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HomeMy WebLinkAbout0696 YARMOUTH ROAD - HAZMAT � 9� Y M��i 2d� �{� ��� `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