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Home My WebLink About0700 YARMOUTH ROAD - HAZMAT 70o y��R 2( ors � -- i //moo t IB r°wti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • ARM ssBLE' ' 200 Main Street• Hyannis, MA 02601 ArfDMP+a`�� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o Date: Location/Mailing Address: 0 Contact Name/Phone: Inventory Total Amount: _ MSDS: License#: 1*111�D Tier II :_ A-)0 Labeling: e Spill Plan: Oil/Water Separator: Floor Drains: go Emergency Numbers: AUA Storage Area U 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. 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 I rease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: @S i►rfi/- Inspector: Facility Representative: 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 Cape Food Mart .-------------------------------------------------------------------------------------------------------------------------------- 700 Yarmouth Road, Hyannis, MA ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•. Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health oil Town of Barnstable • Inspectional Services :msT�RNSTABLE Public Health Division E• 1639 2014NR•FYANNISc MILLS•OS'EFNILL•'rlE:"f B?ILYSfM1BLE N 1639-7034 i Thomas McKean, Director 163q RFD�A 200 Main Street, Hyannis,MA 02601 C." N) .f-j 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 Vw CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ 1 01 — 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?AZES_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: 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 1,6:19 4//0— 9. EMAIL ADDRESS: R /1/ 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: I17 /yl, fJ ✓V 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME H W PRESIDENT TREASURER_ CLERK • 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: 4M�n SIGNATURE OF APPLICANT- % DATE fT Q\Application Fonns\Haz Mat Appli Draft Jan20l9.docx J r Number Fee 1220 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Cape Food Mart 700 Yarmouth Road, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------------------------- ----------------------------------------------------------- --------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health I� � P ' R Town of Barnstable HWE Inspectional Services BABSTABLE J'T r FM915TABLE Q.05 i%:luf-I'm H ig(i_ o Public Health Division Was _.9'+7014+;3BPVSSE 9 MAC $ Thomas McKean, Director q'Ar fog a`m 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 IR Vgr 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? 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: CdO�F 6. ADDRESS OF ESTABLISHMENT: (,'9,14 AIAI� ko AI '&�I's -AM -&,xzo f 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: J a�' -400/0- 2,-//,t1q 9. EMAIL ADDRESS: Azr,D/YIA12--7-j9 _gAbw.J , Ce?V 10. SOLEOWNER: YES X NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME f1 ,IV PRESIDENT &CB N Now TREASURER " AA CLERK ' 12. IF PREPARED BY OUTSIDE PARTY: I NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE o S—'7-/— 'L- l� Q\Application Forms\Haz Mat App Revised 0940-18.docx Old � Xvi 0(JU ki u IS�7 I kguw of Unstable atory ervices THE f Richard V. Scali, Director Public Health Division BARNSTABLE BARNSTABLE, Thomas McKean, Director 1639-2014 y MASS. �. �plE039. 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 C, CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ ��I 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 ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)?.IZ YES NO. 4. FULL NAME OF APPLICANT: YYl 7Q N COY 5. NAME OF ESTABLISHMENT: �' AP Ec( D A`R 7 6. ADDRESS OF ESTABLISHMENT: �JW �n ymo u W y'r+ -kA- Annn i c MR 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �jC� L 1� Q 1 61 9. EMAIL ADDRESS: �P me A w v►� c Sa ma i r o rvrn 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME �A RY hP r5 lc�r PRESIDENT AA-,i,Yy\7r. 1--J nrp►r TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.docx i • • .N- Number Fee 1220 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health 3Z This is to Certify that Cape Food Mart 700 Yarmouth Road, Hyannis, MA Is Hereby Granted a License GJ For: Storing or Handling 26 - 110 gallons 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 C: a T�owa of Barnstable egu atory ervices Richard V. Scali, Director oFt1HE Public Health Division BARNSTABLE • 1639. sunslne�.arrt39-201 ar�rr.yxis 1SZAB A Thomas McKean, Director MARS'°NS"'u;fi,'204 F"St" Y MASS. 0 Ep p`0 200 Main Street, Hyannis,MA 02601 .wl a�, 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 Sti CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 Q� C— -" 9OD-3 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ ��I 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?_ZYES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? ,-' YES NO. • 4. FULL NAME OF APPLICANT: oc>v 5. NAME OF ESTABLISHMENT: C AP - Eac)D �Rpzl� 6. ADDRESS OF ESTABLISHMENT: SW y-A MIA Og601 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: L_ a_PA Way,t � Mai 1 C o rn 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: IL FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME tj RY inPrs j:C PRESIDENT AA-C-XVIA7r t�1c�c�✓ TREASURER CLERK 2—n,1n1 - n A 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: • SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.docx °FIKEr° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMASS , . ` 200 Main Street• Hyannis, MA 02601 ArFDMA� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: e 5 Date:*K Location/Mailing Address: Do `a�w�o.r � a A n 1 S Contact Name/Phone: d Inve ntory Total Amount: L 1119 a 1 MSDS: Dt(- License#: �l Tier II . Labelina. re-+CA i Spill Plan: Oil/WaterSeparator. -� Floor Drains: Emergency Numbers: Storage Areas/Tanks: N 1\6 AC[fobV! 7 \2AkdQ 04fA,as S Emergency/Containment quipment: Waste Generator fD: NA Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. ✓ Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, degfossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector:�L•aV�� Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS