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HomeMy WebLinkAbout0741 YARMOUTH ROAD - HAZMAT'I �. Number Fee ✓ 165 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JMR Honda ................................................................................................................................. 741 Yarmouth Rd., Hyannis, MA .................................................................................................................................. ............................. Is Hereby Granted a License For: Storing or Handling 111 - 499 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 k• i f Town of Barnstable Inspectional Services BARNSTABLE LW..Y:TAe R MIF LU-COT n—ANN15 • Public Health Division MNiS oNt 4'LLS 1639-1639-RL.YFS BAWSAFF , 2014 R Thomas McKean, Director r 1639 �� �. 200 Main Street, Hyannis,MA 02601 nw r . Office: 508-862-4644 Fax: 508-790-6304 c G APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE t , 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 El . J CATEGORY 2 PER-MIT 111 —499 Gallons: $125.00 nr �C.h�. 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 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 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: C/ 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YE _NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: 7/ CORPORATION NAMES PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE to 1i� Q:\Application Forms\Haz Mat Appli Draft Jan docx Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741~Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 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 f Town of Barnstable Inspectional Services Public Health Division BARNMBLS. ` Thomas McKean, DirectorMAE& 9`l'ArE1 639. 0. 200 Main Street, Hyannis, MA 02601 C. Office: 508-862-4644 Fax: 508-790-634°t 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 $ v61� CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ p *A late charge of$10.00 will be assessed if payment is not received by Jules 21 1. ASSESSOR'S MAP AND PARCEL NO. Lfcj, 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: ;, 5. NAME OF ESTABLISHMENT: � �� 6. ADDRESS OF ESTABLISHMENT: ] 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 117 8. TELEPHONE NUMBER OF ESTABLISHMENT: ;7r 9. EMAIL ADDRESS: ��5 10. SOLEOWNER: (jjQ NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRE-&S-;AND TELEPH OF: CORPORATION NAME 7/ fy�L PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: jeg COMPANY ADDRESS • .SIGNATURE OF APPLICAN i DATE 6 l Q:\Application Forms\Haz Mat App Revised 09-10- 8.docx Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 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 VowegulAatory of B nsxable Semces Richard V. Scali,Director �� Public Health Division BARNSTABLE NP0.510.Y5 NIL:S WtNSTMIF.fFllfBlVltIF.CONR•NY STA # •OSTERY:IIF•WP519nPNSTM�E BARNsrMBLE. Thomas McKean,Director 1639-20 4 'gyp 16;9 p�� 200 Main Street, Hyannis,MA 02601 rfD MP'� 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 �V-S 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?—j S_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: �, '`f`� 5. NAME OF ESTABLISHMENT: �I,,, 6. ADDRESS OF ESTABLISHMENT: ( �� s /✓ 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: ��s�J2 ��` 10. SOLEOWNER:`( iEi O IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT JvN d S -e I,J3 A4� 'fX2 tjp01e ezig'? TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: TELEPHONE LIF 7 NAME: COMPANY ADDRESS E IL: SIG NATURE NATURE OF APPLIC / DATE Q:\Application FormsViAZMAT APP 2017 REVISED x °p IKE r°k� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARqB .g' 200 Main Street• Hyannis, MA 02601 �ArFDMP�a`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4av�(. ISM 1P, -A,)A-o 54,e-s Date: Location/Mailing Address: -7y 1 ` Qrmo.s4 . RX, 14 ,t-mo,S 1-D5 9ND o,- MvM 5 Contact Name/Phone: V-in .S0S- '7 Inventory Total Amount: A-' 456 4 aJ SDS: OwkwwL, e,tCQSS License#: 16'5'/ C4+ Tier II : j Labeling: n Spill Plan: ` �s Oil/WaterSeparator: Floor Drains: tJ Emergency Numbers: DK Storage Areas/Tanks: k04-0�1 awl. ivL b wt�4 c1��,M .r %-, rag Emergency/Containment Equipment: 5 ����{ �nlr��lo•\.\.� m� s 1 Ire Waste Generator ID: VAIJ Waste Product: a' Date&Amount of Last Shipment/Frequency: o c.�04) 5%v� 2 00 r e, ova. SA-e, Licensed Waste Hauler&Destination: Other Waste Disposal Methods: ,1 LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous mhterial 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+ �x o-N\ Miscellaneous Corrosives Gasoline,jet fuel, aviation gas k Cesspool cleaners Diesel fuel, kerosene, #2 heating oil a��a�Es Disinfectants — Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: oe 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: w•t 'rye- le Inspector. Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris , 741 Yarmouth Rd., Hyannis, MA ---- ------- Is Hereby Granted a License O� For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------- ------------------------------------------------------------------------------------ --------------- --------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 T nl of rB able ' f to J�� egu atoy ervlces Richard V. Scah, Director ARNSTABLE ti • ,� �"�, Public Health Division I � . IMRIMABM Thomas McKean,DirectorBUM �IWO,,,, y �. i63q 200 Main Street, Hyannis,TNIA 02601 t.. FD MA't a Officc: 508-862-4644 �V` �D` Fax: 508-790-634, 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: $1.50.00 ❑ *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?x YES_NO. I:F 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: �� us 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: � Y4ga a/���� 7. MA:ILING ADDRESS(IF DIFFERENT FROM ABOVE: p� / 8. TELEPHONE NUMBER OF ESTABLISHMENT: �g _—n 9. EMAIL ADDRESS:. 10. SOLEOWNER:�k-YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. I.F PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: p� SIGNATURE OF APPLICANT . ATE CAIaers\Deco(Iik\AppData',LocatiMicrosof-\Windoc e rary Interne Fi s`. ntent.0uttooklBMQD49H2\HAZMAT A P 2017 REVISED.doex °F THEA .Town of Barnstable Office:508-862-4644 Public Health Division Fax`.508-790-6304 • BARMS�LE. • 200 Main Street• Hyannis, MA 02601 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: K�06&6 CA< j0.+) Date: L1181110. Location/Mailing Address: 1 LI I Contact Name/Phone: J.. B• o xs A-0S-'77& --7-2 t 1 O%A- tvt. e Inventoty Total Amount: ^' �� �` 1 MSDS: Iy n 0V License#: 1105 Tier II : oltk Labeling: OK Spill Plan: e5 Oil/WaterSeparator: Floor Drains: Emergency Numbers: V e s Storage Areas/Tanks: I41 h s cK--_A� V\o cvvt�-s. Emergency/Containment E ui ment: jc-\se.t.'l 4-c_ �c�, 5 nc � �4 oA �I-ba- Waste Generator ID: "7 79-1�1 I Waste Product: Oi Date&Amount of Last Shipment/Frequency: Sa -e-cv- 2 ( . e I Licensed Waste Hauler&Destination: k<14.e K. C cavtg�o� 12 Other Waste Disposal Methods: 11 LIST OF TOXIC AND HAZARDOUS MATERIALS ►V n �'`�-\ L1n w w i v� �ti.vv�n-��'`�� max«�k �v�cSe gsc ��- NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA,hazardous material use, ��"�O� q.eJ 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) XJu Windshield wash Motor oils < N k Miscellaneous Corrosives �— Gasoline,jet fuel, aviation gas'(�J< qq��S Cesspool cleaners Diesel fuel, kerosene, #2 heating oil -C 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" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: �''t��vy�eS ORDERS: t v<CC tw-P &VfP S VA6t. S S AX 1 Z. .o� INFORMATION/RECOMMENDATIONS: 5 h v o l S %A- . 0 ce, .avt✓ D 1 ��. 1� - ,ra�1►K 4 rL 5 ►•t 1C. A n Inspector: 1 t 1 �-�l'-e� L7 sb5� 01 �{�,Q PAY1$� ��C�.e,>C�-ivt v,gcility Representative: 1, WHITE COPY- HE01H DEPARTMENT/CANARY COPY-BUSINESS 1 i Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable . Board of Health This is to Certify that JMR Honda/Polaris 741 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 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 f "r Town of Barnstable �t rti Regulatory Services Richard V. Scali,Director °" MAS& Public Health Division B STABLE Mass t63q ,�� waseanu CDe nnsws �fD N10'�s Thomas McKean,Director, 1639-201' 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �-► u 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 0th). 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: '�iV/U,j B T7��i(�i�✓.!' NAME OF ESTABLISHMENT: �✓n'� >P //��17A ADDRESS OF ESTABLISHMENT: 7 w/.. } MAILING ADDRESS (IF DIFFERENT): Sim TELEPHONE NUMBER OF ESTABLISHMENT: S�4y , -7 7,F— 7Z,11 EMAIL ADDRESS: Sates- SOLE OWNER: YE NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEP ONE#OF: PRESIDENT 4 /h,A . �° -�� —5 zig—, e Pe- -00 5 TREASURER r'j LvNPr� CLERK s IF PREPARED BY OUTSIDE PARTY: • SIGNATURE OF PP 'ANT Name: Company Address Telephone#: Email: Q:\Application Fonns\HAZZAPP Rev I6.doex Page 1 of 2 f * Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department „ y ,; '* Public Health Division MAS& Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/9/2016 Permit number: 165 M _ � .Check number: 20514 Check amount: $125.00 Name on check: J.M.R. Honda/Vespa I Business: JMR Honda/Polaris Owner: JUNIUS B JR Address: 741 YARMOUTH ROAD, Hyannis °at ►o Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • en Mr%. ,A A 200 Main Street• Hyannis, MA 02601 " N TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rED MAy Business Name: -�+/K� ova- �o a ,S Date: 9 Location/Mailing Address: -7q i y a.v,•� S Contact Name/Phone: - -;L I 1 Inventory Total mount: 135o q al MSDS: e-S License#: Tier II : D Labeling: Spill Plan: eS Oil/WaterSeparator: Floor Drains: 00 Emergency Numbers: Oil Storage Areas/Tanks: �—c 5 e10 W m,k V"I, Emergency/Containment Equipment: Waste Generator ID: M SO9-1-7 `7Qt Waste Product: Date&Amount of Last Shipment/Frequency: 5' i3 I"1 �. mc2- Q-c 1`2. y r5 Licensed Waste Hauler&Destination: 2a L e 5 -- �! k a ob.�S Other Waste Disposal Methods: ck4. LIST OF TOXIC AND HAZARDOUS MATERIALS I�� ��-�u•/ a�nuv.� �� �v� �v,vs.►�-Cow NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardoull material use, storage nd 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 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) 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: aA- Inspector: Facility Representative: i WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: / IZy l !q TOWN OF BARNSTABLE���FORM TOXIC AND HAZARDOUS MATERIALS NAME OF BUSINESS: �✓4 9 f4ovJe,I PoIa��s BUSINESS LOCATION: I ya.�,n�to�J �Q . val vl✓l,s INVENTORY MAILING ADDRESS: 54 mg— TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDA IONS: ?-YtS -5d11) 4I1ay�. n — Fire District: p ►+� �) $vl�d�Il�-u� rolX�C�'i '1oG� Otic, a des l� o ,t' a>7 rl 15 (7 Q ale, 3 275 4 ) -C-49y- tva6 e- 01 1 ) 5 i►ti 4-s� — tiel-5 d�tmoireo��'ti XZJe Waste Transportation: Last shipment of hazardous waste: 13 I Z Name r +o� 1��5��? 8?A I `� 'vrsDestination: .A4V< g 046k o, pail Waste Product: o t l Licensed?� No MA-tabk SS00D 5® NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum An 'freeze (for gasoline or coolant systems) Miscellaneous Corrosive An ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides �p Q NEW3o d USED,279' (insecticides, herbicides, rodenticides) D Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) J lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine 1 5- Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) D Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials I i Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 Yarmouth Rd., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health f , Town of Barnstable C YD- �3 , TME r Regulatory Services Richard V. Scali, Director ' 9 MASS. Public Health Division �A i63q. ♦� rf039 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 JU N11 y S AP,el AJ� NAME OF ESTABLISHMENT �J'1'I R Ir/v NO ADDRESS OF ESTABLISHMENT. �44 TELEPHONE NUMBER ��d 7 2�-// SOLE OWNER: YE 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 HOME ADDRESS OF: PRESIDENT TREASURER CLERK 1 SIGACTURE OF A ICANT p y RESTRICTIONS: HOM,A ss HOME TELEPHONE#. '4e-a4o r b Q:\Application FormsOAZAPP.DOC 0 MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable.to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q\Application FormsEAZAPP.DOC Emergency Spill Response Plan For Hazardous Materials If there is a..:: • Fire; • Explosion; • Rescue needed; • Serious personal injury; • Life threatening situation; CALL 911 and... • Activate any alarm system; Warn people to evacuate; • Assemble at safe distance; Account for people/staff; • Secure area;--,- Collect spill info and MSDS; Wait for responders:'`` SPILL RESPONSE PLANNING Individuals are responsible for their own spills. Each hazardous material user must be ready through proper advanced training and equipped to handle a spill. Critical Elements for a Safe and Effective Response are: 1. Information and knowledge of materials used 2. Adequate spill response supplies 3. Proper training 4. Knowing when and who to call for assistance: To Prepare: 1. Collect MSDS's (Material Safety Data Sheets) for the hazardous materials you use. Keep them stored outside the potential spill area. _J 2. Maintain a call list (daytime and after-hours) of individuals who should be notified in an emergency. 3. Collect and maintain spill response supplies/spill kits in your shop areas. 4. Train and practice for effective spill response at least annually. HOW TO RESPOND TO SPILLS r 1. Attend to Personal Iniuries. • Clothing on fire: Roll person on floor to smother flame, drench with water if immediately available. • Splash in eyes: Immediately rinse eyes with water continuously for 15 minutes. Forcibly hold eye open to rinse behind eyelids. Obtain medical attention. • Spill on body: Remove'contaminated clothing and flood exposed area with ` running water from faucet or safety shower for 5 minutes. Make sure spill has not accumulated in shoes. • Minor cuts and puncture wounds: Wash vigorously with soap and water. • Report all personal injuries to your supervisor. 2. Assess the Risk. Simple spills meet all these criteria: • Do not spread rapidly • Do not endanger people or the environment except by direct contact • Can be managed safely by people trained to use the material. Major spills meet any one of these criteria: • Do spread rapidly • Involve a personal injury or could endanger people • Present an inhalation hazard Q Could enrlang. er the environ,rnent. 3. Initiate Action. Simple will: • Notify any affected people • Keep the area clear • Plan your cleanup • Call Fire Department for advice if needed. Major spill (10 gallons or more and unable to contain/clean up properly): • Dial 911 or call the Fire Department within 15 minutes • Alarm, evacuate, and assemble at a safe distance • Collect spill information • Wait for responders. Of CHEMICALS t General Guide for Chemical Spills: • Determine identity • Consult MSDS • Avoid breathing vapors, get as much fresh air into area as you safely can • Absorbants and neutralizing agents must be compatible with chemical spilled • Prevent spilled chemicals from going down drains (public water supply) • Dispose of cleanup materials as chemical hazardous waste, small volumes of dilute acids and bases may be neutralized (pH 6-8) and sewered • Call hazardous waste disposal company for hazardous waste pickup, or guidance on cleanup or air monitoring. Simple Spills--liquid • Alert people in area • Wear protective equipment • Contain by diking with appropriate absorbant • Flammable--remove ignition sources (burners, motors, anything that could cause a spark), use plastic or nonmetallic cleanup equipment • Absorb or neutralize with appropriate agent working from outside edges inward. Simple Spills--drV If not water reactive, dampen to prevent airborne dust • Control water reactive dust with sweeping compound • Carefully brush solids into a dust pan or container Keep dust generation down to prevent creating inhalation hazard. Compressed Gas Leak--simple • Presents no inhalation hazard • Restrict access • Place in fumehood if possible, tighten fittings Locate leak with soapy water (at below freezing temperatures use 50% glycerine solution) If cylinder still leaks, contact supplier. Compressed Gas Leak--maior Large or uncontrollable leak or fire hazard • Evacuate, ventilate affected area • Call 911 immediately • Contact supplier. Maior Spills • Evacuate • Call 911 or Fire Department • Wait for responders. REVIEW Conduct Annual Training: • Review your Spill Response Plan with all staff at least once a year. Discuss pre-designated evacuation areas. • Involve input from local Fire Department/HazMat Responders. 4�+ 1: Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $110.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 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 Town of Barnstable Regulatory SemcES Thomas Y Gefler,Director a _ i Pubb.c Health D1TBion MASS ThoT.as McKean, Director 200 Main Start, Hyamlis,MA 02601 F= 508-790-6304 O Ica: 508-5624644 Appjjcalion Fee: $100.00 ASSESSORS AP A.HD PARCEL NO, DATE MAP ATPLICAIION FOR PE I'T TO gTORE .A /OR TT'Tl MORE THAN III QNS OF HAZ�OUS MATERIALS 7L NAME OF APPLICANT ,� NL A� OF ESTABLLS ADDRESS OF EST_ABLISHlvIEN'I' d TELEPHONE NT-NnER 5 07 E 0 WNm YES NO O �a IF APPLICANT IS A PARTNZR='FULL NAB AND HOB ADDRESS OF ALL 0 N o PARTNERS: ~ � I� W r • _ rn 11 APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF IN CORPORATION I+q=NA1Na AND H01Y+ ADDRESS OF: PRESIDENT '" g SIB Yt A OF A2YY C fU 7/ �d A�A� � STRICTIONS: HOAU ADDRESS i HOB TEIXPHONE# 77?— Razdoclwp/q ' Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 Yarmouth Rd, Hyannis,MA 02601 �j 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 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �l cc),OZ� A Town of Barnstable (kc I WS (01' � E r Regulatory Services Thomas F. Geiler, Director '" MASS.LE. Public Health Division 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT •.�� N '� 'aNs' NAME OF ESTABLISHMENT / , ��✓os ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER J 7 a 7 Z 11 SOLE OWNER• YES NO r IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF PARTNERS: At rn IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT A RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# C A 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 r Emergency Spill Response Plan For Hazardous Materials If there is a... • Fire; • Explosion; • Rescue needed; • Serious personal injury; • Life threatening situation; CALL 911 and... • Activate any alarm system; • Warn people to evacuate; Assemble at safe distance; • Account for people/staff; • Secure area;n , • Collect spill info and MSDS, o i{ • 1lVait>for responders. 1 1 i SPILL-- R.E�SPONSE `PL`ANNLNG'' ' Individuals are responsible for their own spills. Each hazardous material user must be ready through proper advanced training and equipped to handle a spill. Critical Elements for a Safe and Effective Response are: 1. Information and knowledge of materials used 2. Adequate spill response supplies 3. Proper training 4. Knowing when and who to call for assistance: To Prepare: 1. Collect MSDS's (Material Safety Data Sheets) for the,hazardous materials you use.,Keep-them'stored outside the.potential spill area.'' ; T�2:---Maintain-a-call-list-(daytime;and after-hours)_of individuals who should be notified in.,an,emergency. �3. -Collect and.maintain spill response supplies/spill kits in your shop areas. -4. -.Tra:in,and..#actice for effective spill response at least annually. L HOW TO RESPOND TO SPILLS 1. Attend to Personal Iniuries. • Clothing on fire: Roll person on floor to smother flame, drench with water if immediately available. • Splash in eves: Immediately rinse eyes with water continuously for 15 minutes. Forcibly hold eye open to rinse behind eyelids. Obtain medical attention. • Spill on body: Remove contaminated clothing and flood exposed area with running water from faucet or safety shower for 5 minutes. Make sure spill has not accumulated in shoes. • Minor cuts and puncture wounds: Wash vigorously with soap and water. • Report all personal injuries to your supervisor. a 2. Assess the Risk. Simple spills meet all these criteria: Do not spread rapidly • Do not endanger people or the environment except by direct contact • Can be managed safely by people trained to use the material. Major spills meet any one of these criteria: • Do spread rapidly • Involve a personal injury or could endanger people • Present an inhalation hazard • Could endanger the environment. 3. Initiate Action. Simple spill: • Notify any affected people • Keep the area clear • Plan your cleanup • Call Fire Department for advice if needed. Major spill (10 gallons or more and unable to contain/clean up properly): Dial 911 or call the Fire Department within 15 minutes Alarm, evacuate, and assemble at a safe distance • Collect spill information 0. Wait for responders. R - - CHEMICALS General Guide for Chemical Spills: • Determine identity • Consult MSDS • Avoid breathing vapors, get as much fresh air into area as you safely can • Absorbants and neutralizing agents must be compatible with chemical spilled • Prevent spilled chemicals from going down drains (public water supply) • Dispose of cleanup materials as chemical hazardous waste, small volumes of dilute acids and bases may be neutralized (pH 6-8) and sewered • Call hazardous waste disposal company for hazardous waste pickup, or guidance on cleanup or air monitoring. Simple Spills--liquid Alert people in area • Wear protective equipment • Contain by diking with appropriate absorbent Flammable--remove ignition sources (burners, motors, anything that could cause a spark), use plastic or nonmetallic cleanup equipment Absorb or neutralize with appropriate agent working from outside" edges inward. Simple Spills--d►y If not water reactive, dampen to prevent airborne.dust Control water reactive dust with sweeping compound • Carefully brush solids into a dust pan or container Keep dust generation down to prevent creating inhalation hazard. Compressed Gas Leak--simple Presents no inhalation hazard Restrict access Place in fumehood if possible, tighten fittings Locate leak with soapy water (at below freezing temperatures use 50% glycerine solution) • If cylinder still leaks, contact supplier. J3 " Compressed Gas Leak--maior Large or uncontrollable leak or fire hazard Evacuate, ventilate affected area Call 911 immediately • Contact supplier. Maior Spills • Evacuate • Call 911 or Fire Department • Wait for responders. REVIEW Conduct Annual Training: s • Review your Spill Response Plan with all staff at least once a year. Discuss pre-designated evacuation areas. • Involve input from local Fire Department/HazMat Responders. 8 Ha ar ous Materials Inventory Sheet Checklist 12-Date Physical Street Address--Check database to ensure it.exists Working Phone Number Victual Amounts.-( ie. gas being used to fuel machines,thinner to clean brushes all..count as hazardous,materials-no blanks) Storage Information Iodation ofistorage, how long is:sto,rage for? If none, note that. isposal Information.-where and who? If none;-note that...< . . Applicant Signature - understand what is listed and:.noted Staff Initial -.any.questions,-know who to.ask Washing/Rinsing?. -..give a vehic.le.wash.ing policy and explain.it; . ach the Business Certificate=with;your sign of -and comments "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. Fill in please: DATE y� cr. - , •._ APPLICANT'S YOUR NAME/CORPORATE NAME (f (//(/jCQiJ��cn (kb'VV&d ISINESS TYPE: (tL/�SS I ( ok� e�OC,(�� BUSINESS YOUR HOME ADDRESS: C ✓ �`� TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS 'The_ C c r Cr-L'- P Have you been given approval from the buildin tvi ion? YES NO _ Q' ADDRESS OF BUSINESS Lit ' (,iY Wry�+ GM�✓i' 6 MAP/PARCEL NUMBER 3Lj C3 C U When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual b en of r ed of the pew it r ements that pertain to this type of business. / Z Mai Gd A� Authoriz ignature** COMMENTS: 3. CONSUMER AFFAIRS (LI ENSING AUTHORITY) This individual has b info d f e licensing requirements that pertain to this type of business. Au Porizeo Signat re** COMMENTS: r i TOWN OF BARNSTABLE Date: TOXIC AND HAZARDO S MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: /- U V S BUSINESS LOCATION: 7 0-/Majftq INVENTORY MAILING ADDRESS: S'9WC VTOTAL AMOUNT- TELEPHONE NUMBER:' -27(0- S" S Cl CONTACT PERSON: may' NL�N7` EMERGENCY CONTACT TE EJP S" y HONE N MBER: ��= 7�� MSDS ON SITE? TYPE OF BUSINESS: tz) I.I)ecyo-C U SS '52 INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111 Section 31 of the General Laws of MA p , hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar CB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap c n i ature Staff's Initials Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 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 6/30/2013 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 f r Town of Barnstable Op THE Regulatory Services a Thomas F. Geiler,Director BAMSMBLE, Public Health Division 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 7/Z 3 //Z APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT J U N ► y NAME OF ESTABLISHMENT 2 J46 IAJ-0 14- ADDRESS OF ESTABLISHMENT 'S TELEPHONE NUMBER V '7 9 7 SOLE OWNER: YE NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: "' d�' M•..> ,ray J IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION , FULL NAME AND HOME ADDRESS OF: PRESIDENT - TREASURER CLERK SI A OF APPLICANT RESTRICTIONS: HOME ADDRESS 7� �� `P� y ��D S,��Q tcJ�c /lifA i HOME TELEPHONE# ., Haz.doc/wp/q I t , 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 FAD 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 Emergency Spill. Response Plan For Hazardous Materials z If there.is a..: • Fire; • Explosion; • Rescue needed; • Serious personal injury; • Life threatening situation; CALL 911 and... • Activate any alarm system; • Warn people to evacuate; • Assemble at safe distance; • Account for people/staff; • Secure area; • . Collect spill info and MSDS; _Wait for_responders._._-~_.._. .._ SPILL RESPONSE PLANNING Individuals are responsible for their own spills. Each hazardous material user must be ready through proper advanced training and equipped to handle a spill. Critical Elements for a Safe and Effective Response are: 1. Information and knowledge of materials used 2. Adequate spill response supplies 3. Proper training 4. Knowing when, and who to call for assistance, To Prepare: 1. Collect MSDS's (Material Safety Data Sheets) for the hazardous materials you Use. Keep them stored outside the potential spill area. 2. Maintain a call list (daytime and after-hours) of individuals who should be notified in an emergency. 3. Collect and maintain spill response supplies/spill kits in your shop areas. 4. Train and practice for effective spill response at least annually. f HOW TO RESPOND TO SPILLS 1. Attend to Personal Iniuries. • Clothing on fire: Roll person on floor to smother flame, drench with water if immediately available. • Splash in eyes: Immediately rinse eyes with water continuously for 15 minutes. Forcibly hold eye open to rinse behind eyelids. Obtain medical attention. • Spill on body: Remove contaminated clothing and flood exposed area with running water from faucet or safety shower.for 5 minutes. Make sure spill has not accumulated in shoes. • Minor cuts and puncture wounds: Wash vigorously with soap and water. • Report all personal injuries to your supervisor. 2. Assess the Risk. Simple spills meet all these criteria: • Do not spread rapidly • Do not endanger people or the environment except by direct contact • Can be managed safely by people trained to use the material. Maior spills meet any one of these criteria: ' • Do spread rapidly • Involve a personal injury or could endanger people • Present an inhalation hazard • Could endanger the environment. 3. Initiate Action. Simple spill: Notify any affected people • Keep the area clear Plan your cleanup •. Call Fire Department for advice if needed. Major spill (10 gallons or more and unable to contain/clean up properly): • Dial 911 or call the Fire Department within 15 minutes • Alarm, evacuate, and assemble at a safe distance • Collect spill information • Wait for responders. CHEMICALS General Guide for Chemical Spills: • Determine identity • Consult MSDS • Avoid breathing vapors, get as much fresh air into area as you safely can • Absorbants and neutralizing agents must be compatible with chemical spilled • Prevent spilled chemicals from going down drains (public water supply) • Dispose of cleanup materials as chemical hazardous waste, small volumes of dilute acids and bases may be neutralized (pH 6-8) and sewered • Call hazardous waste disposal company for hazardous waste pickup, or guidance on cleanup or air monitoring. Simple Spills--liquid • Alert people in area • Wear protective equipment • Contain by diking with appropriate absorbant • Flammable--remove ignition sources (burners, motors, anything that could cause a spark), use plastic or nonmetallic cleanup equipment • Absorb or neutralize with appropriate agent working from outside" edges inward. Simple Spills--dry • If not water reactive, dampen to prevent airborne dust • Control water reactive dust with sweeping compound • Carefully brush solids into a dust pan or container Keep dust generation down to prevent creating inhalation hazard. Compressed Gas Leak--simple • Presents no inhalation hazard • Restrict access Place in fumehood if possible, tighten fittings • Locate leak with soapy water (at below freezing temperatures use 50% glycerine solution) If cylinder still leaks, contact supplier. Compressed Gas Leak--maior • Large or uncontrollable leak or fire hazard • Evacuate, ventilate affected area • Call 911 immediately Contact supplier. Major Spills • Evacuate • Call 911 or Fire Department • Wait for responders. REVIEW Conduct Annual Traininq: • Review your Spill Response Plan with all staff at least once a year. • Discuss pre-designated evacuation areas. • Involve input from local Fire Department/HazMat Responders. Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is.to Certify that JMR HondalPolaris 741 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 6/30/2011 unless sooner suspended or revoked. • ----------------------------------_.. . WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D.__ 6/30/2010 JUNICHI SAWAYANAGI _.,THOMAS,A..MCKEAN,R.S.,CHO ~v Director of Public Health Town of Barnstable �pE1HE rph� Regulatory Services Thomas F. Geiler, Director • BARNSTABLE, MASS. Q Public Health Division 9�p 1 6g q: plf�MP�A 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT cl r'l^J <�5- 1419 "Js NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT ( TELEPHONE NUMBER 5, 2)0 �7-lf SOLE OWNER: Nl<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 HOME ADDRESS OF: PRESIDENT TREASURER CLERK F SIGNAT E OF APPLICANT <;RESTRICTIONS: HOME ADDRESS � �� 0a, j, K4 # H_OMEr{TELEPHONE# Haz.docA%p,'y .Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 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 6/30/2010 ».nless sooner suspended or revoked. WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health (} Town of Barnstable Barnstable �0Tti Regulatory Services Department o, i mica CRY • Public Health Division BARNSTABU- ` 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 7 / A/ APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT it!/v5 13 NAME OF ESTABLISHMENT :��rmA ADDRESS OF ESTABLISHMENT 7W TELEPHONE NUMBER 2" SOLE OWNER: YE NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: - C CC) "1 C 7 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3/ 7 STATE OF INCORPORATION 01 FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK • IGNAT(1RE OF A LICANT RESTRICTIONS: HOME ADDRESS 7/12de/fll Y�L/ �j�f!-4W1e'Af HOME TELEPHONE # Q:\Hazmat\Haz Mat Application2008.DOC I , • 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 time 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 of$100. Please make the check payable to: Town • of Barnstable. The check must be mailed to the address listed above. Allow time for in house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Pa e • QAHlazmat\Flaz.Mat Application200S.DOC • Emergency Spill Response Plan For Hazardous Materials If there is a... • Fire; • Explosion; • Rescue needed; • Serious personal injury; • Life threatening situation; CALL 911 and... • Activate any alarm system; • Warn people to evacuate; • Assemble at safe distance; • Account for people/staff; • Secure area; • Collect spill info and MSDS; • Wait for responders. SPILL RESPONSE PLANNING Individuals are responsible for their own spills. Each hazardous material user must be ready through proper advanced training and equipped to handle a spill. Critical Elements for a Safe and Effective Response are: 1. Information and knowledge of materials used 2. Adequate spill response supplies 3. Proper training 4. Knowing when and who to call for assistance: To Prepare: 1. Collect MSDS's (Material Safety Data Sheets) for the hazardous materials you use. Keep them stored outside the potential spill area. 2. Maintain a call list (daytime and after-hours) of individuals who should be notified in an emergency. . 3. Collect and maintain spill response supplies/spill kits in your shop areas. 4. Train and practice for effective spill response at least annually. • HOW TO RESPOND TO SPILLS 1. Attend to Personal Injuries. • Clothing on fire: Roll person on floor to smother flame, drench with water if immediately available. • Splash in eves: Immediately rinse eyes with water continuously for 15 minutes. Forcibly hold eye open to rinse behind eyelids. Obtain medical attention. • Spill on body: Remove contaminated clothing and flood exposed area with running water from faucet or safety shower for 5 minutes. Make sure spill has not accumulated in shoes. • Minor cuts and puncture wounds: Wash vigorously with soap and water. • Report all personal injuries to your supervisor. 2. Assess the Risk. Simple spills meet all these criteria: • Do not spread rapidly • Do not endanger people or the environment except by direct contact • Can be managed safely by people trained to use the material. Maior spills meet any one of these criteria: • Do spread rapidly • Involve a personal injury or could endanger people • Present an inhalation hazard • Could endanger the environment. 3. Initiate Action. Simple spill: • Notify any affected people • Keep the area clear • Plan your cleanup • Call Fire Department for advice if needed. Major spill (10 gallons or more and unable to contain/clean up properly): Dial 911 or call the Fire Department within 15 minutes • • Alarm, evacuate, and assemble at a safe distance • Collect spill information 0 Wait for responders. CHEMICALS General Guide for Chemical Spills: • Determine identity • Consult MSDS • Avoid breathing vapors, get as much fresh air into area as you safely can • Absorbants and neutralizing agents must be compatible with chemical spilled • Prevent spilled chemicals from going down drains (public water supply) • Dispose of cleanup materials as chemical hazardous waste, small volumes of dilute acids and bases may be neutralized (pH 6-8) and sewered • Call hazardous waste disposal company for hazardous waste pickup, or guidance on cleanup or air monitoring. Simple Spills--liquid • Alert people in area • Wear protective equipment • Contain by diking with appropriate absorbant • Flammable--remove ignition sources (burners, motors, anything that could cause a spark), use plastic or nonmetallic cleanup equipment • Absorb or neutralize with appropriate agent working from outside edges inward. Simple Spills--dry • If not water reactive, dampen to prevent airborne dust • Control water reactive dust with sweeping compound • Carefully brush solids into a dust pan or container • Keep dust generation down to prevent creating inhalation hazard. Compressed Gas Leak--simple • Presents no inhalation hazard • Restrict access • Place in fumehood if possible, tighten fittings • Locate leak with soapy water (at below freezing temperatures use 50% glycerine solution) • 0 If cylinder still leaks, contact supplier. • Compressed Gas Leak--maior Large or uncontrollable leak or fire hazard • Evacuate, ventilate affected area • Call 911 immediately • Contact supplier. Maior Spills • Evacuate • Call 911 or Fire Department • Wait for responders. REVIEW Conduct Annual Training: n • Review your Spill Response Plan with all staff at least once a year. • Discuss pre-designated evacuation areas. • Involve input from local Fire Department/HazMat Responders. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form , at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE: ��c J�l 2 co C-t Fill in please: r ES Xl e Y7 sg 3 C e y � � APPLICANT'S YOUR NAME: i c 2 `C t7 12 /14 F ( d 1 . ' FS7BUSINESS YOUR HOME ADDRESS: fi�l i► t1 i R ►� `tA&,A-- S F'1 d4 ®L6e i a i r TELEPHONE # 6853WHome Telephone Number: NAME OF NEW BUSINESS AMe.,Z e; ROTOeS ►u'C VJ&A A%Ag,7ji TYPE OF BUSINESS O IS THIS A HOME OCCUPATION? YES NO A VTo SALES .Have:you been given approval from thebuilding ivision? YES. NO AD DRESS OFBUSINESS -Lli' /�1R+ko�.r- (�� ,.�.-%��Vn.�S r �'/1� : @L&(^' MAP/PARCEL NUMBER:-' '�LIS'`(�O� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1.` BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: - 2. BOARD OF HEALTH This.individual formed o p requirements that pertain to this type of business. MUST COMPLY WnALL / ( �=!'A74Rr1n�is Rnn,T�?��� � o�rrr n nTrnnrC Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h en inf ed of the I'c ns' r ements that pertain to this type of business. Au orized SignatKre** �! � lt COMMENTS: -�(J � (� � T Date:12 /, / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAMEOFBUSINESS: e� VozioBS Imc P8A Euto- ATj_AsvTit Avi0 Stic6s BUSINESS LOCATION: DLI I /AQ-PA0v114 get i 4'1161410.':S IPA 0&0 INVENTORY MAILING ADDRESS: Sam TOTAL AMOUNT- TELEPHONE NUMBER: -5Q9 - G ;? S - 1L( 60 CONTACT PERSON: �_5 A P-T 14"A m 13C-It� EMERGENCY CONTACT TELEPHON NUMBER: ScA.,M2 MSDS ON SITE? TYPE OF BUSINESS:- 0 ��5 INFORMATION/RECOMMENDATIONS: Fire District: 7 CAS Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) ___ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removersy Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that JMR HondalPolaris 741 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 June 30, 2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN. PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 7 Town of Barnstable Barnstable VE r ti Regulatory Services Department o� N-AmarioaCity Public Health Division + BARNSTABLL ' I`"A3 1639. 200 Main Street, Hyannis MA 02601 �� 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE 0 " APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT j(J/V f y NAME OF ESTABLISHMENT J;�l A 14 OrJ54 Jj—Z7PJ,--/ j��ADDRESS OF ESTABLISHMENT / D ! " _yr� TELEPHONE NUMBER SO 77o9 7 SOLE OWNER: YE NO w IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRE S OF L PARTNERS: co r r— ti IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT J0 NI0S A . Z'f f\LS TREASURER CLERK S AT - F APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# � �n Q:\Hazmat\Haz Mat Application2008.DOC Town of Barnstable OF THE tp� Regulatory Services Thomas F. Geiler,Director Public Health Division 1ARIVSTABLE, Thomas McKean,Director Q 9 MASS: g cb 1639, 200 Main Street, Hyannis,MA 02601 ArFD��A Phone: 508-862-4644 Email: health@town.bamstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 May 8,2008 Mr.J.B.Hopkins RE: Toxic and Hazardous Materials JMR Honda/Polaris On-Site Inventory and Inspection, 741 Yarmouth Road JMR Honda/Polaris, Hyannis,MA 02601 741 Yarmouth Road, Hyannis Dear Mr.Hopkins: On April 24,2008,a Toxic and Hazardous Materials On-Site Inventory and Inspection of the above referenced site was conducted by the Public Health Division(PHD).An On-Site Inventory and Inspection is a review of the sites storage,transport,utilization and/or disposal of toxic and hazardous materials as it relates to the Town of Barnstable Ordinance,Chapter 108:Hazardous Materials. This Ordinance was adopted to protect the public health and welfare,especially as it pertains to the public drinking water supply. The following is a description of the results of the Inventory(enclosed)and Inspection. MATERIALS INVENTORY AMOUNT AND PURPOSE: The Inventory of this site indicates the use or storage of approximately five-hundred and sixty-four(564) gallons of toxic and hazardous material.This material is used in the repair and maintenance of motorcycles and for retail sales: Please be aware that the Town of Barnstable has determined that a minimum of one- hundred and eleven(111)gallons of toxic and hazardous materials requires an annual license. GENERAL STORAGE AREAS AND CONDITIONS: • A one bay garage houses a sink which is used to drain oil into a two-hundred and seventy five gallon waste oil tank located in the basement. There are also two,twenty gallon portable gas tanks, two,five gallons waste gasoline tanks,gear oil,waste antifreeze,a parts cleaner and an acetylene kit stored in this garage. • The"Parts Department"houses all virgin motor oil products,miscellaneous cleaners,and miscellaneous lubricants(i.e.miscellaneous combustibles and flammables).The majority of these materials are packaged for retail sales in small quantity(less than one gallon)plastic bottles and spray cans. SAFETY AND DOCUMENTATION: The Material Safety Data Sheets are on site in a binder,additionally a Honda computer program allows dealers to access Material Safety Data Sheets.JMR Honda/Polaris was in receipt of a License for storing or i y -2- handling 11 I gallons or more of hazardous materials._A Contingency Plan was available but needs to be updated. Speedy Dry was available in the garage;however additional absorbent material should be made available for potentially larger spills. Manifest sheets for the transport of waste oil were provided upon request. Murphy's Waste Oil/Clean Harbors licensed hauler. Waste gasoline is brought to the Barnstable Transfer Station... SITE FACILITIES: There were no floor drains observed. The site building is served by an on septic system. Any deficiencies which were discovered in the course of this inspection with regards to the Hazardous Materials Ordinance are described below. CORRECTIVE ACTIONS TO BE TAKEN: A Contingency Plan outlining emergency contacts,the steps to be taken in the event of a hazardous materials spill on site,the location of the"Spill Kit"(speedy dry,absorbent pads)and the proper disposal of any spill related contaminated material shall be posted by a telephone and a copy submitted to the PHD. The PHD,appreciates your cooperation and acknowledges your intent to maintain compliance with the Hazardous Materials Ordinance.This office will conduct a follow-up inspection within four weeks to verify that all corrective actions have been taken.Please contact me at the above telephone number should you have any questions or comments regarding the Inspection of your site. Very ly�yoourrs, Cyn i A. Martin Haz dous Materials Specialist All orders to orrect violations of Chapter 108 of the Town of Barnstable Ordinance: Hazardous Materials. sh a com eted upon receipt of this letter homas A.McKean,RS.CHO Director of Public Health Enclosure: Toxic and Hazardous Materials On-Site Inventory PAiD,0) P� Date: /,;;t / D TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 2 Rd i 01VIM P01-A1 if BUSINESS LOCATION: -7y/ ��A��oy ���T INVENTORY MAILING ADDRESS: CIS eid0V6 TOTAL AMOUNT: TELEPHONE NUMBER: -rP — 791- ' "�� � r V CONTACT PERSON: 1 8. #01fkIAIS EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 1(0217)-L`CyLA5 3,4-t,"_S ASP 967pA-l!% yEs INFORMATION/RECOMMENDATIONS: S&L-` A177K#t_P Z7ALL 6-7i°,J Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: s WASr�-®lL Destination Waste Product: V-14sr�OIL Licensed? ,T: No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW _15' USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils VA Q/o U-9 Pesticides NEW jj<USED (insecticides, herbicides, rodenticides) D Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 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, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Iota.rqy, Regulatory Services Thomas F. Geiler,Director i NAM ' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 1@8-790-6304 Application Fee: $100.00 air" N tf1 U ASSESSORS MAP AND PARCEL NO. DATE C' 00 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT \J tfi NAME OF ESTABLISHMENTa+ ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER:�YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. d y3I77X 7 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER C.LERx SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 6,440 +eY 90 HOME TELEPHONE 9 .•�o S��e /� POLRRIS qlfI-IONDA Japan Motors Racing% *SUZUKI.,,. i� 741 Yarmouth Road I kwuiis.MA 02601 (508)778-7211 Fax(5081778-1963 Number Fee 165 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that JMR Honda/Polaris 741 Yarmouth Rd., MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------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. May 15, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Gi L Town of Barnstable y Regulatory Services oq I (� Thomas F. Geiler, Director BARNSrABM ` Public Health Division (JV 9� y/ Thomas McKean, Director r110k 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 III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT r ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER �� SOLE OWNER:�YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: r� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK . SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# gam �fZ4 � Q:\Application Forms\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 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q:\Application Forms\HAZAPP.DOC ��� � -� ti� �°°� �Ne����' Town. of Barnstable Regulatory Services Thomas F. Geiler,Director ti. Nt a Public Health Division 8; E / �yp ¢3`9*s'e0r zf � Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 0 A PR 2 0 f+H 8: 43 Office: 508-862-4644 Fax: 508-790-630 Application Fee: $100.00 -- CF±v1�PiJi� �1 ASSESSORS MAP AND PARCEL NO. DATE 7 ` -SIR- RA �� APPLICATION.FOR PERMIT.TO. STORE.AND/OR UTILIZE.MORE THAN. 111.GALLONS. OF.HAZARDOUS MATERIALS b FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NU 2 z->R �v � / . SOLE OWNER: Y NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 31772,S-7 STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK i 9YGriATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/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 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 If t � r�i ( 1kate Date: / 5 / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SIT INVENTORY NAME OF BUSINESS: J/ 14h 11M dA-.,, BUSINESS LOCATION: ,?ql I-M 4��- 1-n/U(5- INVENTORY MAILING ADDRESS: l TOTAL AMOUNT: TELEPHONE NUMBER: -52 ` 2 CONTACT PERSON: lb17/�/i�cl� EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMEND TIONS: 1 - Fire istrict: Lei'Z a- c Waste Transportation: Last shipment of hazardous.waste: Name of Hauler- Destination* Waste Product: Licensed. Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _. Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ' Town of Barnstable °FSNE,�,y Regulatory Services ti Thomas F. Geiler,Director '"ma's''" ' Public Health Division 9� i . �b . 10� 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 7 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT fl NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT ��` Nv �� TELEPHONE NUMBER SOLE OWNER:-%�ES 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 HOME ADDRESS OF: . PRESIDENT TREASURER CLERK a' SIGrLTAE OF APPLICANT RESTRICTIONS: HOME ADDRESS �71 '��/'� HOME TELEPHONE —5,. Hu.doc/wp/q i )� OI WASTE OIL OIL FILTERS &IFEEZE WASTE I j 63 ANITFREEZE �� ► ��� �3, 10,1.jf GASOLINE WASTE GAS DIESEL FUEL W/W FLUID ATF 15 S HYDRAULIC/ MISC. MISC. MISC. MISC. BRAKE FLUID COMMBUSTIBLE FLAMMABLE CORROSIVE PETROLEUM (GEARLUBRICANTS) la a FREON ACETYLENE CAR WASH CAR WASH P TS/ WAX DETERGENTS THINNERS SEALANT CLEANING BATTERIES/ POISION/TOXIC CAULK/GROUT SOLVENTS BATTERY ACID FERTALIZERS WASTE SOLVENT MSDS qt6 - MANIFESTS '� 9 r► V Town of Barnstable IPA Regulatory Services n Thomas F. Geiler,Director 0 / 9'MASS. � Public Health Division i 39 t/ 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 Y FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 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. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK / 4GNATURE OF APPLICANT f, RESTRICTIONS: HOME ADDRESS 71,& 1e111�9 .HOME._TELEPHONE# Haz.doc/wp/q f < 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 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 0-"CAa- BUSINESS LOCATION: 60001 S INVENTORY MAILING ADDRESS: `� TOTAL AMOUNT- TELEPHONE NUMBER: -6-6 $— -7 -7 8 _ `7Z// S176724 ��_s CONTACT PERSON: J.� -6, LIB r-ii s EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: _ (392k2jA 1 Sew Ah C4e_ /MA�or lc�`t4�s es INFORMA ION/RECOMMENDATIONS: � - o�.is�5� -E-�"ne' Fire Dis rict: Sown A 's exlFrne5 o;n 11`7- 04 Waste Transportation: L^e- Last shipment of hazardous.waste: Name of Hauler: CA can 1 6L4 ,af-s Destination: Waste Product:OC I , Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum _ Antifreeze (for gasoline or coolant systems) Misc. Corrosive 19 NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants I/ Motor Oils Pesticides 3 S NEW USED (insecticides, herbicides, rodenticides) Zv G Psoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) c� lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine `— Battery acid (electrolyte)/Batterie Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids `"'� U�( (dry cleaners) yal Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I ate: 6 TOWN OF BARNSTABLE T6XIC AND HAZARDOUS MATERIALS ON- E"IN ;�TORY NAME OF BUSINESS: �� rl >ct��a , �,� •L"q.,pH BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -6-0 `9- -7-7 $ - -7Z/� CONTACT PERSON: �• ��'I' -S EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: �e��.Se wo'cg. IMo kVhc_s LA es INF RMA ION/RECOMMENDATIONS: �e 5��� •P'e Fire Dis rict: awn A s Noe e _ •s e-eN tee. 'C r' en aiy.sueJ Iceftae le><IF ne.$` c�1 -1-7- 04 - Waste Transportation: C Last shipment of hazardous.waste: Name of Hauler: CJleQ a I a ybo-Os Destination: Waste Product: Dc I}S ue-r - Licensed? Qes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants L/ Motor Oils Pesticides 3 NEW USED (insecticides, herbicides, rodenticides) �© Msoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED qA:F- Misc. petroleum products: grease, Photochemicals (Developer) crrA lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) t Caulk/Grout Swimming pool chlorine S Battery acid (electrolyte)/Bat Lye or caustic soda Rustproofers Misc. Combustible 6zoACar wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables ✓ hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids " (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: JMR Honda/Polaris Fax: r � Corp Name: Mailing Address Location: 741 Yarmouth Road,Hyannis Street: 741 Yarmouth Road mappar. '345-008-000-000 City: Hyannis Contact: J.B.Hopkins State: Ma Telephone: .508-778-7211 Zip: 02601 Eme ency: Person Interviewed: J.B.Hopkins Busin ss Contact Letter Date: 6/3/2004 Category: VehicleMamtenance Inventory Site Visit Date: $ py Type: Retail Follow Up/Inspection Date: i rpi aAA 91 ubli water El floor drains El surface drains p c W license required ❑ priva water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc W currently licensed i ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir - �17/2004 ❑� on-s-a sewage ❑ indoor on-site syste ❑ outdoor onsite system date: __..._......... in petted 4/8/94. Remarks 2/4/97 Spedidry for spills. Apparel compliance: ast for rags. MSDS sheets on site. Waste oil&oil filters Satisfactory ed. REMARKS: , 4in black buck @ parts rept. MV 508 7787211 AST in the bsmt. Spills evident on conc. Fl.No vent on tank-needs to be vented outside. Spills covered w/speedy dry. Intestate takes batteries. Parts washer waste added to W.O.tank.Electric car lift. Hand sink in Mechanics Bay not tied-in to plumbing. ORDERS: Vent AST to y outside. Connect hand wash ink to septic. New motor oil-12 cases; Parts washer-1 drum.-16. C� J J �5� V -17 IV' - �?z� a�� 6,0 S �. Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals gty's 111 gals or more description:. unit of measured ' motoroil .................... u_..__.__._... _._.._._.... antifreeze(for gasoline or coolant systems) 5gallons ............__._.._..__ y __...__.._ hydraulic fluids(including break fluid) ��Fl w1 gallons diesel fuel,kerosene,#2 heating oil 5gallons ... �. .......... _ _ ... misc.petroleum products:grease,lubricants 51pounds degreasers for engines and metal _ 1cases batteries/battery acid } 2gallons car waxes and polishes 6 cases _.__....__.._ ..._........._.._........_.......__..............__. paint,varnishes,stains,dyes ? 10 cases Waste Transporter: Fire District 5 Last HW Shipment Date: L( l I Waste Hauler Licensed: Gvy ' Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: DBA: �aS Location: 1 ,Date: C, Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): 2. Waste storage areas: / 3. Satellite accumulation points throughout:/ 4. HazMat stored outdoors — CHECK OUTSIDE: /le o 5. Shipping and receiving areas: / 6. Run down of shop activities: / 7. Housekeeping practices: / l� J HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs DBA: Location: ---7(--k I Site visit date: • Hazardous Waste Manifests: i 51`4-e • Employee training documentation (if required): // • Hazardous substance spill control and contingency plan: / • MSDS on site? • HazMat Inventory records (if applicable): + • HazMat Waste Shipping documentation: • Spill records (if applicable): �/ = TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations, Repair BOARD OF HEALTH O satisfactory 2. Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers ,COMPANY Ac\is y.�u (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS -)q I j A 1�.O�_ tJA Class: -7 7. Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTI gallons Age ITest Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) i new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: r DISPOSALIRECLAMATION REMARKS: F tN o QGyNni n 1. Sanitary Sewage 2.Water Supply `0 Town Sewer OPublic Q � r-Au .4 O On-site OPrivate 3. Indoor Floor Drains YES NO X '��•� � j O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0->I— ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name.of Hauler Destination Waste Product Licensed? YES NO 1. 2. J , T�A,/\ -A, /Po/0 .0V 1'er on (s) Interviewed Inspector - Date ,I TOWN OF BARNSTABLE �; MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD OF HEALTH satisfactory 3.A �J to Body Shops O unsatisfactory- 4.Manufacturers COMPANY_ c << �-�tUCt -�GC�n (see"Orders") 5.Retail Stores �. 6.Fuel Suppliers ADDRESS ��I 1 t�?d�kJ Class: 7. Miscellaneous <�kZ. QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) �C) new motor oil (C) j CS transmission/hydraulic Synthetic Organics: degreasers X Miscellaneous: c CS X DISPOSALIR.ECLAMATION REMARKS: 1. S 1tary Sewage 2.Woer Supply O Town Sewer pPublic Q On-site s OPrivate 3. Indoor Floor Drains YES N0)� r O Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES N0\_l ORDERS: Q Holding tank;MDC O Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed?' 4 YES NO 2. i erson,(s erviewed Inspector Date f I TOWN OF BARNSTABLE �D NCE: CLASS: 1.Marine,Gas Stations,Repair 2. Printers BOARD OF HEALTH © satisfactory r�` 3.Auto Body Shops r O unsatisfactory- � ' 4.Manufacturers COMPANY c,�G Add"�Lckuc1� (see"Orderst);t� 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: �j_ 7•Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks 117 OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) X new motor oil(C) C� transmission/hydraulic Synthetic Organics: degreasers` j Scs x. Miscellaneous: CS DISPOSALIRECLAMATION REMARKS: f 1 1. Sanitary Sewage 2.Water Supply Cj�J 11c �kL�. ` { C( ' Ofl O Town Sewer OPublic VQ ' t-, O 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 NO ORDERS: O Holding tank:MDC ri 43J al 14 r 4 LU I O Catch basin/Dry well O On-site system 5.Waste TransporterUCA V Nanie.of Hauler Destination Waste Product •d 1. YES INO 2. Person W lqieWeweTom�" Inspector ate I TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH ro satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY »v�£t-twN �_i✓S S (see"Orders") 5.Retail Stores nn � 6.Fuel Suppliers ADDRESS 1$3 ��tou �' Class: o� 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS 61se lots Above Tanks Under6n-ound Tanks IN OUT IN OUT IN OUT #&gallons 1Age 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: - Sa d DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply own Sewer Oublic rim On-site OPrivate 3. Indoor Floor Drains YES N0,)L 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES_/S_NO_X, ORDERS: 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 5.Waste Transporter YES NO 2. erson(s) Interviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops _ .� unsatisfactory- 4.Manufacturers 6 COMPANYU � K.1 (see"Orders") .Retail Stores .Fuel Suppliers ADDRESS � fh Class: 7.Miscellaneous A�_A�100Vrs QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSguro IN OUT IN 10UT IN OUT #&gallons Ag;e ITest Fuels: Gasoline,Jet Fuel (A) ' Diesel;Kerosene,.#2,(B) t Heavy Oils: waste motor oil (C) -_._..- 4 new motor oil(C) , Synthetic Organics: degreasers Miscellaneous: DISPOSALfRECLAMATION REA ARKS: 1. Sanitary Sewage 2.Nyater Supply e Q Town Sewer Public On-site OPrivate E z W 4 C �- 3. Indoor Floor Drains YES----No O Holding tank:MDC _ v;�i Z. lei O Catch basin/Dry well v� � O On-site system 4. Outdoor Surface drains:YES N0—)/ ORD RS: O Holding tank:MDC O Catch basin/Dry well ' O On-site system 5.Waste Transporter Name of Hauler Destination .: ' : YES NO 2. P rson Interviewed Inspector Date •` I J �a ca �e. • m I- L —0 Certified Mail Fee / \ Extr Seres&Fees(check bbx,add fee as appropgoje) Q .turn Revicceipt(hardcopy) $ C3 __,,//Retum Receipt(electronic)( $ �Z Postmark C3 certified Mail Restricted Delivery $_ ,� )Here E3 ❑Aduh Signature Required I 0 Adult Signature Restricted Delivery$ �!t• O Postage O Total Posta a an Foes Lam,,• o °>,'�;?12�; ►'q f----------------------------- S�ie�t�and pt. o.,or O Box No. Cry St-e.ZIF ✓� LS_"=e---I�------------------------------------- Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders. Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). _ or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is not available for requires the signee to be at least 21 years of age international mail. e,�ti and provides delivery to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not,change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.It you would like a postmark on. ■For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this.label,affix it to the mailpiece,apply You can request a hardcopy return receipt or"m `appropriate postage,and deposit the mailpiece.•- electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt attach PS Form 3811 to your mailpiece; IMPo11TAN1:Save this receipt for your records PS Form 3800,April 2015(Reverse)'PSN 7530-02-000.9047 Date: r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: AcTofifC� BUSINESS LOCATION: "7LI' v/q rA4 U ��J_ 110a^-� MAILINGADDRESS" Mail To: � � ��� Board of Health TELEPHONE NUMBER: Town of Barnstable CONTACT PERSON: ,a_ P.O. Box 534 EMERGENCY CONTACT TEL&IbNE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: To Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? 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 character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i TO ALL NEW BUSINESS OWNERS Please Fill in: APPLICANT'S NAME &C4V HOME ADDRESS: -21 TELEPHONE NUMBER: x3 95 (Please give us a number where you can be reached) ` NAME OF NEW BUSINESS-4�rj , pw �r .-j cjc) le . TYPE OF BUSINESS IS THIS A HOME OCCUPATION? ?/U ADDRESS OF BUSINESS 7YI. y9t,m o,-,# j MAP/PARCEL- NUMBERf_� �l�S —� -- to When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable.. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor - Town Hall). 1. GO TO BUILDING INSPECTOR'S OFFICE (4TH FLOOR TOWN HALL) This individual has f"i ed ny permit requirements that pertain to this type of business. Authorized Signature COMMENTS: l/l 011 2. GO TO BOARD OF HEALTH (3RD FL OR TOWN HALL) This individual has been inform d of the mit requirements that pertain to this type of business. Aulhgqn ignature COMMENTS: D .�lnie-�:t.. ,-� - ' � j no veG+�c.(Q. ' c1+�i�r eqr/ On zeC. 3: GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY This individual has been informed of the licensing requirements that pe tai00Rn to tSs SCHOOL f ADMINISTRATION sins BUILDING) Authorized Signature COMMENTS: After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost $20.00 for 4 years). A business certificate ONLY registers Your name in the town of Barnstable - it does not give you permission to operate -you must get that through completion of the processes from the various denartments inkrn1w-rl TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. nters BOARD OF HEALTH O satisfactory 3.Auto Body Shops (� unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores COMPANY �a `�, 6.Fuel Suppliers ADDRESS 7 �e�r.�41 Y&,t s tl�d Class: I 7•Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums 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) ,- K transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: f-/G DISPOSAIJRECLAMATION REMARKS:1. Sanitary Sewage 2.Water Supply fj0f 6h1 elk XO-, 12, /46!L9V U ?77-74 O Town Sewer OPublic Axr 4s"tt, fi 1 1 ev OL, G /, 9-On-sitePrivate�!✓�1 ._y, i M b 1 k, Lk(A 01- If- AZRd--J14014C J ekL 1 CV/ (J/tic 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well `() kta 16, w&i'k aQW b 6j.0• datic 6t• G' � �<c O On-site system co--, 4-4. f't ',,, k(4&,i Cj 60 Af'G-) ` 4. Outdoor Surface drains:YES NO_2� ORDERS: �f "��` O Holding tank:MDC ewf ev J'i O Catch basin/Dry well waf 4 Sri. - O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YE N0 1. Gn'� �3� c��J ���' ✓rn ram', 2. bAll sAi rso Interviewed Inspector Date Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: raj C.c/-M ldiv� v fd 2 S BUSINESS LOCATION: .S 4 yv"n MAILINGADDRESS: Wa v"oL4 ffiyiA v� ii ~S�vvv9 Mail To: 7� I Board of Health S�-6 TELEPHONE NUMBER: Town of Barnstable CONTACTPERSON: L' ��` rr e r1 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: LJJ60 CA 5ACaA CIr+X-y Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO Any '�erv,*ct 0.,*®o4?vwv ' -115 1"• 76, Y,�.n 0-u Vh 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: co.e rsre CL4c-r4-iA"I l krsc,-t,� rh yWLrw, oAf1-\, ADDRESS: 06 m m:a.A-e_:c Q V ' fe TELEPHONE: 76o-de03 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Paint brush cleaners Any other products with "poison" labels (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS s aLl lDate: I OXIC AND H�RDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: BUSINESS LOCATION: #wob rh . ko MAILINGADDRESS: 1.�/ Mail To: TELEPHONE NUMBER: S6 d (- 7� s 2,/ Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: -6ff' 7- 7 Hyannis, MA 02601 TYPEOFBUSINESS: Wo7�D� �,C�- ,47-1/ , �/t�f?776 / � Does your firm sto any of the toxic or hazardous materials listed below, either for sale or for you own use? 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: CA-,M 4� TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity 1 Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants ffi or oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) v�6A- 9 Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED /JLI__ begreasers for engines and metal Printing ink `-Degreasers for driveways & garages Wood preservatives (creosote) � (_Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers f1� P s, varnishes, stspss!Aes�� PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ne, rno �. cyC� s Q Lam, TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair tory 2.Printers BOARD OF HEALTH �Cusa'islac 3.Auto Body Shops - ,� nsatisfactory- 4.Manufacturers COMPANy�Y►�L / � V�J/G�l�/� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: a- 7.Miscellaneous l Lt.Cr QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALSCase lots Drums 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) D X transmission/hydraulic ZO X Synthetic Organics: degreasers x 4jv4%'A gv:e c 1:),S"o.z_ l Le-jC4 f'"r� ca-� -- � Miscellaneous: `l DISPOSALIRECLAMATION REMARKS: 01 1. Sanitary Sewage 2. Water Supply 2piLdU fa S' `-r O Town Sewer �Wublic y �@_On-site OPrivate S, 3. Indoor Floor Drains YES NC O Holding tank:MDC 4 � O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO i. ka+-bo v 2. � Per n (s) Interviewed Inspector Date 11TOXIC AND. HAZARDOUS MATERIALS REGISTRATION FORM A 'i )-� �S Mail To: NAME OF BUSINESS: r Board of Health MAILING ADDRESS: ltsdQr_LA Wl&flS' Town of Barnstable TELEPHONE NUMBER: �717 7 y P.O. Box 534l� Hyannis, MA 02601 CONTACT PERSON: <S 8 - o��r✓� 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 gallonsliquid volume or 25 pounds dry weight. 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 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 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 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 Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 0 satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots / Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) P7.� new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Mis ellaneous: I DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer qPublic On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: I 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Perso (s) Int ewed U Anspector Date r I , TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAMEJOF BUSINESS: , �Cel� C�0 //.) Board of Health MAILING ADDRESS: aC/7` y���l Town of Barnstable TELEPHONE NUMBER: '����:`_�5. � P.O. Box 534 CONTACT PERSON: 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 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 Y ( 9 ) ✓ 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 Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, v ' , 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 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 Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business � e J TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers l Stores C0XPANY � o_�(4i�- (see"Orders") 6.Fuel5. 1Suppliers ADDRESS ,J YA �� Class• 7 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATER S Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: f waste motor oil (C) � new motor oil (C) transmiss on/lydraulic Synthetic Organics: degreasers Miscellaneous: a� DIVOSAURECIAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public Jwon-site O Private 3. Indoor Floor Drains YES N0_k104> O Holding tank: MDC 0 Catch basin/Dry well 0 On-site system ' r 4. Outdoor Surface drains:YES NO k-1 ORDE S: 0 Holding tank: MDC O Catch basin/Dry well 0 On-site system 5.Waste Transporter Name of Hauler Destination YES NO Person ( wed Inspector Date rOWN 0-FBARNSIABLL 2. Printers . BOARD OF --HEALTH 0 satisfactory 3. Auto Body Shops unsatisfactory- 4. Manufacturers COMPANYIq (see"Orders") S. Retail Stores ::T7�TA 6. Fuel Suppliers ADDRESS �;� t�„ -} ��„n , Class:�_ 7. Miscellaneous � r QUANTITIES AND STORAGE (IN=indoors; OUT=outdoorf Case lots Drums AboveTanks Underground Tanks MAJOR MATERIALS IN OUT IN IOUT I IN UT # gellons A2e rest Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) ' Heavy Oils: waste motor oil (C) new motor oil (C) i,transmission hydraulic j Synthetic Organics: ! 1 degreasers ; . I ' Mi s cel l aneous•:, DISPOSAL RECLANAATION REWORKS: 1. Sanitary Sewage 2. Water Supply -, �.-._. _,_ _J7 OTown Sewer O�bl ic_64' O,On-site rivate 3. Indoor Floor Drains: YES NO ")( Holding tank: MDC TIN O Catch basin/Dry well _. rJ On-site system t ` 4. Outdoor Surface drains:YES NO OHoldinL• tank: MDC �`' �:ti_ O Catch basin/Dry well A_ OOn-site system _ ,,_T' �r C v`} -- S. Waste Transporter �Zr �. , �;, - �..�,�ic1s. 1-;{��\ ,n.��� icensed? Name of Hauler_ -15f,1ste cProduct YES NO z� ei Person s) I t. e e y- _. _ 'Ins ector1_ i, D e