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0380 YARMOUTH ROAD - HAZMAT
Ola IHE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. .g 200 Main Street• Hyannis, MA 02601 "IFOMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: Date: o6l a A I Location/Mailing Address: _ _ Contact Name/Phone: Inventory Total Amount: l MSDS: License#: Q� I Tier II :_ ® Labeling: Spill Plan: MS Oil/Water Separator: Floor Drains: Emergency Numbers: BPS Storage Areas/Tanks: J ^v , Emergency/Containment Equipment: aste Generator ID: N 50(6 �1 Waste Product: CV- Date&Amount of Last Shipment/Frequencv: iQ CAAAW Licensed Waste Hauler&Destination: i M� Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes _ Bug and tar removers Hydraulic fluid (including brake fluid) V Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers . Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: c Inspector: k�� Facility Representative: Y WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Please print or type.(Form designed for use on elite(12-pitch)typewriter.) UNIFORM HAZARDOUS I.Generator ID Number Form Approved.OMB No.2050-0039 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST p;r t' tx Q',`, 1-800.899.1038 G B F 5.Generator's Name and A9afiing -dressGenerator's Site Address(if different than mailing address) Generator's Phone 6.Transporter 1 Company Name CYN OIL CORPORATION U.S.EPA ID Number 7.Transporter z Company Name MAD 0 8 2 3 0 3 7 7 7 U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number CYN OIL CORPORATION, 1771 WASHINGTON STREET,STOUGHTON, MA 02072 Factitys Phone: 781.341.5108 MAD 0 82303777 92. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10 Containers HIM and Packing Group(if any)) : 11.Total 12.Unit 1 No. Type Quantity Wf.Nol. 13.Waste Codes STATE-REGULATED OIL WASTE — MA98 2. CD 3. 4. 14.Special Handling Instructions and Additional Information 24 HOUR EMERGENCY SPILL RESPONSE 800-899-1038 D.O.T. EMERGENCY GUIDE#128 PASSED DEXSIL 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify thatlhe waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity denl or(b)(if I am a small quantity generator)is hue. Generators fferors ted/lyped flame ($Ignature,, Month D Year j z py, > -r 16.International Sttlpments r ' r ''' ❑Import to U.S. ❑Export froml Port of entry/exit: Z Transporter signature(for exports only): 'T TransporrerAcknowieedgment of Receiptof�vraterial5 Date leaving U S - ... _ W IX Transporter.I-Printed/Typed Name __.__ Signature + - -- a , ,w. r'}, y rR f th Yea IT e. D� Z Transporter 2 Printed7ryped Name ' ! t1✓ / ! <C. Signature" Month Day :''Year, 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type. ❑Residue ❑Partial Refection ❑Full Rejection 18b.Alternate Facility,(or Generator) Manifest Reference Number: J U.S.EPA ID.Number U ��- Faciliry's Phone.... w 18c.Signature of Alternate Facility(or Generator) Q Month Day Year z w1.9.Hazardous Waste Report.Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. - 3. 20.Designated Fad iityrOwner of Operatil Certification oj'receipt of}razardous materials covered by the manifest#apt as n ed In Iteml f Printed/Typed Nitre Signature nt �{ $' �+'`',,�,'f>"�✓yq,�✓ Month {Ao h Day ,{JpYep�af�r £ e... e"l�f./R' .�i' ,/ ... +� .a .,....,„ dip A .. � d✓�/,� e,.® ..r"" �a1 3' 4Y EPA Form 8700 2r((RK 3-05) Previous editl`oris are a sti ete. I E Please print or type. 1.Generator ID Number Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST f r y ' r �� 5 Generators Name and Mailing Address 6646493 Generator's Site Address(if different than mailing address) `Sf '± s r';i...Y.:� 1r4;4 Y tt'; :ir:r iS'31'�1 t �.f'.✓': ; Generator's Phone: 6.Transporter 1 Company Name Y r?i4R--' "'KLEEN Y'STEMS I04fv U.S.EPA ID Number 7.Transporter 2 Company Name .r R08 1 PGa U.S:EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 157 MILL STREX-T F�ilityIsPhone: RI j &480284R 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, W.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes 1. No. Type Quantity wt./Vol. Ix USINIT HAZI RDOUS r TCRIAL)SPEC t 2. f� Ti 9 :r� at�� 5� r..,-� a ? UJ 4 i 3. 4. 14.Special Handling Instructions and Additional Information Cso g s l fig R k i� t - t �3- 1 — II C�"§4 —4� �• c ; ray �r? r. 2Y 90nserater c^anfers 4 Qn;4Zv alAthnm^ 1 GEN 1"0 f FF I A N:,h reb `ecl"are t the`"' nis o stgnrn nfa I a � ate� e'sc etlrab e' e proper ip � €,a" 'a�classifie , e,marked and labeled/placarded,and are in all respects in proper condition'for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary v Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certity that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(If I am a small quantity generator)Is true. Gerx rator's/Offerors Printed/Typed Name Signature Month Day Year 7 C .-1 16.International Shipments Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials Transporter 1 Pnnted[Typed Name Signature ? G y g t , ✓ Month Day Year zTransporter 2 Printed/Typed Name Signature Month Day Year a- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Manifest Reference Number:Generator) U.S.EPA ID Number _J V tai Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year a z y19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatrnent,disposal,and recycling systems) W 1 H1 4 1 —7 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY Number fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES ................................................................................................................................. 380 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 �I 1 i a a -611 Town of Barnstable Inspectional Services BARNSTABLE O` P N1Ta -MMEt LU-CMn-•IAN'tl15 Public Health Division �uXISY S.639-Rt_4 B VS4&E 3639A2014 ♦ r �0 C &AM9rABM = Thomas McKean, Director 200 Main Street Hyannis,MA 02601 h Office: 508-862-4644 Fax: 508-790-6304 ' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE 1 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 ❑ Pd CATEGORY 2 PER]VJIT,_ .L1.1 —499 Gallons:. _$125_.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ jt- oosci-q (� *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD tIT11ES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: r 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: p 8. TELEPHONE NUMBER OF ESTABLISHMENT: 6d 25 f 9. EMAIL ADDRESS: ;2—)�— qc aild A( 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 1 L. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: b COMPANY ADDRESS A EMAIL: t • SIGNATURE OF APPLICANT QE DATE fi Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx . Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 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 06/30/2020 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 BARN LE of T"E Public Health Division MU4X?1 •CENTERVRIE•IXTJR•N?NNI, M�tSSTGNS t�[:-C•0>'iEkMI.IE•tits PAi4SAfl!.% 1.6:i9-20bis IARNWABLE, Thomas McKean, Director 57�5`. MAS S. ,._9 �OrEc39. +>` 200 Main Street, Hyannis,MA 02601 T.• Office: 508-862-4644 Fax: 508 790-6304 i- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE C; 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 e"� CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 * CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3!H Zo ( �4 2 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 QU I IES (25 GALLONS)? YES NO. • 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: d c _:2 7 9. EMAIL ADDRESS: 10. SOLEOWNER:hi YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: *SIGNATURE OF APPLICANT./` ,� DATE ( 19 Q\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 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 06/360/2019 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 1 ti • • • Vowegu'Aatoryof B nsxable Services HE Richard V. Scah, Director ' Public Health Division BARNSTABLE • � BANN6TAElE.f&rtEl1Y1LLE.mTUR.M'MRi15 • BARNSIABM ` Thomas McKean Director """S°"5 M 3.05 FRY3 E.WES Bt NS qEF MM& 8 ) 1639�-72014 IM -- - —-- — -163y- ,0 .-- - - - - -- -— —-- --- - tom- - ArEo s 200 Main-Street,Hyannts�MA-02601----- - - - -.--- h CO Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS .y 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 Vs . 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. 4A i :• ?� 2. IS THIS A PERMIT RENEWAL? -�/YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIAL STORAGE/USE OF i GREATER THAN HOUSEHOLD QUAN T S(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: r r 6. ADDRESS OF ESTABLISHMENT: 12 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: SOS 'll 7 9. EMAIL ADDRESS: Q UMG 1 1 I. 10. SOLEOWNER:TYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: [y NAME: TELEPHONE#:_cj ' 7 COMPANY ADDRESS EMAIL: T G mofI •Ci_ to SIGNATURE OF AP "A4- DATE �I Q\Application Forms\HAZMAT APP 2017 REVISED.docx Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 YARMOUTH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ct, -------------------------------------------------------------------------------------------------------------------------------------------------------------- CIS 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 r 6 chp�-w of Unstable IO (�-�er�egu�atoervices 4-267' Richard V. Scali, Director of t►'�►� �. Public Health Division BARNSTABIE ,ems 9PN`lS.Aelk•CFHTE0.YILLE•CMIT•H POS. �.. • BA"STABLE, • H�xslurn wnLs•osreavuLE•vnsr eaansrais MASS. Thomas McKean, Director 0reo Mpg A��� 200 Main Street, Hyannis, MA 02601 �Dg ; '70/ Office: 508-862-4644WS 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 DULY 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 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3-41 6 f' wt5-.2— 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ��OE-a cT 5. NAME OF ESTABLISHMENT: & 6. ADDRESS OF ESTABLISHMENT: Mt 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: a c c�k1 7--Z- 9 ut*4� � 16 0 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 12< 2-Z 1-7 Q:\Application Forms\FIAZMAT APP 2017 RE ISED.docx Tr i Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health s �o This is to Certify that HARBOR AUTO SALES 380 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. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health pc� K 3 ` a- - Town of Barnstable / ( a_ ,c Regulatory Services EVE► Richard V. Scali, Director o mom ABI, Public Health Division +COTUIT•NYN:NISE•WE519p%.NSTAOLf�BARNSTABLE, x 14bS. ,� Thomas McKean, Director Teo rna+° 200 Main Street, Hyannis,MA 02601 OIr1Ce: JUiS-bOL-4l)44 Fax: 508-790-63T,4 6:77 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS M 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 i CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *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? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • N ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLO S)? YES NO. iA 4. FULL NAME OF APPLICANT: f 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: lv 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPA Y O� E PARTY: NAME: s= TELEPHONE#: -3 COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE (-,,c 17 C:\Users\sousav\DesktopViAZZAPP Revl7.docx Page 1 of Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 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 C� Director of Public Health s c � _ o� & Town of Barnstable Regulatory Services • °� Richard V. Scali,Director Public Health Division 16gq. '°fEc► °' Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.0.0 i ASSESSORS MAP AND PARCEL NO-- 7 �J �b DATE C! 7,% ) i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN i i i GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C l� NAME OF ESTABLISHMENT l.C) • ADDRESS OF ESTABLISHMENT n, - TELEPHONE NUMBER Sd ' '7 7 • $`��� SOLE OWNER:_'�YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: _ IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK •, S GNATURE OF APP T RESTRICTIONS: HOME ADDRESS VW Mt;')L-- HOME TELEPHONE# � �7 • �, C:\cache\Temporary Intemet Fi1es\0LKD3\HAZAPP Rev2015.DOC I i Town of Barnstable office: 508-862-4644 � Regulatory Services Department Fax: 508-790-6304 BARNSTAOLF, Public Health Division • , ' Thomas A.McKean,CHO $j6r; � .� `` 200 Main Street, Hyannis, MA 02601 Payment Receipt ardous Materials Payment received: $110.00 (Check) on 9/9/201S Check number: S728 Check amount: $110.00 Name on check: Willow Street Motors I 'Business: Harbor Auto Sales Owner: GILBERT C WOOD !Address: 380 YARMOUTH ROAD, Hyannis ;Note: $100 + $10 late fee i Number Fee 137 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town-of Barnstable Board of Health This is to Certify that Hyannis Country Garden 380 West Main St., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable °F1HE'°'�ti Regulatory Services Richard V. Scali, Director '"RNMAIS B1� � Public Health Division i639• ♦� p�E%6:39 a Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.()6.q S' DATE '' "I7 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANTh� °,S' NAME OF ESTABLISHMENT n K� �,� �Z1 Y1.,fr� &0, 1'- ADDRESS OF ESTABLISHMENT JR6 z.... TELEPHONE NUMBER (5— 8' 6 c SOLE OWNER: YES U'NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT S A CORPORATION: FEDE IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURE CLERK SIGNATU OF PLICANT RESTRICTIONS: HOME ADDRESS „7LI�D� HOME TELEPHONE Q:1Application FortnAHAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). 'In addition,.please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 8624644 Back to Main Public Health Division Page Q:\Application Forms\HAZAPP.DOC Number fee 1097 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 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 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable °FtHE'°wti Regulatory Services Richard V. Scali, Director i # B" MASS.1�" ' Public Health Division •i639 �� 1DrFa 39 ° Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. -- DATE 17,12=c\ f. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 4 TELEPHONE NUMBER SOLE OWNER: _YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK y. SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS Ii415y HOME TELEPHONE Q:\Application Fonns\HAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous wastes ills, etc). In addition, lease include the required fee p ) p q of$100. Make check.payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing.. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q:\Application FormMAZAPPLOC e t ' Number Fee 1097 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that HARBOR AUTO SALES 380 YARMOUTH ROAD, HYANNIS,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 9/11/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health T` Town of Barnstable - Barnstable Regulatory Services Department MkUwdcaft Public Health Division • IAMSPAHLL " ���' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. ©® �DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT (?1G9Cj-4( C9 I" NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT , 390 Ywk4l�61;11-1-y R Z , TELEPHONE NUMBER �® C� --2 ,3 —2) q 3 SOLE OWNER: t/YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NOS STATE OF INCORPORATION ' FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER � - CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS /4- eD Z HOME TELEPHONE# 6"0,9 Y 77—(f)o y J:\inspection handouts\Haz MatA lication2008.DOC P PP MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow time for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc.) In addition, please mail the required fee of$100. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow time for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page JAinspection handouts\Haz Mat Application2008.DOC SPELL CONTINGENCY PLAN Emergency Coordinator, Name: Address: I Daytime Phone: Evening Phone: S7 r -� Fire Department: AIA.0 Ll m Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 8 88-3 04-113 3 Waste Hauler: Name: Phone: Building diagram indicating hazardous materriaUwaste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). Oil 6F 9wak, b3i ljf� S Actions to be taken to control a spill or release, and preventing it from. reaching a catch basin, sewer system or the ground. I f� TOWN OF BARNSTABLE Date: .I 130 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: f/l64l 4/A////V6 4-9 ?GW6P--WA911,V(6 BUSINESS LOCATION: �3l LUAI-61-IALL UvAlailNAlIf &A 0260 INVENTORY (,t�ZMAILING ADDRESS: 5i tw1-11rC-flALe__ W,9,1 /-//AA11ViS /tlA 02-�1 TOTAL AMOUNT: TELEPHONE NUMBER: ::;Zr-7z-/J-3 6 5� j CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: --4/2J::_7- 1 o'2 MSDS ON SITE? TYPE OF BUSINESS: AAA) ROWOe-WREI)iA1_G INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or •hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas P.hotochemicals (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) ',/ 6 r��c.r 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 &Ao;X 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 Cofi jtl� lq,-r (SSE AS bt-MA/t1.0CD Laundry soil & in removers (including bleach) A10 sr_01e.a 61YII N6-eSfA� y Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS �(Plicanes Signature Staff's Initials Date:3 /21 /�►3 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS ATERIALS REGISTRATION FORM NAME OF BUSINESS: AAAe-.bta, o3 v BUSINESS LOCATION: ` INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT LE NE NUIAE�R� R: SoR •'�? s '� 3 MSDS ON SITE? TYPE OF BUSINESS: � 4� � fh INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum t� Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive L NEW @#USED Cesspool cleaners 520 Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides P NEW 00 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) tqA 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 Initials r • . f Date:$ /2.1 / aa13 ' : . TOWN OF.BARNSTABLE - TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: , Z) BUSINESS LOCATION: - 1 INVENTORY MAILING ADDRESS: F , TOTAL AMOUNT: TELEPHONE NUMBER: SC d1Z�C�z— CONTACT PERSON: EMERGENCY CONTACT ELE <k�QNE NUMBER: p 3MSDS ON SITE? TYPE OF BUSINESS: A I� I e._. INFORMATION / RECOMMENDATIONS: Fire District: , Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum 1� Antifreeze(for gasoline or coolant systems), Miscellaneous Corrosive =��,PNEW C,�` USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants • . 1 Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Photochemicals(Fixers) Gasoline, Jet fuel,Aviation gas Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum,products: grease, Photochemicals (Developer) InAl lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink I j 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 I Asphalt&roofing tar PCBs :Znt Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) I Any other products with "poison"labels ❑ NEW ❑ USED (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 f Staffs Initials ti TOWN OF BARNSTABLE Date: ? / q / `3 � TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: Qrbo! AJf'o Gales BUSINESS LOCATION: 3So AC MO->k , IiQC , a ygvvvl 15 INVENTORY MAILING ADDRESS: -Sr,nu TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: &, b.,, oome I�aJ�er a EMERGENCY CONTACT TELEPHONE UMBER: r015-ih-8933 Wo-we MS12S ON SITE? TYPE OF BUSINESS: vS-9G4r files r< ,t -m8 -A80- 37, Ailo INFORMATION / RECOMMENDATIO S: `)Ob}Q,,ti �a'�a��ovs,+vte.�',�s Fire District: GZvI ��¢� o r, o r Co►'l i rt GP14 3��S f 1 Il--10 ,c r« Q 4✓I 1S , ,,U-c v uW-6-cs 4)6(co sp�lJa rbw��s on 14—F.,e✓hrno( sp)lls SN swecp u a,I S� bS Mar1I 'cg-}5 0 6,� �t' ✓►9, ,ht.l p�t,r5�� ��aaux. ✓�'IS,AS S/��5 4 .ep o►t. ,f�, 7 C ov►�a>wG-I' ',mac. .e�-1 -v�t o r a,,tk- c,n10 va-1 �.c+►'r, r�c �e r+ce w-i's. Waste Transportation: Last shipment of hazarddu�s waste: waste o,/ /s bore,,x , „-. Destination: Waste Product: ,slace Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive S NEW� CYUSED S '- Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 330 Mot Oils �� Pesticides L� EW4 '/USED ;0:/ (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 1_Ss�a� ��yr►1.. 8� ��+� Qv(,�'l�t��� Laundry soil &stain removers (including bleach) h&S wGV16< M e N, pftC-S Spot removers&cleaning fluids (dry cleaners) B�G�A�,or�, Q2� I�aS+e AvtI�2 v`- Other cleaning solvents Bug and tar removers 1 g i v<t r2 S�C� rvy(, . Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's dignature St 's Initials y°FINE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA.%A .g` 200 Main Street• Hyannis, MA 02601 1659.'�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT M+,rA `1,12�17 Business Name: 14fto" Au`1',,,. a./eS Date: 3 2-7 1 t' Location/Mailing Address: et<-vK&,AL, -le 362 l eJ 1"7 Contact Name/Phone: nv v�s1 fo ,- ,o e�-�a o8 8 2-7- 2.9'2Slg� IVL4 Ovt� Il�'e-O� O< i Y1J V WlAA41- AUg0 te> g Rv-&� b)4AS Da:m,ow -7 A71 InventoryTotal Amount: � a SDS: � v`�"A•t, Le./ �r License#: ,U ��' �'�"��-✓� Tier II : 1�i� Labeling: ujk$t-e- Spill Plan: Oil/WaterSeparator: 1J)A Floor Drains: o Emergency Numbers: Storage Areas/Tanks: oo At-k OCL4�-c, 1 Skcca --�A_A gT. by I,w* Q s Emer enc /Containment Equipment: Seto U,<k �+- Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: �• Licensed Waste Hauler&Destination: .ha ther Waste Disposal Methods: \)6„L OkitQ. 0kw.-1q"41e - 6►.V1,A,ar 4^CA4e<5`�a. 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. it Antifreeze (o t Dry cleaning fluids 2- Automatic transmission fluid 2 Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils 3 X ►Xl$$ -Soo alk�✓`�,c, 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 11/ Battery acid (electrolyte)/batteries I deg 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 Z 6Lerosods 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: Jr . LAVuc ,,,� , L ��.,,�, ,p,I �Ql OWL- 44ta<J&VS vja0e- w«.n ASIS Ao-� a 6L I a 14-. ORDERS: P- k ov,- is2. ix e, oil v�\.c.- ah S _01vl ( le— Z INFORMATION/RECOMMENDATIONS: 1 ova oSt •� II r-K_ tj"t-c- Inspector--I,- � V%AAA I .e, 6 OA 8, -e 6,+ )eAg+ SytR'C6• Facility Representativ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE BAR-W 48 04. Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Avg o 4:-�, Address of Offender MV/MB Reg.# Village/State/Zip Business Name VA'A m/pm, on `//;Z-7 20 1"1 Business Address 1(?�n "� c°.*✓�c�,) '�,. °�! Sgnature .of-,,Enforcing Officer Village/State/Zip VN1 r-1 0 Z(S.'p 1 Location ,of Offense OA e v40 5,-, 1'e a �f Enforcing Dept/Division Offense - � Facts 0[>4 'W.- 2:r c)d5 tM,-t f-eyf�6, e. W-,1'tt 'x'fJ tr! jv4 4 6e a5 4a .516, f bt Il��jrr nt f�� 11� "f +Er 1�1 1��1 11►t G{f- �. This will 'serve only as a warning. At this time no legal action' has been taken. `11t is the goal of Town agencies to achieve voluntary compliance of Town .Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W 4t 0 0 Ordinance or Regulation r WARNING NOTICE Name of Offender/Manager ` ° 1' ' ' t� y Address of Offender MV/MB Reg.# 9 Village/State/Zip Business Name am/pm, on 20 1-7 Business Address -r ` ' *�.+'� `4� . ; ,•^." si ✓1 - �'�.-a-' Signature .of Enforcing Officer Village/State/Zip ' ' ` "° '� , � "� ' ' Location of Offense Enforcing Dept/Division Offense ,:, r Facts i� t t°yt. e } „�. '7 �. i .j +P,. e{ 4 '~��' ! V, ;} �, A ryj to•i t P .*l:: { � p �,+�' � �F`. .. � i ' �F{ ,y'c ..t � / �j � . �#� D} 1 �,,n.. � � "i � r"� r L o �[ y` � �,'� "J _ �'f3, � '•'� ,t✓� This will serve only as a warning. At this time no legal action* has been taken." "#It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are. attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.. °FIKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 ' BARN�'E'g 200 Main Street• Hyannis, MA 02601 �'°rE0N1P��`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: kkr6o< �}� �� s !Date: Location/Mailing Address: 360 4vn✓1, S Contact Name/Phone: ej4o o r g - `/ZSZ ✓1'I t 10 Ou)►Aus G.1 000Qi o beck i c-� Inventory Total Amount: — MSDS: OK License#: 10g1 Tier II : Labeling: OVO— Spill Plan: Oil/WaterSeparator: — Floor Drains: o Emergency Numbers: n Storage Areas[Tanks: SS Rat� <a0MS , ��t� o� V�.p. -to bc, P.vHD� a dt< S �a 6e At a'> � Emergency/Containment Eq iu�'nment: 'A 0 Waste Generator ID: Waste Pro uct: Date&Amount of Last Shi ment/Fre uenc : �+� + +S g61u- *5oov� Licensed Waste Hauler&Destination: ov,e.! '�14 vu- + feu) s — Other Waste Disposal Methods: '0111 V.X la4 PwAG vtv� gk ko a q.c,e-, LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: + 0 6'r MO,Q o 0. w J. C a< k1 l a 1`'�.(1. 4 ��ip �ti'�Y���12. Inspector: La.12.(�2r pig►b1� {y ' S rJa g o! 1�v� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °r� Toys - Town of Barnstable) Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA.RS ` 200 Main Street• Hyannis, MA 02601 "? i p ,639.rEO ��0�MP+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT F' Business Name: 4 f 6o< .,-k,) 52,i e S Date: 7 ° Location/Mailing Address: 390 *C-,nno,A1, RAQ ya h✓t S � Contact Name/Phone: Lem A-,) Mee o for -P>=?R JZS'"Z /Vy r: :.tar o- , pVJ Ne rs Inventory Total Amount: --__» MSDS: �'�''�. License#: lCaf1"7 Tier II `Labeling:, 0._ Spill Plan: ' Oil/Water Separator: , Floor Drains: Emergency Numbers: Storage Areas/Tanks: . c, 40 �0 0Q W.r). ti vH' Emergency/Containment Equipment:. -0V 01 5t-cc,PO4t.�a- c VAWV Y + 4f} Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency. r -30o , - Licensed Waste Hauler&Destination: -5-5 O\Jp! Other Waste Disposal Methods-� 4)t ll fax fm Wv A,4 •�, vN, a.-, 1 LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers F.¢ Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils" `"'` ,„ Miscellaneous Corrosives Gasoline,jet fuel, aviation gas x.w 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 I insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents' Printing ink Car waxes and polishes w Wood preservatives(creosote) Asphalt&roofing tar , Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda ;. Lacquer thinners Miscellaneous Combustible Paint&varnish removersi deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers. PCB's' Metal polishes Other chlorinated hydrocarbons ` Laundry,Qsoil&stain rem,overs (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: '- -, j w�. ORDERS: INFORMATION/RECOMMENDATIONS: I, 1i `.0 . 1 t P G' : �Iitie 0 y c�a ' �1iit '`. i ` CJ< �•� (�p -i � � eMc�C�,Sy `� Q SS �. Inspector: � bI, 1�CiC is `".�- �ovtl`'�?� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS `oFIKE'ati Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA�BLE.g` 200 Main Street• Hyannis, MA 02601 �A t639•p�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rfD MP'� Business Name: o Date: S r ►-� Location/Mailing Address: 3 o Contact Name/Phone: &e&ve- o m C e(-o Aff-tla c, 2,7-Y2S2, 9wrwr;5 - i t W,,VP, ►coo 19e.r4`I F-yr Inventory Total Amount: "�26000.-3o Ib MSDS: A 10 License#: I�(7 - � Tier II : A)o Labeling: /Q0 Spill Plan: A)p —�akv Oil/WaterSeparator: AJJA _ Floor Drains: A)a Emergency Numbers: Storage Areas/Tanks: - G�r r ( o Emergency/Containment Equipment: < f\1 avk% 4 \W Waste Generator ID: ✓�✓ ° 2 S�Z. Waste Product: 12 i' Date&Amount of Last Shipment/Frequency: 3 i Licensed Waste Hauler&Destination: r .J o -I-o►ti oe 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. t 0 Antifreeze 10 Dry cleaning fluids .„0 Automatic transmission fluid ?-V Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers L Hydraulic fluid (including brake fluid) Windshield wash 5 a-3 0 Motor oils yX 5'�e'Was fe--4- 1 V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants —� Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants 3a 16 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: Q� � ci K IJI-co CaK+,AI �� S 0�� ry o� r iPQ ORDERS: a, a.l �C-e►ti �� M$ s ��o...�` ' INF MATION/RECOM ENDATIO ; Qom. r'.Puy`, ve,oa4" v1`�`Q N-G" • Inspector: ,p,, Facility Representative: 8aWA6+ >�atkil� Dave atlP-+ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS / °FnWE►ors Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA.RR * 200 Main Street• Hyannis, MA 02601 i0'FOMP�A`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: bor 4 o a. 2S Date: .? 11/1� Location/Mailing Address: ZZO a - QV • a K S Contact Name/Phone: _mar,c A�4vst° .� C1��.2,o NaahF° i -9r--3-51,4.,. Sbo-$V7-�2<2 Inventory Total Amount: MSDS: License#: 101-1 Tier II : no Labeling: Spill Plan: a�\&ko Oil/WaterSeparator: Floor Drains: `Emergency Numbers: Np Storage Areas/Tanks: I- ww,o at k.&-0.1 0 t' _ A 0 0,t1Ao, Emergency/Containment E ui ment: 4.,Je A e Waste Generator ID: Mqo 2L-1 Waste Product: nt f Date&Amount of Last Shipment/Frequency: 4 r o I t oD a( 1 -Z. r Licensed Waste Hauler&Destination: Cv w D i I UTo.aG �o v`,A A A 4 e9,,7 'S1> ,-1-1'7 Other Waste Disposal Methods: 2- 61074 ���� � C+ ov� t Sn a � HEh LIST OF TOXIC AND HAZARDOUS MATERIALS N o � Q*MA*rV y NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of VA, hazardous material use, A5 storage and disposal of 111 gallons or more requires a license from the Public Health Division. 5' 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) :t 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, I hydrochloric acid, other acids) VIOLATIONS: ND &,qf, a Q ed 5 a ORDERS: o o e ,5. %>ksoep soilCOv�t v\ Hoosk ,n 1 a l tJ 5 I FORMATIO /RECOMMENDATI NS: a5 " 4 '' 4 0 " ,2-2 e %A&,CS CQ A aw. 'a r �,r+V- v 3O��LtiI�S 1�10(Q� ( 11Zy�1�y 0;l S 1116 4'Vt A Inspector: COU-S. L° <&o�S t ovt e C�i'�- � jpr Facility Representative:�p ��.�A, re— . WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS +o y o Date: It / 18 / !3 TOWN OF BARNSTABLE ,tip e,+,,]A— TOXIC AND HAZARDOUS MATERIALS R§QSTRK=N FORM NAME OF BUSINESS: ar�of Av�o se,e� BUSINESS LOCATION: 350 P 0 4VIVI I INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: r, / bA"J ,o 2A' o EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION //IRECOMMENDATIONS: �/-k,P�►� �te-)anSo�+ / Fire District: - 4 b4S 2. o r.� r-JaS 00 4 �— 1� f 2i S L r 5 -4w l Woots o44a a,? Cle4K Of i) of/ d►_ r - 45 o ►M4144e5 OK, �, �eY►tava.� `��qr�, o -�oItoLoo ivL ,2-3 oe�eks •+ CoIl ttns ov..�— wt-}-l... i-toC — t'2 asteransportatlon: Last shipment of hazardous waste: Name of Hauler: CqO iW CoAk I vl�s r- Destination: Waste Product: La b-r-) Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials y f Date: "f / /o / / 3 'TOWN OF BARN STABLE ,t r TOXIC AND HAZARDOUS MATERIALS REGkST=RA-[O-N FORM NAME OF BUSINESS: BUSINESS LOCATION: 3?50 A•r,-%o '4-t,,., P,Q ,s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: �, �'�✓oo� ' t'_I ti� r� o4� ' ' ���o EMERGENCY CONTACT TELEPHONE NUMBER: ' MSDS ON-SITE? TYPE OF BUSINESS: --'"""rN INFORMATION / RECOMMENDATIONS: 4am,50,- + Fire District: W J — �4 Col 3,,- Ga 5 2 Oat — w4 Sigl,,'D J 4-4,w 5 ' vN v rm j S' - CAdytrn � 4 OCi5 j19�f 'I -- I/ SAS;- q",-f�fk rm5 l�k+Sge- d1� C'��c�sl Up Ct S � C� eK C006f,, 4e i lore — e 0GS�' �M60 IQ fS ��t G�x�$I2hC2rita � (� �� 1 ��I(a J O z-3 i�e-e�S -f ��I u 5 g G o%A -- w,`}{,� r-n o f-a_ t'�Co vh Zv— V�Dy o S aste ransportatfon: Last shipment of hazardous waste: Name of Hauler: C40 a cc,)44 ) h ers r- Destination: Waste Product: La b-- 1 c- s Licensed? Yes No NOTE: Under the provisions of Ch. 1,11, 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. ;f LIST OF TOXIC AND HAZARDOUS MATERIALS , The Board of Health and,the,.Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible # Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels .(including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes ' Laundry soil &stain removers rr i T (including bleach) f Spot removers&cleaning fluids (dry cleaners) a Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials Phs se print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number WASTE MANIFEST. 1-800-899-1038 ; , 11 r ..r ' G B 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number CYN OIL CORPORATION MAD082303777 7.Transporter 2 Company Name U.S.EPA ID Number ' 8.Designated Facility Name and Site Address U.S.EPA ID Number CYN OIL CORPORATION, 1771 WASHINGTON STREET, STOUGHTON, MA 02072 Facility's Phone: 781-341-5108 1 MAD 0 8 2 3 0 3 7 7 7 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.waste Codes No. Type Quantity Wt.Nol. 0 1 STATE REGULATED OIL WASTE 6NA98 - a w 2. 3. l t ' ? I ' I 4. g t 3 14.Special Handling Instructions and Additional Information 24 HOUR EMERGENCY SPILL RESPONSE 800-899.1038 D.O.T. EMERGENCY GUIDE#128 PASSED DEXSIL 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator'slOfreror's PrintedlTyped Name Signature Month Day Year —a 16.International Shipments i= ❑Import to U.S. ❑Export from U.S. ` Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 P6ntedrryped Name Signature Month Day Year O IL U) ZZ Transporter 2 PrintedfTyped Name Signature Month Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space y ❑Type ❑R 1 El Full Rejection ❑ Quantity T e esidue ❑Partial Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J v Facility's Phone: w 18d.Signature of Altemate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI 1. 2. 3 4 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdntedffyped Name Signature Month. Day Year EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. GENERATOR'S INITIAL COPY Tel. 1.800-899-1038 OUTSIDE MA 1-781-344-0265 ATQ �J 1771 Washington St., P.O.Box 119 1�� 8 E 0 V I fl 0 PM E 0 i 8 L Stoughton,MA 02072 E fl E S EPA No. MAD 082303777 �I iIC Check No.NOS.MA-40 TNH 0019.VT 1 T.HW-28:;RI 315.ME-HWT 84023 Date Received from Address QUANTITY DESCRIPTION AMOUNT. I SW USED OIL FOR RECYCLING .'�y SPENT ANTIFREEZE FOR RECYCLING $ Total $ Driver X Generator X cv, lease print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST `� ''� � .=g 1-800-899-1038 (12,213 3G B F 5.Generator s Name and Mailing Address j{pay t r �l'447 Generators Site Address(if different than mailing address) G tdesi hone:r /2jr 6.Transporter 1 Company Name U.S.EPA ID Number CYN OIL CORPORATION MAD082303777 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number CYN OIL CORPORATION, 1771 WASHINGTON STREET,STOUGHTON, MA 02072 Facility's Phone: 781 341-5108 MAD 0 8 2 3 0 3 7 7 7 ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol: 1. STATE REGULATED OIL WASTE MA98 t Z 2. , CW9 3. 4. ) s 14.Special Handling Instructions and Additional Information 24 HOUR EMERGENCY SPILL RESPONSE 800.899-1038 D.O.T. EMERGENCY GUIDE#128 PASSED DEXSIL 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. neratoeslOffemes Printed/Typed Name Signature _ MW,% Day Year _-r 16.IntemalJonal Shipments _,w �" 1- ❑Import to U.S. ❑Export from U.S. Port of eritrylexit; z Transporter signature(for exports only): Date leaving U.S.: - - W 17.Transponer Acknowledgment of Receipt of Materials - ` - — -- Transporter 1010��t�6/Typed Name j` Signature / Month Day Year Q Transport,V2 Printed(fyped Namb Signature 0" ,� r Month Day Year � � r t- 18.Discrepancy 18a.Discrepancy Indication Space Quantit y El-Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b':Altemate Facility(or Generator) U.S.EPA ID Number U s D LL. Facility's Phone w 18c.Signature Of Alternate Facility(or Generator) Month D.ay, Year Z . N19 Hazardous Waste Repor Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. c 20.Designated racilijqwner or Operator.Certification of receipt of hazardous materials covered by the marp'fest except s noted in Item 18a f PrintedlTyped Naive- �� /� j ( Signature Mont Day Year EPA Form 8700-22(Rev.M5) Previous editions are obsofetd' r Tel. 1-800-899-1038O 211340.OUTSIDE MA 1-781-3440265 1771 Washington St., P.O.Box 119 E If V I B 0 III li`T fl L -Stoughton,MA 02072 SERVICES EPA No. MAD 082303777 Check NO. LIC.NOS.MA-40 TNH 0019.VT Date CT-HW-28.RI 315.ME-HWT 84023 Received from c-y Az, Address QUANTITY DESCRIPTION AMOUNT USED OIL FOR RECYCLING $ r; SPENT ANTIFREEZE FOR RECYCLING Total ) $ Driver X Generator$ -- I-..uw.._.w..-..._...�.,..r.V.�...�.-._—...—»«»r....x .» ...-».r.�L,..�,.._..w,._�..�.�.......,�....__............... _....- -........u..-,..a�........�+-..u. .....,_:W_L.._..+,y�.._.._:..�._.,...�.....�..a...r.�. Ple82e1`ad2t or ty .(Form designed for use on elite(12 pitch)typewriter.) . t.Generator ID Number Form Approved.OMB No.2050 0039 UPIP(�RM HAZARDOUS. 2:Page 1 of 3.Emergencyy Res onse Phone 4.Manifest Tracking Number WASTE MANIFEST 1 r l �?�o-4 -20 !! 5.Generators, a e and Mailing Add ess, �* # JJ I\ � 6 , x�.�` P Generators Site Address(if different than mailing address) Generators Phone: 6.Transporter 1 Company Name 1 t, ,Name WIC U.S.E EPA�D Number0 J 0 0 0.2 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Factlf,Name and Site Address �t E,`FERN It.,Ii�r5- U.S.EPA ID Number ONE DUCH µS WA LINOOLN RI 02865 Facilitys Phone: 401 727-a600 I R 0 0 0 5 0 2 ga. gb.U.S.DOT Description.(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes . i. No. Type Quantity Wtivol. 3 c_a 3. ( 4. f 1 14.Special Ha Aling,Inshuctions and Additional Information 15. GEN ERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged; mad,ed and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the.terms of the attached EPAAcknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b)(if I fm.a small,guantity generator)is true. Generators/Offerors PnntedrTyped Name Signature Month Day, Year g i wit # ! ' ) �i t' ri 16.Imemational Shipments r ❑Import to U.S. Export from U:S. Port of entry/exit Z Transporter signature(for exports only): Date leaving U.S.: . % 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedrryped Name - - _ ® � r Signature -- Month. D�; a Year z Transporter 2 Printedrlyped Name °` Signature ✓ Month Day. Year H 18.Discrepancy 18a.Discrepancy Indication Space 0 Quantit y Type Residue ❑Partial Rejection E]Full Rejection - 18b.Alternate Facility(or Generator) Manifest Reference Number. U.S.EPA ID Number U I Facility's Phone: w 18c.Signature of Alternate Facility(or Generator)- Month Day Year 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU HWI 2. 4. 20.Designated Facility Ovgner ojr,Operator.Certification of receipt of hazardous materials covered by the manifest except as tided in Item 18a PrintedrTyped Name , Signature's Mont Day. Ye r EPA Form 8700 22(Rev.3 05) Pr lousedjtions are obsolete. DESIGNATED FACILITY TO GENERATOR wwwessWin 0119 Inc. One Duchess Way A:Z Environmental Service Company P.O.Box518Lincoln, Rhode Island 02865 (401)727-8600 FAX(401)727-7667 E-Mail:sales@westernoil.com Specializing in Disposal of: Antifreeze Re: Manifest received at Western Oil, Inc. Lincoln,RI Gas Waste Oil To Whom It May Concern: Hazardous Waste Y _ - Waste-Water �- LacquerThinner Enclosed is a completed copy of a Uniform Hazardous or a Non-Hazardous waste Solvents manifest that was received at our Used Oil Processor and Re-Refiner facility. oil Filters Y Non-Hazardous Waste Paint Waste This copy together with the copy of the manifest you received when the waste was Drums T-Packs initially shipped,must be retained in your files as proof that the waste was Bulk Liquids transported and received by an authorized, designated facility. Solids Sludges Our storage and treatment methods are as follows: H061 Fuel Blending Services Provided: All products of our fuel blending process are burned for energy recovery. Lab Packing Drum Removal Thank you for choosing Western Oil, Inc. as your provider of recycling services. Tank Removal For additional information please call our office at 1-800-240-5540 or visit our Tank Installation Tank Cleaning Website at www.westemoil.com. Petroleum Transportation Separator Cleaning Since 1 , Tank Maintenance On-Site Waste Sampling Site Remediation Meli Sa COutu Profile&Manifest Preparation Waste Characterization -Fac--it Coordinator- - — _ _ -- - --- _.-- -— W TERN OIL INC. 24 Hour Emergency Response Licensed in: Rhode Island Connecticut Massachusetts Vermont New Hampshire Maine APR-JO-2017 13:07 From: To:915088274251 Page:111 EMERGENCY RESPONSE Invoice Number 224956 .t,aa INSIDE MA 1-800-242.5818 Invoice Date 10/14/2016 _ OUTSIDE MA 1-800.622.6365 Terms Net 30 Ef+t'�1f3t�Ptl�tL:NT��L PO Number FkbrOi~S Customer ID HAR024 Page Page 1 of 1 SILL TO: Harbor Auto Sales 380 Yarmouth Road Hyannis, MA 02601 Description Refgrence Q X Mift Unit Price Amount Waste Oil Pickup 300.000 GL 0.250 75.00 4 Invoice Total $79.00 Please Remit Payment to P 0 BOX 119 STOUGHTON,MA 0207-0119 TELEPHONE 781-341-5109 FAX 781-344-3318 All accounts will bear Intorost at 1.S%per month. The purchaser agroos to pay all coats of collcewi,including attorney's fees. ... ... . .. . . . . copy Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.-OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 70fl.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST tx % �% �' j fay JJ K 5.GeneratoY�Name and Mailing Address ,? ' j' Generators Site Address(if different than mailing address) a Generator's Phone: /7 Cr,``1-i a1< a tir`^'1 � r 6.Transporter 1 Company Name U.S.EPA ID Number YY '�'!+„4�..�.'i»r.. • - .. 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address : - U.S.EPA ID Number...:.. r£...K_.. _ Facility's Phone s ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity wt./Vol. t i t W2 '^ i V 3. 3 i 3 4. 14.Special Handling Instructions and Additional Information {t firer qe s-..f(�'��e,�:1; r; ;.w c i1 7. t 9' 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity,generator)or(b)(if I am a small quantity gener�al?i)Js true. GeferatorslOfterors Printedfryped Name Signature r '` _ Month. Da Year 1s d. :r . -" c J ri 16.International Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 nted/T ed Name Signature -... Month Day Year m - za Transporter 2 PrintedfTyped Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue Partial Rejection ❑ / El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J V Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q H19.Hazardous Waste Report Management Method Codes(i.e.,nodes for hazardous waste treatment,disposal,and recycling systems) G1. ,- 2• - 3 4. 20.Designated Facility Owner or,Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 186, Pnnted/ryped,N,ar"e. ^` z Sigoatuy fit.#+ ?� ,. M nth Day Year 11-3 EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. -._ D9eStNA.`6"EQ FACILITY T®GENERATOR Cape & Islands 1 V CENTER F-j—.R. Truck 380 YARMOUTH ROAD & Van Rental H1 AN N IS, MA 02601 Trucks & Passenger Vans AGENT FOR HERTZ PENSKE Recreational Vehicles 380 YARMOUTH ROAD SALES, RENTALS, PARTS & SERVICE HYANNIS, MA 02601 BETH CHEYNE TEL.775-6311 508-775-6311 Dana G.Cheyne 1-800-352-7074 Manager TOXIC, AND HAZARTQOU ATERIALS REGISTRATION FORM Mail To: -NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 7-7 z 1 P.O. Box 534 CONTACT PERSON: �l�IV6 G' 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 ' - lease 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 V Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants / 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, 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) f . .- ' Other cleaning solvents L A,rN Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN ,OF BARNSTABLE COMPL/ANCE: 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 r 6.Fuel Suppliers ADDRESS =y �� �� Class: 4.. 7.Miscellaneous ,?V,�-QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERLAS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: ;N3 new motor oil (C) 4 trap mis 14y'al"rauIic Synthetic Organics: de •easers Miscellaneous: v f� 4 DISPOSAIYRE,r,LAMATIOW REMARKS: 1. Sanitary Sewage 2. Water Supply Town Sewer PublicIlkc O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDIFRS. O Holding tank:MDC O Catch basin/Dry well O On-site system 4 5. Waste Transporter Name of Hauler Destination Waste Product 1 / P YES NO 2. Person (s) Interviewed Inspector Date TOXIC ,AND HAZARDOUS MAT I S REGISTRATION FORM Mail To: NAME OF BUSINESS: � ����� Board of Health MAILING ADDRESS: -�' -�2 �� Town of Barnstable TELEPHONE NUMBER:— ' • �-s'!l P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: ''«• A.eT /,D 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 t. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners J Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners J Hydraulic fluid (including brake fluid) Disinfectants J Motor oils/waste oils ./ Road Salt (Halite) Gasoline, Jet fuel Refrigerants J Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, J Other petroleum products: grease, lubricants rodenticides) J Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink J Battery acid (electrolyte) Wood preservatives (creosote) J Rustproofers Swimming pool chlorine J Car wash detergents Lye or caustic soda J Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes J Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) J Paint & lacquer thinners PCBs Paint & varnish removers, deglossers Other chlorinated hydrocarbons, J 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 1 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory . BOARD OF HEALTH 2.Printers3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY�e V� &'& (see"Orders") 6.Retail Stores ADDRESS "FE-0 Yilf r4e-, Class: 7 7.Miscellaneous 77X' 4Kr71` QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test els: Gasoline,Jet Fuel(A) halal, Kerosene, Heavy Oils: waste motor oil(C) � � �^ Vj new motor oil(C) �¢ tran mission/h draulic Synthetic Organics: easers � Mi o s: .) w 2 Gr� I Z 44 2 Q DISPOSALIRECLAMATION REMARKS: 1. anitary Sewage 2.Water Supply �" G g! �S5 � e4.�I ArTown Sewer OPublic 0 On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC ' " O Catch basin/Dry well 0 On-site system P/ 4. Outdoor Surface drains:YES e NO ORDERS' 0 Holding tank:MDC (/ O Catch basin/Dry well - . ,,eOn-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person(s) Interviewed Inspect& Date (Y\& RV CENTER.. 380 YARMOUTH ROAD HYANNIS, MA 02601 f : r Recreational Vehicles SALES, PARTS&SER�V 617-775-6311 Deric G.Cheyne ,r all INN IWE 1'0WN of BARNSTAB E c:urrrwArv�c. �..�, ,. E ( satisfactory 2. Printers BOARD OF HEALTH 3. Auto cods shops f i 0unsatisfactory 4.''Manufacturers „) S. Retal.l Stores (see Orders COMPANY �� ~�� - a �'ti '" ' 6. Fuel Suppliers ; 7. Miscellaneous ADDRESS " J�+ :;'t"it �� r Class: ��^� , ,/ QUAN1'I IES AND STORAGE (IN=indoors; OUT=outdoor rE �` k k I se lot*' ot Drums AbaveTanks Undetgro.und Tanks MAJOR MATERIALS `� IN r IN [Off A e e Fes Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, 12 (B) j rl Heavy Oils: waste motor oil (C) new motor oil (C) r transmission/hydraulic Synthetic Organics:.• ti ti degreasers Miscellaneous: x1r P,c' r' UISPQSAL RED '(10N REMEJtKS: I. Sanitary Sewage 2. Water Supply 0 Town Sewer d(Public u 4 �On-site Private .3. Indoor Floor Drains: YES NO _- Holding tank: MDC t�f O Catch basin/Dry well : On-site systemq>t,'` 4. Outdoor Surface drains:YES NO Q Holding- tank: MUC • 0 Catch basin/Dry well .X� °'�`"``�._. OOn-site system ' 5. Waste Transporter Llcensedl + ante Produce Name of Hauler_ , erson s) .lnt.ery etiea- s° nsp ctor Date r•• IJ I TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: > 77 Town of Barnstable TELEPHONE NUMBER: � � �'4 P.O. Box 534 CONTACT PERSON: c� Hyannis, MA 02601 Does your firm st re any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua ies 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 store Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners V'�- Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants ✓ Motor oils/waste oils Road Salt (Halite) i/1"' 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 COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.11'rinters 3.Auto Body Shops ?. Dp unsatisfactory- 4.Manufacturers COMPANY / �'/�' ( (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS JX, Class: 7.Miscellaneous ANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERUndergroundove Tanks IN OUT IN OUT IN Test OUT #&gallons Age �. v Fuels: Gasoline,�e�-i�) *2 Diesel, Kerosene, #2 (B) 14 Heavy Oils: waste motor oil (C) new motor oil (C) �� transmission/hydraulic x5) 9;V V Synthetic Organics.- degreasers Miscellaneous: z&e.tvg 9 d � e 1 4- eig#Z 11;*�W I H� DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply _ 4-[jl.� Ae O Town Sewer Public On-site O Private 3. Indoor Floor Drains YES NO -P' O Holding tank:MDC U 0 Catch basin/Dry well a ,t/ O On-site system 4. Outdoor Surface drains:YES �INO ORDERS: 0 Holding tank:MDC .4- Catch basin/Dry well 4 O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person ( ) Interviewed Inspector Date TOWN Or [3ARNSTA[3L� , ,COMPLIANCN; CLASS; 1. Marine,Gas Stations,REpair ' �' satisfactory 2. Printers � R p Or HEALTH 3. (lanu Body Shops a 0 unsatisfactory- 4. lanufacturers COMPANYL�- !�S.J, �� J"�I ��� (see"Orders") S. Retail Stores 6. fuel Suppliers A D D R H S S .� Y ► 7Y Class= 7. Miscellaneous "+�'•�,L QUANTITIES AND STORAGE (IN=indoors; OUl'=outcloor. 11AJOR MATERIALS • Case - lots 41noa ums AbdveTanks Undetgrot:nd Tanks I L )t IN Q!!Z s llQns_ 9� Fuels: • Gasoline, Jet Fuel (A) Diesel, Kerosene, 12 (B) Heavy Oils: , .waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetl.c Organics:" •degreeser s Miscellaneous: ISPOSAL RECL M T ON RBv.RKS: 1. Sanitary Sewage 2. Water Supply / �7-' pep/��~p/ _ own Sewer Public (�► � _ T 1'' T�11. On-site V Private (' n! / 3. In oor Floor Drains: YES NO Q Holding tank: MDC O Catch basin/Dry well ORDERS ___..�_._.�..�..y..�.___._....../�1 0 On-site system -�JJM�/��ly/�l , 4. Outdoor Surface drains:YES NO Sl" C- ��r�� Y ��� O Huldin;; tank: MDC � � well / �r ! rr /f O Catch basin/Dry -- O On-site system �.� / ,`. S. Waste Transporter Licensed? llijm"f_llaulrr_ / � _11eetination Was -e Product.. YES -NO— /2 2 7'OAIA' /WAS-7"F r) L,- bV SfiC 0//1> erson s Interviewed `• Inspector Date �� 2J 01 The Town of Barnstable Copy Health Department i )l)7l7�7L 367 Main Street, Hyannis, MA 02601 Office 508-790-6265 �30 as A. McKean FAX 508-775-3344 ` Director of Public Health A o February 3, 1993 John Handel c/o Stephen Jones 3010 Route 6A Barnstable, MA 02630 Dear Mr. Handel: This letter is to confirm the meeting of January 26, 1993 on site at 380 Yarmouth Road, Hyannis with Donna Miorandi, Health Inspector for the Town of Barnstable and yourself along with a representative from Diamond Disposal. . It was agreed upon that the batteries stored outside would immediately be taken care of by storing them inside secured trailer and that the other violations previously noted in letter of January 19, 1993 would be corrected within two weeks time. To reiterate the other violations they were noted to be the transmission stored on the ground and the hydraulic lift stored on the ground which had evidence of an oily sub stance mixed water in the lift. Finally, it was in agreement that the trailer stored on site would be secured against any vandalism or illegal entry and that the dumpsters located on site would be properly maintained. Thank you for your prompt attention to this matter. Sincerely yours, Thomas A. McKean Director of Public Health Town of Barnstable TM/bcs THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA . t^A N B . \ \ r C� ^a 0HILE 00 . �M1� D . rt p A/ v m a M i.� m Eo' 0FCK FOF� l{.id fl//.o_ - DATE o� �'L� M. m .�i y r► p =�o n n� TIME y �iA/J. m m �' rt a $ CL iw M 3 ' moo [OF Eo to a a PHONE RETURNED'" ARE CODE ,:YOUR CALL N MB EXTENSION A p, MESSAGE PLEASE CALL 8 WILL CALL AGAIN CAME TO. V = t. : SEE YOU ... e TV. .. �WANTS,TO1GNED SEE YOU 0D vTOPS FORM 4002 m D pMEL i06 E0 ONOTICE TO ABATE VIOLATI! mDear Mr. Jones: n aDa,On Wednesday, January 13, 1993, Donna M c o v m m o m a the Town of Barnstable Health Department per m 3 a v o o D of your property listed on Assessor's Map 34, �p m m m o < a 0 C. I n 10 m CD CD While on site the following violations o 4 5 a ARTICLE XXXIX. CONTROL OF TOXIC AND HAZARDOI Thank you for using Return Receipt Service. Section 4 (a) . The discharge of toxic or hazardous materials upon the ground or into any surface or groundwaters within the Town of Barnstable is prohibitied. Section 4 (b) . Outdoor storage of toxic or hazardous materials is prohibited, except in product-tight containers which are protected from the elements, leakage, accidental damage and vandalism, and which are stored in accordance with all applicable requirements of Section 5 of this bylaw. MASSACHUSETTS HAZARDOUS WASTE REGULATION: 310 CMR 30.680, 30.690. Each container and tank must be clearly and visibly labelled. . . Each container must be in good condition. Observed were several unmarked 5 gallon containers, full of unknown substance. MASSACHUSETTS HAZARDOUS WASTE REGULATION: 310 CMR 30.351 (8) Above ground containers must be on a surface which does not have any cracks or gaps and is impervious to the hazardous wastes being stored. Area must be secured against unauthorized entry. An outdoor area must have secondary containment. Any spillage must be promptly removed. Observed were batteries stored outside, an engine on the ground and much evidence of spillage of toxic or hazardous materials on the ground. You are directed to correct these violations within forty-eight (48) hours of receipt of this notice. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 1. :T Board of Health MAILING.ADDRESS: ��' - Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: °771 f? /!.p 3 Hyannis, MA 02601 CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua ties totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored i . Please put a check beside each product that you store: 1/ Antifreeze (for gasoline or coolant systems) Drain cleaners J 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, ^'^"^^, ^� ix�s;E}yes'- 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 1 TOWN OF BARNSTABLE COMPLIANCE: 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 3 9" �CjSSS• 7.Miscellaneous U44 UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERS 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: F waste motor oil (C) new motor oil (C) 1' transmission/hydraulic Synthetic Organics: degreasers b r— r 4f 11��, Miscellaneous: g:�j 1/ �!�'`!�� ..�" G•Ate" '> � DISPOSAURECLAMATION REMARKS: �j 1. Sanitary Sewage 2. Water Supply P /'Vfi r,7 O Town Sewer 'Public 410n-site OPrivate 3. Indoor Floor Drains YES NO F' O Holding tank:MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES—NOZ ORDFJIS. f 0 Holding tank: MDC 0 Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product NO 2. OE Perso (s) Interviewed Inspector i+ Date TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair "1` `"' O satisfactory 2• Printers ;BOARD/ ,. OF HEALTH 1 3. Auto Body Shops It unsatisfactory- 4. Manufacturers COMPANYtf .�`%��- _e r d'` i , -� (see"Orders") 5. Retail Stores r. + 6. Fuel Suppliers ADDRESS Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors) MAJOR MATERIALS Case- lots Drums AboveTanks Undetground Tanks �»- fIN OUT IIN IOUT IN UT # & eallonse rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers I Miscellaneous: DISPOSAL RECLAMAATION REMARKS: f a 1. Sanitary Sewage 2. Wa6<blic upply OTown Sewer aOn-site o Private - 3. Indoor Floor Drains: YES NO 4 Holding tank: MDC O Catch basin/Dry well _ On-site system ¢�t,,�,�.`". / ----_.f}'�h...._,.,�__..__ /1ff,I 4. Outdoor Surface drains:YES NO _ Holding tank: MDC '-� o T O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? NgMg of Hauler. .1? sti nati on _JK ste Product YFS NO 1, 11 23 811 Person 7s)}In't.erviewed f Inspector Date TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM L406:w ADDRES ,A tonrAK 4 Major types of materials: 1) 2) 3) 4) S) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal glass paper plastic cans,bottles,jars oa drums,barrels aboveground tanks 0 underground tanks bags,boxes open,loose,uncovered inadequate labelling Z 0/4 0 %A A B. Storage Facility v/or # Remarks/RecommeM u-i.ons 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation ye> ii) floor drains ¢ i?i) inadequate fire protection ww 3m" 2. Outdoor , a) uncovered, exposed to weather b pervious surface/catch basins " III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system ¢ R 3. Separate holding tank C. Off-site disposal 1. hauled by own firm r 2, hired hauler a) name of hauler b) address or disposal site 7 . -- -� - - - - - — — — — — — — — — — Persoh(s) Interviewed — _ — — Inspector" — Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Al,- ��-- Mail To: NAME OF BUSINESS:A ��,2 `279f,&,�d�B �'�'��� 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 quanti s totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES, 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 Please put a check beside each product that you store: _ Antifreeze (for gasoline or coolant systems) Drain cleaners 4_ 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 QMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops .�� O unsatisfactory- 4.Manufacturers COMPANY �� ?`��-� f/�,4' �/ylffsLs�v (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS *2 r " s4A4 'ad Class: p 7.Miscellaneous 'Aq 4QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER�SUnderground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) i Diesel, Kerosene, #2 (B) Heavy Oils: x ' waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer ublic . On-site OPrivate 3. Indoor Floor Drains YES NO - O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO Z 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 2. y . Pero (s nterviewed Inspector Dat rl ti -o OFFICIAL E CCO Postage $ t�YA�1ll�/ Certified Fee p /Postmark C3 Rsem Receipt Fee V-77 Here 00 (Endorsement Required) Restricted Delivery Fee !� p (Endorsement Required) til p Total Postage&Fees ru Sent To a -Aftn-Att !Sf V W-�11'a__ F�ft(b0( ,('ID p Street Apt No.; } r. or PO Box No. O ya r OUA W i ----- i ----------------------------------------------------------- cty --P+ant]5 MA na le01 Certified Mail Provides: o A mailing receipt 0 A unique identifier for your mailpiece 0 A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain ReturnReceipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt Is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt"and present it when,making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047