HomeMy WebLinkAbout0322 YARMOUTH ROAD - HAZMAT 3�a y�,,,.,,..� ipc(
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Number Fee
155 THE COMMONWEALTH OF MASSACHUSETTS $150.00
Town of Barnstable
Board of Health
This is to Certify that Balise Hyundai of Cape Cod
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322 Yarmouth Road, Hyannis, MA
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Is Hereby Granted a License
For: Storing or Handling 500 gallons or more of Hazardous Materials.
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Restrictions:
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This license is granted in conformity with the Statutes and ordinances relating there to,
and expires 06/30/2021 unless sooner suspended or revoked.
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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
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' Town of Barnstable
Inspectional Services BAftA .,Q
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Public Health Division PAkY'T BNiSMAiSttNIS MST4&E "_i
1 MMSTABM = Thomas McKean, Director ,
' JL639. s`� 200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE
HAZARDOUS MATERIALS
IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108,
HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS
GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS
JULY 1 st—JUNE 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 d v,,fr
*A late charge of$10 00 will be assessed if payment is not received by July 1st. n
1. ASSESSOR'S MAP AND PARCEL NO. �•, AG' ty�Jlf /�`J�>f v�U��7
2. IS THIS A PERMIT RENEWAL? ✓YES_NO. IF YES,SKIP QUESTION 3.
• 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: ���, /✓. �e �,T -
5. NAME OF ESTABLISHMENT: /��Q�P GL�l./T�1 /C IMP
6. ADDRESS OF ESTABLISHMENT: , V, am d X-QA1 n15
7.. MAILING ADDRESS(IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: = 2"IP-1✓00
9. EMAIL ADDRESS:
10. SOLEOWNER: YESJNO IF NO,NAME OF PARTNER: �'D-e yew m) JL �,
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT ! lU�y
TREASURER
CLERK r- 100
• 12. IF PREPARED BY OUTSIDE PANTY:
NAME: ta h � TELEPHONE
COMPANY ADDRESS EMAIL:) E t ►l U/�
Y-i 4, � 0�
SIGNATURE OF APPLICAN DATE
QAApplication Forms\Haz Mat Appli Draft Jan20l9.docx
TOXIC AND HA;ARDOUS MATERIA�S REGISTRATION FORM
,4uj_ M p7g. � l"
Mail To:
NAME OF BUSINESS: rFoftlle le 11449, A444 Board of Health
MAILING ADDRESS: I4 S' WW%_�f i:g - � �'�'`�$ 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 A`
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 de4alliw .
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 garages driveways & Printing ink
g 9 g
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
T �
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
F
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS i
Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #�2 (B)
wast Wt,)
ew motor oil (C)
tran miss• n/hydraulic
Synth t' Organics:
degr sers
Miscellaneous:
DISPOSAURECLAMATION REMARKS:
4arn1itary Sewage 2.Jd�ater Supply
own Sewer ublic
n-site O Private
Indoor Floor Drains YES NO 96
O Holding tank:MDC
O Catch basin/Dry well
/4.
O On-site system
Outdoor Surface drains:YESJNO ORDERS:
O Holding tank:MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
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(s) Interviewed nspec or Date