVERLY ROAD HOFFMAN ESTATES, IL 60179 847-286-2500 NAME TITLE 0 0 Lawrence J Meerschaert VP Tax, Asst Treasurer& Secretary Scott E Huckins Vice President & Treasurer • Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. -------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r Town of Barnstable °ptHE Tpy� Regulatory Services Richard V. Scali, Director B" MASS.LE, Public Health Division '°rfa 39. 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 II I GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C1'� NAME OF ESTABLISHMENT K K 7 ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: YES_NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION. Is FULL NAME AND HOME.ADDRESS OF: PRESIDENT eDt.o A►'Z7 TREASURER CLERK �lTGNA�TUIWOVAPPLICANT S/, RESTRICTIONS: HOME ADDRESS U• d� (� a' HOME TELEPHONE# 77 Y Q:\AppGcation Fonns\ AZAPP.DOC Town of Barnstable P��F4HE Tti Regulatory Services <r. Q b 4 Richard V. Scali, Director } BARNSTABLS, f 4� . ��� Public Health Division 1659. pTfo Mai°` Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J. Canniff,D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stared,:transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2 - 3: 1. Please complete the attached application form 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on.or before June.30, 2014. A late charge of$10.00 will be assessed if payment is not received by July 30, 2014. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town WebSite, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DDC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q\Appiication Forms\HAZAPP.DOC I Appendix B — Hazardous Waste Chart (example j I Haardous W"8,te Sepgaflon. Chart, �Fxp'i835CLN'.4$SlC4`ASS- }.p.,yy,..ayzy..?i MOP(liff ,� �,."; �,,,,, � 1. �i.reca rlcfrckixcar'�tts�rrtsaw-1 �*c.�§rarY car• s�'tnn=+�'rix't� � � .� '4'S�"ast� (�c�tgt&�'�7 �`rlcrui6ic,� iar ct� �'clrunai cultxcnra ' evarec: i i2c qry$w npfc: it irib6 k Yc �.d V`•[2G'i'r'k�A'4�4 7f'd'f8a7F.V.i'irR 5.:.,xt rg° ".1N) ue<=t'li aw o a mole=ta;t cin (I mear rr wYtt§a ara ^tL1 ti' rly td:rs�r; pruthw-kEf in toteir ' r,l rtrrru :r$dt9c i i. pFockwt in owtiv,lhL7,fur, wnc;Cibdd ab-,ofbenr,,wa &al�r(:in:.A"r ag x "rr'1 4rf :i effm 1 tX"'Ylri �,'�• 4 $pilt I� ,��� t ,. i4 (4l".•uw6w-v+t kklxv,.�' ctvJ JQ milal �ak-d in,as%ar b;L vaxtN c�sr�Yr ¢,3 or tlrYrx is t m i vraa,"'M Mid put iMO ttM Wta lWkt trucks ttu ca'ac ry af iepmrlurctha.war.cleuieclup- ra"'4t i 5, I t�rta5 ,&cif .t9v ;(rr rattm'r, tl; s t��,�r s ac r' rr 1w, MRMt lv 1 T 4rv.a,r Am*,rw l srrm, r,;,:tsr cntch A r l 1-6WENT-SCARS AM .Karah,a;rttowntd Affisim wO �* � � � .c�x;�lo14 rttc d�rermirsaei� , Sc lid on rv*v and Romwely 63 L"" t asaanr-af�rac'c«�E•fur,arcirev;- `.: whrx, t€a� ha,�a; �3�rrt.a�r�fFitre-ci':"scree vsara.� ��Ct[:rPt ix: " l Isarral In dw r otr.: r S. if a low i tx�,+rr,nt file,or it a 1*7 r.a�x rat p`r1l W",Sm ax gr;nr'rak*rd Onch w;:t pallet aat.a"Airm.gmterar ,,,�,•", tcra.o ter.xv`re�:l,�elrase tzk�t.;�r, n�rirrarnt�l�:ftw tt�rrrrr x'�r ,��•t axttllec;t-:�Ct' •1E:':'�ta�,�iftElfiLIFC"�". C 'Am star A.t'm YMI WW%4 1�e-'epamired 1 --- 44( sg ct v fix r fn;arr,Wvfm r Cymc pry l anal I.)cram,.. •.hMM #tp. ffi' SYt f9A+ 3adl%i TOPIC TAB PAGE REVISED DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 12 of 14 06/20/14 INDEFINITE STORAGE AND DISPOSAL Appendix A — Hazardous Waste Accumulation Area Set-up HAZARDOUS WASTE ACCUMULATION AREA Typical Setup Using Racks/Shelves Hazardous Waste Yellow Tape or Paint Accumulation Area Sign Hazardous 5 s yr` Waste a� Segregation w -w � Chart `° CD F RBRC A vs Box a M fT r XF F CD Y c� Waste fin... s T Aerosols ater�� 3 feet"No Merchandise" Yellow Tape or Paint Continued on next page TOPIC TAB PAGE REVISED DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 8 of 14 06/20/14 INDEFINITE STORAGE AND DISPOSAL Hazardous Materials/Environmental - EAP Version: 3/15/2012 Page 1 of 2 Hazardous Materials Hazardous materials are chemical substances, which if released or misused can pose a threat to the environment or human health. Examples of hazardous materials include flammable liquids (gasoline, paint thinners, and solvents), corrosives (deck wash, muriatic acid, and concrete cleaner), oxidizers (potassium permanganate, iron out) and gases (propane, MAPP gas). The SHC Environmental Helpline provides 24 hour service on Hazardous Material issues. There a is no direct cost to the unit for these services. C e SHC Environmental Helpline - Poison Control Assistance or MSDS Assistance 1. Call1-888-368-7327 2. Select the appropriate option listed below based on your needs. Select 1 -Spill and environmental emergencies 2 - MSDS/ Poison Control `m 3 -Asbestos, paint, mold, indoor air quality 4 - In-ground hydraulic lifts 5 - Permits, Inspections o 6 -Waste pickup, oil water separators, gasoline pick ups MSDS A Material Safety Data Sheet (MSDS) is a document that is intended to indicate what the hazards of the product are; how to use, store and handle the product safely; what to expect if the recommendations are not followed, what to do if accidents occur; how to recognize symptoms of overexposure and what to do if such incidents occur. MSDS - Requests • MSDS are available online from the Environmental Affairs intranet website at http://law.intra.sears.com/sites/environmental affairs/. • Once at the environmental site, the MSDS links can be found in the "Toolbox" on the left. • If you cannot locate the MSDS online, call the Helpline. The Helpline will fax the MSDS to the unit. • Units need to verify local jurisdictional requirements of having a hard copy "binder"of all MSDS on site. Follow all local jurisdictional requirements. • Customers can request MSDS information by calling 1-866-463-9210. Poison Control SHC Environmental Helpline provides 24 hour service to assist Associates on responding to potential poisoning and appropriate emergency treatment. If you have a poisoning emergency, call the SHC Environmental Helpline. If the victim has collapsed or is not breathing, call 911 for emergency services first. Contact with Hazardous Materials If you come in contact with anything considered hazardous materials, do the following; • If splashed into eyes, flush eyes with cold water for 15 continuous minutes • If in contact with skin, wash skin thoroughly with soap and water • If clothes become contaminated, change clothes • Review the product label or the MSDS for additional first-aid measures • If in doubt, seek medical attention immediately Hazardous Waste Hazardous wastes are hazardous materials that are no longer usable and need to be disposed. http://srscdc00siis204:84/Docs/3/3-4p.aspx 6/23/2014 hazardous Materials/Environmental - EAP Version: 3/15/2012 Page 2 of 2 Hazardous wastes can damage the environment and create a risk to human or animal health if not managed properly. Hazardous waste cannot be placed into regular trash and must be handled by special procedures. Spills / Leaks/Clean-up Depending on whether spills or leaks of hazardous materials come from known or unknown sources, it can still present a health or fire hazard. If the spill or leak can be identified and is not a harmful, trained Associates may clean up the spill/leak using the appropriate items within their c Hazardous Material Spill Kit. 0 c W If the spill is large or cannot be safely cleaned by onsite Associates, contact the Environmental Affairs Helpline and select option 1 for assistance. Associates must always seek assistance if a +o spill or leak occurs from an unknown source. a Always Call for Help If... • there is a doubt about the hazard of the spill c ors • the spill is from an unknown source • enters a drain, or is a large spill • the spill occurs outside of the facility If Associates can safely clean-up the spill, refer to the Spill Cleanup Guide on the SHC Environmental Affairs Webpage for guidance: • http:Maw.intra.sears.com/practice areas/environmental affairs/index.htm • Once at the Environmental Webpage, the Spill Guide links are in the "Toolbox" Section Hazardous Material Spill Kit • Each location must have at least one (1) readily accessible Hazardous Material Spill Kit. Additional HazMat Spill Kits can be ordered through POWS. (Item # Swarz 10076). • The following Associates must receive training on environmental operations (which includes hazardous materials spill response procedures): • ASM, Operations a Paint and Hardware Associates • Unit Manager ° Shipping and Receiving Associates • Loss Prevention Associates 0 Logistics • Cosmetic Associates http://srscdc00siis204:84/Docs/3/3-4p.aspx 6/23/2014 Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS 100.0o Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health JUN-26-2014 09:00 Frorn:BRRNST HEALTH 15027906304 To:912472364635 P.�/,4 ` � 1 Town of ]Barnstable pa Ck- `WHE Regulatory Services rckz .Sew Richard V. Scali,Director ➢MAS&LE. " Public Health Division Tbom.as McKean, Director 200 Main Street, Hy Innis, iN&� 02601 Office: 308-862-464 4 Fax: 503-790-6304 Application Fee: $100.00 ASSESSORS 'A/LAP AND PARCEL:NO. DATF APPLICATION FOR PERM1TI TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS y FULL NAME OF APPLICANT LcLa c� NAME OF ESTABLISHMENT 1�1�Y1�-� � SCLAV ADDRESS OF F.STABLIST ENT � zc- fC) TFT,.F_PHONF NUMBER Off' �( I ' CI 97ZP ' C7 SOLE OWNER: YES /NO ..n -- 1F APPLICANT IS A PA-2TNERSHiP,FULL NA NIE AND 11.0MF ADDRESS OF L � :Coo* w r— PA1ZTN Elk S: ,o M 1N A.PPI.,ICA.NT IS A. CORPORATION: STATE OF INCORPORATION FULL NAME AND HOME ADDRESS Ol+: � l'121i;S)1)t�NT a TREASURER CLERK TaxAnalpt sic;lvn � 'or•nrNr,rc:�v�' RFSTRT(TIONS: HOAIE ADDIZESS 3 3 �ce,�1. _ 62-11��, � HOME TELEPHONE#�17 2�r„ ScX n g E S+1 � Q\AppLcaum f omisAHAZAPVj)(?(' ELECTED OFFICERS OF WART CORPORATION FEIN 38-0729500 3333 BEVERLY ROAD HOFFMAN ESTATES, IL 60179 847-286-2500 NAME TITLE Ronalid D Biore President 0 0 Lawrence J Meerschaert VP Tax, Asst Treasurer& Secretary Scott E Huckins Vice President & Treasurer i Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Regulatory Services Thomas F. Geiler,Director BA MASS. ' Public Health Division .9 MASS. 1639. �0 '0'Eanw�A 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. I �.i DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT ma d C c � I-C on NAME OF ESTABLISHMENT �rk r� �)L4 o ADDRESS OF ESTABLISHMENT lunnouaVk TELEPHONE NUMBER SOLE OWNER: YES_NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: # 3o Q 3 11 82-1 13AX �� . IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ✓9' 2250 U STATE OF INCORPORATION i FULL NAME AND HOME�ADDRESS OF: PRESIDENT TREASURER CLERK I�Wl� 1h Gjbr�qa&' TaXAnalyst SIGN OF APPLICANT RESTRICTIONS: HOME ADDRESS Bel FS4; �L HOME TELEPHONE # 2 ton 79 Number Fee O 169 THE COMMONWEALTH OF MASSACHUSETTS $100.00 0 Town of Barnstable Board of Health This is to Certify that K-Mart General Store 768 Iyannough Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. --------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health fl 1� Town of Barnstable Barnstable W Teti Regulatory Services Department uatuv srnst.e. Public Health Division 1 = �0� 200 Main Street, Hyannis MA 02601 163 9. 2007 Office: 508462-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT SOAkS 401-01 A2 GJ- 000- , NAME OF ESTABLISHMENT K- M ko.T ADDRESS OF ESTABLISHMENT -7 -q Au o I,t Cv w- Ro A r:> TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. --7 , 00 1 STATE OF INCORPORATION r FULL NAME A DI) OF: = ma►�a9 er TREASURER CLERK r- SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS So--' -+ t3�z..r ��.n►� 03So$ HOME TELEPHONE# Z.o-i Q:\Hazmat\Haz Mat Application2008.DOC Town of Barnstable THE Tkyjftrg Regulatory Services Barnstable do Thomas F. Geiler,Director A"muicaCity Public Health Division BARNSTABLE. I I Mass. Thomas McKean, Director 2��� 1639. A`0 200 Main Street FD MA'S Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular arti lar site. STEPS 1 — 2 - 3: 1. Please complete the attached application form. 2. Include a copy of your contingency plan (to handle hazardous waste spills, etc.) 3. Submit the fee of$100.00 payable to the: Town of Barnstable. MAIL all of the above to this office on or before June 30, 2008. A late charge of$10.00 will be assessed if payment is not received by July 1, 2008. Upon receipt of the fee and a completed application form, an inspection will be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A permit will be issued once the inspection is completed and has passed. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town.barnstable.ma.us , which is located under the E-Code section if you should have any questions or concerns. r TO: ALL STORE COACHING TEAMS STORE USE Coach's Initials FROM: STORE OPERATIONS ADMINISTRATION (kl) Date Reviewed RE: Bulletin MCC #4413 "Hazardous Waste Identification, Storage and Disposal" (Connecticut, Illinois, Indiana, New York, Massachusetts, Minnesota, Stores Only) Expectation Every associate is responsible under the Code of Conduct to comply with environmental laws. Store coaches must ensure that all store associates are knowledgeable and understand the difference between "Hazardous Material" and "Hazardous Waste." Certain merchandise and supplies may contain hazardous chemicals or components, such as batteries in a toy or alcohol in a perfume. The presence of hazardous chemicals or components makes the merchandise or supplies a"Hazardous Material"that must be properly handled, regardless of whether the item is damaged, defective, or an undamaged return. Refer to Bulletin MCC#02 "MCC Area Standardization"for additional information on Hazardous Materials. Each store is required to properly determine if a damaged, defective, or returned Hazardous Material item is still usable. Definition of a usable item is "if it can be marked down and sold, used by the store (store use), or donated". Under no circumstances can non-usable items(such as leaking containers or aerosol cans) be donated. Once a Hazardous Material has been determined to no longer be usable, that item is now considered to be "Hazardous Waste" and must be stored in the store's Hazardous Waste Accumulation Area. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 1 of 14 03105/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Policy Points Associates who may come into contact with Hazardous Materials and Hazardous Waste must complete Environmental Hazardous Waste Training and Right to Know Training. Basic principles regarding how to handle Hazardous Waste are taught in these courses. Any associate who has not been properly trained will be prohibited from handling Hazardous Waste. Associates who need to take the courses or a refresher must contact the People Coach or a member of the Store Coaching team for assistance. It is imperative that store associates understand the difference between Hazardous Materials and Hazardous Waste. Hazardous Materials refer to chemical containing items that may be discontinued or aesthetically defective or damaged, but still in usable condition (i.e. not leaking, pumping activator still intact, etc.). These items can be shipped back to vendors following Department of Transportation rules. However, there are restrictions on sending Hazardous Materials to the Return Goods Center(RGC). Refer to Bulletin MCC#02 "MCC Area Standardization" for additional information. Hazardous Waste refers to items that are not usable(i.e., non-sellable, non- donatable expired, cannot use in stores, etc.). These items cannot be shipped anywhere and must be properly stored in the Hazardous Waste Accumulation Area. A waste vendor will pick up Hazardous Waste items on a quarterly basis, as set forth herein. The MC&C Associate, the Loss Prevention Coach and the Store Coach will inspect the Hazardous Waste Accumulation Area on a weekly basis to ensure there are no leaks or spills, labels are correct, etc. The MC&C Associate will be responsible for filling out a Weekly Hazardous Waste Container Inspection Log. The weekly log must be completed regardless of whether product is in the totes. The Store Coach and the Loss Prevention Coach are responsible for ensuring the completion of the weekly log. It is important to remember that these weekly logs will be asked for by inspectors. Policy violations identified during inspections MUST be corrected IMMEDIATELY. Please contact Environmental Affairs if you need assistance (1-888-ENV-SEARS)or if an inspector has been at your store. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 2 of 14 03105108 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Hazardous Each store must have a Hazardous Waste Accumulation Area for hazardous Waste items that are no longer considered usable(Hazardous Waste). Appendix A Accumulation has a diagram and several sample pictures of a typical store layout. Area Set Up In most cases, an environmental vendor will set up the Hazardous Waste Accumulation Area. The Store Coach and Coaching Team will be asked to provide assistance with placement of the area and to provide available racking for tote storage. A normal set up is as follows: Containers must be properly labeled and legible, the following must be on each container: • Hazardous waste • Type of hazard (i.e. Flammable, Toxic, etc) • Name and Address of the store • Accumulation Start Date—when a hazardous waste container is emptied by a vendor, a new date must go on the container the first day you start refilling the container with more waste. 1) Eleven (11) 18-gallon industrial strength storage totes(16"w x 24"1 x18"h)with covers will be initially used for waste storage, by category of waste. In some cases, the size or number of the waste storage totes may have to be adjusted depending on waste volume generated by the store—contact Environmental Affairs for assistance if this seems necessary. Other Hazardous Waste containers may also be stored in this area, such as the used fluorescent light bulb box, as well as the Hazardous Waste Spill Kit. The totes are labeled for the following types of Hazardous Waste items. Appendix B has an example for details. A. Flammable liquids/solids—oil-based paint, Goo Gone, fingernail polish, Pine Sol, butane lighters, and other flammable items that are not in aerosol cans or compressed gas cylinders (two totes provided) B. Corrosive Basic— Drano crystals, ammonia, pool chemicals (pH increasers), etc. (one tote provided) C. Corrosive Acidic—CLR, muratic acid, Easy Off, pool chemicals (pH decreasers), etc. (one tote provided) D. Oxidizing —Tilex, Comet, bleach, pool chlorine, etc. (two totes provided) (two totes provided) E. Toxic— herbicides and insecticides, latex paint, detergents, pool chemicals(algaecides), etc. (two totes provided) F. Flammable gas— propane, MAPP gas, etc. (one tote provided) G. Flammable aerosols—spray paint, oven cleaner, Fix-a-Flat, etc. (two totes provided) Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 3 oaf 03105101 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued Hazardous 2) The totes must be set on sturdy, secure, metal racking. Shelves must Waste be set with enough clearance so that waste items can be bagged and Accumulation put into the totes. Area Set-Up 3) The totes must be lined up with side labels facing the same direction. Some categories have multiple totes. Totes labeled "C" and "D" must always be at least a tote width away from tote"A." 4) The area may be set against facade or building walls, although if the area is against an exterior building wall, the totes and other containers must be at least one (1)foot from the exterior wall itself. The area may also be arranged in the middle of a floor, although stockroom pathway minimums and exit locations need to be taken into consideration. Do not use a mezzanine or basement location. The area must be readily accessible to an inspector or a waste vendor. Do not set up in a locked location. 5) The Hazardous Waste Accumulation Area totes and any other Hazardous Waste containers must be at least five (5)feet from sources of high heat(such as a space heater) and electricity (electrical panels, etc.), and must have reasonable air circulation (no closed closet areas). The Hazardous Waste Accumulation Area must also be at least five(5)feet from all food items, and cannot interfere with any exit doors or traffic ways. 6) The totes and any other Hazardous Waste containers must be separated from all new products and store supplies by at least a three foot width space (non-food items)on all non-wall sides. This open area must be marked off with durable, non-slick yellow tape. Only Hazardous Waste containers can be placed into this area. No other items, including ladders, stools and other store supplies or merchandise are allowed inside of the tape line. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 4 oaf 03105108 INDEFINITE STORAGE AND DISPOSAL • - • - -• Hazardous Waste Identification, Storage and Disposal, continued Hazardous 7) The Hazardous Waste Accumulation Area can have NO DRAINS. Waste Accumulation 8) A copy of this bulletin must be printed out and posted in the Area Set-Up Hazardous Waste Accumulation Area. 9) A copy of Bulletin SAF #10 "Spill Response" must be printed out and posted in the Hazardous Waste Accumulation Area. 10) The yellow environmental records folder must be stored on a shelf in the Hazardous Waste Accumulation Area. See Appendix A below for a diagram and pictures of a typical set up. Program Each store must have a Hazardous Waste Accumulation Area with special Tools hazardous waste bags and totes set up to handle the storage of Hazardous Waste items. The waste vendor must post a Hazardous Waste Wall Chart with detailed procedures to help the MC&C Associate properly segregate the various types of Hazardous Waste. The Chart explains how to use the special plastic hazardous waste bags to seal items before placement into the proper waste totes. See Appendix B for an example of a Hazardous Waste Wall Chart. Hazardous waste bags may be ordered from KIN in two (2) different sizes: • Regular—0-91358111-2 • Large—0-91362211-4 Once each week, the MC&C Associate must inspect the Hazardous Waste Accumulation Area, using the Inspection Log in Appendix C as a checklist to verify compliance. Any items found to be incorrect must be corrected and noted on the log. Completed log sheets must be verified by the Store Coach or Loss Prevention Coach before filing the log sheet with other environmental records in yellow environmental records folder. The yellow environmental records folder, KIN 0-86521211-2, must be used to store all environmental records. The folder must be located on a shelf in the Hazardous Waste Accumulation Area. The Weekly Hazardous Waste Container Inspection log must be retained for 3 years. To dispose of these logs that must have a date greater then 3 years and they can be thrown away. Refer to Bulletin MCC#02"MCC Area Standardization" for additional information. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 5 of 14 03/05108 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued General The MC&C Associate must take the following steps for handling Hazardous Procedure Waste: 1) All Hazardous Materials that are placed in the MC&C area must be reviewed by the MC&C Associate to verify whether or not the item is usable. A usable Hazardous Material is one that can be used for its intended purpose in its present form. Example: A slightly dented, non-leaking bottle of bleach is not considered Hazardous Waste (it may be sold at a discount). However, an aerosol can that does not have an applicator tip would not be considered usable, and must therefore be handled as Hazardous Waste. 2) Usable Hazardous Materials that cannot be sold under normal pricing must be aggressively marked down for clearance (follow the progressive markdown guidelines in Bulletin MCC#8"Pantry Merchandise Defective/Damaged/Outdated"). 3) If these items do not sell, any Hazardous Materials that can be used by the store must be transferred into store supply use. It is important that stores do not keep excessive amounts of supplies that will never get used. Store supply containers must be so labeled by writing "Store Use" on the container in black permanent marker. Follow the store use procedures in Bulletin GSO#03 "Store Use Merchandise"for taking correct markdowns and the marking of the merchandise. 4) If any usable Hazardous Materials can be donated under a Kmart donation policy, those items must be stored in the MC&C office, and not in the Hazardous Waste Accumulation Area. Remember that you cannot donate non-usable, broken or leaking hazardous items—these items are considered Hazardous Waste. Also, aerosol cans must never be donated. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 6 oaf 03105/01 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Identification, Storage and Disposal, continued General 5) If a Hazardous Material is determined to be non-usable and is Procedure therefore now Hazardous Waste, the MC&C Associate must use the Hazardous Waste Wall Chart(see Appendix B for a typical example) to determine into which Hazardous Waste accumulation tote the item must be placed. Each item must be individually bagged, sealed, and put into a tote as directed on the Hazardous Waste Wall Chart. Follow the steps below to account for and ensure inventory integrity of Hazardous Waste before placing the items in the tote: • All Hazardous Waste must be processed as a Type 41 620 claim prior to merchandise removal by a Hazardous Waste vendor. If the claim indicates to wait for vendor approval, take the UPC label off of the item and place the label on the waiting approval shelf in the MC&C room. Send merchandise to the Hazardous Waste Accumulation Area. • If no credit is given on the claim then the merchandise must be marked down to zero. • Under no circumstances can Hazardous Waste remain stored in the MC&C process area; this merchandise must be moved to the Hazardous Waste Accumulation Area. 3) Personal Protective Equipment(PPE) must be used when handling Hazardous Waste. Refer to the Right to Know Safety Guidelines for details on use of PPE. To locate the (PPE) information you can log into Internet Explorer/Store Mgmt under myKmart.com. Key in (PPE) under Document Search this will pull up the Right to Know Safety Guidelines with the information. This is also located under LP & Safety in the Kmart Safety/Safety Guidelines. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 7 oaf 03/05/08 INDEFINITE STORAGE AND DISPOSAL i Hazardous Waste Identification, Storage and Disposal, continued Special Certain Hazardous Waste requires special procedures: Hazardous Waste A. Rechargeable Battery Recycling Corporation (RBRC). RBRC provides Processes a free box for recycling Universal Waste (a type of Hazardous Waste). One box is normally placed on the electronics counter for customer recycling, and another box is placed in the Hazardous Waste Accumulation Area. If you do not have a box, contact Environmental Affairs(1-888-ENV-SEARS). The boxes are self-sealing. When one box is full, it can be returned to RBRC via common carrier using the pre-paid shipping label on the box itself. The box must be dated when the first of any of the following items is placed inside. Boxes must be returned to RBRC not later than one (1)year from the date the first item is placed in the box. 1) Rechargeable batteries—Any returned or damaged waste rechargeable batteries from toys, tools, etc. must go into the RBRC box as Universal Waste. 2) Sealed lead acid batteries—Small sealed lead acid batteries(less than two pounds in weight) must be placed into the RBRC box as Universal Waste. Larger sealed lead acid batteries (over two pounds) must be handled in the same manner as automotive batteries (see Bulletin HRD #01 "Automotive Batteries"). 3) Cell phones— Cell phones must be placed into the RBRC box as Universal Waste. The battery does not need to be removed. B. Veolia. Veolia provides recycling for fluorescent light bulbs, and certain electronics. Continued on next page TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 8 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL f Hazardous Waste Identification, Storage and Disposal, continued Special 1) Fluorescent light bulbs —These bulbs include 8-foot, 4-foot, U-tube, Hazardous "twisty," HID and other mercury-containing lights, and "green-cap" Waste fluorescent light bulbs. These bulbs must be disposed of in a Veolia Processes container. If you do not already have containers for old fluorescent (continued) bulb storage, contact Veolia at 800-478-6055. Veolia containers can be shipped via common carrier using the pre-paid shipping label on the box itself. Light bulb containers must be stored in the Hazardous Waste Accumulation Area. Large broken bulbs(such as 8 ft bulbs) may also go into the Veolia container. Powder and other small debris from broken bulbs must be handled as a small spill (bagged and put into the Veolia container). The container must be dated as soon as the first bulb is placed inside. Bulbs can be stored for up to one(1) year before the container must be sent to Veolia. 2) Electronics—Cathode-ray tube devices (such as older computer monitors and televisions), LCD and plasma screen devices, and other computer equipment cannot be thrown away. a. For customer returned un-repairable televisions and other similar electronics contact your appliance haulaway company for proper disposal. b. For old store electronic equipment, contact IT Support for disposition information, or refer to Bulletin SYS#02A "Computer Equipment Repair Replacement Information." Waste electronics must also be stored in the Hazardous Waste Accumulation Area. Questions If you have any Hazardous Waste Identification, Storage and Disposal questions, send a Help Ticket to Category — Loss Prevention and Sub Category Environment Health and Safety, or call Environmental Affairs at 1- 888-E NV-S EARS. For software or hardware system problems contact Support Central at 1-700- 321-1040. Continued on next page TOPIC TABLof DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 03/05101 INDEFINITE STORAGE AND DISPOSAL Appendix A — Hazardous Waste Accumulation Area Set-up HAZARDOUS WASTE ACCUMULATION AREA DIAGRAM Typal 5 dup U&g R cl h Ives YellowTapeorP6t ,�tti�u�lt,�a Hazardous Wash w t77 w a a Yy'y/y ep#ya nChart < ,� � k -•t, tqy �'• � '� za� ,� Sb `�rl Mniv, BY N .� ;N�M� ♦ E+y. � }7 ',} t1t1 Y.Y111 Y11t11 7Y/t11YW7Wt'Y'VMtt 2 `l F 112 ""'"»M"'rS �rx exraxn.e�n�xgxxnr Al�� i§nny� ii�A + q - Y 4£ - TeT Y3 t Sr yq p S i 1 v sus mot¢ .� �L a� �t;; •'a ��s� . fte Gas 1 �a 89 1 T H , art'• � `i 18t83181 /// �r 77, SOIKit 5�'C t c, .- •a.,)r.x`, .,..... .�s ,nq.+.+his; t feet"No%c se" Yellow Tape or hit 1 I TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 10 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Accumulation Area Set-up (Store example) r ti N�. T e 4 � G �r 0 TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 11 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL •' To,' -0 Hazardous Waste Accumulation Area Set-up (Store example) / 3txs � f £ A � / �/�/%ram✓//iir//fr/rl"�°' Q �, - � �4�Y' A -_ �f �s� �zar�l�/ ��tirv/ %vim✓ ?may F �� y a� ��, �a `f`' � i � x TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 12 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Hazardous Waste Accumulation Area Set-up (Store example r +s P� J q F `ate s J� w ar � 1 � r � d f /y��� < :.�, � �'� 3 '.b5 `✓ : �� ^, y� lea TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 13 of 14 03/05/08 INDEFINITE STORAGE AND DISPOSAL Appendix B - Hazardous Waste Chart (example "`", ,u.s Wa sto . . ;;if a rt rrTs.�s��sata`. i..e r."thretch cultawn vA W«.. t�:�,a^✓r v::vs c>. :2'... h�;'�'gr;.TF 'xraAt,�a•::;a::e,„C'aPaT 4;c�x,xtrTr[r,: %�;aiE».k.E#w 4'4w4*«aEr AS Y.ls�al-v'rr t-sr € vxraal�k wat*x An W). bra>iv T='<«.x ,�-r."Jmta in Owia as wrc. m :'s, �a�:r@:#�sr-rf;nx§aiiHft�&sv-�'�rtxa 1'taaMx$t4'E'l:�xEa: rera;lea . s`` Flax Ti `� 4 aw e la.�^k`rxT�°rc 3t x d f ,,,,•�„�„ seiW,a4�Lc._f_<Ew.�s w_`,.wri`�Lira"ttf'C5 YT.Sa.K Si.L..ET 1«c.*c.S.4��'-SR<\<4S • .ram. ��, Tar fi.�;.rtl3:tt+s.".sx.x°3Lraa'w.3-ab�'.r, tuarrzK.:fts �o�nt..+rvatCsacxx: ,5. T� ,'�xr%aay�,«r$t;diatgwr Jfesr=ltavz =�4 t;!3a�xxa aaa, E"• ,.:«�: ;ea�.rrr,<:r;$flfsc. ...�`•".` :4-$a l.:a'^t m).V S axr. C;,,r Et asreas..a�eL9 MQ4m will eq+:r.�'.•_�. <-, .,•`..'°°� �:� �.,.x,�_sFs .,�a.�a :;r£r.T tt;2���re.�r3€t�a r�.r`ss:. w:xa:,a F.rM a,s�.e aiti.ta�a„,�.Tr r,a,�^:"x'^=:aakm e��sxas<. perara�:,ax t. r». ka��•bx.. ,fig ..e-...�- �,. }fr:.R FeE3:Gz �"wr-."^%O8 YY1$,�afY��'�^:sy'3q:$1�5'v'},.;%,`i'em y'rsfl.1E¢'aH� •'°"•••","• EFa�zs...��tea'f�.aalf:F�t�l�x't:l?.trsv-=pFn'�,^sras�xas s x�Y3"',a�s�:lae- z ..�a,r-h s,ffir�rrM 9, V a...e,t e ram. A t .z: 3xaa�T z?y..ata::w t� >l»,;a x s.•;.3'3rTa :w"d T)rors;" [..U'll'"9•. TOPIC TAB PAGE DATE DISCARD DATE HAZARDOUS WASTE IDENTIFICATION, MCC 14 of 14 03/05108 INDEFINITE STORAGE AND DISPOSAL Appendix C — Weekly Hazardous Waste Container Inspection Log Weekly Hazardous Waste Container Inspection Log Print this out each week to perform the required weekly inspection of your Hazardous Waste Accumulation Area. Retain completed forms in your Yellow Environmental Records Folder for 3 years. Store# City State Logged by Title Clock Number Date Signature Verification of weekly inspection by Management: Name Title Signature Date Inspection Items Yes No If no,explain deficiency and correction actions taken Date fixed Is the Hazardous Waste Accumulation Area accessible and separated from and free of merchandise,debris and supplies? You must be able to easily get at waste containers,and nothing but hazardous waste can be stored in this area. Are all hazardous waste containers properly closed? All waste containers must be kept closed except when items are being added or removed. Is there one Accumulation Start Date clearly marked on every container? When a hazardous waste container is emptied by a vendor,a new date must go on the container the first day you start refilling the container with more waste. Are containers properly labeled,and are the labels legible and complete? The following must be on each container label: 1. "Hazardous Waste" 2. Type of hazard(i.e.Flammable, Toxic, etc.) 3. Name and Address of the Store 4. Accumulation Start Date Is the area clear of any spills or leaks? Any spills or leaks must be immediately addressed. Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that K-Mart(GeneralStore) 768-Iyannough 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 Town of Barnstable Regulatory Services °s Thomas F. Geiler,Director STABM NAn ' Public Health Division '°r�aru•� 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 _ �7 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT S(?aCS 4011f)_g NAME OF ESTABLISHMENT KArRT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER '�(� " '7 0 0 l o SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: I IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION ( a FULL;NAME AND HOME ADDRE S OF: - -J/ PRESIDENT 'fiI/fir?/i'J 1: ,tWI S 33.3 f�e�,- �a rL �t /79CPY1 C�S'�CC �S TREASURER CLERK L SIGI ATURE OF APPLICANT r RESTRICTIONS: HOME ADDRESS HOME TELEPHONE 9 AZV 72fCY24 5 r� ALL DIRECTORS OF STORE OPERATIONS ALL DISTRICT MANAGERS ALL STORE MANAGERS/DIRECTORS ALL HUMAN RESOURCES MANAGERS --SPILL CLEAN UP PROCEDURES- -STORES- The Right To Know Law requires that each facility maintain a written set of instructions for cleaning up chemical spills.- The Operations Manager and Department Managers shall have the responsibility of coordinating the clean up of chemical spills. All Kmart associates trained in these clean up procedures are able to assist in the clean up of chemical spills. The Human Resources Manager is to discuss the following guidelines with the designated clean up people and insure that these people are trained on proper clean up procedures. -INFORM ALL ASSOCIATES THAT THEY SHOULD NOT DISPOSE OF HAZARDOUS PRODUCTS IN A COMPACTOR,A BALER,DOWN A DRAIN, OR IN THE DUMPSTER, ETC. (THIS INCLUDES AEROSOL CANS, POOL CHEMICALS, PAINT PRODUCTS, AUTOMOTIVE PRODUCTS, MAINTENANCE PRODUCTS AND GARDEN CENTER PRODUCTS.) IF A HAZARDOUS PRODUCT NEEDS TO BE DISPOSED OF, CONTACT THE ENVIRONMENTAL DEPARTMENT AT 810/637-6544. The best defense against chemical spills. is to prevent the spill from occurring. First keep emergency supplies handy. Supplies should consist of the following: Rubber Gloves Kitty Litter Overshoes(if needed) Broom Shovel Durable Bag and Plastic Container Second assess the Lawn & Garden Center and rearrange products that could produce potential hazards. All garden merchandise in glass bottles should be stored near the bottom shelves with guards surrounding the products. Shelves should be checked to insure that the brackets are strong enough to y; hold the weight of garden chemicals. Take ail of the products off the shelves when bracing the shelves with brackets. x Attached is infohon that will PI pareyou inthe event oran emergency chemical spill. Review these step your associates Frame these instructions and ost themlma�promme areaifoi uick <K p 9 reference ' ,� -� z, A w rn. `�;, � �� ��r � ��� O�Mr=Richard�McLonls �q' i�;, �;•� - 13 AM .� � Director'of Corporate`Safe 4 e 14 ' Code'38=0=930103-1 6 F ergency spill of garden chemicals does occur, immediately take these steps to control the be aware that some people may become ill. These people should be removed to fresh air. If pill occurs, please notify the KIH Environmental immediately at 810/637-6544. If a spill or more bottles of a product,contact: INFOTRAC 800/535-5053 OR CHEVRON CHEMICAL COMPANY CALL DAY OR NIGHT AT 415/233-3737 i 11. ISOLATE THE AREA. Keep people away. 2• VENTILATE THE AREA. Do not.breathe vapors Open doors and windows. Set up portable fans. Close return grilles on air conditioners. 3. KEEP FIRE SOURCE AWAY. Keep away from all heat sources and do not allow anyone to smoke near a spill. 4. PUT ON RUBBER GLOVES AND OVERSunt:c nrT 'Ornor E INVOLVED IN THE CLEAN UP. Avoid contact with skin or clothing. If contact occurs with skin, wash affected area thoroughly with soap and water. If contact occurs with clothing, remove contaminated clothing, wash skin thoroughly with soap and water. Wash contaminated clothing in strong detergent before being worn again. I _ 5. READY FIRE FIGHTING EQUIPMENT. 6. IF A LIQUID,USE KITTY LITTER AND ABSORB UNTIL DRY. 7. CAREFULLY PLACE ABSORBENT OR SPILLED DRY PRODUCT IN DISPOSABLE CONTAINERS. 8. SCRUB SPILLED AREA WITH CONCENTRATED DETERGENT USING BROOM. 9. BEFORE DISPOSAL OF SWEEPINGS AND/OR BROKEN PRODUCT CONTAINERS AND OTHER CONTAMINATED WASTE IN ACCORDANCE WITH RECOMMENDATIONS OF =LOCAL HEALTH AUTHORITIES NOTIFY THE KIH ENVIRONMENTAL'AT 810/637-6544 FOR FURTHER INSTRUCTIONS 10 WASH GLOVES OV ERSHOES AND SHOVEL-WITH STRONG DETERGENT SOLUTION: "CLEAN SUP" PERSON NEV; HOULD' CHANGE CLOTIIING RAND 'WASH SKI1V THOROUGHLY i; � a �WITH"DETERGENT _ Code 38-0-930103-114 Number Fee 169 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that K-Mart(GeneralStore) ?q e 768 IyannougkRd., MA' 02601 Is Hereby Granted a License STORING OR HANDLING 111 GALLONS OR MORE HAZARDOUS MATERIALS. FOR: ------------- - ---- ---------------------------------------------------------------------- =- -- ,-:-----:-------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 imless`sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 15, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable 00 1 j616(o Pd � °F'THE l Regulatory Services °. Thomas F. Geiler,Director / G I 1 * BA ASS.MAS3.LE. * Public Health Division 9 •i679 ArEO 39 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. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT Mar+ 30 go ADDRESS OF ESTABLISHMENT I&F J: � W)IS 61 TELEPHONE NUMBER SOLE OWNER: YES NO .fir IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF PARTNERS: in M n IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.. STATE OF INCORPORATION �('p U . Y 11►C � FULL NAME HOME A DRESS OF: PRESIDENT !S TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Application Fomis\HAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below.. Also include a copy of your Of contingency plan (to handle hazardous waste spills, etc). Iri addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in-house processing.'Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the,address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q Upplication Fonns\HAZAPP.DOC i Town of Barnstable °FtHE Tp�, Regulatory Services Thomas F. Geiler,Director s" MASS. ` Public Health Division Qj .s6gq �0 AlF1639 A Thomas McKean, Director W 200 Main"Street;-Hyannis; MA 0260`1 Office: 508-862-4644 y Wayne Miller,M.D. Fax: 508-790-6304 Sumner Kaufman,M.S.P.H. Paul J. Canniff,D.M.D. NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous Materials,.a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials ate stored, transported, utilized, and/or disposed of at-a particular site. Please complete the attached application form and submit it along with the required fee of$100.00 to this office on or before June 30, 2006. A late charge of$10.00 will be assessed if payment.is.-not received.:by July 1, 2006. Checks should be made payable to the: Town of Barnstable. Upon receipt of the fee and a completed application form, an inspection will be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A permit will be issued once the inspection is completed and has passed. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website,'www.town.bamstable.ma.us , which is located under the E=Code section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DOC i No...... FEE..... ...5..00.... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T own...... o F.......Barns table ...... ..........................................................•-----------•-- Appliration for Uigpn.sFal Works Tonstrnrtion Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: Route 132, Hyannis, MA 02601 -•-• ........._........_.............. ..... ...................... -•.............--•-•-----•-••-•-•-••-----•-•-••---•--•.........._..-•---•.............-•--•------• o ion- dr s or No. Hyannis Moteavi fanner Route 132, Hyannis, �A 02601 ......................_........................ ...... ............................................ ......-•••-----------.....---------•---------•--•.....-•-•-•-•---•------...............-----....-- W A & B Cessp ool enrvice 128 Bishops Terrace TfTf annis, MA 02601 .............. ................ ----......... q. Installer Address UType of Building Size Lot----------------------------S feet �-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ). Other—Type of Building No. of persons............................ Showers a yP g ---------------------•------ P ( )..— Cafeteria ( ) Otherfixtures -----------------------------------------------------------------•----------•-•---•-------•.........••------------- ------ W Design Flow............................................gallons per person per day. Total daily.flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter....-.--.-.--.-. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.--.-..-_--_-_-._.. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z . Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ ,4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-__-_._..-.--.--------. •-- - •----........_....... ---...--•-•---....-- ODescription of Soil and- ----------------- ---------------------- -----....._._..------•-•-----•-------- --------------•.... -----•---------------•--•----•-•----•-•---....._....-•---•--....-------•--....----------------------------........-----....-----------------------.....---------••----- x w UNature of Repairs or Alterations—Answer when applicable.. nstallati on___of-a__1 000-__gallon•-pzre-cast, ............ __-.Repla�cing_acaye-in.-_.- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code—The undersigned further agrees no to place the system in operation until a Certificate of Compliance has been iss4eZf by tfie boa lth. R Signed-- .... ••-------------= 3/15 82 Application Approved By.................... _..! .>.. .... . ---................... ......... A5` ==2-e-------------- Date Application Disapproved for the following reasons----------------•--...........---------------------------------------------------•--•-----•------••-..........._ -----------------•------•-••-•••-------••--------•-------------------------------•••-------•-----------------------•---.--- •-•--•----- Date Permit No...........8 2--•-....-•••---•--•----•--------•...... Issued..3�15/82 Date No..... i2.-.1-2-.0 FEB....Yt....5_.00..... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•--......_..'POW!_...............OF......parrs table. ... Appliration for Ramat Works Tunstrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: --........Route 132:...I?yanntsl...".4 C??..Fnl. .......... ..•--••-----------. ...........-----•----- ------.....---.......----........ -o ation-iVyanni s *,Otel/DaV ddrM anner . Rout. .....--••--.................. wner W A e. R C. ool ervice 12 ' 'Bishops Terrace;dd�Vann_16, A 02601 a . (� Installer ......----•--•--------------•----......-----Address...----....._._._............-•----._..... UType of Building Size Lot............................Sq. feet -� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building g ---------------•--•-----•--- No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' \ pSand--------------------- ---------- - ------- ---- ----•---....-•-----............-•------------•--•-•-•--------------...----•-••-----------•------•----- .. Description of Soil----------- --...... ••------------------------------ -... ---------------•-------------------------------------- •------- ------------------•-----------------------------.. W .-•----------------------------------------------------------------------------•------......--------------------------------------------------------•------••-••-••-•--•----••----•------•--••-•----•-. U Nature of Repairs or Alterations—Answer when applicable_ rs�allati.on.-of-_a. ... gallon pz�e-cast, stone-.packed--lack-•Dit---(overflow _._-_.Replacing•-a••cave-in. • . ----------••......••................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T T':' . 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board gf a alth. SignedG%{ > _. - __. _ < 3/15/82 •.............. Application Approved By.............,, __:.....4A..:.�✓�� .... 3/15 •----� j - -•----^---•--•-- ...-----•---•-•-•---Date.............. Application Disapproved for the following reasons:_...----•-•.....• •-----------••----•--•---•----••--•------------•-------•---•--•---••-•-•---•---••••-..-•--•- --------------------------•--•------•-----.....---------......-------•--•---------------------•-----•---.••---------........•-•-----•-•-----•-•....-••-•--------•-------------••-•--------•--.....•-•--- Date a Permit No......................................................... Issued..3••�5-82 Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........:..........Tew.n..........oF.......Darnsta)le ...................................................... Trrtifiratr of Toutpliana THIS IS TO CERTIFY, That the Jpdividual Sewage Di s osal S stem con trl� d ( ) or Repaired (X ) A & F Cesspool Service, 12^ Bishops TerracE. Hyinni.s,_ °'l by.............:......................................•--•--........._........•-•-----•••-•-••--•-------•--•--------•-•••-•--•-----•----.............--••----•.......•--••-..............--••--....._. at_.._____Hyanni_s hotel, Route 132, ilyannis, iXall-02601 - David Banner has been installed in accordance with the provisions of T 5 of The State Sanitary C g / q cribed in the application for Disposal Works Construction Permit No._ �L'�................... dated_.-.._�i.l�l---...._._...____............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......3//S/p2. Ins ector-•-rn---.. ..'. . ........• ..................--•................_..•••. P Il�'�"•------------•------------•---------------•--------------•--•------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................OF.............�'arnstaole $ 5.00 T awn No...........2., .� FEE........................ Disposal Workv %TAantrnrtivi - rrmit Permission is hereby granted_....A-_& T. Cesspool Service, 128 B shops Ter., Hyannis 02601 ............................................----•-••. ....-•-••---•--••--....•-•---.....••---•.....-•.............••.-•-•- to Construct ( ) or Repair (X) a Individual Sewage Di s System. at No....HyannisMl otel , Route 1n32, Hyannis, I (� �%l - David Fanner Street 3/ 5/ as shown on the application for Disposal Works Construction Perm it No....................- Date ._.._............�2.................. ' o DATE.................3/1.�./P2.............................................. Boa f! ealth FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.8 :. Z '`r� .:',S.x.Q.�............. THE COMMONWEALTH OF MASSACHUSETTS \` BOARD OF HEALTH ..............T.own-.................OF....... ........................................................ Appliration for 1 spoii al Works Tonotrur#iun panfit Application is hereby made for a Permit to Construct ( ) or Repair ( x) an Individual Sewage Disposal System at: ....Hyannis,Motel..= Route..1,�2,...HY-4x?bs,..MA... 026Q�,_•--------•--...----„ ----- •--•----•.........................•----•--•-•--••................. Location-Address or Lot No. ....David Banner Route 7,�2,.. Xs �11a.7,s.,.._NL�.._Q �2Q�................. Owner Address W A & B Cesspool Service 128 Bishops„Texrece-,-,Hyannis,,,,MA••--•02601-,•-•.- a .................•-- Installer Address UType of Building Size Lot............................S........ q. feet �-, Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .......----•-----••......-••--••--•-•-••---•-- ---------------------------- -------------- •---------------------------- W Design Flow_•-•........................................gallons per person per day. Total daily flow..............._............................gallons. WSeptic Tank—Liquid'capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......... ...........-------------------------- -•.--•--------..--••- Date........................................ W .a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.-----------•---_----. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......--...............: P+ ............. ------------------------ ••-•--•••--------------•......•-----•---•..-•-••------•......--•......................................................... 0 Description of Soil._Sand........................................................--•-••-••---. V ......................................................................................................................................................................................................... W ------------------••-------------•----•••--•------••••-••-----•----•-•--••-••--•--------••--•••--•----••-•--•••-------------------•--•-----•-•••--•••------•--•----••----•--------•----•----•-•----•••. U Nature of Repairs or Alterations—Answer when applicable....inaCalla tiara...Qf..2...--.l,.QQQ-.ga7ls�n,_. ....cast:---ston....Packed:,leach_•pits...Coverf Iwo)........•-----•-•------•--------•----••---•-----•-•-------•-•-•-•--•-•--••-••-•.............••. . Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i9sued by the: he 1th. Signe"��.....e.=.............---•----••. -•-- - -. .......... �8 _ ,!✓� D t Application Approved By•••-•-••-•---• /y8T�=18-'•.-•--- Date ----------------- Application Disapproved for the following reasons:-------•------------------------------------•--------------•--------------------------------------...........••. ••-•--•..............••••----•••••----•••••-----••••-----•-•------••--•---...----•-----.........._.....••-------•-----••-----•-••••-••--•-••----••-•--••••-•-•--••-••••--•----•------------••-•--------- / Date Permit No....81- ..................................................... Issued-....8.[_..4Aj81 Date NO.-8�,...._..._..----- .... .00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................f`Own.................O F.,.....BI,Z"Mtabler. .------------.......--•------*...................... Appliratinn for Disposal Works Tonstrurtuan Prratit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal system at --... Hannis-Notgl --,Route..l ,..Hyannisa..r1A 02601. - - - ------------ ._... Location-Address or Lot No. ......................ad Fanner Route 132,...!yannis, M.................................................... 00 -------------------------------------•----•-••---•............---........ ---- Owner Address a A & B Cesspool Service 128 Bishops Terrace, 1.4yannis, INA0.26.01 Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a 1 Other—T e of Buildin a yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W ;Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W ' x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 ---•------••-------•-••---••--•---------------•--•--•------•--•••-------...-••--•---.......-•••------•-•--•---•----......--------•......_.._........... 0 Description of Soil--Sand---------------•-•---.............------------......-----------•-•------------------------•--•---•------•------•-- x U ----•---•----------••------------------------------••--...-•-•------------........----•--••-•------....----------•---•------•••------••-••--••-----•-•--••--------•----------------•-------------------- W ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- U Nature of Repairs or Alterations—Answer when a lira le-...installation of_ 2 — 1 000 gallons pre— �p --------- ------- --- cast, :-tone hacked leach pits �overows . •-------------------------•---------•-•-------•-•--------•-•--------------------..........---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue by the b I doh lth. Signe 8 4 81 ........................•---------...A .......................... te Application Approved By------------------••-•---•-•-------•1 -�� t 4•/81 Date -- Application Disapproved for the following reasons:............... ..........................•-----.._._...----•-----•-------....----------•-------......------------------.--------•--•-•--------•--•-----•-••----•---•••-------••-••-----•---•---•••--------••-----.-•--- Permit No 81. .....-•••--------••-•--•----...----•••....... Issued......B/.4-/81 ...... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........I...........`'own.........O F............Parns table ............................................................... Trrtif iratr of Tuntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by -ACesspool... ervice._..128_.Bishors__TerraCe1_Hyannis,.__MA...02601 ...................... ----•--- • - Installer at.........Route 1321 Hyannis, MA 02601 - Hyannis_P�otel-__---David •Banner-------- has been installed in accordance with the provisions of TIT — `�fL'he State Sanitary Col��sd�;�ribed in the application for Disposal Works Construction Permit No..........................�'..—..._....... dated................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.---------•-8/•••-/91.................................................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS ,Y. BOARD OF HEALTH Town.....OF.._.__.__ Barnstable ................... .... ................-••••-•--.................................... No.........--•............. FEE.. ..5.,00....... Disposal Works Tlanstrnrtion rrntit Permission is hereby granted......A & B Cesspool Service --------------------•---•-------......------•-••--•--•--..........................•----- to Construct ( or Repair X � an In "dual Sewage Disposal System Route 1�32, Hyannis, vIA 02901 — Hyannis Motel — David Banner at No................................................................................................................................................................... Street as shown on the application for Disposal Works Construction No.81.-.._..... to . .........8/..4�81 y i Boar Health DATE......--•------a/S'/81-•••••---------•••-•-•----•----•.............. FORM 1255 HOBBS & WARREN, INC., PUBLISHERS 82- 37 3 -r> No.........--••--.... .. = Fps$... .A 0............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T own..............OF........Barn st abld ................................................................... , pphrFatiou for Biipusal ?darks Tvaagtrurfiott amit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: Hyannis Motel, Iyanouth Rd. , Hyannis, MA 02601 ................_--.............................................................................. •..............._....---•-----•--.........----••...._.......-----...........................------ David Banner Location-Aaaress Iyanouth Rd. , Hyannis, MA 02601 ......................---............................,........................................... ..........--...................................................................................... Owner Add e W A & B Cesspool Service 128 Bishop Terrace, V�ss annis, MA 02601 Ins tall.er Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.................................. _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ---------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter...._............... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...............................--•---•------------------•---------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •-••----•----------------------------------•----------------------....-••--........•-----•-•-----............•--•..._...._..------•----...----•......--....-- ODescription of Soil.............5.aJA................................................................................................................................................. x U ---------------•-----------•-----------------.......................................................................................................................................................... W ..................................................-............................................................----------------------------•--------------•------...------•----•--••--•---...------••-- UNature of Repairs or Alterations—Answer when applicable--inSt_allati Qn_.9-La_lie.aY_V... on stone_.Packed--loch-.P t...0 -•...............•---- -•---------------------------------------....------------------•-•----------------•...-•-•--•-•--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the revisions of TiTT,i", p 5 of the State Sanitary Code—The undersigned further agrees n to place the system in operation until a Certificate of Compliance has been issued by --- thb r -f health. Signed r. 6 2 Ste -------- -leA.>---• - ••' .. Date Application Approved BY r. � ................................. 6/2s82.............. Date Application Disapproved for the following reasons-----------------------------•----•----------------------------...--------------•-----------••---•---------•..... .....................•----------••----------•-----•--------------•--------------------.............._..--I---------------•-------•------------------------------•-----._...-----•----- ------------------ Date Permit No.........82----.......--•- -- Issued....-----•6/29/82 ................ Date 82- 337 �.. No......................... FEE$...5.00............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town............................oF...-...Barnatabld..... -----------------------........................... Appliratinn for Disposal Works Tonstrurtuan rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at: Hyannis ?Rotel, Iyanoutti Rd. , H�rannis,.. ... 02601------------•------------------------------••------••---.............-------•---•_-•---• ...............................at ......................................uhRd ...... Location-Address or Lot No. David Banner Iyanough Rd., H�ra.nnis, IAA 02601 •-..................._........................................................................ ......................................... ............._....... W A & B Cesspool Service er 128 Bishop Terrace;d�Apniss., FA 02601 Installer Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Ga Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—. Liquid'capacity......_..._.gallons Length._.............. Width................ Diameter................ Depth................ \ W Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x 3 Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area_...............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY.......................................................................... Date........................................ aTest Pit No. I............:...minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------------------------------------------------•---•......-•--•-......................................................... O Description of Soil-----------54Xd---------------------------------------------------------- x W -----••----•-------------------•--•----••--•----••------------------------------•------•---•---------------------------------------------------•-------------------••--•------------------••-•---•-•-•-- U Nature of Repairs or Alterations—Answer when applicable-installation_-of_-a--heavy duty-1100Q_-gallon stone Wicked lach__Pi (overflow). ----------------------------------•----•-------------------------------------••--•-•--_.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL,;=. 5 of the State Sanitary Code— The undersigned further agrees nQt to place the system in operation until a Certificate of Compliance has en issued_by the b rd-of health. Signe� 6 2$ 82 Application Approved BY -v ._ �r�, '----------------------------------- ...--.-6..2$ Date Application Disapproved for the following reasons:-----•----------------------------------------------•---------•------------------------------...-----.....••••-- ............................•----------------•----•----------------------......_.........---------.....-----------------•-------•-----------•----•----------•--------•---•-------------------•--•---•--- 2................Date Permit No -82 _ Issued. 6/29/8.. ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town..........o Fr Barnstable Ba�natable...................................................... Tnrtifiratr of Tuutplittnrr T II&S V-TO CER�IgY That thf�j,*i o Se y e s osal S-ste con tru 8t d ( ) or Repaired (X ) esspoo 4_ ce, i ps rac�9 Hya Mss, Mx �2601 bY.................................................................................................................................................................................................... Iyamouj,h Rd. , Hyannis, 1,1A 026011nst=°efiyannis 14otel - David Banner at............................................................................................................................................................................................... has been installed in accordance with the provisions of TIT L�R 2 5 of The State Sanitary Code g� gsg Ted in the application for Disposal Works Construction Permit No--------------- _ ,, ........ dated....______..._._...--_--_//__-____................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM 1Al L F NCTION SATISFACTORY. �� / DATE................2.......2...--... Inspector....� ` i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town o F Barnstable £? ....................... No.............2--- = .� FEE.......$_5...00... Disposal Works Tnnutrttrtion "motif A & B Cesspool Service Permission is hereby granted............................-----------------------------------------------------••---...---------------........-----.................. to Construct ( , or r u Sewa e D> sa S st yazuTis NRo 'e� �Iyane agh c�. Hymn s, MA 02601 - David Banner atNo.............•--•----•--•...-•---•--------•.........-----•----------------.......................----------- --------------------•---.........--------------...------............... Street as shown on the application for Disposal Works Construction Per mit No..................... Dated..K-.. 6/29/�2 6/29/82 Board ealth DATE................................................................................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS LOCATION /�jv' SEWAGE PERMIT EMIT NO. VI.LLAG INSTALLER'S AME D ADDRESS �VC ® U I L D E R OR OWNER DATE PERMIT ISSUED �� 7 DATE COMPLIANCE ISSUED . ����.�, a� . ��a Y \ ., ` � p .y �'1 �3 ____-�, �+�sa� . �1 10,/ LOCATION f3� SEWAGE PERMIT NO. VILLAG KoWl5 IN T A ll R'S` N ME i ,ADDRESS e U 1 L D E R , R: `01IN ER 7;� DATE PERMIT., ISSUED DATE COMPLIANCE ISSUED two A Lt)CATIZ SEVAGE PERMIT NO. Ulf— VILLAGE INSTALLER'S NAME & ADDFWS d4,6 oo<--,x7 yezlx� BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �f�a � i NeW� c. P /000 RA &,37 LO CAT I N SEWAGE PERMIT NO. VILLAGE IN T ER'S NA E i ADDRESS 5S Poo BUILDER OR OwN_ER- &Va a"s H U� DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �1 � � t o . , w 20 LOCATION SEWAGE PERMIT NO. VILLAGE Y-, R� r s INSTALLER'S NA i ADDRESS SUILDER OR VNER DATE PERMIT ISSUED _ �� 8� DAT E COMPLIANCE ISSUED _14 _ez w D peo � Q ' le � G LOCATION SEWAGE PERMIT NO. VILLAGE INSTALLER'S /J NAME A ADDRESS y ® U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ®o ASKS MAP N0: �.. y PARCEL NO: Fps......ZLQ.......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH L_.Q w.• ................OF... .w...u.S - -�-e-- Apptiration for Bhipoii al Vorkti Tomitrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at• �. 5 �... �G7 J- c�•1o�a �cQ 32T r— ... d do s CMocati�,_ p 5 " act c� . rr1 t f e '15 �o Owner � Address ...-Y Installe Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Pq Other—Type of Building ............................ No. of persons..................---------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ----------------------------•-•. - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet..................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by:............................-........------------------------------•-•-•- Date........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� -------------------------------------•-.......----- -----------.......................^--------••--•----------.:_... O Desc ' n of Soil n... • .• •o�c� CSC-t�SG- tru (�ek _ l l 1� + !o rj2_ .ems e `' =•` -'`2�e�c u M �`�-.. J C ...... U -� w S $_ e S '.. - -'?-o-� ---�'-----�'-- --- -------'!............................................. UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---•-----•-••••----•-----•-•-•-•-•---•••--•-•••-------••••-•-----••--•••••--••----•...................••-----------••••--.._...........-••-••••----•-•-•-•-----••-•-•-•••-••-•-•-•---•-••---•--•----••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITI 5 of the State Sanitary Code—The undersigned further rees not to place the system in operation until a Certificate of Compliance by the It. Sign 'I Sg Date Application Approved By............. ---.ts-.,�.�....."„� ------------•----------------- ---------- ^ '- D ate Application Disapproved for the following reasons:................................................................................................................ .............•-•-----•--•------------......_......-•••-•-•-•......-•-••-•-------•...-----....••••--•--•---••-------•••-•-••-•-------•--••--•----••------ Date PermitNo........... ......................... Issued....................................................... Date - e \S No.... .:..3..4? } Fims.....43L( .(......._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1................ --- .......OF............::....`...' , �' t I '- Apphr atinn for Dispoii al Works Tnnitrnrtinn ramit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal Systemat..._.. .. ... - - .............. - ....._ ! .-T- ......---- .....! ......-•-• `' ------ ..... Location-Address - or Lot No: ..........-•--•-...-----------------....---•--•---•-•-•---•-----......----...........-•---....... ...------............................. ............................... Owner Address a -------------------------------=---------•------.....------•------- ---..------------------ ---------------- ._.......:: .._.... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___.•.......................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures -----------------------------------------•-•-- W Design Flow............................................gallons per person per day. Total daily flow----...................-....................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter-------......... Depth................ x Disposal Trench—No..................•.. Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �-' Percolation Test Results Performed by---••---•---...--••--•--------•--.....-•--------••-------•------••••_._. Date....................................... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------------------------....._..................••---------------.._...---------------------------------------------------------------------------- 0 Description of Soil...........----.....-.........------------�..---................._........................-----......------`-`--'-- ---`-- -----...........-•=........... ---- ...........................................-.................................... ........................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •----------------------------------••--------------------------------------------------.....----•--•---......----------------------------------•---------•-----------------------------------------••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT .; p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign_5-----�.-.-:-:--- - __° --------------------------------- Application to Approved By........ ...... ..U----------...-- �...�.� .....1 L..- 3---te � .......... - Date Application Disapproved for the following reasons-........................................----- -----------------------............. -------------------•------- .........................................I..._....•-•-••---------•---•----••---•-•-----•--- Ff- 3 Date PermitNo......................................................... Issued...................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............I............................OF..................................................................................... C15rdifirFatr of ToutpliFanrr THI& 6 CE1 4 h -the Individual Sewage Disposal System constructed ( ) or Repairek( ) ...... -------- hJ t�- ( 7 ns al r ,!'� at............................................................................................ .............................-•--•••-------•---•-------••-...•--------•�-Z+,................... has been installed in accordance with the provisions of T j of The.......... e State Sanitary Code as described in the application for Disposal Works Construction Permit No. -----•--.. dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS k GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......................a,._—.... '..��d---...•....------. Inspector............... -- ....��----------•--------•----_--_--------•-•--- THE COMMONWEALTH OF MASSACHUSETTS BOAR/R OF H-tE{/jA,, (T/, H - No...............•-------.. ..................... OF......................•---•....................._..... ......................... Fix . ....:�......... Ww at�. nr o Tondrndion "unfit �� Permissionis hereby g a ted................................................••••--•••••-•---••-••----••------•-•-••••---•---•-•-•----•--....-•---•...............-•-•-•-- to Const�&(7) of �it .,,t�n�I dividtial S&e ,age(f ispo�s—S�s t��m2 �`� � atNo.•----•-•••-••---•.............. ...........•---- U............................................. ---------- ................................ ..... ....._... Street as shown on the application for Disposal Works Construction Permi N . .......... Dated.......................................... G - G---'-�- -3 3- — 'j - Q K' Board of Health DATE............-................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS raw �✓ No. 9 .......... \ • FEB.....a e...l.............. THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ' ------- -- -----..............--.....OF................................:.:... Appliratiou for Bispnoal lforkg Tnnstrurtinn Prrutit Application is hereby made for a Permit to Construct ) or Repair ( ,) an Individual Sewage Disposal System at: ......... ...A.:. ....__•-•••••.j�ajj......=..7.vs<4..... 11:1-•-••- -••-------------------•------••--•-----•--- I Locat�n-Addr s or Lot No. �J i!1+�x;�-------------L'_� f'.. Owner a, f Address .... .. .. { . :...�-fir.... Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms,,,, Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -----•------------------•------•-------------•--------------------------------------------------------------_------•-----------_----------•-•--•---- W Design Flow.....A21�'V.........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length..._................ Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......................................................................... Date........................................ Test Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water.....................__. 44 Test Pit No. 2................minutes-per inch Depth.of Test. Pit-------------------- Depth to. ground water........................ O Description of Soil.......................................................................................................................................... --------------------------------------------------------------------------------------------------------------------------------------------••-- ! U Nature of Repairs or Alterations—Answ r when applicable !.= __.____ Ss -- ,�;4, ���•.._-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code The unde •gned further agrees not to place the system in operation until a Certificate of Compliance has be n ss by the and of health. 1 Signed......... ----4- --- --------------••-=----------- .............I.................. Date Application Approved By.............. -------- c Date Application Disapproved for the following reasons----------------------------•-•---••------------------------••--------------------------------•-•--•--........--- -•----•-----•-•••-•---.._.....•••••••-••••....--•--------•-•••---------------•---•---•........-----••••--••••••••--•--•..._...----•-------•-••-••----------•-•-•--•------••----• ....................... Date PermitNo......................................................... Issued....................................................... Date ♦•-•••••s•-•se•e•••••ss••••••••.•••••s••ee•e•••se�see�e••+s�•�s�aa�••�►s�•••eeeeee•eeeee••eee•••••ee�••�••a•••••ae••re-.-•�s� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.......................................................... ..................... Ae Tn#ifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by------------------- ......,frr..P.c ...........................................-------------------•------- --•-••---...---------•--•----•------- Install......---- .. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit .............. dated_-...__-._-._-_-___----__.................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._.......--•------•-----------------------------•--------•-••-•••----...-••-_... Inspector.................................................................................... No......... Fps............. v- THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ........................ .......OF......... ......... ................................ AppliraTion for Disposal Works,�tv4strnrfiun rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ; ) an Individual Sewage Disposal System at: . (t 1./ 4 2"'t, /-3-� . ...:....- .J. .... ...............•.....-•-------•-•---.......--•••-••--.....•--•-• -- Location-AI f or Lot No. Address a .....--••••-----------•-••---•---------------------•---...................•....................... ......------............- Installer Address Type of Buildirrig Size Lot----------------------------Sq. feet Dwelling No. of Bedroom, ,.L------------------•_--_----__-__-Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building .............. No. of persons............................ Showers ( ) — Cafeteria ( ) a YP g -------------- P If 0 9 'tures - --------------------------------------.-•------------------------------------------------------------•--------•-•----........-•-•----- W Design Flow..........................................:.gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid'.capacity-----..____-gallons Length................ Width..............._ Diameter---............. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total,leaching area....................sq. ft. Seepage Pit No_,-,---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......`:................. (� Test Pit No. 2................minutes per inch Depth of Test Pit...._............... Depth to ground water-------................. ... .............................................. .......................................... Descriptionof Soil _ -------- ................. --- _........-............ ............. ........................................................ :. V -==-------------•- ---••---- W ......................------------------------------------------------- -----------------...............-............................ ? U Nature of R airs or ten tions—Answer when applicable_____-. %� ! ___.._. �i�G1 �....__.._ .................`.. ._.. ---------------� --..��-----•-----------------------•---......------------•----------------------------------•-----------------------•------. ---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Samtar od �- The urhersigned further agrees not to place the system in operation until a Certificate of Compliance has ee i ed by t oard of health. Signed..... G"" '�t""i-. Date Application Approved BY-----------. y i ................................. Date Application Disapproved for the following reasons--------------------••---------------...--------------- .................................. .................•--•------------•---•--...-------••--------------=--•------ ......................................... 0 r Date - PermitNo......................................................... ISSU61....... _ { Date THE COMMONWEALTH OF MASSACHUSETTS - BOARDS OF HEALTH , f$ OF..............a..............:3...............................:....................... Trrtifiratr l f Tuntplianrr THIS IS`-T0 CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -tom: ----------------••-------•------------•--- Installer at------------------ -• has been installed in accordance with the provisions of TITLE 5 of The State:Sanitary Code as^desdribed in the application for Disposal Works Construction Permit No.. z .._.... ' dated.........................:��;`.._......___._. • ;�y THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT-THE SYSTEM WILL FUNCTI@N' SATISFACTORY. DATE........................................................... ...........:.: Inspector.......................... THE COMMONW 'ALTH OF MASSACHUSETTS r BOARD OF HEALTH ............................OF............................... Disposal Works ITPOnstrudion Vprrmit Permission is hereby granted............. ......... to Construct ( ) or\Repair ( ) an Individual Sewage Disposal System atNo.. .._.........fj ;.... .,z,t -- ---------------------------•------------------:.............. ' � Street � gas shown on the application for Disposal Works Construction Permit,No.__--_••_- _-__._-- Dated................... } .......•-•............ DATEy I oard of Health ---------••--------------------------•------------•�.....:....... .....:.. FORM Fi255 A. M. SULKIN, INC., BOSTOW%+: r ; i No.40?,L3 V a THE COMMONWEALTH OF MASSACHUSETTS BOARD 'e HE LTH �� .---......OF.......:................................. ...._.. Aptiration for Uiipla ial Works Tonstrnrtion Vrrmit Application is ereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal ' - System at: .....--••-------. .`...... .,� .. ---_�. .................................. ........•-- ... - .......... ......... -Locati -Address or Nro�. ....------. .. ....... �...1 .' -. I..................•-- �• Ovyner /// _ •�-- •Address ( ................................................................................................................ Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 14 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Q' Other fixtures -----••-•------------------------------------- ---- ------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow_._._________________________.._._......_.__gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_____________________Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-_---------------------•-------.... ................. _......... --•--•- Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit____._-__________... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ---------------------------------------------------------------•-------......_....._._....-•----_............................................................ 0 Description of Soil---..................................................................................................................................................................... x V •-•----•---------•-•--------•------- --------•--•--- ...--- W _ U N ure of epairs or Iterations nswer whgn appl' blew_..____ .: ........... ....��._._.__.__._.__ _.- Agreement: The undersigned agrees to install the aforedescr ed Individual- isposal System in accordance with the provisions of TITLE 5 of the State Sanitary Cod The undersigned f th ;� rees not to place the system in operation until a Certificate of Compliance has been ' sue by the b and of e Sig --_...- •------•-_... ......- -----• •-•---•-------------•• -- � Date ApplicationApproved By.......................•------------•-.............................. ---------•---........•-•- Date Application Disapproved for the f ollowi re ns:..................................-•......................................................................... --•---------=--------•----_..._.....-•---.._..._.....-•-----_.....__.....---•--------........•----....-----------------••-----••---•-----•--•-----•-------•---••••-•--•-•--•--•---•-••----•••--••------- Date PermitNo......................................................... Issued....................................................... Date -c �THE�COOM^O�N®ACTH OFUACS,SA;MASSACHUSETTS >j BOARD rl G. L 1 I7..................... ....................0 F...............--....-...:.:.......__....--.-............................................ Appliratiaau for Elispaaaittl Warks Taatt3truru ott Frrutit Application is ereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ....._........... - ................................................................... Locati :Address 0fij N, .............:...; ;__.. .._... --_:-- •-••------ ..........• - --•- - .................... W d2"ner ......... .................... YY tr.Q._._.... .....: ....... Installer Address Type of Building Size Lot............................Sq. feet .., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type T e of Building No. of ersons____________________________ Showers C4 YP g ---------------------•------ P ( ) — Cafeteria ( ) Q' Other fixtures _____________________ d -----------------•-----------•--—--------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..........................._.............................................. Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Tit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ - i ---•--------------------------------------•---------------•--••--•---------•-•-••-••--••-••-------- -------------•-•-•----•------------•-•------------•----- : 0 Descriptil Soil_________________ U --------•••......................•-••----------f---....---------------------------...----•-----•-••--•-•------------I_.. ..--•------••--------.....---------- ;- ............................... UW •-•--•-----•--------------------------••---••-••-•-•---•-•-•-------••---•------•-••--------------••----•--•-•--- ----------- N ure of gg-a' or Iterations nswer w n appl blew____._ --- ___.......................... Agreement: The undersigned agrees to install the aforedescr ed Individual S isposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Cod The undersigned f th rees not to place the system in operation until a Certificate of Compliance has been sue by the b and of Date ApplicationApproved By...................--- ....................................................................... Date Application Disapproved for the f ollowi re ons:--•--•-••------•-•-------•-•----••-----••----••--•-•-••-------•-------•---•-----•...........................•-•- .....................•---------------.._--•---•---------._.....-••--------•-----•--...------------...--•-------------------------•--------•--------.................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y�..►/� J/d ..............................•--.........OF...-...... :+.fla.".:•r/.7•':-:r..: :................._.............._... (Intifiratr aaf Taautpliattrr THIS IS TO CERTIFY, at the Individual Sewage Disposal System constructed ( ) or Repaired by - .--...... ------------------------•--- -- -------- -•••-----.......-••-•••---.....•--•..................._....•-----......•- Ipstaller at.._...__.._ - .- ......... has been installed in accordance with the provisions ofT� 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .-el___SY>____________ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 7 /Z DATE...................... .................................. Inspector..--•-- ` �r� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH NreO.............. FEE---••.................. Disposal Works Tonstr tiatt rrutit Permission is hereby granted---------- ------ •• -'........ ::... . '---------------------------------•----------......-------............-•---.... to Construct ( ) or Repair ( an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction It No...................__�D�aed.......................................... Bo��of` Health DATE............. - ��f��.............................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS y� THE Tp No.-----z -- y`� O FICE OF THE BOARD OF HEALTH % BARNSTABLE o OF THE MASS. I 9�'ArFp 39 k�e� TOWN OF BARNSTABLE, M4S§. p — - .-- ---- ------ 19 d n SEW E DISPOSAL PERMIT _ ____ o construct � � Permission is granted to�� --r- - - a-- t 4 - �.• - "' ------- 10 ,Up the Premises of f Sketch __________ _____ ___________ In the. village of T 100 or more feet from any sour of water supply' , 20 feet from building 10 feet from property line ««�- 1' Health Officer. 7 LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A,4 LER'S NAME & ADDRESS "o . I-1-Ae2z I c!!!6 �5S 0 UILDE R OR OWNER DATE PERMIT ISSUED i�; 2 31,*/ DATE COMPLIANCE ISSUED d Q 8 a � -o s -7� /�' CAA ou TOWN�F BA NSTABLE LOCATION S — SEWAGE # VILLAGE L — ASSESSOR'S MAP Cz LOT INSTALLER'S NAME PHONE NO. / A & B CANCO 175-6264 SEPTIC TANK CAPACITY o e ,O,(s ax V lie. Pr- LEACHING FACILITY:(type) AL1-e-Z--5- (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER -�2�,L� DATE PERMIT ISSUED: - ^-4y _ DATE COMPLIANCE ISSUED: p - Z 3-S T VARIANCE GRANTED: Yes No rye/$L lit SAW, Vz n fia v x o �L THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: Lae.. Z3 4r-& BUSINESS LOCATION: I (A a yu 0,.,k 4 MAILING ADDRESS: f' ' INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: 50 9 —77/—SQ06 CONTACT PERSON: A.�7a_�e?a i . C,4&e4 Cr��i,r�eel r7� en c EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: /fit/ SOS- FIDE 0(57IGT OTHER INFORMATION: exi.42a. s G J C,9A / INC9, eon M S AS oh 5if� " Waste Transp ation: 7AJo 14az__ waste Name of Hauler: IV� Destination: Waste Product: Licensed?. Yes No NIA LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid '-7 aak Disinfectants ; _ A— Engine and radiator flushes _6� Road Salt (Halite)�Scc-/a'! - y" Hydraulic fluid (including brake fluid) �/,aaCRefrigerants Motor oils Pesticides '1aat NEW USED (insecticides, herbicides, rodenticides) Gsatine, Jet-Fuel ir�se�r Photochemicals (Fixers) DieseG fuel, kerosene, #2 heating oil NEW USED 2 Other p troleum products: grease, Photochemicals (Developer) lubricants, gear oil , NEW USED , �L Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) t Battery acid (electrolyte) 1-(0 aqA Swimming pool chlorine Rustproofers Lye or caustic soda .2 57 h detergents Jewelry cleaners ) Car wages and polishes Leather dyes Asphalt & roofing tar � Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc: carbon tetrachloride)- Paint &varnish removers, deglossers ._ Paint brush cleaners �4,Any other products with "poison" I;bels (including chloroform,formald-�nyde, Floor &furniture strippers hydrochloric acid, other aci(as) Metal polishes Laundry soil &stain removers Other products not listecJ which you feel (including bleach) may be toxic or hazardous (please list): $ k Spot removers & cleaning fluids Misc.: W /a a�l � Other cleaning solvents _ C. a,L _ Bug and tar removers Z S V\12k V I l + J1,A.14.2004 2:52PM BARNSTABLE BOARD OF HEALTH 80 � 1� 2/3 Town. of Barnstable Regulatory Services / Thomas F.Geiler,Director +� Public Health Divisio Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Me: 509-962-4644 Fox 408.790.6304 �! '�O y Application Fee:�100.00 `g• ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT.TO STORE AND/OR UTILIZE MORE THAN I11.GALW-NS OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT ZZal) Y-O NAME OF ESTABLISHMENT �- ADDRESS OF ESTABLISHMENT �2t24/J�2 TELEPHONE NUMBER SOLE OWNER: YRSNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.. ;y STATE OF INCORPORATION y,!!a,!:m bho FULL NAME AND HOME ADD RE 3 OF: , r ' PRESIDENT GU ' ` 3 3 s TREASURER CLE SIGNATURE OF AAMICAn RESTRICTIONS: ROME ADDRESS /�/ tr1�ryooa . .00ftu HOME TELEPHONE#_ 5 n,9— IiabdooPo�/q _ ' - o .3 t �; T BLE UL " k • S -s - 1� .4+ + j'i �S r 7 "`' .p ti .. a t '� Y. ra t y 4' Number F -0h.; r R. 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't r*� � �- r'1'-�.rt r �' 1't..�; .�-":TM3, ,7 far;.. 7'i tT r'� �'�} ,`a. '�S s. t �'SE+ :7�, ,.� $�fi JY,. r;. a rt� i '�: ♦ J�° ':k � J 'J' ; c a`, c� r� �`.t _ •','.F F.L ,?+ x ,. 'CF yx x r `1 p -, A' . TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM' NAME OF BUSINESS: �"c�_.�.�5 /7t�lc C� �7���°� Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable MAULING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT PERSON: 7i�� ' EMERGENCY CONTACT TELEPHONE UMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above,.please indicate if the materials are stored at a site other than your mailing address: ADDRESS: ` TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case /Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants twMotor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) 'Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) _ 9 Rust roofers / Swimming pool chlorine P Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business • • i ' ' iCOMPLIANCE: CLASS: 1. 0rine,Gas Stattions,Rep • • • ' • ' • �♦ �° Auto Body Shops 4.Manufacturers • 5.Retail Stores 6.Fuel• �� � Suppliers7.Miscellaneous off • Case lots Drums Above Tanks Underground Tanks,,", MENNEN NEMIN I 'go 1.020WIR- A, I MEN M NE11011M 1001011M In MENOMONEE on MENEM �� . . _ IiLL'J►i L./, 0 fflyffln.� rdNa Name of Hauler Destination Waste Product Licensed? TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS:. `7G2 Town of Barnstable TELEPHONE NUMBER: `7 7 / - yo i z P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quan (ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: V Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants L,� Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil ✓ Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink -, Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers ✓ Swimming pool chlorine P-) 5� Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels --y Metal polishes (including chloroform, formaldehyde, Ve Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business • _ J kBLE 1 Ousehold Hazardous Waste Collections, 1991 - 1994 ape Cod, Massachusetts Date Held 7191 Waste Collected 1992 1991 1991 3rn$table 1991 1942 1993 199t no O1D No� No cmucctlma 25ann _ ou me Iro won rJb 2a-1u1 - - 3.mo Fol rewster - 97s to sas 1•Jd sy 2-May S-alar 7-b"T 1.175 2.6m 2A10 1.640 hatham 7-Sep 27 ennis Noaoo�,t 11 � I•� 1-125 1.815 smao 'B No amnacbm 4-A;w!I S-Om No a gkcom No amawcoo 18 No aoaedfao almaulh 1 - 1.100 _ =- 28- S A s.lo5 2.986 2im Ji rwl ch a.71ts �-Oci �17et 22-May/6-Nor 29-Jvt 1.550 2.105 1.655 ss pee 20,.1W No coaamam No rieans 30• ' 'g 1.070 I.Z?S -- sat FALm X Ah roYlnCetOSR La a-M+7 17-Sep 1.592 1aAamm, .180 1.41a , 5 2&4 andwich 5- 13-Now I-0cY 2.noo27-Jut 22-Aus 31.h so.Ail 400 rur0 No dub 1.FaZ0 3.140 SAas 13-Jar 7-ldW/1-0id g� e l l t I e e t I A48 lso/1.906 31-Oct 13-Nov T 1Asf11-Oei g,tp arrnouth 7� SzTVUM saeTt no 22Jua 27�hsn 26Jun 25�� I AM 1.825 2a36 2 SW otals 1 XIS 37.765 21A20 a1 J54S too 011ed by Cape Cod domisaton,daft-WPLId by Tb, rite Collected Is in galimn 's 1963 tad J oo�Lectbat���m''�'��for Tc> ro/We3itleei, 199Q. � t mHe At>Moetawra and Trs:ro 2��m and Wejjticet nc 1993 and 1984.ftLmoutb mod)tom unt of rrastt 0"bl for Trutn f WeWkvI 1198.3.19"mnd ftLnouthjmaahpce(19"Is In bout eas=s aanibiried data from the two to.vsas, l 99-4. the tawas of C5tltam,Dennt,,Falmouth,Or4m�ts,p� saetowrn.Truro, and hmidass wraite in adriftSan to she gaLIOnage sh wrn abovm- collected 2.TZ3.4 pa�ida d aon-lLquW Ltousehold ')=Fatlasazcd data � I f Z '348 e59 776 Receipt for �. Certified Mail No Insurance Coverage Provided 1pUTED STIIrt Do not use for International Mail POST1LL SEhICE (See Reverse) OQf Sent to r, r - , ,t Streei.and No. !//� State and ZIP CoddJ p� O A co Posta e M E Certified Fee O LL Special Delivery Fee Rg�SF�gdiQ;��e,y f `Y,7 ;fiU%p ff�gCe P c5;P. .. to Whom&Date D i Return Receipt Sh t Date,and Address e s a TOTAL Postage &Fees Postmark or Date 09Z STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want tltis•recei" p' t postmarked,stick the gummed stub to the right of the return address leaving the receip�t,`�ttach'ed antl:'present the article at a post office service window or hand it to your rural�rGfer�no�xtr�a chargel.J^S� � 2. If you do not,want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date, rA tdetachiand retain the receipt,and mail the article. ✓ \ L 3. If you want a�eturnreceipt,write the certified mail number and your name and address on a return receipt"corrd,Fmm'3811,avid attach it to the front of the article by means of the gummed ends if space permits:p�theiwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent t—o the number. OC co 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If li p� return receipt is requested,check the applicable blocks in item 1 of Form 3811. a I 6. Save this receipt and present it if you make inquiry. 105603-93-13-0216 1• SENDER: o ■Complete items 1 and/or 2 for additional services. I also Wish t0 receive the �.y ■Complete items 3,4a,and 4b. following services(for an y ■Print your name and address on the reverse of this form so that we can return this extra fee): .. card to you. ai ■Attach this form to the front of the mail piece,or on the back if ace does not d e p p 1. ❑ Addressee's Address permit. •Z d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery, r ■The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. c a 3.article Addressed to: 4a.Article Number m �d Mr. ASP Tr -Ycr► Z 3�f 8 (o59 � 7 `E y� 4b.Service Type I U k'- 1 r /c r-- ❑ Registered Certified c co l I W � / 40 ���Q j ❑ Express Mail ❑ Insured 3 (O c(u�. H I IM C MA ❑ Return Receipt for Merchandise ❑ COD owvl 1 S 0� 7 ate of livery C ;� •- Z �V ; APR � �d/�6 1:3 5.Received By: (Print Name) 3 Addressee's Address(Only if requested c I¢ 9c a/nd fee is paid) t g 6.Sig : Addressee or Agent) v J 10 j-w I Ps Form 3811, December iss Domestic Return Receipt +I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 s Print your name, address, and ZIP Code in this box• w i Board of Health Town of Bamstable P 0.Box 534 Hyannis,Nlassachuaetts 02601 I I Town of Barnstable Health Department } """ 367 Main Street, Hyannis, MA 02601 Office 508-79"265 Thomas A. McKean FAX 508-775-3344 Director of Public Health April 25, 1996 Mr. Art Triveri K-Mart , 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 21, 1996 at 7:00 p.m. Thd meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you have not complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program( 310 CMR 27.00). If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, omas A. McKean Director of Public Health I Date f/ � Dear-- -- - You are required to appear at the Board of Health hearing schedulij on at, 7:00 p.m. The meeting will' be held in the Second Floor Hearing Room f Town Hall. At this meeting you or your representative wi 1 be aske� to explain why you have not complied with the order letter dated a R% regards to the State's Underground Injection Control Program (310 CMR 27.00) . If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, Thomas A. McKean Director of Public Health JUN 7196^ 18 : 26 FIR K—MP LEGAL DEPT . 810 643 10 TO 915087753344 P . 01 Peter Palmer Kmart Corporation Vice President International HtaC,Jorters labor Relations 3100 West Bic Beaver Rood Assistant General Counsel, Troy MJ 48O 4.363 81 0 643 1682 Jeffrey J.Reitmyer $10 643 5619 Shavan Giffen Sherry L-McMillan 810 643 1846 Employment Law& Louis Zednik 810 637 65dd Environmental Richard L.Kalcjian 810 643 1144 Caw Counsel Michael J.Lane 810 6a3 5499 810 643 1631 'I ELEFAX J'RANSMI I"�AL DATE: TO: "�. TELEFAX NUMBER: FROM: LOUIS ZEDNIK SENDING A TOTAL OF 4—PAGES,INCLUDING THIS COVER PAGE. IF YOU ISO NOT RECEIVE ALL PAGES, OR ARE EXPERIENCING OTHER PROBLEMS IN TRANSMISSION,PLEASE CALL THE SENDER AT (313) 637-6544. THANK YOU. Our telefax machine telephone number is: (313)643.2514. COMMENTS: CONFIDENTIAUTY NOTICE: The pages constituting this f rc contain confidential information ' which is legally privileged and intended only for the use of the recipient named above. If you are not the intended recipient,you are hereby notified that any disclosure,copying,distribution or taking of action in reliance on the contents hereof,except direct delivery to the intended recipient named above, is strictly prohibited. If you have received this fax in error,please call immediately to arrange for return to us. JUN 7 ' 96 18 : 27 FR K—MART LEGAL DEPT . 810 643 1054 TO 915087753344 P102 Pater Palmer Kmart Corporation Vice President International Headquarters Labor Relations& 3100 Wes►Big Beaver Road Assistant General Counsel Troy Mt 48084.3163 810 643 1682 Louis Zednik 810 637 6544 Shavan Giifen Matthew J.Home] 810 643 5619 Employment Law& Janet M. Crockett 810 614 1385 Environmental Law Counsel Richard L.lCplojian $10 643 1144 Janet C.Wlosinski 810 643-5499 $10 643 1631 June 7, 1996 Mr. Thomas A. McKean Director of Public Health 4. Department of Health, Safety and Environmental Services Public Health Division P.O. Box 534 Hyannis, MA 02601 Re: Penske Auto Centers 768 Iyanough Rd,Hyannis, MA Kmart#3040 Dear Mr. McKean: This letter will follow-up my telephone message left with your office today. Based on the reasons more frilly discussed below, I am requesting that that you provide Kmart Corporation("Kmart')additional time in which to respond to your late May 1996 letter. I also request that you remove the above-referenced matter from the Health Board's June and July 1996 agendas until Kmart's Landlord has responded to Kmart's enclosed June 7, 1996 demand letter. As indicated in the enclosed formal notice of default letter,Kmart has directed Cape Harbor Associates, the Landlord at the above-referenced location,to comply with the Landlord's responsibility forgovernmental compliance under Article 17 of the parties' lease. Pursuant to Article 17, Cape Harbor Associates is responsible for the auto service center floor drain connection upgrade compliance requirements under the Massachusetts Underground Injection Control ("LIC") Program and Plumbing Code. Given the nature of this environmental compliance issue,Kmart is proceeding in good faith by seeking waiver of the thirty(30)day period under the Subordination,Non- Disturbance and Attornment Agreement with American Saving Bank,FSB to correct or remedy the Landlord's default. Further, in the event that Cape Harbor Associates fails to cure its default, Kmart will undertake the work required to bring the auto service center drainage system into compliance with the Massachusetts UIC and Plumbing Code regulations. JUN 7 ' 96 18 * 27 FR K-MART LEGAL DEPT . 810 643 1054 TO 915087753344 P- 03 Mr. Thomas A. McKean June 7, 1996 _page 2- In light of Kmart's obligations to the Mortgagee and Kmart's commitment to regain compliance should the Landlord fail to cure its default, Kmart requires an additional 30 days in which to obtain(a)either the Mortgagee's waiver or allow for the cure of the Landlord's default and(b)written confirmation of Cape Harbor.Associates' intent to cure the default. Upon my receipt of the Landlord's response, I will advise you as soon as possible, but no later than July 15, 1996. Should you have any questions regarding this matter,please feel free to call me at (810) 637-6544. Thank you for your cooperation. Sincerely, Louis Zednik Environmental Law Attorney Encl. cc: John Walsh,Esq., RIH (w/encl.) Cape Harbor Associates (w/encl.) c/o Trammell Crow Realty Advisors 3500 Trammell Crow Ctr. 2001 Ross Ave. Dallas,TX 75201-2997 VIA FAX AND MAIL (508)775-3344 JUN 7196 18 : 27 FR K—MART LEGAL DEPT . 810 643 1054 TO 915087753344 P.. 04 Kmart Corporation Inteenationol Heodquorters 3100 West Big Beaver Rood Troy MI 48084-3163 June 7, 1996 Cape Harbor Associates c%Trammell Crow Realty Advisors 3500 Trammell Crow Center 2001 Ross Ave. Dallas, TX 75201-2997 Attention: David W. Campbell Re: Kmart#3040 Hyannis, MA Gentlemen: This letter constitutes former notice to you, as Landlord,on the above captioned property as to a default under Article 17 of the Lease("Lease")dated June 29, 1972,as amended. (Article 17 states that Kmart is responsible for compliance with governmental regulations, including non- structural changes insofar as they are due to Tenant's occupancy;however, all structural ehmmes, or non-structural changes if they are required irrespective of the nature of the tenancy, shall be complied with by Landlord at its sole expense. The type of work the Town is requiring here is considered to be stnictural in nature, and as such,Landlord's respon- sibility to perform). During an inspection of the premises by a representative of the Town of Barnstable, it was - observed that the floor drains in the automotive service center were tied directly into the septic drainage field via an oil/water separator system, which type of setup is a violation of the Federal.Safe Drinking Water Act(a copy of the Town's notice to Kmart is enclosed for your reference). Under the State Plumbing Code,oNNmers/opemtors of facilities with floor drains tied to injection wells(which the septic field is classified as)have three(3)options: 1. Seal the floor drains 2. Connect the floor drain to a holding tank 3. Convect the floor drain to a municipal sewer system, if available Option #1 is not viable, as it requires that all previous discharges to the drain be eliminated;as Penske operates this space as an automotive service center,fluids and potential contaminates will continue to be used. Further, we have investigated connecting the floor drains to a municipal sewer system, however,there is no sewer he within a reasonable distance, so Option 43 also does not appear to be viable. It is therefore recommended that Landlord pursue Option#2 to bring the automotive drainage system into compliance with governmental regulations. It should also be noted that, if in the course of performing the outlined corrective action, contatrwiation of the septic field is discovered,then remediation of same will be necessary. JUN 7 ' 96 18: 28 FR K-MART LEGAL DEPT . 810 643 1054 TO 915087753344 P.. 05 l Cape Harbor Associates June 7, 1996 Page 2 In the event of Landlord's failure to cure such default, IGnart Corporation,as Tenant,will have no alternative but to undertake such work and request reimbursement from Landlord. If such reim- bursement is not forthcoming, Kmart will offset the expense of such work from future rentals as provided in Article 29 of the Lease. By copy of this letter,we request American Savings Bank,FSB to waive the thirty(30)day period provided under the Subordination,Non-Disturbance and Attornment Agreement to correct or remedy such default. If Mortgagee does waive such period,Kmart will act to cure Landlord's default upon receipt of waiver,but not sooner than seven(7)days after Landlord's receipt of this notice. Sincerely, KMART CORPORATION By. J t John F.Walsh, Resident Counse JFWf MP/ar Enclosure cc. Cape Harbor Associates c/o RIS Enterprises, Inc. 1303 South Frontage Road, Suite 13 Hastings, MN 55033 cc: American Savings Bank, FSB 1133 Avenue of the Americas New York,NY 10019 D. VanLoo P. A. Gawel L. Zednik D. R. Guthrie-Pittsburgh Construction Office J. Dewar-Albany Construction Oice CERTIFIED MAIL RETURN RECEIPT REQUESTED 1 �' ;.:.. .... x O(A ^t 17 —tali Ckw or lc �` a Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 ba Office 308-790.6265 Thomas A.McKean >; FAX 508-775-3344 Dit f 6f Mile Health h i April 25, 1996 ' s f Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 2191996 at 7:00 p.m. The meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you h6v6 hot' complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program( 310 CMR 27.00). ' If you should have any questions please telephone me at(508) 790-6265. Sincerely yours, �jJ! r. omas A. McKean Director of Public Health t RA t x �• 7 4 f y � +i 6 Date 1 B - Dear-- y:du are required to appear at the Board of Health hearing schedulJon at- 7:00 p.m. The meeting will be held in the Second Floor Hearing Room f Town Hall. At this meeting you or your representative wi 1 be ask� to explain why you have not complied with the order letter dated /`Q Nin regards to the State's Underground Injection Control Program (310 CMR 27.00) . .If you should have any questions please telephone me at (508) 790-6265. Sincerely yours,; 3x Thomas A. McKean Director of Public Health l'r "y S. I' - ® SENDER: 0 ■Complete Items t and/or 2 for additional services. I also wish to receive the ■Complete Items 3,4a,and 4b. following services(for an a► ■Pdnl your name and address on the reverse of this form so that we can return this card to you. extra fee): > ■Attach this form to the front of the mallpleoe,or on the back if space does not . ❑ Addressee's Address o •Wl rite'Refum Recelpf Requested'on the mailpleoe below the article number. fs •The Return Receipt will show to whom the article was delivered and the date 2. Restricted Delivery C delivered. C Consult postmaster for fee. V y3.A.P111cle Addressf ed to- 4a.Article Number bar I ' Ir, ArP Trk'✓er►' Z 3Y 8 1059 —7 7 4, cc E f/, 4b.Service Type R — ' I 1 c r� ❑ Registered Certlfled �g arl O O ❑ c Express Mail ❑ Insured y M A Return Receipt for Merdtandise ❑ COD °a N an n I S fy�A Dog ate of Poilvery 5.Received By:(Print Name) _ A dressee's Address(Onty if requested m Q a d fee Is pa/d) am g 6.Sig : Addressee or Agent) —_ 0 1' PS Form 3811, December 19 N _ Domestic Return Receipt a ..... Z'348 '659 776 Receipt for Certified Mail No Insurance Coverage Provided UIYTEDC4f� `o not use for International Mail OOSr45FYVICF (See Reverse) Sent to r, r T Scree and No. lk1ex P. .,State and ZIP Cod oa 0 Posts e . � Certified Fee ' D Special Delivery Fee '' ,icted Defiveiy;,aF e"'" -R1urn'Aecelpr'SV —�to Whom&bat Return Receipt SDate,and Addrea (/) TOTAL Postage ^ &Fees Postmark or Date �9Z ' P j% P . 496 564- Receipt for Certified Mail .� No Insurance Coverage Provided Do not use for International Mail (See Reverse) Sen o ^ v street andblo.1:21,0 �. n-r) /6 P .,State and ZIP C de Posta e i Certified Fee / /C/ Special Delivery Fee Restricted Delivery Fee Return Receipt Showing O) to Whom&Date Delivered Return Receipt ShovYjgg'tQ'Wt r- Date,and Addre 9;s� d[e§S iY TOTAL Posta + ,� C &Fees Cry ec -7 0 Postmark CV16Je M E % o W a ..:rear STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(we front). y 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address � leaving the receipt attachbd and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return �. address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Ftprm 3811,and attach it to the front of the article by means of the gummed ends 9 space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent•to the number. O " O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E o" 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this receipt and present it if you make inquiry. 102595-93-z-0478 0 SENDER: rn Complete items 1 and/or 2 for additional services. I also wish to receive the • Complete items 3,and 4a&b. following services (for an extra Gii Print your name and address on the reverse of this form so that we can feel: > 4) return this card to you. d • Attach this form to the front of the mailpiece,or on the back if space 1. ❑ Addressee's Address y does not permit. t • Write"Return Receipt Requested"on the mailpiece below the article number. .. � 2. ❑ Restricted Delivery •d • The Return Receipt will show to whom the article was delivered and the date c delivered. _ Consult postmaster for fee. 0 3. Article Addressed to: -' 4a. Article Number 0c m r, A(4- j(, ve r l' c _ r� 4b. Service Type ; � G. ❑ R Istered ❑ Insured v � W �/ j c/a an (� Certified El COD Euyi (� -F—7 iK�/ ❑ Express Mail ❑ Return Receipt for W Merchandise G L/U {�1) ! S/ f 1� �C0 7. Date of Deliv ry a /2— '0 5. Signature (Addressee) 8. Addressee's Address(Only if requested,Y and fee is paid) c H r ` Uj ge 6. S' a re 1 ~ I ; H PS Form 381 , Dec.WnberJ 1991 *u.s.G 0•1ee3-452 DOMESTIC RETURN RECEIPT i UNITED STATES POSTAL SERVI� �N. 9 P fl/ 47 Official Business m ' 0 E C A PENQLTa<�-@R -Rl TE - USE TO YM ' /99C� POSTAG , Print your name, address and ZIP Code here Heaitb Dope 1 Town of Bam W$ P.O.Box 534 <" f11«It1,1j1�,t1„���4I If,1., _I fit Illtl ttill it iI1a11 4 Town of Barnstable Department of Health,Safety,and Environmental Services ■ MSTABLB, ' MASS. Public Health Division 039. &` 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health December 4, 1995 Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis,MA 02601 Dear Mr. Triveri, RE: Penske Auto Centers,768 Iyanough Rd.,Hyannis On December 1, 1995,Donna M.iorandi,Health Inspector for the Town of Barnstable observed floor drains connected to an MDC trap and then to a leach pit,which is considered an Injection Well. As mandated under the Federal Safe Drinking Water Act,the state Underground Injection Control(UIC) regulations prohibit potentially polluting discharge to injection wells. Vehicle maintenance operations commonly use unauthorized injection wells,such as floor drains leading to a septic sytem,dry well, or oil/water separator which leads to any subsurface leaching structure. Under the State Plumbing Code(248 CMR 2.09(1)(c)(3),owners/operators of facilities with floor drains tied to injection wells(or discharging to any surface point)have three options: 1. Seal the floor drain. Contact your local plumbing inspector for the appropriate filing form. If choosing this option,all previous discharges to the drain must be eliminated at theri source. For example,cars should no longer be washed and floors should no longer be hosed down. 2. Connect the floor drain to a holding tank. The tank will need DEP approval. The DEP approves two types of holding tanks for this waste: new installations and conversions of existing structures (e.g. oil/water separators). These tanks are for non-hazardous, industrial wastewater. If solvents, antifreeze,oil and other fluids are washed down the drain,the waste is likely to be hazardous. 3. Connect the floor drain to a municipal sewer system,if available. An oil/water separator is required to be installed under this option. This requires a permit from DEP and the Town of Barnstable Department of Public Works along with the sewer connection application. The amount of discharge shall not exceed ten parts per million(10 ppm). In all cases,the owner must file a UIC NOTIFICATION FORM with DEP. You are directed to comply with the state's UNDERGROUND INJECTION CONTROL regulations (310 CMR 27.00)by informing this department in writing of your intentions within ten(10)days of receipt of this notice and completing the work within thirty(30)days. PER ORDER OF THE BOARD OF HEALTH / �, "Thatfias A. McKean Director of Public Health Enc. Industrial Floor Drains cc: Ed Jenkins,Town of Barnstable Plumbing Inspector Town of Barnstable Department of Health, Safety, and Environmental Services �► MAN. Public Health Division � MAN. Eo+ � 367 Main Street, Hyannis MA 02601 Office: 308-790 6263 Thomas A McKean FAX: 508-775-3344 Director of Public Health 'Deca 1�1k® Afi�'r -rkI V6ki (g J AMOUG4 no i Dear 0 ��l�l/E2% Hlvpvlv/v sW As mandated un er thTOW deral Safe Drinking Water Act, the state Underground Injection Control (UIC) regulations prohibit potentially polluting discharge to injection wells. Vehicle maintenance operations commonly use unauthorized injection wells, such as floor drains leading to a septic sytem, dry well, or oil/water separator which leads to any subsurface leaching structure. Under the State Plumbing Code (248 CMR 2.09 (1) (c) (3), facilities with floor drains tied to injection wells (or discharging to any surface point) have three options: 1. Seal the floor drain. Contact your local plumbing inspector for the appropriate filing form. If choosing this option, all previous discharges to the drain must be eliminated at theri source. For example, cars should no longer be washed and floors should no longer be hosed down. 2. Connect the floor drain to a holding tank. The tank will need DEP approval. The DEP approves two types of holding tanks for this waste: new installations and conversions of existing structures (e.g. oil/water se par These tanks are for non-hazardous, industrial wastewater. If solvent antif eese` it and other fluids are washed down the drain, the waste is likely to be hazardous. 3. Connect the floor drain to a municipal sewer system, if available. An oil/water separator is required to be installed under this option. This requires a permit from DEP and the Town of Barnstable Department of Public Works along with the sewer connection application. The amount of discharge shall not exceed ten parts per million (10 ppm). In all cases, the owner must file a UIC NOTIFICATION FORM with DEP. �owlv of otss6f✓6p na,r` .D2N%NS C01W6Cr640 -7-0 Al /MC T,efi F �IVD 7��N To N t,64C-M Pi l, W� iC#1 iS CO/IASlb626�o ,Q!✓ Si�ti E /D/t� We L)(- You are directed to comply with the state's UNDERGROUND INJECTION CONTROL regulations (310 CMR 27.00) by informing this department in writing of your intentions within ten (10) days of receipt of this notice and completing the work within thirty (30) days. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Cc 0 ic�u o ou> OFF n PLVM811 lovcp6corcc, Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 509-790-6265 Thomas A. McKean FAX 308-775-3344 Director of Public Health April 25, 1996 Mr. Art Triveri K-Mart 768 Iyanough Road Hyannis, MA 02601 Dear Mr. Triveri, You are required to appear at the Board of Health hearing scheduled on May 21, 1996 at 7:00 p.m. The meeting will be held in the Second Floor Hearing Room of the Town Hall. At this meeting you or your representative will be asked to explain why you have not complied with the order letter dated December 4, 1995 in regards to the State's Underground Injection Control Program ( 310 CMR 27.00). If you should have any questions please telephone me at (508) 790-6265. Sincerely yours, omas A. McKean Director of Public Health Health Complaints 07-Jan-02 Time: 4:00:00.PM Date: 1/3/02 Complaint Number: 3222 Referred To: LEE MCCONNELL Taken By: FLORENCE SMITH Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: ILLEGAL OPERATIONS Business Name: K-Mart Number: Street: ikT. 13Z Villager HYANNIS Assessors Map-Parcel: Complainant's Name: Address: Telephone Number: Complaint Description: Between K-Mart Auto Center and K-Mart Garden Center there is a salt pile running into the fresh water pond which is effecting our drinking water. This man has called before and I (Florence) spoke with Dale regarding this matter.and she inturn spoke to the D.P.W. and they said it was susposed to run into this area. According to the man who called it is not running into a catch basen but into our drinking water. He was very upset about this and was also calling conservation regarding this matter. Actions Taken/Results: Lm investigated salt pile in K-Mart parking lot 1/4/2002. The pile is allowed to be kept outside. The run-off is not going directy into town water supply but into a special holding pond which was specifically designed for the salt/sand pile. Spoke with Property manager, , who reported that indeed the drain was connected to the holding pond. Please see pictures in file. Investigation Date: 1/4/02 Investigation Time: 2:30:00 PM 1 Town of Barnstable Department of Health,Safety and Environmental Services Public Health Division,367 Main Street P.O.Box 534 Hyannis,MA 02601 J �yz 1 i 1--' M S �. • � 1 i .,e .:- _�r �_ s.y� �,�ert::w�~ _- a ~„� ,� ,��" �����C ��21L�Iv� �.�T V �( 02 LU�-t .. z � � y - - '. ......_yr 1 ti 02 L �,�, i� ,� - . .� r�. � y <. ���to j , � �� k����-� ��-�-�ti� L�� � y �2 �� W Qva yv REGION VII OFFICE LAKEVILLE HOSPITAL _ LAKEVILLE, MASS. 02346 TELEPHONE: 947-1060 AREA CODE 617 P O February 21, 3.Y7 %CP Y Wayne A. Gilmore .Inc. 1 NSVB --Subsurface Sewage Box 717 bisposai•-K-Mart and Shopping Hyannis, Massachusetts Center Ahase I and IT for :the S"'S, resge Co., Route 132,E Hyannis, Job 'No. 72.379 Gentlement An engineer from the Division of tnvironrnental.,.Health has a ined the sewage disposal worts installed at the above-named location and finds that they have been installed In accordance with the plans approved by this Department in communications dated October 20,4 1972 (Phase $) and Novetber 29, 1972 (phase II). Very truly yours, Pot the Director Sul dersvn, �.- _ _ �i.stri.ct Sanitary Engineer Southeastern Health Region � Lakeville Hospital Lakeville, Massachusetts 02,346 A/Eaja/jH cc; Barnstable Board of Health 'own Hall Hyannis, Massachusetts Barnstable County Health Dept* County court Hausa Barnstable, Maos. Garcia, Hauck & ,Richard Engineering Corp. 75 Tark In Hill Road New Bedford, Maas. TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r Osatisfactory 2. Printers BOARD OF HEALTH 3. Auto Body Shops unsatisfactory- 4. Manufacturers COMPANY �� 1 �mV�T (see"Orders") S. Retail Stores 6. Fuel Suppliers ADDRESS � �-� ] QLffZA Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbdveTanks Underground Tanks IN IDUT IN IOUT IN UT # all n e rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: 1 waste motor oil (C) new motor oil (C) transmission/hydraulic ' Synthetic Organics: i degreasers MisceV aneous: i DISPOSAL RECLAMAATION REMARKS: 1. Sanitary Sewage 2. Water S y flf OTown Sewer Pub 1 i c _ i n ..—_� c��p c OA U)� -site O Private 3. Indoor Floor Drains: YES - 0 Q Holding tank: MDC O Catch b ' ./Dry well 1� e of� . -site system r ©cam, C Noi o i c, 4. Outdoor Surface ,drains:YES NCz_ O Holding, tank: MDC O Catch basin/Dry well'. ell A-V9 O On-site system r S. Waste Transporter 'D ' t n Licensed? Name of Destination Wasp 0 81 Person(s) Interv.,.e�wed Inspector ate f -T4`WN• OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS i .fPEC IT ON SHEET FIRM A ADDRESS :., - - i Major types of materials: 1) 2) _3) 4) 5) 6) I. Description of material (s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,-j ars drums,barrels ��� aboveground tanks 51,V i � underground tanks bags,boxes open,loose,uncovered .inadequate labelling B. Storage Facility ./or•# : Remarks/Recommendations 1. Indoor - a) separate, contained room b) stored in general work area i) inadequate ventilation r � ii) floor drains' l A iii) inadequate fire protection v �. 2,'. 2. Outdoor p a) Uncovered, exposed to weather b) pervious 'surface/catch basins III. Disposal A. Reclamation/Recycling unit r B. On-site disposal 1. Town. sewer 2. Regular septic system 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler �� �'�` 21 b) address or disposal site, .. 1.. ^ ... -... yt _ Person(s) Interviewed - � 2 ✓ Inspector/i� Date / / ' Yf '¢ `�`p�! 1 S-`��� COMPLIANCE: L rine,Gas .Stat.ions,Re air ,-OWN OF B �� P ���/� �.` t �' � �satisf'acto syp F 'E'LT ry\\ to :� Sho sunsatisfactory- anufacturers (see"Orders") tail StoresCOMPANY el Suppliers ADDRESS y f'y Class: scellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetgrauad Tanks IN LIT IN O IN UT # e e ? Fuels -Gasoline, Jet Fuel'. (A) Diesel, Kerosene, #2 (B) ! Heavy Oils: _ a waste -motor oil (C) new motor oil (C) {transmission/hydraulic - . Synthetic Organics f K - 1 Miscellaneous: DISPOSAL RECLAMATION REMARKS: � .1. Sanitary Sewage 2. Water Supply �`y O Town Sewer ® Public oOn-site . Private 3. Indoor Floor Drains: YES NO Holding tank: MDC �aich .basin/Dry well � _^.__-.------------------- ,.-., On -site system = - 4. Outdoor Surface drains-YES NO ® Holding tank: M C r o Catch basin/Dry well ` ® On-site system . — — - — 5 . Waste Transporter '' r Lice�ised? 'Name of Hauser D .� i na ion Mast Rro ct NO _ L� _ x -- 1u M Person(s) Interviewed .. Inspector Date r - ,� TOWN OF BA R N STA B L E co rANCE: CLASS: 1. Marine,Gas Stations,Repai.r satisfactory 2. Printers BOARD OF HEALTH 3. Auto Body Shops M O unsatisfactory-- 4. Manufacturers K- I rcr (see"Orders ' S. Retail Stores COMPAN'f 6. Fuel Suppliers ADDRESS PL='Tc k'no 4� Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbdveTanks Underground Tanks IN OLIT IIN IOUT f IN IOUT Lyallons ze s ? Fuels: _ Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: f waste -motor oil (C) I-2 new motor oil (C) C) 200 transmission/hydraulic Synthetic Organics: ' degreasers f _ I MiscelMn DISPOSAL RECLAMATION REW RKS: 1. Sanitary Sewage 2. Watex pply O Town Sewer Public �-- -site V Private 3. Indoor Floor Drains: YES V NO is Q Holding tank: MDC OCatch basin/Dry well _._.__ ORDERSE �:. O On-site system �tF1�/In,u �F r=z ern 4. Outdoor Surface drains:YES\ NO 02 PC7rv-t`, �c. O Holding, tank: MDC Ut-r e3 E.. /ft r c f c:YV-7 TOO O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? ���,, _ Q- _, Waste Pr oduct _YFS1 No 1. IV . Z) na Alt 2L n a + 1z_ 81 Person(s) Interviewed Inspector Date s OF BARNSTAE3LEL-unsatis ANCE: CLASS s �I Marine,Gas Stations,Repair B OAR D• OF HEALTH satisfactory' • 2. Printers factory- 4. Auto Cody Shops 4.' Manufacturers MPANY �"� t \ E� •�' see"Orders") S. Retail Stores 6. Fuel SupFliers DURESS g� � �.r � ,,, .yY; :� , . {'` Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUl'=outdoors) JOR MATERIALS 'e to Drums * AbdveTanks Undetground Tanks _ JUL DUL w 1 6 geIIons a rest? Fuels: Gasoline, Jet Fuel O Al �J Diesel,' Kerosene, 2 (B) j heavy Oils.: _ waste motor oil (C) t new motor.".oil (C) transmission/hydraulic / �' + 4-nthetic,Organics: 'degreasers ro r iscellaneous: :" + C ,AAA PUSAL RE 5WRIF1uN . Sanitary Sewage. 2. Water SupplyI f,L- .•-� ,� ' . �J ` , >> > OTown Sewer Public f l; -' ;rye ,, J,� is O . _ __ �-� On-site t �, � i _�.. � Privy e , /j ,r - . ,Indoor Floor Drains: YES ,.-- Q.Nolding tank: MUC i Catch basin/Dry well 4 V On-site system Outdoor Surface drains:YES , NO 0 Holding tank: MUC -1 ems, i.f A O Catch basin/Dry well -r On-site system Waste Transporter 'Licensed? { may" ,•........ ,� _ ly n _..Scs� e td /{�• ;7'J e1 ,� `k,erson s) lnt.e.ry ewe r�'�`-< •' S FAWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r Osatisfactory 2. Printers BOARD OF HEALTH 3. Auto Body Shops unsatisfactory- 4. Manufacturers COMPANY #` (see"Orders") 5. Retail Stores }i. t��'Uc- 6. Fuel Suppliers ADDRESS ' vtf rV rill11. Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) ' MAJOR MATERIALS Case lots Drums AbdveTanks Undetground Tanks fIN IDUT IIN IOUT INIOUT # & izallonserest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil transmission/hydraulic Synthetic Organics: degreasers Miscellaneous• E6 t DISPOSAL RECLAN.ATION RivlftK54: ��.� ^a . � 1. Sanitary Sewage 2. Water Supply inhere G -" ` ''• ` :: �t'�r'"" OTown Sewer O Public 's- ._a.>C, a�___�_..,, �, 0 On-site O Private 3. Indoor Floor Drains: -Y�ES�NO f fi ;�.� ,,. �, r_e 'c,� ( .�+ ! t j: ;; fl' _ _. _ 4 Holding tank: MDC -Z-1-P C-Cc! --c-k ("t e O Catch basin/Dry well On-site system1"4- CD , r 4. Outdoor Surface drains.-YES NC Holding tank: MDC `r.,k, O Catch basin/Dry well ?—T w r`'U-' ��,5'•�r' `k'i _" On-site system O ., `�M:•c' („.C: - B fi.'`.j rr"" ''T.__.-.! =..}__._i .`«. F'r.._. t' �._.0 _:n) \ V'2_l_ _ S. Waste Transporter .� rt U1� c_ r, ., °r, �+ p 1,t,'1 ,! �r try?- �r�.,c-� �r� � ` Licensed. Name of Hauler,. iha i one. ��_- '_..,_- as e ProdLct S NO C-:d ,a ,-$�C'C�--a, 12 23 B1 Person(s) Interviewed VInspector Date TOWN OF BARNSTABLE COMMANCE: CLASS: 1. Marine,Gas Stations,Repair BOAR ' satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY,. N �V� , '� (see"Orders") 5.Retail Stores -Q 'T 6.Fuel Suppliers ADDRESq'` _ �f11T1 C18SS' 7.Miscellaneous r.. a QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MAT RIALS Als IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) �transmissio> y raulic S� __. -Synthetic Organics: degreasers � "Lk)) X/ Miscellaneous: X DISPOSAURECLAMATION REMARKS: t 1. anitary Sewage 2.Water Supply h (,IGS- Rt - #Z R) Lk4 A- -Town Sewer C�§Fublic YD I O On-site OPrivate 22-L ff r t�-k� 3.Indoor Floor Drains YES:)/-,NO ,Holding tank:MDC ff,, O Catch basin/Dry well ti- O On-site system (' 4. Outdoor Surface drains:YES N RDERS: Q Holding tank:MDC Occu LL O Catch basin/Dry well O On-site system 5.Waste Transporter Nan eSLination , Fi' 2. 9 k Ar')21 6L( > q rson(s) n rviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Rep r satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY lr';Vl gyv' 0 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 2�� 7•Miscellaneous 4r"r QfJANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR AfATE IALS 'Undergi-ound Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) newn o or oil(C) Synthetic Organics: degreasers P40r-AA-0" ' s f� . a Miscellaneous: !?_5V A ry DISPOSAURECLAMATION REMARKS: 1.&nitary Sewage 2.Water Supply �'�-��� ,13? Town Sewer Public O On-site OPrivate 3. Indoor Floor. Drains YESJNO O Holding tank:MDC_ O Catch basin/Dry well O - 4. Outdoor Surface drains:YES____NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter � . NO , 1. 2. Person(s) Interviewe Inspector Date f Town of Barnstable � v �tMME T° Regulatory Services ti °t Thomas F. Geiler,Director MASS. ' Public Health Division 9� 639.9• � q_ 'OrEcnnn+' 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 � -yejpy/ZT NAME OF ESTABLISHMENT (� ADDRESS OF ESTABLISHMENT 7 (52 Q TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION ! r / (C,64 (C-,*IJ FULL NAME AND HOME ADDRESS OF: PRESIDENT S T 6`t T-724c:f/E TREASURER CLERK /d/e f6V//aav AaLIC-1 SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# SL Haz.doc/"/q 3040 Wart 768 IYANNOUGH RD. HYANNIS, MA 02601 OFFICERS AND DIRECTORS OF KMART CORPORATION 3100 W BIG BEAVER ROAD--TROY,MI 48084 (248)463-5308 NAME TITLE ADDRESS USA NONE 09/05/03 Town of Barnstable °FINE rgy� Regulatory Services 6 Thomas F. Geiler,Director ' '" MASS. A' Public Health Division 9 MASS. 0 1639• �e 'OrEo Ma+" 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 ? a- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 1*1641-W L 92,1GZXNQ NAME OF ESTABLISHMENT i��iJ7� ( LP Pj-,-LQ �� ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: YES__4/NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3�a 7d� 00 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT 3/04 Ay- Qi6 ef-W4.e TREASURERoY, CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS A//?��i c% .?7— r���s'.�y� �'���fi✓L� HOME TELEPHONE# C,5�) Haz.doc/wp/q TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: / /u k 2: !, Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: V 7/ P.O. Box 534 CONTACT PERSON: Rom,. Via&. -rd,.z ra hu 2r[ Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If.you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored i Please put a check beside each product that you store: y. Antifreeze (for gasoline or coolant systems) Drain cleaners v Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel c/ Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, t/ Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes f/ Paints,- —`�, Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners I White Copy- Health Department/ Canary Copy-Business �✓ �.L t n TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH Satisfactory Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste ) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: G l/ F" /fa DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC .S a e �� O Catch basin/Dry well G O On-site system 5. Waste Transporter 11 Name of Hauler Destination Waste Product YES NO 1. 2. rson (s) Interviewed Inspector Date TOWN OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair LTH /'satisfactory 2.Printers BOARD OF HEA 3.Auto Body Shops �Junsatisfactory- 4.Manufacturers COMPANY %/^gaez A1717w�-��Y O (see"Orders") 5.Retail Stores ,� 6.Fuel Suppliers ADDRESS /t�2t� ass• 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots 1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: AG- 61me, et uel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) � transmission/hydraulioe57 Synthetic Organics: de easers �5y Miscellaneous: l L� DISPOSAUR.ELLAMATION REMARKS: y 1. Sanitary Sewage 2.Water Supply ' lj` ;ilr Town Sewer ublic 0 On-site �rivate �. 3. Indoor Floor Drains YES V NO 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank: MDC 0 Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. rson s) Interviewe Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair `� satisfactory 2.Printers BOARD OF HEALTH O 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers 1 ADDRESS �M1 I f �9 �`� , �'� i Class: t %._Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUndergroundove Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) } Diesel, Kerosene, #2 (B) - Heavy Oils;_ -waste motor oil'(C)•) 1 new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: � Af,4462(, a DISPOSAL/RECLAMATION REMARKS: o 1. Sanitary Sewage 2.Water Supply O Town Sewer �OP` ublic r0`On-site OPrivate ��1�11�� � 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well Z � (�-�'!� O On-site system c� C 4. Outdoor Surface drains:YES NO yQI(DERS: O Holding tank:MDC or) O Catch basin/Dry well A/(-) � O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product Licensed?i 1. � ���• ( + t! . �� !�t/�� t �� o( �_ � YES NO Person (s) InterviewedY Inspector Date TOWN OF BARNSTABLE OMPL/ANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 'M AP- �KGf Gee (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 10—'WA W\ -ill ?=b Class: 7•Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) T�j _�aj I transmission/hydraulic < j Synthetic Organics: degreasers � Miscellaneous: c nn'3 -J $w-Tr-egifS ,w'isz Cy0 DISPOSAIJR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply ) O Town Sewer OPublic WSL7S' )Lf P"T I O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC SfLIF- ' L 1 6 O Catch basin/Dry well Vro O On-site system 5.Waste Transporter YES NO 2. p 44:1e�11 vkv�A erson(s) Interviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops 910=yA^hyq CAC,14 � , r 13 DL. 0 unsatisfactory- 4.Manufacturers COMPANY�Q�/�/Y a� c (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS .,vez Class: !` 1-r 1 7•Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS - IN OUT IN OUT IN OUT #&gallons Age Test Fuels: as el (A Fhtsef,K #2 (B) Heavy Oils: waste motor oil(C) j Y new motor oil (C) transmission/hydraulic Synthetic Organics: .� degreasers S Miscellaneous: 17 i I' vo- 1/21 �4 i DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Sewer A1-1 Public � � ! -)- ,yn � O On-site Opriv to 3. I door Floor Drains YES V NO *Holding tank:MDC 10 O Catch basin/Dry well _ O On-site system ' 4. Outdoor Surface drains:YE NO L' ORDERS: O Holding�:tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Deg�irf , M 2. AA A ' ' rson (s) Interviewed Inspector Date Date: S 0 y TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: �iLaf �iPic c� ���-rt C.9,0�) BUSINESS LOCATION: —7 9 O �� a4, (-�,al, , l-�cAQL ,.n,�s .MAILINGADDRESS: INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: 5-0 S 7 7/— 00/2— CONTACT PERSON: a)a�c'_a a,-4 5e e— /91&nm e y, I h 0 70.5 Mans EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: 0P�4'cw(- ���� DfSTRIcT OTHER INFORMATION: P/ems .ealbe-4 __f� LGIS C Pit ��.� .M S®S 54C_ (a P S .t Cam=6r1 "� Waste Transportation: Name of Hauler: Destination, Waste Product: Licensed? es No LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners (5ee_ �Z 3 NEW USED Cesspool cleaners Au matic transmission fluid 1/ ul Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) =37 � Refrigerants Motor oils '7 110 Pesticides � �IEW SS USED (insecticides, herbicides, rodenticides) Gkoline, Jet F&6l Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals(Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways& garages Wood preservatives (creosote) Battery acid (electrolyte) ,-Meu es ZSwimming pool chlorine Rustproofers Lye or caustic soda ��Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt& roofing tar 3 Fertilizers 3 Paints, varnishes, stains, dyes PCB's Lacquer thinners q Other chlorinated hydrocarbons, �SaANEW USED (inc. carbon tetrachloride)- Paint&varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners �Floor'&furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach may be toxic or hazardous (please list): �V�3 Spot removers & cleaning fluids Misc.: jiic4,;;,4meAd �{ (dry cleaners) e_ 3� �`7 Other cleaning solvents a� I_� �t e� f3 �- � �c Bug and tar removers j-, �-(�-{3, c�•( 25'6 've_ /0 �GL�t. °tee_ t 3c�t -' TOWN OF BARNSTABLE . COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH ),4. 3.Auto Body Shops ff/ ' �.,'�^ unsatisfactory- 4.Manufacturers COMPANY - �(1A (6e 1Jh_Cu S1U � (see"Orders") 5.Retail Stores ^�� 6.Fuel Suppliers ADDRESS � WWWO6,1A K , Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS _ IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil(C) 0 cf)1 new motor oil(C) ;C)o transmission/hydraulic Synthetic Organics: degreasers S u Miscellaneous: New bnrvm,Ej& FW11 fvt QC) 1, C 10 . t,+ p►ai N6 Iat� y , 5il�Im / W \PfL- C.'PtAy pwk OT Ob )a wa�- �ll► cow c uLV90 - 1u 75 � F2�"1L12 I5 9 m U, T — 4ag goo pa V. (a Lb I DISPOSALIR.E(;LAMATION REMARKS: 1. S itary Sewage 2. ter Supply Town Sewer public _ O On-site OPrivate 3. Indoor Floor Drains YES_X_NO O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES,?< NO ORDERS• O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter ina ionName of Hauler est., ro ,, , YES N0 1. PrPsxe GP\ew"r— 4bv i� 1 2. Person(s) Interviewed Inspector Date T r TOWN OF BARN STABLE TABLE OMPL/ANCE: CLASS: 1.Marine,Gas Stations,Repair 2. Printers BOARD OF HEALTH satisfactory 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers COMPANY �r Myw_" (6ta S'lb (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS MC), 11 j a u 1J R--P• Class: `� 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS - IN OUT IN OUT IN OUT #& ge gallons Age Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: (�,U pv upc� . Ck�_a . I W a fvv I , to �� (�►� le . DISPOSALIRECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 1 \n L� O Town Sewer OPublic e O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Nanie of Hauler nestination Was d Licensed. YES NO 1. 2. Person(s) Interviewed Inspector Date y4, t W Date: S Oy TOXIC AND HAZARDOUS MATERIALS ON-SI E INVENTORY NAMEOFBUSINESS: BUSINESS LOCATION: -"7 9 O 4,1.,_�d.� INVENTORY MAILINGADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 5-0 9 -- -7 7/— DD/Z -7-725--2 25 13 CONTACT PERSON: _/�, p 70 3 EMERGENCY CONTACT TELEPHONE NUMBER: FIRE D� It�; 'TYPE OF BUSINESS: �^P - 57 GLydyttS OTHER INFORMATION: Pie . ,0a.,be.4 4-hz_ w4,4� oi4 �Ta 'c- it • s � cal .3 M 505 0� �'rf� dg' . s a.. e L12 S Waste Transportation: Name of Hauler. Destination• Waste Product: _- Bart-e�r,�•� Licensed?.. es No LIST OF TOXIC AND HAZARDOUS II/IATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): >/ Antifreeze(for gasoline or coolant systems) Draincleaners See- �22-3NEW USED Cesspool cleaners Autdmatic transmission fluid I/leW Disinfectants Engine and radiator flushes - Road Salt(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils "7 110 T,Pesticides -793 NEW 5. i-USED (insecticides, herbicides, rodenticides) Moline, Jet FEtel Photochemicals Fixers Diesel fuel, kerosene, #2 heating oil NEW USED AtOther petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Battery acid (electrolyte) b�Oti es Swimmi aL ng pool chlorine Rustproofers Lye or caustic soda . Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt& roofing tar .51 Z01 3 Fertilizers (L !maPaints, varnishes, stains, dyes PCBs Lacquer thinners Other chlorinated hydrocarbons, f Sy 4NEW USED -�}- (inc. cargon tetrachloride)- Paint&varnish removers, deglossers D Any other products with ' oison' labels Paint brush cleaners (includingchloroform,formaldehyde, Floor&furniture strippers y ' hydrochloric acid, other acids) Metal polishes 1-;4j5 Laundry soil &stain removers Other products not listed which you feel CJ (including bleach may be toxic or hazardous (please list): ( 9 ) axf',r,&=e-i- __?33 Spot removers& cleaning fluids Misc.: (dry cleaners) e aA Q'7ajalOther cleaning solvents Bug and tar removers 6�-m6.k�lw� Fau 4Pt4zeWve-- r3 i Town of Barnstable Regulatory Services Thomas F.Geiler,Director '" }s Public Health Division . sgum, * ' Thomas McKean,Director MIA �69 200 Main Street, Hyannis,MA 02601 f...y Phone: 508-862-4644 Email: healthna,town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—5:00 K-Mart Attention: Bill Weisensee,Manager June 8,2004 790 Iyanough Road Hyannis,MA 02601 RE: Hazardous Materials License Required Dear Mr. Weisensee: Thank you for your time and cooperation during the Toxic and Hazardous Materials On Site Inventory at K-Mart of Hyannis. The inventory total from June 7t'and 81'shows that you have approximately 11,070.3 gallons of toxic and hazardous materials being used/stored/generated/disposed of at your place of business(Please refer to the Toxic and Hazardous Materials On Site Inventory sheet). The Town of Barnstable Board of Health has determined that using, storing, generating and/or disposing of over 111 gallons of hazardous materials per month requires businesses in the Town of Barnstable to obtain an annual Hazardous Materials License. This license should be purchased by your business as soon as possible from: Town of Barnstable Town Offices Public Division of Health 200 Main Street,Hyannis Passing your Hazardous Materials Inspection and obtaining your license will keep your business compliant with the Control of Toxic and Hazardous Materials ordinance(Article 39). Following the recommendations given after your annual inventory can prevent contamination of Barnstable's existing and future drinking water supply,prevent environmental contamination which can bankrupt site owners,lead to future regulatory,and possibly,legal problems,lower or destroy land values,drive out residents and industry,depress local economies and endanger public health. You will receive your Hazardous Materials License certificate after you have passed your inspection and paid the license fee. Your continued cooperation is greatly appreciated. If you have any questions or need further information,please do not hesitate to contact the Public Health Division. Thank you, Thomas A. McKean,RS,CHO Director of Public Health I Town of Barnstable-Health Department Pag, 1 4 HAZARDOUS MATERIALS INVENTORY SITE VISITS b ` DBA: :K-Mart(General Store) Fax: Corp Name: Mailing Address Location: 790 lyanough Rd Street: 790 lyanough mappar: City: Hyannis Contact: (i, �.At 5 p�r150 - State: Ma 6 Telephone: Se$_ .7.7 00(7- Zip: 02601 Ireq Emergency: Person Interviewed: Business Contact Letter Date: Category: Inventory Site Visit Date: Type: Follow Up/Inspection Date: ❑d public water ❑ indoor floor drains Eloutdoor surface drains ❑ lic lk-1�1 ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed d❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir -- -- - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ..._........ ._. ...._.... compliance: J ONO /60 )-f;-z 2- z Ile ty y/'/ ) 12 o , —7, •�5 r , � � s Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals gty's 111 gals or more hit S ZGt Waste Transporter: Fire District: Last HW Shipment Date: Waste Hauler Licensed: No 3 p , 3 > C,f , Z-J z I � Town of Barnstable-Health Department Page 1 a HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: K-Mart(Penske Garage) Fax: — Corp Name:''�' Mailing Address Location: 790 nnough Rd. Street: 790 lya ugh Rd. ......... mappar: City: Hy is Contact: State: a Telephone: 02601 Emergency: Person Inte 'ewed: Business Cont Letter Date: Category: I ntory Site Visit Date: .... ..__. Type: Follow Up/Inspection Date: ❑ public water ❑ indoor floor drains ❑ ou or surface drains ❑ license required El private water El indoor holding nk mdc Eloutdoo olding tank mdc ❑ currently licensed El town sewage El indoor cat, asin/drywell ❑ outdoor ca basin/drywell expir - - ❑ on-site sewage ❑ indoor -site syste ❑ outdoor onsite stem date: ..................._...._._.__._............ Heavy Oils,New motor o',Transmission/Hydraulic,Synthetic Organics, compliance: Degreasers, Cat �.✓ ear. cy� AN j . C Li 2 r Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑d gty's 111 gals or more descnptbn. 9tY:. ` unit of measure �. . motor oil 0 _.___.............__.._..__._.__._.....___....._..__.._.._____._......._.........._. _._...... ._...__.._..._.....___.._.__......__...........__..._..._.;..._..._..............._......._......__.................. automatic transmission fluid 0 degreasers for driveways and garages 0 W __ Waste Transporter: Fire District: Last HW Shipment Date: Waste Hauler Licensed: No _..... �-zrl� Sid i- toll $ —� (40 � 11 7 y 3 �. -73 Z. ) ; �� Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: :K-Mart#3040 Garden Shop Fax: Corp Name: Mailing Address Location: .790 lyanough Rd.Capetown PI. Hyannis Street: 790 lyanough Road _... .. ........... .__... _..._ ....__. mappar: City: Hyannis Contact: Jay Sprout State: Ma Telephone: i771-0012 Zip: 02601 Emergency: Person Interviewed: Business Contact Letter Date: Category: (Retail Store Inventory Site Visit Date: Type: Follow Up/Inspection Date: public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed S6 town sewage ❑ indoor catch basin/drywell ❑d outdoor catch basin/drywell expir - - -- --- - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: ..._._..................._............................... 1999-REMARKS:Waste Harbor-BFI compliance: Satisfactory i s and ►� s 6,V/ � f Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more y descrrpt,�On „ _ qty unitsof�measure antifreeze(for gasoline or coolant systems) 20cases ................._._...._.....___.._.._._.__..._.._....._....._.............. ______.__._._____.__.............._..._..._... motor oil 100: warts paint,varnishes,stains,dyes 200gallons laundry soil&stain removers(including beach) 30gallons __.._..._._..............--_...________..._..._.......__.._..._..._._......_..._....._................__....._.....__.._._.....__..._____;......_....._...__...____._.____.._....._....._................. pesticides 5cases swimming pool chlorine 50pounds _ car waxes and polishes -� — 40units — automatic transmission fluid 30pints — ----.._......___.___..__..__—_-----..........--.--.___.................__............._....__.._._._._._.._..___._._....__..__._._.._...._......_......................_.....____.._..._.._._............._...... .._.. hydraulic fluids(including break fluid) 25 quarts Windshield Wash 21;cases _.._...._..___......_...__._....._..._.__.._..._.............._...___....._..__._-__..__.___._._._.._._..._...........__.._._...__._...__._..__............... drain cleaners 15 quarts degreasers for engines and metal 56pints _........_.__....__...._.....____............._.......__.._._.._.._._.-.....______..._......_........._.__.................._..___....._.__....___.—_._ misc.petroleum products:grease,lubricants 30units household cleaners i 20cases Waste Transporter: Fire District: Last HW Shipment Date: Waste Hauler Licensed: No o�s 167, YA s L- I - 1 6 1 Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: DBA: OV Location: =0 Date: Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): N 1A 2. Waste storage areas: 3. Satellite accumulation points throughout: N 4. HazMat stored outdoors — CHECK OUTSIDE: 5. Shipping and receiving areas: 6. Run down of shop activities: 7. Housekeeping practices: fez= S f 64 �P► I HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs DBA: Location: P Site visit date: -6 — g —0 o6--�—� • Hazardous Waste Manifests: • Employee training documentation (Of require . V • Hazardous substance spill control and contingency plan: • MSDS)n site? • HazMat Inventory records (if applicable): Dr2i � • HazMat Waste Shipping documentation: /lj 1A • Spill records (if applicable): �� P. 1 COMMUNICATION RESULT REPORT ( JUL.14.2004 2:58PM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE ---------------------------------------------------------------------------------------------------- 545 MEMORY TX 95087782813 OK P. 3/3 v3 d Oq °o --------------------------------------------- ---------------------- ------------- - ------------- REASON FOR ERROR E-1) HANG UP OR LINE FAIL E-2) BUSY E-3) NO ANSWER E-4) NO FACSIMIL CTION xovm f Barnstable . _ ILDate; sere. Number of Pages including cover sheet: To: From: Town of Barnstable RgL Divisim 200 Main Street MA 02601_ P e: -7001 Z. Phone: 100�644 Fex $ Fax phone: 1 (50$)990-6304 CC: DV ivvzc. ri TTrmmm+ rl VA*VA11Vr0kccrPmsl AQALu, h WLeea nnvnrnM+ I Toww of Barnstable . CF tHE G� w = Date: . FAX . �sr"m * —�—/L-i —C)y l639' ►� Number of pages including cover sheet: ED MPS To: From: Town of Barnstable C I �e.15 se E_ Health Division 200 Main Street - � Hyannis,MA 02601 Phone: `7-7/ -D O! Z Phone: 1_(508)8624644 Fax phone: --7-R — Fax phone: 1{508)790-6304 CC: REMARKS: ❑ Urgent ❑ .For your review x Reply ASAP ❑ Please comment 1 P. 1 COMMUNICATION RESULT REPORT ( JUL.14.2004 2:43PM ) TTI BARNSTABLE BOARD OF HEALTH FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE 541 MEMORY TX 95087782813 E-3)3l P. 0i3 ---------------------------------------------------------------------------------------------------- REASON FOR ERROR HANG UP OR LINE FAIL E-2) BUSY E- NO ANSWER E-4) NO FACSIMILE CONNECTION Town. f Barnstable . I."LA Date:k Number ofpages including cover sheet: To; From: Town of Barnstable F -1 Fie�lth Divi�ioa 200 Main Street p nl=' ,MA 02601 , Pho e: -D O phone: 1.(508)862-4644 Fax": Z'$ Fax phone: 1 �508)790-6304 CC: 7.19ADWAZe rl TTrn4n+ n rp%ran„r*a,ia:, V.I., AQAD n Dl�.��....w....e..� l CleanHarborS ENVIRONMENTAL SERVICES COMPANIES 94 THORNTON DRIVE P.O. BOX 2068 HYANNIS, MA 02601 (617)778.2341 M.D.C. TRAP INSPECTION FOR CLEANING August 21 , 1987 K MART AUTOMOTIVE Cape Town Plaza, Route 132 Hyannis, MA 02601 To Whom. It May Co nc ern: On August 21 , 1987 the M.D.C. trap located at the above address was inspected visually by Clean Harbors of Hyannis. The following condition was found: M.D.C. trap i " n . p n good condition M.D.C. trap in " fair " condition; pumping and cleaning suggested in the near future. M.D.C. trap in an 11 unsatisfactoty " condition; pumping and cleaning is recomended. M.D.C. trap cleaned on 8/21/87 INSPECTOR: AuA DATE: *;24 KINGSTON,MA NATICK,MA SOUTH BOSTON,MA SOUTH PORTLAND.ME ALBANY,NY PROVIDENCE,RI HOOKSETT,NH FARMINGTON,CT (617)585-5111 (617)65543863 (617)269-5830 (207)799.8111 (518)434-0149 (401)461-1300 (603)644-3633 (203)674-0361 �P��FTHETO�o TOWN OF BARNSTABLE OFFICE OF sAaISTLU UM MUM BOARD OF HEALTH sooe,i639 9� •Fam k� 367 MAIN STREET HYANNIS, MASS. 02601 August 14, 1987 Arthur Traveri K-Mart Automotive� � Capetown Plaza, Rte . 132 Hyannis, MA 02601 Dear Mr. Traveri : You are reminded that State regulations require periodic pumping and or cleaning of all MDC traps (Metropolitan District Commission, gas and oil separator tanks) . You are directed to ^ contract with a licensed hazardous waste transporter\contractor to perform the required pumping and or cleaning of your MDC trap by September 11 , 1987 , or provide proof of such maintenance performed within the past three months . You are further directed to have your MDC trap inspected and cleaned if necessary, by a licensed hazardous waste contractor every three months . Written proof from a licensed contractor will be required. Inspections will follow by the Health Department to verify compliance. You are reminded that failure to comply could result in a fine of $200 . 00 daily under the Town of Barnstable Toxic and . Hazardous Waste By-law. Very Truly Yours, PohnVM.% Kelly Director Barnstable Health Department r q IN THE UNITED STATES BANKRUPTCY COURT, FOR THE DISTRICT OF DELAWARE In re: Chapter 11 FILENE'S BASEMENT, INC., et al., 1 ) Case No. 09-11.525 (MFW) Debtors. ) Bid Deadline;June 3,2009,at 4:00 p.m. E.T. . Auction: June 5,2009,at 9:00 a.m. E.T... Deadline to Object to Sale Motion: June 3,2009,at 4:00 p.m E.T. Sale Hearing:June 10,'2009,at 10:30 a.m. E.T. NOTICE OF AUCTION AND SALE HEARING REGARDING DEBTORS' PROPOSED ASSETS , PLEASE BE ADVISED that on May 4, 2009,..Filene's Basement, Inc.,the above captioned debtors and debtors in possession(the "Debtors'), filed the Debtors'Motion for an Order (I)Approving Asset Purchase Agreement and Authorizing the Sale of Certain of Their Assets Outside the Ordinary.Course of Business to Crown FB LLC or a Higher and Better Bidder; (H)Authorizing the Sale of Assets Free and Clear. of All Liens, Claims, Encumbrances and Interests Pursuant to'Sections 363(b), 69 and(m)of the Bankruptcy Code, (III)Authorizing, s the Assumption and Assignment of Certain Executory Contracts.and Une pined leases; aM— - (IV) Granting Related Relief the"Sale Motion a( ) g f( - ), pursuant to which the Debtors'—' uest Y i7, authority to sell certain of their assets (the "Assets")pursuant to and on the terms'-- ,-' conditions !: . S` The Debtors in these cases,along with the last four digits of each Debtor's federal tax identification number,are: Filene's Basement,Inc.(8237);FB Services LLC(7224);and FB Leasing Services.LLC(7228). The address for all Debtors is 25 Corporate Drive;Suite 400,Burlington,MA 01803, 28189-001\DOCS DE:147077.15 set forth in an asset purchase agreement dated May 1, 2009 (the "Agreement") by and between i the Debtors and Crown FB LLC(the "Purchaser"). PLEASE BE ADVISED that,on May 15,�2009, the Bankruptcy Court entered an Order(the "Bid Procedures Order") approving certain bid and auction procedures (the "Bid Procedures"), which procedures are to be applied in connection with•the proposed sale (the "Sale"or"Transaction") of the Assets. The Assets will be sold free and clear of all liens, claims, rights, encumbrances and other interests in accordance with.l 1 U.S.C. §§ 363(b)and (f) and 365(b). PLEASE BE FURTHER ADVISED that, other than the bid of the Purchaser which has been and is deemed received'anY,and all-bids must be in accordance with the Bid Procedures and must be RECEIVED by the following parties on or before June 3,2009, at 4:00 p.m. Eastern time: (i)the Debtors, c/o Abacus Advisors, 10 Reuten Drive, Closter., NJ 07624, Attn: Alan Cohen(e-mail: acohen@abacusadvisor.com), with a copy to counsel for the .F Debtors,Pachulski Stang Ziehl,& Jones LLP, 919 N. Market St., 17th Floor, Wilmington, DE 19801, Attn: Laura Davis Jones (e-mail: ljones@pszjlaw.com); (ii) the Purchaser, c/o Wachtel & Masyr, LLP, I 10 East 59`h Street,New York,NY 10022, Attn: Morris Missry (e-mail: , missry@wmllp.com); and(iii)counsel to the Committee, Cooley Godward Kronish LLP, 1114 Avenue of the Americas, New York, New York 10036, Attn: Lawrence C. Gottlieb and Cathy Hershcopf(e-mail: lgottlieb@cooley.com; cershcopf@cooley.com) (collectively, the "Notice Parties"), by the Bid Deadline (provided that any confidential financial information may be delivered to the Debtors and their counsel only). 2 28189-00100CS DE:147077.15 a y PLEASE BE FURTHER ADVISED that on June 5,2009, at.9:00'a.m. Eastern time, the Debtors may hold an auction (the "Auction")for the sale of the Assets at the offices of Pachulski Stang Ziehl & Jones LLP, 919 North Market Street, 17th Floor,'P.O. Box 8705, Wilmington, Delaware 19899-8705. The Auction will be governed by the terms and conditions of the Bid Procedures, which have been authorized and approved by the Bankruptcy Court. PLEASE BE FURTHER ADVISED that the Bankruptcy Court has scheduled a hearing for June 10,2009, at 10:30 a.m. Eastern Time (the"Sale Hearing"}to consider the relief requested in the Sale.Motion and to confirm the result of any.Auction. The Sale Hearing may, however,be adjourned in open court from time to time, without further notice. The Sale S Hearing will be held before the Honorable Mary F. Walrath, United States Bankruptcy Judge, at the United States Bankruptcy Court for the District of Delaware, 824 Market Street, Fifth Floor, Courtroom No. 4, Wilmington, Delaware 19801. PLEASE BE FURTHER ADVISED that objections or responses to any relief requested by the Sale Motion(an"Objection") shall set forth, in writing, with particularity, the ` grounds for such objections or other statements of position and be filed with the Bankruptcy Court and served on the Notice Parties in such a manner that it is actually RECEIVED on or _ i before June 3,2009, at 4:00 p.m. Eastern time. Objections that do not conform to the foregoing will not be considered by the Bankruptcy Court. PLEASE BE FURTHER ADVISED that, all requests for.information concerning the Sale Motion,the Bid Procedures Order,the Agreement,the Assets, or,the Auction should be directed, in writing, to the undersigned counsel for the Debtors, Pachulski Stang Ziehl &Jones 3 28189-001\DOCS DE:147077.15 ,. �y"4'f� 1 i4 °'y a. y i F '' •a • rt .{ ,.r.'r'f" - .- ,c! .. + .i LLP, 919 North' Street, 17t, Floor; P.O. Box 8705, Wilmington,Delaware 19899-8705 (Courier,19801. (Attn: Laura Davis'Jones, Esquire)'or by e-mail to ljones@pszjlaw.com. Dated: May f , 2009 � PACHULSKI STANG ZIEHL &JONES LLP ' aura Davis Jones (Bar No. 2436) • rt . k David M. Bertenthal (CA Bar No. 167624) :Michael R. Seidl (Bar No.3889) t Joshua M. Fried (CA Bar No. 181541) 919 North Market Street, 17`h Floor Wilmington, Delaware 19801 Telephone: (302) 652-4100 Facsimile:. (302) 652-4400 :. E=mail:. Ijones@pszjlaw.com dbertenthal@pszjlaw.com s.mseidl@pszjlaw.com jfried@pszjlaw.com `[Proposed] Counsel to Debtors and + 4 „Debtors in Possession 28189-001\DOGS DE:147077.15 IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE In re: ) Chapter 11 FILENE'S'BASEMENT, INC., et al., 1 ) Case No. 09-11525 (MFW) .i Debtors. ) Bid Deadline: June 3,2009,at 4:00 p.m.E.T. Auction:,June 5,2009,at 9:00 a.m. E.T. Deadline to Object.to Sale Motion: June 3,2009,at 4:00 p.m.E.T. Sale Hearing:June 10,2009,at 10:30 a.m. E.T. s NOTICE OF SALE PROCEDURES, AUCTION DATE,AND SALE HEARING PLEASE BE ADVISED that on May 4, 2009,the debtors and debtors in possession (herein the "Debtors") filed the Motion of the Debtors for-an Order (A)Approving Sale Procedures Relating to Sale of Assets Not Included in the Sale to Crown FB Acquisition LLC, (B)Approving Sale of Assets Free and Clear of All Liens, Claims, Encumbrances,and Other Interests Pursuant to 11 U.S.C. § 363(b), (f), and (m), (C) Approving Procedures for the Assumption and Assignment of Executory Contracts and Unexpired Leases, (D) Authorizing the Assumption.and Assignment of Executory Contracts and Unexpired Leases Pursuant to 11 2 U.S.C. § 365, and (E) Granting Related Relief(the"Motion").2 PLEASE BE FURTHER ADVISED that the procedures attached hereto as Exhibit A (the"Sale Procedures") shall govern the bidding process and the sale at any auction t ' ' The Debtors in these cases,along with the last four digits of each Debtor's federal tax identification number,are: Filene's Basement,Inc.(8237);FB Services LLC(7224);and FB Leasing Services LLC(7228). The address for all Debtors is 25 Corporate Drive,Burlington,MA 01803. Z Capitalized terms not otherwise defined herein shall have the meanings set forth in the Motion. 28189-001\DOCS DE:147743.7 E (the "Auction") of the assets of the Debtors as described in the Motion and the Exhibits thereto (the "Purchased Assets"). Any party in interest that wishes to receive a copy of the Motion or ; the Procedures Order(as defined below) shall make such request in writing to Pachulski Stang Ziehl & Jones LLP,919 North Market Street, 17th Floor, P.O. Box 8705, Wilmington, Delaware 19899-8705 (Courier 19801), Attn: Laura Davis Jones. These Sale Procedures have been 6 approved and authorized by an order signed by the Honorable Mary F. Walrath, United States Bankruptcy Judge, at a hearing on May 15, 2009 (the"Procedures Order") in the chapter 11 case of the Debtors, which case was commenced on May 4, 2009.. . PLEASE BE FURTHER ADVISED that this Notice provides a summary of the Sale Procedures approved in the Procedures Order. 'In the event of any inconsistency or conflict between this Notice and the Procedures Order, the Procedures Order shall control. The Sale Procedures are without prejudice to the right of any Bidder to participate in the Crown Sale and to bid for the assets that are the subject of the Crown Sale, provided that bidding for assets which are part of the Crown Sale will be governed by bid procedures as fixed by the Court in connection with'the Crown Sale. . Y '1 Summary of Sale Procedures Purchased Assets: The assets being sold by the Debtors are all commercial real property leases not associated with the Crown Sale; all inventory wherever located; all furniture, fixtures, and equipment (the , "FF&E") other than the FF&E associated with the,Crown Sale; and all executory contracts other than personal service agreements.and other than those to be assumed and assigned in connection with the Crown Sale (the "Purchased Assets"). Bid Deadline: The deadline for submitting bids by a Qualified Bidder (as defined in the Procedures Order) is June 3, 2009, at 4:00 p.m. Eastern Time: 2 28189-001\DOCS DE:147743.7 Deposit: The bid must specifically designate the Purchased Assets for -with the bid is made. A deposit is required of the greater of ten percent (10%) of the purchase price bid or $25,000. The Deposit will be held and applied to the Purchase price or as damages on default, or returned, in accordance with the Procedures Order. Closing: Closing shall take place as soon as practicable after entry of the Sale Order, but no later than June 19, 2009. Qualified Bid: A Qualified Bid must be made using the form of asset purchase agreement(the "APA")prepared in connection with the sale of the Purchased Assets. Any party desiring'a copy of.the APA may make a request in writing.to Pachulski Stang Ziehl &Jones LLP, 919 North Market Street, 17th Floor, P.O. Box 8705, Wilmington, Delaware 19899- 8705 (Courier 19801),Attn: Laura Davis Jones.- Auction: The Auction will be held on June 5, 2009, at 9:00 a.m. a ,, prevailing Eastern time at the offices of Pachulski Stang Ziehl &Jones LLP, 919 North Market Street, 17cn Floor, P.O. Box 8705 Wilmin gcon , Delaware 19899-8705. At the Auction,the minimum starting bid shall be the amount that is the highest Bid submitted or such amount as the Debtors will determine in their discretion and upon consultation with the . Committee. Each subsequent overbid shall be in the amount determined by the Debtors in their discretion and upon consultation with the Committee. The Debtors reserve the right to'reject any bid and to declare at the conclusion of the Auction that no acceptable bids were submitted and to proceed to a hearing on the Sale. Conclusion of Auction: At the conclusion of the Auction, the Debtors I( will announce their determination as to the highest or otherwise best bid(s) for all or any portion of the Purchased Assets by the bidder(s) who will. ' become the "Successful Bidder(s)"; provided, however,that the Debtors may in their discretion, and upon consultation with the Committee, determine which bid or combination of bids, if any,.in the aggregate constitute the highest orotfierwise best offer at the Auction and,thus,the 'r Successful Bid(s). Formal acceptance of a winning bid, if any, will not ,t occur,unless and until the Bankruptcy Court enters an order approving the winning bid and authorizing the Debtors to consummate the Sale following the conclusion of the Sale Hearing. PLEASE BE FURTHER ADVISED that objections to the proposed Sale as requested by the Motion shall be set forth in writing and shall specify with,particularity the grounds for such'objections or other statements of position and shall be filed with the lz 28189-001\DOCS DE:147743.7 , 1 Bankruptcy Court by not later than June 3, 2009, at 4:00 p.m. Eastern standard time, and shall be served so as to be received by that same date and time on (i)Debtors' counsel—Pachulski Stang Ziehl &Jones LLP, Attn: Laura Davis Jones, Esq:,919,North Market Street, 17th Floor, P.O. Box 8705, Wilmington, Delaware 19899-8705 (Courier 19801) facsimile number(302) 652- fi 4400 (e-mail: ljones@pszjlaw.com); (ii)the Office of the United States Trustee,J. Caleb Boggs Federal Building, 844 N. King Street, Suite 2207, Lock Box 35, Wilmington, Delaware 19801, ' 1 Attn: Jane Leamy,Esquire (e-mail: Jane.M.Leamy@usdoj.gov); and (iii) counsel.for the . Committee—Cooley Godward Kronish LLP, 1114 Avenue of the Americas,New York, New a York 10036,'Attn: Lawrence C. Gottlieb and Cathy Hershcopf, facsimile number(212)479-6275 (lottlieb@cooley.com; chershcopf@cooley.com). PLEASE BE FURTHER ADVISED that an evidentiary hearing (the "Sale Hearing") on the relief requested in the Motion with respect to the,Sale.(among other things,to confirm the results of any Auction and approve the Sale of the Purchased Assets to the Successful Bidder(s) (as defined in the attached Sale Procedures))will be held before the Honorable Mary F. Walrath, United States Bankruptcy Judge, on June 10, 2009, at 10:30 a.m. yid as counsel may ' (prevailing Eastern time) or as such time thereafter y be heard. The sale of the Purchased Assets will be subject to the entry-of an order of the Bankruptcy Court approving the l Sale. . PLEASE BE FURTHER ADVISED that all requests for information concerning . information on the Sale Procedures, the proposed sale'of the Purchased Assets or the Motion should be directed in writing to Pachulski Stang Ziehl,&.Jones LLP, 919 N. Market Street, 17`h 4 " 28189-001\DOCS_DE:147743.7 Floor, P.O. Box 8705, Wilmington, Delaware 19899-8705 (Courier 19801), Attn. Laura Davis Jones, Esquire, facsimile.number(302) 652-4400 (e-mail: ljones@pszjlaw.com). Dated: May 1 2009 PACHULSKI STANG ZIEHL& JONES LLP , aura Davis Jones (Bar No. 243 ) David M. Bertenthal.(CA Bar No. 167624) Michael R. Seidl (Bar No. 3889) Joshua M. Fried(CA Bar No. 181541) 919 North Market Street, 17th Floor Wilmington, Delaware 19801 Telephone: (302) 652-4100 Facsimile: (302) 652-4400 E-mail:, ljones@pszjlaw.com dbertenthal@pszjlaw.com mseidl@pszjlaw.com jfried@pszjlaw.com [Proposed] Counsel to Debtors and Debtors n Possession 5 28189-001\DOCS DE:147743.7 ��) I®'`I I�p. , � y j 1. - - - .. it d - - � SALE PROCEDURES By Motion dated May 4, 2009 (the"Motion"),the debtors and debtors in possession (collectively, the "Debtors"), sought approval of, among other things,the procedures through which they will determine the highest or.otherwise best price for the sale (the."Sale") of any or all of all the Debtors' commercial real property leases not associated with the Crown Sale; all inventory wherever located; all furniture, fixtures, and equipment(the"FF&E") other than the FF&E associated with the Crown Sale; and all executory contracts other than personal services contracts and those to be assumed and assigned in connection with the Crown Sale (collectively, the "Purchased Assets") and procedures with respect to assumption and assignment of executory contracts and unexpired leases (the"Assumed Agreements"). On May 15, 2009, the United States Bankruptcy for the District of Delaware(the "Bankruptcy Court") entered an order(the "Procedures Order") which, among other things, authorized the Debtors to determine the highest or otherwise best price for the Purchased Assets through the process and procedures set forth below(the ."Sale Procedures"). Through the.Sale Procedures,the Debtors will solicit bids and, in their'discretion and upon consultation with the Committee,conduct an auction of the . Purchased Assets. The Debtors reserve the right to seek approval of the Sale of portions of the Purchased Assets (each a"Sales Transaction"). The Sale Procedures are without prejudice to the Debtors' right to seek approval of the engagement of one or more retail inventory liquidation professionals prior to or in connection with the.Sale Procedures and Sale Hearing. The.Debtors further reserve the right, to be exercised in consultation with the Committee, to waive Sale Procedures; to the extent such waiver is in the best interest of the Debtors' estates. The Debtors have also moved for and will seek entry of an order(the "Sale Order") by the Bankruptcy Court authorizing and approving the Sale and the assumption and assignment of the Assumed Agreements to a Qualified Bidder(as defined below), which the Debtors determine to have made the highest or otherwise best offer for the Purchased Assets. The Bankruptcy Court will conduct a sale hearing on June 10, 2009, at 10:30 a.m. (or,such other date and time as may be designated) (the "Sale Hearing")'at which the Debtors shall seek entry of the Sale Order. The Sale Procedures are without prejudice to the right of any Bidder to participate in the Crown Sale and to bid for the assets that are the subject of the Crown Sale, provided that bidding'for assets'which are part of the Crown Sale will be governed by separate bid procedures as fixed by the Court in connection with the Crown Sale. The Bidding Process Set forth below is the general process to be employed by the Debtors with respect to the Sale of the Purchased.Asse6: (i) Any person interested in making an offer to purchase the Purchased Assets shall comply with these procedures. (ii) Only Qualified Bids (as defined below) shall be considered by the Debtors. 28189-001006S DE:147743.7 Upon failure to consummate the Sale because of a breach on the part of a Successful Bidder after an order entered at the Sale Hearing (as defined below), the Debtors shall be permitted to select the next highest or otherwise best-bid to be the Successful Bid and to consummate such j transaction without further order of the Bankruptcy Court.. Participation Requirements In'order to participate.in the bidding process or otherwise be considered for any purpose hereunder; a person interested in the Purchased Assets (a"Potential Bidder")must first deliver the following materials to the Debtors and their counsel: (i) An executed confidentiality agreement in form and substance satisfactory toahe Debtors and their counsel; F (ii) The most current audited and latest unaudited financial statements. (collectively, the "Financials ') of the Potential Bidder, or, if the Potential Bidder is an entity formed for the purpose of a Sale Transaction, (x) Financials of the equity holder(s)of the Potential.Bidder or such other . form of financial disclosure as is acceptable to the Debtors,in consultation with the Committee, and their counsel and (y)the written commitment acceptable to the Debtors and their counsel of the equity holder(s)of the Potential Bidder to be responsible for the Potential Bidder's obligation's in connection with a Sale Transaction. In the event that a Potential Bidder is r; unable to provide Financials, the Debtors may, in their discretion and upon consultation with the Committee, accept such other information sufficient to.demonstrate to the Debtors' satisfaction that such Potential Bidder has the financial wherewithal to consummate a Sale Transaction' and (iii) A Bid must include information with respect to adequate assurance of future performance with respect to any assumed agreements (the "Adequate Assurance Information"). A."Qualified Bidder" is.a Potential Bidder whose Financials or other information demonstrate,;-in,the Debtors' discretion, and upon consultation with the Committee, the financial capability to consummate a Sale Transaction and the Bidder's financial ability to provide "adequate assurance of future performance"within the meaning of 11 U.S.C. § 365(f)(2)(B) of any executory contracts and unexpired leases to be assurnedand assigned to such Bidder, should the.bidder be a Successful Bidder, and which the Debtors determine, in their discretion, and in , consultation with the Committee, is reasonably likely to make a bona fide offer. The Debtors shall determine, in consultation with their advisors and the Committee, whether a Potential Bidder is a Qualified Bidder. In the event that the Debtors determine that a Potential Bidder is not a Qualified Bidder, the Debtors shall provide prompt notice thereof to the Potential Bidder. A�Potential Bidder that,complies with the Participation`'Requirements may engage in direct negotiations with landlords and vendors,provided that (a)'none.of the Debtors' 2 28189-001\DOCS_DE:147743.7 s '. confidential information is used in such communications and(b)nothing is said by the Potential Bidder in.those discussions that could compromise the integrity of the sale process. Obtaining Due Diligence Access Access to the Debtors' electronic data room for the purpose of a-Potential Bidder's ' performing due diligence shall be provided,:upon reasonable request to the Debtors, at the r discretion of the Debtors and within their reasonable business judgment to any Potential,Bidder who executes a confidentiality agreement in form and substance satisfactory to the Debtors and their counsel. The due diligence period will end on the Bid Deadline (defined below). The Debtors shall not be obligated to furnish any information relating to the Debtors,the Purchased Assets, and/or a Sale to any person except in their discretion. . The Debtors shall coordinate all reasonable requests for additional information and due diligence access from Potential Bidders. No conditions relating to the completion of due diligence shall be permitted to exist after the Bid Deadline. y Bid Deadline The deadline for submitting bids by a Qualified Bidder shall be 4:00 p.m. prevailing Eastern Time on June 3,2009 (the"Bid Deadline"). Prior to the Bid Deadline, a Qualified Bidder that desires to make,a bid shall deliver written copies of its bid to the following: (i) Debtors' counsel—Pachulski Stang Ziehl & Jones LLP, Attn: Laura Davis Jones, Esq., 919 North Market Street, 17"Floor, P.O. Box 8705, Wilmington, Delaware 19899-8705 (Courier 19801) facsimile number (302) 652-4400 (e-mail: ljones@pszjlaw.com); ii The Debtors— c/o Abacus Advisors,Attn: Alan Cohen, 10 Reuten Drive, Closter,NJ 07624 (e-mail: acohen@abacusadvisor.com); (iii) Counsel for the Debtors' secured lenders— Riemer& Braunstein LLP, Attn: Donald E. Rothman, Esq., and Jaime R. Koff, Esq., Three Center Plaza, Boston, MA 02108, facsimile number(617) 880-3456 (e-mail: drothman@riemerlaw.com); and x (iv) Counsel for the Committee—Cooley Godward Kronish LLP, 1114 Avenue of the Americas,New York,New York 10036, Attn: Lawrence C. Gottlieb and Cathy Hershcopf, facsimile number(212) 479-6275 (lottlieb@cooley.com; chershcopf@cooley.com). Due Diligence From Bidders Each Qualified Bidder shall comply with all reasonable requests for additional information by the Debtors or their advisors regarding such Qualified Bidder's financial wherewithal to consummate and perform obligations in connection with the Sale(the"Bidder Related Information"). Failure by the Qualified Bidder to comply with requests for additional 3 28189-001\DOCS_DEA 47743.7 information may be a.basis for the Debtors to determine that a bid made by the Qualified Bidder is not a.Qualified Bid. Unless the applicable Bidder consents to the Bidder Related.Information being provided to other parties in interest, only the Debtors and their counsel and advisors will be provided with the Bidder Related Information, provided that the.Debtors shall, upon request, share such Bidder Related Information,solely with counsel for the Committee and/or its advisors but not with members of the Committee. Bid Requirements A bid for the Purchased Assets must be a written irrevocable offer from a Qualified Bidder that (i) states that the Qualified Bidder offers to consummate a Sale Transaction pursuant to an agreement that has been marked to show modifications to the APA (unless another form of JI sale agreement is accepted,b the Debtors in their discretion and upon consultation with the g Y p. Committee), including price and terms,that are being proposed by the Qualified Bidder, which terms shall not materially alter the terms of the APA, as applicable, (the "Marked APA"); (ii)confirms that,the offer shall remain open until the 1.closing of a Sale to the Successful.Bidder or the Next Highest Bidder; (iii)encloses a copylof the proposed Marked APA; (iv) if for less than all of the Purchased Assets, shall designate the Purchased Assets for which the.Bid is made; (v) identifies those executory contracts and unexpired leases of the Debtors the Bidder wishes to have assumed by the Debtors and assigned to it and those liabilities that the Bidder intends to elect to have assumed and assigned to it(executory contracts and unexpired leases identified by the bidder may be removed from the list by mutual consent of the Debtors, upon consultation with the*Committee, and the bidder);.and(vi) is accompanied by a certified or bank check, wire transfer, or letter of credit reasonably acceptable to the Debtors in the amount of at least ten percent(10 %)of the.purchase price bid (the "Minimum Deposit"). l 3 Any bid for the Purchased Assets must also, unless otherwise determined by the Debtors 4 in their discretion and upon consultation with the Committee: (a) be on terms that are not materially more burdensome or conditional than. . the terms of the APA; (b) not be conditioned on obtaining financing or the outcome of any due diligence by the bidder; (c) not request or entitle the bidder to any break-up fee, expense reimbursement or other similar type of payment; (d) provide that the bidder can and will close the Sale Transaction by no later than June 19, 2009; (e) cannot be conditioned on the outcome of any unperformed diligence or receipt of board, shareholder, or other corporate approval, cannot contain a ; The Debtors reserve the right in their sole discretion,upon consultation with the Committee,to consider and alternative minimum deposit. 4 2 8184-001\DOCS_DE:147743.7 f. financing contingency, and cannot require any break-up fee, expense h reimbursement, or bid protection of any kind for the bidder; shall.establish,to the Debtors' satisfaction, upon consultation.with the Committee,the bidder's financial ability to consummate the proposed transaction; and (g) shall include a statemeaas:to whether the bidder intends to employ former employees of the Debtors, and, if so, whether the bidder proposes to assume all or any part of the Filene's Basement, Inc. Pension Plan. A bid received from a Qualified Bidder and that meets the requirements set forth above will be considered a"Qualified Bid" if the Debtors believe, in their discretion, and upon consultation with fhe Committee;that such bid would be consummated if selected as a".` j Successful Bid (as defined below). Auction . ; •.z;; f An auction (the "Auction")with respect to.,a.Sale Transaction shall take place on June 5,, 2009, at 9:00 a.m.,prevailing Eastern Time at the Debtors' counsel's office at Pachulski Stang Ziehl.&.Jones LLP, 919 North Market Street, 17th Floor, P.O. Box 8, 705,Wilmington, DE 19899-8705,or such other place and time as the Debtors shall.notify all Qualified:Bidders,the Committee, and other invitees. If,however, no Qualified Bid is received by the Bid Deadline, then the Debtors may determine, in their discretion and upon consultation with the Committee, that the Auction.will not be held.. Only a Qualified Bidder who has submitted a Qualified Bid will be eligible to participate' at the Auction. Unless otherwise determined by the Debtors in their discretion and upon consultation with the Committee, only the authorized representatives of each of the Qualified Bidders, the Committee,and the Debtors shall be permitted to attend the Auction. At the Auction, Qualified.Bidders will be permitted to increase their bids.. j1 Each.Qualified Bidder participating at the Auction will be required to confirm that it has not engaged in any collusion with respect to the bidding or the,sale. The bidding at the Auction shall start at the purchase price'stated in the highest or otherwise best Qualified Bid as disclosed to all Qualified Bidders prior to commencement of the Auction(the "Starting Qualified Bid'), and then continue in increments to be determined by the Debtors in their discretion, and upon consultation with the.Committee. The Debtors, in their discretion, an upon consultation with the Committee, may adopt rules for the Auction at or prior to the Auction that, in their discretion, will better promote the goals of the Auction and that are not inconsistent with any of the provisions of the Procedures Order. All such rules will provide that all bids shall be made and received in one room, on an open basis,,and all other bidders shall be entitled to be present for all bidding with the understanding that the true identity of each bidder (i.e., the principals submitting each bid) shall be fully disclosed to all other bidders and that all material terms of each Qualified Bid will be fully disclosed to all other bidders throughout the entire Auction. 5 �. 28189-001\DOCS DE:147743.7 " s� Immediately prior to concluding the Auction, the Debtors, in consultation with their secured lenders and the Committee, shall (i)review each Qualified Bid; (ii)determine and. identify in the exercise of their reasonable discretion the'highest or otherwise best Qualified Bid (the "Successful Bid") and the next highest or otherwise best offer after the Successful Bid (the "Next Highest Bid"); and (iii)have the right to reject any and all bids. The determination of the Successful Bid will be made by the Debtors in their discretion, upon consultation with the Committee, taking into account, including but not limited to, the total consideration provided for in the offer(whether such consideration is cash or through assumption of liabilities, such as the Filene's Basement, Inc. Pension Plan)to the Debtors' estates. Immediately upon selection of the Successful Bid, if the Minimum Deposit does not equal ten percent(10%) of the purchase price in the case of a bid(s) for less than all of the Purchased Assets, the Successful Bidder(s) shall provide the Debtors with immediately available funds so that the Minimum Deposit is equal to ten percent(1.0%) of the purchase price in the case of a bid(s) for less than all of the Purchased Assets. The Auction may be adjourned as the Debtors, upon consultation with the Committee, deem appropriate. Reasonable notice of the time and place for the resumption of the Auction will be given to all Qualified Bidders, the Committee,,and other invited parties. The Debtors reserve the right to waive Sale Procedures, in their discretion and upon consultation with the Committee, to the extent such waiver is in the best interest of the Debtors' estates. Promptly after the closing of the Auction, the Debtors shall (a) file and post on the web site of the Debtors' claims agent a notice identifying the prevailing Successful Bidder(s)and summarizing the assets acquired"together with contact information for the Successful Bidder(s) and (b) e-mail such notice of any creditor or landlord who has requested that information in writing to counsel for the Debtors and provided an e-mail address. At the conclusion of the Auction, the Debtors shall provide by e-mail or overnight delivery.the Adequate Assurance Information of any Successful Bidder to the affected landlord(s) and to the PBGC. Acceptance of the Successful Bid The Debtors will present the results of the Auction to the Bankruptcy Court,at the Sale Hearing, at which certain findings will be,sought from the Bankruptcy Court regarding the Auction, including, among other things,that(i)the Auction was conducted and the Successful Bidder(s) was selected in accordance with these Sale Procedures, (ii) the Auction was fair in substance and procedure, and (iii) consummation of the Sale Transaction contemplated by the Successful Bid will provide the highest or otherwise best value for the Purchased Assets and is otherwise in the best interests of the Debtors and their estates. In the event that, for any reason, a Successful Bidder fails to close the Sale transaction contemplated by its Successful Bid,then, without notice to any other party or further court order, the Debtors shall be authorized to close with the Qualified Bidder that submitted the Next Highest Bid. Return of Minimum Deposit Except as otherwise provided in this paragraph with respect to any Successful Bidder and any Next Highest Bidder, the Minimum Deposits of all"Qualified Bidders required to submit such a deposit under the Sale Procedures shall be returned upon or within one business day after Closing-of the Sale. The Minimum Deposit of a Successful Bidder shall be held until the closing 6 28189-00RDOCS DE:147743.7 of the Sale and applied in accordance with the Successful Bid. The Minimum Deposit of the Next Highest Bidder shall be returned upon or within one business day after closing of the'Sale to the Successful Bidder. In the event the Debtors proceed to closing with the Next Highest Bidder;.the Minimum Deposit of the Next Highest Bidder shall be held until the closing of the Sale with the Next Highest Bidder and applied in accordance with the Next Highest Bid. If a closing does not occur by June 19, 2009,the disposition of Minimum Deposits shall be as . provided in the relevant bids. As Is,Where Is The Sale of the Purchased Assets shall be on an"as is, where is"basis and without representations or warranties of any kind, nature, or description by the Debtors, their agents, or their estates-except to the extent set forth in the APA. Each Qualified Bidder shall be deemed to acknowledge and represent that each has had an opportunity to conduct any and all due diligence regarding the-Purchased Assets prior to making its offer, that it has relied solely upon its own independent review, investigation,'and/or inspection of any documents and/or the Purchased Assets in making its Bid, and that it did not rely upon any written or oral statements, representations, promises, warranties or guaranties whatsoever, whether express, implied, by operation of law or otherwise, regarding the Purchased Assets, or the completeness of any information provided in connection therewith or the Auction, except as expressly stated in the Bid Procedures or the terms of the sale of the Purchased Assets.that shall be set forth in the final APA. ie 7 28189-001\DOCS_DE:147743.7 Palk , P,541e4j Date: TOWN OF BARNSTABLE CM6 ee+edu TOXIC AND HAZARDOUS MATERIALS ON-SIT INVENTORY NAME OF BUSINES BUSINESS LOCATIO - INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: dot- 4 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: E�iZ Fire istrict: © .! A 0 i s Waste Transportation: Ald 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 materials 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) __ Misc. 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 Misc. 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 Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Cosh Laundry soil & stain removers 90 /� Q j�d I I'd (including bleach)fJ(p_jF ! Spot removers &cleaning fluids (dry cleaners) �Q Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Attica OIL WASTE OIL OIL FILTERS ANTIFREEZE WASTE a9 b- ✓ ZDj ANITFREEZE 31 22: GASOLINE WASTE GAS DIESEL FUEL W/W FLUID ATF tiv 1� ✓ �\ HYDRAULIC/ MISC. MISC. MISC. MISC. ` BRAKE FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM 1 / to �p 1� i i// (GEAR OIL/GREASE/ ✓ �/ LUBRICANTS) q`� 3olbr2� 151bs.A3 FREON ACETYLENE CAR WASH CAR WASH PAINTS/ WAX DETERGENTS THINNERS �o 210 0 50 SEALANT CLEANING BATTERIES/ POISION/TOXIC CAULK/GROUT SOLVENTS BATTERY �I n Dn ✓ ACID15 ` j ERTALIZERS WASTE SOLNENT MSDS 100 IpD 240 i j�� JAp C(os&�- ,, �N5y� 4q6 - MANIFESTS R n -e� d ES SSG i � rm 30 t® ��b Ib q8 110 0 Town of Barnstable Regulatory Services Thomas F. Geiler,Director - "vVil -'. F BARa4 -:ABLE '"MASS. Public Health Division 1659.rED MA'S a Thomas McKean,Director _ Y 2 1 R 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644f : 508-790-6304 Application Fee: $100.00 lri (IAa t UU((�J �.a23 •�5 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 - O —1 (�cp(ZED+-AM 0 N NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT g `/r'�rN al0Lt&yr TELEPHONE NUMBER 1 . 509, `7? l• 00 1 ;L- SOLE OWNER: YES_kNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: � IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. ,3S®`-7vpp�/ STATE OF INCORPORATION �Y1�c� as✓� FULL NAME AND HOME ADDRESS OF: . PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT r RESTRICTIONS: HOME ADDRESS I �I &cJ-Jc,, I'. W HOME TELEPHONE# -' — •S Haz.doc/wp/q h �o 4 ti April 24, 2007 NOTIFICATION OF ASBESTOS ABATEMENT ATTENTION: Hyannis Health Department 200 Main Street Hyannis, MA 02601 Northeast Remediation will be conducting an asbestos abatement project at the following location. Please note the site and dates listed below, with the latter being subject to changes. Do not hesitate to contact our office for more detailed scheduling information at 617-389-9188. BUILDING LOCATION: K-Mart Store#3020 768Iyannough Road Hyannis, MA 02601 START DATE: 5/8/07 END DATE: 5/18/07 Asbestos signs will be clearly posted in all areas where work is being conducted. Please take the necessary precautions in the event you are required to enter the building during an emergency. If you have further questions with respect to this abatement project,please do not hesitate to contact our office at any time at(617) 389-9188. Thank you very much for your attention regarding this matter. , Very truly yours, ` NORTHEAST REMEDIATION Sarah Marcone N ` Projects Coordinator Corporate Headquarters New England Office 462 Getty Avenue 25 Storey Avenue#256 Clifton,NJ 07011 Newburyport,MA 01950 Tel.617-389-9188 Fax 617-389-9198 IF Commonwealth of Massachusetts __■ j 100054463 Asbestos Notification Form ANF-001 Decal Number Important:When filling out A. Asbestos Abatement Description � forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less? ❑Yes ❑✓ No to move your cursor-do not b. Provide blanket decal number if applicable:use the return Blanket Decal Number key. 2. Facility Location: K-MART STORE#3020 768 IYANNOUGH ROAD a.Name of Facility b.Street Address _ BARNSTABLE 102601 (508)771-0012 c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this THROUGHOUT 1ST FLOOR form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑✓ Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational NORTHEAST REMEDIATION 253 LOW STREET SUITE 224 Safety(DOS) a.Name b.Address notification NEWBURYPORT 01950 6173899188 requirements of 453 CMR 6.12 c.City/Town d.Zip Code e.Telephone Number AC000392 f.DOS License Number g. Contract Type: ❑✓ Written ❑Verbal MICHAEL CHAIN WATTERSON ENVIRONMENTAL REP. h.Facili Contact Person i.Contact Person's Title JUAN JOSE MEDINA AS072957 6' a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number 7 RHODE ISLAND ANALYTICAL I IAA000028 a.Name of Pro'ect Monitor b.Project Monitor DOS Certification Number YEE CONSULTING GROUP AA000145 $' a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number 05/08/2007 05/18/2007 0 9' a.Project Start Date mm/dd/ b.End Date mm/dd/ 0 10PM-6AM N/A N c.Work hours Mon-Fri. d.Work hours Sat-Sun. �o 10. a.What type of project is this? �o ❑Demolition ❑✓ Renovation ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: o ❑ Glove bag ❑ Encapsulation o ❑ Enclosure ❑ Disposal only �LL ❑Cleanup ❑ Other, specify: ❑✓ Full containment b.Describe z �Q 12. Is the job being conducted: 0 Indoors? ❑Outdoors? ■ anf001ap.doc-10/02 Asbestos Notification Form-Page 1 of 3■ Commonwealth of Massachusetts __■ 100054463 y Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or enca sulated: 0 ® 1 18000 a.Total pipes or ducts(linear ft) T I otal other surfaces(square c.Boiler,breaching,duct,tank I_J surface coatings Lin.ft. Sq.ft. d.Insulating cement Lin.ft. Sq.ft. e.Corrugated or layered paper If.Trowel/Sprayer coatings u pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. Sq.ft. i.Cloths,woven fabrics j.Other,please specify: Lin.ft. S ft. Lin.ft. S .ft. k.Thermal,solid core pipe VAT/MASTIC insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: 3-CHAMBERED DECONTAMINATION FACILITY WITH SHOWER 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): ACM WILL BE WET(HAND TO BAG)ACM WILL BE LABELE, PACKAGED&TRANSPORTED 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: NIA a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver# NIA e.Name of DOS Official f.DOS Official Title N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# --o 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? Yes No B. Facility Description N �0 RETAIL STORE 1. Current or prior use of facility: �o 2. Is the facility owner-occupied residential with 4 units or less? El ❑Yes No SEARS HOLDINGS MANAGEMENT CORP. 3333 BEVERLY ROAD 3' a.Facility Owner Name _ b.Address �o HOFFMAN ESTATES, IL 160179 o c.City/Town d.Zip Code e.Tele hone Number area code and extension �U_ 4 MICHAEL CHAIN,WATTERSON ENVRNMTL 1 1169 MAIN STREET, SUITE#103 a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address Z MATAWAN, NJ 07747 1732-583-3003 ------ Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Pa e 2 of 3■ Commonwealth of Massachusetts 100054463 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) N/A 5' a.Name of General Contractor b.Address c.City/Town d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer Policy Number h.Exp. ate mm/dd� 6. What is the size of this facility? a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): NORTHEAST REMEDIATION 125 STOREY AVENUE#256 Note:Transfer a.Name of Transporter b.Address Stations must INEWBURYPORT, MA 101950 (617)389-9188 comply with the c.Cityfrown d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP 58 PYLES LANE a.Name of Transporter b.Address NEW CASTLE, DE —� 19720 J 1(877)999-9559 c.City/Town d.Zip Code e.Telephone Number 3. N/A a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e.Telephone Number 4. JA$L SALVAGE INC a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 11225 STATE ROUTE 45 1 ILISBON c.Final Dis osal Site Address d.City/Town OH —�� 44432 coe.State f.Zip Code g.Telephone Number Oo D. Certification N The undersigned hereby states,under the ISARAH MARCONE �0 penalties of perjury,that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations 1PROJECTS CORDINATO 04/24/2007 for the Removal,Containment or c.Position/Title d.Date mm/dd/vwv) Encapsulation of Asbestos,453 CMR 6.00 and (617)389-9188 NER s� 310 CMR 7.15,and that the information contained in this notification is true and correct e.Tele hone Number f.Representing o to the best of his/her knowledge and belief. 125 STOREY AVENUE#256 o .Address u_ NEWBURYPORT, MA 1 101950 h.City/Town i.Zip Code Z anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 h � i February 5, 2007 NOTIFICATION OF ASBESTOS ABATEMENT ATTENTION: Hyannis Health Department 200 Main Street Hyannis, MA 02601 Northeast Remediation will be conducting an asbestos abatement project at the following location. Please note the site and dates listed below, with the latter being subject to changes. Do not hesitate to contact our office for more detailed scheduling information at 617-389-9188. BUILDING LOCATION: K-Mart Store#3040 790Iyannough Road Hyannis, MA 02601 Photo Shop START DATE:" 2/19/07 - END DATE: 3/2/07 Asbestos signs will be clearly posted in all areas where work is being conducted. Please take the necessary precautions in the event you are required to enter the building during an emergency. If you have further questions with respect to this abatement project,please do not hesitate to contact our office at any time at(617) 389-9188. Thank you very much.for your attention regarding this matter. Very truly yours, NORTHEAST REMEDIATION �i Sarah Marcone Projects =oordinator s _ lE S^` Corporate Headquarters New England Office 462 Getty Avenue 25 Storey Avenue#256 Clifton,NJ 07011 Newburyport,MA 01950 Tel.617-389-9188 Fax 617-389-9198 ♦ l Commonwealth of Massachusetts ■ 100051271 Asbestos Notification Form ANF-001 Decal Number Important:When filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-cit ,town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less? Yes ✓❑ No to move your cursor-do not b. Provide blanket decal number if applicable:use the return Blanket Decal Number key. 2. Facility Location: K-MART#3040 790 IYANNOUGH ROAD a.Name of Facility b.Street Address BARNSTABLE MA 02601 c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this PHOTO SHOP-1 ST FLOOR form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑✓ Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational INORTHEAST REMEDIATION 253 LOW STREET SUITE 224 Safety(DOS) a.Name _ b.Address notification INNEWBURYPORT 01950 6173899188 requirements of 453 . CMR 6.12 c.City/Town d.Zip Code e.Telephone Number AC000392 f.DOS License Number g. Contract Type: ❑✓ Written ❑Verbal MICHAEL CHAIN WATTERSO I ENVIRONMENTAL REP. h.FacilitV Contact Person i.Contact Person's Title EDWIN ALMONTE I JAS033135 6' a.Name of On-Site Su ervisor/Foreman b.Supervisor/Foreman DOS Certification Number 7' COVINO I IAA000006 a.Name of Project Monitor b.Project Monitor DOS Certification Number YEE CONSULTING GROUP AA000145 8' a.Name of Asbestos Anal ical Lab b.Asbestos Analytical Lab DOS Certification Number 02/19/2007 1 103/02/2007 i-O 9' a.Project Start Date mm/ddl b.End Date mm/dd/ �0 10PM-6AM NIA N c.Work hours Mon-Fri. d.Work hours Sat-Sun. _o 10. a.What type of project is this? o ❑ Demolition ✓❑ Renovation ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: o ❑ Glove bag El Encapsulation o ❑ Enclosure ❑ Disposal only emu_ ❑ Cleanup ❑ Other, specify: ❑✓ Full containment b.Describe Z �Q 12. Is the job being conducted: FZ] Indoors? ❑Outdoors? ■ anf001ap.doc-10/02 Asbestos Notification Form-Page 1 of 3■ w' r Commonwealth of Massachusetts ■ . 100051271 ---� Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed,or encapsulated: _ a.Total pipes or ducts(linear ft) b.Totalother su aces square t) c.Boiler,breaching,duct,tank d.Insulating cement surface coatings Lin.ft. Sq.ft. ((Lin.ft. Sq.ft. e.Corrugated or layered paper I� pipe insulation Lin.ft. Sq.ft. f.Trowel/Sprayer coatings Lin.ft. Sq.ft. g.Spray-on fireproofing h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. Sq.ft. i.Cloths,woven fabrics j.Other,please specify: 400 Lin.ft. S .ft. Lin.ft. S .ft. k.Thermal,solid core pipe VAT/MASTIC insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: 3-CHAMBERED DECONTAMINATION FACILITY WITH SHOWER 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6..14(2) (g): ACM WILL BE WET(HAND TO BAG)ACM WILL BE LABELED, PACKAGED&TRANSPORTED. 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: NIA a.Name of DEP Official b.Title 01101/2007 c.Date mm/dd/ )of Authorization d.DEP Waiver# N/A e.Name of DOS Official f.DOS Official Title 01/01/2007 g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# N _0 17. Do prevailing wage rates as per M.G.L.c. 149, §26, 27 or 27A—F apply to this project? ®Yes[✓1 No B. Facility Description N _0 1. Current or prior use of facility: RETAIL STORE �o 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes [✓ No SEARS HOLDINGS MANAGEMENT CORP. I 33 B 33EVERLY ROAD 3' a.Facility Owner Name b.Address o HOFFMAN ESTATES, IL 60179 o c.City/Town d.Zip Code e.Telephone Number area code and extension MICHAEL CHAIN,WATTERSON ENVIRNMNT 169 MAIN STREET#103 4 a.Name of Facili Owner's On-Site Manager b.On-Site Manager Address Z MATAWAN, NJ 1 107747 732-583-3003 �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Pa e 2 of 3■ J Commonwealth of Massachusetts _......_... s 100051271 m Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) N/A 5' a.Name of General Contractor b.Address c.Cit /Town d.Zip Code e.Telephone Number area code and f.Contractor's Worker's Comp.Insurer .Polic Number h.Ex .Date(mm/dd/ 6. What is the size of this facility? a_-� —� �_ a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): NORTHEAST REMEDIATION 125 STOREY AVENUE#256 Note:Transfer a.Name of Transporter b.Address Stations must INWEBURYPORT, MA 01950 (617) 389-9188 comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP 1 158 PYLES LANE a.Name of Transporter b.Address NEW CASTLE, DE 1 1(877)999-9559 c.Cit /Town d.Zip Code e.Telephone Number 3. N/A a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e.Telephone Number 4. JA& L SALVAGE INC a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 11225 STATE ROUTE 45 1 ILISBON c.Final Disposal Site Address d.City!Town O H _�� 44432 e.State f.Zip Code g.Telephone Number Cl) O D. Certification N The undersigned hereby states,under the ISARAH MARCONE penalties of perjury,that he/she has read the a.Name _ b.Authorized Signature o Commonwealth of Massachusetts regulations JPROJECTS COORDINATI 10210512007 for the Removal, Containment or e.. c.Position/Title d.Date mm/dd/ Encapsulation of Asbestos,453 CMR 6.00 and (617)389-9188 NER 310 CMR 7.15,and that the information contained in this notification is true and correct e.Telephone Number f.Representing to the best of his/her knowledge and belief. 125 STOREY AVENUE#256 o a.Address �L INEWBURYPORT, MA 01950 Z h.City/Town is Zip Code Q •• anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 5VI91F KC-0-1-S BUSINESS LOCATION: . 50 IY1106001,16H �0-) INVENTORY MAILING ADDRESS: '! !( f�i���Tt��3►, , TOTAL AMOUNT: TELEPHONE NUMBER: _15-0 2' ?7/ ' 31iR CONTACT PERSON: EAIL1 --�LLE & F A A rn2 EMERGENCY CONTACT TELEPHONE NUMBER: 9n r� MSDS ON SITE? TYPE OF BUSINESS:_ AT I1 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 materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. UST 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) Misc. 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 Misc. 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 Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): 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 t Z 348 6'59 774 -05TReceipt for Certified Mail -No Insurance Coverage Provided UN11E�D�STATES Do not use for International Mail Vos—SERviLE (See Reverse) Sent t� eIQ Street and No�� �a State and ZIP Lode Q In 1 0 - co Post ge ^ co J! M E Certified Fee O r' l LL Special Delivery Fee rA � 1 R�5trfo[etl�D'eti3ety✓Fee t I gbturmFf4oaipttgffo, to Whom&Da I re r O Return Rec Sh o Date,and d e ' dress TOTAL P 1 &Fees yam' Postmar 117�' QQ� vy STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. It yo9^Ado no�t�want this:-receipt postmarked,stick the gummed stub to the right of the return address§rof,thearticle•datedetach and retain the receipt,and mail the article. Oz '►11. 3. f'�du v'ant -return receipt write the certified mail number and your name and address on a r turn receipt aW,N igy381,?,and attach it to the front of the article by means of the gummed e s if l ace permits�Qt�ierwA', ffix to back of article.Endorse front of article RETURN RECEIPT RE UE/STED adjacenf,fe,tthe number. C 4. If �tk2 n restricted to the addressee,or to an authorized agent of the addressee, M endorse TIRIGTED DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.It LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and present it if you make inquiry. 105603.93-B-0218 ai SENDER: I also wish to receive the •Complete items 1 and/or 2 for additional services. rn ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address d permit. d ■Write'Retum Receipt Requested°on the mailpiece below the article number. 2. ❑ Restricted Delivery fn ■The Return Receipt will show to whom the amide was delivered and the date a delivered. Consult postmaster for fee. O •a 3:Article Addressed to: I 4a.Article Number cc c 4b.Service Type � E-�e� o� ; VY?el�inn�e, Rye n �/ d ❑ Registered CertifiedPh Im °C � rn ❑ Express Mail ❑ Insured y I o ❑ Return Receipt for Merchandise ❑ COD i a ot-n o"S� , Da o 7.Date of Delive Z a T ' 5 5.Received By:(Print Name) 8.Addressee's ddre s(Only if requested c W and fee is paid) t � t- 6.Signature:(Addresse or Agent) , H X PS Form 3811,'December 1994 ' ,�; Domest'cri%to elpt i i UNITED STATES POSTAL SERVICE First-Class Mail i Postage&Fees Paid f USPS i Permit No.G-10 I i • Print your name, address, and ZIP Code in this box • I i i i Health Department Town of Bamstable P.O.Box 534 Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 f ,1 � lr� Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health January 10, 1996 Debby's Petland Attention: Melanie Ryan, Mgr. K-Mart Plaza 768 Iyanough Road Hyannis, MA 02601 RE: Animal Carcass Disposal On January 3, 1996, it was brought to the attention of our office that your establishment was placing dead animal carcasses into your dumpster for disposal. Please note that this practice is not allowed under the guidelines of"State Sanitary Code Chapter VIII: Storage and Disposal of Infectious or Physically Dangerous Medical or Biological Waste", specifically regulation 105 CMR 480.010 (d). You shall dispose of all animal carcasses through either an approved incineration facility or an approved interment facility. If you have any questions, please refer to the above mentioned guidelines or contact this office at your convenience. Thank you for your attention and cooperation relative to this matter. Very truly yours, s A. cKean Director of Public Health q/wp/chris/cd I aeii le 'PI y Q- l -3 u 0A \,� zz� IVAh Lff Ingo, -,a A --° O J ( !, CY f 7L PQ Lc. ou L Leo- Pi Pm .- r o _ _ P— /4q S ., ``i' �� ;� i- � ✓ N �+. r - � h. `' I `t ' I t '1 1 C �� �' F S r 1 i � ' � l 1� �� { �� �• � . , � � r � � .� — �, ..I i �, { '� � _, � >� r � + 'R` � ' 4 �, F ... ` �� _ � . — s ;� _ �� ` "� ...ti`% .-� >> 1 V I z