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0500 YARMOUTH ROAD - HAZMAT
f� 'Vr' I ��,c-c.h e s �I Z. ��b I►c. S M E A D No.2-153LY UPC 12934 smead.com • Made In USA y FWt=NTWDQO WLW SFIAMMrr'E ° anWsaFROWnr cFRno souQari� 1ME r°y� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARARS9 E. MASS. p* 200 Main Street• Hyannis, MA 02601 1659. 7 0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: My lJQI-, Amcka, Date: I� .,� Location/Mailing Address: bOo Contact Name/Phone: A`R, C0 0 9 ' 1. Inventory Total Amount: C MSDS: Lks- co License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: U D� ao o� Emergency/Containment 'pment: ` Waste Generator ID: v Waste tProduct: e . 6, Date&Amount of Last Shipment/Frequency: Q I/5 Licensed Waste Hauler&Destination: Lam I WI 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 V Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants V 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) VAsphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes v 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: no Inspecto . Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER BMW OF CAPE COD 500 YARMOUTH ROAD, HYANNIS, MA Is Hereby Granted a License For; Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------- ---------------------------------------------------------------------------------------._- ---------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable p Inspectional Services BARNSTABLE �FSHE Tn,• �nwsrnnlE•xre:r;L•co-um.rurcr f Public Health Division °s,°w""5 1539-r°:•°::�'.'`: Y 1679-Inta 9�UBLE.$ Thomas McKean, Director 57 JL639.t A 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304LA g 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 v *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. h1 2. IS THIS A PERMIT RENEWAL? V/ YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: " 0 ph, 1AA VL S. NAME OF ESTABLISHMENT: 44b MMAWA JU UK cUX MWID9rhd 6. ADDRESS OF ESTABLISHMENT: np M11" , I jAftw,, M It p,)1d a I 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5O8 "815' SS�� 9. EMAIL ADDRESS: �er�, dunrnL(,PiI�.C�I�YI_ 10. SOLEOWNER:4—YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHON #OF: CORPORATION NAMELAX,11POM, MA PRESIDENT O MR- Oaa-qg TREASURER CLERK -2 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q\Application Forms\Haz Mat App Revised 09-I docx r� Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod 460 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 Vwofor Brnsxable eg atory ervsIces • Richard V. Scali,Director Y Public Health Division rs*: ��AB . • Thomas McKeanMAM , Director E� ` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 0 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 N . 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: V U a W-Vum 5. NAME OF ESTABLISHMENT: Q ,�� h tp lA 6. ADDRESS OF ESTABLISHMENT: lL , 0 ; Oa(QBI 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: r 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: o 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME (04 PRESIDENT TREASURER CLERIC 12. IF PREPARED BY OUTSIDE PARTY: . NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE Q:\Application Forms\HAZMAT APP 2017 REVI ocx • z Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER BMW OF CAPE COD 500 YARMOUTH ROAD, 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 AA 'THE Inspectional Services BARNSTABLE CF raY amsrnn�.e•crvr�e��:2,co"m 45 c Public Health Division MWSTGSNt�S15.19f1tL_l3BHq E isas5-7xn�ia SARNSTABLE, : II" � Thomas McKean, Director i639 �0� Argo .a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ` APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 *A late charLye of$10.00 will be assessed if payment is not received by July Ist 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?V 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: 5. NAME OF ESTABLISHMENT: 440 MMA 'J UAt MX WID 6. ADDRESS OF ESTABLISHMENT: ID V(1t� �� 1 � o UAh 4, M i4 Da to of 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: `��� �d��,Q,Y►lap,�,CO�YI� v r 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHON #OF: A� CORPORATION NAME t�J�e PRESIDENT TREASURER , CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS / EMAIL: r . F SIGNATURE OF APPLICANT DATE Q:\Application Forms\iaz Mat App Revised 09-1p- .docx v` Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod ---------------------------------••------------•-----•--------•---------------•-•-------••--------------•----•----.....---------- 460 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 L of ine r� Inspectional Services BARNSTABLE Public Health Division ias-7nia D ssS. Thomas McKean, Director Dg 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 1N 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 Yv(l_ *A late char a of� $10.0 0 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL?I YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: --�Menk 0 aj n 5. NAME OF ESTABLISHMENT: q � U A wt. 2 N w'cai 6. ADDRESS OF ESTABLISHMENT: , f f ba 10011 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8to UI (� 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5C�' Jr •SOU O 9. EMAIL ADDRESS: (, 10. SOLEOWNER:ZYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONIE#OF,: d CORPORATION NAME C "k, PRESIDENT ®� TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS % EMAIL: SIGNATURE OF APPLICANT `Z DATE Q:\Application Forms\Haz Mat App Revised 09-10-1 o y Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod 460 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 DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health • Town of Barnstable Fz Inspectional Services BARNSTABI,E , • Public Health Division 6rA BLE, Thomas McKean, DirectorM . 19. � 0 Arfo �A` 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT.TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 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 xv(�"17 *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: AQq Of 5. NAME OF ESTABLISHMENT: 771 kki. � IA'=, d1le � ,����bG� 6. ADDRESS OF ESTABLISHMENT: 4A ,41MMAkA . ff'4Q,IU4,(d, Mg NMI 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: �( �{ U 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5M•g1_ 5 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF CORPORATION NAME q C PRESIDENT r(, ULKAM- 0 16 Uf P60 1AAA W its At IV Oa TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: I SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat App Revised 09-10-1 0 y Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER BMW OF CAPE COD 500 YARMOUTH ROAD, 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 I� 'ROwr t y%ervIce le eg atory ervices �z ram, Richard V. Scah,Director o Public Health Division BARNSTABLE t =ARNSI'ABLE, • eauns*,.e .�rrtomue.mnnr.xvumu _ Thomas McKean,Director """ """�;�"014" �a`� 200 Main Street, Hyannis,MA 02601 �77g Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS 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 0 VI 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,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: V 5. NAME OF ESTABLISHMENT: bm W 6. ADDRESS OF ESTABLISHMENT: �Q7CQ 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: CORPORATIO NAME PRESIDENT ACO TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY_ : • NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLI DATE Q:\Application Forms\HAZMAT APP 2017 ISED.docx F Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 B"RMA.q $ 200 Main Street• Hyannis, MA 02601 i639 ate. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rE0 MP'� Business Name: 6�lW o �.��Co,X `f cc"Ic f, Date: Location/Mailing Address: .Soo A-iw UA-�.. I s Contact Name/Phone: a - Mules Lcav,46 -,sate nn Cd11860-C17o-t,,&oA3 CA43 Inventory Total Amount: N 4 030 a( SDS: c 6\l1�t�1�n�C<ow� vet.( License#: +.O 05-t I I9-4v Tier II : Yes - oil b,kkktcg Labeling: oo Spill Plan: �-o o5k- Oil/Water Separator: Ita"O/c Floor Drains: " s �'� X Emergency Numbers: Storage Areas/Tanks: -5°o 1 o,t AS'�*4 20 oo a I.aaji+�.o,'� 2 o a 1►aasdc/•FAST z-t a 1 Q,W,As'f Emergency/Containment Equipment:5 \1 ,k o,n 5,' c. W I e, S oowt5� mL Waste Generator ID: C D 00C1'20 - Waste Product: 01 ,1 hers, 4,AA, e,- e. -PaAss Date&Amount of Last Shi ment/Fre uenc : 24'4,0 t 1 ...3rV &1 Kcy t 1 -1 16 2f01 \0,1 Licensed Waste Hauler&Destination: e4A&_ QS V,-k4 ; 81ZS 11, (Ko eal k, Other Waste Disposal Methods: ;A kxs W LIST OF TOXIC AND HAZARDOUS MATERIALS �V VA&')v<Gkaw�-„ti ,vl.V4mA- -fy gIACe_Ia51'Iv44 NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazaMous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. ✓ Antifreeze x warkt. 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 t Wagtre, 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,4, Swimming pool chlorine Paints, varnishes, stains, dyes ��-��I 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/RECOMMENDATION`S: &vn, `u k k t .� ,..�I\ al w�uti,, �A 6 C. Yk 4-Jk.� a 'S'S S W Inspector: Facility Representative: /1i,� _41�-,p �5�^(-- WHITE COPY- EALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that BMW OF CAPE COD 500 YARMOUTH ROAD, 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 �L 1 d tx^n Town of Barnstable �T'IE*qy� Regulatory Services Richard V. Scah, Director r*N BLE Z '" MAN&� ' Public Health Division ,� w 1659. 0� TVrI•MYAM1�S 3 � ``nn ST Bu1MSTP8IFThomas McKean, Director $ ` C 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 1 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 O's rA late charge of$10.00 will be assessed if payment is not received by Jules ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: I ADDRESS OF ESTABLISHMENT: O(� y % D(J c Gam► //� MAILING ADDRESS(IF DIFFERENT): TELEPHONE OF ESTABLISHMENT: �o U O / S5NUMBER00 EMAIL ADDRESS: V 1 l )if/ /� �" ' -- SOLE OWNER: _ZYES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADD SS,AND TEL PHO #OF: CORPORATION NAME PRESIDENT �6, TREASURER = D CLERK . IF PREPARED BY OUTSIDE PARTY: S P T Name: Company Address Telephone #: Email: QAAp/icatioZr.ms\HA7ZZAPP Revl6.docx Page 1 of 2 Avk 1 _ �,+ �� fog � 1�1,•�I y4+7 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMs�+.e.$ 200 Main Street• Hyannis, MA 02601 163+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 5m kA S C- Coa Date: y 7 /6 Location/Mailing Address: 00 of RA AViyli s Contact Name/Phone: r1r+ o +-eta p4 s r fY M v/es L J, - S e-V,0 I sot C e-I 030 41 Sob- ` 1 -SSo6 �5cvc r- G S„,Q,-Q + „J I8�-670-660$ Inventory Total Amoun : �% jv)<5f-k SDS: y�5 - �'� License#: ier -6, s Labelina: 4i7od- Spill Plan: os� Oil/Water Separator: Floor Drains: 0 %i1 ah4Emergency Numbers: e Storage Areas/Tanks: R-'Soo a( \ 1 7-00 o 4,1 Ww.O, 2 al A -r A f '2Z to•t.3. Emergency/Containment Equipment: +I 'AA -" 5 -&Vt � ,Ane, Waste Generator ID: Waste Product: oik . a ee:re3etr-s c-IRAX,f Date&Amount of Last Shipment/Frequencv: act ti c I of/,,- Ix rna.o Licensed Waste Hauler&Destination: Other Waste Disposal Methods:4iz.k4,4k,& A2.%n o,4 by Sg" 111e2H. 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. J 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 J 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 N Swimming pool chlorine X Paints, varnishes, stains, dyes �wy+. 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: s 10 CDAy ,v VLC &Av Aok vlo 15 f'�w��C., aQ- C�w1►� ✓R«+� vw-G� � i s c v+ ORDERS: oS Wr, kw 5 +l (-ovl 1 vl tit c a v� 1 -kvt X i W INFORMATION/R OMMENDATIONS: XW oi' ,,L i �L+ \VW4Ak0c A a.\ o Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Lavelle, Timothy From: Eric Montiero [emontiero@drivepremier.com] Sent: Thursday, April 07, 2016 2:33 PM To: Lavelle, Timothy Subject: Fluid quantity at BMW Hi Tim, Here is a list of fluids (new) in the parts dept. and quantity: Motor oil= 225 gallons (in liter containers) Transmission fluid= 30 gallons Gear oil= 30 gallons Coolant/Antifreeze= 75 gallons: Brake fluid= 10 gallons ✓Bulk motor oil= 1000 gallons Power steering fluid= 5 gallons Diesel exhaust fluid= 100 gallons ?/ I 2 r�s G�Q?j D 9 4- Thanks, Eric Montiero Parts Manager BMW of Cape Cod 500 Yarmouth Road Hyannis, MA 02601 emontiero@drivepremier.com 508-815-5500 ext.3130 508-827-7770 fax 1 Number Fee ` 1182 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that BMW OF CAPE COD 500 YARMOUTH ROAD, HYANNIS, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted inconformity 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 M Town of Barnstable Regulatory Services Richard V. Scan,Director ASS Public Health Division Thomas McKean,Director I 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 ax 508-790-6304 Application Fee: $100.0.0 0 � I ASSESSORS MAP AND PARCEL NO. 3 l I D Lj I DATE - 30-/,5" APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ili GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Z-44*0 NAME OF ESTABLISHMENT 6t- el-�0-10 . ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER:V YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO " z --Off STATE OF INCORPORATIONj� FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER (ZI ly I T�;ZM CLERK • SIGNATPU OF APPLICANT I -9�) RESTRICTIONS: HOME ADDRESS � �J` ��A � �� HOME TELEPHONE Mcache\Temporary Intemet Files\OLKD3\HAZAPP Rev2015.DOC S � Town of Barnstable ,OfTME Regulatory Services Richard V. Scali,Director t `BAPIAJIL * Public Health Division �Ep Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Canna D.M.D. Junichi Sawayan* NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTA13LE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous • Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a j particular site. STEPS 1 —2: 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the:. Town of Barnstable. MAIL all of the above to this office on or before June 30, 2015. A late charge of$10.00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town barnstable.ma.us , which.is located under the E-Code section if you should have any questions or concerns. i QAHazmat\Haz Mat Permit Utter.DOC i IRE►Oki Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM..8q 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: BVX 1� a a Date:112b I Location/Mailing Address: - ro rma Contact Name/Phone: E-r% r►�t t _ v, Eel/ 8b(�- 7D-lo6og 508115--5Soa A� /J Inventory Total Amount: to � cov�c�`- MSDS: otubw, License#: Tier II : dvL}� 1 e V",koi o,1 Labeling: (SvoZ Spill Plan: Oil/WaterSeparator: Floor Drains: A4 74,111+4�kkEmergency Numbers: Storage Areas/Tanks: 7-50g4l A<m-110wx i-6io jul kg`C oaw nk i�mDD4a Emergency/Containment Equipment: .Sp I1I Iz.V- sir s �vt�I�bI Waste Generator ID: M A G OD 2,D Waste Product: _at_�,q, #,46 4AMxz e Date&Amount of Last Shipment/Frequenc S'We 11 Licensed Waste Hauler&Destination: Y t Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine (oo Paints, varnishes, stains, dn, I V, kXO r Lye-or caustic soda Lacquer thinners Miscellaneous Combustible +e-y- 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: INFO MATION/R COMMENDATIONS: Q c vL -.Aw M S c ��et¢. loof.t Wc�l(gJ -09 OC t t J Gc9 J Xo Oc-;tip r.Q .��! - �b rn� �a-1�av` Cr 5�, 11 ,�1�v.—��(( `�c.�� p o 5-H 1�,rM��} 9�,I I I/��►�Q-Ix Inspector: �hcgad ity Representative: Za WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS � 7 v 436 Yarmouth Road Existing Hazardous materials on site vs proposed Existing r w ,OR S I'Z Y rs Proposed 1000 Ilon in ground oil dispensing syster rr 1000 gallon in ground oil 1000 gallon in ground waste oil storage 1000 gallon in ground waste oil 485 gallons miscellaneous fluids and hazardous materials 500 gallons micelanious fluids and hazardous materials (2)275 gallon above ground waste oil tanks=550 gallons 47 gallons soy based bio-fluid Smart Lifts (4-6)55 gallon drums of oil=330 gallons Total= 3,365 gallons Hazardous Materials Total= 2,547 gallons Hazardous Materials (Approximately 818 gallon reduction in Hazardous materials stored at the site) In addition to the above: In addition to the above: Site has a 1500 gallon MDC trap tank Site will utilize all new state of the art smart lifts,storage methods and tanks The site also had a tenant who parked a 3500 gallon oil delivery truck-on evenings and weekends f� 208 Old Yarmouth Road I"'94 fisting Hazardous materials on site vs proposed / Existing Proposed Items other than refrigerants Site will not be used to store Hazardous Materials qnd will be utilized by the proposed BMW dealership for non service purposes and parking Item# Description Max Qty. F1-39 CLEANER,CONCENTRATE,1 GAL HAZ 6 F1-32 CLEANER,EVAPORATOR COIL,1 GAL 52 F1-31 CLEANER,COIL BRIGHTENER,1 GAL 14 F1-100 SQUICK,STEAM BOILER CLEANER _ 7 F1-115 BOILER SOLDER,16 OZ 2 F2-58 LUBRICANT,WD-40,11 OZ SMART STRAW 6 F1-55 DEGREASER,FAST DRYING,14 OZ AEROSOL,HAZ 48 f1-15 CLEANER,SOOT SPRAY,14 OZ,SH,HAZ 8 F1-44A CLEANER,ICE-MACHI NE,8 OZ. EXTRA STRENGTH 6 F2-23 TREATMENT,OIL,STR2 1 GAL DISPERSES SLUDG 6 F7 TREATMENT,OIL,SUPERHEAT,1 PT 48 4135-08 COIL CLEANER,CALCLEAN,1 GAL 2 4120-P2 COIL CLEANER,ALKABRITE,1 GAL 3 List of Refrigerants Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that PREMIER BMW OF CAPE COD 500 YARMOUTH ROAD, HYANNIS, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. �O --------------- ------------- ---------------------------------------------------------- ---------------------------------- -------------------------- ----------------------------------------------------------------------------------------------------------------------- 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 - Tow of Unstable Pdc # mof �RegUoervices �t T Richard V. Scali,Director f.RBR Public Health Division BARNSTABLE � NFI(S:tYS I�WS•OSIiPVILLE•VlSf B4cryiiaB:E Thomas McKean,Director 1639-2014 200 Main Street, Hyannis,MA 02601 575 C Office: 508-862-4644 CQL �01V Fax: 508-790-6304 -`' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS S 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 V I \_ *A late charge of$10.00 will be assessed if payment is not received by July 1st. �J 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: , j()Wh I Laly' ►' 1 5. NAME OF ESTABLISHMENT: o - 6. ADDRESS OF ESTABLISHMENT: ai I MM[ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 66 8- gl s-- 9. EMAIL ADDRESS: �1 UI'! e, n ft ` COM 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF.- CORPORATION NAME 4410U vwlmoum PRESIDENT TREASURER U CLERK L-oLhowV1 12. IF PREPARED BY OUTSIDE PARTY• • NAME: % TELEPHONE#: COMPANY ADDRESS / EMAIL: SIGNATURE OF APPLICANj DATE CQlo�7�I�] Q:\Application Forms\HAZMAT APP 2017 REVcx Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $150A0 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod _ 460 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 NI; and expires 06/30/2018 unless sooner suspended or revoked. --------------------- ------- ����... PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �,f; Tower of B nstable � oegulatory ervices �( T Richard V. Scali,Director Public Health Division BAMSTABLE '� Bn0.YSfp0.t[.iFHI[V:41LLE.[ONIT•NYa:l:IS ��� ASTABLE. = Thomas McKean,Director NWSTU'S.¢51 319n2014W 51 eacrT al —4 200 Main Street, Hyannis,MA 02601 C> Office: 508-862-4644 Fax: 508-790-6304 X APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS 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: $150.004 Vas, *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: ytin La M/y, 5. NAME OF ESTABLISHMENT: i9fel yll Pl- 6. ADDRESS OF ESTABLISHMENT: � �U l:C` 1 //c. �f l 4 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: J ��✓����� CVO" 10. SOLEOWNER: /-YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AIND TELEPHONE#OF: CORPORATION NAME q ,Q(44f, ( C- PRESIDENT TREASURER A CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS ,' EMAIL: SIGNATURE OF APPLICANT �. DATE Q\Application FormsWAZMAT APP 2017 REVISED.do 1V` Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod(Chrysler Jeep Dodge) 460 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 F r Town of Barnstable Corti Regulatory Services • Richard V. Scali,Director (� XABL ` Public Health Division (� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 ?tz f' Office: 508-862-4644 r F= 508-790-6304 Application Fee:$100.0.0 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 -�1/056afi NAME OF ESTABLISHMENT �1 J'5;e, in CAD ADDRESS OF ESTABLISH1NT (�,) TELEPHONE NUMBER 5- 09 - 9/5 'DOO SOLE OWNER: /YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION N0.6�1 STATE OF INCORPORATION 64Y FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER I1�— CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADD SS e5I/ 6Vj Jw-om HOME TELEPHONE# 67 Mmche\Temporary Internet Files\0LKD3GAZAPP Rev20151)OC Town of Barnstable ,dFTME'eiti� Regulatory Services Richard V. Scali,Director BAMt `& ' Public Health Division 0►9. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 Paul J.Canna D.M.D. Junichi Sawayanagi NOTICE TO ALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town of Barnstable Town Council adopted, Chapter 108: Hazardous • Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and eleven (111) gallons or more of hazardous materials are stored, transported, utilized, and/or disposed of at a particular site. STEPS 1 — 2: 1. Please complete the attached application form 2. Submit the fee of$100.00 payable to the:. Town of Barnstable. MAIL all of the above to this office on or before June 30, 2015. A late charge of$10.00 will be assessed if payment is not received by July 10, 2015. Please feel free to view the above Code, Chapter 108: Hazardous Materials on the Town Website, www.town:barnstable.ma.us , which.is located under the E-Code section if you should have any questions or concerns. I QAHazmat\Haz Mat Permit Letter.DOC Town of Barnstable Office: 508-862-4644 Fav 508-790-6304 Regulatory Services Department R* Public Health Division_sax�v�ra� MASS. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt ,Hazardous Materials Payment received: $110.00 (Check) on 7/31/2015 Permit number: 1040 I Check number:number: 16599 Check amount: $110.00 Name on check: Premier Companies i y j Business: Premier Cape Cod (Chrysler Jeep Dodge) !Address: 460 YARMOUTH ROAD, Hyannis I Note: $100 + $10 Late fee • Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod 460 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 6/15/2015 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 SPILL CONTINGENCY PLAN Emergency Coordinator Name: g Y To lam, ✓1 ��'N OVa= Address: Z S F,4 c.rj,?o u-rH JZ dD. u Yt4,-%jAxrs 'en/q Daytime Phone: SO,� . ! 6 Z - Yo Y fa' Evening Phone: 57)'' `?'6 Z. - yO V 6 Fire Department: 5 Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: :51+r ?` — L E.£AJ Phone: g6 p_ 7yZ- q 171 - qQ l-7 51- Q $0 Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). /47T,4 C 41E n Actions to be taken to control a spill or release, and preventing it from reaching a catch basin, sewer system or the ground. 5t!rl L 14--r7 TS — O� 5.Z6:-H BMW:•VOLVO of CAPE COD Z, V1DL�0 To Whom It May Concern: Through our vendor partner, we continue weekly and monthly inspections of our Storage tank. Per the 108.3 and 108.4 requirements we have an authorized/certified hazmat Spill kit on sight and action plan for Safety Kleen and or Clean Harbor on call for emergency Services. Our plan is as in the past submissions unchanged from our last renewal. John Lendvai �/So8.962.4046 2 25 Falmouth Road • Hyannis, MA 02601 Office: 508.815.5500 • Fax:508.771.6113 9 Premierbmwofcapecod.com M 4 't S. SPILL CONTINGENCY PLAN Emergency Coordinator, Name: Address.—.- o k\ YJ Cr FN'4v'4 7 Daytime Phone: Evening phone: Fire Department: _ Barnstable Public Health Division: 508-862-4644 DEP 24.Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: Phone: Building diagram indicating h azardous materia Waste storage area, location of absorbent scavenger materials, fire extinguishers and evacuation route (if applicable). ' firearm (if present), �6afp's6 Oil . G �e� Actions to be �'� D taken to control a spill or release reaching a catch basin, sewers stem or the ' and preventing it from y ground. 14 d Y\ /A 'Or .n 1)6 r .5 w SPILL CONMGENCY PLAN Emergency Coordinator Name: �� ( /� �- " 1 Address: Daytime Phone: /h A Evening phone: Fire Department: V Barnstable Public Health Division: 50 _ - 8 862 4644 DEP 24 Hour Spill Hot Line: 888-304-11 33 Waste Hauler: Name: Phone:• X L__f r. Building diagram indicating of absorbent scavenger hazardous material/wa,ste storage and evacuation route i f aterials, fire extinguishersar area, location ( plicable). , fire alarms (if present), 0�i�l KTT Oil k0 51 IL A toe - Cry ldo t a � i Actions e taken to control a s ill or reaching y P release a catch basin, sewers stem or the ' and preventing it from ground. IA,)A 37r2:- o l 1,5 , b fL:�i r L)rA"n 112 15/,0- IAq jk ," S ,fl A d-6A ` Town of Barnstable J 1151 Regulatory Services Thomas F. Geiler,Director Public Health Division w Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Appltaatron Fee:$109.00 ASSESSORS MAP AND PARCEL NO. `1"-f 3 `t DATE L. APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE MORE.THAN. 111. GALLONS.OF.HA7A DQUS MATERIALS FULL NAME OF APPLICANT AE NAME OF ESTABLISHMENT,—,- ADDRESS OF ESTABLISHMENT O 'rmo a tt,,— ann.(!ts: A- Op�------------ G� TELEPHONE NUMBER SOLE OWNER: 'AYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL --� PARTNERS: ® ,:2 CD 51 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. - 35 STATE OF INCORPORATION UUC1 FULL NAME AND HOME DRESS OF: , (� PRESIDENT 50�SQnVN 4.QlY - Ig"O Po �-Vml TREASURER 11 CLERK t SI OF APPLICANT((�,, RESTRICTIONS: HOME ADDRESS 187 O Cc �C2n�W l�l HOME TELEPHONE# - 1 I - r:�l D -(o A 00 Fazdoc/wp/q 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 �: ',' F. • ; 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-Ha kdous48te 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-f&dr day's�for'in-house processing. For further assistance on any item above, call(508) 862-4644 C II 5 r SPILL CONTINGENCY PLANT Emergency Coordinator, Name: &;( Lem n6r\ Address: 14YY1p �� L Daytime Phone: Evening Phone: Fire Department: S- -77,501, Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: . Phone: Building diagram indicating hazardous material/waste storage area, location of absorbent scavenger materials, fire extinguishers, fire alarms (if present), and evacuation route (if applicable). 014 Go -(Sf fb6r 6 e 6 o 6-D ,A 60 ) 60CID Actions to be taken to control a spill or release, and preventing it from. reaching a catch basin, sewer system or the ground. Ck ,I kr r(5 CLS1 0ed -rd AArdle-- /fin 07�e r -/ur,d for �5 /)G UV4 3� Ut f S S'ra red, 1)) 1 � Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod 460 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 n t Town o Barmtable CjIME Regulatory Services 3 Thomas F. Gei3er,DireetDr �e 'A Public Health Division A a Thous McKean,Director 2DO Main St t-4 Hyannis, MA 02601 0fEcz: 508-S62-4-644 Fay. 50&790-6304 Applicafcn Fee. $10aAa ASSESSORS SAP AND PARCEL NO. ��, l 5 APPLICATIOIN FOR PER= TO STORE AND/®R L71U= MORE THAN III GALLONS OF HAZARDOUS MATERIALS � " II FULL NANSE OF APPLICANT OFESTABT,7�NT 499jou SPA dkC• ,:�fD f Le QaW 06di ADDRESS OF ESTAB7,T. = �t64nni,!, , &Xo O TELEPHONE NUIY�ER ''9 6 SOLE Off: ✓ DIES NO IF APPLICANT I5 A PARTT-EP=,FULL t-AIIE AND HONTE ADDRESS OF AID PARTNERS: I I I,4 APPLICANT IS A CORPORATION: FEDEI1,AT IDEA=CATION NO. STATE OF INCORPORATION RESIDN��bS2 VN ADDRESS om-. g OpQn 7ro ' Xe� NA =EASURER 11 11 C1-= l e l� SIGNATURE OF APFidCANT PESTRICTIONS: HOM ADDRESS 0 b L Kew" �.�•C lrl�• HOAU T=HOlNE # Dfo(m i u�zdaclwp/q i 1 1 ' SPILL CONTINGENCY PLANT Emergency Coordinator, Name: Ad dress: ��vrtp�.�-�-d,�/n �f Daytime phone: Evening phone: Fire Department: Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Narne: Phone: _ = Building d'agran' indicating hazardous materiaUwast of absorbent scavenger materials, fire a storage area, location and evacuation route (if applicable). extinguishers, fire alarms (if present), 11I f�l :� &r 6D GD �D (L Actions to be taken to control a s ill orelease, D �® G D reaching a catch basin, Sewer system or the as , and d preventing it from Arc, w� kep-r o <fonv-A) ��`sk, i s /A'S t)(I DrA,�� 1)6 MJ50 3G p, ( i S i SPILL CONTINGENCY PLAN Emergency Coordinator Na me: Address: Daytime Phone: /�A ��� / Evening phone: . Fire Departtnent: Barnstable Public Health Division: 508-862-464 4 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler: Name: Phone: Building diagram indicating hazardous material/waste Of absorbent scavenger materials(if storage area, location , fire extinguishers,and evacuation route guishers, fire alarms (if present), plicable). - oil ko - 9> re, 40 oil IL 5i \ bvl� I ce— i Actions `j a taken to control a spill or release, and prev it reaching a catch basin, sewer system or the g from ground. (!tall3'I etc 5 fic�r tab f 76o r QrA _ A B ,C)oAznt s Arc-- -��rej/Z" -ra 8.0 a s a fi' IA�1)k T llk 0") kl-'PA(-bAy: � Number Fee 1040 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Premier Cape Cod 460 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 06/30/2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 09/11/2008 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health PREMIER CAPE COD ® z:�Oimo G E Jeep 2— September 11, 2008 Cynthia A. Martin Hazardous Materials Specialist 200 Main St., Hyannis, MA 02601 Re: Toxic &Hazardous Materials Premier Jeep 460 Yarmouth Rd., Hyannis Dear Cynthia, Below I have outlined the hazardous waste listed on your report dated May 15, 2008 &how it was used. • 250 Gallon Drum—all remaining oil was burned in the heater. We have since given the heater Jeff Denesha of Cadillac-Saab of Cape Cod. • The Transmission fluid was used on vehicles. • The cleaning supplies are still on the premises,but have been relocated to the back building. Enclosed you will also find the application to store and utilize hazardous waste along with the$100 application fee, due to the fact that we still have the cleaning supplies. If you should have any additional questions you may call me at 508-888-0175 xx524 or my cell 508-648-2869. Since i , Paula Pavao V) r r c -v u c,� r � rrt, f CHECK PREMIER JEEP CONTROL NO. 5243 ISSUED BY: ARRUDA,_EUSEBIA EAST SANDWICH,MA 02537 PAGE 1C INVGICE INVOICE PURCHASE DISCOUNT/ NET STOCK NO DATE ORDER NO CO;MMENTIV I N AMOUNT ACCOUNT NO AMOUNT 091008 APPLICATION FEE FOR HAZ MATERIALS 100 .00 5243 10300 -100 . 00 OWNOFBARNST 39010 100 . 00 TOTALl 10300 100 . 00 DETACH AT PERFORATION BEFORE DEPOSITING CHECK REMITTANCE ADVICE Town of Barnstable Regulatory Services Thomas F. Geiler,Director w Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Appikation Fee:$100.00 3 UZJ 0 08 002 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION.FOR PERMIT.TO.STORE.AND/OR UTILIZE.MORE.THAN. 111.GALLONS.OF.HAZARDOUS MATERIALS FULL NAME OF APPLICANTYar- NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER �(/�)-" n)p- �o :. 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 D S OF- PRESIDENT ��99 PRESIDENT _ OME iY 16 UJ1P/! /Nd 0.w TREASURER CLERK SIGNATURRE OF APPLICANT RESTRICTIONS: HOME ADDRES In io 1 /ad Kl�i �F,64ut(A` HOME TELEPHONE# Hmdoc/wp/q s 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 Number Fee 178 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Miskinis Motors Hyundai 460 Yarmouth Rd., MA 02601 Is Hereby'Granted*a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -----------------------------------------------------------------------------------""-------- ------------------------------------------------------------------ --------------------- --------------------------------------- - This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. July 17, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health I t Regulatory Services P� Thomas F. GeUer,Director �r Public Health Division, 7 IT Thomas McKean,Director ` 200 Main Street H inns MA 02601Alp Office: 508-862-4644 Fax:.508-790-6304 Application Fee: $100.00. ASSESSORS MAP AND PARCEL NO. DATE 3 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 tJ'D ��(,i✓1�1�, i,�U�'��1 IZL� C1 l'� I'�I'� /'1 C( G�(1 TELEPHONE NUMBER D � SOLE OWNER: l' YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF AL , PARTNERS:. IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. Dui z aaao STATE OF INCORPORATION - FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK f SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# H=do0*q. Na Number Fee 1091 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that BMW of Cape Cod 436 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 6/30/2013 unless sooner suspended or revoked. --------------- ---, WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health szl�'V/ce, Yorlj O Town Of Barnstable ��yy�� Op1HE Regulatory Services 1-13&) �r//Lda# °- Thomas F. Geiler,Director } AA RNASS.R�' i Public Health Davisi®n A?Fa nnay 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. / 00 DATE J! APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �OS�i . M NAME OF ESTABLISHMENT o 0-,ao (0 4 ADDRESS OF ESTABLISHMENT q3, 0 \11-11-moj-hccz� TELEPHONE NU'AOER �l C3-E2 5 CCU SOLE OWNER: YES NO o -+ ZE -`1 IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL co w"a PARTNERS: 70 - sra rx� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.. �Vo� STATE OF INCORPORATION I)Il FULL NAME AND HOME ADDRESS OF: PRESIDENT`- - I barn 8 h7���, d[,A)iCh 4414 61,60 TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS % Q %I %r(,t kc R -,VCt� HOME TELEPHONE# ,5o g D 8a Haz.doc/wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. 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.. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable, The check must be mailed to the address listed above. For further assistance on any item above, call (508) 862-4644 i i i i i i i i i i V Number Fee 1182 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that BMW OF CAPE COD 500 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 INE'Owti Regulatory Services Richard V. Scali, Director * BARNSTABLE, MASS. Public Health Division. 039. ♦0 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT 6 NAME OF ESTABLISHMENT ��U� �14 40 4�-aO ADDRESS OF ESTABLISHMENT SO® "aolo I l 0 / " 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.W 10(0 8961 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT 11Ch TREASURER ` _ h MA CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS QeQ9A HOME TELEPHONE# - jcj,6 J:\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 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 AXED 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:U-AZAP R DOC - - I Make application to local Fire ueparunen►. Fire Department retains original application and issues duplicate as Permit. a / a✓ „ �Gv7:Y%yJ'LtmGl1e �12- i2� CG.�,ICGG G66.1e-�Z' [m(27e1,-vC0e6 — ✓ 0amda�C rare ��i�r✓u�r�Ccar� APPLICATION and PERMIT )r storage tank removal and transportation to approved tank disposal yard in accordance with the provisions f M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: i Tank Owner Name(please print) /:/ U. � �� �`��s I ~ Signature , aprly,ng orparmrtJ Address �fblJr'►t� (4R Alf0. niS srar6 yip Company Name Advanced Environmental Service Co. or Individual i Print Prinr AddressP•O.Box 472, 197 Great Western Rd. Address Print i So. Dennis, MA Sign atur i pplyi fo mit) �� Signature (if applying for permit) IFCI Certified Other ✓ = IFCI Certified = LSP Other Tank Location 1 -- -- �---�"- staat].jidCraas c;,y � � i Tank C`pacity(gallons) -- A)/6G 1`---�-•--- --Substance-Last-Ster-e �✓T="O. i Tank Dimensions(diameter x length) Remarks: I, i Firm trans ortin 9 waste Advanced Environmental State Lic. # MV5083856100 P i Hazardous waste manifest# E.P.A. i Approved tank disposal yard J.G Grants Co. Tank yard # 008 Type of inert gas 1�f9 Tank yard address. Wolcott St. , Readville, MA 01381 City or Town �1h'o.1 FDID# al o? Permit# — Date of-issue—"-' _ �_� Date of expiration 3 O � Toil Free Tel. Number- 800-322-4844 Dig sate approval number: � � Signature/Title of Officer granting permit 'ter removal(s)send Form FR-290R signed by Local Fire Dept. brb`* Aegulatory Complia it nce U , One Ashburton Place, 1 oom 1310, Boston,MA 02108.1618. ?Devised 9196) : :. TOWN OF BARNSTABLE fQb ^ �� �d a . j UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME i Ar Co b _S / RaL —VC- ADDRESS • ��`� !9 01 ✓ARA+/vim De D VILLAGE ✓ASH�`r LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL N�arT 7T 6.4j,Pdmow � sTxZ- G 0Wb. q-1 (Give same information for any additional tanks on reverse side of card) T Do��'T lfi+v.wJgDArf wAcGa.1so DATE OF PURCHASE OF EACH: 1. 5 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS THE ry TOWN OF BARNSTABLE �4_ OFFICE OF BAfl MASS. E, : BOARD OF HEALTH y MASS. � o�OTEam�Ar- 367 MAIN STREET HYANNIS, MASS. 02601 August 11, 1980 Manager Cape Cod Pest Control , Inc. 444 Yarmouth Rd. Hyannis, Ma. Dear Sir: The information you returned to us indicated the age of your underground fuel tank as being twenty years old. You must have this tank tested using the Kent-Moore Pressure Test by November 20, 1980. Please submit testing results and their interpretation to this office prior to November 20, 1980. In addition, this test must be performed annually and the results - --- sent-to--this--off-i.ce. - - -- - For your convenience, we have enclosed a listing of companies who perform this testing. You may also utilize any other concerns qualified to perform this testing. Very truly yours, hn M. Kelly irector of Pu lic Health JMK/mm encl. 1 "y �� NAME LOCATION Cape Cod Pest Control, Inc. Yarmouth Rd. Yarmouth Rd. - P.Q. lox 1268 Hyannis Hyannis, Mass. BOOK & PAGE - DATE GRANTED AMOUNT STORED 77/87 April 21, 1960 Under - 2,000 gals. Gasoline DATE PAID 1973 - March 2 19 7 1974 Nr� a U 1�j74_. 1975 Al P. i ='l 2 '_ a 0 1976 1977HK 1 1' 1978 MAR 2 4 1978 _ _�� ����3 �' l � �� ��� �� ` , ��r�.. 'n ® SENDER: Complete Items 1, 2, 3, and 4. R y —AdJ your address In the "RETURN TO" . space on reverse. (CONSULT POSTMASTER FOR FEES) t. The following service Is requested(check one). X Show to whom and date delivered............... t h ❑ Show to whom,date,and address of delivery.. g 2. O RESTRICTED DELIVERY........................... " . t (The restricted Mvery tea Is charged/n addttBpn to the refurn receipt too.) TOTAL S 3. ARTICLE ADDRESSED TO Mr. Frank J. Nuovo Cape Cod Termite & Pest Co tro: 444 Yarmouth Rd.HYANNIS MA. 260: 4. TYPE OF SERVICE: ARTICLE NUMBER ❑REGISTERED ❑INSURED 3(§9TIFIED ❑coo P478 764 8 9 ❑EXPRESS MAIL (Always ostaln MInature of addrasses or agent) I have received the article described above. SIGNATUREess a Auttscr5zed a ens czw R-� - ,&- 5' DATE 0 E VER POSTMARK (may be on reverse side) 6. ADDRESSEE'S ADDRESS(only it mquasted) c m z 7. UNABLE TO DELIVER BECAUSE: 7a. EMPLOYEE'S m INITIALS 19 *GPO:19e23M593 UNITED STATES POSTAL SE_RViEE OFFICIAL BUSINESS SENDER INSTRUCTIONS 6 J/'r Pilot your name,address,and ZIP,Code In tha space below. •Complete items t,2,S,and 6 an the reverse. ®®® •Atteeh to front of article N space permits, otherwise affix to back of article. •Endorse article"Return Receipt Repuested" PENALTY FOR PRIVATE I •ad{ecent to umber. USE,SM RETURN TO BOARD OF HEALTH TOW4N"OL"TABLE P. O. Box 534 (Street or P.O.Bona a HYANNIS MA 02601 0534 (City,State,and ZIP Code) P 4`7,68 764 649 RECEIPT FORZERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sent to Mr. Frank J. Nuovo Street and No. P.O.,State and ZIP Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered Return Receipt Showing to whom, N Date,and Address of Delivery 00 o� TOTAL Postage and Fees $ p Postmark or Date 00 o _ mailed 4/21/83 w rn a. S�T1CK POSTAGE'STAMPSiTO'ARTICLE-MCOVER-FIRST"CiASS-PiCMGE, C[MM'V-MAIL FEE;-A 1rUAAGES"FlWUY-SELECTED-fPTlblfl[)-SERV=:j;rt+7rW If you vyata this receipt postmarked,stick the gummeds Ubontheleft-portiohofiheaddresssTdo ofthelt le�eaving€tieroceiptatt an Iii sen achaddttfieartibFeafaposfofficeserVTceVvindowof `•hand it to•your rural carrier.(no extra charge) 2.If you do not want tfifs receipt postmarked,dfrCk five gxrmm"ed stab on the h5ft portion of the addm;s-side otthe-arricte,data,detach and retain the receipt and'trtall the article.' 3 (f you vaeert a retm receipt wrfte the certfrred-mail number and your name and address on a return-rece Pot card;Form3811;arid attach ift6'ifiefr©ritofthe'ariicleiytrie`an'softiiigumroedendS If space peranits.Otherwise,affix to back of article.Endorse from of articie RETURN RECEIPT REQUESTED adjacent-to the number. + 4.11•you want delivery restricted to the addressee,or to an authorized agent of the addressee. endorse Re9TRTCTFV(7ELN'tRY on the front of the article. t S.,Eater fees for the services requested in the appropriate spaces•4h the front df fft fo'cetpt ff return reeefpt is requested,check the applicable blocks in Item 1 of Form 3811, 6.Save this receipt and present it if you make inquiry. 4 4 4 Yarmouth Road,Hyannis, Mass. 02601 Telephone(617) 775-0600 cape cod termite and pest control October 26 , 1982 Town of Barnstable Office of the Board of Health 367 Main Street Hyannis , Massachusetts 02601 Attn: Mr. Kelley and Mr. Gifford Gentlemen:- Please accept this letter as response to your recent visit to my office pertaining to the testing of the gasoline tank, and your request for a letter stating the particulars in this matter. I contacted the Cape Pump and Tank concern of Harwich in order to arrange for a testing of the tank. I was advised that due to a prior committment at the down .Cape well. fields , they are unable to perform any tests on our- tank for quite some period of time. When I learned on this fact, I immediately telephoned Chief Farrenkopf of the Fire Department and advised him that I was unable to arrange for testing as called for by your department. He advised that he understood the situation and that I could arrange to. have the test done when the tank testing people were available. The tank has been empty for over a month now, and will not be used until the testing has been completed. I trust that the foregoing is as you requested, but should you have any further questions , please feel free to contact me at any time. Yours very truly, CAPE COD TERMITE & PEST CONTROL Frank J. uovo FJN:jam Hyannis Wareham Falmouth Orleans Vineyard Haven Plymouth 775-0600 295-1506 548-2227 255-2400 693-0836 746-6830 �' }yf i 3^` yt •fka r a�• ,.�• [ + �i 'j �r., • `• •`�rf .�Y ^r �'.' § 4t ,. hc- r 'Y tC�c+ '° .,., :. ip t 13 v +. t d ;r•t a .4 t Y7 [d '� Z ; r{ '�•°,e `F'F.-.;'"J*` f' ) {4e ri• +.X i" + ;, 'A ' nti fS r r F ?+ r F.., t . . rS ✓A• 4r,4;, d •.x •. +.. 7z. +.+s. ° err k 1 '-,,c'rt P `:�'y e^+�,•r. ' , >'4, " VI , "ix v r r .y ,y$ *�� �.',' +r+:a`""k -41, ,�.., t..4. , J .,T.* A- ,,s W L r `� 4 h' ✓ .'r' +. a r..t'y Af�a;. ; . R t.` 0 r„ tr l -r+.`y A`� t 1 ..� r '�," s + r y ., i ,4,I 1f,t Y r r.Y J i 4.. a�i rK �s 'a^ v c r r f 4 �, A *�^ : r `tb -. , t' A. `* a ,, + e t ,� »R rt r`� x C a 4 . '' , 1 ,4.',`�,`•« Z t x' f ' =r1 'P, a ._ r$� 9 r,, F r... e , r p. r �+ ' y i" t.^ I* $ j. ,.r,t " . t.w t .. y M -, 4. . ,i ,t Y r „t''` '� r 'i .r,* , §:.: .+: ~r 3,r. "1. y+"+s ? �> O. ,t.' 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'y " it T y. ! °.1.'./'rt ,4' e I r "r- ^I '{ AAugust,`19/ r1982 ,fir«4y F$p t. t +.`r ¢ sue, + tr r :+ w n# z �t t h + ra r * 4 u S A a A ' "' t` r'^: T L raw ,;r i. 4 riy ^'`. u}I ,,, N 4r .« , 4 `:�g , 1. ,a: r.+. ..* ° r t,...,rw r r,* +i .� 'f w q4 ..,m t e C y m4 t' ' .,,r.. - `, , l• a ....t.,, P'., ' +. 3=a .. d r .i r n.7 h `*, ,,: y9 ;.,,r s/ . sy s y C'' k a j r w a i t, ,� a r "•,. y, r + �w i t r. , tr, A, � "� ' } ".r r: fi t . A4 n; f C Er � x t .,re' s • r F A, 7. i' _ ,t + `?,P. c ztR� A '1;+ r :.. ', sft b' �. `, c'^ .r n y .� '«, t," ,t, r`x' 4. 's. 4,,,,%�: r r.'. ',t `'.e;.11. M, >t;.''f' 4.F da w ,I•r'+ w y .� +�`4`ti.. $ r t y -rj,'..,,w "e..r - ?* ' t y e v. t A # +.r •,!! `4 y' ¢F �. e« e♦y�` 4 ..r t dk ;x rr+. .h ,r S .2 C n .tr`+iY vi c x s "I d' . -'+` � ,S L s N ��., �.t i�e,,.;°r .yr{�,`iyy .�+, n y, '"� e e,* y' .°' i g� At,,e�.�,,'4i+�.ti A I- �:•7 t�r r ,�,�4 Y« i` k f h c;, 'r �A .t' W {t �.N' e i .s € Malla/�er ' t {q,,, x y , ,r : � ', d y 4:r. �ftI,, ! "t a r +.„ t .# x i # 'i` "? 7 •.z 3 9 tr "� ..�,' x,}•aA "s' , ' o jy •a f� '..: r. `:: F r, ." *r x �' •f 4 } z,7T,.' r S m, a f* tA, '. r w 21^ it• �' q.{ w.s �.st -'. r,+, "r�Ca e�Cod'.Pest-Control; .Inc , j `� x ,t"9 "� 0 r�y� r M1 ji s� � � � g t „,} 't' < t h i N'"'# "a;^' y+♦ y� ,4 < LA_. S .., ,� r, .y -:rtsr • hr P r +",}r �� 444 Yarmouth .Road;.r°. *r `*$tA. z ." s-.;<a. a-` _ �' �:v 2 Z- , +r A."', v i.-�r ? f�,,• <r a•. A, '. ,r;�..i :s... t +° -°d �„ ,.. yr N."': '4 +` °s'•L�`s'S v�yd t.''" � ._¢,.F" cA' 3".'"y r..♦,J w f r @sw ,,r. riz ,r, $ J, S 1 rt �f,W ihniS,`Maw"; i 4� s 9.ke 3 �. 8 r; .`ih >.r n ? *. { k / a ` %,�t "?"oy Y I, ji j" � *N d 3 d �a 't,,,'" ri r r .r ,.3 ss. T xJ' /''a y fir. ft r ' - J.`� , rr ; 'rx fir > �4R� 1' g �'� 3�s. �y tig^`r y ' , i`4 .. Sr } `,1 G�S� x ` v . <t- i s 1 'fir",: ¢ f'z i"rg u r+. •a - , t 7 'rr M 1 ' r r<-- !• • 1. ;w .t �I,,. �.r: - i' r' sky'h. c"t f ^ '? i �' , .w.,y.,'Qt• gt ,,.. . ✓ � `'•� +. a. f,ri *1;K{<r.r�`:.i a.IDear¢Sir I- ,.,; , s , r,,. 'K t,`,' ,r. ' r 9 , .1, +` y:: ��Ls.i+S^• r 1. 4, °"t x#,„4''.y�n3 t `f �. '�'t�� •"6,. A. ,.-w„"� r. 4, �f 4.4 •``'fir• , w�,',• a�r a a ''•.a1. �6k`d A ,�'r,•.,, i � ,Jge vi f4 r 2 L 7. 'r,,*, ' $ �, t > 3',a. ,z!'�"F •'%i q-"a " '^F'. » d,,,"• ;Ap, °• ` d �+! r[. :.g. t, !F` n ,�.r T,�/n'',}>�',t.i�'?,,..' 3 = T' ? nr a+ 4^i.w,-,:7 k! e.,.' f I�: fr,*t,!:, �` r,g�A �.+�` �8 d � � �. r a�-,��, �. Underground#'fuel'tanJss twerity�pyears old'that have a capac�ty of 'ov.L Kk 0-gallons.'°� d " a nIY A . ,. t.. x, -. p • yv*LM, d r,rsS-L r ,. , Y +4L sG Yg.a,x., i 't t{ r . * ,k; musty be«tested,each year,for%�leaks. The Kent Moore Pressure e,Test is 'the pre, r,, ,ro , r > .too- r �. + r f, �.y r F,• �� - t r*J. � P, •r,... • s, t* t1' ar' ',4 a f 4. y3.'+:i.- ,�., i. � e, .. z 'III . ferired�test, loWever,,:ari empty4 tank can_bestostedby a 5 PSI'airupressuretest �,, , * held°fors;a;min3m=';af°two lhours s ':,The .air'pressu n test cari only be done°on', an i114.t 1` ` +fin a a ra r r a^- a f' s a <sr ` ,r�emptya tank andr isriot the prefereed test `" -r = r r r }''?' �y. r•. ._-.'jN .,'y'_.;"�,,«v " , -r 4`a ,f - r f 7.� y t^, ,.."y r 2','-t' * ,g. t, a,a,~+ t 4 r ti r�' r,�r r '�. rr.. +g .•y ;•, f•' -' r 1. 4':s r r rrt d 4 4 A`4`,0, i ,`«Xty ;' .r•Y r r ,"9 a :p..rw 'ax}d4,,$ v,,Y,A� ,r,ypa.. i �?d a ,- to Tis ✓t * ..twa � a�f: ,Your ,tank"is .tt4enty°two years old`.and.was tested on November-*6i,. 198A 74, �, ,%'`fir .',°' r {. ` *,rx tr y k ;., r a, i_, " :e� Fa., sr -+• le r ,r;+. ', L.r" r r¢ .. y r e a/s A r -.- w'�i a1. ^, .,, „�+ xi „et`,`.4 F A r i t .,>S ,r^'' :R,.A a�'iky' r �..J i� ,� x i {:. r .` ,? ar-.r# " .A'.yy w„ r, z 4,� 4 _i. 3, n•,ta A, rrr, a ':+. - {4.` 'r: "' ,` "' ♦! ':w.. F d r , kf`r t + x"'i P-' H. Y: ,�r sy , t * gy At t '4»4t •*a�.�ti:-'`You, are':"dir®cted"�-y�to hive�the°,tarik tested=by4 OctQber�l:5 w'119.82w,`ancle+�a copy;ofx�the .^ 9 f';ray3 k ,` '• .+�7'xj R. .., '�,c "� g.a vr+,�,-a= t• i '� J ro�a•�U �+ram #5 d'l!`.1 I'afr'+r ,.r.r i •J^ N.. [� �-X! ;. ri , ,results must;be+sent t" the Health`Department � �, a, ,�,. r, a, � �„ ' .N^. ', x' �• r WR ' rk' 'Wr + ,y r d T +u n .4 I "!,. .ti , '°r'+. ).' r t L d r,w �+#, 6'47`. h ,,,`' ,"• - - o f i�w.: :, 3' ,S°-* i x. , Y", s..a +1 :' rt + haw d`* :: S"b'i +� .. *�{ L yz":may' a u,F g• 9 r. « +r ,f st,, ,5'f,. Jai�r-,�,",,.0 a..0. . �l.III;-. �•+r '6" `, ,�„ "duj. i '9x; ,r",4ur^y tp < Failure to have�thetank tested could result.in a `fine,rof not�mor® than $200 'aZA r -Vn t;`,' Each` s parate`,�day's` failure -to comply with an order shall constitute a separate;±} ,r` `` ` ' � Vlolatzon r: t f r' r ♦ t 4«* k 'S r'e a t ;'i r `"'t ` y ° I. r; z3�ir y , Rt� /'ti. 68/ } +'", :4 xN", ' 4 e ' " r;``P tj" .lf 1�`�et 7� '�rA `7e� " .y3 .7 Se ' g'' * .:,r sr 1. At, ,i # -We Awould'appreciate your cooperataon in-,this,matter so'•�ita1 toy the .water quality xt`` n y, .a r .. &s. a . s x« k t - of=stile town ,�f +,q. .�`' > ,T'ti , ^r,.,�;w A )i ., rz >" w t•:`y - - y A� Y,, J tv i 1. t.I.. X•h fir t. r _., 11 riS'w�` 4 i."' ^: "r ''4'4+''a„ i`d' 0, t a% `ri, i ""'' r �.I'r 116 I,�,,'a° .-f'r y `r. 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" z ar '.' .'e„ e 2` "~^� •a '.! ,r „ +"_ a «, t a _� t t x �• Ar i c r. N F.+s s y.• ti ''r a ',p r §4 *r,. d t ;' r 4 � t tY L r s ; / t o �. t5i r x 1 vj r sy „. a o ¢ h t r' ; ♦ �}j r -,""u•t L ,.i ,-,..r ar „,,17 i^ , t r. ` '? r r � s a = rit� , rat ,dA. 4�,I ti * e i{ b f- e ' S a,, 4. r �;,f r+ S ¢ "�.a ." j d'"d`' j•rL• r dt S ,i?'.yr +iYY*Y > $+ :; y tr .< r, t` _µ ' C w ,. A�rb t .`� t, `,A 71 i,��, d :' s x. y+;� xa r' �, ���•_,11 . •sd"..:ce ?.� r ,' a,wP„71 a.r, fv. n,• `°, s..A ,r r tS'r -' &.• 'r.c' 4�0 R t yr Y'11: •k ,�a n �i' ram": , 3 .a,..- ,.?,,•[r+.., �`- t'•t K , I. , r w being returned to you.The return receipt fee will provr .a you the name of the person delivered to and the date of delivery. For additional fees the following services are C available.Consult postmaster for fees and check box(eO 'for serrvyvice(s) requested. 1. `$how to whom,date and address of delivery. I W 2. ❑ Restricted Delivery. 3. Article Addressed to: Cape ,Cod Pest Control Inc. 444 Yarmouth Rd. Hyannis ,nn ` s , Ma. 02601 4. Type of Service: Article Number Registered ❑ Insured Certified ❑ COD /J ❑-Express Mail Always obtain signature of addressee or agent and DATE DELIVERED- 0 5. Signa tressee O E -1§ignpv— Agent D to of Del'Walk C e. Z 8. Addressee's Address(ONLY if requested and fee Paid) .m m Q ° PM I➢ , UNk=�OSI'MEWUSERVICE ``� SENDER INSTRUCTIONS u®® Print your name,address,and ZIP Code in the space below. • ComPlste items 1,2,3,and 4 on the reverse. • Attach to front of article if space permits, PENALTY FOR PRlYA { otherwise effhr to back of article. USE,$300 • Endorse article"Return Receipt Requested" adjacent to number. RETURN TO YNerve of Se INo.and Street,Apt,Suite;P^O, x or RA No.) K ��� (City, 'tated ZIP Code) f r it l P-5-2`2 4 6 2 510 RECUT FOR CERTIFIED MAIL 0 JPJSURANCE COVERAGE PROVIDED RIOT FOR INTERNATIONAL MAIL (See Reverse) Sent eape Cod Pest Contro C. v Street and No. 444 Yarmouth Rd. o. POHyanriisPC i 02601 d 6 Postage $ tlJ * Certified Fee 1. 50 Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to whom and Date Delivered Return receipt showing to whom, Go of Date,and Address of Delivery m.TOTAL Postage and Fees $1 . 5 0 U. Postmark or Date is 2/7/85 E 0 LL a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CF-4TIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front) 1. >11 you ant As receipt postmarked,stick the gummed stub on the left portion of the address side of the article leaving t(receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) A y2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the article.date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card, Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- quested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. U w wr- 1. t. ` �, t 4'S+r .`"'t ° r i c:�f i'Y'1n y `, } f „J4 J"� ,r'L d r f ' r `f e} N,` e i•* } Oze x r r r� y 4 '°r 1Y..-r fx •.,T�` r. P .. w. 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MAR 191 f FIN 'p STICK BEFORE AND AFTER EACH COMPARTMENT DROP OR.EACH .METERED DELIVERY QUANTITY Tank 04mster K / ;) ` Product in full tank(up to fill:pipe) t.: 18. SPECIAL CONDITIONS AND PROCEDURES TO TESL' THIS TANK VAPOR RFC( R Sea manual 6 ' ions applicable Check below and record pronedure in log(26). i C� Stage I VYeter fn tank Hi h water table In tank excavation `� Line(s)being tested with LVLLT U 4tige,11 21. TEMPERATURENOLUME FACTOR (a)TO TEST THIS TANK 19. TANK;MEASUREMENTS FOR r I TSTT ASSEMBLY s Today warmer? ? 'I Colder I I.:._ F ,Product InTank__°F -up:Product on truck ___°F Fxpes Bottom of tank to Grade*...... a 'for 4"L Thermal Sensor`reading after.ctr'culatron _ _.11_ Add 30 Aigits -Neales"la'-,. Add 24"for 3 L,or air seal _ ' 23.` Digita,'per F th range of'expeaiai change , r ,z dgfB Tatul t.ibiug to assemble' Approximflte _, ,_. n. ' 24. 3a u tv I? 20. EXTENSION HOSE SETTING , ; •,; J Q anti iri' coefficient of ex ansion for Pvolume change,in Tank'top to grade• ._•,�1_,_ full.tank,(t6 ar.17)_ Involved product er°F• Extend hose on suction tube G or more } 25 below tank top rl y vokime change per*(24) Otgits;per F•in test ` Volume chaefp6°pr If Fill pipe extends above grade use top of fill: Range(23) '.Gomputt tp 4,daC 30. HYDROSTATIC" 34." 38 N r LOG.OF TEST PROCEDURES PR4SSURL VOLUME MEASUREYENTS(YI iEMPEAAIURE'GAMPEMSATION CO.NTROt RECORA T0`,001 GAL. USE,FACfAR(at:. EACH Rs 28 29 Standpips Level 321 35. 36 37. '„ i. Tempe, Product in Prodoet 'Record.detetls of setting up m fnchor Change Coiopotation Adfusr' Resins _.� Graduate Replaced I-) end itfotting te8fs(Use,fUll No ----- Thermal Higher.+ it)x(a) �Yd'Urc' Begmmdp Level to --- - --- -- r Sensor Lawei I Ex'aearon+r length of hne ifneededi)` o Fxpaasfc' of which Before After Product Readmg Ic) Coatrachon ' 0 gdfng t?ertored Heading ; N6adleg. 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I Station&&t - . �A j, most accunu �y±t t� Tans�tanutacturer's Chan/ NommM Capacity _ capaGty cnM aya:Lbb lesnnn or t twp Ga Iona a s . _ _ ;J Company Erpitasrinp Data -. _ ..Is there doubt os to T—Capac,ty? �u ��'tMws supplied with TSTt - ' - - - - Bona ana Goes - Sea Section."DETERMINING TANK CAPACITY"' Other FILL•UP FOR TEST" ` Stich Raadtnpa., rota(6allem . ro N In, Ga" as Flaadkq Slick Walter SWom ) (.d ,. - - - .+•'�' bafpra FtIWP i]f - � .Invremry C,l'f . to St im -Gallons.•. :Fin up.STICK BEFORE AND AFTER EACH:COM PARTMENT-DROP.OR EACH.METERED DELIVERY QUANTITY - Tank Dialasahr yam^ << - t .• U / -,L• Product 111 IW tw*(up tD 6p Pipl SPECIAL CONOMONS:AND PROCEDURES TO TEST THIS.TANK VAPOR RECOVERY"SYSTEM �Ses'manual sections applicable Check below mW racotd procadua n.lop 426j.. _ ,U Staff eat in tank Hipla rpaf table in tank a:tavatlon U1+4a1 kailq taand Mtn LVLLT ❑ 6. TEMPERATURENOLUME FACTOR(al-M TEST THIS=TANK .. Is Td6ry YgttnatT❑-CDldsr?❑— F. Rtadwa s itsi' f Fdl�p`ProduG On Truck F �E>meped.Chaztge(+of (617)a32J216. " TMtmahS near w. —me at*tyrowedaa r hdYKf Par'F b ranya el.aap IMil:tynetpa )IM'S.PUMP-&TANK SERVICE :T - FEATURING KENT•MOORE TESTING:EQUIP X. gaatttlly b mMedata d aapttlsaion to vohataa tdaraq�:b a" -. 4, sm,Y ". P.O.80z 22a JIM CHASE WIC HARH MA ONO 37 x pa►°�t2Fl ulys yr F b w vdw.t.ttl.ty.par a lft , ttaaa 6F TESTPROCfOQRa:' - M RIIBt tit7s�R 10 f®ElMaaF/9 ':`;, ItET VatUYE T® a* �- - = :CMTaIN. �m m i1L FtAO!tq # atAaets CNAaRE ;fi - r MR It cord dm-iii aF aeniy q state .leer (,:,a Y hal s 'n hr•.a Cwim _Rtataoa F1 teasel Nt/teT* (tl _.pI WYn a IMs.:and ruenin0 -IUsn hR as 6pni.E. t.wt la" - ta.r: E■rrie.r'= Examine tel or r 1.twr"seem langtk OE GM If naadad.l: ai teat!" Mara A(ir helped ltaaf+ta `Is1. camadusa- c algni0ll I-,). :ta'ap W om •. Rs rJ Bale, a 6so d: %win ti+Mal*:.,�RataerfM:tel, _ -yytM a�i) ttaFa aratrY .-_ Its (' c(Z 'L>!• iCt4' I - s G x v" 9q 3 I Dear i .j[ I� �`l v c£byl C." �- 0 G ( D f b ti p ' s �. , 277 1 1 p ..iy �i _ a •. {f Jam— ell ANI— aa..MDr M r.w TANK TO TEST CAPACITY F'O" S.Chat .40 ✓a 4 A Sl N r c' G�,V,G/ Nom"m Copma1.J y y D ,e:owgv a .YM. ,_ Tw*Muw+,ut a awe E `Cornown Erowwq Omw 1s ttlaro dowM as to Trlw Camcav F �`h❑ wu NraiPh d wmi TSTT ... .... 6"fwom"DETERMINING TANK CAPACITY' - ❑ O,� RU-UP FOR TEST ukx Rs"kn. Tottd Gaftm .. to N k► Qopra K RfWkq suck wow peeoto •�� - /�'' ` - Q eron�w w.mr _Z_ POW STICK•SEFOIIE ANO AFTER EACH'COMPARTMENT DROP OR EACH METERED OEUVERY OUANW" - - Tw*Dlrtoalr '.T D / (/ / t.' ' Product in Rd ttwK IW b li Poe) SPECIAL CONDITIONS AND PROCEDURES TO TEST THIS TANK VAPOR RECOVERY SYSTEM S..w•arwal wcm-pp4CabW Cnaov kelp+and rapprd ItrccmdW w IN(26). � _ _ ❑pt�� cl womm to talk ❑Nipk-sto yob in talk YKGYM1of1 ❑ Ur*$)b"t..t.e WON LYLt T . ❑&or TEMPERATUREIVOIUME FACTOR(6)TO TEST THIS TANK . .. N Tofty WamwT❑ COW I_'f. PrarO■Too F FE Prpdutt m TttlOt F Expeufd Cnalpt 1-r-1 :.Thw"u*.Bao.o. • Olplb par IF In raopf of expecod dwgf 5 N.�w JIM'S PUMP 8 TANK SERVICE' FEATWNNG KENT440GRE TESTWG EQUIP. r vw worm"In otorRNrK of ofponflon for vokw»alrrYa in plb trek- ad%a*(16 WIT) kr.rmd ptoduel pr'F .. P.O.BOX 224 - J M CKW , N.RwICN.MA o26{s w t�Q ]���1) �� d� v TV"is, voke n cAayk.par T pq. OWN Pr'P W wE pob-- gr par-dpL- Eka ROW I= Cowpom to A ao ng pkmm'. IMM(4* OMPMATK 'LpS r lFSt rlCERMS- : - PEAS E r_. .:InpEu6Ef iseamrComm �,'amntiATEe . !Ta I6 AI EL lu FIE#HI ;, -tACK.MAOM C Nown CINTRIL L"d 'harfk. Hark M 61 �of (aa 1 r" ._ tamm roar _ �fyr .prkia�tll-1 Ttrwt R� Nv�er- i to .Erg Lo—-. Upown• E�r�l 1.1 k r u"—00 IfYp ff ifk R nf6fL) r nkltf 6dwa ARm hilrr r+V W C.M.N.- tE6 . Rudaf Rrtkrr trri ft"Wl tttMfl•1 afTM-afTlry olma>.r w t►� I 4f,2'o 0t' C c'' 0`yL" D D po 4, 44 ?o 7/0 i i 7 IT oe I . TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:��/dV ��f.0 MOVERS Board of Health MAILING ADDRESS: � � I m o yrV RP Town of Barnstable TELEPHONE NUMBER: 7 7 YV P.O. Box 534 CONTACT PERSON: IVOW e— 4'574)n-VeV Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: I/ Antifreeze (for gasoline or coolant systems) Drain cleaners y Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners ✓l Hydraulic fluid (including brake fluid) Disinfectants ✓ Motor of /waste oils ✓ Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, CUwr 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 V"' Car wash detergents Lye or caustic soda ✓' Car waxes and polishes Jewelry cleaners L/" Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) dy 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 P/ Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business •. ..».'4r'�'+•.�..�.;,-•.�r.,.:,.,ti r s�wr`wr'$�+." 7.+t.�,:.�F'Y •r- + ,.,�s i.:.4a...,_.w�"^ ...,::.,..w�i"..,�:..ww*+tit.irr-......a=,..vV''''..+K^..«�,t^"Y+'+r^. _ ,..�.....y. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD f E�TH 2.Printers ,,t satisfactory 3.Auto Body Shops �/f ,!?'%✓! O unsatisfactory- 4.Manufacturers COM;pANY!Y fi �`/�rvrj ,, •s'-*� e� (see"Orders") 5.Retail Stores r 6.Fuel Suppliers ADDRESS ,4& ,f�t 't ,..,i _ Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSCase lots 1Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) f ' Heavy Oils: ^ waste motor oil (C)•-' 'new motor oil(C) � t' ' -. transmission/hydraulic Synthetic Organics: F ; - •` degreasers i p ': r`G tee`` i kiscellaneous: ��f??{, LI�•- /\ 1. ill i,I `� ` r .i JJ11 / f •��l'f Y�� �fLGr'•/rtt� t Y(.� l (: 7" DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply •`.nip O Town Sewer. OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well .4 O On-site system 4. Outdoor Surface drains:YES NO ORDERS: ` O Holding tank:MD•Ci ' O Catch basin/Dry,well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product ' YES NO 1• 2. Person (s) Interviewedt tt Inspector '' Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 771, /FA/ P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 a Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totallin at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES 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 ' . Please put a check beside each product that you store: — Antifreeze (for gasoline or coolant systems) Drain cleaners V Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners V/ 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 _JZ 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 An other products with "Poison"pP y plabels 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 V Bug and tar removers Household cleansers, Gv9P-ctearaesa White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops /� O unsatisfactory- 4.Manufacturers COMPANY flfLo z"� I 'fj�►akleiLQ (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS MU-" Class: "1 7.Miscellaneous wW QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATER Drurns Above Tanks Underground Tanks ='i IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics:- degreasers Miscellaneous: 2 2�e DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer 41public Alit Xon-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 A1'NO ORDERS: O Holding tank:MDC Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product Licensed? YES NO 2. Person (s) Intefviewed nspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF- FIRM: 1+ yAp_ MAILING ADDRESS: `� > y.FX\rMc_,,-,Z� i� ?IYaV\V11S, v' 0�601 TELEPHONE NUMBER: CONTACT PERSON: 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 N,/ NO This form must be returned to the Board of Health regardless of a YES or NO answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that.you store: Antifreeze (for gasline or coolant systems) Refrigerants Automatic transmission fluid _ Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) - Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform,. formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners ) R E C E I V E D list..;; Other cleaning solvents HEALTH DEPT. Bug and tar removers TOWN OF BARNSTABIE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants. �. R„ 5 10,81. Road Salt (Halite) � TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM f,f f- J ADDRESS r \ Major types of materials: 1) aa 2) �I C1 G�Q S 3) 4) 5) 6) I. Description of material (s) use: 5 II. Storage (denote product by number listed above) A. Containers `: . metal glass paper plastic cans,bottles,j ars drums,barrels aboveground tanks underground tanks _ bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility V/or.# Remarks/Recommendations 1. Indoor a) separato, contained room b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection 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 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site r Person(s) . Interviewed(/= nspectox Date - - - TOWN OF BARNSTABLE BOARD OF HEALTH CO ROL F T XI D HAZARDOUS MATERIALS - INSPECTION SHEET FIRM 6 l _ ADDRESS:--- 11 t Major types of materials: 1) 2) 3) 4) 5) 6) I. Description of material(s) use: II. Storage (denote product by number listed above) A. Containers metal 0, glass �Ypap.er plastic cans,bottles,j ars drums,barrels. ' aboveground tanks underground tanks moo• -"FNM bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility V/or.# Remarks/Recommendations 1. Indoor f a) separate, contained room b) stored in general work area i) inadequate_ventilation=- _ ii)-floor, drains �,. _ ° - ii'i)- inadequat-e-fire_protection 2. Outdoor a);uncovered-,.expo�,ed=�tol.1.4.eatter=z. b) per- bus-snFface%catch`basins Ftoo III. Disposal A. Reclamation/Recycling unit` B. On-site disposal 1. Town sewer Al 2. Regular septic system -� 3. Separate holding tank C. Off-site disposal 1, hauled by own firm 2. hired hauler f a) name of hauler b) address or disposal site 77 Person(s) Interviewed _ _,� _ - �_ - A Inspector' 'i" ";%' _ _ _ - - _ - _ _ v Date - - - - - - - - - r FORM 77-IUU�r. �s , {J 21103 364) „ r ,i _r' Data Chart for Tank System Tightness'Test USING KEN?,-MOORE CORPORATION TANK TIGHTNESS TESTER MODEL :1000 For� ) � at . µ' ` ' i+r pY 9 ®Kemt•Moore Corporation 1877 '' of harts s PLEASE PRINT , " I Co n ht gldBr.)23388-A l sd r .� ,': I e . >o 1. ''OWNER'Property �" h 1 + 1R` �-: � / '} ; , ( ,.6 (` Tanks) e preaente. Telephone d, n nit -l"To , Nam Address Re Name - Address Representative" Telephone 4' 1. OPERATOR Lc * 7 .cs.�.0 �f, 'i2-�,Z l . r `` Name :. . Address Telephone r . _ ' 3. REASON FOR . TEST Q vcf t v!/.. (Explain Fully) n . ,. { : txi t .. 4. WH*0 REQUESTED. cr. !'I"1a-� �� �.. G? .r e; c i' 7 z `J; .+ TEST"ANu iti�trriEN Nams Title t Qdmt.tP+Y or ANi.aUon Date �, "(w a �' `sJt ', i , Address,. - Telephone "'��ed1 rFr 1', 6 J - ! e 9 i �b r s 5. WHO IS� PAY.ING - -,�-.. C r'!a+ I -� al C © r ha , r FOR THIS.JEST? rsoq Authorizing Tlde Telephone ,' G h fr i, Comp y,Agency or Individual Pe Billing Address City State Zip Mg to i 1 Attention of: Order No.• Other Instructions ai Itify by Direction Capacity Brand/Supplier Glade Approx.Age SteallFtberglass 4; ,6. JANK(S) INVOLVED ' e °U -t.; _ - - Sry �- y i - _ 1.- t _ 2` tL 4 I.G , S4 4 , I t . ' �Pi a:J u `.. Location Cover Filla Vents Slphones Pumpai a t r 4, 7 INSTALLATION �• r I� �r `�." i aQ t"' x ,"', DATA jG f.FC ?o�,�' J`r ,�k.c h1l f„ u$ w' North Inside driveway Concrete,Black Top, : Slie,Titefill make,Drop .Suction,Remote, i ii, ' J , Rear ofatatlon,etc. Earth,etc.., tubes;Remote Fills -.Sl:e,Manitolded .. Which tenks� Make it known' i P t, r 8 ,UNDERGROUND.' - l i t� Is the water over the tank?j r+ i ae 1_ WATER Depth to the Water table Yes c r Tanks to be filled hr. Date Arran ed b ,r € a' 9. .FILL'Up" ,, ,. n Name Telephone t' ; F <tZ a Extra product to"top off"and run TSTT.' How•and who to provide 1 Consider'NO Lead." wit rx;`rr{k ARRANGEMENTS . i ��t� ` . r rl „ p . l .Terminal or other contact ' �v; kf f =++3 p 3+7 k, for notice or inquiry` 4rfi § ' , "� ;yen' 'r3 ' t' i, dCompanyL,.. Narhe t Telephone. j�', ekJSp', ,. " 1 A. ,CONTRACTOR " ' q` o a , 1 n i i 6;t t,;�' br ilit u' MECHANICS 1 any oth r�contractor `` :. l t,6I ti, 6,'i+ � y €,1 '; r a r t. J i ''.4 r _ I t 1 1 1 11. OTHER ? ,I r; 1 i ; INFORMATION ' — �, y:'"L. OR REMARK$ Additional information on amy items above'Oftici n als or others to be advised when testing is in progress or completed,.Visitors or observers prssen4 J �r i a' 1 during test etc. _' t f s Tests were madwon the above tank systems In accordance with test procedures prescribed for Kent-Moore Tank Systems Tightness f t 12., TEST RESULTS Tester Model loon as detailed on attached.test charts with results as follows, "''' Tank Identification T` ht . ''' Leakage Indicated Date sted } (( �L }''`' ., - x A4 j ' ;' 1 . - - 4' i' J t) '-1r - l 7 i . pp}i i ; I - - ... .. lid t�,�t i This Is to certify that these tank systems were tested on the dates)shown.Those indicated as Tight"meet the criteria'established by ' . t 13. CERTIFICATION the National Fire Protection Asocladon Pamphlet 329. �i t r / Jj n LL Date T tiny Contractor or Com/paany By Signature ,F ' " �� o� ( YI2.Livi vv.c� f✓l t —�!/tC Q ( , G4Ir.L[ G fi Let,�� a NIIL rL Senal No.bf Thermal Techniaans Address , I Sensor ,' ' ti i;. ui r �'�l� �„ , ,: f r H. {a k s' . if S k,vir . tit r r: '...!`'' i ": r.:f ,,.' ! r x 7 w.a, hY t a,;;� a�q ��.,KreA°�¢y f lfd r,ki�l��n it t7 r��,,� i, p ta�iFdithf 77 1(rOcM , �i x Data Chart `for Tank System Tightness West q `i-l"'Qa' I •s+ " 1 { USING KENTA-If �'E CORPORATION TANK TIGHTNESS TESTER:MODEL 1000 For Pt c'kefi ,[ ;�'-<-' „ Copyright®Kent=Moore Corporation'1977 oii &;e �rr s .: 'i �, 1� .PLEASE PRINT.. ,.e:' "Oider14 '! 18-A ( + � * _`� i a ti, 1, 1. :OWNER Property.d `e r 1 f ( L Jy f/a t4 .. } t; l y '1 r 1 Name Address : Representative' Telephone - z +l i 11k 1 + r; Tenk: _ i r r r. i. ( t r <11; Name Address• _ Representative Telephone r *', 2.': OPERATOR c< rr ' . e° �,' i 11 2 4 `? Name •,'^ - ;Address. - •rw Telepha's F l 1r 3: REASON FOR , 1 TEST p vt/`. ' r > (Explain Fully) w� -, t 1 ,t f: , . 4. ,WHO REQUESTED C ,er M r,' 7�e ' �- o ..r� '. s � r 1 TEST AND WHEN Name :Title,._ Company or Aflillatlon Q I. -' $1{ ` Address- +. ?elephone $+p E 5 WHO tS PAYING re- C /4`A I fE *-. © & do i r 1 4"_I�",,,i�J. H ^ Comp Ay,Agency or Individual' Person Authorizing Title TelephpM 3. - FOR THIS ,TEST? I a ,, i ". Ai d t ' Billing-Address - Clty. Stale 2lP£ Y t ,d + > .. 6 4 + �" "Attention of: ',Order No. 'Other Instructions d' a P Itityby Direction Capacity Brand/Supplier. . Grade Approx.Age Steel/fiberj`lass F; 8. TANK(S) INVOLVED .e r r Pl , r l r f ) . S 4 .'e. a1 1 r!i Pi ' I _.. ,Ay ,,Ay 1 Location/ Cover fills Vents $lphones Pumps-tf r ,1 t E 1 7. INSTALik'ION �- 4 Lt{C T �->;/ `� �z ` �! " '' ' DATA r�` @ -r ,�,4, e eF North Inside driveway, Concrete,Black Top; Slze,Titeflll make,Drop , r�:' $uct:ou,R,3mote, 1�x"i„,w r 'I ,;, Rear,of station,etc.' Earth,etc. tubes,Remote Fills' .Slze,Msnifolded which tanks T ,, , Make It k'iown: .;', fi , n' s� , f4,y,;: F'> ki UNDERGROUND.; ;" '! e r �� s th water over the tatti);.i r Ir l a i t i WATER , -De thtotheWetertable l: Yes r �,rfio - I >f 'ras �1 ti ;': } =t ", Tanks to be filled hr. Date Arranged by k 1 l t, ' y,. ..-` ,Name +: t 9, FILL UP. . . ,, ,, Tered,one :j ,i + :t NI` t ,� e Extra product to top off. and run TSTT. How and who to provide 7 Consider,NO Lead P,l 'r ,u4 I ARRANGEMENTS r d' j� ,r <. j Terminal of other contactia' , ui} 1 for notice or inquiry h r to" r )C l ,f ,Company Name Telephone 4 o - i at , . . i(a ly ':All h M 10. CONTRACTOR, ' 9 a MECHANICS. ;x an t r , t , z, o her contracto Y s Y .{.1 ;- involved'. - - . a q l . ,F, l i +rr i ' 11 '`OTHER 1 INFORMATION ` , I OR REMARKS 11 Additional information on any items above.Officials or others to be advised when testing is in progress or completed Visitors Or obse•ve present f �4 during test etc. I a . a r s; Tests were made on the above tank systems In accordance with test procedures prescribed for Kent-Moore Tank Systems i lyhtnese , i > Teeter Model 1000 as+detalied on attached test charts with results as follows: a i 12. TEST RESULTS . = t I ; ,j r, Tank Identification Tight Leakage Indicated Date Test f i 6? r +i3 t l' ',T' + .l ,' ('�. £ 1 1. —'t 1 , E L , v ), :r f . 1. S.. . This Is to certify that these tank systems we tested on the dates)shown.Those Indicated as,Tight. meet the criteria established by r " ; 13. CE TIFICATION the National Fire Protectio Asoclation Pamphlet 329. t} „ i ,;, r " l lI4Date hs 7 ting Contractor or Company. By,: Signature + I r, l ^ ( !,/e/�(n<YI.c.,,___.c '',i f,�t .k /�&�.a '�"` ( l6I%t,.T L 4' / > ' s Stnel NO.of Thermal Technicians . Address * . - ` ' l ilq q Ale �fc t" .� :�i' i w � ij t .. i �' 1o, r 5. ra� v 5j.*art r =1 J p tt tt ra.,, „ ., ::r r, ,,,.w., Fdrr.i..w ., +[�,. .:,.....: ', .,. -r;::: e •.., •".^ .,., i.: . ,.�f',. ti.•. ,_�d!. ,., r .,,.,N �,;:uf.'r`..•, „. e�,.,r j{L( r%Rn4Srt�,.�'1£ •. ` f� ,