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HomeMy WebLinkAbout0431 YARMOUTH ROAD - HAZMAT _ guy/nay J�- - - � ---- — — � Commonwealth of Massachusetts _ Executive Office of Environmental Affairs Department of h Environmental Protection '� 3•I irn Southeast Regional Office (I William F. Weld _. Governor Daniel S.Greenbaum } • Commissioner r April 1, 1992 B.K.R. Realty Investment Trust RE: BARNSTABLE--WSC/SA 4-1029 One Belmont Road, Apt 313 Barnstable Aquifer We s t Harwich, Massachusetts 02671 Protection Project NOTICE OF MEETING/ COMMENCEMENT OF WORK ATTENTION: Raymond J. Riseberg M.G.L. C.21E Section 4 Gentlemen, The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , is investigating releases of oil and hazardous materials in the Hyannis area in accordance with M.G.L. c. 21E and the Massachusetts Contingency Plan (MCP) . Numerous confirmed priority disposal sites and Locations To Be Investigated have been identified in the zone of contribution of the Barnstable Fire District Well #2, the Maher Electric Water Supply wellfield and the Mary Dunn wellfield. Overlapping contaminant plumes at different depths into the aquifer have been found during hydrogeologic studies in the subject area. The Department has reason to believe that the property located at 444 Yarmouth •Road, Hyannis, Massachusetts (hereafter the Location) , a property you (as used in this letter "You" refers to B.K.R. Realty Investment Trust) either own or operate, is a potential source of contamination threatening the water supply of one or more of the several public water supply wells located in the area. The Department is holding an informational meeting to discuss the future response actions that are planned in the area. The meeting has been scheduled on April 8, 1992, at 2: 00 p.m. at the Barnstable Town Hall, 2nd Floor Auditorium, 367 Main Street, Hyannis, MA. Due to the existing and potential migration pathways, and the complexity and magnitude of the releases, the Department has determined that the interrelationships of all identified sources needs to be assessed in a systematic Comprehensive Site Assessment. This assessment will provide relevant information to protect the public health, safety and the environment. Therefore, the Department, pursuant to its authority under M.G.L. c. 21E section 4 , has assigned its contractor, HMM Associates, Inc. (HMM) , under the Site Assessment and Remediation Support Services (SARSS) , to undertake the following tasks: Lakeville Hospital a Route 105 9 Lakeville,Massachusetts 02347 9 FAX(508)947-6557 9 Telephone(508)946-2700 2 - Compile and analyze existing information. Develop an area wide Phase II - Comprehensive Site Assessment Scope of Work. - Coordinate and oversee the field operations during the implementation of the Scope of Work. - Review and interpret the data generated. - Provide conclusions and recommendations for future work. HMM is currently reviewing the information that exists on file with the Department and soon will begin work on the other tasks. The property located at 444 Yarmouth Road, Hyannis, Massachusetts, in addition to approximately thirty other sites, will be included in the Comprehensive Site Assessr-en''t. In addition, as part of the ongoing investigation, the Department will conduct a viability survey of all existing groundwater monitoring wells in the area. In order to perform this survey, the 'Department requires access to the Location. Enclosed, please find a request for site access agreement. Your anticipated cooperation in this project is appreciated. If you have further questions, please contact Maria Pinaud or David Ellis at the letter head address or at (508) 946-2862. The Department looks forward to your attendance to this meeting. Very truly yours, Mark J. Begley, Chief Site Remediation Section Enclosure B CERTIFIED MAIL #P 656 840 981 RETURN RECEIPT REQUESTED cc: DEP - BWSC - Boston DEP - SERO - Data Entry 3 ` cc: Town of .Barnstable Town Hall Hyannis, MA 02601 ATTN: Warren Rutherford Town Manager Hazardous Waste Coordinator P.O. Box 534 Hyannis, Massachusetts 02601 ATTN: Tom McKean DEP - Div. of Water Supply - SERO ATTN: Larry Dayian Barnstable Fire District P.O. .Bdx .54F Phinney's . Lane Barnstable, MA 02630 HMM Associates, Inc. 196 Baker Avenue Concord, MA 01742 ATTN: James D. O'Brien 4 SITE ACCESS PERMISSION FORM The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , has contracted with HMM Associates, Inc. (hereinafter "HMM") , to conduct an assessment of the integrity of existing groundwater monitoring wells with regard to future use of these wells in the Comprehensive Site Assessment of the Barnstable Aquifer Protection Project and hereby requests your permission to enter the property located at: 444 Yarmouth Road Hyannis, Massachusetts In consideration of the foregoing, the Department agrees that it shall exercise due care and caution in the performance of the work. Therefore, the Department is hereby requesting access to the Location for the Department or its contractors to conduct the work described above. Please sign and return the enclosed permission form within ten (10) days of your receipt of this letter. The Department will make every effort to notify you by telephone prior to entering the Location. Please signify your authorization and approval by signing below in the space provided for your signature. Should you fail to return the signed form or contact the Department within the prescribed time frames, the Department will assume consent and will enter the Location. Pursuant to c. 21E, §8, the Department or its contractors have authority to enter any site or property adjacent thereto - in order to perform response actions pursuant to Section 4 . If you have any questions regarding this matter, please contact Maria Pinaud or David Ellis at the above address or at (508) 946-2862. In any correspondence to this office, please refer to case number WSC/SA-4-1029. The Department thanks you in advance for your anticipated cooperation. Accepted and agreed to: NAME DATE SIGNATURE TELEPHONE 4-0901 ADDRESS DEP SITE ID Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA ........................................................................................................................................................................ Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ............................................................................................................................•....................................... Restrictions: .................................................................................................................................................................... This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ,i Town of Barnstable Inspectional Services BARNSTABLE MNTAUPublic Health Division ANNIS ; _"' °"``��WN-� " • � � 1639-2014 g. �71g R ,AM E Thomas McKean, Director MASM E 3s`� 200 Main Street, Hyannis,MA 02601 n41 a. . Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE " N HAZARDOUS MATERIALS U IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 VIES i C{ . *A late charge of$10.00 will be assessed if payment is not received by July 1st. S 1. ASSESSOR'S MAP AND PARCEL NO. 3 v' r l 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 ORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 1 4. FULL NAME OF APPLICANT: r G K(�I..S r qj r t" 5. NAME OF ESTABLISHMENT: '1'1 lA Cu 6. ADDRESS OF ESTABLISHMENT: (( M Ci VI 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES v/NO IF NO,NAME OF PARTNER: C I 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATIO AME f-a m p U n C PRESIDENT b (( fl A Kot S�6 A A,1 1n TREASURER G . ,° " 1,. 14 Yn CLERK- ,h( i 5 S R 1, V\ 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS zi EMAIL: SIGNATURE OF APPLICA, DATE Q\Application Fonns\Haz Mat Appli Draft Jan2019.do x Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. PAUL J.CANNIFF,D.M.D,CHAIRMAN D_ONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r i Town of Barnstable1� 0 Inspectional Services BARNSTABLE 'THE r C • � II"� �wsrne!E.cirirE.r.:i.co'utt.Nrnxxi° �;`.. "I PStC`-Nf:!.5•CS'EFY:LLE v;_T 84q'Fi.'RXE Public Health Division * BsTsrr. ` Thomas McKean, Director $ r� Eo39. �a`0 200 Main Street, Hyannis,MA 02601 ' Office: 508-862-4644 Fax: 508-790-6304 0 *IQ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 x�5TrdC�� � *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. -p / 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 §TORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? v/ YES NO. 4. FULL NAME OF APPLICANT: . Z�r 9,470 klk 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: _ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 7A4, �41 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES ; NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION NAME $244 Alk,AL PRESIDENT TREASURER CLERK 4� 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\Haz Mat App Revised 09-l0-18.doc Paramoun*ooring: 413 Yarmouth Road - Hyannis, MA. 020 Emergency Angency Plan, :v �—————B ————J Garage Door I I Door ; Office Retail Store =---------------------i r —— 1 — Main r-—� Entrance I I I I I I C I ID I 1 AI I 1 I I I I I 1 I I I I I I I I I i 0 I I Pro Shop Area Retail Store Area 1. Area's marked by A, B, C, D, and E show where all Hazardous Materials are Stored. 2. 0 Shows where the Fire Extinguiser is located 3. This Diagram is posted in the Retail Store Office 4. In the event of an Emergency call 911 IMMEDIATELY, then call Sean& Greg ** Emergency Contacts ** Greg Kashgagian Owner Cell # (508)989-0183 Sean Clark Manager Cell # (770)401-6914 Revised on April 21,2016 Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 Ton of Unstable egu atoervices / Richard V. Scali, Director � Ft r .4 Public Health Division BARNSTABLE BARNSTABLE•[ElRERVILLE•C°TUIT•Nt'ANNIS sA SMBLE. ` Thomas McKean, DirectorMASS. f0N5M1 ;fi;;Zo 4w !ANs`AB n �p�0� 200 Main Street, Hyannis,MA 02601 ��' ND CD 1-� Office: 508-862-4644 Fax: 508-790-6304 ` APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE -10 HAZARDOUS MATERIALS S'" h� IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS, ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 JZ 11S . *A late charge of$10.00 will be(�assessed if payment is not receivedby 1st. l 1. ASSESSOR'S MAP AND PARCEL NO. 0 V� `�` 0 ��� 0 3 3 ' �U�,"1 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: 5. NAME OF ESTABLISHMENT: (�(V\4 f rhc. 6. ADDRESS OF ESTABLISHMENT: v1 1 I mU uk' 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 9 k V.Q.n�f S (U lv� '�� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: ;rP " Q Gt�(jl G i�t n r f Lk 10. SOLEOWNER: YES \/ NO IF NO,NAME OF PARTNER: C k f 6 hCAS n 140 11. FULL NAME,HOME ADD S,AND TELE HRNE# OF: CORPORATION NAME fiO " �'� G 1n 1`X4, o r C PRESIDENT f al S V\ oae A v2 16 Tff 6 ti* 0-�A Y1, `A�L /�A 6 2 6d'1 TREASURER . C 1.�,'S M A r M sy rws ptl A �uH CLERK -f S (n 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICA DATE Q:\Application Forms\HAZMAT APP 2017 REVI ED.dj e` Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----------------------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------ ----------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health SZ:I0.4o BIZ r � ' of B nstable eg atoty Services Richard V. Scah,Director cF'ME rq Public Health Division BARN.�ABLE BPRNSfA0l1•v:FNIGRL�R!•CONK•MinFt:15 = R�� . = Thomas McKean,Director 163 e 4 039. `� 200 Main Street� Hyannis, MA 02601 _ Office: 508-862-4644 Fax: 50 790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS �* IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT - 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V S • *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: (3 p 5. NAME OF ESTABLISHMENT: A 44,Ad, J of,14,4 /In 6. ADDRESS OF ESTABLISHMENT: I 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: .7 Atdz' r, I 8. TELEPHONE NUMBER OF ESTABLISHMENT: /���1 ���hi 9. EMAIL ADDRESS: 10. SOLEOWNER: YES O IF NO,NAME OF PARTNER: ' 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION NAMEAT PRESIDENT � 41 TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC N DATE Q:\Application FonnsTAZMAT APP 2017 c Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------=-------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI - THOMAS A.MCKEAN, R.S.,CHO Director of Public Health tr'� Q- Town of Barnstable Regulatory Services Richard V. Scali,Director B"R`''A`"B`E ` Public Health Division BARNSTABLE .�. BnRnsinol.[NlIFRNLLE mN'I wM1K,\^S 1639. t.t F•FDirector nU50YJL5.OSTE0.NLLE W3 BRRHS iBF men Mpg a Thomas Mckean,Director' . , s'`* `' 1639"2014 200 Main Street, Hyannis,MA 0260 ( 75 Office: 508-862-4644 3iil' I Fax: '508 790-6304; ACID 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 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 x Y S A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. � _ 0 —I DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: 41 ADDRESS OF ESTABLISHMENT: MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: low EMAIL ADDRESS: SOLE OWNER: YES efNO IF NO,NAME OF PARTP;Z: 41Z f 'A) FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER Al An 07 V CLERK • -. IF PREPARED BY OUTSIDE PARTY: S U O A ANT Name: Id Company Address Telephone #: Email: Q:\Application Forms\HAZZAPP Rev I6.docx Page I oft y°pAME TOkti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BA LE MASS. A. 200 Main Street• Hyannis, MA 02601 " 163 9. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED MA'S Business Name: I D&Ct co Date: V ro h7 Location/Mailing Address: ( � inn,S Contact Name/Phone: 2lLy� C.(ar�2- 7 -- Pilo Inventory Total mount: SDS: OV-11we- a<GCeSs License#: i 3 �v Tier II : A 0 Labelina: Jvm.�\ Spill Plan: (3k*?- Oil/Water Separator: VA Floor Drains: J® Emergency Numbers: Storage Are C&v1k0,w—e-51 V-P- -'r S — �jJ �, Aatl eiu_t �1,� � °v}cTra�_ Emergency/Containment Equipment: V'w Waste Generator ID: t3 A Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: i LIST OF TOXIC AND HAZARDOUS MATERIALS MO � NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, W4 feAlO1� storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid V 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 en ines&gar es Pesticides: Caulk/Grout/Aoe SdO\e(6 insecticides, herbicides, rodenticides Batteryacid elect a/batteries Photochemi I( yt ) ca s(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar ye�e � Swimming pool chlorine Paints, varnishes, stains, dyes r, Lye or caustic soda Lacquer thinners V+; 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: Inspector: ° Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS `0F1HE r� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B""M SS. 200 Main Street• Hyannis, MA 02601 i639. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT i rFo Mn+ Business Name: PQ CLW0owA ,^Cv Co cLr Date: Location/Mailing Address: l3 4,k,✓ vs Contact Name/Phone: e.Xv^- qvIZ 5-08--7-1 Inventory Total Amount: A---7 5�o MSDS: e5 - License#: VD 5-- Tier II : Nlok Labeling: t ke,,k \c, Spill Plan: Aa"p— Oil/WaterSeparator: Floor Drains: o lergency Numbers: 2 TT Storage Areas/Tanks: Skvc )V , kt>,L%nOl SSo►h�- Emer enc /ContainmentE i ment: <iL�eb bo.tit� Ov Waste Generator ID: Waste Product: Date&Amount of Last Shi ment/Fre uenc : Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS v'� 01\[J:v-� I°v °L I ' 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 VDegreasers 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: z- yA Jill INFORMATION/RECOMMENDATIONS: o D 5vC ©,,( C-2C.o,Mw�Ca/l I�Lt G- �5 Inspector: ocU Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS °p 1HE rod Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMA R&Le 200 Main Street• Hyannis, MA 02601 ta,q. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO MP'�s Business Name: PQ,r0.W"&�%A:� %,� Date: 18 1 y Location/Mailing Address: 413 4 _ 4, w4g,,k s o Contact Name/Phone: :ea C a<k 2>8-7&S- 1 96,4 Inventory Total Amount. �SDga� MSDS:OK-gJ4.1 00,xa, License#: Tier II : 0 Labelina: OK Ra. ,\ Spill Plan: of Oil/WaterSeparator: NIA Floor Drains: No Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: OkL SA�,e, Waste Generator ID: QIA Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 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 x�p�So Swimming pool chlorine O Paints, varnishes, stains, dyes IJ,70,k�00.M Lye or caustic soda Lacquer thinners .000 Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes to 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) VI0LATI NS: VQ,1� l�a'E �ov��,nq.�<-t.a\�S �,rcan�e_4.v.b� 1.p,11 ORDERS: vt, tgcrzmk v . D05A K, V a k., INFORMATION/RECOMMENDATIONS: Inspector: , LA�I�-�l•2� Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS i Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS RE 41STRAMM FORM NAME OF BUSINESS: ra ,Mom IQvaI Cbv�,(��c►�y BUSINESS LOCATION: q/3 Yar,rqo�. 9,,A2, d,►4Y,,nis INVENTORY MAILING ADDRESS: 3awue_ TOTAL AMOUNT: TELEPHONE NUMBER: ?>E - I 7! CONTACT PERSON: .5eax. Glarl2 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 6+'k,I eat' loor. INFORMATION / RECOMMENDATIONS: r. L/ark cJ4S v10-i'a•/a�1�I�l e- Fire District: J<� � I vt 5 +%o K. Jo a +A- 'Wt 1e*e J 5 I o — .54-,I V kyt, . i a b 5ac 6t,:+5 . Tie-,I,+,) In ws S�'�ta„p o �rooQ�G�'�vr�f'•e..��.,1 5 a.�2 oyl.l,� — na Ma �or ekavl9�eS ,H ,nv�e�'�� s,nUe. 4, 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 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, to Lacquer thinners (including carbon tetrachloride) O 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) a-ce, p cabs a�rJ�-Spot removers removers&cleaning fluids (dry cleaners) �jl''II� ,C�1 ' C ►4.GrJ If- eX`�i ✓IStuC Other cleaning solvents Bug and tar removers I VL G1wl I eAl l i'04d" 5aI-e,6 S Windshield wash 10 .eMA i g ,`) cow A K_— WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature S aff s initial Paramount Flooring: 413 Yarmouth Road - Hyannis, MA. 02601 Emergency Contingency Plan 1 1 �————�B ———— Garage Door Door ; Office ; Retail Store -------------------- r 1 1 Main Entrance � k . � � Yam•'.; 1 1 c I 1°D , A 1 I" y pD A z Y L t C:G 1 1 1 1 Pro Shop Area Retail Store Area - 1 1 1 1 1 1 1 1 1 1. Area's marked by A, B, C, & D show where all Hazardous Materials are Stored. 2. 6 Shows where the Fire Extinguiser is located 3. This Diagram is posted in the Retail Store Office 4. In the event of an Emergency call 911 IMMEDIATELY,then call Sean&Greg ** Emergency Contacts ** Greg Kashgagian Owner Cell#(508)989-0183 Sean Clark Manager Cell#(770)401-6914 Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health P Town of Barnstable Regulatory Services ° Richard V. ScaU,Director ` Public Health Division z639. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee:$100.00 ASSESSORS MAP AND PARCEL NO.3 9 4—M �'� DATE a H 1 S i APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C(A G Ll) � CIA 6 (6 v1 �- NAME OF ESTABLISHMENT P(Af Ayr y) Cd C • ADDRESS OF ESTABLISHMENT VI 13 JC4 C M 6 M. I� GZ r1 n TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D LI— 2 3$YS�rS STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: L PRESIDENT {f i v 4 S� ot. .�Y) ,-n o�vi S 1 �a Vi e e i M Q a TREASURER r 3V G 'A n o a 5 Q rs 1 0 d y CLERK • OF PLICANT RESTRICTIONS: HOME ADDRESS -L e j4, ,l e In �9 .�j- HOME TELEPHONE# le Mcache\Temporary Intemet ReAOLKWEAZAPP Rev2015.DOC r Town of Barnstable Office: 508-862-4644 -Fax: 508-790-6304 o Regulatory Services Department sA104.MEILF, Public Health Division MASSs Thomas A. McKean,CHO 1639 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $100.00 (Check) on 6/30/2015 'Check number: 35253 Check amount: $100.00 Name on check: Paramount Rug Company, Inc. ;Business: Paramount Rug Co. ,Address: 413 Yarmouth Road , Hyannis I i i • II Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health � w 5 Town of Barnstable �pPTHEro�� Regulatory Services Richard V. Scali, Director 9 ASSSB g Public Health Division 1639• ♦� ArFD►�(►`la Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 "96ek 41 .4 &;,.f � ASSESSORS MAP AND PARCEL NO. et2S tyr DATE 1 a s I I APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT4 4 W / ADDRESS OF ESTABLISHMENTAd- "f`S TELEPHONE NUMBER SOLE OWNER: YES ✓NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: c . F 1-C wo me 4 F F_ F F&W N '0!*7 6.4 09-In f C go 11"i ®a�y� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. _ 5X STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER f CLERK ee S N T Wrof P NT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# J:\HAZAPP.DOC d, MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page J:UiAZAPP.DOC s Paramount Flowing: 413 Yarmouth Road e H.yanbn is, MA. 0260E lEine;gc ney Con ingenev Plan B Q1-age.Door Okt°ar 0fice A®®o®omom®®� Retail ° stvrc J} !---------------------• k Ravin ]s11tranee I I I 1 I I 1 1 1 1 C I I memo a® E 1 I 1 J ._ CL � c kl� <-------- Pro Siwp Area Retahll Store Area 1. Area's marked by A, I3,C, &D show where all Hazardous Materials are Stored. 2. i� Shows where the Tire Extinguiser is located 3. This Diagram is posted in the Retail Store Office 4. In the event of an Emergency call 911 IMMEDIATELY, then call Sean&Greg Emergency Contacts �* Greg Kashgagian Owner Zell #(508) 989-0183 Sean Clark Manager Cell #(770)401-6914 1 - -- TownOf Bamstabl8., Office:508-862-4644 : .. Putilic`Health Dlvlslon Fax:508-790-6304 . 8 8=,B ,, 200 Main`.Street Hyannis,MA U601 +` TOXIC AND HAZARI OUS MATE#i%t.S.I CTION REPORT Business Name: vtiov„ ,a' , `t ! Date: Location/Mailjng dress:� w 4 a.� ,� v<" :, , I a VA4,.ICIk s Contact Name/Phone: a -7-71. '. laQ. Inventory Total Amount: MSDS: 4 . License* a '0, hp+ a5 Tier II; I o Labelm �C. �.:a ill Plan: ht ' { Oil/Water Separator e�< _ Floor Drains:; Emergency Numbers: Storage AmWTanks: . alkVIIA ! Eme eaz&6ntajnmen#Equipment: Waste Generator ID:. MIA TWOte:Product: I Date<&Amount of LAStLhjhi6m ehtffi*uen�y. . Licensed Waste-Hauler&Destination: Other Waste:Disposal=Methods: LIST OF TOXIC AND HAZARDOIS MATERIALS NOTE:Under the provisions.ofi Ch`. 1 i 1, Section 31,of the General Laws of MA,hazardous.rnaterial:use; storage and disposal of 111 all or more requrres a icense.from the Pubic Wealth Division. Antifreeze Dry cleaning fluids'" i Au#oma#ic trans mmssionfil Old, Other cteaningsotyents&spot removers Engine and radiator flushes . Bug and tar removers Hydraulic fluid`(including brake fiui i) VNindsh eld W' h Motor oils Miscellaneous Corrosives Gasoline;jet fuel, aviation gas Cesspool cleaners Diesei fuel, kerosene;.#2 hs Jng oi! D�srnfiectants Miscellaneous:petroleum products: Road sal#s grease; lubricants,gear oif �Refngerant s Degreasers for engines&garages F'esfiacicles , Caulk/Grout insecticides;herbicides; rbdentibides Battery acid(electrolyte)/batteries Phot6dhi i -als(Fixers) _ Rustproofers Photochemicais.(DeveloPee)> Car wash detergents PnntingMink Car waxes and polishes y Wood preservatives(creosote), Asphalt&roofing tar ya 40 SwrmrnGng pool chion '3O Paints; varnishes,stains dyes -Ye or caustic'"soda :> j Lacquer thinners I Combdstible I Parnt&varnish;rerriovers,de#toss�ers Leather:dyes:. o Miscettanes Fl ouammabies Fertilizers Floor&furniture strippers e Metal.polishes Otherchlorhated hydrocarbons j Laundry`-soil&stain;removers (including.carbon tetrachloride) f (including bleach) Any other products with"poison labels". (includ�rig chloroform,formaldehyde, hydrochloricacid,other acids) VIOLATIONS: e,iA At 'vts� dR DERS: c c k , e s( E INFORMATION I RECOMMENDATIONS: i r t tspecor- - £ d Fm 7 5 WHIM-b6iPy--.HEALTH DEPARTMENT 7 CANARY Ei^1PY l3upp",5S r { Y M Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to'Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r i Towu of Barust-:ble Thomas Y Ge33er,Director aeaxsrar _ j Public Health D1�753�� 200 Main St-�, $yajs,AAA 02601 F� 50�-790-b304 5a&-S )-4644 Applicaton Fee: V OUG A S�LSC}RS 1)1—p At�7�FAQ CAL O. DATE ,jPLCATION FOR Pepe' TO STORE /OR V�MORE TE- 1,N 111 G ,nNS Off' HAZARDOUSI-A.TERLA-LS Al uU L NSA._g OF APELIC.ANT Aim+ OF ESTABI 7r p�QAA/1UN 1 �V(S bJtS oz&6 DI DRESS OF ESLADLISg' EY- j=HOj�,T tN TbfBER FPZICANT IS. S A p_kRT1 ETA ANC HOlYSE ADDRESS OF AI,� i o i A2PIJCANT IS A C•OpJ`ORA=O?q; FEDER.,�L IDE��CATIO'N STATE OF INC013POAA2I0N v —7jjL��T_Ai�A.N HO�i� Z�kESS OF; ' I IJCANT t 4'.i 1.1S1C 110�17: HONE ADDRESS _ HON9 TX=EONE 9 Paramount Flooring: 413 Yarmouth .Road v Hyannis, MA. 02601 Emergency Contingency Plan f ®. �. t=arage D(Da:Dr n Door Office Retail Store �---------------------t ®®�I Main I Entrance I I I I I I I I C I Al 1 I I I I L —_.-1 I I <- Pro Shop Area > E Retail Store Area 1. Area's marled by A. B. C. show, where all liazardOLIS Materials are Stored. _. + Shums where the l=ire I_xtin�guiser is located ;. This Dia`_rann is posted in the Retail Store Otiice 4. In the event of an Emergency call 911 IMMEDIATELY. then call Sean & Greg xr Emergency Contacts xx Greg Kashgagian Owner Cell 4 (508) 989-0183 Sean Clark Manager Cell 4 (770) 401-6914 b r.• u Number Fee 1053 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Paramount Rug Company 413 Yarmouth Rd., Hyannis,MA 02601 Is Hereby Granted a License t � � FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. N -------------------------------------------------------- -- -------------------------- - --------------------------------------------------------- ------- ------------------------------------- --- ------------------------------------------- - - - - This licensels granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2012 unless sooner suspended or revoked. ------------------------------"-------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable _- Regulatory Services Thomas F. Geiler,Director M. :.� Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Applicatron-Fee:$100:00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. III GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT �-\\` `•\ p ���� 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. 4 1 3�l 5o�j STATE OF INCORPORATION ADMOkp� Mau\ `Q) FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK I OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE#' 4 p Hazdodwp/q