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I..., , , , - - , ,`�� '",�l�, 1§11A q �1-11 - UT - 1539k K,_l�,'� " � . � " 11 _4, ,� _R��Z ; 1, 'i, �,.;,� - , -, , , - - � � , ­ ,,,, , ,�,,� , � � ,� - �" _ _� _ _ " 1. . . �'l 11 ...... . ��; I I w �IN - .r 1, � 0 1 ON .. -,1!4ijt;niiig6tzih� J„ Number Fee 1195 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CGC Express (DBACRoa , Credit Express") 202 Yarmouthnnis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------- Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BAMSTABLE Public Health Division 1 BAMWAB.E, ? Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 cti r Office: 508-862-4644 Fax: 508-790-6304 k_� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 CATEGORY 2 PER":1117 111 -4.09 Gallons: $125.00 P-. Ch t--w CATEGORY 3 PERMIT 500 or more Gallons: $150.00 tOL4 31 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. � 14 I 2. IS THIS A PERMIT RENEWAL? I/ YES_NO. IF YES,SKIP QUESTION 3. • 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. - 4. FULL NAME OF APPLICANT: 0_0_1L Gt S 5. NAME OF ESTABLISHMENT: C C L EXxf�S S 02l 1 6. ADDRESS OF ESTABLISHMENT: 020 2. R-A)4i an S rnn t 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 5�!l c_t'r� , Rd 0 02/�p� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5O,�i" '� ry,!5- 1 goo 9. EMAIL ADDRESS: (ICLA G(,t D S C'�aff- 0_bD OR) GsmO-11• co 10..SOLEOWNER: V YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME E Cclt 0 S 55 l ' 26 n z(en PRESIDENT a.n I O G -7 5 TREASURER C.G,-jeL IJ�y t ne�-r,ZcO (8 r endet-s Ln,ilrlr�ru rcx�� M i 11 Y 12 ©�4 CLERK (L4 5-n T Ey i n p&9- 12 IF PREPARED BY OUTSIDE PARTY: NAME: * " TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:Wpplieation Formsftz Mat App Revised 09-10-18.d Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Auto Repair .-------------------------------------------------------------------------------------------------------------------------------- 202B Yarmouth Road, Hyannis, MA .-------------------------------------------------------------------------------------------------------------------------------------------•--..............----------- Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ff ''� Town of Barnstable A Inspectional Services URNSTABIR PwRY.TPBtE•[ENiFNil1E•CONR•FYARk15 ;1;.iSi011S#'ll5.OSFFMLL•Y.T.Si B?WYST4&E Public Health Division 16333999G--2•0a,14 eJU L T i BAANMBLF Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 N) C� Office: 508-862-4644 Fax: 508-790-6304;_s x: 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. �2'C 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ��,1?al qi�\C�°�- 5. NAME OF ESTABLISHMENT: iek Cxl&jjn 6. ADDRESS OF ESTABLISHMENT: Qoa �D.n,�MK� � UGrC11 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: pp 8. TELEPHONE NUMBER OF ESTABLISHMENT: J® O p 9. EMAIL ADDRESS: 10. SOLEOWNER:JX YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND T LEPHONE#OF: CORPORATION NAME O PRESIDENT �p O TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS AR EMAIL: SIGNATURE OF APPLICANT 1 V DATE QAApplication Forms\Haz Mat Appli Draft Jan20l9.doc • • • P 4 s` _y`, i Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Auto Repair 202E Yarmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 a 499 gallons of Hazardous Materials. --------------------------------------------------------------------------- --------------- ------------------- ---------- ------------------------------ ----------------------------- --- --- --- ------------------------------------- ----------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------------------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health 4� u Town of Barnstable Inspectional Services BARNSTABLE xi %u�LLs,S'EF�It�'=�l BRue�la'RttE �..i Public Health Division = =1< BARNSTABLE, Thomas McKean, Director • Arg1o6�;9�a � 200 Main Street, Hyannis,MA 02601 � i� Office: 508-862-4644 Fax: 508-790-6304 t.._ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 X V., i CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ I *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? -Z YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. • 4. .FULL NAME OF APPLICANT: (� a 5. NAME OF ESTABLISHMENT: A y -1- ® F [RAY �`Y 9 K 6. ADDRESS OF ESTABLISHMENT: YUInOOM lv ix43 OA 01 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 509 444 306 6 9. EMAIL ADDRESS: aulo- V ¢ o (2-0 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:. CORPORATION NAME S PRESIDENT -D60S �° GUILD S g r�10 �l?� G j1'-" TREASURER r CLERK a 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE l �Application Forms�Haz Mat App Revised 09-10-18.docx Q: t Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department s�tas•YsgY.�: Public Health Division Thomas A. McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/6/2019 Permit number: 2019-2020 i :Check number: 7778 Check amount: $125.00 Name on check: JR Auto Repair i Business: JR Auto Repair Owner: Deusdedit Guedes Junior Address: 202 YARMOUTH ROAD, Hyannis i Note: Cateogry II Permit _ _. __.._... . ...... -. _ _....... ._........ • IKE roq� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARM.1;1; E. ' 200 Main Street• Hyannis, MA 02601 9 a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rfD MP'� Business Name: �r �v�o .c,t Date: Location/Mailing Address: 962- Vq Vtn , Contact Name/Phone: 13:1,06 1 or Q5 .�a - - 8og aell 7-7 -z 2-o Inventory Total Amount: N l 80 a1 SDS: 6"' t f- R cep 4 5 License#: 12 2- Tier II : O Labeling:Y- Spill Plan: ±b Oil/WaterSeparator: 01A Floor Drains: N Emergency Numbers: StorageAreas/Tanks: Emergency/Containment.Equipment: �!✓h Waste Generator ID: Waste Product: O Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 00Kk 10l v.V-e- %%10, ry Stv�L� �kSi' 1w-, o ti- �b� NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous aterial use,��� a��t 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 -V W Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts J 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: La. -A Pa,-A e'A X Wo-c.I,-f&.• cvK e k.1..L4-5 k vt,.S 4 a 4-C•e 5 5 -5,kg-2 .c Z .¢ S o w o, P ote.� INFORMATION/RECOMMENDATIONS: Q5r,1% e-g o a�e5 �5��_nMa�n� VeS�- +o , Inspector: i' / Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p IME r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BABMSASS. 200 Main Street• Hyannis, MA 02601 t639. 0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: -;TV- Ao-�o � a� Date: Location/Mailing Address: ;202 19 14v-rvw o eri+ti g Contact Name/Phone: vvt i o� S o -7 - gB al 7'7 -212,-D '�- 1019 1 MSDS: License#:�6 Cag'I Inventory Total Amo nt: � �S Tier II : I Labeling: AawV-wL`kw �- Spill Plan: os-� Oi[/Water Separator: tJ Floor Drains: o Emergency Numbers.` o Storage Area s/Tanks: OWAl'C W.fl Emergency/Containment E i ment: l-11 r a1 Iti We- Waste Generator ID: MV610 I a 8 Waste Product: 01 Date&Amount of Last Shipment/Frequency: I I Z o0 14,1 ewe 3 mas . Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS /es4 ►� �oj raw p�m�a�}- t u7as '� o, / NOTE: Under the provisions of Ch. 111, Section 31, of the Genera 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 Oxlake.4 100 qal t to.,� 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: INFORMATIO /RECOMMENDATIONS: Viust o I14- 2 or 1 hq,¢�f ov I1 �►.� av` 3 ub,nn,-E a S 0 4k- Inspector: , Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS SPILL CONTINGENCY PLAN Emergency Coordinator, Name: JK A0j 9 Rr&,R Address: , �%gQMoork &D HyAljNiS Daytime Phone: 5OS - TU -3203 Evening Phone: Fire Department: 4VAtJ(Jr S Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Cleanup: Name: C-V O &j\jj&o d t C/J f-A S'rQ�i�t5 Phone: S Up_ 6a —10 8 Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). 4 • ix Li - i �asfr I �Q f x .. - - � , 50 W PSC ►� � ( 5 r G S Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. Vn CcSk �4 018UWt4QLc-% W 0\4R-- J 6 0Sc: 9 \j o'rn y . n i . i °FtNE rok� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARN STABLE.�E. ' 200 Main Street• Hyannis, MA 02601 �" i639 1e� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'�e Business Name: < Date: 6 Location/Mailing Address: VNVX k s Contact Name/Phone: A,o '7-1y-2.12-05,11 Inventory Total Amount: /. i1'\ MSDS: 0 License#: Tier II : El 0 Labeling: o \ WAAz a., Spill Plan: Oil/WaterSeparator: N Floor Drains: O Emergency Numbers: Storage Areas/Tanks: 5 wl 1<00&0 L,-,J)6L ®,k k aC $ bV4 k Emer enc /Containment Equipment: � aJc�A0 i i -•'A,-J-S. Waste Generator ID: `( Waste Product: o, Date&Amount of Last Shipment/Frequencv: ko o rk\ (%VW-Ats, kAc, 1, _156 Licensed Waste Hauler&Destination: 00 ava�Aaw, rn A 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, storageand disposal of 111 gallons or more requires a license from the Public Health Division. / J✓ 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, ^1 hydrochloric acid, other acids) VIOLATIONS: _I" ,NHS 4J t'Ah\V ,- ORDERS: 5 ( S S o f D JL ��( JCC.\/�� 2.2 0�- INFORMATION/RECOMMEND TIO S: 01 <JM 0. 1 ate( os ` Wkske, Inspector: ' Lat-Lo1 Facility Representative: 4/0 WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Date:,� /2 3 3 / I TOWN OF BARNSTABLE �s�� ►� TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: 75; XAe> BUSINESS LOCATION: '2� Hy-i A-.4)S INVENTORY MAILING ADDRESS: 54-4L.0 TOTAL AMOUNT: TELEPHONE NUMBER: S 3 bO P, CONTACT PERSON: QU ,914- Gv°e,06-s EMERGENCY CONTACT TELEPHONE NUMBER: 7"7 9 2i 2 OJ q i MSDS ON SITE? TYPE OF BUSINESS: +0 INFORMATION / RECOMMENDATIONS: Fire District: A v`U va.op— 0-f- 6. + 6,aLl I ,-c,.r am n 1 s r .{?�. Ut. + ®� Z move mil. a vise WLy-,L, i Do -�-o�►LL �'0 1 l S u,O� ' ex. 11+4 I� �+ZX-,t� 1- A01 I e� A�tc-4�4.g Waste Transportation: 4e-!5 Last shipment of hazardous waste: b 1 12 Name of Hauler: 1JAS4z,(*vL?), I Destination: b K co)vL, RT— Waste Product: 100 e.I ix1rfe o, Licensed? es No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Anti eeze (for gasoline or coolant systems) Miscellaneous Corrosive �- M NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) I Hydraulic fluid (including brake fluid) Refrigerants M,ottoor Oils / Pesticides "70 NEW 13 USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initia r Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is�to Certify that JR Auto Repair 202B Yarmouth Road, Hyannis, MA 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, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f d s1asch4,t ow of Unstable Regulatoervices Richard V. Scali,Director "IK Public Health Division BARNSTABLE A BAMMa�ss�.LE. Thomas McKean,Director 1639-2014 9`bAr16 � 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644t/ Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 168 HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS 1� i MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 3Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 X V-S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?_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: P 6 06b,Q 7 I i''/r�le D 5. NAME OF ESTABLISHMENT: AK A u r o (�Oe PA I 6. ADDRESS OF ESTABLISHMENT: �0-2, A R1Mt9 j-6 YVAtIJAII 5 1144 O" ' 0 a 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: _6 L) O 1 f 9. EMAIL ADDRESS: 10. SOLEOW`11I , YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: _ CORPORATION NAME JfZ AUTO RE7pj;j P, 5 ,5690 C-E Z-5 �- PRESIDENT T>e L)!,2 p,6 Qi-r �/'I'%tom GUEI��� ��1;0; TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS „ EMAIL: SIGNATURE OF APPLICANT DATE Q\Application FormsViAZMAT APP 2017 REVISED.docx L Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JR Auto Repair . 202B Yarmouth Road, Hyannis, MA 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,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 f ! 4 ' r w of B stable � ;� egUory ervices I 2e ll-) Richard V. Scali, Directortl �A Public Health Division BARNSTABLE ` BPNNS7Atll1•iixEI:VILt•CONIi•NYAi,:15 BARNSTABI.E, Thomas McKean, Director i 39-2o a"""A'"SfAtlE MUSS. ATf1 39. p 200 Main Street, Hyannis,MA 02601 575 --" Office: 508-862-4644 o? � QCC JO Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑, CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00. *A late charge of$10.00 will be assessed if payment is not received by J<uly Ist. 3 tl 9. '"" UZ 90 NfIf 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?_N/, YES_NO. IF YES,SKIP QUESTION 3., 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: r 1✓V S ,1T 1I ��2 �� �� '1;' �1 O Q 5. NAME OF ESTABLISHMENT: A D TO 6. ADDRESS OF ESTABLISHMENT: Q�qa (14 e 1n,06)r/� �� �V A nl N 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50g 71 r 3970 0 9. EMAIL ADDRESS: _ -TR 3—a f kot n3)�l I - cc m 10. SOLEOWNER:>!�' YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: , CORPORATION NAME Q, .�iCxfiO �e Pf�1 R S ER V iCG"� _n C PRESIDENT r E-V �6L 17%T U►jA g C�v c 6-5 0 _'T 2 v TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE` �- Q:\Application Forms\HAZMAT APP 2017 REVISED.docx • Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $125.00 c Town of Barnstable Board of Health This is to Certify that JR Auto Repair 202B Yarmouth Road, Hyannis, MA 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,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 Richard V. Scali, Director $"M ' Public Health Division1639. BARNSTABLE AE& �. Thomas McKean, Director 1639-2014 " 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 \ Fax: 508-790-6304W; APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 map CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: P EV S 6,s=-br l '1/I X►l(Z Gr�,ei;-17 E 5 to Iv `► '0 R, ME HME - NA OF ESTABLISNT: c5 9, A u-T,, 9 C?P,- ADDRESS OF ESTABLISHMENT: o2 Dot V'q R 1"Dv T/4 j,D, /4 U A ry lv i s hn Y�-o a b ©l MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: J" O$ EMAIL ADDRESS: n fain R e rya i h b1cat 1 alf•e-Dr✓i SOLE OWNER: ✓ YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME i PRESIDENT V. o TREASURER CLERK y. IF PREPARED BY OUTSIDE PARTY: SIGNATURE LICANT Name: Company Address Telephone#: Email: Q:\P.pplication Forms\HAZZAPP Revl6.docx Page 1 of 2 I 4 E ' S� Number Fee 1217 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that JR Auto Repair 202E Yarmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 04/01/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health 1 9m lT Town of Barnstable • THE Regulatory Services Richard V. Scali, Director ""AS& ` Public Health Division BARNSTAB. 1679wrsns*neic Dmrt nue.mnm•mnaws S10 unsvma nn•s•osiaMU- euu Thomas McKean, Director 139'°'" 200 Main Street,Hyannis,MA 02601 f.. Office: 508-862-4644 Fax: 508-790-64 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 �L CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by.July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: )E0527 c V 11 A (UE7'5 NAME OF ESTABLISHMENT: �� A U 1 0 R L?A i (k ADDRESS OF ESTABLISHMENT: ®Q! � V I�MOy-r !&J) f-4VA�; IV1�4 MAILING ADDRESS (IF DIFFERENT): y y p ? Q TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: arR i auto APR i P,® H`t ma 1 G 4in SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME JTK Auto Rc PRf of E S6 f CE S x ►yC PRESIDENT DES�p CD1*T- Vi;L 1l R &V4]65 TREASURER CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATU APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department Public Health Division Thomas A.McKean,CHO i639` r` 200 Main Street, Hyannis, MA 02601 Payment Receipt !Hazardous Materials Payment received: $50.00 (Cash) on 4/1/2016 i !Business: 7R. Auto Repair Owner: Guedes ;Address: 202 YARMOUTH ROAD, Hyannis Note: Category I Permit ........ .........._................. ............... ...._...... . _ _.... ...._... � \\ Number Fee \ 1195 THE COMMONWEALTH .OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that CGC Express (DBA "Car Guys Credit Express") 202 Yarmouth Road, 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 w° a Town of Barnstable FSHE l° Regulatory Services Richard V. Scali, Director " `",MASS. ' Public Health Division 9 MASS. i63939.' iO�En 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 lsL c `e�S ojl C e!�'-JyS ADDRESS OF ESTABLISHMENT • 7 - GU TELEPHONE NUMBER S Z3 SOLE OWNER: YES ,,INO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. - V STATE OF INCORPORATION FULL NAME AND IME AD„pSS OF: I'N ll �1 PRESIDENT / 4/ prn-A �9 a � S TREASURER Ca , ,wzevT CLERK 361-1 VJ46rlvf • SIGN P IC NT p RESTRICTIONS: HOME ADDRESS 6044 �`c/ HOME TELEPHONE# ~ 7 7 JAHAZAPP.DOC Number 1195 THE COMMONWEALTH OF MASSACHUSETTS Fee $1Fee 25.00 Town of Barnstable Board of Health This is to Certify that CGC Express (DBA "Car Gu=AlLA4 Express") 202 Yarmouth Road, i 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, and and expires 06/30/2020 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable - Inspectional Services Ft r�`" Public Health Division BARNSTABLE y ' 16'.9201a ■^ MASS. Thomas McKean, Director M y ASS. $ 1639. n 39.t A`` 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY I 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 ❑ 1 - *A late charge of$10.00 will be assessed if payment i nJot received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. -2v / 2. IS THIS A PERMIT RENEWAL? \ YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIESS (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: L� c (SyyS 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 0 6� fi �5 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: V6 _ o?66 / 8. TELEPHONE NUMBER OF ESTABLISHMENT: -775--igo 9. EMAIL ADDRESS: � r(*S 1,4AoLA0 q�IjG�� CGS 10. SOLEOWNER: �,,4ES_NO IF NO, NAME OF PARTNER: 11. FULL NAME, HOME ADDRESS, A&TF�LF,P ONE # A�alh �CORPORATION N ME N (� E,�� PRESIDENT CSI Mee L, 4fv1/) TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • *SIGNATURE OF APPLICANT DATE his b Q:\Application Forns\Haz Mat App Revised 09-10-18. o Number Fee 1195 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CGC Express (DB "Car Guys Credit Express") 202 Yarmouth Road, Hyannis, MA 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, 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 01 ~� ow of B nsxable -Regu�atory�ervices KE Richard V. Scali, Director mot " BARNS LE Public Health Division .: f BARNSiAOLE•fFMERVILLE•D7NR•NYMA'IS .�7..x �� r Thomas McKean, Director ° ^"�° p �� ^�� y MAR& A 1639-201 y y�t ,erfo , 200 Ma-m Street;Hyarinis�MA-02601- Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE f; HAZARDOUS MATERIALS '` IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V'•S CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late char a of$10.00 will be assessed if pument i not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 28 111q 2. IS THIS A PERMIT RENEWAL?_YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: (-,Ag 5. NAME OF ESTABLISHMENT: J / C- 6. ADDRESS OF ESTABLISHMENT: 26?- G<J �EJS 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 7Y, / �y 9. EMAIL ADDRESS: C � S C802cj6j . Ca" 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION AME CGC Y .� PRESIDENT 1(\jW a &,, fi TREASURER CH lad t CLERK Gn/ adjaPQArr 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.mt")/ L sa Number Fee 1195 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CGC Express (DB "Car;Gu:ysCredit Express") 202 Yarmouth Road, Hyannis, MA 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,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 = woho LT Fs I b 4s r Town of Barnstable Office: 508-862-4644 .. Fax: 508-790-6304 Regulatory Services Department • *.;;, STIAB Public Health Division - Thomas A.McKean,CHO id39 � s 200 Main Street, Hyannis, MA 02601 Payment Receipt ,Hazardous Materials Payment received: $135.00 (Check) on 8/4/2017 Permit number: 1195 Check number: 5690 Check amount: $135.00 Name on check: The Car Guys, Inc. Business: CGC Express(DBA "Car Guys Credit Express") Owner: DOUGLAS E TR Address: 202 YARMOUTH ROAD, Hyannis Note: 2017-2018 Category II Permit/ $125 + $10 late fee ...... - ----- --- - _- _ ........ I • r' Number Fee 1195 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that CGC Express(DB ar Guys Credit Express" � 202 Yarmouth Road, Hyannis, MA 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,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 r V Town of Barnstable �tH Regulatory Services Richard V. Scah, Director WANSTABM Public Health Division BARNSTAE 1659. • a" « ♦ gpy� ��fOMA'�► Thomas McKean, Director 1639-2014 r 573 200 Main Street, Hyannis,MA 02601 ► r Office: 508-862-4644 Fax: 508-790-4SO4 C8 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 T MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 3 0th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late char a of$10.00 will be assessed if VaVment is not received by July 1st. ASSESSORS MAP A PARCEL NO. 32P Z/�2 DATE 7r ND l FULL NAME OF APPLICANT: U�NC�'�`' - NAME OF ESTABLISHMENT: C— C41LS ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): �+ 7 TELEPHONE NUMBER OF ESTABLISHMENT: V s-Ci,r � ��r Z3 6 6 EMAIL ADDRESS: C� G��S CCr�e G� .,o aka t • Ca w1 SOLE OWNER: YES ZO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION ANTE G . P 5 S - C PRESIDENT -J i N TREASURER 'CI-sElf 0 I N6zeJr CLERK IF PREPARED.BY OUTSIDE PARTY: 4SIGN T ( T Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of r �pp�NE ipk� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B^ ASS.M 200 Main Street• Hyannis, MA 02601 .639.s,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'� Business Name: T 1�e- Car&'v r-c al,r a.ra Date: Location/Mailing Address: o2- YWr -',, , Contact Name/Phone: )(&v. b.e.\/k"� VD8- 775- /$aa er- 1 S08-�g�-I7S7 Inventory Total Amount: �D �� SDS: �a Jy1S�S--vw-A,�Ojicense#: 11�!S Tier II : 0-o Labeling: 5c4 wok-(- Spill Plan: �, es Oil/WaterSeparator: Floor Drains: C Emergency Numbers: es Storage Areas/Tanks: 2 o2r.,.�'i w�5{c v t�t _way i'c-aka, <Kx�e�, t-. o- i -AT t= Emergency/Containment Equipment: 50e e-,,2 ��� d►ti 5+i'2.. i Waste Generator ID: $"175 1 -402C26 Waste Product: Date&Amount of Last Shi ment/Fre ue c : 2 tS 1? 50jAj 1 k 2 ++to Licensed Waste Hauler&Destination: I L IvL T Other Waste Disposal Methods: \ LIST OF TOXIC AND HAZARDOUS MATERIALS IJ v +ti.a, O� G+� t V+ t 1ti�1 Q,,no•cy $tvt� '��•� � �p� ;o NOTE: Under the provisions of Ch. 111, Section 31, of the G1 neral Laws of MA, hazardous mlterial use, t storage/and disposal of 111 gallons or more requires a license from the Public Health Division. +l Antifreeze t W"h k-o-' 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 V Motor oils*+mast-. 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: ECILVIt bkec Or,5��2.. to5S "-I- S, Cczy oav— 10 T k t vt. � !-5= A s a��2 •c,p v,ti INFORMATION/RECOMMENDATIONS: Inspector: �' 1 �^Ay4 —e— Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS i_ �p IMF "ry Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE.g` 200 Main Street• Hyannis, MA 02601 039. ♦0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CEO MPS h Business Name: --rla, �ar 6v SDate: 36 /b Location/Mailing Addres ROZ y4i Q�wt ah✓lrS Contact Inventory Total Amount: `�� MSDS: ok OWk &\,& License#: Tier II : Labeling: 066te,Ate k mill Plan: Oil/Water Separator: p Floor Drains: Qv Emergency Numbers: Storage Areas/Tanks: my t m% X<jvvi t wwstchyAe, wLvi AT1F, t u-w o, Emer enc /Containmen Equipment 154",QN < 0 5 0,<1 o<S ,ti 5 Waste Generator ID: avq,i 16 Man -5{5 Waste Product: n� Date&Amount of Last Shipment/Frequency: '- 3 I l h oo JJ• o 1' Licensed Waste Hauler&Destination: A )A/fA,6`61her Waste Disposal Methods: ,4, LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, �$torage and disposal of 111 gallons or more requires a license from the Public Health Division. (Sfi� �Antifreeze 0�ws�<— 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 � 1105 — Motor oils I i o wctsker Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants — Miscellaneous petroleum prod ts: Road salts grease, lubricants, gear oil, Refrigerants Degreasers for engines&garages -7- Pesticides: Caulk/Grout insecticides, herbicides, rodenticides I Battery acid (electrolyte)/batteries I 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: o 10 1� Cow�� avt o5 0 g &NrM Vaao ORDERS: V— D 4 Dos+ ,11 a , 9 vt, $ s t+ a Q,I 1 fl �� I6 eeg L 21 s ►�.cs �s " a �S �- 1v �,s�'��e� INF MA ION/RECOMMEND TI NS: v6 I c4 6-1 J - /� 1 / �1vtd ro �Q.-z&,rG/�CDUS Wq,S+.e, WtA.vli-ct5+"s CVI� Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p IKE►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 `x 98A MAArR9. 200 Main Street• Hyannis, MA 02601 "rFDMA+°,e TOXIC AND HAZARDOUS MATERIALS IN PECTI N REPORT Business Name: ►c'L Cx-r(� 5 kk`� Date: 8 2 6 i Location/Mailing Address: 7,02 ,- h n, S Ao fl%- a ,ee-- -14Kc Co tact Name/Phone: a 7 . o -17.5--190D J5. k/A J<< 1 J5'0& Vq R"75 Cell Invento V Total Amount: �- iRoq�I�4'�O�b MSDS: Y License#: o - Tier II : o I Labelina:,�?C`,)V►lS is JkWty Spill Plan: Oil/WaterSeparator: Floor Drains: Nv Emergency Numbers: Storage Areas/Tanks: - a1 c-xXtS 00,5ke o, I - vo"�-e_ ,J < eSP_ Emergency/Containment Equip ent: o < 5 k� v`. Waste Generator ID: Waste roduct: , e Date&Amount of Last Shipment/Frequency: o \ %W_4 2 v w V'R S . 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. 160 Antifreeze i�yt S�vcvA4, Dry cleaning fluids V Automatic ansmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash t Motor oils ` -t \10 v2agAe, 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 1 Refrigerants 3D 5 k3o1\30 Degreasers for engines&g rages t Pesticides: Caulk/Grout Qe<50 insecticides, herbicides, rodenticides —�� Battery acid (electrolyte)/batteries %,,*v� 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: Ao S'P1ilg`� ��t.�,��,dG �a ,mac �� O k-5 &-. ORDERS: Im4 wi 0. S I FORMATION/ 'O-MM v .5 v-- c> �Ccn\A.t. - or ��'. J `V6+c99_ 15' e I sn pector: QV� g�CoCA av � I��) acility Representative: -e.Q'CS - L'j-Q.2-9'm l�.�vl.. ���- �,��t,(��•�� l a�j , WHITE COPY'-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °ate►off Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE. ` 200 Main Street• Hyannis, MA 02601 039. �ArFDMP+& TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: A C i V\�(, Date: Location/Mailin Address: 2-02- alnn own v\ Contact Name/Phone: ZJf_ \biz o -17 '► Inventory Total mount: I �J MSDS: oVl��u-Z�- 4�� � License#: � Tier Il : O Labelina: �E-�kS\AQ\&%e*.k p°C.,.� ill Plan: -�o Oil/WaterSeparator: tJ A Floor Drains: O Emergency Numbers: -9 11 Storage Areas/Tanks: Ss e, o% t- 5 til -,WL w .p— z- Emer enc /Containment E ui ment: < <, 0A )P Waste Generator ID: Waste Product: o1 Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: C.yv� , I 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 -v I Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes / Bug and tar removers Hydraulic fluid (including brake fluid)IX I Windshield wash l 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 3 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 l Lacquer thinners I 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: or e2 D —A GLvt O Ca A .e•C �[Ooor O JA'ilevr p,k Ins ecto L�.AJ`e.�`.A-- C�zk EPA So J ^ '�'�y►q,A Clop(Facility Representative:a: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ,Y �� TOWN OF BARNSTABLE Date. 3 TOXIC AND HAZARDOUS MATERIALS ,RE-GISTRATI©N—FORM NAME OFJ'BU.SINESS: j�o C�I��� BUSINESS LOCATION w. -2,4PZ y4,c-yvMP,)+ .,`. ye,GQ INVENTORY MAILING ADDRESS: TOTAL AMOUNT— TELEPHONE NUMBER. z:F--7,, !.' t i 4. Y P4... •2Y pA' .h r - . j t ,E V k CONTACT PERSON: ' }e y�1.4 N�.6,6te EMERGENCY CONTACT TELEPHONE NUMBER: ar+ .-w ' • . x MSDS'.ON SITE? TYPE OF BUSINESS: r4-Da /Uo INFORMATION / 1R,E.COM.^MENDATIONS:' . M Y f Fire.,,District: 777 ar`" .✓�"i�+ .1��-(Gt.�K.Gfj� �'l�'Q-S ,. t ,� �1�Sf 1�1�t;1J Waste Transportation: A//A Y S-ee, h.14e Last shipment of°hazardous waste: Name of Hauler: Destination: N: ` Waste Product: Licensed? Yes No NOTE: Under the provisio s of,Ch. 11.1, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. i- 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 , `if Observed / Maximum,, Antifreeze (for gaass°line or coolant systems), Miscellaneous Corrosive CN NEW LZ USED "' i y „, ' Cesspool cleaners ; Automatic transmission fluid °yt, � Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brakejluid) Refrigerants Motor Oils �:'r r* Pesticides ❑ NEW ❑ USE'D" (insecticides, herbicides, rodenticides) �-t w�; Photochemicals (Fixers) Gasoline, Jet fuel,Aviation gas Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED / Photochemicals (Developer) Miscellaneous petroleum products: grease, lubricants, gear oil ❑ NEW ❑ USED ✓ Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers ./ Windshield wash J/ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials y// t r a Hazardous Materials Inspection Notes March 25, 2013 Auto Clinic 202 Yarmouth Road Hyannis, MA Timothy Lavelle, PHD Steven Hebden, Manager The annual inspection of the above facility was conducted on 3/25/13. The last inspection was done on 7/7/11, when the new auto repair shop opened for business. The facility consists of a two bay garage with attached office and storage space. The garage is leased from Darrell Fiertz, Auto Smart. The types of hazardous materials being stored have not changed since the last inspection. The materials included motor oil, waste oil, windshield washer fluid, steering fluid, brake fluid, miscellaneous aerosol flammables, antifreeze, and car wash detergents. The total quantity of hazardous materials in the entire facility was estimated to be less than 40 gallons. New products are stored in a bermed room with a concrete floor. Materials in use are stored on a concrete floor in the garage area. Waste oil is stored in two five- gallon containers in a corner of the garage area. Absorbent materials are onsite and readily available. Based on this Hazardous Materials inspection, the facility is not subject to the Town of Barnstable's Hazardous Materials licensing requirement. However, regardless of the amount of materials, all businesses are subject to certain safety, storage, and disposal requirements. CORRECTIVE ACTIONS TO BE TAKEN: Material Safety Data Sheets (MSDSs) for hazardous materials used at the facility were not available. MSDSs must be on-site and readily accessible to employees. These can be obtained from the supplier of the materials. Employees should be trained in how to read and understand the MSDSs. An MSDS information sheet has been included with this letter. There were no records, in the form of manifest sheets, for the off-site shipment of waste oil, waste oil filters, or used antifreeze and no records of using a licensed hauler or designated waste receiving facility. Therefore, a Hazardous Waste Identification Number was unavailable. The Identification Number is required as the business does generate Very Small Quantities of Waste Oil (i.e. less than 27 gallons per month) and can be obtained from the Massachusetts Department of Environmental Protection. As a Very Small Quantity Generator of Hazardous Waste, you may transport your own waste with certain conditions. However, the types, quantities, and receivers of the waste must be kept in your records for a minimum of five years. Fact Sheets entitled "The Very Small i Quantity Generator of Hazardous Waste", which explains the storage and transporting requirements of hazardous waste, and"Self-Assigning a Hazardous Waste Generator Identification Number" are included with this letter for your use. Waste containers are to be labeled with the words "Hazardous Waste", the type of waste and the associated hazard (i.e., ignitable, toxic, corrosive, reactive). For the two containers of waste oil, "Hazardous Waste", "Waste Oil" and "Toxic" would be the appropriate labeling. Absorbent materials were spread out on the floor throughout the garage. After the materials have dried,they should be swept up and disposed of properly to prevent accidental tracking of the materials away from the garage. The fire extinguisher at the facility was last serviced in November 2001. The fire g Y extinguisher should be taken to the fire department to be inspected. g p p A car was observed being washed during the inspection. Vehicle washing with soaps or detergents is prohibited by the Town of Barnstable. A copy of the Town's Vehicle Washing Policy is enclosed. ;'0; j COMMONWEALTH OF MASSACHUSETTS {h s` DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING DIVISION 0 -SOLID AND HAZARDOUS WASTE rz C One Winter Street � '• Boston, Massachusetts 02108 Please print or type.(Form designed for use on elite(12-pitch)typewriter,t"=, UNIFORM HAZARDOUS 1.GeneratorUS.EPAIDNo. Manifest 2.Page 1 InformatioA in the shaded areas Document No. WASTE MANIFEST of is not required by Federal law. 3.Generator's Name and Mailing Address ~ A.Statl Manifest Document Number 3 tiz ; a� � r MA, CO22824. n { 'Ma ' a f f't f �,z, }y.�} B.State Gen.ID x1rt r1 4.Generator's Phone n4 i " . eo .7 , s ;9d O ru 5.Transporter 1 Company Name 6.. US EPA ID Number C.State Trans.ID ru $A _ ; V. ru 7.Transporter 2 Company Name' 8. US EPA ID Number' b,Transporter's hone E. tate Trans.ID 00 9.Designated Facility Name and Site Address 10. US EPA ID Number I 00 t• < .; �� ,� F.Transporter's Phone( ► t1 - � G.State Facility's 1D Not Required ContaH.Facility's Phone"(,` � + iners. 13. .. V 00 11.US DOT Description(Including Proper Shipping Name,Hazard Class,and/D Number) Total Unit Waste No. -- No. Type Quantity WtNol 3 4.,. to '+.+ _ _ r - syy M i c G b Z � E - M can N aD E D R c. 0O m C ° . d co TD a Z R d. m L y io Z v J.Additional'Descriptions for Materials Listed Above(include physical state and hazard code. K.Handling Codes for Wastes listed Above M 1 ty' y a..,,t A.,= D t c. a. c., . r co { � Gl m b M E d: b. d. Z E 15.Special Handling Instructions and Additional Information m D a _q u) O p 16.GENERATOR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and Uare classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national C government regulations,and all applicable State laws/regulations.Unless I am a small quantity generator'who has been exempted by statute or regulation from the duty to make a waste minimization certification under Section 3002(b)of RCRA,I also certify that I have a program in-place to reduce the volume and toxici- m ty of waste generated to the degree I have determined to be economically practicable and I have selected the method of treatment,storage,of disposal currently avilable to me which minimizes the present andAuture threat to human health and the environment EN ,_0' Z--,- ..� Date 4­ Printed/Typed Name 4 Signature Mo h= D O y aLIE UR 17.Transporter 1 Acknowledgement of Receipt of Materials C A Printed/Typed Name Signaturelit o N S P 0 18. r n rt Ac owledgement of eceipt of terials Date R T E Printed/Typed Name Signature Month, Day Year R F 19.Discrepancy Indication Space A C I • L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. T Date y Printed/Typed Name' Signature Month Day Year Form Approved OMB No.2000-0404.Expires 7-31-86 EPA Form 8700-22(Rev.4-85 Previous edition is obsolete) COPY 8: GENERATOR•RETAINED BY GENERATOR 1- — _ z INSTRUCTIONS FOR COMPLETING THE UNIFORM HA'ZARDOU.S WASTE MANIFEST t `Ittem G`STATE FACILITYiS ID—No entry is required-by Massachusetts. ;S - "` *Item H:FACILITY PHONE-Enter a telephone number with area code for the TSDF designated to receive the wastelisted on the manifest. IMPORTANT:READ ALL INSTRUCTIO1.NS BEFORE COMPLETING THIS FORM. 1 Item 11:US DOT DESCRIPTION—All of the following must be entered:The correct US DOT(Department of Transportation)name for the ' waste as identified in 49CFR Parts 171-177(usual) found in column 2 of section 172.101),the assigned DOT Hazard Class(usual) State and Federal regulations require Generators,transporters,and Treatment,Storage,and Disposal Facilities(TSDF's)to use this form and, Y 9 y in col- if necessary,the Continuation Sheet for interstate and intrastate shipments of hazardous wastes. �� umn 3)and the 4 digit UN/NA ID number:lcolumn 3A).(e.g.:Waste Sulphuric Acid,spent,corrosive material,LIN1832 RQ).US DOT requires the word"waste"before or in the shipping name for all hazardous waste. q , The MA manifest contains 8 copies.ALL COPIES MUST BE LEGIBLE[(Illegible manifests submitted to the State will be returned to the generator f for proper completion.)Thisform is designed foruse on a 12 pitch Wits)typewriter.A firm 6alrpoint pen may also be used if you press down Item 12:CONTAINERS(NO.&TYPE)—Enierthe number of containersf6r each waste and the appropriate abbrevriations from Table I(below) HARD.Each of the 8 copies must be filed with the appropriate party as it is completed.Copy distribution is as follows: for the type of container used: _ I ' COPY 1: DESTINATIONiSTATE—Mailed by TSDF:the original stays with the shipment from generation to cpmpletionby the TSDF: I I TABLET-CONTAINER TYPE,: r - Whenthe manifest is completed,the TSDF must mail this copy to the state where the+facility is located. DM=Metal drums,barrels kegs - DW=Wooden drums,barrels,kegs -DF�Tiberbdard or plastic drums,barrels, l - l TP=Tanks,portable t TT=Cargotanks',(tank trucks) kegs'j-, COPY 2: GENERATOR STATE—Mailed by TSDF:When the TSDF has completed his section of the manifest,,he mails this copy tq the DT=Dump truck ; _ CY=Cylinders •, TC=Tank cars State where the waste was generated. CW=Wooden boxes,tartans,cases -CF Fiber or plastic boxes;cartons,c —cases CM Metal boxes,cartons,cases(incl. COPY 3: GENERATOR COMPLETED COPY—Mailed by TSDF;When the TSDF has completed his section of the manifest,he mails this I, - roll-ovs) '? BA Burlap,cloth,paper/plastic bags .4Item 13:TOTA copy back to tFie Generator of the waste,.who must retain it on-site for his-records., t - L QUANTITY—Enter the total quantity of waste described on each line. - COPY 4: TSDF CONY:When the TSDF has completed his section of the manifest,he Deeps this copy for his records. - - , r • Item 14:UNITi(Wt.Nol.)-Enter the appropriate abbreviation from Table 111below)for the unit of measure used in determining the total quantity COPY 5: TRANSPORTER 1:When the transporter has completed his section of the manifest and transferred the waste to the TSDF,he of waste described on each line.Do not use fractions. keepsthis copy for his records. 9 " TABLE II—UNITS OF MEASURE NOTES If a continuing transporter is used,the generator is responsible for supplying him with a legible photo-copy of the Pounds ' - P manifest,which must contain signatures where requwed. '" G=Gallons(liquids only) S. L=Liters(liquids only)- Y=CubicYards K=Kilograms - l , T=Tons 120001bs.1 COPY 6: DESTINATION STATE—Mailed by Generator:When.the Generator has completed his section of the manifest..and transferred M=Metric Tons(1000 kgP, N=Cubic Meters R. .his waste to the transporter,'he mails.this copy to the State where the designated facility(TSDFI is located.. •Item lo-WASTE NO.—Enter the 4 digit:EPA hazardous waste number as it appears in 40 CFR Part 261,Subparts C and D.If a non-RCRA COPY 7: GENERATOR STATE—Mailed by Generator;When the generator has completed his section of the manifest and transferred State-regulated wastestream is being manifested,enter the State waste codehere.If both the Destination and Generator States have assigned his waste to the transporter,he mails this copy to the State where the waste was generated. codes use the Destination State code.If there is no EPA/State code,enter'.,none';. I , COPY 8: GENERATOR:When the Generator has completed his section of the manifest and transferred his waste to the transporter,he 'Item J:ADDITIONAL DESCRIPTIONS FOR MATERIALS LISTED ABOVE—Enter description of analysis for any waste which does not have keeps this copy for his records. a'U.S.DOT shipping name or has an N.O.S.designation.Enter constit6ent percentages,chemical names,physical states IS=Solid,L=Liquid, + - G=Gas,SI=Sludge)and EPA Hazard Codes Ilgnitable(1),Corrosive(C),Reactive(R),EP Toxicity(E),Acute Hazardous(H),Toxic(T).Enter GENERATOR SECTION the specific gravity if otherthan 1.0.Any additional desired waste description may also be entered here. Item 15:SPECIAL HANDLING INSTRUCTIONS AND ADDITIONAL INFORMATION Use this space to indicate special transportation,treat- Item 1:GENERATOR'S m er you NO.n MANIFEST DOCUMENT NO.ly Enter the n EPA generator's 12 digit identification number.Then ment,storage or disposal or Bill of Lading information.If an alternate facility 1TSDF1 is designated,note it here.For international shipments, enter a unique 5,digit number you assign to this manifast..Use of serially increasing numbers leg.00001,00002,etc.,)is recommended. I r � Generators must enter the point of departure(City and State)from the US through which the waste must travel before entering a foreign coun- Item 2:PAGE 1 df_,—Enter the total number of.pages used to complete this manifest,i.e.,the first form plus the number of Continua- try.This space may also be used for emergency response telephone numbers,and other information the Generator wishes to include about tion Sheets,if any.Any EPA approved continuation sheet may be used,but distribution and completion must meet Massachusetts manifest the shipment,including placarding. requirements. - 'Item K:HANDLING CODES—TSDF Completes this section—See"Designated Facility Section"(below). ~ 'Item A:STATE MANIFEST DOCUMENT NUMBER—Number preprinted by MA except on the Continuation Sheets.Enterthis number in Item Item 16:GENERATOR'S CERTIFICATION=The Generator must reed,sign(by hand)and date the certification(with date of transfer to L on each Continuation Sheet attached to or part of a manifest. ,� transporter).If a mode other than highway is used,the.word"highway"should be lined out and the appropriate mode(rail,water or air)in- serted(asnotified in the space below.If another mode in addition to the highway mode is used,enter the appropriate mode leg."and rail")in the space below. l address should be the location that will manage the return ad manifest forms. Item 4:GENERATOR'S PHONE NUMBER—Enter's telephone number with area code where an authorized agent of the Generator can be reach- ` TRANSPORTER SECTION ed i. an'emergency. - d , - - Item 17:TRANSPORTER{il ACKNOWLEDGEMENT—Print or type the name of the person accepting the waste on behalf of the first -item B:STATE GEN 16_-The State Generator ID is the street address of the Generator's pick-up location.If the mailing address and the street Transporter.That person must acknowledg(;acceptance of the waste described on the manifest by signing and entering the date of receipt. addres@ are the same,enter"same"in this block. Item 18:TRANSPORTER 2 ACKNOWLEDGEMENT—If applicable,follow the instructions for Item 17 for Transporter 2. . Item 5:TRANSPORTER 1 COMPANY NAME—Emer the company name(as notified to.EPA[of the first transporter who will transport the waste. - .DESIGNATED FACILITY(TSDF)SECTION i Item K:HANDLING CODES:TSDFSHOULD COMPLETE—Enter the ultimate handling method utilized at the designated facility for each waste Item 6:'US EPA 10 NUMBER—Enter the US EPA 12 digit identification number of the first transporter identified in Item 5. listed in Item 11.Only the following process codes may be used: 'Item'C:STATETRAN 10—Enter the State of registration anil the license plate number of the waste-carrying portion of the vehicle being TABLE III—PROCESS CODES - used to make the pick-up.. STORAGE: S011C0ntainanl S03(Tank) S03(Wasta Pile) SO4(S,rIa lmp 6� )• SOB(0ener-sp.cef,) *Item.D:TRANSPORTER'S PHONE—Enter a telephone number with area code where an authorized agent of the transporter can be reached. TREATMENT.Ralaaa40CFRp,n265,Appana.1.Tahla2. Item 7:TRANSPORTER 2 COMPANY NAME—If applicable venter the company name(as notified to EPA)of the second transporter who will DISPOSAL: D79(inia..wall) 08OILandid) 1381(1.aad Application), D82(Ocaan Disposal) D83(S,daca Imp.) transport the,waste.If more than two transporters will be used,,use a Continuation Sheet and list the transporters in the order they will be D8410the,-Speedy) - transporting the waste. - Item 1.9:DISCREPANCY INDICATION SPACE—The authorized representative of the designated facility's owner or operator must note in Item 8:;US EPA ID NUMBER—If applicable,enter the US EPA 1.2 digit identification number of the transporter in Item 7. this space any significant discrepancy between the waste described on the tnanifestand the waste actually received at the facility.Any re- .I I - .f jetted materials should be listed here,along with an indication of the disposition of the rejected materals Any applicable Discrepancy or Ex-_ 'Item E:STATE TRAN ID—If applicable,enter the(;econd t4insporter's State of registration and license plate number for the waste carry- caption reporting requirements must also be complied with.Federal and state regulations may vary. If ing portion of the vehiclebeing used to make the pickup: - _ Item 20:FACILITY OWNER OR OPERATOR CERTIFICATION Print or type the name of the person accepting the waste on behalf of the owner 'Item F:TRANSPORTER'S PHONE—,If applicable,enter the second traosporter's telephone number with area code where an authorized agent or operator of the designated TSDF.That person must acknowledge acceptance of the waste described on the manifest b ,signing(by hand) of the:transporter can be reached. 1'. - and entering the date of receipt.The signature of the authorized TSDF agent indicates acceptance•of lexceptfor items st acified irLmT1HE and agreement with statements on this manifests z Item 9,DESIGNATED FACILITY NAMEAND SITE ADDRESS—Enter the company name(as notified to EPA)ofthe TSDF designatedto receive the'waste listed on this manifest.The address must bethe site address,which differfrom mailing address-. - NOTE:FOR INTERSTATE SHIPMENT YOU MAY BE.REQUIRED TO COMPLY WITH THE MANIFESTING REQUIREMENTS OF ` - DESTINATIONAND.GENERATORSTATESREGARDINGTHECOMPLETIONOFSPECIFICINFORMATIONINCLUDEDINLETTF Item 10:US EPA ID NUMBER--Enter the US EPA 12 digit identification number of the designated TSDF listed in Item 9. A-K, - -- - - TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: '� l' .sr �l �� Town of Barnstable TELEPHONE NUMBER: ' �7 f�' P.O. Box 534 CONTACT PERSON: � Z Hyannis, MA 02601 47 Does your firm store any of a toxic or hazardous materials listed below, either for sale or for your own use, in quantities total ' g, 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: y Antifreeze (for gasoline or coolant systems) Drain cleaners t/ Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners (/ Hydraulic fluid (including brake fluid) Disinfectants h Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants a / Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, V 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 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) :e d-0j Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business 4"TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine Gas Stations Repair air satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers CO` PANY , j?,`;O (see"Orders") 5.Retail Stores Yr .fYor�' .i' 6.Fuel Suppliers G G f 7.Miscellaneous ADDRESS ' r��a Class: �r pQUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots /rums Abo' ve Tanks Underground 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) "OW c.� new motor oil (C) �� transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 7" ' DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply , r"" A 4Z.a O Town Sewer ,QPublic ,, , 'On`site OPrivate f% 3. Indoor Floor Drains YES P/NO O Holding tank:MDC ° O Catch basin/Dry well O On-site system YI.e•t f A111- 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank: MDC " O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product 4 /�fg/r' A,JPA"I, L&OA W_el,ml"Al of 14-1 Person(s) Interviewed Inspector t1 Date r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: Ylt r1 ary %,Gt k RL tk�o SOJU MAILING ADDRESS: look Yqo rrnovAt"% TELEPHONE NUMBER: CONTACT PERSON: I®S a(,Do Mk 1c 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasline or coolant systems ) Refrigerants Automatic transmission fluid . Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides ) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel , Kerosene, #2 heating oil (creosote) Other petroleum products: grease,lubricants Swimming Pool chlorine Degreasers for engines and metal Lye or caustic soda Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) i Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other _ Metal polishes acids) Laundry soil & stain removers(including bleach ) Other products not listed which you feel may be Spot removers & cleaning fluid E C E ! V E D toxic or hazardous (please (dry cleaners ) HEALTH DEPT. list) : Other cleaning solvents TOWN OF BARNSTABLE Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners JUN 1 1981 Disinfectants Road Salt (Halite ) TOWN OF BARNSTABLE 4 BOARD OF HEALTH CONTROL F TOX C HAZARDOUS MATERIALS - INSPECTION SHEET FIRM r Oda. r < t ADD ES Major t of materials: 1) 2) 4,. 3) r 4) . 'et, .. S) 6) I. Description of material(s) use: II. Storage .(denote product by numb-r"'listed above) A. Containers . n)etdl glass paper plastic cans,bottles,jars Ar drums,barrels ' aboveground tanks -1 underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility Vor # Remarks/Recommenu ::.ions 1. Indoor a) separate, contained room b) stored in general work area , i) inadequate ventilation ii) floor drains ' iii) inadequate fire protection 2. Outdoorf l a) uncovered, exposed to weather b) tpIgrvious surface/catch basins III. Disposal k kl A. Reclamation/Recycling unit /6114 B. On-site disposal 1. Town sewer 2. Regular septic system " "' 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site Person(s) Interviewed _ _ _ r Inspector,. -- _ ` _ _ _ Date. 6 30 81 - - - - �r t ONIV N OF Bf RNSTABLE COMPLIANCE: L . Karine,Gas Statiors,Repai.r i Osatisfactory • Printers .i BOARD O � EALTH . ano pod Shsps J O unsatisfactory= 4. (see"Orders . Ret Stores COMPANY 1►� J . Fue�uppliers ADDRESS Class: . Mis laneous QUANTITIERAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums anks Undetgrouad Tanks IN IDUT IN [OUT IN IOUT gEllons ALe Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) Lf transmission/hydraulic 1 Synthetic Organics: !; degreasers P015(VA50. to i Miscellaneous: N P64 I ISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply U ) All Q Town Sewer Public AQA�AlA1 On-site FPrivate �`� ' f /00 3. I.ndQor Floor Drains: YES x NO Holding tank: f ' oCatch basin/Dry well ----._-_ --- ------- - ----,—� 0 On-site system ORDERS: 4. Outdoor Surface drains-.-YES NO X ` Holding; tank: MDC����. ® Catch basin/Dry well OOn-site system � 5. Waste Transporter Licensed? Name of Hauler Destination }haste Product YES NO 1. h RZ\ Person(s) Int.erviewed . "" pe . or Da e TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: o x�ars Cr,ak74C MAILING ADDRESS: ao,'t arryocc ko. alaaI"es,'/4r5-, O26o/ TELEPHONE NUMBER: 77/- 673// CONTACT PERSON: /r7 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 K 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: Antifreeze (for gasline or coolant systems)w Refrigerants Automatic transmission fluid Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils _ Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar Paints, varnishes, stains, dyes carbons, (inc.carbon tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners) R E C E I V E ® list)1 , Other cleaning solvents HEALTH DEPT. _ Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners _ Disinfectants 'MAY i 5 1981 Road Salt (Halite) Y S TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM : / ADDRESS , ' Major y 'es of materials: 1) 2) 3} - . 4) V 5) 6) I. Description of material(s) use: II. Storage (denote product by numbe ' listed above) A•. Containers metal glass paper. plastic cans,bottles,jars n drums,barrels " aboveground tanks 440 underground tanks 0 bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility v/or # Remarks/Recommenc: .ions 1. Indoor a) separate, contained room b) stored in general work area N . i) inadequate ventilation ii) floor drains iii) inadequate fire protection ' s 2. Outdoor r a) uncovered, exposed to weather b) pervious surface/catch basins Ire III. Disposal F` A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system 3. Separate holding tank C. Off-site disposal 1, hauled by own firm 2. hired hauler 444 ra a) name of hauler %op b) address or disposal site Perso.n(s) Interviewed { - �, Ins ector. � . • � —�� — - - - - - - - p �? - - - . — — — — — — — — Date ��_ - - - - - - - - 6 30 81 L ANCE: GI� S'S ;a; Marine,Gas Stations,REpai.r TOWN. OF BARNSTABLE �'.., 2: Printers fr BOARD OF HEALTH factory 3. Auto Body Shops sfactory- 4. Manufacturers �� �� Retail Stores A COMPANY , see Orders ) S. 6. Fuel Suppliers ADDRESS, Class:Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbdveTanks Undetground Tanks. RIA IN UT I IN IOUT IN IOUT # & izallonsarest? Fuels: Gasoline, Jet Fuel (A) , I Diesel, Kerosene, #2 (B) 3 Heavy Oils: { I waste -motor oil (C) new motor oil (C) transmission/hydraulic _.. Synthetic Organics: i degreasers ' I Miscellaneous: i e DISPOSAL RECLAMATION REWtRKS: 1. Sanitary Sewage 2. Water Supply 0 Town Sewer O Public 0 On-site O ��� .�7� {•�t� .r - _ Private 3. Indoor Floor Drains: YES / NO 4 Holding tank: MDC O�Catch basin/Dry well __.__ _ _......_....... _ -._..__...._ '.._....... . 0 On-site system 4. Outdoor Surface drains-.YES NO O Holding tank: MDC O Catch basin/Dry well OOn-site system ,' S Waste Transporter Licensed? Ns 4 Cm_0 of Ham_ sestina ion W[a-qte Product YFS NO 2. 7-1 iz 23 ea Persons _ Interviewed Inspector Date l TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: -7 Board of Health MAILING ADDRESS: 2 2 ` Town of Barnstable TELEPHONE NUMBER: -"� /ve ` P.O. Box 534 CONTACT PERSON: �J� 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 storeds Please put a check beside each product that you store: 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 Mo roils/wast_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) 9 g ( p ) 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 V Paints, v 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 n TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANYc r (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ;ZraCjaSS' 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 motor oil (C) new motor oil (C) Z transmission hydraulic r=. Synthetic Organics: degreasers Miscellaneous: Ij DISPOSAU/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer VPublic Von-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 Name of Hauler Destination Waste Product YES INO 2. 4Tdrson (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: � � �� P.O. Box 534 CONTACT PERSON: f9 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 totallin at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES �q�NO Z 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 ' Please put a check beside each product that you store: V I 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 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 Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2•Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS " Class: 7.Miscellaneous y�QTANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIADS Case lots Drums A I bove Tanks Underground Tanks IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) �4CS transmission/hydraulic .q lq4r/ Synthetic Organics: degreasers 41-7 Jts /4�51 OAlffscellaneous: III DISPOSAVRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply 4�S O Town Sewer Public On-site OPrivate 6. Indoor Floor Drains YES NO d' _ 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 Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Interviewed Inspector Date I eR-,qo?6o, TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: FAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 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 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: 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 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 1/ Car wash detergents Lye or caustic soda IL Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers � ADDRESS Z "a �"_ Class: 2: 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 motor oil (C) new motor oil (C) transmissi draulic Synthetic Organics: degreasers Miscellaneous: 16 DISPOSAU1 CLAMATION REMARKS: 1. Sanitary Sewage 2�ater Supply O Town Sewer Public ,d(On-site OPrivate 3. Indoor Floor Drains YES V NO 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 'Name of Hauler Destination Waste Product 1. 2. Person (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM r Mail To: ;NAMt OF BUSINESS: 1 Board of Health MAILING ADDRESS: Z-0Z .C.P ,,.,4r Town of Barnstable TELEPHONE NUMBER: r 7 2-J P.O. Box 534 CONTACT PERSON: /'�i.c,� l3/-}r`?gyre r 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 tot Ili g, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO1 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: - 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 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 f� Car wash detergents Lye or caustic soda 1/ 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) 7-1 i) C L/--t L/ n d 0 7 Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business r..'�'' �,� '7�Y;.� .aR, d iC�""�mz^`+«a„va,..�°-.t.' it,r4..3 �.. •,Y.. �,.,y,..rwV••Y -' *+a.� ,.. .. _ `""-.^i.�;an..K•-.,,nM.«w.....�,�e. .r^i, ... .. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH ;o satisfactory 2.Printers 3.Auto Body Shops / O unsatisfactory- 4.Manufacturers comp" NWo1 'qa (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESSr Class: "fir 1/ 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 motor oil (C) new motor oil(C) r transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: z DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply P,6 O Town Sewer ,OPublic O On-site OPrivate . 3. Indoor Floor Drains YES NO O'Holding tank:MDC >` ��t `` ii� 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 Name of Hauler Destination Waste Product ,r fie" AV 4", � ,� YES N0 2. � r° �. �����v %,...( lam.��.--t,c.�l`�" '.��-�� �_.✓�,�°'J,>Z.�Z.- .�i�%��"-h�.:�'' Person (s) Interviewed Inspector V Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: qW,3-' G' 9 Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: � ��' P.O. Box 534 CONTACT PERSON: '0 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners i 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 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 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 TOXIC AND HAZARDOUS-MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: �9 '. �u Board of Health MAILING ADDRESS: a y�� r�� ` �Af,*,fX W Town of Barnstable TELEPHONE NUMBER: ts ?' P.O. Box 534 CONTACT PERSON: /a 45 w r <a 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: 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 Motor oils/waste oils S 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 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 x White Copy-Health Department/ Canary Copy-Business BARNSTAB i:ii�iYi.ewrG: rOWN � 2. Printers SOAR D O� HEALTH C satisfactory ; j 'S;..3... Auto P,ody Shops Q unsatisfactory- 4. ,Manufacturers ,� ,; --•'�' (see"Orders") S. Retail .Stores COMPANY 7' f. 6 6. Fuel Suppliers 7 Miscellaneous ADDRESS { Class: f' QUAN ITIES AND STORAGE (I indoors; OUTroutdoor • Case lots Drums AboveTanks Undetground Tanks MAJOR MATrIALS a IN 'f A 6 geIIons- e Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, 12 (D) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics:.• ti degreasers f I C47 Miscellaneous: ° - Ss zr ------------- Ui SPOSAL RE- ,A'f10�i REME.RKS: 1. Sanitary Sewage 2. Water Supply QTown Sewer ublic --An On-site Private • •3. In oor Floor Drains: YES NO ( -- — Holding tank: M �,��� •- OCatch basin/Dry 7ell _._._»...�._.... ._.--- - . 0 On-site system \ ItI3E : ----'-'-•-'_. _ . 4. Outdoor Surface drains:YES Ncl� ' Hulding• tank: MUC o Catch basin/Dry well -- - QOn-site system S. Waste Transporter Licensed? Aue of Hauler_ h etina inn jaate Product_ / ffl ' u as et Person(s) -lrit.tfir ewe - , Inspector 4 to r %i r s js r o OV lu - r Y � 1 x r a. A