HomeMy WebLinkAbout0696 YARMOUTH ROAD - HAZMAT � 9� Y M��i 2d�
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`pp�ME)Ok'b Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMAPSSBLE.g' 200 Main Street• Hyannis, MA 02601
�pjFOMP��,O TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: e, Date:
Location/Mailing Address: b9c
Contact Name/Phone:
Inventory Total Amount: ISO SDS: Q S License#: �a1�
Tier II : Labeling: rpi I I Spill Plan: �S
Oil/WaterSeparator: N NIA
Drains: d Emergency Numbers:
Storage Areas/Tanks:
Emergency/Containment Equipment:
Waste Generator ID: Waste Product:
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Jntifreeze 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 /6
Motor oils - Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil V Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages .Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers/C) (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform, formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION RECOMMENDATIONS: Se
Inspector- 44i
Facility Representative: VVVV"'' _ I"
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS
r
Number Fee
1220 THE COMMONWEALTH OF MASSACHUSETTS $so.00 J
Town of Barnstable
Board of Health
This is to Certify that 7-Eleven
696 Yarmouth Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 110 gallons 6f Hazardous Materials.
-------------------------------------------------------------------------------------------------------------------------------- ---------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2018 unless sooner suspended or revoked.
PAUL J.CANNIFF, D.M.D,CHAIRMAN
DONALD A.GUADAGNOLI,M.D.
07/01/2017 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
� Cash
TRown�of Unstable
egu atory ervlces 14
Richard V. Scali, Director
of THE jp�
Public Health Division BARNS TABLE
M 4 w5luls.1 ..NtERVt LLE.COMT•X 5TQ
r HARSIUNS X1LL5•p51£RVI1* WE51 BH—NIy
'• ■�ATABLE, Thomas McKeanSS. , Director 1639-2014 0
e
AjE1639. `0� 200 Main Street, Hyannis,MA 02601 575
I -+ , 3>
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 1st—JUNE 30th).
APPLICATION FEES
CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 '� `�Fb °�'
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO..
2. IS THIS A PERMIT RENEWAL? !/YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF
GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: 1 U e r
5. NAME OF ESTABLISHMENT:
6. ADDRESS OF ESTABLISHMENT: �� ��✓moo ^ Zc�
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: f v\5 � VVI Q 2(o 0
8. TELEPHONE NUMBER OF ESTABLISHMENT: ��
9. EMAIL ADDRESS:
10. SOLEOWNER: YES ENO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME —I
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE ��7
Q:\Application Forms\HAZMAT APP 2017 REVISED x
Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BA MA3,q.LE.g` 200 Main Street• Hyannis, MA 02601
1639.�ArFOMA+6 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
Business Name: 7— Cl eVe-K-- Date: 3 30 ►7
Location/Mailing Address: to'?to 4,V-wtoJ NYI
Contact Name/Phone: JL
v owe, 08-7 7 1- 1371 vts i-v% qssA-YIA,,
Inventory Total mount: ^-7(v ° SDS: M53J 5 - olo}a��•5�5 License#:
Tier II : NV I Labeling: C2.ke.. Spill Plan:
Oil/WaterSeparator: Floor Drains: b 0 stn�Emergency Numbers:
Storage Areas/Tanks: Na..\ a )XA
Emergency/Containment Equipment: S �� .� Socb�k5 ova C
Waste Generator ID: �� Waste Product: N
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
S Antifreeze 3 % 3 }1 Dry cleaning fluids cc4� 3
1 Automatic transmission fluids 3� x) Other cleaning solvents&spot removers 2O
Engine and radiator flushes Bug and tar removers oo- ^%#0 ��t�a'^"�5
Hydraulic fluid (including brake fluid) 10 Windshield wash 3r-1 1+ ;Mcz),
�'b Motor oils 1 +tZ 2 Miscellaneous Corrosives Iv\u�a2`s
Gasoline,jet fuel, aviation gas Cesspool cleaners � ��ti �11,),5 C-1 e r.
l a a5 �q �h..rr,
Diesel fuel, kerosene, #2 heating oil 3 Disinfectants t-R}q<<.3
Miscellaneous petroleum products: Road salts gI I.P„cP�.,t c1ea►,�
grease, lubricants, gear oil Refrigerants atja o%u►a c.le airs
Degreasers for engines&garages Pesticides: 4-k�Iv`
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives (creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
-1 Miscellaneous Flammables to l � Fertilizers
Floor&furniture strippers .*i qw �„�,� PCB s
Metal polishes Other chlorinated hydrocarbons
—� Laundry soil &stain removers 1.4 b (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform,formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECOMMENDATIONS: cap \ 8 1 5.,.G1-[.aV,,1 ,. - V-14LJ--
5 J« 0.k e-0,AN-k\%& ,CS M�C��J`�'gv�b�� �n at\&x 6t4l. CA a'i V,1.
5�� tq C) inspector:
Facility Representative:C,
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
`oFISHE To Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
BARMS�LE.�`' 200 Main Street• Hyannis, MA 02601
" 163
9.
ems. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rF0 MAC
Business Name: - >!V2 Date: I
Location/Mailing Address: 6 r• a n,^i S
Contact Name/Phone: So - Lk. ors r+ti r
4W a.
Invento Total A Jou . _ qu.l k'��5 MSDS: �5 License
Tier II : Labeling: C a Spill Plan: Clk* -
Oil/WaterSeparator: Floor Drains: 0 Emergency Numbers: '!I
Storage Areas/Janks: a.Nk Gtk - t aw \ Cow
Emergency/Containment Equipment: M14
Waste Generator ID: /J �c Waste Product:
Date&Amount of Last Ship rent/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
(o Antifreeze b 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'�5 k 3
l S Motor oils k$ I Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil �� Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
�_ CVutc��e. 1,gti,}�cl (including chloroform, formaldehyde,
- I hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/ COMMENDATIONS:
Inspe or: 1 4\3wd I�P—
Facility Represent ive:
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
}
Number Fee
1220 THE COMMONWEALTH OF MASSACHUSETTS $5o.00
Town of Barnstable
Board of Health
This is to Certify that 7-Eleven
696 Yarmouth Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 - 100 gallons of Hazardous Materials.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2016 unless sooner suspended or revoked.
-------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF,D.M.O.
04/14/2016 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
{
Town of Barnstable
THE� Regulatory Services
Richard V. Scali, Director
BAMfffABLE ` Public Health Division BAMSTABLE
.us�a"V uE WSTPMx 4a
Thomas McKean, Director 16�� "
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 I PERMIT 26— 110 Gallons: $ 50.00 X�<,I,-
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑
• A late charge of$10.00 will be assessed if payment is not received by July 1st.
ASSESSORS MAP AND PARCEL NO. DATE
FULL NAME OF APPLICANT:
NAME OF ESTABLISHMENT:
ADDRESS OF ESTABLISHMENT: l P/� ,���trn�,
MAILING ADDRESS (IF DIFFERENT):
TELEPHONE NUMBER OF ESTABLISHMENT: �Q b 12I 13 I
EMAIL ADDRESS: Jaw-
SOLE OWNER: YES_LNO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
IF PREPARED BY OUTSIDE PARTY:
n IGN TURE OF APPLICANT Name:
Cf C;�Z Company Address :
Telephone#:
Email:
Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2
Town of Barnstable Office: 508-862-4644
Fax: 508-790-6304
Regulatory Services Department
Public Health Division
. Thomas A.McKean,CHO
200 Main Street, Hyannis, MA 02601
Payment Receipt
Hazardous Materials Payment received: $50.00 (Cash) on 4/14/2016
.Business: 7-Eleven
Address: 696 Yarmouth Road (HYANNIS) , Hyannis
Note: Category I Permit
I
•
Number Fee
1220 THE COMMONWEALTH OF MASSACHUSETTS $5o.00
Town of Barnstable
Board of Health
This is to Certify that 7-Eleven
696 Yarmouth Road, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 26 100 gallons of Hazardous Materials.
This license is granted in conformity with the Statutes and ordinances relating there to,and
and expires 06/30/2017 unless sooner suspended or revoked.
---------------------------------------
WAYNE MILLER,M.D.,CHAIRMAN
PAUL J.CANNIFF, D.M.D.
07/01/2016 JUNICHI SAWAYANAGI
THOMAS A.MCKEAN,R.S.,CHO
Director of Public Health
Town of Barnstable
°FINE r Regulatory Services
Richard V. Scali, Director .
* `"MAASS. # Public Health Division BARNSTABIE
9
1639. ��� MMRSTO 5MILLS[Ni ERV.UE-W ;'iR'NIS
AI�.'D..•`� MILLS 20014k':ST 2kiN5TAeLE
Thomas McKean, Director
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 ❑
• A late charge of$10.00 will be assessed if payment is not received by/July 1st.
ASSESSORS MAP AND PARCEL NO. DATE
FULL NAME OF APPLICANT: � ev�v�
NAME OF ESTABLISHMENT: -7- \\
ADDRESS OF ESTABLISHMENT:
� C72Ci�U 1
MAILING ADDRESS (IF DIFFERENT):
TELEPHONE NUMBER OF ESTABLISHMENT:
EMAIL ADDRESS:
SOLE OWNER: YES NO IF NO,NAME OF PARTNER:
FULL NAME,HOME ADDRESS,AND TELEPHONE# OF:
CORPORATION NAME
PRESIDENT
TREASURER
CLERK
IF PREPARED BY OUTSIDE PARTY:
8I{ TURE OF APPLICANT Name:
Company Address
Telephone#:
Email:
Q:\Application FormsWAZZAPP Rev I6.docx Page 1 of 2
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
/� Mail To:
NAME OF BUSINESS:Z" � �' � � Board of Health
MAILING ADDRESS: 60
Town of Barnstable
�
TELEPHONE NUMBER: ��� P.O. Box 534
CONTACT PERSON: AM MAlkl ' Hyannis, MA 02601
'
Does your firm stor ny of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities to Iling, 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. M
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address
ADDRESS: t,p
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
c antitie id
t. Please put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
Motor oils/waste oils br Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
#2 heating oil Pesticides (insecticides, herbicides,
Other petroleum products: grease, lubricants rodenticides)
Degreasers for engines and metal Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
Battery acid (electrolyte) Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes/and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
Paints, ;- 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 fir' 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)
v Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners ` 6k,'�' �
White Copy-Health Department/ Canary Copy-Business
CAPE COD FIREPLACE SHOP INC.
Your Fireplace Headquarters
29t'' 690 Yarmouth Road
HYANNIS, MA 02601
YEAR (617) 775-2511 420-0322
jell
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.M 'ne,Gas tions,Repair
''" 2.Printers
r i* BOARD:.OF�HEALTR _ satisfactory 3.Auto Body Shops
G O unsatisfactory- 4.Manufacturers
COMPANY - Z?c1_r"t"oL0 S (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Y"W n'40;dt onw Class: 7.Miscellaneous
7�d'�� •// f%�'y""� QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Qksuh4ie eWffle, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscell neous:
1�
A ylp/ 20
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer OPublic
&On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES 1 NO ORDERS:
O Holding tank:MDC
Catch basin/Dry well lQ�
O On-site system /-4ZO
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
Pe nwIlIfterviewed. spector Da