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Home My WebLink About0100 BREED'S HILL ROAD - Health (2) 60 BREED'S HILL.Rb-P�'D 314-023 r: o Barnstable a c� a s i ` 1 n o s d r y Y December 8, 2008 p Massachusetts Department of Environmental Protection ' BRP Drinking Water Program t Underground Injection Control Program. t _ One Winter Street, 6th Floor : ; Boston, MA.02108 w Re: Notification of Ownership.Change This letter and registratson'packet is to Inform your department of an ownership change for'Cape ' Cod Potato Chi.. Company; Inc. of Hyannis MA, Please the-updated information: included P Z. -on six(6) registration forms for'the facility: As-required in.the Instructions, complete°copses of these forms area' being forwarded to the regional..MassDEP office, the local Boa d of Health and the local Plumbing Inspector ' Please contact Mr.-�Patnck Blake at our facility if you have any questions:or,require further ' a information k4 r ,. :° - Sincerely Newell irector'of Operations cc: Massachusetts Department'of Environmental Protection Southeas1 .t Regional Office_"`UIC Program 20 Riverside Drive Lakeville, M&02347 Board:of Health f � Town of Barnstable ° ' P.O. Box 534 �. a Hyannis, MA 02601 r Q Y Plumbing Inspector r.. ; Town of Barnstable .; E3 P.O. Box 534' cis Hyannis, MA 02601vry a s CAPE COD POTATO CHIPS •.Te1:508-775-3358 ' Fax:508-775-2808 100 Breed's Hill Road,Hyannis, MA 02601 a Massachusetts Department of Environmental Protection Bureau of Resource Protection - Drinking Water Program BRP WS 06 a.,b,c� Transmittal Number Registration of Discharges to Underground Injectio6`W611s .0 BRP WS 06 Modification to an'Existirig;UIC Registration, See Instructions UIC Registration Fee` check thew i. roy rlate well type category) J � PP P . YP 9 rY) Important:When filling out forms ❑ a. High includes the following well types-5A5,5D4,5W20&5X25 Registration Fee=$480.00 on computer, use only the tab ❑ b. Moderate includes the following well types-5A6,5A19,5F1;5S23& Registration Fee=$240.00 key to move your 5X27 cursor-do not .. use the return El C. .Low includes the following well-types-5A7,5A8,5622,5D2,5G30, Registration Fee=$ 90.00 key. 5R21&5X29 A .Pre-closureMS-06d form--for UIC wells not previously registered with MassDEP. Registration of these wells is not done using this form.They must be submitted on a,Pre-Closure/WS-06d form. ; e. Residential Exemption[for four units or fewer]-the following well types(typical residential activities) are exempt from a UIC registration fee:and have a separate registrationform WS-06e—5A7;5D2, 5G30&5X18. Seethe Class V Injection Well TyP6 Table at the end of the Instructions for well type. See instructions Transaction.Type Registration: -. ❑ Initial-new registration ❑ Initial existing registration ❑ Conversion ❑ Partial Closure/Registration - Modification: ® Change of owner/operator ® Change in or additional well/code(s) C . Change in location well(s) ❑ Change in of discharge wells(+/-) For modifications(required) MAS41A020001 UIC Registration ID#issued by MassDEP in the original UIC A. Facility Information For modifications, enter new or revised information: See Instructions Cape Cod Potato Chip Company; l'nc 100 Breed's Hill Road • Facility/Property Name Facility Street Address 2096 Company Name. SIC Code# (MassDEP Use Only)Facility# Hyannis Barnstable MA, 02601 Cityfrown County State Zip Code Facility PWS ID#(if appropriate) 508.790.3900 Facility Telephone Number `Facility Email(optional) EPA Hazardous Waste Generator ID# EPA Hazardous Waste Generator ID# UIC Updates 2008 01 to.CCPC•rev.08/06 BRP WS 06 a,b,d-Registration of Discharges to Underground Injection Wells•Pagel of 1 LlMassachusetts Department oftEnvironmental-Protection z . Bureau of Resource"Protection.- Drinking Water Program BRP WS 06 a;b,c h Transmittal Number . Registration of Dischakges.to Underground Injection Wells ❑ , BRP WS 06•Mod'ification to an Existing UIC Registration• - B.'Owner/Operator information a See Instructions For modifications,enter.'new or revised'information:• Lance, Inc. d/b/a Cape,Cod Potato Chips - 14120 Ballantyne Corporate Place, Suite 350': Name of Owner ,;;' Address'of owner(if different from facility) Charlotte NC NC City/Town y State • Zip Code Name of Operator(if different from owner) 'Address of operator(if different from facility) s City/Town State City/Town Mr.Jeff:Newell . •:'5o8.7§0.3900 _ hLegal Contact Legal Contact Phone# Legal Contact Fax# . Ownership Type Private: '®. Industrial ❑ Commercial ❑ Non-profit , ❑ Residential - Public: ❑1 Local ❑�pkegional ❑,�StateF' ❑ ,Federal G.:Inj fiction Well Information For modifications, enter only new or revised:information:, See instructions- ;. c table at end Registration: Individual- >or .❑ Area Storm Water Leach Pit 5D4 M Well:Type Well Code Number of wells Well Construction(check all that apply) p ❑ Cess ool Du Well❑ Drywell Septic Tank p ❑ g '❑ Improved Sinkhole EJ Drainfield/Leachfield ❑ Dustwateryonto the ground Other(describe): w Type of discharge See instructions.> table at end Source of water dischargedto the well _. Average flow(gallons per day)' MonthNear of well construction MonthNear ceased using well(s)for previous.use(s) #of entry points to existing system #of entry,points for proposed system Total of entry points to system }See instructions - - '• List any treatment devices in place or proposed prior to the injection point: h UIC updates 2008 07 to CCPC-rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 2 of 2 f Massachusetts.Department of Environmental Protection Bureau of Resource Protection;-Drinking Water Program BRP WS 06� ab,c s Transmittal Number Registration of Discharges-to'Underground.Injection Wells' BRP WS 06 Modification to an Existing UIC'Registration, C. Injection Well,lnformation (cont); -See instructions Depth to water table(feet) - Depth to bedrock(feet) Soil type(s)at side-e.g.;fill,sandy till,gravel,sand Distance toy nearest private drinking water well(within'1250')` r Distance to nearest Public Water Supply(within 2500') Name of nearest Public Water Supply ..Operational Status See instructions ' ❑ et not,Desi ned constructed. g y ❑ Under Construction El Active; ❑ Temp.abandoned ❑,Conversion to another well type Partial Closure/conversion to anottier well type:(well code)+ ❑ Active/Partial Closure :. ❑` Permanently'abandoned/not reported previously' ',"Source of injection fluid(#1) Source of injection fluid(#2) Source of injection fluid(#3) Rate of injection(gpm or other unit value) Potential contaminant.#1 Potential contaminant#7 Potential contaminant#3 Potential contaminant#4 E.' Site Information Are there-any other discharges on site? ET Yes' _ ❑, No If yes, are they permitted with MassDEP? ❑ Yes ; ❑'No, If no,are they re with MassDEP.as Class V• ❑ Yes ❑ No wells? Please list the type or types of.dischargesc JCheck any of the following that apply to this site: ❑ Superfund site If yes,Federal ID# - b; ❑ Bureau of Waste Site.Cleanup Priority Site If yes,file number c: ❑ Bureau of Waste'Site Cleanup Waiver Site If yes,file Ytumber Please provide a copy'ofthe Fetter of authorization,if,applicable.,,-, UIC Updates 2008 01 to CCPC r rev.08/06 _ - BRP WS 06 a,b,c Registration of Discharges to Underground Injection Wells-Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection'-,Drinking Water Program . BRP WS 06 allb;c Transmittal Number Registration of Discharges,to Underground Injection Wells. BRP WS .06 Modification to an Existing UIC Registration E. Site Information (cont.) See instructions If the site is currently being regulated by the Bureau of Waste Site Cleanup,check any of the following that apply: ❑ Incident Response ❑ Short Term Measure - Activity and use limitations: Confirm that the applicant has checked that the site does not have.any activity restrictions!with t respect to limiting,discharges on the site.. ❑, No restrictions ❑ Restrictions(please explain'.attach additional sheets if.f.'necessary):.. a Location of Facility: Is the facility located on Native Amencanlands? ❑ Yes. ID No G . .Latitude: Longitude: degrees. min(')sec("). degrees min(')sec(") Latitude,:&Longitude are no longer.optional data. See instructions , Identify th e method used for locating the latitude/longitude coordinates for the UIC Class V well(s): Type.` -.- ❑ Approximate location of point of UIC Class-V well(s) ` ❑ Approximate center of drainfield(s) Approximate location of area wellfield(s) El.,Approximate center of facility(ies) ❑Approximate center of area where discharges are,located Accuracy: ❑ Estimated horizontal accuracy is less than+/-100 feet ❑ Estimated horizontal accuracy is less than+/-500 feet • ,; ❑ Estimated horizontal accuracy is less than +/- 1000 feet ; UIC Updates 2008 Ot to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells••Page 4 of 4 Massachusetts Department of:Environmental.Protection . Bureau of Resource Protection;- Drinking.WaterProgram BRP WS' 06 a,b,c Transmittal Number Registration of Discharges:to.Underground Injection Wells ❑ :,4,: 'BRP WS 06 Modification to an Existing UIC Registration. E. Site Information(cont.)"_=- Provide a narrative description of the site and the feature to3be permitted.As an example:"The site.is on the west side of MaimStreet,the third'build'ing north of High Street':The disposal field lies`100 feet _ off the southwest comer-of the building,." Must be .. All additional information that is relevant to the installation or operation of.this injection well and to the } attached-see determination of its otential to endanger underground sources of,drinkin water USDWs instructions P 9 9 9 ( ) including a site map showindthe facility and UIC well(s), on-site drinking water wells, all other on-site "d discharges and the drains leading to the well and/or drainage area served by the well. MSDS sheets for chemicals likely to be discharged into well must be submitted.Analytical data available'on the . discharge-or raw water as applicable: []'Map attached ❑ Detail sheets attached ❑ MSDS sheets attached ❑.Other information'attached Attach a map of the facility,based on a USGS'topographicaI map.or MassGIS-Color Ortho Photography that clearly indicates both your facility and the location of the discharge. The USGS topographical map is available at: http://maps.massais state.ma.us/MassGISTopos/viewerhtm' a or the Color Orthophotography At http://ma0s.massgis:state.m6:us/MassOISColorOrthos/viewer.htm. , Attach a site plan showing buildings, boundaries, abutting streets, location of test pits,location of all. 'UIC wells, location of on=site drinking water wells, location of monitoring wells and a locus map. Attach a narrative description of the shallow injection well system and its major components.The description should contain a diagram including the plan view�and cross sectional.view of the shallow` injection well system, indicating piping,junction boxes, tanks, and leachfields. Dimensions of all major components and design calculations must be included.. ' Attach the Material Safety Data Sheets for all chemical products'stored or used at the facility which may intentionally(additive)discharge or unintentionally(spill/leak)discharged to the shallow.`injection' well(s). Attach existing analytical testing data from the existing waste stream or raw water"for expected contaminants improposed waste stream, based 76n specified testing parameters: For stormwater submittals(ifapplicable): 'Attach.a letterfrom the local municipality or other responsible party committing to long term` maintenance of the UIC system,`as described in.the maintenance stipulations of the UIC Program Registration.Approval if this applies(responsibility for maintenance is to be.transferred). Attach a letter from the local municipality or other responsible party if;there is a discharge from the UIC system(actual or proposed)to another offsite system(town storm sewer or wetlands). UIC Updates 2068 01 toCCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 5 of 5 " Massachusetts Department of.Environmental Protection }� Bureau of Resource Protection-'Drinking Water�Program BRP WS 06 a,b,c Transmittal Number, " Registration of Discharges to Underground Injection Wells BRP WS 06 Modification to an.Existing UIC Registration E. Site Inform'ation"(con't.) f . Who must register: Any party who discharges to a Class V Well as defined'in.310 CMR`27.00 must apply except those listed as exempt from the registration requirement as per 310,CMR 27.07: (2) Groundwater Remediation Projects.Any injection into a Class IV:or Class V injection well during a response action conducted or performed mn accord,ance;with.the-provisions of M.G.L.;c.21 E A<. and the Massachusetts Contingency Plan, 310 CMR.40.0000,or for the purpose of remediation at a release site, pursuant to the provisions under the:Comprehensive Enviro,nmenta[Response, ; Compensation; and Liability Act of 1980 (CERCLA),42 U.S.C.9601-9675,or pursuant to. requirements and provisions under the Resource Conservation and Recovery Act(RCRA),42 U.S.C.6901-6992k shall be exempt from: (b)the registration requirements set forth in 310 CMR 27.08; t 3) Registration.The following Class V injection wells are also.exempt from the registration requirements of 310 CMR 27.08: r ' (a)on-site subsurface sewage disposal systems used solely,for the disposal of sanitary sewage and regulated under 310,CMR 15.000 _ (b)Class,V injection wells'permitted under 314 CMR 5.00. Any party closing a UIC Class V well that has not previously registered with the MassDEP UIC Program must register using the BRP WS-00 Pre=Closure Form. If you have:not previously registered and you are closing the use of the well(s)for one(or more)uses but want to continue using the well(s)for one(or-more)uses'you must mark the top of this form by ° checking the box for"Transaction'Type".-Partial Closure/Registration and attach the Pre-Closure Notification Form to this submittal;The Pre-Closure Notification-Form must be submitted to the Boston Office.The Boston Office will forward the Pre-Closure form to the appropriate , MassQEP Regional Office for those uses.that'you intend to discontinue"to discharge to the; Class V Well.All further,communication on closure.of;the well(s)including filing of the Post Closure document should be with the appropriate MassDEP Regional Office. If you have not previously Registered and you are converting the well from a"prohibited"use to a use that is"authorized by rule"•you must mark the top of this form by checking'the box for"Transaction Type"-Conversion and attach the'Pre-Closure Notification Form for those uses that you intend to discontinue to dischar"ge to the Class V Well. The Pre-Closure Notification Form must be submitted to the Boston Office.The Boston Office will forward the Pre-Closure form to appropriate MassDEP Regional Office for.those uses that you,mntend to'discontinue discharging to the Class V Well.All further communication on closure of the well(s)including filing of the Post-Closure document should be with,the appropriate MassDEP Regional Office. -If you are registering a well(s)at a residential structure(four,;units or fewer),the MassDEP UIC registration form WS-66e'should be used instead of this one. Who must submit a notification form: If the Owner or Operator information(name address or other contact information)changes-you must notify the UIC ;program at least 30 days prior to the change(s) If you are adding wells(Area Registration);relocating the well(s),changing the.discharge.(Well Code)to the well(s)or adding additional discharges(Well Code)you.must notify MassDEP at least 60 days prior to the change. If you are closing the well(s)and relocating the well(s)and are planning to"have the same discharge(Well Code),you must mark the top of this form by checking:the box for.Relocation of Well(s)and attach to'this submittal a Pre-Closure Form for the well(s)being closed. UIC Updates 2008 01 to CCPC•irev.08/06 BRP M 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 6 of 6 y- Massachusetts Department of Environmental ect�Protion i� Bureau of Resource Protection - Drinking:Water Program ' BRP WS06ab?c Transmittal Number. Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC Registration _ E.,Site.information (cont.) Fees: An application fee(effective,:10/08/04)is due when the Registration applicationis submitted. There rio application fee associated with submitting a"Modification application to an existing Registration.,'` Registration Form Category - -Registration Fee BRP WS 06 a ' High, i480.00 BRP WS 06 b Moderate 240.00 BRP WS-06 c . Low $ 90.00 y BRP WS.06 d Pre-Closure/Registration $ 90.00 BRP WS 06 a Residential Registration No fee=-,exempt F. No MassDEP Transmittal Form or number is needed when submitting,a Modification to an existing UIC Registration or when submitting a Residential Registration Forrh(WS-06e). . .:` "y There is no annual compliance fee associated with this Registration. { UIC Updates 2008 01 to CCPC•rev.08/06. BRP WS 06 a,b,c Registration of Discharges'to Underground Injection Wells•Page 7 of 7 - Massachusetts Department of Environmental Protection ?r" Bureau of Resource Protection.`=,Drinking Water Program BRP WS 0.6 a .;b' c � Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing,UIC Registration F. Affidavit . The injection wells)described above is used for placement or injection of fluids into the ground. I/we understand that this well is subject to inventory requirements,and':compliance with the regulations under the Underground Injection Control,Program.established pursuant to the Safe Drinking Water Act,P.L.93-523, arid amendments,,and l/we hereby serve notice that the well is proposed or in service. rc /we agree 1. That,the wells)described'herein will not be used for discharges other than those described above; .-2.. That /we will notify theMassachusetts Drinking Water Program/UIC Program(onforms provided by the UIC program)if any of the information(including Ownership, Location or Type of discharge)for the,above well(s)changes;.Out before the-Change(30 days minimum notice on ownership/operator and 60 day notice on all other changes); 3. That I/we will notify the Massachusetts Drinking Water.Program/UIC Program(on forms provided u . . by the UIC program-Pre-Closure Notification Form)when the.above well(s)is no longer in use; but before abandonment and file a Post Closure Notification Form within seven days of completing the closure with'the UlC program, 4. That.I/we will maintain financial responsibility for the well described above;.and 5. . That t/we will provide a sampling tap(approved by MassDEP).and''allow sampling at the point of injection. I/We'certify under penalty of law that I/we have personally examined and am/are familiar with the information submitted ih.this document and all attachments and based on my personal knowledge or inquiry of those individuals immediately responsible for obtaining the information. I/We believe the ;information•is true, accurate;and complete.,I/we am/are'aware that there are significant penalties for sutra itting fals ' fo ation, including,possible fines'and,imprisonment. vs f; .Si ature of Preparer Date e Newell. Director of Operations nted Name of Preparer Position/Title UIC Updates 2008 01 to CCPC rev.08/06 BRP WS 06 a,b,c—Registration of Discharges to Underground Injection Wells•Page 8 of 8 Massachusetts Department of Environmental Protection' Bureau of Resource Protection - Drinking Water Program. d BRP WS 06. a,b',c r - '- Transmittal Number, . Registration of Discharges to_Under'round Injection;Wells 0 = BRP WS 06 Modification to an.Existing UIG Registration Questions An questions may be directed to the UI• , y q y C Program.at(617)348=4014 or.fo the UIC-,Contact:at your Regional MassDEP Office. Find your region: http://mass.gov/,deo/abodt/r6gion/findyour.htm 1, Submit Application to: MassDEP Drinking WaterProgram 1 Winter,Street—6th Floor, Boston, MA 02108 Attn`:`UIC Program, MAILING ADDRESSES 4; UIC Program,.MassDEP Northeast Regional Office(NERO), 7t. 205b Lowell'Street,Wilmington, MA 01887 . UIC Program, MassDEP Southeast Regional Office(SERO); 20 Riverside Dr. Lakeville;MA 02347 UIC Program,MassDEP Central Regional Office(CERO), 627 Main Street,Worcester, MA 01608 UIC Program, MassDEP Western Regional Office(WERO), State House West,41h Floor,436-Dwight Street;Springfield, MA l)1103 UIC Program; MassDEP Boston Office, One Winter Street-6th Floor,Boston; MA 02108 SERVICE CENTER PHONE NUMBERS: Northeast.Regional Office 978-694 3200 Southeast Regional Office 50&946-2714` - Central Regional Office 508-792-7683 Western Regional Office .413-784-11.00 ext.214 - Send duplicate copies of all forms to; Local Board of Health Local•Plumbin0 inspector i y UIC Updates 2008 01 to CCPC s rev.08/06 BRP WS 06 a,b,c-Registration.of Discharges to Underground Injection Wells•Page 9 of 9 Massachusetts Department of Environmental Protection Bureau of Resource Protection Drinking Water,Program,, BRP WS 0 6 a,b,c Transmittal Number Registration of Discharges tit Underground InjectionMelts BRP WS 06 Modification to an Existing.UIC Registration .V See Instructions UIC Registration fee (check the appropriate'welf type category) Important:When filling out forms ❑ a. High includes the following well types-5A5,5D4,5W20&5X25 Registration Fee=,.$480.00, on the computer, use only the tab ❑' b. Moderate includes the following well types.-5A61 5A19, 51FT,5S23&key to move your 5X27 Registration Fee=$240.00 cursor-do not use the return 5R21&5X29 �' 9 .YP 5A8,5622;5D2;5G30, Registration Fee=$ 90.00 ❑ C. Low includes the followin well t es 5A7, key. d. Pre-closure/WS-06d form-.for UIC wells not previously registered with MassDEP., Registration of these wells is not done using this form.They must be submitted on a Pre-Closure/.WS-06d form. e. Residential Exemption[for four units or fewer]—the following well types(typical residential activities) are exempt from a UIC registration fee.and-have a separate registration form WS-06e—5A71 5D2, 5G30&5X18. See the Class V Injection Well Type Table at the end of the Instructions for well type. See instructions Transaction Type Registration:- g' . ❑ Initial-new registration ❑ Initial'-existing registration ❑ Conversion "Partial Closure/Registration; ; Modification: '® Change of ownef/operator Z Change in or additional well/code(s) ❑ £hange in location well(s) ❑ Change in#.of discharge wells For modifications'(required) MAS41A020002 - UIC Registration-ID#issued by MassDEP in the original UIC ' A. Facility Information; For modifications,enter new or revised information: See Instructions Cape Cod Potato Chip.Company, Inc 100 Breed's Hill Road Facility/Property Name Facility Street Address 71 2096 Company Name SIC Code#. (MassDEP.Use Only)Facility# Hyannis Barnstable MA 02601 CitWTown' County State Zip Code E Facility PWS IN(if appropriate) 508.790.3900 Facility Telephone Number 'Facility Email(optional) EPA Hazardous Waste Generator ID# : EPA Hazardous Waste Generator ID# UIC Updates 2008 02 to CCPC•rev.'08/06 BRP WS 06 a,b,c—Registration of Discharges to Underground.injection Wells-,Page 1 of 1 Massachusetts Department of Environmental:Protection Bureau of Resource Protection -Drinkin "' ' ater Program - BRP WS 06 'a b,c ' Transmittal Number Registration of Discharges to Underground Injection Wells ❑, „. BRP WS 06 Modification to an Existing U'IC-;Registration 1z. B. Owner/Operator information See Instructions For modifications, enter:hew or revised information: Lance, Inc. d/b/a Cape Cod Potato Chips 14120 gal lantyne Corporate Place, Suite 350 u Name of Owner Address of owner(if fiJifferent from facility) Charlotte NC' NC CitylTown State Zip Code Name of Operator(if different from owner) Address of operator(if different from facility) City/Town State City/Town W.Jeff Newell 508.790.3900 f Legal Contact Legal Contact Phone# Legal Contact Fax# Ownership Type: Private- ® Industrial ❑ Commercial ❑ .Non-profit ❑ Residential ❑ Regional ❑ State ❑ Public' El Local Federal C. Injection Well Information . for,modifications;enter only new' or revised information: Y See instructions a table at end. Registration: Individual or. ❑ Area Storm Water Leach Pit 5D4 Well Type - WeII.Code Number of wells Well Construction(check all that apply) ❑` Drywell ,❑ Septic Tank ❑ Cesspool- ❑ Dug'-Well ❑.Improved Sinkhole ❑ Drainfield/..Leachfield ❑ Dustwater onto the ground. ❑, Other(describe): Type of discharge See instructions table at end Source of water discharged_to the well Average flow(gallons per day) MonthNear of well construction MonthNear ceased using well(s)for.previous use(s). #of entry points to existing system #of entry points for proposed system Total#of entry points to system See instructions List any treatment devices in place or proposed prior to the injection point: . UIC Updates 2008 02 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to-Underground Injection Wells•Page 2 of 2 a LlMassachusetts Department of,Environmental Protection �ry Bureau of Resource Protection - Drinking Water, Program BRP WS °06,a,-b,c Transmittal Number Registration of Discharges to'Underground Injection Wells BRP WS 06 Modification to an Existing`UIC Registration C. Injection.Well Information (cont.) See instructions Depth to water table(feet) Depth to bedrock(feet) Soil type(s)at side-e.g.,fill,sandy till,gravel,sand Distance to nearest private drinking'Water well,(within 1250') Distance to nearest Public Water Supply(within 2500') Name of nearest Public.Water Supply D. Operational Status See instructions Designed, not yet constructed' ❑' Under,Construction ❑'Active ❑ Temp.,abandoned `';° ❑ Conversion to another well type ❑-Partial Closure/conversion to anotherwell.type(well code) 'R Active/Partial Closure ❑.Permanently abandoned/not reported previously A Source of injection fluid(#1) Source'of injection fluid(#2) Source of injection fluid(#3) Rate of injection(gpm or other unit value) Potential contaminant#1 Potential contaminant#2 Potential contaminant#3 Potential contaminant#4 . . E. .Site Information - Are there an other discharges on site? Y 9 ❑ Yes ❑ No If yes,are they permitted with MassDEP? ❑ Yes ❑ No If no;are they registered with MassDEP as Class V ❑ Yes ❑ No wells? Please list the type or types of discharges: Check any of.the following that apply to this site: a. ❑ Superfund site If yes,Federal ID# b. ❑ Bureau of Waste Site Cleanup Priority Site If yes,file number C. ❑ Bureau of Waste Site Cleanup Waiver Site If yes,file number Please provide a copy of the letter of authorization if applicable. UIC Updates 2008 02 to CCPC rev.08l06 BRP WS 06 a,b;c Registration of Discharges to Underground Injection Wells-Page 3 of 3 Massachusetts Department.of Environmental Protection - Bureau of Resource Protection'- Drinking`Water Program BRPWS06abc >�. Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP W&06 Modification town Existing;UlC Registration E. Site Information„(cont,) See instructions . If the site is currently being regulated by the Bureau of Waste:Site Cleanup,check any of the. following,that apply: ❑ Incident Response '° ❑ Short Term Measure Activity and use limitations Confirm that the applicant has checked that the.site does not have any activity-restrictions with respect to limiting discharges on the site. ❑ No restrictions ❑ Restrictions(please explain; attach:additionaI sheets if necessary):` - t- Location of'Facility:° ' ls the facility located on Native American lands? ❑ Yes ❑ .No'' Latitude: Longitude: - degrees; min(`)sec(") ong degrees : min(')sec(") Latitude&'Longitude are no longer optional data. See instructions - Identify-the method used for locating the latitude/longitude coordinates for the UIC Class V well(s): . Type q a .. ❑`Approximate location:of point of UIC Class V well(s) ❑ .Approximate center of drainfield(s) :. .,❑ Approximate location of area welifield(s) ❑ Approximate center of facility(ies) ❑-Approximate center of area where discharges are located Accuracy:, - E] Estimated horizontal accuracy is less than:'+/-100 feet ❑ Estimated horizontal accuracy is less than.+/-500 feet ❑ Estimated horizontal`accuracy is less than +/- 1000 feet . UIC Updates 2008 02 to CCPC•rev.08/06 SRO WS 06 a,b,c-Registration of Discharges t.o Underground Injection Wells•Page 4 of 4 li- Massachusetts Department of Environmental Protection, r, Bureau of Resource Protection,- Drinking Water Program BRP WS 06 a,4 c -< Transmittal Number Registration of Discharges to Underground Injection Wells EJ BRP WS 06 Modification to an Existing UIC Registration E. Site Information (cont.) Provide a narrative description of the site and the feature to be permitted.As an example:"The site is on the west sideof Main Street,the third building north of High Street.The disposal field lies 100 feet off the southwest comer of the building. , Must be All additional information that is relevant to the installation or operation of this injection well and to the attached-see determination of its potential to endanger round sources of drinking water USDWs• instructions - P 9 g 9. . ( )— including a site map showing the facility.and,UIC well(s), on-site drinking water wells, all other on'-site discharges and the drains leading to the well and/or-drainage.area served by the well. MSDS sheets for chemicals,like'ly to be discharged into well must be submitted.Analytical data available on he: discharge or raw water as applicable. - Ma Detail sheets El Map attached ❑ is attached MSDS sheets attached.'E Other information attached Attach a map of the facility based on a USGS topographical map or MassGIS Color Ortho Photography that clearly indicates both your facility and the location of the discharge. The USGS topographical map is available at: hftp://mai)s.massdis.state.ma.us/M6ssGISTopos/viewer.htm or the Color Orthophotography At: httg://maos:massgis.state:ma.us/MassGlSColorOrthos/viewer.htm. Attach a site plan showing buildings, boundaries, abutting streets,location of test pits, location of all UIC wells,;location of on-site drinking water wells, location of monitoring wells and a locus map. Attach a narrative description of the shallow injection well system anditsymajor components.:The:.. description should contain a'diagram including the plan view and cross sectional view of the shallow injection well system`indicating piping;junction boxes,tanks, and leachfields. Dimensions of"all major 4 components.and design"calculations must be included Attach the Material Safety Data,Sheets for all chemical products stored or used at the facility which may intentionally(additive)discharge or unintentionally(spill/leak)discharged to the`shallow injection well(s).:, y, Attach existing analytical testing data from the existing waste stream or raw water for expected contaminants in proposed waste stream, based on specified'testing parameters. For stormwater submittals(if applicable): Attach a letter from the local-municipality or other responsible party,committing to-long term maintenance of the UIC system, as described in the maintenance;stipulations of the UIC Program Registration Approval.if this applies(responsibility, .for maintenance is to be transferred): Attach a letter from the local municipalityy or other responsible;party if,there is a discharge from the UIC system(actual or proposed)to another offsite system,(town storm sewer or wetlands). - UIC Updates 2008 02 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 5 of 5 n, Massachusetts Departmentof.Environmental Protection Bureau of Resource Protection,- Drinking Water Program B R P WS 06 a,b, Transmittal Number ' Registration of Discharges to Underground*Injection Wells0 BRP WS 06 Modification to an Existing UIC.Registration; Ll E. Site Information (cony.) Who must register: Any party who discharges to a Class"V Well as defined in 310 CMR'27.00 must apply except those' listed as exempt from the registration-requirement as per 310,CMR 27.07 (2) Groundwater Remediation Projects Any injection into a Class IV,or Class V injection well during a response action,conducted or performed in accordance with the provisions of M.G.L. c.21 E and the Massachusetts Contingency Plan,'310 CMR 40.0000, or for.the purpose of�emediation at a release site,pursuant to the provisions under the'ComprelibnsiVe Environmental Response, Compensation, and Liability Act of 1980(CERCLA),42 U.S.C. 9601-9675,'.or pursuant to requirements and provisions'vnder the'Resource Conservation and Recovery Act(RCRA),42 U.S.C.6901-6992k shall be exempt from: (b)the registration requirements set forth in 310 CMR 27:08; 3) Registration.The following Class V injection wells are also exempt from the registration requirements.of 310 CMR 27.08: , (a)on-site subsurface sewage disposal systems used solely for the disposal of sanitary sewage and regulated under 310 CMR 15.000.. (b)Class V injection wells permitted under 314 CMR 5.00. Any parry closing;a UIC Class V w' ell-that has not previously registered with the'MassDEP UIC . Program must register using the BRP WS-06d.Pre-Closure Form. 1f you have not previously registered and you are closing the use of the well(s)for one(or more)uses but want to continue using the well(s)for one(or more)uses you must mark the top of this form by checking the box for"Transaction Type"-Partial Closure/Registration'and attach the Pre-Closure Notification Form to this submittal:The Pre-Closure Notification Form must be submitted to the Boston Office.The Boston.Office will forward the Pre-Closure form to the appropriate MassDEP Regional Office for those uses thatyou intend to,discontinue to discharge to the Class V Well.All further communication on closure of the well(s)including filing of the Post Closure document should,be with the appropriate MassDEP Regional Office. ` If you have not previously Registered and you are converting the well from a"prohibited",use to a use that is"authorized'by rule"you must mark the top of this form by checking the box for"Transaction Type"-Conversion and attach the-Pre_Closure Notification,Form for those uses that you intend to discontinue to discharge to the Class V.Well:The Pre=Closure Notification Form must be ,submitted to the Boston Office:The Boston Office'will forward the Pre-Closure form to ` appropriate:MassDEP Regional Office for those uses that you intend to discontinue discharging,to the Class V Well.All further communication.,on closure ofthe virell(s)including filing of the Post-Closure document should be with the appropriate MassDEP Regional Office. If you are registering a`well(s)at a•residential structure(four units or-fewer),the MassDEP'UJC registration form WS-06e should,be used instead of this one. Who must submit a notification form: If the Owner or Operator information(name address or other contact information)changes you must notify the"UIC program at least 30 days priorto the change(§). If you are adding wells(Area Registration);relocating the well(§),changing the discharge(Well Code)to:the.well(s)or adding additional discharges(Well'Code)you must notify MassDEP at least 60 days prior to the change. If you are closing the well(s)and relocating the-well(s)and are planning,to'have the.same discharge(Well Code),you . must mark the top of.this form by checking the box for Relocation of Well(s)and attach.to this submittal a Pre-Closure Form for the.well(s)being closed: UIC Updates 2008 02 to CCPC•rev.08/06 BRP WS 06 a;ti,c-Registration of Discharges to Underground Injection Wells-Page 6 of 6 •; it Massachusetts Department of Environmental Protection Bureau of Resource Protection-;- Drinking Water Program BRP WS 06a,,b, "` c Transmittal Number Registration of Discharges to pUndergr'ound ion Inject Wells 0 a BRP WS 06 Modification'to an Existing UIC Registration E. Site Information (cont.) Fees: An application fee(effective 10/08/04)is due when the Registration application is submitted. There is no application fee associated with submitting�a-Modification_application to an existing Registration. + Registration Form . Category Registration Fee ; BRP'WS 06 a High $480.00 BRP WS 06 b Moderate . $240:00 BRP WS 06 c Low $ 90.00 ? BRP,WS 06 d ,•. „�. .Pre-Closure/Registration: $ 90:00 BRP WS 6 -i _0 e R es dential Registration No _ P fee. exempt No MassDEP Transmittal Form or number,is needed when submitting a Modification to an existing t 5y UIC Registratior or when submittirg a Residential Registration Form(WS-06e): There is no annual compliance fee associated with this Registration. UIC Updates 2008 02 to CCPC-rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells t Page 7 of 7 Massachusetts Department"of Environmental Protection ; Bureau of Resource Protection - Drinking Water Program BRP WS 06. a,b,c Transmittal Number Registration a of Discharges to Underground.Injection Wells- BRP 9 9 1 � . BRP WS 06 Modification to an Existing UIC Registration' F. Affidavit The injection well(s)described'above is used for placement or.injection of fluids into the ground,. Me understand that this well is subject to.inventory requirements and compliance with the regulations under the Underground Injection'Control,Program established pursuant to the Safe Drinking Water, $. Act, P.L.93-523,and amendments, and /we hereby serve notice,that the well is proposed or service. . /we agree: 1. That the well(s).described herein will not,be used for discharges other than those'describ'ed above; 2. That I/we will notify the Massachusetts Drinking Water Program/UIC Program(on forms provided- by the UIC program)if any of.the information(including Ownership,Location or:Type of discharge)for the above well(s)changes, but before the change(30'days minimum notice orr, ownership/operator and 60 day notice on all other.changes); 3. That I/we will.notify the Massachusetts Drinking WaterProgram/UIC Program(on forms provided . by the UIC program—Pre-Closure Notification Form)when the.above well(s)is no longer in use, but before abandonment ah&file a Post Closure:Notification Form within seven days of completing the,closure with the.UIC program, u 4. That I/we will maintain,financial responsibility for the well"described.above-and 5. That I/we will provide a sampling tap(approved by MassDEP)and allow.sampling at the point of injection. Me certify under penalty of law that I/we have personally examined and am/are familiar with the information,submitted in this-document and all attachments and based on my personal knowledge or inquiry of those individuals immediately,responsible for obtaining the:information. I/We'believe the' information is true,accurate,and complete. I/we`am/are aware.,thaf there are significant penalties for" sub itting false Zation, including possible fines and imprisonment. Ignature of-Preparer Date Jeff Newell Director of Operations Printed Name of Preparer. Position/Title' . UIC Updates 2008 02 to CCPC rev.08/06 BRP WS 06 aAc-Registration of Discharges to Underground Injection Wells•Page 8 of 8 Massachusetts Department'of Environmental-Protection'. Bureau of Resource Protection`, Drinking,Water Programs j BRP WS 06 'a,b,c. Transmittal Number. Registration of Discharges to;Underground Injection Wells ❑ BRP WS 06'Modificationlo an Existing UIC'Registration , Questions Any-questions may be directed to the UIC Program at(617)348-4014 or to the UIC Contact at your Regional MassDEP.Office., Find,yourregion `http://mass.gov/deg/about/region/findvour.htm Submit Application to: MassDEP , Dnnkm :Water Program, 1 Winter Street—6tn Floor, Boston, MA:02108 a. Attn:UIC Program MAILING,-ADDRESSES UIC.Program MassDEP Northea$JfRegiona(Office(NERO), 205b Lowell Street,Wilmington, MA 01887 ; .peg: '•1:. - . .. rt UIC Program, MassDEP Southeast Regional,OfFice(SERO),' F 20 Riverside Dr.;"Lakeville, MA 02347 UIC:Program, MassDEP Central Regional Office(CERO), 627-Main Street;-Worcester, MA 01608-'` F UIC'Program, MassDEP Western'Regional Office(WERO), State House West,4th Floor,436`Dwight Street, Springfield; MA 01.103 UIC'P..rogram, MassDEP Boston.Office - F. One Winter Street—6th Floor, Boston, MAY02108 SERVICE CENTER PHONE NUMBERS: Northeast Regional Office 978-694-3200 Southeast Regional Office ' .50817-946-2714 Central Regional Office 508-792-7683 Western`Regional Office. 413-784-1100 ext.214 Send duplicate copies of all forms.to: Local Board of Health Local 4Plumbing,Inspector UIC Updates 2008 02 to CCPC•rev.08/06 ".BRP W506 a,b,c-Registration'of Discharges to Underground Injection Wells,-Page 9 of 9 -Massachusetts Department.of Environmental Protection gyp, Bureau of Resource Protection- Drinking Water�Prograni B R P W S 06 ;-Transmittal Number Registration of Discharges to'Underground Injection Wells BRP WS 06 Modification to an.Existing UIC Registration" See Instructions UIC Registration Fee (check the appropriate well type category')' Important:When y filling out forms ❑ a. High includes the following well.fypes,-5A5, 04,5W 20&5X25 Registration Fee=$480.00 on the computer, ; use only the tab ❑ b. Moderate includes the following well.types-5A6,5A19 5F1.5S23&. Registration Fee=$240.00 key to move your 5X27 cursor-do not " ' use the return ❑ C. Low includes the following well types 5A7, 5A8,5B22,5D2,5G30,: Registration Fee $ 90.00 key. 5R21&5X29�. p d. Pre-closure/M-06d form-for UIC.wells not previously registered'with MassDEP. Registration of these wells is not done using this form.They must be submitted on a Pre-Closure/WS-06d form. e. Residential Exemptwn[for four units orfewer]—'the following`well types(typical residential activities), are exempt from a UIC registration fee and have a separate registration form WS=06e—5A7,5p2, 5G30&,5X18. See the Class V Injection Well Type Table at the end of,the Instructions for,well type. .r See instructions =TranSBctlon Type y' Registration: ❑, Initial-new registration ❑ Initial'existing,registration'; ❑ Conversion El Partial Closure/Registration Modification: Z ,Change of owner/operator,' Change in'or additional well/code(s) Change in location well(s)"`- ❑ Change in#of discharge wells ry 1For modifications(required) MAS41A020003 ' UIC Registration ID#issued by MassDEP in the original UIC " A. Facility Inforrhation For modifications; enter new or revised information: - See Instructions Cape Cod PotatoChip Company, Inc 100 Breed's Hill Road' Facility/Property Name Facility Street Address' 2096 CompanyName SIC Code#" , - (MassDEP Use Only)Facility# t Hyannis Barnstable Mk 02601 - Cityrrown County State Zip Code Facility PWS ID#(i appropriate) E 608.796.3900 - Facility Telephone Number Facility Email(optional) EPA Hazardous Waste Generator ID#; EPA Hazardous Waste Generator ID# Ll UIC Updates 2008 03 to CCPC•rev.08106 BRP WS 06 a,b,c-,Registration of Discharges to Underground Injection Wells•Page 1 of 1 f Massachusetts"Department of Environmental Protection Bureau of Resource Protection - Drinking Water Program BRP WS 06 a,b,c.l Transmittal Number Registration of Discharges to Underground Injection Wells Ej BRP WS 06 Modification to an Existing U IC,Registration B. Owner/Operator nformation See Instructions For modifications,enter new or revised information Lance, Inc.d/b/a Cape Cod Potato Chips 14120 Ballantyne Corporate Place, Suite 350 Name of Owner Address of owner(if different from facility) Charlotte NC, NC City/Town .. State Zip Code : Name of Operator(if different from owner) Address of operator(if different from facility) City/Town State 7 City/Town Mr.Jeff Newell 508.790.3900 Legal Contact Legal Contact Phone# Legal Contact Fax# Ownership Type: } Private: ® Industrial ❑ Commercial " ❑ Non-profit ❑ Residential Public:. ❑ Local ❑ 'Regional ❑ State ❑ Federal C. Injection Well Information For modifications,:<enter only,hew or revised information: a See instructions- table at end Registration: ❑ Individual or ❑ Area Storm Water Lea&Pit 5D4 Well Type Well Code " Number of wells Well Construction(check all that apply) ❑ Drywell " '❑.`,Septic Tank ❑ Cesspool ❑ Dug Well ❑ Improved Sinkhole ❑ Drainfield/Leachfield ❑ Dustwater onto the ground ❑' Other(describe). Type of discharge See instructions- table at end Source of water discharged to the well Average flow(gallons per day) MonthlYear of well construction MonthNear ceased using wells for previous use(s) #of entry points to existing system #of entry points for proposed system Total#of entry points to system See instructions List any treatment devices in place or proposed prior to the injection point: UIC Updates 2008 03 to CCPC•rev.08/016 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 2 of 2 " i , Massachusetts Department of Environmental Protection Bureau of Resource Protection;="Drinking,W ter•Program BRP WS .06,ajb;O. i Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC'Registration C. Injection Well Information (cost`) See instructions Depth to water table(feet) , ,.. Depth to bedrock(feet) '.f ' Soil type(s)at side-e'.g.,,fill,sandy till gravel sand Distance to nearest priJate drinking water well(within 1250) f, Distance to nearest Public Watersupply(wlthln 250.0')1'' Name of nearest Public,WaterSupply, t D. Operational Status See instructions Designed, not yet constructed,, ❑.Under Cons ❑truction t Active *s . • Y . •❑ Temp.abandoned.,: ',. ❑ Conversion to another.well-type:: y ;.❑ Partial Closure/conversion to another'wellape(wellr;code) ❑ aActive/Partial-Closure �;�; ❑ :Permanently abandoned/not reported previously s s' Source of injection fluid(01) Source of injection`fluid(#2) t' " Source of injection fluid(#3) Rate of injection_(gpm or other unit value) Potential contaminant#1 Potential contaminant#2 Potential contaminant#3 - Potential contaminant#4 _E. Site Information �. Are there any other discharges on site? -; El' ❑ No If yes are they perrrlitted with MassDEP? Yes'- ❑ 'No are they registered with MassDEP asrClass^V " wells? ❑ 'Yes' ❑' No Please list the type or types of discharges: Check any of the following that,apply to this site: ' R a•' ❑.Superfund site_ If yes,Federal ID At b. ❑ Bureau of Waste.Site Cleanup Priority.Site If yes,file number c. ❑ Bur eau.of Waste.Site CleanupWaiver Site if yes,file number Please'provide a copy of the letter-of authorization iflapplicable:. UIC Updates 2008 03 to CCPC•rev:08/06` BRP WS 06 aAc RegStrat:on of Discharges to Underground'Injection Wells•Page 3 of 3 z , Massachusetts Department of Environmental;Protection: Bureau of Resource Protection - Drinking Water Program BRP WS .06 a,b,c Transmittal Number Registration of Discharges to Under round In'ection Wells EIRP WS 06 Modification town Existing'UIC Registration t. . .E. Site Inf ormation (cont.) See instructions If the site is cur`r'ently being regulated by the Bureau of Waste Site Cleanup,check any of the following that apply:, g ' ❑• Incident Response , ❑. Shorf.Term Measure Activity and useairnitations:". Confirm that the applicant has checked that the site;does not`have any activity restrictions with respect to limiting discharges on'the site.. . ❑ No restrictions ❑ ;Restrictions(please explain; attach additional.sheets if necessary): , °A . ^° Location of Facility: Is the facility located'on Native American lands? ❑ Yes ❑ No g s . Latitude: Longitude:degrees 4.,miri sec degrees min(')sec(") ' '• Latitude&Longitude are no longer optional data. See instructions Identify the method used r • fy � for locatngahe latitude/longitude coordinates'fortke UIC Class V well(s): ' Type: ❑" Approximate location of point of UIC Class.4y well(s) ❑, Approximate center of drainfield(s)„ ❑ Approximate location of area wellfield(s) ❑ Approximate center of facility(ies) ❑Approximate center of area where discharges are located Accuracy: . - ❑ Estimated horizontal accuracy is less than+/-100 feet ❑ Estimated horizontal accuracy is less than+/-50o feet ❑ .Estimated horizontal-accuracy is less than+/=1000 feet.-,.,,. UIC Updates 2008 03 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 4 of 4 Massachusetts Department-of Environmental Protection Bureau of Resource Protection - Drinking Water Program . BRP WS 06- a,b,c h Transmittal Number. Registration of Discharges to`Undergk: Injection Wells ❑;;: BRP WS 06 Modification to an Existing UIC Registration E. Site Information (cont.) Provide a narrative descri'ption.aof the site and the feature to,be:pe.rmitted.As an example:"The site is on the west side of Main Street,the-third building1north.of,High Street.The disposal field lies 100feet off the southwest corner of the;building." Must be All additional vinformation that is relevant to the installation or operation of this injection well and to the attached-see determination of its potential to endanger underground sources of drinking water USDWs instructions P 9 9 9. ( )— including a site map showing.the facility and UIC well(s), on-sita.drinking water wells,all other on-site discharges and the drains leading to the well and/or drainage area served by the well.MSDS sheets for chemicals likely to be discharged into well must be submitted:Analytical data available on the- discharge or raw water as applicable. ❑ Map attached ❑ Detail sheets attached ❑ MSDS sheets attached ❑ Other information attached Attach a map of the facility based on a USGS topographical map or MassGIS Color Ortho, Photography that clearly indicates both your facility and the location of the discharge. The USGS topographical,map-is available at r hftp://maps:massqis.state*.m'"ai6siMissGitT6D6s/vie'wer.htm or the Color Orthophotography At: http://maps.massdis.state ma.us/Mas'sGISColorOrthos/viewer.htm. Attach a site plan showing buildings, boundaries;abutting.streets, location of test pits, location of all UIC wells, location of on-site drinking water wells,location of monitoring wells and a locus map: Attach a narrative description of the shallow Injection well system and its major components.The description:should contain a:diagram including the plan view and cross sectional view of the shallow injection well system, indicating piping,junction boxes,tanks, and Jeachfields. Dimensions of all major components and design calculations must be,included. Attach the Material Safety Data Sheets for all chemical:products stored or used at the'facility which may intentionally(additive)discharge or unintentionally(spill/leak)discharged to the,shallow'injection well(s). . Attach existing analytical testing data from the existing waste stream or raw water for"expected contaminants in proposed waste stream,based on specified testing parameters: For stormwater submittals(if applicable); Attach a letter from the local municipality'or other responsible party committing to long term maintenance of the UIC system,,as'described in the maintenarice.stipulations of the UIC Program.. " Registration Approval if this applies(responsibility for maintenance is to be transferred). Attach a letter from the.local municipality or other responsible party if there is a:.discharge from the t,. UIC system(actual or proposed)to another offsite system(town storm sewer or wetlands). UIC Updates 2008 03 to3CCPC•rev.08l06 t3RP'WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 5 of 5 Massachusetts Department of Environmental'Protect ion' Bureau of Resource Protection- Drinking Water Program BRP WS061..ab,c t tTransmittal Number Registration of Discharges"to Underground Injection Wells- El," BRP WS 06 Modification,to an Existing UIC Registration .' E. Site Inforr'nation (Cont.) Who must register: Any party who discharges to,a Class V=Well as defined in•310 CMR 27.00,must apply except those.' listed as exempt from the registration requirement as per.31 d CMR 21.07: ` (2) GroundwaterRemediatlon Project Any injection into a`Class IV or Class V injection well.during ;. a response action conducted or`performed iri accordance with the.provisions of M.G.L.c:"'21 E and the Massachusetts Contingency Plan, 31.0`CMR;40.0000, or for the'purpose of remediation at a release site, pursuant'to the provisions under the'Comprehensive Environmental Response, Compensation, and LiabilityAct of 1980 CERCLA 42,U.S.C. 9601-9675 or ursuant to requirements`and provis ions;under,the Resource'Conservation and Recovery Act(RCRA),•42 U.S.C. 6901-6992k shall:be exempt from:` (b)the registration requirements set forth in 310 CMR 27.08; T 3) Registration.=.The"following Class V:injection'wells.are also`exempt from`the registration t P' requirements of 310 CMR 27.08: (a)`on-site.subsurface sewage disposal systems used solely for the'disposal of sanitary sewage and regulated under 310 CMR 15.000, -': (b)Class V injection wells"permitted 314 CMR 5.00: Any'party closing a UIC Class V well that has not previously,,registered with the MassDEP UIC . Program must register using the BRP WS-06d Pre.-Closure Form. ktr If you have not previously registered and you are closing the use,of the well(s)for.one_(or more)uses but want to continue using the well(s)for'one(or more)uses-you must mark the.top of this form by checking the box for"Trans action Type Partial Closure/Registration and attach the Pre-Closure Notification Form to this submittal.The Pre-Closure Notification Form must be submitted to the Boston Office.The Boston Office will forward,the Pre-Closure form to the appropriate: MassDEP Regional Office,for those uses that you intend to discontmue to•discharge to the Class V Well.Allfurther communication on closure of.the well(s)including filing of the Post Closure.document should be with the appropriate MassDEP Regional Office. If, ou fjave not reviou'sl Re istered and ou are-convertin the well'''from a'` rohibited" 'use to a use y P y g y 9 P that is"authorized by rule"you must mark the top of this form by checking the boiefor"Transaction Type"-'Conversion and attach the Pre-Closure Notification Form for those uses-that you intend to discontinue to discharge to the Class V Well.The Pre-Closure Notification,Form must.be submitted to the Boston Office.The,Bost' Office..will forward the'Pre-Closure-form to appropriate Mass'DEP Regional Office for those uses that you intend to discontinue discharging to the.Class V Well.All further communication on closure of the well(s)including filing of the Post-Closure documentshould be' with the appropriate MassDEP,Regional Office. If you are'registering awell(s)at a residential.structure(four units or fewer), the MassDEP UIC registration form WS=06e should be used instead of.this one. Who must submit a notification form: If the Owneror Operator information(name address or other'contact information)changes you must notify the UIC program at least 30 days prior to the change(s): If you are adding wells(Area Registration);relocating the.v✓ell(s),changing the discharge(Well Code)to the well(s),or adding additional discharges(Wolf Code)you must notifyMassDEP at 14ast 60 days prior to the.change. If you are-closing the well(s)and relocating the well(s)and are planning,to have the same discharge(Well Code),you must mark the top of this form by.checking the box for Relocation of Well(s)and attach to this submittal a Pre-Closure Form'for the'well(s),being closed. UIC Updates 2008 03 to CCPC.-rev.08/06 BRP.WS 06 a,b,c-Registration of Discharges to Underground Injection Wells-Page 6 of 6 I I Massachusetts Department of Environmental Protection - Bureau of Resource Protection Drinking Water Program b BRP WS 06 'a, ,6 F Transmittal Number Registration of Discharges to Underground Injection Wells ElBRP WS 06 Modification to an Existing.UIC Registration E.Site Information (cost.), " Fees: An application fee(effective 10/08/04)is due when the Registration application-is submitted There is ' no application fee associated with'sbb mitting'aModification application to an existing Registration: Registration Form. Category Registration Fee BRP WS 06 a High $480.00 BRP WS 06 b Moderate $240.00 BRP WS 06 c Low $ 90.00 BRP WS 06 d Pre-Closure/Registration $ 90.00 BRP WS 06 a $Residential Registration No fee-exempt No MassDEP Transmittal Form or number is needed when submitting a Modification to an existing UIC Registration or when submitting a Residential Registration Form(WS-06e). III)III-% There is no annual compliance fee associated with-this Registration. UIC Updates 2008 03 to CCPC-rev.08/06 BRP WS 06 a;b,c-Registration of Dischargesto Underground Injection Wells•Page 7 of 7 i r Massachusetts Department of Environmental Protection Bureau of Resource Protection- Drinking Water'Program BRP.ws..0 6 .a,b; Transmittal Number Registration of Discharges to Underground Injection-Wells ❑ , - - BRP WS'06,Modification,to an Existing UIC Registration ®; F. Affidavit 4 The injection well(s)described above.is used for placement orinjection.of fluids into the ground: I/we understand that this well is subject to inventory requirements'and compliance with'the regulations « under the Underground Injection Control Program'established pursuant to the Safe Drinking:Water Act, P.L.93-523,and:amendments,.and I/we hereby serve:notice.that the well is proposed or in service`. /we agree: 1. That the well(s)described herein will nofibe used for discharges.other than those described above; 2. That:I/we will notify the Massachusetts Drinking Water Program/UIC Program(on forms provided by;theiUlC;program)ifany of the information(including ownership ,Location or;Type of discharge)for the-above well(s)changes, but'before the change(30 days minimum notice on ownership/operator and 60 day notice on ill other changes);, 3. , That I/we will notify the-Massachusetts Drinking Water Program/UIC Program(onJorms provided _. by-the;UIC program.-Pre-Closure.Notification Form)when the above wells)is no longer in use, but before abandonment and file.a Post Closuie Notification Form within seven days of ' completing the closure.with the�UIC program. ;y t 4. That I/we will maintain financial-responsibility for'the well described above;and ws 5.F That I/wewill provide a samplinq tap(approved-byMassDEP)and'allow sampling'at the point of . injection. I/We certify under penalty of law that I/we have persorially,examined and am/are familiar with the } information submitted in thisdocument and all attachments and based on my personal knowledge or inquiry of those individuals immediately'responsible,for obtaining-the information. IMIe believe the information is true, accurate,and complete. I/we am/are aware that there are significant penalties for -im lse,in f rmati n, including, ossible fines and imprisonment. «fir parer - Date = Director of.operations Preparer Position/Title Ll • UIC Updates 2008 03 to CCPc rev.08/06 BRP WSJ06,aAc-Registration of Discharges to Underground Injection Wells•Page 8 of 8 t - Massachusetts Department of Environmental Protection Bureau of Resource ry Protection Drinking Water Program BRP WS .06 a,-b,c Transmittal Number f Registration of Discharges to Underground Injection.Wells ❑ BRP WS 06 Modification to an Existing UIC Registration'` Questions Any questions may be directed to the UIC Program at(617)3484014:or to the UIC Contact at your Regional MassDEP Office; Find'your region: http://rras's'g6v/dei)/about/re6ion/findvour.htm Submit Application to: '< M ro MassDEP, Drinking�Water Program t1 Winter +reet—6 Floor, `Boston; MA 02108 Attn: UIC Program MAILING ADDRESSES .: ry UIC Program,MassDEP Northeast Regional Office:(NERO), - 265b'Lowell.Street,Wilmington, MA 01887 .. UIC Program; MassDEP Southeast Re'66nal.Office,(SERO),, a 20 Riverside Dr.-Lakeville, MA 02347 71 UIC Program, MassDEP Central`Regioral Office(CERO), 627 Main Street,Worcester,'MA'01608 UIC Program, MassDEP Western Regional Office(WERO), State House.West,4th Floor,436 Dwight Street,Springfield, MA 01103 UIC Program,iMassDEP Boston'Office, F" One Winter Street-,6th Floor, Boston;'MA 02108 SERVICE CENTER PHONE NUMBERS: ' Northeast Regional Office - �978-694-3200 Southeast Regional Office: 508-946-2714; Central Regional Office 508-792=7683 . Western Regional Office, 413-784-1100 ext.'214 rt Send duplicate copies of all forms to: Local Board of Health Local Plumbing Inspector, Ll .`UIC Updates 2008 03 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 9 of 9 Massachusetts Departmentof.Environmental`ProtectionJ W� Bureau of Resource Protection Drinking:Wate'r Program" BRP 1IIIS 06 a';b,c } Transmittal Number a Registration of Discharges to Underground Injection Wells BRP WS 06 Modification to'an.Existing:U1C Registration See Instructions - n'Fee (check the'appropnate:w UIC Registratioell type category) Important:When ,. filling out forms ❑ a. High includes the following well types 5A5;564,5W20&5X25 Registration Fee'=$480.00 on the computer, 1 use only the tab ❑ b. Moderate includes the following well types-5A6 5A19,51171;5S23✓'& Registration Fee=:$240.00 key to move your 5X27 - cursor-do not rt ,. , - use the return Elc. Low includes the following,well types 5A7,5A8;5622 5D2, 5G30 , ke 5R21&5X29 ,: t Registration Fee=$A 90.00 Y. q o d. Pre-closure/WS=06d form-for UIC wells not previously,registered with MassDEP. Registration of these wells is:not done.using,this fgrm.They must'be submitted on aPre-Closure/VVS-06d form. e. , Residential Exemption.[for four units or fewer)—the following well;types:(typical residential activities). are exempt from a.UIC registration fee and have a separate registration form WS-06e—5A7,5D2; ti 5G30&'5X18., .< { • . -See the Class V Injection'*ell Type Table at the end of the Instructions for well type: See instructions Transaction 'Type. - Registration. - Ini i h n w r� 'f t a - a e'istr'ation .` -initial existin y�r i r i e st at on Conversion 9 9 9 ❑ r - v Partial Closure/Registration, '. Modification ® Change of owner/operator ® Change in or additional;well/code(s) ❑, Change in,locatior well(s), Change in#-of discharge wells(+/-) MAS41 A020004.: For modlfCatlOrlS(required) UIC Registration ID#issued byMassDEP in the original Ulc A. Facility` InformationiT For modifications, enter new or revised information: See Instructions Cape Cod Potato Chip`Company;:Inc. ".100 Breed's Hill.Road Facility/Property Name Facility Street Address. 2096 Company Name SIC Code# )(MassDEP Use Only)Facility# Hyannis Barnstable MA 02601 Cityrrown 'County ;F State Zip Code Facility PWS ID#(if appropriate) _ t. 508.790.3900 Facility Telephone Number Facility Email(optional) EPA Hazardous Waste Generator ID# EPA Hazardous:Waste Generator ID# a � UIC Updates 2008.04 to CCPC rev.08/06.. x°^ BRP WS 06 a b,c`-Registration of Discharges to Underground Injection Wells.Page 1 of 1 v ' t Massachusetts Department of Environmental,P-rotection Bureau of Resource Protection - Drinking Water Program BRP WS 06 a,b;c ' Transmittal Number Registration of Discharges to,Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC Registration B. Owner/Operator Information See Instructions For modifications,'enter new or.revised information: Lance, Inc. d/b/a Cape Cod Potato Chips`"l 14120 Ballantyne Corporate-Place, Suite 350 Name of Owner 'A _Address of owner(if different from facility); Charlotte NC NC City town '' -} ... State. Zip Code . Name•of Operator(if different from owner) Address of operator(if different from facility) City/Town • State CitylTown Mr.Jeff Newell 508.790.3900 " G. Legal Contact Leg al,Contact Phone# Legal Contact Fax# " Ownership.Type: Private:`- ® Industrial ❑ Commercial ❑ .Non-profit ❑ Residential Public: >`❑ _Local ❑ Regional ❑•:State TJ .Federal C Injection Wei 'Information, For modifications,enter only new or revised information:; See instructions- table at end, Registration: Individual, 'or'- ❑�Area Storm Water Leach Pit. _, _ 041, F Well Type ' • Well Code Number of wells Well Construction(check all that apply) 4 ❑,,DryweIF ❑ Septic Tank ❑ Cesspool ❑ „Dug.Well ❑ Improved Sinkhole; ,:Drainfield/Leachfield.. ❑'`Dustwater onto'the"ground Eli Other(describe): Type of discharge See instructions-. table at end.;; ;Source of water discharged to the well z Average flow(gallons per day) Month/Year of;well construction Month/Year ceased using well(s)for previous use(s) #of entry points-to existing system #of entry points for proposed system : Total-#of.entry points to system See instructions List any treatment devices in place or proposed prior to the injection point: UIGUpdates 2006 04 to.CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells-.Page 2 of 2 i Massachusetts Department of Environmental Protection Bureau f _ o Resource Protection: Drinking Water Program BRP WS 06 a,b,c Transmittal Number Registration of Discharges to Underground Injection Wells BRP WS 06 Modification-to an Existing UIC'Registration C. Injection Well Information (cont.) See instructions Depth to water table(feet) Depth to bedrock(feet) Soil type(s)at side-e.g.,fill,sandy.till,gravel,sand; Distance to nearest private drinking water well(within 1250') Distance to nearest Public Water Supply.(within'2500') Name of nearest.Public Water Supply D. Operational Status See instructions Designed, not yet constructed ❑ Under Construction. ❑Active ❑ Temp.abandoned ❑,Conversion to another well type artial Closure/conversion to.another well type(well code) ❑ .Active/Partial Closure P ❑,Permanently abandoned/not reported previously; Source of injection fluid(91) Source of injection fluid(#2) Source of injection fluid{93) Rate of injection(gpm or other unit value) Potential contaminant#1'+ Potential contaminant#2 Potential contaminant#3 , Potential contaminant#4 E. Site Information Are there any other discharges on site? ❑ Yes ❑ No If yes,are.they permitted with MassDEP? ❑ .Yes ❑ No ' If no,are they registered with MassDEP.a's Classy Yes ❑' No wells? El 'Please list the type or types of discharges. Check any of the-following that apply.to this site: a. ..❑ Superfund site If yes,Federal ID#.b. ❑ Bureau of Waste Sit e.Cleanup.Priority Site If yes;file number c. ❑ Bureau of Waste.Site Cleanup Waiver Site — If yes,file number Please provide a:copy of the`letter.of authorization if applicable. ' UIC Updates 2008 04to CCPC•rev.08106 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells Page 3 of 3 A Massachusetts Department of Environmental,Protection; "` Bureau of Resource Protectidn-- Drinking Water Program r� BR , WS 06,.ab,c r Transmittal Number Registration of Discharges to,Underg round,Injection Wells#❑ ti BRP,WS 06'Mod ifil ation,to an fidsting`•UIC'Registration E. Site Information(cont.) z See instructions If the site is currently being regulated'by the:Bureaa of Waste Site Cleanup, check any of the following that apply El Incident Response ❑ Short Term,Measure Activity and use limitations: Confirm that the applicant has checked that the site does not.have any activity,restricti on s.with respect to limiting discharges on the site. w ions lease explain;attach additio ❑ .'No restrictions ❑ Restrict (p p nal sheets if necessary): a Location of Facility: Is the facility located on Native American lands? ❑:.Yes ❑ No ,. Latitude: Longitude: F degrees mm;(')sec(") degrees min(')sec,(") Latitude&Longitude are;no longer optional data: .. Y.♦ ) _ See instructions - ��Identify'the method used forlocating`the latitude/longitude coordinates for th`e°UIC Class V well(s): Type: ❑'Approximate location of point of UIC Class well(s) ❑. Approximate center of drainfield(s) ❑ Approximate location-of area wellfield(s) Y. ❑'Approximate center of facility(ies) ❑Approximate,center of area where discharges are located, Accuracy: Estimated horizontal accuracy is less than+/-100 feet ❑ Estimated horizontal.accuracy is less than+/-500 feet, ❑ Estimated horizontal accuracy-is less than ti-1000 feet UIC Updates 2008 04 to CCPC-rev.08/06 BRR 1NS O6 a,ti,E-Registration:of Discharges to Underground Injection Wells•Page 4 of 4 ti Massachusetts Department of Environmental Protection Bureau of Resource Protection,,- Drinking Water Program R V R P WS 06 a,~/ & Transmittal Number Registration of Discharges to Underground Injection Wells ❑ ., BRP WS 06 Modification to an'Existing'UIC Registration E. Site Information (cont.) Provide a narrative description of the site and the feature to be permitted.As an example:"The site is on the west side of Main Street;the third building north of High Street.The disposal field Iies 100 feet off the southwest comer of the building." Must be All additional information that is relevant to the installation or.operation of this injection well and to the attached-see determination of its potential to endanger under round sources of.drinkin water USDWs instructions p 9.; 9. 9 ( )- s including a'site map showing the facility and UIC well(s), on-site drinking water wells,all other on-site discharges and the drains leading.to the well and/or drainage area served bythe well:,MSDS sheets for chemicals likely.to be discharged into well must be submitted.Analytical data available on the discharge or raw water`as applicable. : ❑ Map attached ❑ Detail sheets attached . ❑ MSDS sheets attached ❑ Other information attached Attach'a map of the facility based on a USGS topographical map or MassGIS Color Ortho Photography that clearly indicates.both your facility and the location of the discharge. The USGS topographical map is available at: : hftp://maps.massqis.state.ma.us/MassGISTopos/viewer.htm or the Color:Orthophotography At-.http://maps.massgis.state.ma.us/MassGISColorOrthos/vieWer:htm. h Attach'.a site plan showing buildings, boundaries, abutting streets, location of test'pits, location of all UIC wells, location of on-site-drinking water wells, location of monitoring.wells and a locus map. Attach a narrative description of the shallow injection well system and its major components.The description should contain'a diagram including the plan,view and-cross sectional view of the shallow injection well system, indicating piping,junction boxes,tanks, and leachfields..Dimensions of all major components and design calculations must be included Attach the Material Safety'Data'Sheets for all.chemical products stored or used at the facility which. may intentionally(additive)discharge or unintentionally.(spill/leak)discharged to the shallow injection well(s). Attach existing analytical testing.data from the existing':waste stream or raw water for expected contaminants in proposed waste stream,,based on specified testing parameters. For stormwater submittals(if applicable): Attach a letter from°the local municipality or other responsible party committing to long term maintenance of the UIC system,as described.in the maintenance stipulations of the UIC Program Registration Approval if this applies(responsibility for maintenance is to be transferred). Attach-a letter from the local municipality'or other responsible party if there is;a discharge from the UIC system(actual or proposed)to another offsite system (town.storm sewer or wetlands). UIC Updates 2008 04 to CCPC-rev.08/06' BRP WS 06 a;b,c-Registration of Discharges to Underground Injection Wells•Page 5 of 5 Massachusetts'Department of En vironmental`Protection �`— `Bureau of Resource Protection - Drinking.Water.Program f BRP WS 06 a,-b,c t . Transmittal Number Registration of.Discharges to.Underground'Injection Wells. ; BRP WS 06 Modification to an Existing'UIC,Registration _ - Y4. E. Site Information (cc nt ),." Who must register: }, Any party who discharges to"a Class V Well as defined in'310-CMR 27.00 must apply'excepfthose listed as,exempt from the registration requirement as per,310 CMR 2707: ; (2) Groundwater Remediation Projects.Any injection into a Class IV or Class+V,lnlecfion well dunng a response action conducted or performed in accordance.with"the'provisions of M.G.L:c:21 E and the Massachusetts Contingency Plan,3,10 CMR 40.bbbo,or"for the purpose of remediatlon, ` at a release site;pursuant to the`provisions and"'the Comprehensive'Environmental:Respon`se;. Compensation, and Liability Act of 1980(CERCLA);42 U.S.0 9601 9675;,or pursuant to:. requirements and'provision's under the Resource Conservation and Recovery Act_(RCRA),42 ` 4 U.S.C.6901-6992k shall be exempt from `(b)the registration requirements set forth in`310 CMR 27.08; 3) Registration.The following Class V inlectlorrwells are also exemptjfrom,the registration requirements of 310'CMR 27 68 a^ (a)on-site subsurface sewage disposalsystems used solely for the disposal of sanitary sewage y and regulated under.310 CMR 15:000. (b)Class V'injection wells permitted under314 CMR 5 00„* Any party closing a'UIC Class V well that has not previously registered with the MassDEP.UIC Program must register using_the"BRP WS-06d Pre-Closure Form: <. If,you have not previously registered and:you;are closing the use of the well(s)for one(or more)`uses but want to continue using the well(s)for one(or more)uses you must mark:the top of this form.by checking the box for"Transaction';Type' PartialfClosure/Registration and attach'the'Pre-Closure Notification Form to this submittal.They Pre-Closure Notification Form,.must be'submitted.to the Boston Office.The`Boston Office will forward'the`Pre.Closure form to the appropriate MassDEP Regional Office for those:uses that you:intend to discontinue.to discharge to the;. Class V Well.All furthercommunication:on closure of•the well(s)including filing:of the Post- Closure document should lie with the appropriate MassDEP RegionalOffice. If you have not previously Registered and you,are conyerting;;the%well.from a"prohibited",.use to a.use . r that is"authorized by�rule you must mark the top of this form by'checking the box for".'Transaction Type"-Conversion and:attachkthe.Pre-ClosureNotificatiori Form,for thoseruses.that you intend to discontinue to discharge to the Class V Well.,The Pre-Closure'Notification Form must be submitted to the Boston Office:The Boston Officewill.'forward the'Pre-Closure form to appropriate MassDEP Regional Office for those uses that you intend to discontinue discharging to the'Class V,Well 'All further communication on°closure of tliewell(s)including: filing of the Post-Closure document should'be with the appropriate MassDEP Reg ional_Office. if are registering a well(s)at a residential structure(four units or.fewer), the MassDEP UIC re istration form WS-06e should be used instead;-of this one. a , Who'must:sub-mit a'notification form t " If the Owner or'Operator information(name addressor other con#act information)changes you.must notify the UlC program at least'30 days prior to the change(s). If you are.adding wells(Area Registration);relocating the well(s),changing the discharge(Well Code)to the.well(s)or adding additional discharges,(Well Code),you must notify,MassDEP'at least 60"days prior to the change. If you are closing the well(s)and relocating the well(s)and are planning to have the same discharge(Well,Code),you must mark the top of this form.by checking the box for Relocation of Well(s)and attach to this submittal a Pre'Closure Form for.the well(s)being closed: UIC Updates 2008 04 to CCPC•rev.08/06 BRP WS 06 a;b,c-Registration of,Discharges to Underground Injection Wells-Page 6 of 6 I Massachusetts Department of Environmental Protection. Bureau of Resource Protection= Drinking WaterProgram . BRP WS ,06 a !b!-ic Transmittal Number Registration of Discharges to Underground Injection.Wells 0 BRP WS 06 Modification to'an Existing UlC, Registration E. Site Information;{cont.),,,r; Fees: ;. An application fee(effective 10/08/04)is due when the Registration application is'submitted There is no application fee associated with submitting aModification application to an existing Registration. Registration Form Category Registration Fee : BRP WS 06 a High $480.00 BRP.WS 06 b Moderate $240.00 BRP WS 06 c Low $ 90.00., BRP WS.06 d Pre-Closure/Registration $-90.00; `- BRP WS 06 a ` Residentiar-keg stration No fee-exempt y No MassDEP Transmittal Form ornumber is needed when submitting a Modification to an existing UIC Registration or when subm'itting.a,Residential Registration Form`(WS-06e). There is no annual compliance.fee associated with this Registration. UIC Updates 2008 04 to CCPC•rev.08/06 BRP WS 06 a,b,c=Registration of Discharges to Underground Injection Wells•Page-7 of 7 V F Massachusetts Department'of,Ewitonmental Protection Ll Bureau of Resource Protection -.Drinking Water,Program BRP WS 06 ,a,b,c -: Transmittal Number Registration of Discharges to-Underground Injection Wells Q BRP WS 06 Modification to an,Existing UIC Registration F. Affidavit The injection well(s)described above is used for placement or injection of fluids into the ground. I/we.- understand that this well is subject to inventory requirements and compliance with the regulations; ; under the Underground.Injection Control Program established pursuant to the Safe Drinking Water ' Act, P.L.93-523,and amendments,and I/we,hereby serve notice that the well is proposed or in service. I/we agree: �`1. _That the well(s)described herein will-not be.used for discharges other than those described above; 2. rThat I/we will notify the`Massachusetts.Drinking WaterPrograrn/UIC Program(oh4orms provided by the UIC program)if any of the inforrnation;(including Ownership,Location or Type.of discharge)for the above.well(s)changes; but before the.change(30 days minimum notice on ownership/operator and.60 day noticeon-all'other changes); 3.` That I/we will'notify the Massachusetts Drinking Water Program/UIC Program(on formsprovided by the UIC program—Pre-Closure'Notification Form)when the above well(s)is no longer in use, but before abandonment and file a Post Closure Notification Form within seven days'of' :completing the closure with,the U.IC program. 4. That Uwe will,maintain financial responsibility for the well described above;and 5. That I/we will provide'a sampling tap'(approved by`MassDEP)and allow sampling at the point of injection. I/VUe certify under penalty of law that I/we have,personally examined and.aim/are.familiar with,the information submitted in this document and all attachments and:based on my personal knowledge or. . inquiry of those individuals Immediately.responsible for obtaining the information. ILWe believe the information is true;accurate, and complete..I/we am/are aware that there are significant penalties for submitting false i forma ion Including possible fines and Imprisonment: Sig a re of Preparer .,'Date JeYNewell Director'of Operations Printed Name.of Preparer Position/Title,. UIC Updates 2008 04 to CCPC-rev.08/06 BRP WS O6 a,b,c-Registration of Discharges to Underground Injection Wells•Page 8 of 8 ti Massachusetts Department of`Environmental Protection ; Bureau of Resource Protection -Drinking Water,.Program V RP WS ,0 -,, Transmittal Number Registration of.Discharges to�Underground Injection Wells ❑ BRP WS 06 Modification'to an Existing UIC Registration. .®, Questions Any questions may,be.directed to the UIC Program at:(617)'348-4014 or to the UIC Contact at your, Regional MassDEP'Ofrice: �. Find your region: http://mass.gov/der)/about/regio'n/findyour.htm Submit Application to: king.Water Program . 1'Winter Str - t,h eet 6 .Floor s' :Boston, MA 02108 Attn: UIC�Program MAILING ADDRESSES UIC Program, Ma§sDEP Northeast Regional Office(NERO), ; 205b Lowell Street,Wilmington, MA 0.1-887 ` UIC Program,.MassDEP`Southeast Regional Office(SERO), 20 Riverside Dr.-, Lakeville, MA 02347 UIC Program MassDEP,Central.Regional Office(CERO); 627 Main Street, '`Wc cester,°MA!01.608 UIC Program, MassDEP Western:Regional Office(WERO), w State House West;4th Floor,436=Dwight Street'Springfield, MA 01103 UIC Program; MassDEP'Boston"Office;: One;Winter.Street-6`h Floor, Boston'; MA 02108. SERVICE CENTER PHONE NUMBERS: Northeast Regional Office - .978-694-3200 .. Southeast Regional'Office 508-946-2714 Central Regional Office ` : 508-792-7683 " Western Regional Office 413-784-1100ext.214 Send duplicate copies of all forms`to:., Local Board of Health Local Plumbing Inspector T. UIC Updates 2008 04 to CCPC rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 9 of 9 i Massachusetts Department of Environmental Proteetlon"" Bureau of Resource Protection Drinking Water Program B R P WS 06 a 90. t Transmittal Number Registration of Discharges to Underground Injection Wells. ❑'„` _.° 'BRP WS 06 Modification to an Existing UIC Registration ® i See Instructions UIC Registration,Fee (checkAhe appropriate.well type category)` Important:When filling out forms ❑ a. High includes the following well types-5A5,5D4,5W20&,5X25 Registration Fee=$480.00 ' on the computer, a ; t�- use only the tab ❑ b. Moderate includes the following well types-5A6,5A19'5F1„5S23& Registration Fee=$240.00 key to move your 5X27[Icursor-do not ,° 3 use the return C. Low includes the following well types-5A7;5A8,5622I 5D21 5G301 key. 5R21&5X29 Registration Fee $'90.00 d. Pre-closurelwS-06d•form-for UIC'wells not previously registered with MassDEP. Registration.& these wells Is not done using this form.-They must be submitted on a Pre-Closure/WS-06d form ' e. Residential Exemption[for four,units or fewer]—the following well types(typical residential activities) are exempt from a UIC registration fee and have separate registration form WS-066 SA7 5D2„'.. 5G30,&5X18. See the Class V injection Well Type Table at the end of the Instructions for well type..; ' See instructions Transaction Type Registration ❑,.Initial-new registration ❑ initial.-existing registration ❑ Conversion ,. El -Partial Closure/Registration Modification:.. . ®,'`Change of owner/operator ®° Change,in or additional.well/code(s) ❑, Change in1ocation well(s) ❑' Change in#of discharge wells For modifications(required) MAS41A020005 UIC Registration ID#issued by MassDEP in the original UIC A. Facility Information For modifications, enter new or revised information:. f. See Instructions Cape Cod Potato Chip Company, Inc 100 Breed's Hill Road Facility/Property Name Facility Street Address k 2096 Company Name SIC Code# _(MassDEP Use Only)Facility# Hyannis Barnstable: MA 02601 City/Town County `State Zip Code Facility PWS ID#(if appropriate) _ 508.790.3900 Facility Telephone Number Facility Email(optional) EPA Hazardous Waste Generator ID# - EPA Hazardous Waste Generator ID# UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 06 a,b,c;Registration of Discharges to Underground njection Wells-Page 1 of 1 k A, Massachusetts Department of Environmental Protection v^ 9 1 Bureau of Resource Protection 9;"- Drinkln Water„Pro ramm' BRP WS 0.6,,aAq Transmittal Number Registration of Discharges-to Underground Injection Wells_ ❑ ' BRP WS 06 Modification to•an.Existing PIC,Registration t` B. Owner/Operator Information:_ ' '- See Instructions For modifications,enter new or revised information: - Lance, Inc. d/b/a Cape Cod Potato.Chips ,,' 149.20 Ballantyne Corporate Place,Suite 350 Name of Owner, Address of owner,(if different from facility) " ,•, Charlotte '. NC NC , City/Town> State Zip Code ' . Name of Operator(if different from owner) Addr,ess of operator'.(if different from facility) } Cityrrown State City/Town Mr.Jeff Newell j _ 508:790.3900" Legal Contact" Legal Contact Phone'# Legal Contact Fax# Ownership Type: Private ® Industrial, ❑ `Commercial,:, ❑r Non-profit ❑ Residential a Public ❑'Local; ❑ Regional' ❑ State ❑ Federal ' C. Injection Well Information, For modifications; enter,only new or revised information: + _ See instructions- , table at end. Registration: ® Individual or • ❑ Area Storm Water Leach Pit 5D4 Well Type Well Code _ Number of wells Well Construction(check all that apply). - p : ❑ °Drywell ' ❑ Septic Tank ❑`'Cesspool El Well<', ❑ •Improved Sinkhole' ' ❑ Drainfield/Leachfield ❑ Dustwater onto the ground ❑ Other(describe): 'Type of discharge " See instructions- table at end Source of water discharged to the well Average flow(gallons per day)' MonthNearof well construction MonthN6ar ceased usingwell(s)for previous use(s) #of;ent , - entry to existing system #'of entry points forproposed system Total`#of entry points to:system See instructions . ; List any treatment devices in place or proposed'prior to the injection point: UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 2 of 2 Massachuse tts Department,.of vi n E 'ronmental f Protection Ll Bureau of Resource Protection - Drinking Water Program BRP WS 06 a 3l�!Il C Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC Registration C. Injection Well,Information (cont.) See instructions '> Depth to water table(feet) Depth to bedrock(feet) Soil type(s)at side-e.g.,fill,sandy till,gravel,sand Distance to nearest private drinking water well(within 1250') " Distance to nearest Public Water Supply(within 2500') Name of nearest Public Water Supply x D. Operational Status: See instructions _ ElDesigned, not yet constructed ❑.Under Construction ❑Active ` El Temp. abandoned El Conversion to another well type ❑ Partial Closure/conversion to anotherwell'type(well code) ElActive/Partial Closure El' Permanently abandoned/not reported previously a Source of injection fluid(#1) Source of injection fluid(#2) y Source of injection fluid(#3) Rate of injection(gpm or other unit value) , Potential contaminant#1 Potential contaminant#2 Potential contaminant#3 Potential contaminant#4 E. Site Information_ Are there any other discharges on site? El--Yes ElNo If yes,are they permitted with MassDEP?: ❑;Yes ❑ No If no,are they registered with MassDEP.as Class V Wells?, ❑ El Yes .No Please list the type or types of discharges: - Check any of the following'ttat apply to this site: a. '❑ Superfund.site If yes,Federal ID# t). ❑ Bureau of Waste_Site Cleanup Priority Site If yes,file number c. El .Bureau of:Waste.Site Cleanup Waiver Site If yes,file.number Please provide a copy of-the letter of authorization if,applicable. UIC Updates 2008 05 to CCPC•rev.08/06 -BRP WS O6 a,b,c-Registration of Discharges to Underground Injection Wells-Page 3 of 3 , , his Y r LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Drinking;Water Program = ` .BRRWSW�a:,b,c Transmittal Number Registration of Discharges to,Underground Injection Wells BRP WS 06 Modification to anfExistingµUIC Registration ® ' E. Site`Inforrriation (cont j" ' See instructions If the site is currently being regulated by the Bureau of'Waste Site Cleanup,check any of the following.that apply:, ❑ Incident Response. ❑ Short Term,Measure Activity and use limitations: ; . Confirm.that the applicanYhas checked that the site does not have any activity restrictions with respect to limiting discharges-on the site. a ❑, No. restrictions,< E] Restrictions(please explain;attach additional;sheets if necessary): . Location of Facility: w ;^ Is the facility^located on Native American lands? 's, .❑ Yes ❑ No' Latitude: Longitude: degrees min(')sec(") ?degrees. min,(')sec,(").. a :Latitude&Longitude ar,'e no longer optional data.. See instructions Identify the method used for locating the latitude/longitude coordinates.for he UIC Class V well(s):. Type: k t' ❑.Approximate location.of point of UIC Class V well(s)q+� ❑'�Approximate'center of drainfield(s) i ❑'Approximate location of area uwellfield(s) Approximate,center of facility(ies) `❑Approximate center of area where.discharges are located ; Accuracy:, ❑ Estimated horizontal accuracy is less than+/-100:feef ❑ Estimated horizontal accuracy is less than+/-500 feet+ 'Estimated horizontal accuracy is:lessthan,'+/- 1.000 feet r UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 06 a,b,-c-Registration of Discharges to Undergroundlnjection Wells•Page 4 of 4 Al • K.- - - ` Massachusetts Department of Environmental Protection Bureau of Resource Protection`- Dunking WNgter Program X:` BRP WS 06 a;b;c Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an"•Existmg UIC Registration E. Site Information;(cont.) Provide a narrative description of the site and'the feature to be permitted.As an example:"The site is on the west side of Main'Street„tlie thirdbuildir g north?of High Street.The disposal field lies 100 feet' off the southwesttcorner:of the,building."Must be b. attached`-see All additional information that is relevant to-the installation or operation of this injection well and to the ' instructions determination of its potential to endanger underground sources of drinking water(USDWs)— including a,site map showing the facility and,UIC.well(s), on-site drinking water.wells all other on=site discharges and the drains leading to the well and/or drainage area served by the well.MSDS.sheets for chemicals likely to be discharged into well must be,submitted..Analytical data available on the' discharge`or raw water'as-applicable: EJ Map attached ❑ Detail sheets attached., ❑'MSDSsheets attached ❑ Other information attached Attach a map of the facility based on a_USGS topographical map or MassGIS Color Ortho Photography_that clearly indicates both your facility'and•the location of thedischarge. 3 The UlSGS topographical,rnap�is available.at: , + http://maps.massgis.state.ma.UswassGI STopos/viewer.htm or the Color Orthophotography At:http://maps.massgis.state.ma.us/MassGISColorOrthos/viewer.htm. Attach a site plan showing buildings;boundaries;abutting streets, location.of,tesf pits, location of all UIC wells, location of on-site drinking water.wells, location of monitoring wells and a locus map. Attach a narrative descri• tion of the-shallow injection well• p system and its major,components.The: description should contain.a d'iiagram including the plan.vlewand cross sectional view of the shallow • injection well system, indicating piping,junction boxes`tanks, and leachfields.;:Diimensions of all major components.and design;calculations.must be includedI- I : Attach the Material Safety,Data'Sheets for all chemical products stored or used at the facility which may,intentionally(additive)discharge or unintentionally(spill/leak)discharged to the shallow injection . Attach existing analytical testing data from the.existing.waste stream or raw.water for expected contaminants in proposed waste stream, based.on specified testing parameters. For`stormwater submittals(if applicable): " Attach a letter from the-local municipality or other responsible-party committing to long term' maintenance of the UIC system, as described in,the maintenance tipulations of the UIC Program Registration_Approval if this applies(responsibility for maintenance is to 13e'transferred). Attach a letter from the local municipality or other responsible party,if there is a discharge from the. UIC system(actual or proposed)toanother offsite system. own storm sewer or wetlands)-. UIC Updates 2008 05 to CCPC-rev.08/06 BRP WS 06 a,b,c-Registration of.-Discharges to Underground Injection Wells•Page 5of 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Drinking Water.Progrom BRP. WS 06 a,b,c ;, . .. Registration of Discharges to. Underground Injection Wells 0, Transmittal Number BRP WS 06 Modification to an Existing UIC`Registration E. Site Information (cost.)' t e Who must register. a; Any party who discharges to a lClass;V Well as'defined in 310 CMR 27.00 must-apply except those{ listed as exempt from the registration requirement as per 310 CMR 27.07. (2) Groundwater Remediation Projects.Any injection into a Class'IV or Class V.injection well during a response action-conducted or performed in accordance with the provisions of UG.L. c.21 E and the Massachusetts Contingency Plan,�310 CMR 40.0060, or for the purpose of remediation at a release site, pursuant to the'provisionsUnder the�Comprehensive`Environmental Response, Compensation, and Liability Act of•1980(CERCLA),42 U.S.C.,9601-9675,_or pursuant to requirements and provisions`under the Resource Conservation and Recovery Act(RCRA);42 U.S.C. 6901-6992k shall be exempt from: y . b the registration - re uirements set forth in'310 CMR 27. Oq 08, 3) Registration.The following Class.V injection wells are also exempt from the registration requirements of 310 CMR 27:08: (a)on-site subsurface sewage disposal systems used solely for the disposal�of sanitary sewage, and regulated under 310 CMR 15.000. (b)Class V injection wells permitted unde014 CMR 5.00. Any party closing a UIC Class V'well that has not previously registered with_the MassDEP UIC Program must register using the BRP WS-06d Pre=Closure Form. ' If you have not previously registered and you are closing,the:.use ofAhe-well(s)>for one(or more)uses but w ant to continue using the well(s)for one(or more)uses you must mark the top of this form by checking the box for"Transaction,Type -Partial.:Closure/Registration and attach the Pre-'Closure Notification Form to this submittal.The.Pre-Closure Notification Form must be submitted to the Boston Office.The Boston Office will forward the Pre'Closure:form to the appropriate. MassDEP Regional Office for those uses that you intend to discontinue to discharge;to the, 1 Class V Well.All further communication on closure of the well(s)including filing of the Post. Closure document should be with the appropriate MassDEP Regional Office. If you have not previously,Registered and you are converting the well from a"prohibited" use to a use that is"authorized by rule"you'must mark the top of this form tiy'checking the box.for"Transaction" Type"-Conversion and attach the Pre-Closure Notification Form for those uses that you intend to` discontinue to discharge to the Class V Well.The Pre-Closure Notification Form must lie submitted to the Boston Office.-,The Boston Office will forward the.Pre-Closure form to , appropriate MassDEP Regional Office for those•uses thatyou.)ntind to discontinue discharging to the Class V,,Well.All.further,`commun!cation on closure of the Weil(s)including x filing of the Post-Closure document should be with the appropriate MassDEP Regional Office. „ If you are`eegistering swells)at a residential structure(four units or#ewer), the MassDEP UIC registration form WS-06e should be used instead of this one. rWho must submit a notification form: . . If the Owneror Operator information(name address or.other contact information)changes you-must.notify the UIC, program at least 30 days prior to the change(s). If you are adding wells(Area Registration);relocating the well(s),changing the discharge(Well Code)to the well(s)or, adding additional discharges,(Weil Code);you must notify MassDEP at least 6Q days prior to the,change.. If you are closing the well(s)and relocating the wells)and are planning to'have the same discharge(Well Code),you 'must mark the top of this form"by checking the box for Relocation of Well(s)and attach to this submittal a Pre-Closure Form for the well(s)being closed. - UIC Updates 2008 05 to CCPC-rev.08/06 BRP WS 06a,b,c Registration of Discharges to Underground Injection Wells Page 6 of 6; e • 5 - {.i. ' 4� ' Massachusetts Department of Environmental Protection' . 7 Bureau of Resource Protection;- Drinking Water Program y BRP WS 06 ab,`c -- Transmittal,Number Registration of Discharges_to Underground Injection Wells" BRP.WS 06 Modification to an Existing UIC„Registration a y E. Site Information` cont. Fees: _ Ana application fee effective 10/08/04 i pp ( ) s due when the Registration application Is submitted. There Is . no application fee associated with submitting a Modification'application to an existing Registration: Registration Form Category Registration Fee BRP WS'06 a,. r'.High`- r$480:"00 ,. . BRP WS 06 b a Moderate $240.QO BRP,WS 06 c Low .0 BRP WS 06 d Pre-Closure%Registration $ 90.00 : BRP.WS 06 a Residential,Registration No fee-exempt No MassDERTransmittal form onnumber Is needed when submitting a Modification to`an existing YlC Registration or when submitting.a Residential Registration Form (WS-06e). There is'no"annual compliance fee associated with this`Registration. .. i. - f.. UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 7 of 7 R • f e. Massachusetts Department of Environmental-Protection Bureau of Resource Protection Drinking:Water Program. BRP WS O Transmittal Number Registration of Discharges to Underground Injection Wells BRP WS 06 Modification to an Existing,UlC Registration ® ` a F. Affidavit` The injection well(s)described above isFused'for placement or injection of fluids into rthe ground. I/we '& understand that this well is subject to inventory requirements and compliance with.the;'regulations " under the Underground Injection Control Program established pursuant to the Safe Drinking Water Act, P.L.93-523,and amendments,and I/we hereby serve riotice`that the well is proposed or in - service. /we agree: 1._ -That the well(s)described hereinwill not be used for'discharges other than those described above; 2. That I/we will notify the Massachusetts Drinking,Water Program/UIC Program(on forms provided by the UIC program)if any.of the information(including Ownership, Location or Type of _discharge)for=the above well(s)changes, but before the change(30:days minimum'notice on ownership/operator and 60 day notice on all other changes); 3. That I/we will notify the Massachusetts Drinking Water Program/UIC Program(on forms provided by the UIC program.-Pre-Closure Notification;Form)when,the:above well(s)is.no longer,in Use, but before abandonment and file a Post Closure Notification Form within seven days of .completing the`closure with the'UIC program. 4. That.1/we will maintain financial responsibility for the well described above;and 5. That I/we will provide a sampling tap(approvedlby MassDEP)and allow sampling at the point of injection. I/We certify under penalty of law that I/we.have personally examined and am/are familiar with the yp information submitted in this document and all attachments and based on m ersonaI knowledge or inquiry of those individuals immediately responsible for obtaining the information. I/We,believe the, information is true,:accurate,and complete. I/we am/are aware thatthere are significant"penalties for submitting false infor ation, including possible fines and imprisonment: .' 14 ZZ -nature of Preparer Date �eff Newell Director of Operations Printed Name of Preparer Position/Title UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page8 of 8 Massachusetts Department'of Environmental Protection Bureau of Resource-Protection 9 9.Drihkin Water;Pro ram BRP WS .06; a,b,cj Transmittal NUmbeF ' Registration of Discharges,to Underground Injection Wells ❑ BRP WS 06 Modification.to an Existing UIC Registration' ➢ Questions Any questions may be directed to the UIC Program at(617)348-4014 or to the UIC Contact at your Regional MassDEP Office. Find your region: http:/imass.pov/dep/about/region/findvour.htm J Submit A li i cat on to. PP . . MassDEP Drinking Water Program ' 1,,Winter-Street=6th'Floor;` b ...-Boston,,MA 02108' 4 _Attn: UIC Program MAILING ADDRESSES z UIC Program, MassDEP Northeast Regional Office,(NERO); 2056Lowell Street,Wilmington;MA,01887 UIC Program MassDEP-Southeast'Regional Office(SERO),. 20 Riverside Dr., Lakeville,,MA'02347 UIC Program, MassDEP Central Regional Office(CERO), 627 Main Street,Worcester,1MA'0.1608 UIC Program, MassDEP Westem Regional Office(WERO), State House West,,4th Floor,436.Dwlght.Street'Springfield, MA.01103 UIC Program MassDEP Boston Office, u One Winter Street 6th Floor, Boston;NA 02108 SERVICE CENTER PHONE NUMBERS: Northeast Regional Office, 978-6,94-3200:. Southeast Regional'Office 5087946-2714 t Central Regional Office 508 792-7,683. •Western Regional Office 413-784-1100'ext.214 Send duplicate copies°of all forms to: Local Board of Health Local Plumbing Inspector 4 - UIC Updates 2008 05 to CCPC•rev.08/06 BRP WS 66 a,b,c Registration of Discharges to Underground Injection Wells Page 9.of 9 { i 3 Massachusetts Department of Environmental Protection T Bureau of Resource Protection - Drinking Water Program - BRP WS 06 a,b4 Transmittal Number, ' Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC Registration See Instructions UIC Registration Fee (check the_appropriate well type category) ` Important:When t filling out forms ❑ a: High includes the following well types-5A5,`.04..5W20&5X25 Registration Fee=$480.00 on the computer, s use only the tab ❑ b. Moderate includes.the following well types-5A6,,5A19,5F1,5S23& ; Registration Fee=$240.00 key to move your 5X27 - cursor-do not r` ' . use the return Elc: Low includes the following well types-5A7,5A8,5B22,5D2,5G30, Registration fee F$ 90.00 key. 5R21&5X29 d Pre=closur`e/WS=06d form=for UIC wells not previously registered,with,MassDEP. Registration of these wells is not done using this form.They must be submitted on a Pre-Closure/WS-06d form. e. , Residential Exemption[for four units or fewer]—the following well types(typical residential activities) . I� are exempt from a UIC registration fee and have a separate registration form WS-06e—5A7,5D2, 5G30&5X18. See the_Class V Injection Well Table at the end of,the Instructions for well type. See instructions,: Transaction Type - a Registration: - ❑ Initial new,registration ❑ Initial--existing,registration ❑ Conversion , Partial Closure/Registration Modification: ® Change of owner/operator ® Change in or additional well/code(s) N - r ❑ Change in location well(s)� ❑ `Change in#of discharge wells(+L) " For modifications(required) MAS41A020006 UIC Registration ID#issued by MassDEP in the original UIC A. Facility Information , For modifications,°enter new or revised information:.'.' See Instructions Cape Cod Potato Chip Company, Inc' -100 Breed's Hill Road Facility/Property Name Facility Street Address 2096 Company Name SIC Code# (MassDEP Use Only)Facility#. ,w Hyannis Barnstable MA •02601, ' Cityrrown County State Zip Code Facility PWS ID#(if appropriate) 508.790.3900 ' facility Telephone Number 4 Facility Email(optional) EPA Hazardous Waste Generator ID# EPA Hazardous Waste Generator ID'# UIC Updates 2008 06 to CCPC•rev.08/06 BRP WS 06 ab6c-Registration of Discharges to Underground Injection Wells•Page 1 of 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection. Drinking Water'Program BRP WS 06 a,b,c t: Transmittal Number . Registration of Discharges to Underground Injection Wells ;E] BRP WS 06 Modification to an Existing UIC Registration' B. Owner/Operator Information See Instructions For modifications, enter new or revised information: . Lance, Inc. d/b/a Cape Cod Potato Chips : 14120 Ballantyne Corporate Place, Suite 350 '_ Name of Owner, Address of owner(if different from facility) Charlotte NC NC Cityrrown State.. Zip Code Name of Operator(if different from owner) Address of operator(if different from facility) City/Town, .. ' ., ;, State City/Town Mr. Jeff Newell 508.790.3900 Legal Contact „,. Legal Contact Phone# Legal Contact Fax#. Ownership.Type: ' Private: ® 'Industrial ❑ Commercial ❑ 'Non profit ❑ Residential Public: .w w❑, Local ❑ Regiyonal El "State ElFederal C. Injection Well Information For modifications, enter only new or,�evised information: See instructions- table at end . Registration:, ®; Individual or '❑ Area' Storm Water Leach Pit 5D4 Well Type. Well Code Number of wells t , = Well Construction(check all that apply) ❑ Drywell ❑ .Septic Tank ❑ Cesspool ❑ Dug Well ❑ Improved,Sinkhole ❑ Drainfield/Leachfeld. ❑ Dustwater onto the ground El, Other(describe): Type of discharge See instructions- table at end• "'r Source of water discharged to the-well Average flow(gallons per day) MonthNear of•well construction MonthNear ceased using well(s)for previous use(s) #of entry points to existing system • #of entry points for proposed system Total#of entry points to system See instructions List any treatment devices in place or proposed prior to the injection point: UIC'Updates 2008 06 to CCPC-rev'oi/06"- s - BRP WS 06 a,b,c-Registrations of Discharges to Underground Injection Wells•Page 2 of 2 Massachusetts Department'of Environmental Protection Bureau of Resource Protection - Drinking Water Program BRP WS 06 alb,c ` _ a - Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an Existing UIC Registration C. Injection Well Information (cont.)' See instructions Depth to water table(feet), Depth to bedrock(feet) Soil type(s)at side-e.g.,fill,sandy till,gravel,sand Distance to nearest private drinking water well(within 1250') . - Distance to nearest Public Water Supply(within 25001 _ Name of nearest Public Water Supply " D. Operational Status See instructions -' ❑ Designed, not yet constructed T7 Under-Construction ❑Active _ ❑'Temp.abandoned' ❑ Conversion to another well type ❑ Partial Closure/conversion to another well type(well-code) ❑ Active/Partial Closure ❑ Permanently abandoned/not reported previously v". Source of injection fluid(#1) .:. Source of injection fluid(#2). . Source of injection fluid(#3) Rate of injection(gpm or other unit value) Potential contaminant#1 Potential contaminant#2 - Potential contaminant#3 Potential contaminant#4 E. Site Information Are there any other discharges on site? ❑ Yes _ ❑ No If yes, are theypermitted'with MassDE:P? ❑ ,Yes ❑ No If.no,are they registered with MassDEP as Class V ❑ Yes El No wells? 4 5 Please list the type or types of discharges: Check any of the following that apply to this site: a., ❑ Superfund site If yes,Federal ID# b. ❑ Bureau of Waste Site Cleanup Priority Site If yes;file number. C. ❑ Bureau of Waste Site'Cleanup Waiver Site If yes,file number Please providea copy.of the letter of authorization if applicable: UIC Updates 2008 06 to CCPC-rev.O8/06 BRP WS 06 ab',c-i Registration of Discharges to Underground Injection Wells-Page 3 of 3 Massachusetts Department„of Environmental Protection Bureau of Resource Protection DOA'king Water Program BRP WS 06 a bX Transmittal Number , Registration of;Discharges to.Underground Injection Wells ❑ BRP WS 06 Modification to.an Existing UIC Registration E. Site Information (cont.) See instructions If the site is currently being regulated by the Bureau of.Waste Site Cleanup, check any of the-, Ll following,that apply: Incident Response ❑. Short Term Measure Activity and use limitations Confirm that the applicant has checked that the site does not have any activity restrictions witti" respect to limiting discharges on the site. ❑ No restrictions ❑ Restrictions(please explain;attach additional sheets if necessary): Location of Facility: Is the facility located on Native Americany lands? '❑ Yes ❑ No Latitude: Longitude: 9 de rees - min sec " degrees`• min '• sec . Latitude&Longitude are no longer optional data. w See instructions Identify the method used for locating'the latitude/longitude coordinates for the.UIC Class V well(s):,. . Type ❑ Approximate location'of point of.UIC`Class V well(s) ❑ Approximate center of drainfield(s) El Approximate location of area wellfield(s) Approximate center of facility(ies) ❑Approximate center of area where discharges are located y r Accuracy: F ❑ .Estimated horizontal accuracy is less than+/-100 feet ❑ Estimated horizontal accuracy is less than+/-500 feet ❑ Estimated horizontal accuracy is less than+/- 1000 feet % UIC Updates 2008 06 to CCPC•rev.08/06 BRP WS 06 a,b,c-Registration of Discharges to Underground Injection Wells•Page 4 of 4 Massachusetts Department of Environmental Protection A Bureau of Resource Protection= Drinking Water Program r BRPWS 06 a`j!l1 b, Transmittal Number Registration of Discharges to-Underground lnjection'Wells ❑' BRP WS 06 Modification.to an Existing UIC Registration . t E. Site Information (cost" _ } Provide a narrative description of the site and the feature to'be' permitted:.As an example:"The site is' on the west side of Main Street,the third building north,of High Street.The-disposal-field lies`100 feet off the southwest comer of the building." Must be All additional information that is relevant to the installation or operation of this injection well and to the ,: .attached see determination of its.potential to endanger Ground sources of drinking.water USDWs ' . '. '• instruction's P _ 9 g _ ( )— T including a site map showing the facility and UIC well(s), on-site drinking water wells, all other on-site discharges and the,drains.leading to the well and/or drainage area served by the well: MSDS sheets for chemicals likely to be discharged-into well must be submitted:Analytical data available on the` discharge or raw water as applicable.' El Map attached.❑ Detail sheets attached "❑` MSDS sheets attached ❑ Other information attached , Attach a map of the facility based on a USGS topographical map or MassGIS.Color Ortho Photography that clearlyindicates both yourfacility and the location,of.the discharge. The USGS topographical map1s available at: hftp://maps.massqis.state.ma.us/MassGISTopos/view6r.htm .or the Color Orthophotography At: http://mabs.massgis.state.ma:us/MassGIS�ColorOrthos/viewer.htrh. Attach a site plan showing buildings, boundaries;abutting streets;location of test pits, location of all UIC wells, location of on-site drinking.water wells,location of monitoring wells'and a locus map. Attach a narrative description of the shallow injection well system and its 'major components.The description should contain a diagram including the.plan view and cross sectional view of the shallow injection well system; indicating piping;junction boxes, tanks, and'leachfields. Dimensions of all major_ components and design calculations must be included;,. f Attach the Material Safety Data Sheets for,all chemical products-stored,or used at the facility which may intentionally(additive)discharge or unintentionally(spill/leak)discharged to the shallow injection well(s). Attach existing analytical testing data from the existing waste stream or raw'waterfor expected contaminants in;proposed waste stream, based on specified testing parameters: For stormwater submittals(if applicable): _ y Attach a letter from the local municipality,or other`responsible,party committing to longterm maintenance of.the UIC system,as described,in the maintenance stipulations of.the UIC,Program r. Registration Approval if this applies(responsibility for maintenance is to be transferred). „ Attach a letter from the local municipality,or other responsible party if there is a discharge from the` ' UIC system(actual or proposed)to;another offsite system(town storm sewer or wetlands)... , UIC Updates 2008 06 to CCPc•rev:08/06° BRP WS 06 a,b,c Registration of Discharges to Underground Injection Wells•Page 5 of 5 Massachusetts Department of Environmentalv _ '• ` + Protection Ll Bureau of Resource Protection-Drinking Water;Program x BRP WS 06 a,b,c Y rt F Transmittal Number Registration of Discharges to Underground Injection Wells ❑ BRP WS 06 Modification to an•Existing UIC Registration E. Site Information(cont.)` Who must register: Any parry who discharges to a Class V Well as defined in 310 CMR 27.00 must apply except'those - listed as exempt from the registration'requirement as per 310 CMR'27.07: (2) Groundwater Remediation Projects.Any.injection into a:Class IV or Class V injection well during a response action conducted or performed in accordance with the provisions of M.G.L. c.21 E and the Massachusetts Contingency,Plan, 310 CMR 40.0000,or for the purpose of remediation L at a release site,pursuant to'the provisions.under the Comprehensive Environmental Response, Compensation,'and Liability Act of 1980(-CERCLA), 42 U.S.C.9601-9675,.or.pursuant to. r... requirements and provisions under the Resource,Conse'rvation and Recovery Act(RCRA),42- U.S.C. 6901-6992k shall be exempt from: ,. (b)the registration>requirements set forth in 310 CMR 27.08; „ 3) Registration'.The following Class V injection wells are also exempt from the registration ` requirements of 310 CMR 27.08: (a)on-site subsurface sewage'disposal systems used solely forthe disposal of sanitary sewage r and regulated under 310 CMR 15.000. (b)Class V injection wells permitted under 314 CMR 5.00. Any party closing a UIC.Class V well that has not previously registered with the MassDEP UIC Program must register using the,BRP WS=06d Pre-Closure Form: g 9 g If you have not previously registered and you are closing the use of,the well(s)for one(or more)uses but want to continue.using the well(s)for.one(or more)uses you must mark the top of this form by checking the box for"Transaction Type'-Partial Closure/Registration and attach the Pre-Closure Notification Form to this submittal.The Pre-Closure Notification Form must be submitted to the Boston Office.The Boston Office will forward the Pre-Closure form to the appropriate ' MassDEP Regional Office for those'usesthat you intend to discontinue to discharge to the Class V Well.All further communication-on closure of the well(s)including,filing of the Post- Closure document should be with the appropriate MassDEP Regional Office: If you have not previously^Registered and you are converting the_well from.a"prohibited" use to a use that is"authorized by rule"you must mark the top of this form by checking the box for"Transaction Type" Conversion and attach the Pre-Closure Notification Form for those uses that you intend to discontinue to discharge'to the Class V.Well.The Pre-Closure Notification Form must be submitted to the Boston'Office.The'Boston Office will forward the Pre-Closure form to appropriate MassDEP Regional Office for those uses that you intend to discontinue, , - discharging to the Class V Well.All further communication on closure,of the well(s)including r filing of the Post-Closure document should be with the appropriate MassDEP Regional Office. If you are registering'a well(s)at a residential"structure(four units or fewer), the MassDEP UIC °« registration.form WS-06e should'be used instead of this one: e r Who must submit a'notification form:. If the Owner or,Operator'information`(name addIress.or other cont actIinformation)*changes you must notify the UIC y program at least 30 days'prior to ttie,change(s): =g If you are adding wells(Area Registration);relocating the well(s),chan 11 ging the discharge,(Well Code)to the well(s)or adding additional discharges(Well Code)you must notify MassDEP at least 60 days prior,to the change.., r If you are closing the well(s)and relocating the well(s)and are planning to have the same discharge(Well Code),you must mark the top of this form by checking,the box for Relocation of Well(s)and attach to this submittal a Pre-Closure Form for the well(s)being closed. UIC Updates 2008 06 to CCPC-rev.08/06 ` BRP.WS 06 a,b,c-Registration of Discharges to Underground Injection Wells-Page 6 of 6 ` 1 Av y, Massachusetts Department of Envi'ronmental'Protection, �..Bu` _ reau of Resource Protection'. Drinking Water m Progra B RP.r.WS 106 Fla .gib c n` Transmittal Number.r. F Registration of Discharges to-Underground.InjectionWeiIs El K; BRP WS 06 Modification to'an Existing U16 Registration ", iz Fit E. Site Information (contF)`�- f Fees. An application fee(effective 10/08./04)is due when the, egistratlon application is subrnitted'.`.Thereis ; no application fee associated,with submitting a Modification application•to an exist'ng,`Registration. .; a 4. RegistratiomForm Category;' Registration Fee r 4. BRP WS 06 a Hlgli° ,' ; $480.00 N. s F> e BRP WS`06 b .�i,Moderate . $240.00 `BRP WS706 c Low, $ 90.00 ' BRP WS-06 d' Pre-Closure/Registration: $:90.00. ` rr 1 F BRP WS 06 a Residential Registration No fee exempt No MasspEP Transmittal Forrn;or number Is rieeded when submitting a Modification to an existing ` A UIC Registrationorwherisubmitting a Resjdential Registration'Foim;(1NS-06e); x !'There is 66 annual compliance fee associated wlth'this.Registration. rr Al t f.. •. i k o e r s x- , UIC Updates 2008 06 to CCPC rev.'OSN6 ; y, BRP WS 06 a,b,c RegistFa6on of Discharges to Underground Injection Wells•Page 7 of 7 g + Y s r, - Massachusetts Department of Environmental Protection Bureau of Resource Protection - Drinking Water Program BRP WS 06-.a,b,c r Transmittal Number Registration of Discharges to Underground Injection Wells-,0 BRP WS 06 Modification to an Existing UIC Registration'' R Affidavit t; The injection well(s)described above is used for placement or injection of fluids into-the ground: I/we' understand that this well is subject to'inventory requirements and'compliance with the regulations a under the Underground Injection Control Program established pursuant to the Safe Drinking Water. Act, P.L. 93-523, and amendments, and I/we hereby serve notice that the well is proposed Pr in- service. /we agree: , 1. That the;well(s)described herein will not be used for discharges other than those described above; 2. That 1/we will notify the Massachusetts Drinking Water Program/UIC Program(on forms provided by the OIC program)if any of the information (including Ownership,-Location or Type of discharge)for the abovd)well(s)changes, but before the change(30 days minimum notice on ownership/operator and 60 day notice on all other changes); 3. That I/we will notify the.Massachusetts Drinking Water.Program/UIC Program(orrforms provided by.the UIC program-yPre.-Closure Notification Form)when the above,well(s)is no,longer in'use, z but before abandonment and file'a Post ClosLre Notification Form within seven days of completing the closurewith the UIC program. 4. That I/we will maintain financial responsibility for'the'well described above; and 5. That I/we will provide a`sampling tap(approved by,MassDEP)and allow sampling at the point,of injection. I/We certify under penalty of law that l/we Piave personally examined and am/are familiar with the information submitted in this,document and all attachments and based on my personal knowledge or inquiry of those individuals immedl3tely responsible for obtaining the information. INVe believe the information is true, accurate,and complete. I/we am/are aware that there are significant penalties for submitting fats �f �rrtation, includi possible fines and imprisonment. Signature of Preparer " Date Jeff Newell' Director of Operations Printed Name of Preparer Positionf.Title UIC Updates 2008 06 to CCPC•rev.08/06 BRP WS O6 a,b,c-Registration of Discharges to Underground Injection Wells•Page 8[ofa8 a 'iLMassachusetts Department of'Environmental'Protection Bureau of Resource Protection - Drinking Water Program BRP WS 06 a,b,c # . Transmittal Number Registration of Discharges to Underground Injection Wells BRP WS 06 Modification to an Existing UIC Registration Questions Any questions may be directed to the UIC Program at(6.17)348=4014 or to the UIC Contact at your Regional MassDEP Office. Find your region:http://mass.gov/dep/about/region/fiindvour.htm Submit Application to: 'MassDEP Drinking Water Program, 1 Winter Street—6l''Floor, Boston, MA 02108 Attn:,UIC Program, MAILING ADDRESSES UIC Program, MassDEP Northeast Regional Office(NERO), °E 205b.Lowell Street;Wilmington, MA 01887 UICProgram,MassDEP Southeast Regional Office(SE.. - RO); 20 Riverside Dr., Lakeville, MA 02347 UIC Program,'MassDEP'Central Regional Office(CERO), - 627 Main Street,Worcester, MA 01608 y UIC Program; MassDEP Western Regional Office.(WERO), State House West,4th Floor,436 Dwight,Street, Springfield, MA 01103 d, UIC Program, MassDEP Boston Office;,' One Winter Street—6th Floor, Boston,,MA 02108 l SERVICE CENTER PHONE NUMBERS: x Northeast Regional Office 978-694-3200 -,Southeast Regional Office 508-946-2714 I' Central Regional Office 508-792-7683 Western Regional Office 413-784-1100 ext.214 Send duplicate copies of all forms to: Local Board of Health " t Local,Plumbing Inspector UIC Updates 2008 06 to CCPC•rev.08/06 BRP,WS 06 a,b,c-Registration of'Discharges to Underground Injection Wells•Page 9 of 9 f No. . V (IJ Fee 41 S . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye" application for �Dt5po5al *pftem Cougtruction Permit Application for a Permit to Construct O Repair O Upgrade O Abandon(/0 Complete System ❑Individual Components Location AddressoLot N � Ow�qnerry's Name,Address,iand e Tel.N . (O 4Crc,Ass eapr DU 61 ►a C' Installer's Name,Address,and Tel.Nolq.�,p��-� � Designer's Name,Address and Tel.No. ,• ' IR 0 VZ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date `�Udl(�_ "7 tr 9 � Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. a o/ &4?Z j Description of Soil Nature of Repairs or Alterations(Answer when applicable) �GG(Jw �Cf�✓ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo f ealthh..1)�7 Signed !/'�o �t'✓� Date 7ApplicatiomApproved;by, Date 0 a� y ! Application:Disapproved:'by: _Date 'for the:following reasons Permit No. (J (v Lf(2[I Date Issued 11 �- No. C -`WON Fee THE COMMONWEALTH�OF MASSACHUSETTS Entered in computer: _/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 4,5,pogal �§pztem Cow5truction Vermit Application for a Permit to Construct O Repair O /Upgrade O Abandon O ❑ Complete System ❑Individual Components Location A dress or of No.r r(' lJh 0 Ow er's Name,Address,and Tel. o. .4- As sor' Map/Parcel $(0 QU S� 8/ d t `�. —. - PAC ' j rF►C Installer's Name,_Address,and Tel.Ng. Designer's Name,Address and Tel.No. 00 3�todt, l o tin•+�s Type of Building: Dwelling No.of Bedrooms 1 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures µ Design Flow(min.required) gpd Design flow provided gpd a Plan Dateu.ylQ i 9 g m Number of sheets Revision Date Title /- ' Size of Septic Tank :Q� Type of S.A.S. w . .. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �d✓?Gu'��! Q 747o G( rm-T-, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental-Code and not to place the system in operation until a Certificate of Compliance has been issued by this B•ar aoffteoalth (� �}Signed � ~✓)�� y rA�2bv1-f Date /V-0-0b Application Approved by .�'!'2 Date /n/2 Y104 Application Disapproved by: .� ` .. Date for the following reasons t'`�•�_ .., .✓ Permit No. �)C)(_,) L-(,o �"" .,�- Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of- Compliacnce THIS IS TO CERTIFY,t at the Olin-site S we a ••Dispo l>,Systern Co tru\cttod ),!N}epaired ( ) Upgraded( ) i Abandoned )by at Y IIJ�1_ /0 �11 6 /1/K. H— / ff VONIFL? een' oc nstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. N q%— dated Installer Designer #bedrooms ® Approved design flow t gpd The issuance ofAislpermi�sha I not be construed as a guarantee that the system wffl function ass-ddessiigaied/ Date / '^/ Inspector + Fee _--.-No�� ir7tf ----�----------1---------- ,��• .•��'Cs� ---- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Mi.5po!6at *p5tem Construction Vermit n Permission is hereby ranted to Construct ( ) Repair (, ) Upgrade ( ) Abandon ( ) System located at - x� , and as described in the above Application for Disposal System Construction Permit.The applicant reco-nizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed.within three years of the date of this permit. ) bfi q/�Date b Approved by= p TOWN OF BARNSTABLE SEWER CONNECTION PERMIT OFFICIAL USE ONLY �� J Assessors Map No yM. 3 , X{a^ ?`':�i:"j?S::Yv??:'r::;:?''•:::vni{'L ti:�:?:::::L?�i':}j}�i?;ii Assesso rs Parcel ............ ....:.............. ?;ism;isf;,�::�{:::i':is?:':::k?}>i?:Y:i:??:':}>:'}}ti ::V}}x•:::n:�i}:i'.�}.�i}?:<.::t•.}.:.,:•:•;••?:;::;ti??a:::::4n•:;.^•.:•.:::}:•..a:.4;•.,,.,•}"•::,tin,:••?;:^•.::•:, .•..;r.......;.:, ?}::, Street: GO :`;�;.r,.;}.\•,�:::::{•}:o}:?;•>•>:cY}:•}::::::`�::`:::' "` `:�\v:?.}.>},,.,�.;>.;;,.,...:;•:cY;:. {iJ't??::S2:i+{T\v .v Y.ry,n ::n4::+^C•�:i v;v.. n�3 n4:'i s- .r. {..., PROJECT CONTACTS PROPERTY OWNER (Mail!qg Address SEWER INSTALLER Name: L1= S.NAC/!a /iYG Name: -1�/:4NGtrGp 7rA1i.�-i��s Address: Address: Phone: Phone: Ly-�Q - e r License No: OWNER'S AGENTIENGINEER Name: C/.fCa TAY�iL J�(/L Address: Phonw.. PROJECT DESCRIPTION REGULATORY REQUIREMENTS AT i1;?4{illr? E4 ::3"i •i<.:'ri::ii::ijjj::?;:j::?.. ..: y� '�•, r.;yr.;'..t... p R% •:1{:� i:�;:��lr"r.::v:;::a5i:•.��:i�i.Y.�i'V'iitidi.''•`:;:�i::':i:;`% v.�::::::;•}:•}:.}:�:•Y:{;{::{.y e Instal lation of all sewer co nnections ns must be done nac cordance with the provisions of Article )OONI, Town of Barnstable , General By-laws and RESIDENTIAL. regulations issued by the Department of Public Works. Before excavating within a Town Way the sewer Installer must also obtain a Road Opening COMMERCIAL permit and comply with the Construction Standards and Specifications outlined therein. At least 48 hours prior to the installation,the applicant must RESTAURANT notify the Department of Public Works,Engineering Division for the purpose of inspecting the Installation. The Inspector will complete the Compliance INDUSTRIAL Sketch locating the installed lines and connection. By signing the Application, the applicant acknowledges and understands the regulatory requirements and STANDARD INDUSTRIAL CLASSIFICATION NO. understands that failure to comply with them shall be grounds for revocation of the Sewer Connection Permit and the denial of any future application. 140.OF BUILDINGS NO.OF BEDROOMS SIZE OF PARCEL ACRES STIMATED DAILY SEWAGE GALLONS PIPING:LENGTH DIAMETER �CPECTED INSTALLATION DATE 'IGNATURE(INSTALLER/AGEN DATE IIGNATURE(DPW APPROV - DATE �Z �" t _ PEf NIff NO: O/ • SEPTIC ABANDONMENT PERMIT TOWN OF)�ARNUABLE OBTAINED FROM HEALTH DEPT. /170Di-f 4:7-1(J� SEWER CONNECTION PERMIT : Abandonment Petm1t Not Required OFFICIAL USE ONLY - 1 Assessors Map No. Assessors Parcel I No 3 vZ Q Street: U tree. tip � S 2.cz- >�c. ....:...:.:. f M P Xx PROJECT CONTACTS PROPERTY OWNER(Mailing Address !'SEWER INSTALLER 110T4i Name: eA& � � U-< Name: �/V/C1i�0—S- ft Address: T(Q(� 8��!s �T•�� 7h Address: y3y3 aJ C.L,C� g'aa/ P- Phone: ��b � 335� Phone: /V ) 7A License No: OWNER'S AGENT/ENGINEER Name: Address: Phonw: PROJECT DESCRIPTION REGULATORY REQUIREMENTS LAN ..t.1SE�T.A....:.............................,..... tz �iRi»..I�C� e installationo wer connections Th f all se must be done In accordance rd nce with the provisions of Article XXXVI Town of Barnstab le General By-laws 8 I ws and P � Y RESIDENTIAL regulations issued by the Department of Public Works. Before excavating within a Town Way the sewer installer must also obtain a Road Opening COMMERCIAL permit and comply with the Construction Standards and Specifications outlined therein. At least 48 hours prior to the installation,the applicant must RESTAURANT notify the Department of Public Works,Engineering Division for the purpose of inspecting the installation. The Inspector will complete the Compliance INDUSTRIAL � Sketch locating the installed lines and connection. By signing the Application, the applicant acknowledges and understands the regulatory requirements and STANDARD INDUSTRIAL CLASSIFICATION NO.),dOd Rdt/�f understands that failure to comply with them shall be grounds for revocation of the Sewer Connection Permit and the denial of any future application. NO.OF BUILDINGS N0.OF BEDROOMS d / C—.7C,4117 j SIZE OF PARCEL ACRES 6 ESTIMATED DAILY SEWAGE GALLONS PIPING:LENGTH /� DIAMETER EXPECTED INSTALLATION DATE SIGNATURE(INSTALLEWAGENT) DATE SIGNATURE(DPW APPROVAL) DATE COMMONWEALTH OF MASSACHUSETTS { EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION u' SOUTHEAST REGIONAL OFFICE ARGEO PAUL CELLUCCI - TRUDY COXE Governor lop x^ Secretary DAVID B.STRUHS N Commissioner October 7 1998 Mr. Larry Keith RE:`' BARNSTABLE -WSC #4'-0937 Director of Environmental Affairs The Cape Cod Company Anheuser Busch Companies, Incorporated 100 Breeds Hill Road` 1 Busch Place (202-4) RESPONSE ACTION OUTCOME Saint Louis, Missouri, 63118,-,0.000 STATEMENT AND REQUEST FOR ADDITIONAL REMEDIAL .t'. ACTIONS, M.G.L. c .21E and 310 CMR 40 . 0000 Dear - ' Mr. Keith. - The Department of .'Environmental Proteceion, Bureau" of 'Waste Site Cleanup (the Department) is in 'receipt of a .report titled "Phase II -Comprehensive 'Site Assessment ' and Phase III Remedial Action Plan" dated December 1996„ and 'prepared by ,,Van Breusegen & Associates, Incorporated,. The Report. was accompanied by .BWSC Form Numbers 104 and 108 titled , ,"Response i Action `Outcome k(RAO) Statement & Downgradient, Property ' Status Transmittal"`, and "Comprehensive Response , Action Transmittal Form & Phase I Completion Statement" , respectively. The 'Forms were prepared on . your behalf by Prasanta Bhunia, the Licensed Site Professional of record for the above referenced site: The Phase 'II ,Report indicated"that the Cape Cod 'Potato Chip Company is connected to the Barnstable Municipal Sewer System and the on-site septic systems .haves been removed from the, property.. The Reportd`also' indicated that groundwater samples were 'collected from beneath Flint Rock Pond', in` March 19{93�. These '+ samples - contained chloroform at concentrations` up to` 230'`parts per billion (ppb) :z4 However, the hydraulic relationship between the groundwater and surface water was not determined and, therefore, 20 Riverside Drive•Lakeville,Massachusetts 02347• FAX(508)947-6557•Telephone(508)946-2700 This information is available in alternate format by calling our ADA Coordinator at(617)574-6872. DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep i�l�Printed on Recycled Paper r , HALe the potential impacts associated with contaminated groundwater to the Pond and the ecological system were not assessed In addition, it should be noted that groundwater samples have ' not been collected since the groundwater treatment system was shutdown in December 1997 . Four (4) seasonal groundwatersampling events should be conducted to demonstrated that the objectives of this system have been met . u e Based on the information specified above, the Department determined that the '- full. extent of -."contamination " was- ,,'not' delineated for the site., The Department also determined that additional data is , necessary to demonstrate , that -a. level of , '"No Significant Risk" has been achieved ' at the site to support the Class A-2 RAO submitted for, the . portion of the site bound • by .they , Cape Cod Potato Chip Company. and° Flint Rock Pond: In order to .address ""'the{`4Phase' II ' def iciencies speci•f ied c= �+ above, a Phase II Addendum. Scope of Work (SOW) which describes the activities proposed to address the potential impact*:to Flint` . . Rock Pond should be submitted ,by November'2, 1998 ., The Department also requests that copies of all the documentation -(i.e. , field screening data, analytical "data, . permits, etc. ) generated as . a result of the removal of the on=site` septic systems be submitted' with the SOW. . . Groundwater, samples `should;"also, ,be collected from,•.the -wells <: , designated as M2-89, M5-90, CC-3-92 , CC-4-92, PS-13-90, PS-43792, PS-45-92 , PS-47-92, _ ,PS=48.792 , PS-51-92 , k PS-61-92 and'. PS-62-92 : depicted on the map': titled "Chloroform Remediation' Project;_ Barnstable, MA, Measured Chloroform Levels (ppb) September 1996'!,. i. and analyzed for volatile organic compounds- via EPA .Test ' Method ' ' . 8260 . The samples should be analyzed by a- Massachusetts State Certified Laboratory and the data provided to ther•_Department, upont 'LL' availability. The first round of samples should_be collected in December 31, 1998 . Subsequent rounds. should be'' coilected"'in April L: 1999, July 1999 and October 1999 .` In addition, ,those,, wells .which have been' damaged or, contain obstructions , should eitherr be. repaired. or' , decommissioned „ in _ accordance with, ''Department ' Pol-icy WSC-310-9.1 11 titled , •`'`'!Standard: " References for Monitoring Wells—.. if a well 'is, decommissioned the need for a replacement well should be evaluated. A ,# list indicating which wells which have been decommissioned and` repaired should be submitted to, the Department with the Phase- II ,Addendum SOW. The list should also provide a description 'of' the repairs performed on the wells. 3; The Department will re-evaluate the applicability of the' RAO upon' review of the information specified above..; Should , you have questions regarding this letter, please contact Laura- Stanley at the letterhead address or at (508) ' 94672880 . The `Department appreciates your anticipated cooperation in this .matter. Sincerely, . G raid M.R. Martin, Chief ite Management & Permit Section M\LAS\re t CERTIFIED MAIL NO. z 598 ,884 728' RETURN RECEIPT REQUESTED cc : Barnstable Board of Health " E ' P.O. Box 534 Hyannis, Massachusetts 02601 ATTN: Tom McKearn, Hazardous,`Waste `Coordinator Town of Barnstable 367 Main Street Hyannis, Massachusetts :02601.;� , z. ATTN: Warren Rutherford, Town Manager Barnstable Water Department 1841 Phinney' s Lane - ` P.O. Box 546 p Hyannis., Massachusetts 02630-0546 ,3 ATTN: Jon Erickson Cape Cod Commission a 3225 Main Street • P.O. Box 226n n Barnstable, Massachusetts 02630. { ATTN: Tom Cambareri s Van Breusegen & Associates,-,,Incorporated . i 18124 Sunny Top Court Glencoe, Missouri 63038 4` ATTN: Sharon Roberts v r.ks CC : Weston and Sampson Engineering 5 Centennial Drive ! Peabody, Massachusetts 01960-7985 ATTN: Prasanta K. Bhunia, tSP , DEP-SERO ATTN: Data Entry S r 4A. Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of s Environmental Protection ' Southeast Regional Office William F.Weld Trudy Coxe Gowmor Secretary Argeo Paul Cellucci ,� David B.SVuhs LL Governor Commissioner April 9, 1996 Mr. Walt Lehman RE: BARNSTABLE--WSC/ASM-4-0.937 Anheuser Busch Companies, Inc. The Cape Cod Company Corporate Environmental Affairs Division of Eagle Snacks One Busch Place (202-4) 100 Breeds Hill Road St. Louis, Missouri 63118-1852 INSPECTION FINDINGS/RESPONSE ACTION TIMEFRA OS FOR TITER I SITES/REQUEST FOR INFORMATION M.G.L. c.21E and 310 CMR 40.0000 Dear Mr. Lehman: On March 7, 1996, the Department of Environmental Protection, Bureau of Waste Site Cleanup (the Department) , conducted an inspection at the Cape Cod Potato Chip Company (the site) , located at 100 Breeds Hill Road -in Hyannis, Massachusetts. The inspection consisted of .a review of the file, a site walk over and a discussion of the activities conducted at the site to date. f INSPECTION FINDINGS A review of the Department's files indicates that the site is currently in the Phase II Comprehensive Site Assessment stage of the revised Massachusetts Contingency Plan (the MCP) effective October' 1993 . A Tier IA Permit Statement (the Permit) was issued to Anheuser Busch Companies, Incorporated on May 23, 1994. The Permit became effective on December 1, 1994. Response actions conducted to date include the installation of numerous monitoring wells and recovery wells at the site and the installation of two (2) groundwater treatment systems as a Short Term Measure. The Permit requires that these treatment systems continue to operate until contaminants identified in the groundwater beneath the site have been reduced to the GW-1 groundwater standards as specified in 310 CMR 40.0900. The Permit also requires that monitoring reports documenting the effectiveness - of the treatment systems and summarizing the operation and maintenance activities conducted at the site be submitted to the Department on a quarterly basis. 20 Riverside Drive a Lakeville,Massachusetts 02347 • FAX(508)947-6557 a Telephone (508) 946-2700 i,Printed on Recycled Paper y -2- On December 22, 1994, the Department received a letter report dated December 21, 1994, prepared by. Bart Petracca of Cape Cod Potato Chips reglesting the Department's approval to shutdown recovery wells RW-lA through RW-1C and monitoring wells CC-4-92, PS-13-91, PS-51-92, PS-62,,M-1-89, M-2-89 and M-5-90. On February 10, 1995, the Department approved a temporary shutdown of the wells located in the area of recovery well number one (1) provided a groundwater sample was collected from each of these wells for the analysis of volatile organic compounds including chloroform. Samples are to be collected from each well proposed for shutdown on a quarterly basis for a period of one (1) year. In addition, the Department requested that a sample be collected from monitoring wells PS-1, PS-7 through PS-11 (excluding PS-8) , PS-18 (or the nearest well if inaccessible) , PS-45, M-3 and M-4 during the first quarterly sampling event. At the end of the year, the Department will review the analytical data provided and determine whether or not these recovery wells must be reactivated. In addition, two (2), well shutdown reports titled "Chloroform Treatment Plant" dated May 11, 1995 and "Cape Cod Company, Barnstable--WSC/SMP-4-0937" dated December 18, 1995, both prepared by Whitman and Howard, Incorporated (Whitman and Howard) were reviewed. As a result of the review it was determined that the Chloroform Treatment Plant Report is incomplete since it does not contain the analytical data for groundwater samples from monitoring wells PS-1 and PS-10 as requested in the Department's February 10, 1995 letter. Therefore, a sample must be collected from each of these wells and analyzed for volatile organic compounds, I including chloroform, using EPA Test Method 8240 or 8260. The samples may be collected during the next quarterly sampling episode. In addition, the Department requests that .a copy of the well shutdown report generated for June 1995 to August 1995 be submitted to Department within sixty (60) days of receipt of this letter. REQUEST FOR INFORMATION The review of the Department file also indicated that the file was incomplete or additional information is necessary for the Department to completely evaluate the site conditions. As such, the Department requests that the . following. documentation be submitted within sixty (60) . days of receipt of this letter: 1. Boring logs and well construction diagrams for wells designated as PS-1=90, PS-2-90, PS-43-92 through PS-57-92, PS-59-92 through PS- 64-92, RW-lA through RW-1C, RW-2A through RW-2E, CC-3-92, CC-4-92, 84-3, 84-4, 86-5, 64J, 64 K,. 64M, 64N, M-5-90, MW-15D and MW-16D. . 2. A modified site plan which depicts the location of wells designated as PS-56-92, PS-5.7-92, PS-64-92, CC-5-92, MW-15D, MW-16D, MW-36D and MW-37D. _3_ . RESPONSE ACTION TINEFRAMES FOR TIER I SITES ^'As discussed with Doug DeNatale on March 7, 1996, and pursuant to 310 CMR 40.0550(2) (b) , a Phase II Comprehensive Site Assessment Report . and if applicable, a Phase III Remedial Action Plan must be submitted to the Department for the site no later than December 1. 1996. These Reports must be prepared in accordance with 310 CMR 40.0800. Please be further advised that a Phase II - Scope of Work pursuant to 310 CMR 40.0800 must be submitted to the Department prior to. the implementation of 'any field work associated with the Phase II. However, if a Response Action Outcome (RAO) can be achieved prior to this date a Phase II and Phase III Report do not need to be submitted. The Department understands that Anheuser Busch Companies, Incorporated intends to sell the Cape Cod Potato Chip Company in -the future. . On February 21, 1996, you assured Laura Stanley .of the Department via telephone that Anheuser Busch will continue to conduct the response actions necessary to achieve a permanent solution at the site after the sale. The Department requests that Anheuser Busch notify the Department when the sale of the site is finalized and provide the name, address and telephone number of the new owner of the Cape Cod Potato Chip Company. The Department .requests that a written response be submitted to the Department within seven (7) days of receipt of this letter, indicating whether or not you intend to take the actions specified herein. Your response should also state your intentions regarding the cleanup of the site once it has been sold. Should you have questions regarding this letter, please contact Laura Stanley at the letterhead address or at (508) 946-2880. The Department appreciates your anticipated cooperation in this matter. Ver my yours, rard M.R. Martin, Acting Chief Site Management and Permit Section M\LAS\bh CERTIFIED MAIL NO. Z 401 084 915 RETURN RECEIPT REQUESTED cc: Barnstable Board of Health P.O. Box 534 Hyannis, MA 02601 ATTN: Tom McKearn Hazardous Waste Coordinator -4- cc: Town of Barnstable 367. Main Street bHyannis, MA 02601 ATTN: Warren Rutherford Town Manager Whitman and Howard, Incorporated 45 William Street Wellesley, MA 02181-4050 ATTN: Doug DeNatale Cape Cod Commission 3225 Main Street P.O. Box 226 Barnstable, MA 02630 ATTN: Tom Cambareri Barnstable Water Department Barnstable Village 1841 Phinney's Lane Barnstable, MA 02630 ATTN: Jonathan Erickson DEP-SERO ATTN: Andrea •Papadopoulos, Deputy Regional Director Jonathan Hobill, Acting Regional Engineer Mark Jablonski Data Entry MISSION AP CAPE COD COMO% 3225 MAIN STREET v ,# P.O. Box 226 r }4" BARNSTABLE,MA 02630 q 5 S �� 508-362-3828 a FAX:508-362-3136 May 24, 1995 Lynne Doty RE: WSA4-190 Site Remediation Section Southeast Regional Office Department of Environmental Protection 20 Riverside Drive Lakeville, MA 02347 w Dear Ms. Doty: This letter is a follow-up to our conversation-regarding additional activities at the Barnstable Fire Training Academy and the Cope Cod Potato Chips Chloroform Plume. Barnstable Fire Training Academy Action Background ' Groundwater monitoring data and soil gas analysis of the fire training grounds indicate a continuing chronic source of volatile organic contamination associated with the "round pit." Originally there where four fire training concrete pits. All but the round pit were demolished during early remedial activities at the site.. The round pit was.capped with concrete prior to site discovery in 1986. In addition the ground in the immediate vicinity of the round pit is hard pack and impermeable. This is the only area remaining at the site where there is a source area that has not been removed. Objective The objective of the proposed action 1 is to demolish and remove the round pit and associated soils that may be heavily contaminated. This action will remove,a chronic source of volatile organic contamination. In addition, action 1 with action 2 will allow the area to be oxygenated and allow aerobic biological action to degrade the deeper soils. Action 1 The pit is twenty 20 feet in diameter and approximately two feet thick. The demolished concrete will be stockpiled on site. Approximately 2 feet of contaminated material beneath and around the pit would be excavated and tested for subsequent removal by a licensed hazardous waste hauler, if necessary. The estimated volume of material to be removed is 40 to 80 cubic yards and will be kept ` below 100 cubic yards in keeping with a limited removal action. The hole will be filled in with clean fill and landscaped. Action 2 The Soil Vapor Extraction Unit which has been off line since winter 1993 will be '. rehabilitated and run through the Summer. Cape Cod Potato Chips Chloroform Plume Toe Proposed Action I have discussed with you my conversations with Anheuser-Bush and Weston and Sampson regarding additional groundwater monitoring wells in the vicinity of PS- 68 to document plume capture to the'north of the recovery wells. The wells will be located as shown on the attached map; constructed of two inch PVC and screened at a depth of 38 to 43 feet below the water table, which is concurrent with the de th of p p the chloroform plume in the aquifer. I have received verbal approval from you on this action. Please contact me if you have any questions regarding these proposed activities. Sincere homa . Cambareri Water Resources Program Manager Hydrogeologist, CGWP. LSP cc: O. Paul Shew, County Administrator Walter Lehman, Anheuser-Busch David Delorenzo, DEP-SERO DWS George Wadsworth, Barnstable Water Company Prasanta Bhunia, Weston and Sampson Douglas DeNatale, Whitman and Howard Tom.Mckean, Barnstable Health Director I� . CAPE D CO COMMISSION At 3225 MAIN STREET O P.O.Box 226 ,_r:K., ;:• BARNSTABLE,MA 02630 • 508-362-3828 A 5 S FAX:508-362-3136 January 31, 1995 Lynne Doty RE: WSA-4-190 Site Remediation Section Southeast Regional Office Department of Environmental Protection 20 Riverside Drive f Lakeville, MA 02347 " Dear Ms. Doty: l�1 This is a letter report of the fourth quarterly groundwater monitoring round for the BTEX plume from the Barnstable Fire Training Academy and the Chloroform P g Plume Toe from the aDe Cod Potato Chins facility according to the DEP approved sampling and monitoring plan and subsequent recommendations of the Weston and Sampson Short Term Measure Start-up and monitoring report of May 1994. Required wells to monitor the BTEX and Chloroform plumes are listed below. CHLOROFORM BTEX OW-8 FS-1sa MW-9d M.W-3s MW-14d MW-13s MW-15d MW-15s MW-16d MW-21 MW-36d MW-28 MW-37d MW-32 CC-5 MW-37i CC-8 PS-65 MW-32 i- *j P �4 + Eagle Snacks - Hyannis February 15,-1996 TT( Warren Rutherford Town Manager 367 Main Street20 Hyannis, MA 02601 SUBJECT: Eagle Snacks, Inc. Cape Cod Potato Chip Company SARA Title III Section 311/312 Reporting Dear Mr. Rutherford, Under cover of this letter, please find the completed Tier II Hazardous Material Inventory form for the hazardous materials used at our Hyannis, Massachusetts facility as required by Sections 311 and 312 of SARA Title III. Liquid nitrogen was the only hazardous material used during the 1995 calendar year which meets reporting requirements of Sections 311 and 312. If you have any questions or require additional information, please contact: John Shankey, Plant Manager Cape Cod Potato Chips 100 Breeds Hill Road Hyannis, MA 02601 508-775-33 58 Sincerely, t Bart Petracca Environmental Administrator Eagle Snacks, Inc. 231 S. Bemiston St. Louis, MO 63105 314-877-8821 Revised June 1990 Page pages Form Approved OMB No.2050-0012 Flacillty IdelntlNceldon Owne►lOperaior,:Name _ , Name —C ttf)l_ COSH Pdi'ff-ro of/f,S Name J�At*,-tom SNAe-kSrr, ANC , Ptane (3 1 y 1 yr'e Tier Two Sir" i oo E ie0-0As /./f'L c. gz> EMERGENCY /� RNNIS MaaAdmess231 Sr ZE AT �M�/STO -.V I'i'e (004 City AND y county R N S Stde ...L 1 A � O O uo / c !.o v+S r-O 40 a t O�" HAZARDOUSmerpc�ltcy Coniet:t CHEMICAL SIC Code ❑ O 9 (D Du Nu�r O Z - 7 e2 _ / 3 4 Name title /• �T ►`114NACrEre' INVENTORY Toii" SlfrkNk6l Speck .. Phone (50$ ) ?7 S'3 S& 24 Hr.Phone (S08 ....... .............. ............... .... Information by Clumtcd '`>':'`FOR >:< Ntlrrte -AI!✓">" t=m!ACC A This ENV• 14 DYY1 t s'Jt 5 Ta'a4 t(3l� 1 477-88z1 Ode Received Phone 24 Mr.Phone ( 3 %0 Important:Read all instructions before completing form Reporting Period Fern January 1 to Decenber 31,1+a-15- eltbn f�CNeittod thmwn betaw f►ittentil attotfts fh+altpltidl 6:J. ninsd fast ,::..,• :. :.:::::.:..:::........................... i. t........ ............ ...... .:...........:...:.: ..:.:.:.... :....:•::�:::.::.�::•::::::::.: ::;: :::::::: :::�::::......... ct:tocatia►ns::: ::; 1. end :::>::» :::::><:>>:>.: r:<::::>: a1... egc�r� .tcr .... ........:.............. ..... .. ... ::..::.: ::::::::::::::..:::::.tnvente ::............ ..... ...... ::::.::.::.:::.::.:p:: ::.::.;. :;::.:; ::.... ......::::.: :..::::.::::::::.:. ..:::::: :.:.:.:::::.::.:.:...................................................::::.:::::......................... ....... :::... .:.:...:............ .... 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Sudden Releaw Chem.Na me dP raesu ro Reactivity ;•:.:::`" .:. :: :: .;.:::.::.;;:.:;•;;::;::..:::::.::.:: cArck.fl ImrnedWe(acute) tAr ❑ ❑ ❑ Odayed(chronic) ::.::;•:.;::.;•:::::: �............ ePOh Pun Mix Solid ,Q�:�!��...............:.;:.:;.;: Liquid Gae EHSY. EHS Na me ' L ' rn ads Tr CAS U,J ❑ Seaet❑ Fin Chem. Name Sudden Release d Prsesu ro Reacivityp� CArclt as Immediate(acute) rAsr Wtvh• ❑ ❑ ❑ ❑ Puro Mix A � `�; Sdid liquid Gas EHS Li Delayed(chronic) .:>: EHS Name �rnrrplilueg a reeteons) .., re. Ina mend Ce 1 caddy under penalty of law that 1 have personally examined and am familiar with the information submitted in pages one through__L,end Ihd based 1 have attached a she plan on my inquiry of those individuals responsible for obtaining the information,1 believe that the submitted information is true,actor ts-,�—and�c[ornplete. I have attached a list of site +1� CHART PETzaccll, EN✓lli4A/A?,FA, `,g�.,. ADMINtST1QA-?Ole F•i /v'[�(� C.L/ .Z.�S/9fp coordinate abbreviations ' rator OR owner/ 1 have attached a description of Name and official title of owner/ope oparaloi s authorized representative Sinnature Mr.^�� dikes and o1her salequard measures Warr en Rutherford POIA-Ia- Uld�5 Town Manager 367 Main Street Hyannis, MA 02601MINrl Dear Warren Rutherford, September 24, 1993 ...- .: In: order, to comply with MGL Chapter 111 , I have enclosed an updated MSDS list along with additional MSDS' that are being submitted for the first time. They are: Acrylic Enamel paint Petrifilm E Coli Calcium Carbonate Petrifilm Aerobic Carbon, Activated Pol-E-Z 692 Polymer Cat floc r,—_ e-ulyiiiGt"' 7070 70 uDt... :-r•eC' Cle:=:iseY" Dyna--Blue Cable Lubricant Fast Orange Hand Cleaner Lot ion i:red :Hand Cleaner MS :iS deletions include: Austin Al Bleach Hayssen Lubrican Foam Xtra ?ell Add 1 Glacial Acetic Acid Polyamide Mark 198 Going Horne Hand Cleaner Monarch 680 Grease Strip Rigid Nuclear Cutting Fluids Ultra black Silicone Our current contact and emergency information is as follows: Company Cape Cod Potato Chips Breeds Hill Rd. Hyannis, MA 02601 Business Phone: (508) 775-3358 Emergency Phone: (508)477-8126 Bart Petracca, Quality Control (50S) 771-5"202 Donna Hoke, Employee Relations SIC Code: 2096 Average # of Employees: 135 Thank you, Bart Petracca Quality Control Supervisor TO ' d S�'z$$tr�� i � i tr£ : i i NOW i6-2 -A-IiW AI wk 11 mook— EL Cal PW Am *,O,ion 6f AHUvAaI NlIri1N�01�560et . T.W90ene: $12430•tr►0 MATERIAL SAFETY DATA SHEET Date Prepared: MAY 10 1987 SUCTION Z. GENERAL Product Navei Dyna-Blue Cable Pulling Lubricant ufact�user: A.,rican Polywater Corporation 11222 -- 60th street North P..O. Box 53 Stillwater, MN 55082 U.S.A. } r Emergency Numbers: Telephoner (612) 430-2270 Telex: $51647 (Amer polywater) Chemical Description 6 9 non s: Polymer/Water Solution Cheaicsl Famil : Water Solution,- Water is primary ingrsdisnt• SECTION II. HAZARDOUS INGREDIENTS This water-basad lubricant contains ao known hazardous ing r edients. There ire.no OSHA Or ACGIH threshold limit values for pradue f RT SECTION III. PRYSYCAL DATA ,Appearance; An opaque, light-blue, viscous gel with no odor. Boiling point: 212°F (100°C) Vapor Pressure (us )ig): 18 mo @ 72"F Vapor Density (Air - 1): .9 to 1. 1 9pecI Crsvitl �RgO 1.01 9olubilitl in Water! Infinite Viacom: 110,000 — 150,000 cps. Percent Volatile (Weight): 97.06% Percent Wat*r-_(WaiLht): 97.062 Ignition Teneratura; None fit 6.5 8.5 SECTION IV. FIRE 6 MLOSION HAZARD Plashpointt No flash via TCC. Flatsmable Limits: product is not flammablee product boils at 21? F 000. Extinguishing Media: Does not apply- Special Procedures: Does not apply. Unusual Ratardet Sealed container can build pressure when exposed to high heat. Hazardous Decomposition Products; Nigh temperature steam, potentially carbon monoxide an carbon dioxide. -- -- ir'il If..�-�, i :3 i�`- T'�T 'I_ T [ _F', _t?,�''.�l_1 �_, • d s?�o8b?? i i Si : i i N 0 W {b-i +Material Safety Dot& Sheet Oyna-slue• Lubricant SECTION V. REACTIVITY DATA Stg_bility: Excellent. No spacial handling or conditions to avoid. Hazardous PolZmerina_tion: Will not occur. Incompatibility: Avoid contact with materials which react with water. SECTION VI, HEALTH HAZARD Threshold Limit Value: Norte established for, Dyne-Bluee Lubricant. Ingestion Hazard: Haterial. containe 2.00E by weight polyathylanse and polypropylene glycols. These materials have oral LD (rat) greater than 35 g/kg. Material contains .42% (wt.) hydroxyetNyl cellulose with oral LD5o (rot) greater than 20 g/kg. No effect is expected on ingestion of small quantities. Inhalation Hazards No inhalation hazard with water vapor. Ski` b Eye Hatardt No dermal toxicity hazard. Contact with Dyna-Blue Lubricant may cause skin ,or. eye irritation in soma individuals. Effects of Ex osure: No adverse health effects are expected when Dyna-Blue . Lubricant is used consistent with good industrial hygiene practice. No known medical conditions are aggravated by exposure. First Aid: Ingestion: No first aid expected to be required. If difficulties arise, contact physician. Inhalation: No first aid expected to be required. No inhalation hazard. ' Skin' lrritation: Wash area thoroughly with soap and water. If ` irritation continues, obtain medica Vottention. Eye 'Contact: Flush eyes with water for 15 minutes- If 'irritation Continues, seek medical attention. CarcinoAsnic Status: Dyna-Bluee Lubricant is not known to be carcinogenic and '1r.• -��1 Y4 Y1�i�is not listed, nor are, any of its components listed, by IARC,- NTP or OSHA. SECTION VII, PRECAUTIONS FOR HANDLING AND USE k t, Spill or Leak Proca ure: Dyna—Blue0 Lubricant is extremely slippery. it should ba was ed, swept or squeegead from floor using wet mops. Oxidizing agents, such as household bleach, can also be used to eliminate the slippery character. Outside, spills should be covered with. sand, dirt, gravel or calcium chlorides Waste Disposal Method; Dispose of waste. in accordance with local. state and federal regulations. For waste disposal purposes, Dyna—Blu*O Lubricant is not defined or designated as hazardous. Precautions in Handling & Storing: Keep product containers closed When not in use. 8 etial Precautions; Avoid spills and clean them up immediately when they occurs Product is very slippery. SECTION VIII. CONTROL MEASURES Respirator; Protection: None required. Ventilation! None required. Protective Clothing; Imparmeable gloves can be worn to prevent skin irritation on sensitive individuals. Eye Protection: Safety glasses recommended. SECTION IX. TRANSPORTATION DOT Ship2fng Nases Not applicable, ' DOT Hazard Class; Not applicable, DOT Label. Not applicable. ON/RA Hazardt Not applicable, For domestic transportation purposes, this product is not defined or designated as a hazardous material by the U.S. Department of Transportation. r p:A PAGE 2 DATE 05112lQ3 ACCT 119886 O1 DATE. 05/12/93 ACCTx':' 11988..6.-01 INDEX '. .....31.91g5 CAT,;ltpa Cb4504 PO NBR 273i.11 INDER 4931.3.19105 CAT NOt'Cb4SOQ . PO NBR 273111 **CALCIUM CARBONATE** TOXICITY **CALCIUM CARBONATE" CALCIUM CARBONATE: CALCIUM CARBONATE IRRITATION DATA: 500 MG/24 HOURS SKIN-RABBIT MODERATE; 750 UG/24 HOURS MATERIAL SAFETY DATA SHEET EYE-RABBIT SEVERE. ________________________________________ TOXICITY DATA:6450 MG/KG ORAL-RAT LD50. CARCINOGEN STATUS: NONE. FISHER SCIENTIFIC EMERGENCY NUMBER: (201) 796-7100 LOCAL EFFECTS: IRRITANT- SKIN, EYE. CHEMICAL DIVISION CHEMTREC ASSISTANCE: (800)424-9300 ACUTE TOXICITY LEVEL: SLIGHTLY TOXIC BY INGESTION. 1 REAGENT LANE TARGET EFFECTS: NUISANCE DUST. LAWN N 07410 AT INCREASED RISK FROM EXPOSURE:.PERSONS WITH RENAL DYSFUNCTION, FAIR J FAIR 796-71 GASTROINTESTINAL HEMORRHAGE, HYPOTHYROIDISM, HYPERCALCEMIA, OR OTHER METABOLIC DISTURBANCES. THIS INFORMATION IS BELIEVED TO BE ACCURATE AND REPRESENTS THE BEST ADDITIONAL DATA: INTERACTIONS WITH MEDICATIONS AND FOODS HAVE BEEN REPORTED. INFORMATION CURRENTLY AVAILABLE TO US. HOWEVER, WE MAKE NO WARRANTY OF MERCHANTABILITY OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED,WITH RESPECT TO - - SUCH INFORMATION, AND WE ASSUME NO LIABILITY RESULTING FROM ITS USE. USERS HEALTH EFFECTS AND FIRST AID SHOULD MAKE THEIR OWN INVESTIGATIONS TO DETERMINE THE SUITABILITY OF THE INFORMATION FOR THEIR PARTICULAR PURPOSES. INHALATION: CALCIUM CARBONATE: -------------- ------------------------------------------------------ NUISANCE DUST. SUBSTANCE IDENTIFICATION ACUTE EXPOSURE- MAY CAUSE MECHANICAL IRRITATION WITH COUGHING AND SNEEZING. NO PATHOLOGIC FINDINGS WERE NOTED IN SACRIFICED RATS EXPOSED TO 81.2 . CAS-NUMBER 471-34-1 MG/M3 FOR 90 MINUTES. EXCESSIVE CONCENTRATIONS OF NUISANCE DUSTS IN THE SUBSTANCE: **.CALCIUM CARBONATE** WORKROOM MAY CAUSE UNPLEASANT DEPOSITS IN THE NASAL PASSAGES. CHRONIC EXPOSURE- NO DATA AVAILABLE. TRADE NAMES/SYNONYMS: CARBONIC ACID, CALCIUM SALT; CALCIUM MONOCARBORATE; FIRST AID- REMOVE FROM EXPOSURE AREA TO FRESH AIR IMMEDIATELY. IF BREATHING PRECIPITATED CALCIUM CARBONATE; CARBONIC ACID CALCIUM SALT(1:1); HAS STOPPED, PERFORM ARTIFICIAL RESPIRATION. KEEP PERSON WARM AND AT REST. CALCIUM CARBONATE (CAC03); CALCIUM CARBONATE (1:1):C63; C64; M123; CAC03; TREAT SYMPTOMATICALLY AND SUPPORTIVELY.GET MEDICAL ATTENTION IMMEDIATELY. ACC03880 - SKIN CONTACT: - CHEMICAL FAMILY: CALCIUM CARBONATE: METAL SALT IRRITANT. ACUTE EXPOSURE- APPLICATION OF 500 MG/24 HOURS TO RABBITS RESULTED IN MOLECULAR FORMULA: CA-C-03- MODERATE IRRITATION. CHRONIC EXPOSURE- REPEATED AND PROLONGED CONTACT WITH IRRITANTS MAY CAUSE MOLECULAR WEIGHT: 100.09 DERMATITIS. CERCLA RATINGS (SCALE 0-3): HEALTH=2 FIRE=O REACTIVITY=O PERSISTENCE=3 FIRST AID- REMOVE CONTAMINATED CLOTHING AND SHOES IMMEDIATELY.WASH AFFECTED NFPA RATINGS (SCALE 0-4): HEALTH=2 FIRE=O REACTIVITY=O AREA WITH SOAP OR MILD DETERGENT AND LARGE AMOUNTS OF WATER UNTIL NO EVIDENCE OF CHEMICAL REMAINS (APPROXIMATELY 15-20 MINUTES).GET MEDICAL. COMPONENTS AND CONTAMINANTS ATTENTION IMMEDIATELY. COMPONENT: CALCIUM CARBONATE PERCENT: 100.0 EYE CONTACT: CAS# 471-34-1 CALCIUM CARBONATE: IRRITANT. OTHER CONTAMINANTS: NONE ACUTE EXPOSURE- MAY CAUSE REDNESS, PAIN, AND TEARING.APPLICATION OF 750 UG TO RABBIT EYES FOR 24 HOURS RESULTED IN SEVERE IRRITATION. EXPOSURE LIMITS: CHRONIC EXPOSURE- REPEATED AND PROLONGED EXPOSURE TO IRRITANTS MAY CAUSE CALCIUM CARBONATE: CONJUNCTIVITIS. 5 MG/M3 OSHA TWA(RESPIRABLE OUST); 15 MG/M3 OSHA TWA (TOTAL DUST) FIRST AID- WASH EYES IMMEDIATELY WITH LARGE AMOUNTS OF WATER OR NORMAL SALINE, 10 MG/M3 ACGIH TWA (TOTAL DUST) OCCASIONALLY LIFTING UPPER AND LOWER LIDS, UNTIL NO EVIDENCE OF CHEMICAL 5 MG/M3 NIOSH RECOMMENDED TWA (RESPIRABLE DUST):10 MG/M3 NIOSH RECOMMENDED TWA (TOTAL DUST) REMAINS (APPROXIMATELY 15-20 MINUTES)•GET MEDICAL ATTENTION IMMEDIATELY. ---------------`------------------------------------------------------=------ INGESTION: PHYSICAL DATA - CALCIUM CARBONATE: ACUTE EXPOSURE- INGESTION MAY CAUSE GASTRIC IRRITATION WITH BELCHING, DESCRIPTION: ODORLESS, HYGROSCOPIC WHITE TO OFF-WHITE OR GRAY POWDER OR OCCASIONAL NAUSEA, CONSTIPATION OR DIARRHEA, AND AN INCREASE IN GASTRIC f SECRETIONS. CRYSTALS WITH NO TASTE. CHRONIC EXPOSURE- MAY CAUSE INTESTINAL OBSTRUCTION AND FECAL CONCRETIONS. REPEATED OR PROLONGED INGESTION MAY RESULT IN HYPERCALCEMIA WITH SYMPTOMS MELTING POINT: 1517-2442 F(825-1339 C) (DECOMPOSES) - OF ANOREXIA, NAUSEA, VOMITING, CONSTIPATION,ABDOMINAL PAIN, DRY MOUTH, THIRST,AND POLYURIA.ALKALOSIS, CALCINOSISI AZOTEMIA, HYPOPHOSPHATEMIA, SPECIFIC GRAVITY: 2.7-2.9 VISCOSITY: 0.0% PH:8-9 (AQ SOLUTION) - - ALKALURIA, AND RENAL CALCULI HAVE ALSO BEEN REPORTED. SOLUBILITY IN WATER: NEGLIGIBLE FIRST AID- TREAT SYMPTOMATICALLY AND SUPPORTIVELY-'GET MEDICAL ATTENTION IMMEDIATELY. IF VOMITING OCCURS, KEEP HEAD LOWER THAN HIPS TO PREVENT. SOLVENT SOLUBILITY:SOLUBLE IN ACETIC ACID, HYDROCHLORIC ACID, NITRIC ACID, ASPIRATION. OTHER ACIDS, AMMONIUM CHLORIDE; INSOLUBLE IN ALCOHOL. - - ANTIDOTE: MOHS HARDNESS: 3 NO SPECIFIC ANTIDOTE.TREAT SYMPTOMATICALLY.AND SUPPORTIVELY. __________ ------------------------------ ----------------------------- FIRE AND EXPLOSION DATA REACTIVITY .FIRE AND EXPLOSION HAZARD: - REACTIVITY: NEGLIGIBLE FIRE HAZARD WHEN EXPOSED TO HEAT OR FLAME. STABLE UNDER NORMAL TEMPERATURES AND PRESSURES. INCOMPATIBILITIES: CALCIUM CARBONATE: FIREFIGHTING MEDIA: ACIDS: CONTACT MAY RELEASE CARBON DIOXIDE GAS. EXTINGUISH USING AGENT SUITABLE FOR TYPE OF SURROUNDING FIRE. ALUM: INCOMPATIBLE. AMMONIUM SALTS: INCOMPATIBLE. FIREFIGHTING: FLUORINE: CONTACT MAY CAUSE VIOLENT REACTION OR IGNITION. NO ACUTE HAZARD, MOVE CONTAINER FROM FIRE AREA IFPOSSIBLE.AVOID BREATHING MAGNESIUM: MIXTURE MAY EXPLODE WHEN HEATED IN A STREAM OF HYDROGEN GAS. VAPORS OR DUSTS; KEEP UPWIND. DECOMPOSITION: _________________________________________________________ THERMAL DECOMPOSITION PRODUCTS MAY INCLUDE CORROSIVE CALCIUM OXIDE AND TOXIC RAGE' 1 :': AGE' ' si >9886 Ol DATE... .::05112f..9.3 ..:::..ACCT,.::.:,il....... ,.; D.ATEi 05l12/93 ACCT 11988¢—Ol I:NDEXs. 0/►93133:9I05 CAT:F10 C176500 PO NB,R 223i:11 > . INDEXs .:i1A931319105 CAT NO .C176.500 PO NIB R 27311! **CARBON,.ACTIVATED** - **CARBON, ACTIVATED** EXTINGUISH USING AGENTS INDICATED.MOVE MATERIAL FROM FIRE ONLY IF SAFE AND **CARBON, ACTIVATED** PRACTICAL. USE WATER ONLY IN FLOODING AMOUNTS. MATERIAL SAFETY DATA SHEET --------------------------------------------------------- ' -----------'------TERIA------Y DAT---------------------------------------- TRANSPORTATION DATA - ---------- FISHER SCIENTIFIC EMERGENCY NUMBER: 201) 796-7100 DEPARTMENT OF TRANSPORTATION HAZARD CLASSIFICATION 49-CFR 172.101: CHEMICAL DIVISION CHEMTREC ASSISTANCE: (800)424-9300 FLAMMABLE SOLID V REAGENT LANE FAIR LAWN NJ 07410 .. DEPARTMENT OF TRANSPORTATION LABELING REQUIREMENTS 49-CFR 172.101 AND 1201)796-7100 SUBPART FLAMMABLE SOLID THIS INFORMATION IS BELIEVED TO BE ACCURATE AND REPRESENTS THE BEST INFORMATION CURRENTLY�AVAILABLE TO US. HOWEVER, WE MAKE NO WARRANTY OF DEPARTMENT OF TRANSPORTATION PACKAGING REQUIREMENTS:49-CFR 173.162 MERCHANTABILITY OR ANY OTHER WARRANTY, EXPRESS OR IMPLIED, WITH RESPECT TO EXCEPTIONS:49-CFR 173.162 SUCH INFORMATION,AND WE ASSUME NO LIABILITY RESULTING FROM ITS USE. USERS FINAL RULE ON HAZARDOUS MATERIALS REGULATIONS IHMR, 49 CFR PARTS 171 180). SHOULD MAKE THEIR OWN INVESTIGATIONS TO DETERMINE THE SUITABILITY OF THE DOCKET NUMBERS HM-181, HM-181A, HM-181B, HM-181C, HM-181D AND HM-204. INFORMATION FOR THEIR PARTICULAR PURPOSES. EFFECTIVE DATE OCTOBER 1, 1991.HOWEVER, COMPLIANCE WITH THE REGULATIONS IS AUTHORIZED ON AND AFTER JANUARY 1, 1991. (55 FR 52402, 12/21/90) SUBSTANCE IDENTIFICATION , EXCEPT FOR EXPLOSIVES, INHALATION HAZARDS. AND INFECTIOUS SUBSTANCES, THE CAS-NUMBER 7440-44-0 EFFECTIVE DATE FOR HAZARD COMMUNICATION REQUIREMENTS IS EXTENDED TO SUBSTANCE: **CARBON, ACTIVATED** OCTOBER 1, 1993. (56 FR 47158, 09/18/91) TRADE NAMES/SYNONYMS: U.S. DEPARTMENT OF TRANSPORTATION SHIPPING NAME-ID NUMBER,49 CFR 172.101: ACTIVATED CARBON;ANTHRASORB; CARBON-12; CARBON ELEMENT; ELEMENTAL CARBON; CARBON, ACTIVATED-UN 1362 FILTRASORB; GROSAFE; NACAR; NITTAN; NORIT;SHIRASAGI;SUCHAR;SUPERSORBON; U.S. DEPARTMENT OF TRANSPORTATION HAZARD CLASS OR DIVISION,49 CFR 172.101: DARCO KB;SPILL-X-S;STCC 4917310; UN1362; C170; C176; C277C; ACC04246 4.2 - SPONTANEOUSLY COMBUSTIBLE MATERIAL CHEMICAL FAMILY: U.S. DEPARTMENT OF TRANSPORTATION PACKING GROUP,49 CFR 172.101: NON-METALLIC ELEMENT PG III MOLECULAR FORMULA: C U.S. DEPARTMENT OF TRANSPORTATION LABELING REQUIREMENTS, 49 CFR 172.101 MOLECULAR WEIGHT: 12.011 AND SUBPART E: SPONTANEOUSLY COMBUSTIBLE CERCLA RATINGS (SCALE 0-3): HEALTH=2 FIRE=3 REACTIVITY=O PERSISTENCE=1 U.S. DEPARTMENT OF TRANSPORTATION PACKAGING AUTHORIZATIONS: NFPA RATINGS (SCALE 0-4): HEALTH=U FIRE=3 REACTIVITY-0 EXCEPTIONS: NONE COMPONENTS AND CONTAMINANTS NON-BULK PACKAGING:49 CFR 173.213 -------------- BULK PACKAGING:49 CFR 173.241 COMPONENT: CARBON, ACTIVATED PERCENT: 100.0 U.S. DEPARTMENT OF TRANSPORTATION QUANTITY LIMITATIONS 49 CFR 172.101: CAS# 7440-44-0 PASSENGER AIRCRAFT OR RAILCAR: 0.5 KG OTHER CONTAMINANTS: NONE — - CARGO AIRCRAFT ONLY: 0.5 KG ' EXPOSURE LIMITS: TOXICITY NO OCCUPATIONAL EXPOSURE LIMITS ESTABLISHED BY OSHA, ACGIH, OR NIOSH. r --------- --------` ---------------------------------------- CARBON, ACTIVATED: PHYSICAL DATA TOXICITY440 MG/KG INTRAVENOUS INHALATION-RAT RR PRODUCT VE EFFLGON ECTS DATA RBON CORP (R ECS)..) IPTION: ODORLESS, BLACK AMORPHOUS SOLID. - CARCINOGEN STATUS: NONE. DESCR ACUTE TOXICITY LEVEL: MODERATELY TOXIC BY INHALATION. MELTING POINT: 6606-6687 F(3652-3697 C) (SUBLIMES) TARGET EFFECTS: NO DATA AVAILABLE. ------------------------------------------------------------- SPECIFIC GRAVITY: 1.8-2.1 VAPOR PRESSURE: 1 MMHG Ca 3586 C HEALTH EFFECTS AND FIRST AID ' SOLUBILITY IN WATER: INSOLUBLE - _ INHALATION: i SOLVENT SOLUBILITY: INSOLUBLE IN ACIDS AND ALKALI. CARBON, ACTIVATED: ACUTE EXPOSURE- INHALATION OF DUST MAY CAUSE SLIGHT MUCOUS MEMBRANE ---------- ------------------------------------------------------- IRRITATION. FIRE AND EXPLOSION DATA CHRONIC EXPOSURE- REPEATED OR PROLONGED EXPODURE MAY CAUSE SLIGHT IRRITATION. - FIRE AND EXPLOSION HAZARD: FIRST AID- REMOVE FROM EXPOSURE AREA TO FRESH AIR IMMEDIATELY. IF BREATHING MAY IGNITE SPONTANEOUSLY ON EXPOSURE.TO AIR" HAS STOPPED, PERFORM ARTIFICIAL RESPIRATION. KEEP PERSON WARM AND AT REST. DANGEROUS FIRE HAZARD WHEN EXPOSED TO HEAT OR FLAME. TREAT SYMPTOMATICALLY AND SUPPORTIVELY.GET MEDICAL ATTENTION IMMEDIATELY. DUST-AIR MIXTURES MAY IGNITE OR EXPLODE. - SKIN CONTACT: CARBON, ACTIVATED: ACUTE EXPOSURE- NO DATA AVAILABLE. CHRONIC EXPOSURE- NO DATA AVAILABLE. FIREFIGHTING MEDIA: FIRST AID- REMOVE CONTAMINATED CLOTHING AND SHOES IMMEDIATELY.WASH AFFECTED DRY CHEMICAL, SAND, EARTH,WATER SPRAY OR REGULAR FOAM AREA WITH SOAP OR MILD DETERGENT AND LARGE AMOUNTS OF WATER UNTIL NO (1990 EMERGENCY RESPONSE GUIDEBOOK, DOT P 5800.5). EVIDENCE OF CHEMICAL REMAINS (APPROXIMATELY 15-20 MINUTES).GET MEDICAL FOR LARGER FIRES, USE WATER SPRAY, FOG OR REGULAR FOAM ATTENTION IMMEDIATELY. (1990 EMERGENCY RESPONSE GUIDEBOOK, DOT P.5800.5). EYE CONTACT: FIREFIGHTING: CARBON, ACTIVATED: MOVE CONTAINER FROM FIRE AREA IF YOU CAN DO IT WITHOUT RISK.APPLY COOLING ACUTE EXPOSURE- CONTACT WITH DUST MAY CAUSE MECHANICAL IRRITATION. WATER TO SIDES OF CONTAINERS THAT ARE EXPOSED TO FLAMES UNTIL WELL AFTER FIRE CHRONIC EXPOSURE- REPEATED OR PROLONGED EXPOSURE MAY CAUSE MECHANICAL IS OUT.STAY AWAY FROM ENDS OF TANKS" FOR MASSIVE FIRE IN CARGO AREA, USE IRRITATION. UNMANNED NMANN D HOSE F RE HOLDER (10R MONITOR NCOZZLES; IF ONT ISISIMPGUIDEBOOK,SI LE, P WITHDRAW FROM FIRST AID- WASH EYES IMMEDIATELY WITH LARGE AMOUNTS OF WATER OR NORMAL SALINE, AREA GUIDE PAGE 32). BURN OCCASIONALLY LIFTING UPPER AND LOWER LIDS, UNTIL NO EVIDENCE OF CHEMICAL REMOVABLE THREAD ER' MAINTENANCE COMMUNICATION RETWININO COMPOUND 60? MAINTENANCE COMMUNICATION RUBBERFLEX PATCHING CEMENT MAINTENANCE COMMUNICATION RUST-O-THANE ACTIVATOR MAINTENANCE COMMUNICATION RUST•-O-THANE TOPCOATS MAINTENANCE COMMUNICATION SCOTCH-GRIP ADHESIVE MAINTENANCE COMMUNICATION 7:. r^. !.S I 1 n �.IT' n1. C ,Ol vl1 hi T10 0 V . .�� S1-R�:�OL`;O MAINTENANCE ENt-ilt{!�E [_ '{-It {LI vIGA f 1Ch! 7070 ODC FREE CLEANER . MAINTENANCE ' COMMUNICATION . SILVER NITRATE SOLTN, n/1 0 O. C. CCIT{h'IUN I CA"-10N Sf"IAW L'Lf-tom l R t.Jd!G7 TYPE CODE—ARC 308 MAINTENANCE COMMUNICATION MR AC-DC SH W r ECT Rvr E, TYPE EASY-ARC 3 08 MAINTENANCE HINTEN=NCE COMMUNICATIONAC--DC- SODIUM OrTUM HYDROXIDE S _TN 7 11 i' O. C. COMMUNICATION SODIUM CLTJM Tn T CSuL =HTr -C COMMUNICATION OvMUFlC TTON SOLDER SEAL LIQUID WRENCH MAINTENANCE COMMUNICATION S FA^Cn ME JF hT T JRIn_ COMMUNICATION OM1lNIGAT!ON . Sr R,L Ery WHn WHSJ IvG DETERGENT O. C. COMMUNICATION OM1LvT rTION STARCH Qc COMMUNICATION 9 i STEEL MAINTENANCE - COMMUNICATION STRUK TOL SBA 2080 DEF=OAMER WASTEWATER COMMUNICATION SUPER KAEON SANITATION COMMUNICATION SUPi:_T: LUBC AEROSOL ..& MAINTENANCE COMMUNICATION SWIFT SET CEMENT MENT M I f MAINTENANCE - COMMUNICATION THORIATED TUNGSTEN ELECTRODE MAINTENANCE COMMUNICATION T HREDK UT 99 CUTTING OIL - MAINTENANCE GOI Mh 6N I CAT I O ti THREE-IN-ONE HOUSEHOLD OIL MAINTENANCE COMMUNICATION 3M OIL SORBENT MAINTENANCE COMMUNICATION 2?0 ADHESIVE/SEALANT MAINTENANCE COMMUNICATION rJ 1 r C !ZINC OXIDE) MAINTENANCE HINTENANCE COMMUNICATION O M NIC TT N WELCO AN X uLENE MAINTENANCE COMMUN I CA-I-I ON ?EP j {hA SOL MAINTENANCE COMMUNICATION n .F ;TrA ION - METHANOL •l O. C.� C. Gv� i�" l� nTIOJ • M I`;CO O GREASE MAINTENANCE COMMUNICATION MOBIL _ FORMULA . ,^ '•.) MAINTENANCE ^1N _ : iNCE COMMUNICATION MORrON MENrRLT _C `^� • r OD ?C •rvi COMMUNICATION OMM NSC. IOh MOTOR O_I L '•t:);+40 WASTE WATER COMM;!N I CAT 16N NATURAL GAS MAINTENANCE COMMUNICATION J tIC.. .=2 WHITE FC7C:t t rR:=,DE PTFE MAINTENANCE COMMUNICATION i NITROGEN (CRYOGENIC LIQUID) PRODUCTION COMMUNICATION MAINT. , S/R, PACK AG I c:• THINNER (PAINT) MAINTENANCE COMMUNICATION OXYGEN MAINTENANCE COMMUNICATION OXYGEN Gci`: aE:•:SOf-i ASSEMBLY MAINTENANCE EN. NG_ COMMUNICATION , PAINT THINNER MAINTENANCE COMMUNICATION PERMATEX THREAD SEALANT MAINTENANCE COMMUNICATION FETRIF I _w L CO_i QUALITY CONTROL COMMUNICATIONFETn I F I L1 AEROBIC ER0= IC QUALITY CONTROL 0NTRiL COMMUNICATION PHENOLPTHALE I N SOLUTION,ON, 1;; O. C. COMMUNICATION PLASTIC WET SURFACE ROOF CEMENT MAINTENANCE COMMUNICATION POL--E'- : 692 POLYMER WASTEWATER COMMUNICATION POLYAM I DE EPDXY—COMPONENT A MAINTENANCE COMMUNICATION POLYAM I I=)E EPDXY—COMPONENT R MAINTENANCE COMMUNICATION ' POTASSIUM CHROMATE . o. C. CO!`'!MUN I CATION INDICATOR, 5% POTASSIUM CHLORIDE SOLTN. WASTE WATER COMMUNICATION PRIMER NO. 6 MAINTENANCE COMMUNICATION PRO—LOCK PIPE SEALANT MAINTENANCE COMMUNICATION PST(R) ^N TEMP ANT I—GALL I Na PIPE SEALANT MAINTENANCE COMMUNICATION PVC PRIML-R MAINTENANCE COMMUNICATION PVC Cc:MrE.•_PN•T- CLEAR MEO.I UM MAINTENANCE COIF MUN I CAT 10114 -�v FIT r-.n MAINTENANCE nn:C i>iL�I:..r•: METAL (TM) PRESS r I 1 REPAIR l�x' !•!r.I sa 1 EP��r-II`a�E COMMUNICATION H40ARD TRANSMISSION OIL MAINTENANCE COMMUNICATION 1 IMPROVED TREMSEAL GP MAINTENANCE COMMUNICATION INDUSTRIAL ENAMELS MAINTENANCE COMMUNICATION ISO-OCTANE QC COMMUN I ACTION ISO-PROPANOL PACKAGING/QC COI"iMUN I CATION K i_Cr /2'-% (PENWALT PETROLEUM MAINTENANCE COMMUNICATION LUBRICATING OIL LIQUID FRY CLEAN SANITATION COMMUNICATION LOCi':LJ I C• PRIMER (AEROSOL) MAINTENANCE COMMUNICATION LOCQU I C PRIMER GRADE N MAINTENANCE COMMUNICATION 1 O•T•T O F 1 T Z E♦-. HAND n h 1 D CLEANER 1 n h 1 E . SANITATION ITT/\ T O A COMMUNICATION L�_! 1 u!�_d L!� i••1H!V,• LY LEHIyG�. aH�'�1 1 HT 1 U1�I LulRIP Ln r E n C L SERIES MAINTENANCE COMMUNICATION LUBR I i'LATE F GL SERIES MAINTENANCE COMMUNICATION L L_r I P n TE F MO-HW SERIES MAINTENANCE COMMUNICATION LJBR T r LAf E HO SERIES MAINTENANCE COMMUNICATION UM- yATr SANITATION COMMUNICATION MARVEL ,ri MYSTERY w\i r,-�•rr.\i ,-,• WASTE E WATER. COMMUNICATION IL PIASTER GASKET PRIMER MAINTENANCE COMMUNICATION MCR-43 GLOSS EPDXY MAINTENANCE COMMUNICATION T n N � � MAINTENANCE r.,11" ,,1:CAT i is I'`•� {•�ET:...Ct �>r::..rh�G::T SuF'EFt .. Cu1.11 ILA.`, COV•TONBEED '._OKINJ OIL PROCECSINU 6 f9M U1`IC It AT IOho COAL TAR E:P O X Y, COMPONENTS A:+B MAINTENANCE COMMUNICATION Y-,EP t OACTIVATO.R. MAINTENANCE COMMUNICATION DEPEt.YtO ( ) NO—.MIX AL+F'+ESI..E � MAINTENANCE COM IUNICI rION D I METHY'._AM I N ri u C= L COMMUNICATION riT+.�j E�:�i rc. i+E�;_•I C �iT WASTE WATER r'("t 1•.�r^Un1 I("`n-s•ry T iJr N! D N A—B SU E CABLE LU B R I Cnt!T MAINTENANCE COMMUNICATION ELECTROLYTE (ACID) 2A•TTERY FLUID Q. C. (W.HOUSE) COMMUNICATION E, I—S,_: ,__ L..._Al'i D+..= . .._.. MAINTENANCE,.. +aCE COMMUNICATION ETHYL ALCOHOL, DENATURED D O. C_ !SAN I T. COMMUNICATION PACKAGING EAST ORANGE HAND CLEANER MAINTENANCE COMMUNICATION 5Wc_?47 PREMIUM CONTACT CLEANER MAINTENANCE COMMUNICATION FUL r,AC SANITATION COMMUNICATION r GASKET ELIMINATOR MAINTENANCE COMMUNICATION nS 1E AUTOMOTIVE :� E MAINTENANCE E C0d 1+ '1;1 ATT +ira.=:OLIhv�, Iy:�TO, :O'T'I :� MAI,y , Er.s. .,•iCr_ .r�_tlh'f...::�ICr� , _01':11 r_Arc CLEANER (BULK )n SANITATION TAT I rr HEAVY DUTY Y EPDXY ACTIVATOR MAINTENANCE COtJ!NlUt4I CAT I O HEAVY DUTY EPDXY .PRIMERS MAINTENANCE COMMUNICATION HEAVY DUTY EPDXY TOPCOAT MAINTENANCE COMMUNICATION HYDROGEN SULFIDE � � MASTER - COMMUNICATION 1 + r . N HAZARDOUS MATERIALS LIST 0?/24/?3 CHEMICAL OR PRODUCT NAME DEPARTMENT MSDS LOCATION --------------------------------------------------------------------- ACETIC AC I D: GLACIAL WWT. - COMMUNICATION ACETONE MA I NTENANry COMMUNICATION ACETYLENE � MAINTENANCE COMMUNICATION ACRYLIC ENAMEL PAINT MAINTENANCE COMMUNICATION ACTIVATED ALUMINA PROCESSING COMMUNICATION AC I ;A TO; (PO _YAM r E RESIN) MAINTENANCE COMMUNICATION ADHESIVE S 1 c^a MAINTENANCE COMMUNICATION ALCONOX O. C. COMMU!•;I CAT I ON ALUM (DRY) WASTEWATER COMMUNICATION MAINTENANCE nl.ln_ COMMUNICATION nl tM-n-; 1 MAIN ( ENANCE r(�.L•:•: H .._ill=: ALUMINUM 1Ma :M MAINTENANCE ENANCE COMMUNICATION :N LtEROL :-la C=. •',;_�i COMPRESSOR O I L MAINTENANCE NE MUNICATION NS 11 FIRE r-.E S 1 r.r-r�`^. nl. PRODUCTION COMMUNICATION ANTI—FREEZE MAINT. , S/R, COMMUNICATION WAsTE 'WATER' ANTISOIL HF SANITATION COMMUNICATION ARGOh•J MAINTENANCE COMMUNICATION DIG "D 11 WATER SOLUBLE WASTE WATER COMMUNICATION DEODORANT, LEMON BUFFER SOLUTIONS: pH 1-5: .-8 WASTE WATER COMMUNICATION CALCIUM CARBONATE QUALITY CONTROL, COMMUNICATION CH BO J, ACTIVATED CTIVHTEL QUALITY CONTROL CATION CAT—FLOCK K—5 POLYMER !'WASTEWATER COMMUNICATION CHELCAC _EAh ES SANITATION COMMUNICATION CHEM•-CAL HYDRATED LIME WASTE WATER COMMUNICATION CHEMGRATE PROCESSING COMMUNICATION CITRIC ACID, ANHYDROUS QUALITY CONTROL COMMUN I CAT I ilh•! Commonwealth of Massachusetts Executive Office of Environmental Affairs W Department of Environmental Protection Southeast Regional Office William F.Weld Gcvemor Trudy Coxe Secretary,EOEA Thomas Bt Power A�g Commissioner September 6, 1994 Bart Petracca RE: BARNSTABLE--WSC/SMP-4-0937 Cape Cod Potato Chips The' Cape .Cod Company , 100 Breeds Hill Road Division of Eagle Snacks, Hyannis, Massachusetts 02601 Inc. , 100 Breeds Hill Road WELL SHUT-DOWN CRITERIA M.G.L. Chapter 21E and 1 310 CMR 40. 0000 Dear Mr tPetracca: This letter is in response to your request for written. guidance for recovery well#l.,shut-down criteria. This request was made during a recent site visit by Lynne Doty and Rick Rondeau of ' my staff on August 24 , 1994. The following procedures for shut- down shall apply to the portion of the plume within .the zone, of influence of Cape Cod Potato Chip's recovery well #1: * You may submit a proposal and request for well closure after three consecutive quarterly sampling rounds demonstrate that chloroform concentrations in each well. to be shut down are below 5 µg/1. * The wells may be shut down. upon approval by the _ Department. * The wells which are shut down shall be -sampled to ensure that chloroform levels are below 5 µg/1. Samples must be collected and analyzed every other month for the first six months and tY cn again at the end of one year after shut-down. All data shall be submitted to the Department_ as it - becomes available. * The wells may be decommissioned one year from the time of shut-down if the sample results collected during that year demonstrate that less that 5 µg/1 . chloroform remains. \ * Wells shall be decommissioned inaccordance with the criteria established in the Department's document entitled "Standard References for Monitoring Wells" . * The, Department may modify the above criteria if chloroform levels in the shut-down wells equal or exceed 5 µ9/l. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 -2- Please contact Lynne Doty at 508-946-2886 if you have any questions. The Department site number, SMP-4-0937, should be referenced on all future correspondence regarding this. site.. Very truly yours, jtn�ahan E. Hobill ing Section Chief r Site Management , and Permits Section H/LD/jt cc: Anheuser-Busch Companies, inc. One Busch Place (020-4) St. Louis, MO 63118-1852 ATTN: Walt Lehman Barnstable Board of Health P.O. Box 534 Hyannis, MA 02601 ATTN: Tom McKean, Hazardous Waste Coordinator Town of Barnstable 367 Main Street Hyannis, MA 02601 ATTN: Warren Rutherford, Town Manager DEP - SERO - Operations ATTN: Andrea Papadopoulos, Deputy Regional Director DEP - Sero ATTN: Data. Entry o,1N�>o,4 The Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 r�ra Office 508-790-6265 Thomas A. Mclean FAX 508-775-3344 Director of Public Health April 22, 1993 Mr. Bart Petracca Quality Control Manager Cape Cod Potato Chips Breeds Hill Road Hyannis, MA 02601 Dear Mr. Petracca: You are granted permission to utilize an over-pack drum to store acetic acid outdoors. Permission is granted because you stated in your letter dated April 14, 1993 that the over-pack drum is rated at 95 gallons, well over the recommended 150% capacity. Also, Captain Glenn B. Coffin of the Barnstable Fire Department stated that the Fire Department is "very much in favor of this solution. " In addition, Health Inspector Donna Miorandi stated that this proposal meets the requirements of Town Ordinance, Article XXXIX, Control of Toxic and Hazardous Materials. Thank you for your attention and cooperation in this regard. Sincerely yours, Thom s McKean Director of Public Health cc: Captain Glen Coffin I i Eagle Snacks - Hyannis TO t- y hA Ne AGLE February 27, 1995 Warren Rutherford Town Manager 367 Main Street Hyannis, MA 02601 SUBJECT: Eagle Snacks, Inc. Cape Cod Potato Chip Company 4,, __SARA Title III Section 311/312 Reporting Dear Mr. Rutherford, Under cover of this letter, please find the completed Tier II Hazardous Material Inventory form for the hazardous materials used at our Hyannis, Massachusetts facility as required by Sections 311 and 312 of SARA Title III. Liquid nitrogen was the hazardous material used during the 1994 calendar year which meets reporting requirements of Sections 311 and 312. If you have any questions or require additional information, please let me know. Sincerely, Bart Petracca Quality Control Manager i PAMsed June 1990 Page, _j_aie w+.�e►�o 00 pagm Ftoi:IlN�Idonlltitxtlion OwlwdOperator Name ,�,,, E Pot Td CfflP-S we. �c> S�v C �/�C_ 13IN 1577 Tier Two I o r, e.<r -B2 i4«r s��Q WalAd ,a 23f 51 l�ErnisToN SyIrE koo 19700 AND ENCY N a i"✓N 1> G.W)/ fA-jCns sum A >m a Z Leo/ fi O HAZARDOUS Emergency Cdnfea CHEMICAL INVENTORY co6a Z 0 �'°lN D Z Z t - Name Specific Phmw 1 U E 1 221 3 5 S N w.Phww ( oq I / v Gr ejcm ETIR C,C . Tab Noll. I 50 a 1 77.1.-_ 3 3.S 8 td W.PMn. t 'ov►_ �. Important:Read all instructions before completing form RePWdn0 Parlod .F—il.roy I I.o.o.ne.r 31. 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' Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas S. Powers Acting Commissioner February 10', 1995 Bart Petracca RE: BARNSTABLE--WSC/SMP-4-0937 Cape Cod Potato Chips The Cape Cod Company 100 Breeds Hill Road Division of Eagle Snacks, Hyannis, Massachusetts 02601 Inc. , 100 Breeds Hill Road RECOVERY AREA .41 SHUT-DOWN APPROVAL M.G.L. Chapter 21E and 310 CMR 40. 0000 Dear Mr. Petracca, The Department of Environmental Protection Bureau.,of Waste Site Cleanup (the "Department") has reviewed your December 21, 1994 proposal to shut down wells in recovery area #1 for the above referenced site. Additionally, a meeting was held on January 27, 1995 to further define the scope of the shut down criteria with interested parties. The Department hereby approves the. shut down of wells in the portion of the plume within the zone of influence of Cape Cod, Potato Chips recovery well #1 with the following conditions: 1. The recovery and monitor wells proposed for shut .'down shall be sampled to ensure that chloroform levels are below 5 µg/1. Samples must be collected and analyzed quarterly for a period of one year from the date of this letter. Sampling and analytical procedures shall be in accordance with Department Policy #WSC-300=89 entitled, Minimum Standards for Analytical Data for Remediation and Response Actions Under M.G.L. c. 21E. All analytical I results shall be submitted to the Department as it becomes available. 2 . The first quarterly sampling shall be performed in March, i995 by a representative of the Barnstable Fire District Water Department. 3 .. Wells in the entire plume area shall be sampled in the first quarter. Additional wells which must be included in this sampling event are as follows: PS-18 (or nearest well if inaccessible) , PS- 11, PS-10, PS-7, PS-9, PS-1, M-3 , M-4, and PS-45. 4. A proposal to decommission wells in area #1 may be submitted one year from the time of shut-down if the analytical results during the shut down period demonstrate that less that, 5 , 4g/1 chloroform remains. Consideration shall be given to keep . monitoring wells active on all .property not owned by the tape Cod Company and its parent Company. 20 Riverside Drive 9 Lakeville,Massachusetts 02347 a FAX(508)947-6557 9 Telephone (508) 946-2700 -2- t 5. The Department may modify the criteria listed above . if chloroform levels in the shut-down wells equal or yexceed 5 49 6. The recovery and treatment system associated .with area #1, shall be preserved and ready for reactivation. . until a Response Action Outcome (RAO) Class A can be achieved for both recovery areas #1 and #2 . 7 . By June 30, 1995, a Scope of Work shall be submitted to. the Department for assessment of the source area and to determine if soils in the septic system are a continuing source of. contamination. A schedule of proposed activities shall be included with this Scope of Work. 4 Please contact Lynne Doty at 508-946-2886 if you have any questions. The Department site number, SMP-4-0937, should be referenced on all future correspondence regarding this site. V ry truly yours., than Aobill, Acting Chief S to Management and Permits Section .H/LD/KN cc: Anheuser-Busch Companies, Inc. One Busch Place (020-4) St. Louis, MO 63118-1852 ATTN: Walt Lehman Board of Health P.O. Box 534 Hyannis, MA 02601 ATTN: Tom McKean, Hazardous Waste Coordinator Town of Barnstable 367 Main Street Hyannis, MA 02601 ATTN: Warren Rutherford, Town Manager Barnstable Fire District 184 Phinneys Lane P.O. Box 546 Barnstable, MA 02630 ATTN: Jon Erickson DEP-SERO-OPERATIONS ATTN: Andrea Papadopoulos, Deputy Regional Director cc:. DEP-SERO-Water Supply ATTN: Dave Delorenzo DEP-SERO-Data Entry .. ATTN: John Handrahan r Commonwealth of Massachusetts Executive Office of :Environmental Affairs Department of . Environmental Protection William F.Weld Governor Trudy Coxe Secretary,EOEA NO Thomas B. Powers Acting Commissioner January 4 , 1995 Anheuser-Busch Companies, Inc. Executive Offices One Busch Place St. Louis, Mo. 63118-1852 Attention: Walter Lehman, . P.E. ` Re: Barnstable - Request for ground water permit . determination f, at: Cape Cod Company - Eagle Snacks, Inc. Dear Mr. Lehman: The'Department, of Environmental Protection (DEP) has reviewed your letter, dated Dedember 19, 1994 , requesting a written determination from the DEP concerning the requirements ' for permitting and/or registering storm water discharges from your facility in Barnstable, Massachusetts. Your letter indicates that storm waters from parking areas and building roofs at the Barnstable facility are directed to six (6) storm water runoff leaching systems. Each one of these systems contains at least one leaching catch basin (leaching pit) . Please be advised that the DEP has not required ground water discharge permits for the discharge of storm water runoff from building roofs or parking lots. . The DEP does require registration of subsurface leaching facilities in compliance with 310 CMR 27. 00, the Underground Injection Control Program (UIC) , when such leaching facilities are deeper than they are wide (some. leaching pits and drywells) . If necessary, forms for registration of underground injection facilities can be obtained by contacting the DEP infoline at 1-800-462-0444 and requesting form WS06.. One Winter Street • Boston, Massachusetts 021 D8 • FAX(617) 556-1049 . • Telephone(617)292-5500 r Should you have any further questions please contact Ron White at 617-292-5790 or Ron Stelline at 617-292-5859 . Sincer y� Ronald J. hite Environm tal Engineer Division of Water Pollution Control cc: DEP/DWPC/SERO DEP/DWS/SERO OBoard of Health, Barnstable, Ma. UIC Program/DWS/Boston i Zj Cape Cod Potato Chips December 21, 1994 Ms. Lynne Doty Site Remediation Section Department of Environmental Protection Southeast Regional Office 20 Riverside Dr. Lakeville, MA 02347 Dear Ms. Doty, This letter will serve as a proposal to commence shutdown procedures for the monitoring and recovery wells listed below for our chloroform remediation site SMP-4-0937. All of these wells have chloroform levels less than 5 ppb for at least three consecutive quarters. Please review the attached tables for well test history.Later this week, the next quarterly.sampling will take _ place. For the wells that are to be eventually closed down, does the one year time frame begin with the first time a well was less than 5ppb or the third quarter sampling? All the wells that have been tested previously will be tested this week but I need to know how to proceed with testing for 1995 with the wells to be shutdown. The list of these wells: RECOVERY WELLS: RW-lA, RW-1B, RW-1C MONITORING WELLS: CC-4-92, PS-13-91, PS-51-92, PS-62, M-1-89, M-2-89, M-5-90 In addition, is there a difference between shutdown procedures for monitoring wells versus recovery wells? After you review this information, perhaps we can meet to discuss how I should proceed with this matter. " Thank ycu ir. ,dvance.for ,our aRCictanre, and I hope to hear from you soon. Sincerely, l?J a Ih, � 3 Bart Petracca Quality Control Manager cc: Doug DeNatale, Whitman&Howard, Inc. Jon Erickson, Barnstable Fire District �" �oo� t�✓ q Walt Lehman, Anheuser-Busch, Inc. Tom McKean, Barnstable Board of Health Warren Rutherford, Town of Barnstable ® OW A 'Jt D rage CAPE COD POTATO CHIPS- GROUNDWATER REMEDIATION CHLOROFORM SUMMARY TABLE UG/L DATE SAM RAW TREATED RW-lA TRW-1B RW-1C RW-2A RW-2B RW-2C RW-2D RW-2E 3/16/93 85 BRL 60 26 23 7 34 180 300 180 4/1/93 49 BRL 28 22 13 4 22 130 95 62 4/14/93 33 BRL 23 17 10 4 23 89 68. 35 5/18/93 2 BRL 16 8 8 5 25 75 50 19 5/28/93 21 BRL 6/11/93 18 BRL 15 5 7 4 25 68 .38 13 6/25/93 20 BRL 7/9/93 23 BRL 8/6/93 23 BRL 8/18/93 17 BRL 9/9/93 18 BRL 10 2 4 4 21 64 35 6 9/30/93 19 BRL 10/14/93 17 BRL 10/30/93 13 BRL 11/17/93 13 BRL 11/24/93 12 BRL- 12/22/93 10 BRL 12/29/93 12 BRL 1/13/94 11 BRL 5 0;9 2 4 13 40 19 4 2/10/94 10 BRL 15 35 14 2/23/94 8 BRL . 3/10/94 8 BRL 3/30/94 8 BRL 3 0.5 2 3 10 24 7 3 4/6/94 6, 6 4/20/94 7 BRL 5/19/94 6 BRL 5/25/94 7 BRL 6/16/94 6 BRL 6/21/94 7 BRL 3 0.5 1 3 8 19 5 4 7/18/94 6 BRL 7/25/94 7 BRL 8/04/94 6 BRL 8/12/94 6 BRL 8/22/94 6 BRL 9/01/94 6 BRL 9/20/94 5 BRL 9/29/94 5 BRL 2 BRL 1 3 5 17 5 3 10/12/94 5 BRL rageD CAPE COD POTATO, CHIPS MONITORING WELLS CHLOROFORM TEST RESULTS WELL 3/1/93 9/2/93 1/26/9/-' 6/21/94 9/29/94 CC-2-91 0.7 CC-3-92 79 88 14 18 3 CC-4-92 1 BRL BRL BRL BRL . CC-5-92 78 CC-8-92 60 PS=13--91 1 BRL BRL - BRL BRL PS-25-91 1 PS-43 75 65 22 2 1 ` PS-51-92 14 2 2 3 2 PS-53 230 300 BRL PS-54 BRL PS-55 24 5 BRL P'S-60 1 PS-62 BRL BRL BRL BRL M-1-89 2 2 2 BRL BRL M-2-89 37 3 2 BRL -2 M'S 90 1 BRL BRL BRL FA 9 58 49 13 21 . 3 I J. ANHEUSER BUSCH COMPANIES November 28, 1994 Mark Jablonski Department of Environmental Protection Southeast Regional Office 20 Riverside Drive Lakeville, Massachusetts 02347 PERMIT#82627 TRANSITION STATEMENT Dear Mr. Jablonski: I have enclosed the Transition Statement for Eagle Snacks accepting the new conditions. Lynn Dotty of your office asked'me to send it directly to you. Sincerely, ANHEUSER-BUSCH COMPANIES, INC. Walter D. Lehman, P.E. Senior Environmental Engineer Environmental Affairs TEL: 314-577-4164 FAX: 314-577-1032 cc:Kevin F. Bowler, President, Eagle Snacks, Inc. -,-'rom McKean, Barnstable Board of Health Warren Rutherford, Town of Barnstable r11.ouser-Eusch Companies. Inc. cxe.c0tive Offices One Busch Place St. Louis. MO U.S.A. 631 1 8-1 852 i elc,x 447 -117 ANBUSCH STL r 0j; TOWN OF BARNSTABLE c MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF EALTH *WtBody Shops O unsatisfactory- ufacturers COMPANY I�. �� (see"Orders: Fuel Stores 6.Fuel Suppliers ADDRESS lass: 7.Miscellaneous i .TANTITIES AND TORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS ,Case lots Drums Above Tanks Underground Tanks ] � a� IN OUT IN OUT IN OUT #&gallons Age Test I F e s: soli Je Fuel (A) Heavy Oils: waste metew.oil (C) , " new► or of ) Synthetic Organics: .edegreas�rs' d�CJ d r v Miscellaneous: Ak r a o-4.,e- 0, � DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.YV ater Supply_, �lvw, ✓�✓iJ own Sewer 4wublic -- O On-site OPrivate 3. Indoor Floor Drains YES PNO � O Holding tank:MDCG�C O'Catch basin/Dry well � � O On-site syst V- ' ,V e, ,O-.Ixo` Z 4. Outdoor Surface drains: NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system { 5.Waste Transporter Name of Hauler Destination Waste Product 1. i0'�s '. 2 07 NO 2. �-- A0 Person(s) terviewe3 Inspector Date Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F.Weld Govemor Trudy Coxe Secretary,EOEA omas B. P tin i otse`rl , August 17., 1994 Bart Petracca RE: BARNSTABLE--WSC/SMP-4-0937 Cape Cod .Potato Chips The Cape Cod Company 100 Breeds Hill Road Division of Eagle Snacks, Hyannis, Massachusetts ' 02601 Inc. , 100 Breeds Hill Road REVISED_ INSPECTION APPROVAL M.G.L: Chapter 21E and 310 CMR 40. 0000 Dear Mr. Petracca: The Department received your request dated August 9, 1994, for written approval to revise your original Short Term Measure Design Document relative to inspection frequency. Our records .,:indicate - that, on May 27, 1994, Maria Pinaud of this office gave. verbal approval of a revised Security Plan for the above referenced site to Sharon Roberts. The Security Plan revision was approved with the condition that. site visits occur at least once per week. Your request to reduce. daily inspections to days when the production facility is in operation is hereby approved. You mint conduct these inspections, st least weekly and whenever conditions of inclement weather exist which could damage any component of -the treatment system: Please contact Lynne Doty at 508-946-2886 if you have any questions regarding this matter. The Department site number, 4- 0937, should be referenced on all future correspondence regarding this site. ry truly yours, na han E. Hobill, Acting s ction Chief, Site Management and Permits Section H/LD/jt cc Sharon',IRobert'S .Anheuser-Busch Companies, Inc. One Busch Place (020-4) St.. Louis, MO 63118-1E 52 20 Riverside Drive 9 Lakeville,Massachusatts 02347 9 FAX(508)947-6557 Telephone (508) 946-2700 -2- cc: Barnstable Board of Health P.O. Box 534 Hyannis, MA 02601 ATTN: Tom McKean, Hazardous Waste Coordinator Town of Barnstable 367 Main Street Hyannis, MA 02601 ATTN: , Warren Rutherford, Town Manager DEP - SERO - Operations ATTN: Andrea. Papadcpoulos, Deputy Regional Director DEP - SERO ATTN: Data Entry t y . r c� 1' 01-22 3M General Offices 29890 3M Center St. Paul, Minnesota 55144-1000 612/733-1110 MATERIAL SAFETY DATA SHEET DIVISION: SURGICAL DIVISION TRADE NAME: PETRIFILM - AEROBIC COUNT PLATES 3M I.D. NUMBER: 70-2005-7212-4 70-2005-7215-7 ISSUED: FEBRUARY 19, 1992 SUPERSEDES: OCTOBER 23, 1991 DOCUMENT: 05-3658-1 1 . INGREDIENT C.A.S. NO. PERCENT GUAR GUM 9000-30-0 15.0 - 25.0 SILICONE Unknown 10.0 - 20.0 CELLULOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9004-34-6 10.0 - 20.0 POLYETHYLENE . . . . . . . . . . . . . . . . . . . . . . . . . 9002-88-4 10.0 - 20.0 ACRYLATE ADHESIVE . . . . . . . . . . . . . . . . . . . . Unknown 5.0 - 15.0 NUTRIENTS Unknown 1 .0 - 10.0 POLYPROPYLENE�FILM . . . . . . Unknown 1.0 - 5.0 DOUBLE SIDED TAPE Unknown 1.0 - . 5.0 2. PHYSICAL DATA BOILING POINT: . . . . . . . . . . . . . . N/A VAPOR PRESSURE: N/A VAPOR DENSITY: N/A EVAPORATION RATE: . . . . . . . . . . . . N/A SOLUBILITY IN WATER: N/D SP. GRAVITY: N/A PERCENT VOLATILE: . . . . . . . . . . . N/D VOLATILE ORGANICS: . . . . . . . . . . N/D VOC LESS H2O & EXEMPT SOLVENT N/D pH: 6 0-8.0 VISCOSITY: N/A MELTING POINT. . . . . . . . . . . . . N/D APPEARANCE AND ODOR: Solid, WHITE OPAQUE FILM WITH YELLOW GRID. MUSTY ODOR. 3. FIRE AND EXPLOSION HAZARD DATA FLASH POINT: . . . . . . . . N/A FLAMMABLE LIMITS - LEL: . . . . . N/A FLAMMABLE LIMITS - UEL: . . . . N/A AUTOIGNITION TEMPERATURE: . . N/D EXTINGUISHING MEDIA: Water spray, Carbon dioxide, Dry chemical, Foam SPECIAL FIRE FIGHTING PROCEDURES: Wear full protective clothing, including helmet, self-contained, positive pressure or pressure demand breathing apparatus, bunker coat and pants, bands around arms, waist and legs, face mask, and protective covering for exposed areas of the head. Use water to keep fire-exposed containers cool. UNUSUAL FIRE AND EXPLOSION HAZARDS: Not applicable. NFPA-HAZARD-CODES: HEALTH 1 FIRE 1 REACTIVITY 0 UNUSUAL REACTION HAZARD: None ti Abbreviations.: N/D Not Determined N/A - Not Applicable 01-2� - 3M General Offices 29891 3M Center a� St. Paul, Minnesota 55144-1000 612/733-1110 MATERIAL SAFETY DATA SHEET MSDS: PETRIFILM AEROBIC COUNT PLATES FEBRUARY 19, 1992 PAGE: 2 of 4 4. REACTIVITY DATA STABILITY: Stable INCOMPATIBILITY - MATERIALS TO AVOID: Avoid strong oxidizing materials. HAZARDOUS POLYMERIZATION: Will Not Occur HAZARDOUS DECOMPOSITION PRODUCTS: Carbon monoxide and carbon dioxide may be emitted upon combustion 5. ENVIRONMENTAL INFORMATION SPILL RESPONSE: Not applicable. RECOMMENDED DISPOSAL: Sterilize where appropriate. Normal means of disposal may include incineration and landfill. , ENVIRONMENTAL DATA: Not applicable. SARA HAZARD CLASS: FIRE HAZARD: Yes PRESSURE: No REACTIVITY: No ACUTE: Yes CHRONIC: No 6. SUGGESTED FIRST AID EYE CONTACT: Immediately flush eyes with large amounts of water. If irritation persists, call a physician. ` SKIN CONTACT: No need for first aid is anticipated in the event of skin contact. INHALATION: No need for first aid is anticipated for inhalation exposure. IF SWALLOWED: No need for first aid is anticipated. 7. PRECAUTIONARY INFORMATION EYE PROTECTION: Avoid eye contact. SKIN PROTECTION: Not applicable. . VENTILATION PROTECTION: Not applicable. RESPIRATORY PROTECTION: Not applicable. . Abbreviations: N/D - Not Determined N/A - Not Applicable I of • J -�, 01-22 '4 3M General Offices 29892 r 3M Center St. Paul, Minnesota 55144-1000 612/733-1110 ' MATERIAL SAFETY DATA SHEET 's MSDS: PETRIFILM - AEROBIC COUNT PLATES FEBRUARY 19, 1992 PAGE: 3 of 4 7. PRECAUTIONARY INFORMATION (continued) PREVENTION OF ACCIDENTAL INGESTION: Not applicable. RECOMMENDED STORAGE: Store in a cool place. Store away from heat. Store out of direct sunlight. Keep container dry. FIRE AND EXPLOSION AVOIDANCE: Not applicable. EXPOSURE LIMITS INGREDIENTS VALUE UNIT TYPE AUTH SKIN* GUAR GUM NONE NONE NONE NONE SILICONE NONE NONE NONE NONE CELLULOSE 10 mg/m3 TWA ACGIH CELLULOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 mg/m3 TWA OSHA POLYETHYLENE . . . . . . . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE ACRYLATE ADHESIVE . . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE NUTRIENTS NONE NONE NONE NONE POLYPROPYLENE FILM . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE DOUBLE SIDED TAPE . . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE * SKIN NOTATION: Listed substances indicated with "Y" under SKIN refer to the potential contribution to the overall exposure by the cutaneous route including mucous membrane and eye, either by airborne or, more particularly, by direct contact with the substance. Vehicles can alter skin absorption. SOURCE OF EXPOSURE LIMIT DATA: - ACGIH: American Conference of Governmental Industrial Hygienists - OSHA: Occupational Safety and Health Administration NONE: None Established S. HEALTH HAZARD DATA EYE CONTACT: Mechanical eye irritation: signs/symptoms can include irritation, redness, scratching of the cornea and tearing.' SKIN CONTACT: No adverse health effects are expected from skin contact. INHALATION: No adverse health effects are expected from inhalation exposure. IF SWALLOWED: No adverse health effects are expected from swallowing. Abbreviations: N/D - Not Determined N/A - Not Applicable O 1-2-2, 3M General Offices 29,$93 3M Center St. Paul, Minnesota 55144-1000 612/733-1110 MATERIAL SAFETY DATA SHEET w W- 1 MSDS: PETRIFILM - AEROBIC COUNT PLATES FEBRUARY 19, 1992 PAGE: 4 of 4 SECTION CHANGE DATES ENVIRON. DATA SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE FIRST AID SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE PRECAUT. INFO. SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE HEALTH HAZD. DATA SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE Abbreviations: N/D - Not Determined N/A - Not Applicable The information on this Data Sheet represents our current data and best opinion as to the proper use in handling of this material under normal conditions. Any use of the material which is not in. conformance with this Data Sheet or which involves using the material in combination with any other material or any other process is the responsibility of the user. x Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup (BWSC) TIER I TRANSITION CLASSIFICATION AND PERMIT STATEMENT This Permit is Issued to For DEP Use Only /One Permittee Effective Date: Expiration Date: ❑ More than One Permittee* *A list of all Permittees is attached. One Permittee: Name of Organization: Anheuser Busch Companies, Inc. Permittee Name: �i P2 Title: ► Street: One Busch Place (202-4) City/Town: St. Louis State: MO Zip code: 63118-1852 Telephone: 5 r1 rl- 4--1(04- DEP Finding Concerning Tier Classification Ed/Transition Tier IA (BWSC04) ❑ Transition Tier IB (BWSC05) Permit No. 82627 This permit authorizes comprehensive remedial response actions at: Disposal Site Number: 4-0937 Disposal Site Name: The Cape Cod Company, Division of Eagle Snacks Street: 100 Breeds Hill Road City/Town: Barnstable State: MA Zip code: 02630 The Permittee has 120 days from receipt of this Transition Permit to sign and submit the Transition Statement. This permit shall be effective upon the Department's receipt of the signed and dated Transition Statement. This permit shall expire 5 years from its effective date. Rev. 12/93 1 r Permit Conditions (1) All response actions conducted pursuant to this Tier I Permit shall comply at all times with M.G.L. c. 21E, 310 CMR 40.0000, the terms and conditions of the permit and any other applicable federal,state or local law. (2) In every proceeding, the burden shall be on the Permittee to demonstrate compliance with the terms and conditions of a permit at all times. (3) Each Permittee shall comply with: (a) submittal of a Class A, B or C Response Action Outcome Statement within five years of the effective date of the permit, unless otherwise provided in the permit; (b) submittal of a copy of the signed and completed Transition Classification and Permit Statement to the Chief Municipal Officer(s) and the local boards of health for the communities where the disposal site is located. (c) notification in writing to the Department: 1. as required in 310 CMR 40.0500; 2. upon gaining knowledge of any technical, financial or legal inability to perform any necessary response action, in accordance with 310 CMR 40.0172; 3. upon a decision by a permittee who is performing response actions as an Other Person to not proceed as required by the permit; and 4. of any change in the LSP of Record for the disposal site no later than ten days after the effective date of such change through the filing of a Minor Permit Modification by the permittee in accordance with 310 CMR 40.0725; (d) compliance with: 1. all applicable submittal requirements, .including but not limited to, scopes of work, Status Reports, Completion Statements, Phase Reports, and RAOs; 2. all requirements for record keeping and document retention, including but not limited to 310 CMR 40.0014, 310 CMR 46.0022 and 310 CMR 40.0023; 3. the Notification Regulations, 310 CMR 40.0300, in the event of discovery of a new releases located at the disposal site, threat of release or Imminent Hazard; 4. the management procedures for excavated soils and wastes and requirements for remedial air emissions set forth in 310 CMR 40.0030 and 310 CMR 40.0040; and 5. all public involvement activities required by 310 CMR 40.1400 through 40.1406; (e) inclusion of the Disposal Site Number and the permit number on documents submitted to the Department with respect to the disposal site; Rev. 12/93 2 i M certification of documents submitted to the Department as required by 310 CMR 40.0009; (g) evaluation of the need to perform Immediate Response Actions in accordance with 310 CMR 40.0400 as new or additional information about the disposal site is obtained; (h) modification or cessation of any response action as necessary to maintain compliance with any permit condition or to prevent an actual or potential threat to health, safety, public welfare, or the environment; (i) notification, orally or in writing, to the Department within seventy-two hours of obtaining knowledge of the need to modify or cease any response actions for the reasons in 310 CMR 40.0740(3)(h); provided that any such oral notification shall be confirmed by the permittee in writing within sixty days of such oral notice and any written notice shall include a Status Report prepared by an LSP; and timely remediation of any adverse impacts to health, safety, public welfare or the environment that result from the performance of response actions; (j) at disposal sites where groundwater investigation is necessary, delineation of the vertical and horizontal extent of contamination, identification and confirmation of groundwater flow directions, identification of groundwater migration pathways, including but not limited to, the identification of possible partitioning of dissolved volatile organic compounds at the water table interface which may lead to vapor transport into subsurface structures,homes or other occupied or unoccupied buildings, and monitoring of groundwater wells, discharges and/or other monitoring points in a manner which provides for the timely development or representative information about conditions and changes in conditions at the disposal site; (k) acquisition of all required federal, state and local permits; (1) proper operation and maintenance of all treatment, storage, abatement or control systems and of all equipment required to continue or complete response actions; (m) authorization for personnel and authorized agents of the Department to enter, at reasonable times and upon the presentation of credentials, any premises owned or controlled by the permittee for the purpose of investigating, sampling, or inspecting any records, conditions, equipment, practice or property relating to response actions at the disposal site, or protecting health, safety, public welfare, or the environment; and (n) notification upon a change of the Primary representative in accordance with 310 CMR 40.0703(7), if one is designated. (4) A Tier I Permit does not grant any property rights or exclusive privileges, nor does it authorize any injury to private property or invasion of property rights. Special Conditions: Special conditions, as set forth in Attachment A, are included in this permit. Each Permittee shall comply with these special conditions. ' ❑ Yes l� No Rev. 12/93 3 i DEP Authorization Issued by the Department of Environmental Protection: Name (Print): Gi Hunt Date of Issuance: !S Lai—a q� Signature Notice of Appeal Rights Any person aggrieved by this permit decision may request an adjudicatory hearing within 21 days of the date of issuance (the postmark date of this Permit as described in 310 CMR 40.0008) of this permit, if the Department has imposed special conditions (as set forth in Attachment A) without the Permittees consent or agreement, in accordance with 310 CMR 40.0050. Rev. 12/93 4 i a Primary Representative and LSP Information PrimaryRepresentative (only applicable i there is ep � J'aPP f more than one Permittee). For more than one Permittee, a Primary Representative can be designated and authorized If you are designating a Primary Representative provide the follouRng information: O Check if Primary Representative is also a Permittee. Name of Organization: Primary Representative Name: Title: Street: City/Town: State: Zip Code: Telephone: - - Primary Representative Certification: I certify under the penalties of law that I am fully authorized to act on behalf of all persons conducting response actions under this permit for the following purposes: a) to receive oral and written correspondence from DEP with respect to this permit; b) to receive oral and written correspondence from DEP with respect to the performance of response actions upon issuance of a Tier I permit; and c) to receive any statement of fee required by 310 CMR 4.03(3) under this Tier I permit. I am aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for wilfully submitting false, inaccurate, or incomplete information. Name (Print): Position or Title: Signature: Date: Note: The Primary Representative for more than one Permittee will receive the annual compliance assurance fee statement for the disposal site. Rev. 12/93 5 i LSP Information Provide the following information if an LSP has been engaged or employed to submit LSP Opinions concerning response actions that were approved prior to October 1, 1993. Name (Print): I F-( ,J 46 LU ag o License Number: Transition Statements Note: Each Permittee must complete this section. For disposal sites with more than one Permittee,make copies of this section, have each Permittee complete this information, and then attach all copies to this Transition Permit. Check one of the following to indicate your response and then sign the appropriate paragraph (1 through 3)and the Certification of Submittal: ❑ I accept the Transition Permit (sign "1") ❑ I do not accept the Transition Permit and I am, attaching a Major Permit Modification application (sign "2") ❑ I do not accept the Transition Permit and I intend to conduct response actions which were approved by the Department prior to October 1, 1993. (sign "3-A") ❑ I do not accept the Transition Permit and I do not intend to conduct response actions which were approved by the Department prior to October 1, 1993 (sign "3-B"). 1. Transition Permit Acceptance SWanent I agree to conduct all response actions pursuant to the terms and conditions of any and all Department approvals that are in effect as of October 1, 1993 as shown in Attachment B 1. I agree to conduct all future response actions at this disposal site which are not subject to an existing Department approval in accordance with this Permit and the provisions of 310 CMR 40.0000, including response actions with approvals pending on October 1, 1993 and subsequently approved and listed in Attachment B2. I believe that I have the technical, financial, and legal ability to proceed with response actions at this site in accordance with M.G.L. c. 21E, 310 CMR.40.0000 and other applicable requirements. I am aware of the requirements set forth in 310 CMR 40.0172 for notifying the Department in the event that I am unable to proceed with such response actions. Name (Print): F—VI N F. ��wUr Position or title: Pf�Tc S pac.�T� [/a(L L SSA'rNc.�-Si . Signature: (. 2�✓ Date: Rev. 12/93 g L r I Transition Statement(if not accepting Transition Permit and attaching Major Permit Modification application). a I do not accept the enclosed Transition Permit, since the disposal site, in the Opinion of an LSP may be reclassified as Tier (Insert Tier IB, IC, or Tier II, whichever is applicable). I am attaching a Major Permit Modification application pursuant to 310 CMR 40.0707. Name (Print): Position or title: Signature: Date: 3. Transition Statement if not accepting Transition Permit and providing statement regarding future response actions at the disposal sits 3-A RPIPRP/Other Person intends to conduct response actions approved by DEP prior to October 1 1993 I do not accept the enclosed Transition Permit, however, I intend to conduct response actions which were approved by the Department prior to October 1, 1993. I have attached and incorporated within this Statement a schedule for when this work will be completed and a Status Report indicating whether one or more Temporary and/or Permanent Solutions have been achieved or will be achieved at the disposal site, including an LSP Opinion regarding the completion of response actions to date and the response actions remaining in order to achieve a Temporary or Permanent solution at the disposal site. Name (Print): Position or title: Signature: Date: 3-B. RP/PRP1Other Person does not intend to conduct response actions approved by DEP prior to October 1 1993 I do not accept the enclosed Transition Permit and do not intend to conduct response actions including any response actions approved by the Department prior to October 1, 1993. I have attached an explanation of why I will not continue with response actions at the disposal site including,where appropriate, an explanation of any technical, financial, or legal inabilities that preclude me from undertaking response actions at the disposal site as outlined in 310 CMR 40.0172. I have attached and incorporated within this Statement, a Status Report indicating whether one or more Temporary and/or Permanent Solutions have been achieved or will be achieved at the disposal site, including an LSP Opinion regarding the completion of response actions to date and the response actions remaining in order to achieve a Temporary or Permanent Solution at the disposal site. Name (Print): Position or title: Signature: Date: = Rev. 12/93 7 } Certification of Submittal (All recipients must sign the following certification) I certify under the penalties of law that I have personally examined and am familiar with the information contained in this submittal, including any and all documents accompanying this certification, and that, based on my inquiry of those individuals immediately responsible for obtaining the information, the material information contained herein is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties, including, but not limited to, possible fines and imprisonment, for wilfully submitting false, inaccurate or incomplete information. Name (Print): V ;;J F b J u�t,6z- Position or title: (�7t r� s+D E� �a�� S tQ A t k S 12O C Signature: Date: /�f Z 3/9� - Rev. 12/93 8 . i This Attachment will be completed by DEP ATTACHMENT A TO PERMIT NO.82627 Each Permittee shall comply with the following special conditions: Check here if not applicable to this permit. 9 1 i This Attachment will be completed by DEP ATTACHMENT B TO PERMIT NO. 82627 B1. The following Department approvals were in effect as of October 1, 1993: 0 Check here if not applicable to this permit. - The installation, operation and maintenance of two (2) groundwater treatment systems as a Short Term Measure. The first system was approved by the Department on June 29, 1992, and the second system was approved by the Department on July 23, 1993. The treatment systems shall continue to operate until groundwater has achieved current GW-1 groundwater standards. Quarterly monitoring reports shall continue to be submitted to the Department. The groundwater remediation effort can only be terminated upon written Department approval. B2. The following response actions, which were pending as of October 1, 1993, and are now approved by DEP and in effect under this permit. 2 Check here if not applicable to this Permit. 10 L r G?AM u'1r1,tR BSC WESTWOOD MASS p�? ^' ^ 93 LOCTITE CORPORATION 705 NORTH MOUNTAIN ROAD ISSUED 14 19 NEWINGTON, CONNECTICUT 06111 126s:26:19 EMERGENCY PHONE: (203) 278-1280 TELEX: 275207 MATERIAL SAFETY DATA SHEEITT Page 1 of 3 PRODUCT IDgNTIFICATION Product Name: 7070 ODC Free. Cleaner Itel No.+ 11�62 ro uct e: �iy roc arbon lend ormula Nip: Res not app y TI. COMPOSITION Ingredients CAS No. X lyd otreated heavy naphtha 64742-48-9 80-85 Lrfmonene 5989-27-5 15-20 III,, CHEMICAL AND PHYSICAL PROFK T� IES VV,aapoor Presqurei Less than 5 mm Hg at 77OF D yy heavier h air tolu i It T'Vater: Not avai ad e peci£ic ro avitys 0.7S 41o'F ailing Point: ound310 'Volatile Organic Comp (EPA Method 24) 1002; 750 grams. per liter Evaporation Rate Not avai]abl+� Ether - 1) Dose n t a 1y AHAppenrance: C putt y ho y liquid Otlb r TV FLAMMABILITY AND EXPLOSIVE PROPERTIES Flash Point: 130°F Method: Tag Open Cup Eatimdted NFPA Code: Health Haz4rdi 1 Reec aZZitxy Hazards 0 ly Specif c hazard: Does not app Estimatel HMIS Codes H alth Hazards Flammability Haz rd: Reactivit Mar : 0 Personal r tectlon: H Explosive Lim ts: lX by vo ume n air Lower Not available X by yo u%e in air Lower eco,mendeExtnguishing Agents.; Carbon di hidQ foam, dry chemical The t�Qe o Selz contained app rates s 9Qcommended for tir iQ titers. Water Kay je u su.1ta l9 as an extinguts ini edia, but eII ul r 11 adiacent Con In rs cool. Avoid spread ping butning liqu d with water used for coo ang purposes. Hazardous Products Formed b F* a Thermal Decomp Oxides of carbon. UnKsu Firpr e or Explosion Hazards: Vapors are heaor th n sods and may travel al n theround or Nia move b ven iilat on naa 1gn t d by heat, iInt. otl ghtsd ofher lames an' i nit on ourC s at ocat Ong �stant ff om ma t8ria andl n o Never use we An or cutt ng torch on or nia rums (even empty) ecause pro uct or esidu@@s can ignite ex losivel . Kee work areas ret pf hot metal surfaces an� othe sources of gn t1on. Compressed Gases: None Pressure at Room Temp. : Does not apply V. SPILL OR LEAK AND DISPOSAL PROCEDURES Steps to be t ken in case of spill or saki ee so r ee of igni n nd hot metal surfaces faolate ram the sp Q aintai d uate ventilation. Flush sp Iiel. mate,rra � it0 suits l� retainin ar as or contai ers with la ge qua t t e quantiti s of water. small amounts o mate s Store inclosed co�taanea�pun�iladispoaalbent. Re o mended methods o� �isposali Incinerate following EPA and local regulations. 08-30-93 11 ; 57AM FROM BSC WESTWOOD MASS Pn,) LOCTITE CORPORATION 705 NORTH MOUNTAIN ROAD ISSUED 7/09j93 A � EMERGENCY'POONEEc(2C3) 278-1280 TELEX= 275207i19 WABIAL SAFETY DATA SHEET Page 2 of 3 Product Names 7070 ODC Free Cleaner Item No. 1 20162 VI. STORAGE ING PROCEDURES Storages Store awa from sources o9 1 nition in a cool, dry area. Keaf conPims ti§ t closed. Handling: AvoIg pro onge s con act. Kee awa from eyes. AA ognittothing vapors. Do not USS nea aouces VI2... SHIPPING REGULATIONS DOT (49 CFR 172 Proper Shipping Name Ground: Unrestricted Not more than 110 Naphtha solution (More than 110 IlonaAir: UnrsetrictiQdi Not' more than 110 al1:11ons) ; ons ; Hazard Class or Naphtha solution (More than 110 jallons Division Grounds Unrostrlted (Not more that 110 ggallons) ; com ust a liquid (Mare t an 110 allons) Air: Unr 9tri l#.ed ((No more tha�s 110 allons) ; Com ustlgie liquid (Mc� a than 11� gallons) Identification Number None (Not more than 110 ggal ons) ; UN 2553 (More than 110 allons) IATA oper Shiggp n Name Naphtha solution ass or A3vision C1gss 3, Packing Group III IMOUN or ID Number UUgK 1256 11 11 MSru no Pollutant Status Not avallagie sass Not ava a e Subsidiary Risk Label Not ava a e NJDG Code Page Not ava a to NN Num er Not ava a is VIII. REACTIVITY DATA Stabilitys S le Hazar oue ppolymerizations W not occur. Haza dous Decom sitign Pxo acts ppn-triermal) s None knjVdizing Incompatab Hty: st on agents,. strong acids or bases, se ec a amnos, EXt ;NEAGgNCY TUATMENT PROCEDURES Ingestions Do not induce vomitin . Keep individual calm. Obtain mod cal agent n. Inhalation: Remove to resh air. vie iTtq expo i@n es continued breat n dl fiicu ties, a man star o y egn u �tiqqt melcl as istan Q c fn be render d. amid obata nnimletffhebml caftattentianespirat on Skin Contacts W sh it oa and at r. Remove c t mii}ated cc othTn 'onta?n med ca attention rrItation ersist Eye Contact: Fl h t least 15 minutes with water. obtain me �ca� attention. X. PERSONAL PROTECTION Eyes: Safer glasses, chemical goggles, and/or face Shielyda. Skin Im erm able ru be or etc love and rons. p Q pp B gg Ventilation: General melchan r t1 at an ma be suf ii to kee gAp concentration within specif�ed®nt tame-wgighta TLV ran esi. I gen1ral ventilation roves inadeEa. te to a nta n sa a va or proves atiosuemental to al exiauet ma ba Yre u red. Otr s gg1a1 precant Ong such as p respiratory masks or environmental containment dev,lces may be re uire in extr me cases. The use of respiraory protection depen s on vapor concen ration above the time-we kited TLV: use a NIOSH approved cartridge respirator or gas mask. X1. HEALTH HAZARD DATA Toxicity: Respiratory tract it 8tant, Anesthegia ire hi h concentrations. Pose a eye and skin irrita t. Primary Routes of Entry: None known Sips and Symptoms o Exposure: Irritation of eyes, skin, or respiratory tract, 08-?O-9 ? ? 'i11M FROM BBC WESTWOOD MASSPull: LOCTITE CORPORATION 7055 NORTH MOUNTAIN ROAD ISSUED 7/09/93 +^ E E GENCX'PEONEl (203) 278-1280 TELEX: 2 5107s19 MATERIAL SAFETY DATA SHEET Page 3_ of 3 Product Name: 7070 ODC Free Cleaner Item No. : 20162 XI... HEALTH HAZARD DATA (continued) EXieting Can¢itions Aggravate py Exposure! None known Exposme Limits (TWA) ACGVH OSHA OTHER InBBre ente (TL Hydrotreated heavy naphtha 5mg/m3 TWA mist 5mg/m3 TWA mist None Exposure Limits (STEL) ACGIH OSHA Ingredients (TLV) (PEL) Hydrotreated heavy naphtha 10 mg/m3 mist None Ingregients for which no Exposure Limits have been established are not lists above. Literature Referenced Carcinoggen Ingredients Target Organ and Other Health Effects NTP IARC OSHA HyA otreated heavy naphtha No ata NO No NO d- Umonene No Bata NO N/A NO ------------------------ ----------1----------------------------------- ------ Abbrev:.ations N/A Not Applicable X_11. PREPABATION INF'OBNATION P e aced By: $$te hen Repet o T t�e: Res6 rch Chem1st Environmental H alth & Safetyy Go Loc to Co 765 N. Mt. Rd, Now ng.ton, CT 06111(2pjanTl r Phones �20i 278-1Z8�Revsion Date: une 24, 1993 Revision: First Issue J Paul Orenge® Lotlaa Hand Cleaner with Fine punka MATERIAL SAFETY DATA SHEET ITEA1 PART CONTAINER ITEM PART C43NTAIt;,FP ' a PERMATEK INDUSTRIAL CORPORATION 14ived: May 1+1992 NO. NO. slzF no, NO. slzE 7as North Atouataln Rood 26104 2b•108 7A 8.oz Squ Bottle,aszo SOMIe 26210 26.213 ot fl.or(1 gal) P lassie ltewinglom,CT 06111 25104 26.104 128 D-oz Fiat Top Omlton Be whh FREE pump Phone: (SOD) 641.7374 ro r use,with o6.137 26908 25-908 Counter Display-12-7-S Fail OranQegl Lotion Hand Cleaner with F1no Purnles Dispenser 11,oz Bottles of Fast I PRODU=T ID61,17IFICATIOY 25816 2"16 Intro Pak{2.1 gal Plastic Orange Pumice Formula Bottles (M2181 wf90-128 Hand Cleaner product Naves Item No.► WallBraakel 26300 25.300 2.75az7ubebulkearda Product Typ e. 011 Ln a 1Yater gmulsion 25114 26.114 14 fl.az Pumplalnat 25151 25-151 2.75 11.or tube cardod F Does not_Frnula No-: pp y Ii. c6HPOSITlOY • 4II, SHIPPING P.EGULATIORS Ingredlante CAS No. I A0T rap r 4h1721 gB P0.oaed Ciaea or Name Unreetcirtsd Aster 7732-1S-5 65-so H Gnrestricted d-l.'moncne 598.9-27-5 5-15 1 M8iV Non onlc surfactant 69013AS-9 IATIddeentification Number Rona Pus: Cs 11�32-09-8 5-14 Non onic surfactant 3 3_5-02-7 D.1-10 Copet Shipppiingg Name Unreatticted Yerpenea and terpenaids, Clans or DLVis3on UnrNone suect or@mpgg-ail 65647-72-3 CC 11 19 UN or T_D Humber Naae Trie-hanolabine 9003-101- 0:1-2 Acty�ie aciid polyoec 9003-0'-4 0.1-2 I�6ubstnocq Not Ave leyyy : Aloe vacs 4001-97-6 Trace NCriae Pollutant Statue Not Ave lope jojoba oil 61789-91-1 Trace 1pa9 Nak avn Is e .i" Lanolin 8006-54 4 Trace Suasidiary Rick Label Not avn 1e e Lard ealo``aiapthiexolinane 26172-SS-4 Trace I710G Cyyde Page Not avn legte HatNethf�icothiazolinone 2682-20-4 Trace ON Nuvhe[ Not avn la e y IUTACTIpTY DATA III. C]IEN=CAL AND PHYSICAL PROPERTIES Stebi its: SC b1e Vapor Ores;ure: } flat available Bazar ousoipmeriZatiani YL�i »ot occur.. 1's ar D nsity: o ayaila le assi ous D.., a t Qn SoluyyiilItY ib ueterr SaLupble PtoCuets [eon-thezma_)r Hooe Speiifie CravLty: 1.03 Inconpatab list': Hooe .. �b ii g Point: Not Available tra atta Or sic CDopound 24.9= (maximum) JX ENERGENCv TREATMENT PROCEDURES s. (EPA Hethod 24) Ia eatLanr Do npt ind ce vomitlog- Keep lndivioual calm. yet••+ Evaat :gLjan Rate Not available g Obtain medcl attention. N ez - 5.5 Iphalationr Does n4k apppp 7 dIA 0 5lhite viacaus lotion Skin Coo tact: Vpsh With §ba and later. ppeorance: orange Eye Contacts Feu64h at least 13 aicutes With voter. Obtain u Oaor: g medical attention. IV. FLARHABILITY AtfO EXPL09IYE PROPERTIES X PERSONAL pROT$CTION Flash Points More than 140'F Hethodi Pensky-Martens SaEat la es of joggles. EsCCLooted NFPA Code: Healt't hazard: 1 Bent None not needd. Fire ozatd: 2 , Ventilations Does not apply Y':.. OAT ivi aeacttty hazard: D Specific Hazard: Boas not apply XI. 11EAL1tH HIJ2ARt) B EstSmsteC HYIS Code: Taslcitye oral LD5o more than SD00 mg/kg Ileelth Na ards it Fismmab41 t• Hazard: Reaetivst �axard: 0 d-Llmooene has b on eh vn'tto cause tuoorc an dv toe reproductive Peactiv4 yr taction: See Section X. efffaces in esper� edt Y ani aLr when iD opted �n far a amounts and pi1es ve L m te: adve�se behave R aItogte �n experimen al animals w wn. inserted into gt by volume n air tower Not available the uodenus or the pet toneum. 1 {i by vodldu a in air)Upper Not available Ei°t ilea uee �9 Agents. Catbon dioxide, chemical powder P inert' gouter of Entry: Skin contact, ingestion, and inhalation. gg S Ins end 5ymptome Hone under normal conditions of use. I l[ zard6ue PZa7Uets Foroad o Ex osuene 3x ati�ig Cppnditions �yy Firre pr Thermal Oeconp Irritating organic vapors x Btigrevite by Erpoeure: None knovn O^HER Un4auai Fire o[ Ezploslora Hazards: None Ex oeu a Lioite ACGIU OSHA Com re sae Casesr None I Pamprese at P.oc•o Temp.: Does not apply n�r:d eats (^LVj tTLV) V. SPILL 03 LEAX ANO-DLSPOSAL PROCEDURES - Vot¢r None None None d-Liaonane None None ?Jane Steps o be t pken in case Nonionic surfactant HHone one None y.a Nane None None of spill1 or leaks Rinse avay with voter or vice p With a towel. Pum ce None Han: None Be 0amended methods Nonionic sucfaetaut ,.; o disposal: Norm iefuae or sewage• Follow EPA and local Ter penes and to anoids. None None regu at one. rp RA cp t1°ne hone None ;_. Trietheno�atone11 None yi. STORAGE AND 1(NDLING PROCEDURES % rFF fe acid polymer None None No Aloe very Hone Nona None statager Band C1eana:r should be stared bgtveea 40 F and o;oba o11 None Fone None 100 F in order to insure long life of thea3io1 n None hone }tone 3e emul1sion. ashhy# cbloFoie9tthiazoli.-r0n9 None Kane None } Handling: pDllov all general safety precautions. Xeep away et isot>tlazolinone Hone Hone hone from children- Literature Referenced CarcinaaRen Ingredients Target Organ and Other Health Effects NTP 1ARC OSNA No Data ta No NO 00 aonane }�o DDIL 00 HO W x. ironanlc surfactant No data Ao DJata NO NO NO on onic surfactant No Data z ' JLE MATERIAL SAFETY DATA SHEET i PERMATEX INDUSTRIAL.CORPORATION issued;May 1,i992 7oS North Mountaln Road Newington CT 06i t 1 Phone: (800)641.73TS Fast Orange® Lotlon Hand Cleaner with Fine PumWo iI. NEALTH HAZARD DAiA (continued), Ter?anea and to penoids, No Data NO NO NO ev$et arang9-OI1 g Triethanol mine No&Oats Na KbA 3 A r Iic ac�d polymer tic beta No A veza No Data Io�aba all Lanolin Q N. Hethyl cblo aisithiasoiinone No Data NO Ng Hethyllieott•. azo inane No Data Abbreviations Hill Nat Applicable IRR Irritant SLZ Skin i XII. PREPAF1.Ttoli INFORY.A713N P spared By* Stephen 119 tto 7�tle: RRase rch Cheaiet Ervironne tot1 H alth i Safi y Oouppan Loct�to Con 765 N. Ht. R�, Nev�ngtom, CT .1111 ((14hr ) Phan e� [[203) 278-128b Revision slate: Jsnuary 23, 1992 Revision: 0022 .fir. s a N Z:d . iz Rqt CAPE COD COMMISSION r 3225 MAIN STREET PO -0 O hj PO Box 26 aa v 2 BARNSTABLE, MA 02630 JtTA 5 S 508.362-3828 FAX:508-362-3136 March 24, 1993 Mark J. Begley, Chief RE: WSA-4-190 Site Remediation Section Southeast Regional Office Department of Environmental Protection Lakeville Hospital Route 105 Lakeville, MA 02347 Dear Mr. Begley: This is a letter progress report on activities at the Barnstable Fire Training Academy. As indicated in our last progress report, almost all of our efforts have focussed on the preparation of the Short Term Measure (STM) design report. Because of the activity associated with the STM, we have only just started working on the Phase III Final Remedial Response Plan. Due to the anticipated activity associated with the STM over the next two months we will require an extension of at least two months from today for, the Final Remedial Response Plan. Weston and Sampson submitted the STM Design plan to your office on 12 February 1993. We met with Anheuser-Busch and Whit-man and Howard on Wednesday March 17, 1993 to finalize the locations of"the recovery wells for the chloroform plume. I discussed the proposed location and the rationale with George worth. He is agreeable to the locations and the rationale but requested that a satisfactory sampling plan of the toe of the chloroform plume include weekly sampling and a plan for communication of the results to his attention. I am also meeting with VAPEX this month to discuss the long term prognosis for the Soil Vapor Extraction System. Please contact me if you have any questions regarding this matter. Sincerely, 7Cambar Thomas eri Water Resources Coordinator Hydrogeologist, CGWP cc: Barry Johnson, County Administrator Sharon Roberts, Anheuser-Busch Inc Tom Mckeon, Barnstable Board of Health Jon Erickson, Barnstable Fire District Norman Nault, Barnstable Fire District Prasanta Bhunia, Weston and Sam' pson Douglas DeNatale, Whitman and Howard Commonwealth of Massachusetts Q �j Executive Office of Environmental Affairs Department of �J Environmental Protection Southeast Regional Office William F. Weld Governor k O Daniel S.Greenbaum Commiaslorror June 29,, 1992 Anheuser Busch Companies, Inc. RE: BARNSTABLE WSC-4-0937 One Busch Place (202-4) The Cape Cod Company, St. Louis, Missouri 63118-1852 , Division of Eagle Snacks Inc, 100 Breeds ATTENTION: Mr. John Stier Hill Road, Short Term Measure Plan Approval (� M.G.L. Chapter 21E and 310 CMR 40.542, Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , is in receipt of the following report: DOCUMENTS AND SPECIFICATIONS ' �I FOR _ S� }. CONSTRUCTION OF GROUNDWATER TREATMENT SYSTEM V u CAPE COD PLANT " BARNSTABLE, MASSACHUSETTS MAY 1992 The report was prepared on your (as used` in this letter you and yours refer to the,Anheuser Busch Companies, Inc. ) by Whitman & Howard, Inc. , for the Cape Cod Company, Division of Eagle Snacks, Inc. , 100 -Breeds Hill Road, Hyannis, Massachusetts (the "Site") . The purpose of the report is to propose remedial measures to treat the chloroform contaminant plume that currently exists in the environment in the area of the Barnstable Fire District Public Water . Supply Well #2. The proposed Short Term Measure (Measure) consists of a groundwater treatment system that includes two groups of recovery wells set at various depths in the aquifer to treat the full vertical extent of the plume. Contaminated Groundwater pumped at - a rate of up to 80 gpm will be treated by passing through a counter current packed aeration tower. The treated water will discharge to the ground via two on-site recharge galleries located upgradient •of the recovery wells. Lakeville Hospital 9 Route,105 • Lakeville,Massachusetts 02347 • FAX(508)947-6557 9 Telephone(508)946-2700 i ° -2- The Department, pursuant to 310 CMR 40.536 (2) , approves the proposed Measure with the following provisions: 1. You shall continue to evaluate the need for additional Measures and notify the Department immediately upon the discovery of an imminent hazard in accordance with 310 CMR 40.542 (1) (d) . _ 2. Monthly progress reports relative to the installation, completion and operation of the Measure shall be submitted to the Department -with' the first report due within thirty (30) days of receipt of this letter. The report must contain, at a minimum, all the field data, sampling and testing data, a current groundwater and plume contour map; system maintenance information and a discussion of the progress of the Measure. Submit an as-built plan including a description of all system units and the installation procedures with the first report. 3 . You shall comply with all applicable Federal, State and local permits throughout the implementation of the Measure. This approval pertains only to the construction and operation of a groundwater treatment system. { Based on the concentrations of contaminants and the remote location of the treatment system the off-gas controls for the air-stripping tower are not deemed necessary. If influent contaminant levels increase and/or odor problems arise then an evaluation of the need for off-gas controls for the Measure will be completed and submitted to the Department for approval. 4. If during the implementation of the Measure a determination is made that modifications to the approved Measure are necessary, submit to the Department a revised Measure plan' for review and approval prior to implementation. . . 5. Cessation of groundwater treatment efforts must be authorized in writing by the Department. 6. The approval of the Measure should not be interpreted as an approval of the Phase III - Development of Remedial Response Alternatives andthe .Final- Remedial, Response Plan as noted in 310 CMR 40.546. -3- The Department may require additional` actions based on specific conditions at the Site. You should be aware that this Measure does not relieve you from undertaking a full Phase II - Comprehensive Site Assessment. However the work you undertake in the course of a Measure may contribute significantly towards the assessment of the Site and a permanent solution to the Site. You have been previously informed of your liability in a Notice of Responsibility letter dated March 7,- 1991. Should you have any questions regarding this letter, please contact Maria Pinaud at (508) 946-2869. In any correspondence to this office, please refer to case WSC/SA 4-0937. The Department appreciates your continued cooperation in this matter. Very truly- yours, y Ro .rt E. onovan, egi al Engineer for Wast Site/Clea up D/MP/rr CERTIFIED MAIL #P656 841 010` RETURN RECEIPT REQUESTED cc: DEP - BWSC - Boston . : DEP - WPC Boston DEP - AQC - SERO , DEP - SERO - DWS ATTN: Larry Dayian . _ a A DEP - SERO - Data Entry Town of Barnstable Town Hall Hyannis, MA 02601 ATTN: Warren Rutherford Town Manager , k • -4- cc: Hazardous Waste Coordinator" P.O. Box 534 Hyannis, MA 02601 ATTN: Tom Mckean Barnstable Fire District P.O. Box 546 - s Phinney's Lane . Barnstable, MA 02630 ATTN: John Erickson Whitman & Howard, Inc. 45 William Street I Wellesley, MA 02181-4050 ATTN: Douglas DeNatale .r•a. v� t"y.-.>�'px;�:n.^ti-3'k9:.;r! -c.ri...wr.i.'�:�.: ,...-.K:.-...... , '. .:.: :. _ 1�e�v.,aGouoct o�(�,avcrt�,zauas�Jr��cctio-ia , ' _2�L�aot�h crl.�odh�a` -�m��oc�.C• �.�"��r4�/y�� DANIEL S.GREE`rBAUM JA 99 2 Commissioner '' A,L GILBERT T.JOLY r0{N�H p TM DEff Regional Director January 28, 1992. Anheuser Busch �:ori"pansies, Inc. RE: BARNSTABLE--WSC-4-0937 One Busch Place (202-4) The Cape Cod Company, St. Louis, Missouri 63118-1852 f Eagle Snacks Inc 100 Breeds Hill ATTENTION: Michael G. Richter, P.E. Road, NOTICE OF RESPONSIBILITY/Short Term Measure Plan, M.G.L. c.21E and 310 CMR 40. 000 _ Gentlemen: This letter concerns the existence of chloroform in the environment in and around the Cape Cod Company ' Division of Eagle - - Snacks, Inc. , located at 100 Breeds Hill Road, Hyannis, Massachusetts, (hereafter, the "Site") . The Department of Environmental Protection, Bureau of Waste Site. Cleanup, (the "Department") , has determined that the Site is a confirmed priority disposal site within the meaning of the Massachusetts Oil and Hazardous Material Release Prevention and Response Act (M.G.L. , C. 21E) . The assessment and cleanup of disposal sites is governed- by _ M.G.L. , C. 21E, and by 310 CMR 40.000, The Massachusetts Contingency Plan (the MCP ) . The Site is located within the proposed zone II of the Barnstable Fire District Public Water Supply Well Number Two (BFD#2) . BACKGROUND In response to the Location To Be Investigated" letter issued to you (as used in this Notice "You" refers to Anheuser Busch y 4 Companies, Inc. ) on June 19, 1990, the Department has received the following reports: "Phase I - Limited Site Investigation, The est dated November,Cap991Cod Company, Barnstable, Massachuset k This report al so. contained aPreliminary Assessment Report an an Interim Site C1 ssification "Form. - A Short Term Measure (STM) P1an,. Cape Cod Company, Barnstable,_.. Massachusetts" dated January 9, 1992 Y The reports were prepared ,and submitted on our behalf by Whitman & lkward, .Inc. * t 71 s L y 5 1u: r ,>-'<• d 'ai A f c -.. u r tk. a -7 zr / ; c Y .z.l2 r al "a ;... , j . .... .7. a j _C E it %4t ,h + rya• t � ��77 x •ry rt § t Y t L t-Recy►cled Paper) i Y -2- DETERMINATIONS The Department concurs with Whitman & Howard's findings presented in the above mentioned reports, namely: - The Site is a confirmed disposal site. - An imminent hazard exists at the Site as defined in 310 CMR 40. 020 and identified under 310 CMR 40.542 (2) ; and - The Site is a priority disposal site pursuant to 310 CMR 40.544 (2) (c) l. Therefore, pursuant to 310 CMR 40.531, any additional work at the Site requires Department approval. STATUTORY LIABILITIES I; The Department has reason to believe that you are a potentially . responsible party (a "PRP") with liability under M.G.L. , C. 21E, Section 5, for response action costs. Section 5 makes the following parties liable to the Commonwealth: current owners or operators of a site where oil or hazardous-materials are - located; any person who owned or operated a site at the time hazardous material was stored or disposed of; any person who arranged for the transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is or has been a release or threat of release of such material; and any person who otherwise caused or is legally responsible for a release or threat of release of oil or hazardous materials at a site. This liability is strict, meaning it is, not based on fault but solely on your status as an owner, operator, generator, transporter ' or disposer. It is- also joint and several, meaning that you may be liable for all response action costs incurred at the Site, regardless of the existence of any other liable parties. You may be liable for up to three (3) times all response action costs incurred by the Department. Response action costs include the cost of direct hours spent by Department employees arranging for response actions or overseeing work performed by PRPs or their contractors, expenses incurred by the Department in support of.° those= direct..-hours and;::payments:_-to- the_:;-De ar_.tment's - P Ym . P = contractors. For more , detail -.on cost 'liability, see 40. 600: Cost Recovery. The Department may 'also assess interest -on costs incurred at the rate of twelve percent (12%) , compounded annually. ='. To secure , payment of this -debt, the Commonwealth _may. place liens .on.:all:w of your property within the. Commonwealth -To recover .the debt,..the . - { .., 4 t tom' .a '4 t 4 •t. . 5 'S ^f '' t t t ..1..• L .f t."' y+:hv i : :.,e.tn K f$ i y d d x°{i:rg r:,.4 d u ,, rt a 4.'yt t a"'"i s'ti� rr r y+nYs ' J .:;,..F rip, �., �'' Y... g J 1x•' ,Yr�tE xa,Jt5 r°d 'F 7 4 ry i2t,C�Y .'+A ,.::.h o': .'.M -., ., `. s . xS h 1 tJr'v e •t r - ._ .. .,_.-........-.s: .......... ....:...........,. .....:•:...mM.w�.....nvw.nr.«www^rvu:r.-M..,,rr..M.7".^1'.,. -..� v,., t ,v9"'q+`a:T r E�Jl3±lEfA'1NF+^.i .'�"`; nri -3- ------ commonwealth may foreclose on these liens or the Attorney General- may bring legal action against you. In addition to your liability for up to three (3) times all response action costs incurred by the Department, you may also be liable to the "Commonwealth for damages to natural resources caused by the release. Additionally, penalties may be imposed under M.G.L. , C. 21E, Section 11 and other laws for each violation of M.G.L. , C. 21E or other laws, or under M.G.L. , C. 21A, Section 16, for violations of C. 21E, and other statutes, regulations, orders or approvals. The Department encourages PRPs to take response actions at sites. By taking the necessary response actions, you can avoid liability for costs incurred by the Department's contractors in performing these actions. If you do not take the' necessary response actions, or fail to perform them in an appropriate or timely manner, the Department is authorized by M.G.L. ,.- C. 21E to have the work performed by its contractor. _ NECESSARY SITE ACTIONS The following remedial response actions are necessary at-the- Site: 1. Within thirty (30) days from receipt . of this Notice, submit to the Department for review and approval prior to implementation, a scope of work to define the leading edge of the contaminant plume. 2. The Department has reviewed the letter report titled 4 "Short Term Measure (STM) Plan, Cape Cod Company,, Barnstable, Massachusetts" dated January 9, '1992. The purpose of the report was to propose the conceptual design for a groundwater treatment system as a Short Term Measure (STM), in compliance with 310 CMR 40.542. The Department concurs with the proposed groundwater treatment system conceptual design with the exception of the location of the effluent discharge structure. The Department recommends the location be moved upgradient to the proposed location, near the access road. Therefore, within ninety (90) days from receipt of this Notice, submit to the Department for review and approval prior to implementation, the following: a) Design plans for 'a groundwater treatment system consisting of design parameters and schematic diagrams showing all the ; system's units; .g b) Complete plans and specifications for.all r , on-site treatment, storage and .disposal S r tv z `fT 4} ,y..'a 4,4' t _ .s G F x f A... '� 7 fir) .`"` '.E 2?:�. } - � r� a' ✓( '( q •X -Fil k_ ' a ,.t-: S .. _ A vs t : s F ..t+, rt•.; t ., i�F.' .�, 'Y.eT'..: �' - ...z+....n*+.+r r. n ry M1+Rnv•mrvMxrMT91^J'lmcTloA^"tVl1a'fi+ 1Wil,?q P.... r,v;u�T - activities related- to the STM; o implementation mentation of the c A schedule f p , proposed STM; d) An environmental monitoring plan, including construction and long-term monitoring, to include sampling of key groundwater monitoring wells; e) A preliminary contingency plan; f) A preliminary security plan; g) An estimated cost of design, construction and operation and maintenance (O&M) ; I„ h) Identification of all records, reports, logs and other pertinent. information which shall be maintained to document construction activities; i) A preliminary health and safety plan; and -- - -- - j) A preliminary quality assurance/quality control plan; and k) A list of names, addresses and telephone numbers of the persons responsible for operation of the treatment system. All existing local, State and Federal. permitting and approval requirements must be in compliance throughout the-implementation of the STM. In addition, your consultant shall continue to evaluate the need for additional STMs as defined in 40.542 of the -MCP, If at any time an imminent hazard is discovered at the site, you must immediately notify the Department and submit a proposal for a STM. _ This evaluation shall continue throughout the assessment process for the site. The Department may impose additional requirements based on specific conditions at the Site. The approval of the STM will not relieveyouu from undertaking a -full ;Phase,.II_- Comprehensive Site Assessment. In addition, you may also-have=to compile-a-Phase, w - Development of Remedial Response Alternatives and a Final Remedial Response Plan, and you may have to undertake a Phase IV -. Implementation of the ,Approved Remedial Response Alternative,.. as r required under 310 CMR 40.000. i .t 1� � 5� �`.rL M ,p,,rt� � a d �u3�.- .• v rr t ,, i. r cP �,� �t5 s��y,.Sr +�,."� at. '"t �„N ,^ F rPy n*" �ja, '` g{�5 {• {4 y7R� yt� ^.3kSt .t'i:r tr y �,f _ -.T, 1 -` ,;_Yy If you have any questions regarding this matter, you may contact Maria Pinaud of this office at (508) 946-2869. In .any correspondence regarding this case, please refer to case WSC/SA 4- 0937. The Department appreciates your cooperation in this matter. Very truly yours, a _ Mak J. B ley, C '52 Site Remediation Section"/ B/MP/re CERTIFIED MAIL IP306 703 071 RETURN. RECEIPT REQUESTED cc: DEP - Boston - BWSC DEP - SERO - 'DWS ATTN: Larry Dayian DEP - SERO - Data Entry -:: - Town of Barnstable Town Hall Hyannis, MA 02601 ATTN: Warren Rutherford Town Manager Hazardous Waste Coordinator P.O. Box 534 Hyannis, MA 02601 ATTN: Tom Mckean Barnstable Fire District P.O. Box 546 h Phinney's Lane Barnstable, MA .02630 ATTN: John Erickson Whitman & Howard, Inc. 45 William Street _. Wellesley, MA 02181-4050' ATTN: Douglas°.DeNatale w. 4 ." -e{•.,. 4 T 1 C•T d L- �_. t... µ� -.M' 4 4 t ,iq y1 -. 4 1}`' A _- _. r,.,.r . Try-n»++n av v.mcm:szsrfslaeN'e, C•. . ` 01-22 3M General Offices. 29886 3M Center St. Paul, Minnesota 55144-1000 612/733-1110 MATERIAL SAFETY DATA SHEET ` DIVISION: SURGICAL DIVISION TRADE NAME: PETRIFILM - E. COLI COUNT PLATES 3M I.D. NUMBER: 70-2005-7213-2 70-2005-9014-2 ISSUED: FEBRUARY 19, 1992 SUPERSEDES: OCTOBER 23, 1991 DOCUMENT: 05-3671-4 1 . INGREDIENT C.A.S. NO- PERCENT POLYETHYLENE TEREPHTHALATE) 25038-59-9 45.0 55.0 POLYSTYRENE . . . . . . . . . . 9003-53-6 10.0 - 20.0 ACRYLATE ADHESIVE . . . . . . . . . . . . . . . . . . . . Unknown 10.0 - 20.0 POLYPROPYLENE FILM . . . . . . . . . . . . . . . . . . . Unknown 1.0 - 10.0 GUAR GUM . . . . . . . . . . . . . . . . . . . . 9000-30-0 1 .0 - 10.0 DOUBLE SIDED TAPE . . . . . . . . . . . . . . . . . . . . Unknown 0.0 - 5.0 2. PHYSICAL DATA BOILING POINT: . . . . . . . . . . . . . . . N/A VAPOR PRESSURE: . . . . . . . . . . . . . N/A VAPOR DENSITY: . N/A EVAPORATION RATE: . . . . . . . . . . . . N/A SOLUBILITY IN WATER: N/D SP. GRAVITY: N/A PERCENT VOLATILE: N/D VOLATILE ORGANICS: . . . . . . . . . .� N/D VOC LESS H2O & EXEMPT SOLVENT N/D pH: . . . . . . . . . . . . . . . . . . . . . . . . . 6.0-8.0 VISCOSITY: . . . . . . . . . . . . . . . . . . N/A MELTING POINT. . . . . . . . . . . . . . . . N/D .,APPEARANCE AND ODOR: Film, OPAQUE RED AND WHITE FILM WITH, YELLOW GRID. MUSTY ODOR. 3. FIRE AND EXPLOSION HAZARD DATA FLASH POINT: . . . . N/A FLAMMABLE LIMITS - LEL: N/A FLAMMABLE LIMITS - UEL: N/A AUTOIGNITION TEMPERATURE: '. . . N/D EXTINGUISHING MEDIA: I Water spray, Carbon dioxide, Dry chemical, Foam SPECIAL FIRE FIGHTING PROCEDURES: Wear full protective clothing, including helmet, self-contained, positive pressure or pressure demand breathing apparatus, bunker, coat and pants, bands around arms, waist and legs, face mask, and protective covering for exposed areas of the head. . UNUSUAL FIRE AND EXPLOSION HAZARDS: Not applicable. NFPA-HAZARD-CODES: HEALTH 1 FIRE 1 REACTIVITY 0 UNUSUAL REACTION HAZARD: None _ 4. REACTIVITY DATA STABILITY: Stable INCOMPATIBILITY - MATERIALS TO AVOID: Strong oxidizers. Abbreviations: N/D - Not Determined N/A - Not Applicable 01-22 3M General Offices 29887- 3M Center St. Paul, Minnesota 55144-1000 612/733-1110 MATERIAL SAFETY DATA SHEET " � s , MSDS: PETRIFILM - E. COLI COUNT PLATES FEBRUARY 19, 1992 PAGE: 2 of 4 4. REACTIVITY DATA (continued) HAZARDOUS POLYMERIZATION: Will Not Occur HAZARDOUS DECOMPOSITION PRODUCTS: Carbon monoxide, carbon dioxide, styrene and hydrocarbons. 5. ENVIRONMENTAL INFORMATION SPILL RESPONSE: Not applicable. RECOMMENDED DISPOSAL: Sterilize where appropriate. Normal means of disposal may include incineration and landfill. ENVIRONMENTAL DATA: Not applicable. SARA HAZARD CLASS: FIRE HAZARD: Yes PRESSURE: No REACTIVITY: No ACUTE: Yes CHRONIC: No 6. SUGGESTED FIRST AID EYE CONTACT: Immediately flush eyes with large amounts of water. If irritation persists, call a physician. SKIN CONTACT: No need for first aid is anticipated in the event of skin contact. INHALATION: No need for first aid is anticipated for inhalation exposure. IF SWALLOWED: No need for first aid is anticipated. 7. PRECAUTIONARY INFORMATION EYE PROTECTION• Avoid eye contact. SKIN PROTECTION: Not applicable. . VENTILATION PROTECTION: Not applicable. RESPIRATORY PROTECTION: Not applicable. . PREVENTION OF ACCIDENTAL INGESTION: Not applicable. Abbreviations: N/D - Not- Determined N/A - Not Applicable 1 ;y 01-22 3M General Offices 29888 a 3M Center St. Paul, Minnesota 55144-1000 ' 612M3-1110 MATERIAL SAFETY DATA SHEET , MSDS: PETRIFILM - E. COLI COUNT PLATES FEBRUARY 19, 1992 ' S. PAGE: 3 of 4 7. PRECAUTIONARY INFORMATION (continued) RECOMMENDED STORAGE: Store in a cool place. Store away from heat. Store out of direct sunlight. Keep container dry. FIRE AND EXPLOSION AVOIDANCE: Not applicable. EXP05UR13 LIMITS ' INGREDIENTS VALUE UNIT TYPE AUTH SKIN*I POLY(ETHYLENE TEREPHTHALATE) . . . . . . . . . NONE NONE NONE NONE POLYSTYRENE NONE NONE NONE NONE ACRYLATE ADHESIVE . . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE POLYPROPYLENE FILM NONE NONE NONE NONE GUAR GUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE NONE NONE NONE DOUBLE SIDED TAPE NONE NONE NONE NONE: * SKIN NOTATION: Listed substances indicated with "Y" under SKIN refer to the potential contribution to the overall exposure by the cutaneous route including mucous membrane and eye, either by airborne or, more particularly, by direct contact with the substance. Vehicles can alter skin absorption. SOURCE OF EXPOSURE LIMIT DATA: NONE: None Established 8. HEALTH HAZARD DATA EYE CONTACT: Mechanical eye irritation: signs/symptoms can include irritation, redness, scratching of the cornea and tearing. SKIN CONTACT: No adverse health effects are expected from skin contact. INHALATION: No adverse health effects are expected from inhalation exposure. IF SWALLOWED: No adverse health effects are expected from swallowing. SECTION CHANGE DATES ' ENVIRON. DATA SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE . FIRST AID SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE PRECAUT. INFO. SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE. HEALTH HAZD. DATA SECTION CHANGED SINCE OCTOBER 23, 1991 ISSUE Abbreviations: N/D - Not Determined N/A - Not, Applicable 01-22 3M General Offices 2988•? i .. 3M Center St. Paul, Minnesota 55144-1000 i y 612/733-1110 MATERIAL SAFETY DATA SHEET MSDS: PETRIFILM - E. COLI COUNT PLATES FEBRUARY 19, 1992 PAGE: 4 of 4 Abbreviations: N/D - Not Determined N/A - Not Applicable The information on this Data Sheet represents our current data and best opinion as to the proper use in handling of this material under normal conditions. Any use of the material which is not in conformance with this Data Sheet or which involves using the material in combination with any other material or any other process is the responsibility of the user. T?dl # = ` . FEB 26 A 9 9 Warren Rutherford Town Manager 67 Main S•t,reet, Hyannis, MA 02601 February 18, 1992 SUBJECT: Eagle Siiac-Ksy Ii•rr d Crape Cod Potato Chip Company SARA Title III Section 311/31.2 Reporting Decor Mr. Rut:her•forCIy Under cover of this letter, please find •t,h e completed Tier 11 Hazardous Material Inventory form and pan updated list of Material Safety Data Sheets 'f•o r 't,h e hazardous materials used at our I••Iyanni.sy Massachusetts facility •as required by Sections 31.1. and 31.2 of SARA 'Ti.•t:1.e 111 Liquid nitrogen was the only hisz•arCIcauis material tos:,c,d during the 1991 calendar year which meets t I+e reporting requirements of SeC:'t,i.cans, 31.1. •:anCI 312. If you have any questions or require addi't.:iona.I. information , please let me Know. inc_ere l.y y Bart Petrucco. Quality Control Mrdn•ailer'• Cape Cod Pobato Chips Reviseii June 1990 FecilN:y tder�llificatbn net!Ow afar Nana Form Approved OMB pages apes 205�0072 Name C AL6 COD YOT/�TA rtFIE EAG LE Sl'toc&s �NC Tier Two Name Phone (zl4 Izws"Ilk Street /00 �kEED$ H/GL RI) Mail Address $1L� PR.EST fjL City OI1) RD• WlTE 300 jALdS :ZX 7SZZ.,$- AND EMERGENCY Hy—ANN1S County Slate 3fJei.1. Mn 23P - MR OZ(oD HAZARDOUS Fmer`en C CHEMICAL . rY: ontal�t INVENTORY SIC Cade Z O (p Dun u Nunberr O - 7 01 - .3 (0 3 Name T'RPJ B T OS$D�PJ E Specific (S0$ ) 77S-33.5'k rllb YLftuT I1lfF/YftCrf .. lnJorma,ion Phone 24 Hr.Phone (50 13(62'-53(4S by Chemical FOR: ID r t tICIAt. :_;' Name _f36K7T �E67-R }CCf} . Title �+ALI i�OL M1GR USA Date Received Phone - 90 ) ?��- 33S-3- 24 Hr.Phone (�� 1 4 7? 8 12 6. ONLY.: Important Read all instructions before completing form Reporting Period From January 110 becerrber Jt,►B� Ck d1� dentfce lathe mlormat on eilCrirttee lasf ysilr.�l d L >: Stbb' Odes.and Luca Chemi aL De$: too : and ear _ tone �nventa y L H88rd3 ; o (Nott»C0nfldentX. ial) N L a1'th b: H ► a Storage Locatarns e,as 7 a ? 3 7 ® ` Trade.❑ Fire o a>r.: �l ly Amdlthi(04dA}: oZ ONE STO K�C*F T(tN AS T Sudden Release Chem.Name 1�I(-fROCrE/� PEe-irAF E- uF (,,j T a/r4-T d Pressure My ® ❑ ❑ ❑ L ❑ Ek °filed' Amount tcxtde) ; Friel c 17Y. CMc!au x 7 X Immediate(acute) dw apply: _ Pure Mix Solid Liquid Gas EHS Delayed(chronic) "WIR=R EHS Name. X El CAS ❑ ❑ sa❑ Fire INatc.betty Sudden Release :AttlQtJl7tl(Qode) Chem. Name of Pressure Reactivity CAm!aV ❑ ❑ El ❑ ❑ ❑ Immediate(acute) Pure MIv Solid Liquid Gas EHS Li Delayed(chronic) NO Ot neyra EHS Name El Qn- lttr�dy>r) CAS ❑ ❑ �a❑ r•re fT'`1 Mez,na0y Sudden Release Chem. Name of Pressure Reactivey :AVg Daft cv.Ctau ❑ ❑ ❑ ❑ ❑ ❑ Amounliwde) Immediate(acute) rAaropp!). Pyre Mir Solid Liquid Gee EHS Dole NO OILIe Delayed(chronic) yX EHS Name do-�lte(days) ®rtl Calton' (:,;.. axd:rigna ereolnp(tli�g; .rectwns) ..,;: > on's ttac manes I ceARy under penalty of law that I have personally examined and am lami4ar with the inlor matron submMed in pages one through t ' ' � " :L:"'!" -' on my inquiry of those individuals responsible for obtaining the information,I believe Ihal the subrritted rnlormalbn is True,accuratq,end oomph e1h�based I have attached a sile plan I have attached a list of site 6�ETi ccA QV><tL)� r��r-r,�o ingr✓ K �j Z��/yz coordinate had a is of s Name and nllirial title of ownedoperaior OR ownedoperalor's authorized r 1 have attached a descrlptlon of representative Signature Dale signed dikes and other salequmd moasures - � T 2 /9/182 ' M�TERI�LS LIS ` ��Z�RDOUS � LOC�TION ^ `` DEPARTMENT �L OR PRODUCT NAME -' --------------- IC�TION COMMUN ` ------- WWT ^ ` L COMMUNICATION 6CETIC �CID' GLACIAL ' MAINTEN�NCE COMMUNICATION ACETONE M6INTENANCE COMMUNIChTION ACETYLENE OCESSING � �R - - COMM �NIChTIUN ACTIVATED Al MAINTENANCE " �CTIV�TOR(pOLy�MIDE RESIN) M�I�TENNCE COMMUNICATION COMMUNICATION ADHESIVE B1669 Cn~*MUNIChTIDN ' �LCONO� W�STEW�Tf�h ICATION ' �LUM(DRY) MAINTENHNCE ~— , IC�TIDN CO�nun M�IMTEN�NCE ' ''-- 'COMMUNICATION ALUMINUM MhINTENhNCE ' ' SSOR OIL pRODUCT NIChTION ANDER OL 4q7 SYN COMPRE ION COMMU ' SS�NT ' COMMUNIC6TION ANSUL FIRE SUPPRE S/R, ^ & WASTE WATER 6NTI-FREEZE OMMUN SAWITATIONIC�TION � . � COMMUMIC�TION 6NTISOIL HF MAINTENANCE COMMUNICATION ' ARGON M�INTEN�NCE COMMUNICATION BELT DRESSING ` WASTE WATER ICATION� W�TFR SOLUBLE� / ION BIG ' ' CO**8�IC�T LEMON _ .,._ - ' ' ^6TE WATER ~- DEODORANT -- ' Wn� 5 6-8 DUFFER SOLUTIONS�pH' 1- ' ' BUF COMMUNIChTION 9-11 WASTE WATEV-\ ' CHEM-CAL HYDRATE PROCESSING LIME pRBCESSING COMMUNICATION ' CONTROL COMM . NICATION HEMGR�TE ITY COW C � - ^ �NHYDROUS . CITRIC ACID' ' ' � . ' ' ' COAL TAR EPDXY , COMPONENTS A+B MAINTENANCE COMMUNICATION DEPEND ACTIVATOR MAINTENANCE COMMUNICATION DEPEND(R)NO-MIX ADHESIVE MAINTENANCE COMMUNICATION �~ DIMETHYLAMINE P.C. COMMUNICATION � DRIERITE DESSICANT WASTE WATER COMMUNICATION � ELECTROLYTE(ACID) BATTERY FLUID Q^C^ (W^HOUSE) COMMUNICATION � EPI-SEAL LEAK DETEX MAINTENANCE COMMUNICATION ` � ETHYL ALCOHOL, DENATURED Q^C ^/SANIT , COMMUNICATION . PACKAGING � 5W047 PREMIUM CONTACT CLEANER MAINTENANCE COMMUNICATION � . FOAM X-TRA � SANITATION COMMUNICATION ' GASKET ELIMINATOR MAINTENANCE COMMUNICATION - - GASOLINE' AUTOMOTIVE MAINTENANCE COMMUNICATION GLASS CLEANER(BULK) SANITATION COMMUNICATION GOING HOME HAND CLEANER SANITATION COMMUNICATION GREASE STRIP PACKAGING COMMUNICATION � H/\YSSEN LUBRI-CAN: AIR LINE MAINTENANCE COMMUNICATION LUBRICATION HEAVY DUTY EPDXY ACTIVATOR MAINTENANCE COMMUNICATION HEAVY DUTY EPDXY PRIMERS MAINTENANCE COMMUNICATION HEAVY DUTY EPDXY TOPCOAT MAINTENANCE COMMUNICATION INDUSTRIAL ENAMELS MAINTENANCE COMMUNICATION ' ' ISO-PROPANOL PACKAGING/QC COMMUNICATION JELL ADD ' SANITATION COMMUNICATION KLCr 5/20 (PENWALT PETROLEUM MAINTENANCE COMMUNICATION LUBRICATING OIL) LIQUID FRY CLEAN SANITATION COMMUNICATION LOCQUIC PRIMER(AEROSOL) MAINTENANCE COMMUNICATION LOCQUIC PRIMER GRADE N MAINTENANCE COMMUNICATION \ � � .. JON MAINTENANCE ~ ^ . LUB�IpL�TE ACL SERIES - T M . INTEN6NCE COMMUNIChION / FMO-�W SERIES ' N�NCE COMMUNICnT Iu`` LUBRIPLATE M�INTE COmMUN �-ChTION LUBRIpLATE HO SERIES WASTE WATER C�TION COMMUNI MARVEL MYSTERY OIL MAINTEN6 N C E w*iU�IC� | ION T PRIMER C0^— MASTER G�SKE M�INTEN�N[� ION COMMUNICATION GLOSS EPDXY ' � NTEN�HCE MCR-43 FLEX' �MOMT SUP �R M6I] COMMUNICATION METHBO ^ O.C. - COMM UNI CAT ION ' METHANOL MhINTENhNC�� COMMUNIC�T U MIXCO O GREASE MAINTENANCE COMMUNICATIONFORMUL� 30 � « MOBIL 1 � W- SANITATIONON ^ **U�IC�T I COMMON MONARCH 880 - pRBDUCTION ^ ION ' w*UNIC�T 5�LT C0^'— n�&DRITIC ' �' W�TER MORTON ~-- - W�STE COMMUNICATION �TION � IC � - OIL 10W46 �INTENHN[E MOTOR M ' ' ICATION CO � NATURAL GAS E pTFE MAINTENANCE ~_� ` ICeTI( N FOOD GRAD CUnnun SZ WHITE pRODUCTION' NEV- RYOGENIC LIQUID) M�I MG ' NITROGEN(� PACKM�� ICATION COMMUN M�INTEN�NCE ' ' nMMUNIC�TION 160 THINNER(P 'INT) M�INTEN�NCE �C~'` C�TID ^ ' COMMUNI `` OXYGEN MAINTENANCE � ' OX LY COMMUNICATION - OX Y GEN SENSOR ASSEMu MAINTENANCE N ' COMMUNICATIO PAINT THINNER MAIMTEWANCE ` �TIOW COMMUNIC ' SE�� . `"` ~~_ prRMHTEX THREAD 7- Q^C^ IC�TION~' 1% OMMUN n\ ' C ^~' pTHALEIN SOLUTION' ^ MAINTENANCE - PHENOL. CEMENT M� �TION pL�STIC WET SURF�CE ROOF MAINTENANCE COMM UNIC TION ENT �EPO X�-C~O—M PpOOMN— CC O MM^UNICCA pOLYAMIDE MAINTENANCE ENTB v*UJ'JI pOLyA MIDE RESIN M�INTENNCE AEPDXY COMMUNICATION pOLy-CARBM ^ 198 PART ` ' MAINT. ENMNCE 198ART B POyAM^NE pOLY-CARBMK^ ' COMMU NICATION, E SOLUTION POLYAMID Q,C^ | ROM�TE � POTASSIUM CH INDICATOR' 5% ' . POTASSIUM CHLORIDE SOLTN^ WASTE WATER COMMUNICATION PRO-LOCK PIPE SEALANT MAINTENANCE COMMUNICATION PST (R) N TEMP ANTI-GALLING PIPE SEALANT MAINTENANCE COMMUNICATION � PVC PRIMER ` ~ MAINTENANCE COMMUNICATION PVC CEMENT CLEAR MEDIUM MAINTENANCE ^ COMMUNICATION QUICK METAL(TM)PRESS FIT REPAIR MAINTENANCE COMMUNICATION QUICK SET INDUSTRIAL ADHESIVE MAINTENANCE COMMUNICATION REMOVABLE THREADLOCKER MAINTENANCE COMMUNICATION RIGID NUCLEAR THREAD CUTTING OIL MAINTENANCE COMMUNICATION RETAINING COMPOUND 609 MAINTENANCE COMMUNICATION nuBBEnFLLX PATCHING CEMENT MAINTENANCE COMMUNICATION RUST-O-THANE ACTIVATOR MAINTENANCE COMMUNICATION RUST-O-THANE TOPCOATS MAINTENANCE COMMUNICATION SANI-T-1O SANITATION COMMUNICATION SCOTCH-GRIP `ADHESIVE MAINTENANCE'' COMMUNICATION 723 SPRASOLVO MAINTENANCE COMMUNICATION �-� SILVER NITRATE SOLTN' n/16 Q C^ ^ COMMUNICATION ' � SHAW ELECTRODE, TYPE CODE-ARC 308 MAINTENANCE COMMUNICATION MR AC-DC . � SHAW ELECTRODE, TYPE EASY-ARC 308 MAINTENANCE COMMUNICATION � AC-DC � � | SOAKAHOLIC ' | MAINTENANCE COMMUNICATION SODIUM HYDROXIDE SOLTN, n/10 O.C. COMMUNICATION ' SOLDER SEAL LIQUID WRENCH MAINTENANCE COMMUNICATION SOLO 100 CANOLA OIL � QUALITY CONTROL COMMUNICATION � SPARCREME ' JANITORIAL COMMUNICATION | SPARKLEEN WAREWASHING DETERGENT Q ^C ^ COMMUNICATIOm / STEEL MAINTENANCE COMMUNICATION \ STRUKTOL 2080 DEFOAMER WASTEWATER COMMUNICATION ( - ( | | 'UNIC�TION COMM ' SANITATION ""^~^. ._- SU-'ER &ABON MAINTENANCE COMMUNICATION SUPER LUBE AEROSOL CAN MAINTENANCE COMMUNICATION FT SET CEMENT MI '�'WI X-- MAINTENANCE COMMUNICATION ^ / TAPFREE MAINTENANCE COMMUNICATION THORIATED TUNGSTEN ELECTRODE n MAINTENANCE COMMUNICATION THREE-IN-ONE HOUSEHOLD OIL _ COMMUNIC�TION ' MAINTENANCE ` 3M OIL SORBENT - COMMUNIC��ION M�INTEN�NCE 290 ADHESIVE/SEALANT � COMMUNICATION ' ULTRA BLACK(TM)RTV SILICONE MAINTENANCE . WEL- MAINTENANCE �N} 15 FC (ZINC OXIDE) COMMUNICATION COMM UNICATION MAINTENANCE ` XYLENE MAINTENANCE COMMUNICATION ' ZEP DYNA SQL ' ~ SANITATION ^ COMMUNICATION ZEP LEMONEX - ' ` ^ ' ^ ' . ^ ' ^ ^ ^ . - ' / . ' ' ` ' . . ` � . ' r I Warren Rutherford Town Manager367 Main Street TOWN OF 8,oNsTABLE TOWN 1� OFFICE 1"I y�a I"�I"�:I.tii p i�'t f'� 02601. � Dear Warren Rut'.l' er'f`orc:lp February :I.ON .IP ''•20 A 9 :57 In carder to comply w:i't.Ii MGL Chapter :C:IIFp T have enclosed !% an updated M S:S D S:S list along wit! Additional M S:S D S:S` that a r e being submitted for 't l i e first time. r l�e y are: Alum(Dry) R:i.rl:i.d ittoc::1.e•ar Thread Electrolyte (Acid )battery Fluid; Cutting O:i.I• Glass Cleaner(Bulk ) 1:,tobl:aerfi:I.E•x Patching Mixco 0 Grease Cement Mobil I Formula w-30 Super Kalao►••, Natural G a s MS:SDS:S deletions i.nc:ltode Aries 29' Polymer 1;;1:i.tommon:i.um Phosphate B W Dish Soup 111: Digestion Solution (COD) t:a r g:i:t:f.r Immersion O i:l. l"I y u ra r ci Transo & )•'I y cl r a to l a Chelaclean ES Oil Cool Total 11 I._emone c Super t:i:i.c is Our current con't+act and emergency information is as follows: Company : Cape C:cacl Pcafi,rato Chips Breeds Hill Rd . Hyannis, MA 02601. Business Phone! 5 0.. i / J' ,. ,_,.!8 Emergency Phone! ( 08)4?•i'••••8:I. 6 Bart Pet' rac::c:ap Qto•:al.:i.•t:.y Control. (508)771"'•5202 Donna I"1oKeu Employee Relations SIC Code: 2096 Average 0 of EIrip:I.oy'ee:::! 1.35 •T.hanK yi:aup Bart Petracca Quality Con1,ro.l. S:+f"tperv:r.::ior � ' C7 7x� � '~ \ ^ ' i HAZARDOUS MATERIALS LIST 2/18/92 � | � � CHEMICAL OR PRODUCT NAME DEPARTMENT MSDS LOCATION --------------------------------------------------------------------- \ . \ ' ACETIC ACID, GLACIAL WWT ^ COMMUNICATION � | ACETON MAINTENANCE COMMUNICATION ` ' | ACETYLENE MAINTENANCE COMMUNICATION | ACTIVATED ALUMINA PROCESSINS COMMUNICATION ACTIVATOR(POLYAMIDE RESIN) MAINTENANCE COMMUNICATION � ' ADHESIVE 81669 MAINTENANCE COMMUNICATION | � | ALCONOX O.C . COMMUNICATION ALUM(DRY) ` WASTEWATER COMMUNICATION ALUM-A-LUB MAINTENANCE COMMUNICATION ALUMINUM MAINTENANCE COMMUNICATION ! ANDEROL 497 SYN COMPRESSOR OIL MAINTENANCE COMMUNICATION � � ANSUL FIRE SUPPRESSANT PRODUCTION ' COMMUNICATION ANTI-FREEZE MAINT^ , S/R, COMMUNICATION & WASTE WATER - ANTISOIL HF SANITATION COMMUNICATION ' ` . ARGON MAINTENANCE ` COMMUNICATION ' BELT DRESSING -' MAINTENANCE COMMUNICATION' , BIG "D" WATER SOLUBLE ' ^ ` ' WASTE WATER COMMUNICATION � DEODORANT' LEMON BUFFER SOLUTIONS!pH W 1-5,6-8 ' W�GTE ATER COMMUNICATION 9-11 ` CHEM-CAL HYDRATED LIME ` . WASTE .WATER COMMUNICATION ` ' ^ CHEMGRATE PROCESSING COMMUNICATION � CITRIC ACID, ANHYDROUS QUALITY CO'NTROL COMMUNICATION `\ i ` | ' ' ' COTTONSEED COOKING OIL PROCESSING COMMUNICATION =` COAL TAR EPDXY, COMPONENTS AfB MAINTENANCE COMMUNICATION DEPEND ACTIVATOR- MAINTENANCE COMMUNICATION DEPEND(R)NO-MIX ADHESIVE MAINTENANCE COMMUNICATION ' DIMETHYLAMINE P.C . COMMUNICATION DRIERITE DESSICANT WASTE WATER COMMUNICATION ELECTROLYTE(ACID) BATTERY FLUID Q ^C^ (W^HOUSE) COMMUNICATION EPI-SEAL LEAK DETEX MAINTENANCE COMMUNICATION ETHYL ALCOHOL, DENATURED Q^C ^/SANIT ^ COMMUNICATION PACKAGING 5WO47 PREMIUM CONTACT CLEANER MAINTENANCE COMMUNICATION � � FOAM X-TRA SANITATION COMMUNICATION � i � GASKET ELIMINATOR MAINTENANCE COMMUNICATION GASOLINE, AUTOMOTIVE MAINTENANCE COMMUNICATION � GLASS CLEANER(BULK) SANITATION COMMUNICATION GOING HOME HAND CLEANER SANITATION COMMUNICATION GREASE STRIP PACKAGING COMMUNICATION ' � HAYSSEN LUBRI-CAN: AIR LINE MAINTENANCE COMMUNICATION LUBRICATION � ' ( HEAVY DUTY EPDXY ACTIVATOR MAINTENANCE COMMUNICATION � HEAVY DUTY EPDXY PRIMERS MAINTENANCE COMMUNICATION � HEAVY' DUTY EPDXY TOPCOAT MAINTENANCE ' ' COMMUNICATION � ' INDUSTRIAL ENAMELS MAINTENANCE COMMUNICATION ISO-PROPANOL PACKAGING/QC COMMUNICATION ' � JELL ADD SANITATION COMMUNICATION / � KLCr 5/20 (PENWALT PETROLEUM MAINTENANCE COMMUNICATION ' LUBRICATING OIL) LIQUID FRY CLEAN SANITATION COMMUNICATION LOCQUIC PRIMER(AEROSOL) MAINTENANCE COMMUNICATION LOCQUIC PRIMER GRADE N MAINTENANCE COMMUNICATION | | MAINTENANCE COMMUNICATION RIES | C-"~'-P— COMMUNICATION M�INTEN�NCE LU\»RIPLATE FMO-AW SERIES COMMUNIC�TION MAINTENANCE LUBRIPLATE HO SERIES � WASTE WATER COM| UNICATION ' MARVEL MYSTERY OIL ` ' COMMUNICATION � MAINTENANCE MASTER GASKET PRIMER ` MAINTENANCE COMMUNICqTION MCR-43 GLOSS EPDXY ' ^METABO FLEXIAMONT SUPER COMMUNICATION MAINTENANCE COMMUNICATION ' Q,C^ METHANOL � � COMMUNICA TION ' MAINTENANCE MIXCO O GREASE ' ' MAINTENANCE ' COMMUNICATION . MOBIL 1 FORMULA 5W-30 ^ SANITATION COMMUNICATION MONARCH 880 DUCTION COMMUNICATION _ PRO MORTON DENBRITIC SALT ^ COMMUNICATION WASTE WATER ' MOTOR OIL 1OW40 COMMUNICATION � MAINTENANCE NATURAL GAS ' COMMUNICATION MAINTENANCE n| EV SZ WHITE FOOD GRADE PTFE - COMMUNICATION PRODUCTION' - . NITROGEN(CRYOGENIC LIQUID) MAINT , , S/R' PACKAGING ' ' NIC�TION COMMU MAINTENANCE . `,~~.. . -- 16O -THINNER(PAINT) I ' COMMUNIC�TION ' . MAINTENANCE� OXYGEN UNICAT ION ' MAINTENANCE. -- OXYGEN SENSOR ASSEMBLY ' COMM ' COMMUNICATION ' ^ MAINTENANCE n PAINT THINNER MAINTENANCE COMMUNICATION PERMATEX THREAD SEALANT COMMUNICATION pHENOLpT Q H�LEIN SOLQTION' 1% ^� .^C^ ' � O 'MU� IC�TION PLASTIC WET SURFACE ROOF CEMENT M `�. ' AINTENANCE � � .` . COMMUNICATION MAINTENANCE POLYAMIDE EPDXY-COMPONEN" MAINTENANCE COMMUNICATION ' POLYAMIDE EPDXY-COMPONENT B ~ � ` COMMUNICATION POLY C�RD MK . 198 PART � EPDXY RESIN MAINTENANCE n ` - ` COMMUNIC�TION PART B POLYAMINE MAINTENANCE . N . POLY-CARB MK ^ 198 POLYAMIDE SOLUTION . _ ' COMMUNICATION G .C. POTASSIUM CHROMATE INDICATOR, 5% | ' ' ` , � POTASSIUM CHLORIDE SOLTN^ WASTE WATER COMMUNICATION ` � PRO-LOCK PIPE SEALANT MAINTENANCE COMMUNICATION � � PST(R) N TEMP ANTI-GALLING PIPE � SEALANT MAINTENANCE COMMUNICATION � � PVC PRIMER MAINTENANCE COMMUNICATION � PVC CEMENT CLEAR MEDIUM MAINTENANCE COMMUNICATION QUICK METAL(TM)PRESS FIT REPAIR MAINTENANCE COMMUNICATION � � QUICK SET INDUSTRIAL ADHESIVE MAINTENANCE COMMUNICATION � REMOVABLE THREADLOCKER MAINTENANCE COMMUNICATION RIGID NUCLEAR THREAD CUTTING OIL MAINTENANCE COMMUNICATION RETAINING COMPOUND 609 MAINTENANCE COMMUNICATION RUBBERFLEX PATCHING CEMENT MAINTENANCE COMMUNICATION RUST-O-THANE ACTIVATOR MAINTENANCE COMMUNICATION � � RUST-0-THANE TOPCOATS ' MAINTENANCE COMMUNICATION SANI-T-10 SANITATION COMMUNICATION SCOTCH-GRIP ADHESIVE MAINTENANCE COMMUNICATION 723 SPRASOLVO MAINTENANCE COMMUNICATION SILVER NITRATE SOLTN, n/10 U.C. COMM NICATION SHAW ELECTRODE, TYPE CODE-ARC 308 MAINTENANCE COMMUNICATION MR AC-DC SHAWELECTRODE, TYPE EASY-ARC 308 MAINTENANCE COMMUNICATION AC-DC � , SOAKAHOLIC MAINTENANCE COMMUNICATION � SODIUM HYDROXIDE SOLTN, n/10 O .C. COMMUNICATION ' ^ SOLDER SEAL LIQUID WRENCH MAINTENANCE COMMUNICATION SOLO 100 CANOLAOIL QUALITY CONTROL COMMUNICATION � SPARCREME JANITORIAL COMMUNICATION SPARKLEEN WAREWASHING DETERGENT ' Q ^C ^ COMMUNICATION STEEL MAINTENANCE COMMUNICATION STRUKTOL 2080 DEFOAMER WASTEWATER COMMUNICATION SUPER SANITATION ' ~~..'~.,^^" ` ^"" ~SOER UBE AEROSOL CAN MAINTENANCE COMMUNICATION / SWIFT SET CEMENT MIX ~M"JNTENANCE COMMUNICATION TAPFREE . MAINTENANCE COMMUNICATION, ' � � � THORIATED TUNGSTEN ELECTRODE MAINTENANCE ' COMMUNICATION THREE-IN-ONE HOUSEHOLD OIL ' MAINTENANCE . COMMUNICATION � 3M OIL SORBENT ' '` � ^ M�I |TEN�N' E . COM . UNI CAT ION � � 290 ADHESIVE/SEALANT MAINTENANCE COMMUNICATION � - ` ` ULTRA. BLACK(TM)RTV SILICONE ` _ ` MAINTENANCE COMMUNICATION � WELCO AND 1� FC (ZINC OXIDE) MAINTENANCE ` C |MMUNICATION ' XYLENE MAINTENANCE COMMUNICATION , ZEP DYNA SOL MAINT�ENAiCF � COMMUNICATION � ' ZEP LEMONEX SANITATION ' COMMUNICATION . ' ' ` ^ ^ . ' ` . � . . , . - ' . . . - ' - ` ` SK-0381 Page 1 of 3 05/30/90 'MATERIAL SAFETY DATA SHEET H.B. Fuller Company - Monarch Division 3900 Jackson Street NE Minneapolis, Minnesota 55421 Prepared by: Anita L. Boldt/DSM 612/781-8071 Emergency Telephone Number: 800/228-5635 PRODUCT IDENTIFICATION H.B. Fuller Company Name.: SK-0381 Trade Name: Super Kabon DOT Proper Shipping Name: Cleaning Compounds, Liquid, NOI HAZARDOUS INGREDIENTS Material Name/ CAS # % Level OSHA PEL ACGIH TLV In Product (1989-1990) Ethyl Alcohol (64-17-5) 1-10 1000 ppm 1000 -ppm PHYSICAL DATA Physical State: Liquid Boiling Range: >200 F pH: 6.6 Percent Volatile by weight: 100 Weight per Gallon: 8.2 lbs. FIRE PROTECTION Flash point/Method: NA Appropriate Extinguishers: NA (Liquid material is non-flammable) Special Fire Fighting _ Procedures: Persons exposed to products of combustion should wear self-contained breathing apparatus and full protective equipment. - t NA = not applicable NE = not established R SK-0381 Page 2 of 3 05/30/90 Unusual Fire and Explosion Hazards: There is the possibility of pressure buildup in closed containers when heated. Water spray may be used to cool the containers. REACTIVITY DATA Stability: Stable Incompatibility: NE Hazardous Decomposition Products: Incomplete combustion can yield low molecular weight hydrocarbons, carbon monoxide, and nitrogen compounds. Hazardous Polymerization: Will not occur. EFFECTS OF OVEREXPOSURE Acute: Eye contact will cause severe irritation. Skin contact with the liquid will cause severe irritation. Chronic: No anticipated chronic effects. This product does not contain regulated levels of NTP, IARC or OSHA listed carcinogens. EMERGENCY AND FIRST AID PROCEDURES For ingestion: Do not induce vomiting. Give large amounts of water or milk. Get immediate medical attention. Never give, anything by mouth to an unconscious person. For Eye Contact:' Flush immediately with water for 15 minutes. If irritation persists, get medical Y ' attention. For Skin Contact: Wash affected area with soap and water. Inhalation: Remove to fresh air. Get medical attention if irritation persists. NA = not applicable NE = not established- L SK-0381 Page 3 of 3 05/30/90 OCCUPATIONAL CONTROL PROCEDURES Eye Protection: Safety glasses. Skin Protection: Rubber gloves. Respiratory Protection: Not normally required. Ventilation: Standard industrial ventilation. SPILL, LEAK AND DISPOSAL PROCEDURES i Spill or Leak Procedures: Wear rubber gloves. Contain and remove with inert absorbent. Keep spill out of sewers s and water sheds. 6 Waste Disposal: This product does not meet the definition of hazardous waste under 40 CFR 261. Dispose of in accordance with local, state and federal regulations. For additional disposal information contact H.B. Fuller Environmental Services at 612/481-1588. - F REGULATORY INFORMATIONI f TSCA all components of this product_ are registered under the regulations of the Toxic Substances Control Act. SARA TITLE III i i Section 313: This product does not contain any toxic chemical subject to the reporting requirements of section 313 of Title III of the Superfund Amendments and Reauthorization Act of 1986 ,(SARA) and 40 CFR part 372. ADDITIONAL INFORMATION No additional information. y S NA = not applicable NE = not established r Material Safety REPUBLIC POWDERED METALS, INC. Data Sheet P.O. BOX 724 - 2628 PEARL ROAD #1100 W-DINA, OHIO 44258 TELEPHONE: (216) 225=3192 ******�r****�•****�r***�r�r�r**�r*�r**�r****�*�**��**�r**�-�•****+��*�**�r*�**********�t�t-pit***��t�t�r�t*�t**�t***�t�t****�t�t*�t�t***�t�t** REPUBLIC PRODUCT NAME: .RUBBERFLEX PATCHING CEMENT REPUBLIC PRODUCT NUMBER: 1100 LATEST REVISION DATE: 3/15/89 ATTENTION: PLIANT MANAGER/SAFETY DIRECTOR----- ------------------------------------------------------------------------------------------- -- ----------- SECTION I - PRODUCT IDENTIFICATION -------------------------------------------------------------------------------------------------------------- GENERAL' OR GENERIC ID: ACRYLIC PATCHING CEMENT DOF HAZARD CLASSIFICATION: NOT REGULATED -------------------------------------------------------------------------------------------------------------- SECTION Il - HAZARDOUS COMPONENTS -------------------------------------------------------------------------------------------------------------- SEE SECTION IX. - --------------------------------------------------------------------------------------------------------- SECTION III —PHYSICAL DATA ------------------------------------------------------------�--------------------------------------------- PROPERTY VALUE INITIAL BOILING POINT OF VOLATILE PORTION 212°F VAPOR PRESSURE OF VOLATILE PORTION 17 mm AT 68°F VAPOR DENSITY (AIR-1) OF VOLATILE PORTION HEAVER -- SPECIFIC GRAVITY OF PRODUCF 1.392 r PERCENT VOLATILES BY VOLUME OF PRODUCT 47 EVAPORATION RATE (BU AC = 1) OF PRODUCT SLOWER GAWON WEIGHT (LBS/GAL) OF PRODUCT 11.6 ---------------------------------------------------------------------------------------------------------- SECTION IV - FIRE AND EXPLOSIVE DATA ----------------- ----------- --------------------------------------------- ------ FLASH POINT °F (TAG CLOSED CUP): NONE FOR WATER BASED PRODUCT DOT FLAMMABILITY CLASSIFICATION FOR -PRODUCT: NONE LOWER EXPLOSIVE LIMIT (LbL):.-NOT APPLICABLE EXTINGUISHING MEDIA:. NOT:APPLICABLE - HAZARDOUS DECOMPOSITION PRODUCTS: FIRE'CONDITIONS MAY YIELb OXIDES OF CARBON - - SPECIAL FIREFIGHTING PROCEDURES: NOT APPLICABLE] UNUSUAL FIRE] &-EXPLOSIVE HAZARDS: MAY SPATTER WHEN- TEMPERATURE EXCEEDS BOILING POINT' -------------------------------------------=---------------------------------------------------------------- SECTION V - HEALTH HAZARD DATA ---------------------------------------------------------------------------------------------- - EFFECTS OF OVEREXPOSURE' - AVENUE-OF.ENTRY:.. .,. EYES - DIRECT LIQUID CONTACT WITH.EYES MAY CAUSE,MILb IRRITATION SKIN - POSSIBLE MILb IRRITATION FOR SENSITIVE INDIVIDUALS BREATHING - VAPORS COULD CAUSE' IRRITATION OF EYES AND NOSE IN SOW 'INDIVIDUALS SWALLOWING - INGESTION OF LARGE AMOUNTS COULb GIVE TOXIC EFFECTS FIRST AID: . IF IN EYES: FLUSH EYES WITH COPIOUS AMOUNTS OF WATER IF ON SKIN: WASH SKIN WITH SOAP AND WATER IF BREATHED: MOVE SUBJOCT TO FRESH ROOM TEMPERATURE AIR IF SWALt'OWED: INDUCE VOMITING, GIVE WATER, AND CONSULT A PHYSICIAN -------------------------------------------------------------------------------------------------------------- SECTION VI - REACTIVITY DATA --------------------------------------------------------------------------------------------------- HAZARDOUS POLYMERIZATION: WILL NOT OCCUR STABILITY: STABLE INCOMPATIBILITY: NONE KNOWN ---------------------------------------------------------------------------------7-------------------- SECTION VI I - SPILL OR LEAK PROCEDURES ------------------------------------------- ---------------------------------------------------- STEPS TO BE] TAKEN IN CASE MATERIAL IS RELEASED OR SPI ED• DIKE AND ABSORB SPILL WITH INERT MATERIAL (SAND, ETC.) AND-DISPOSE' SUITABLY WASTE DISPOSAL METHOD: DISPOSE OF IN ACCORDANCE WITH FEDERAL, STATE, AND LOCAL ROGULATIONS - REFER, TO HAZARD CAUTION INFORMATION EMWHORE ON THIS SHEET. -------------------------------------------------------------------------------------------------- SECTION VIII - SAFE HANDLING AND USE INFORMATION -------------------------------------------------------------------------------------------------------------- RESPIRATORY PROTECTION: NONE REQUIRED UNDER NORMAL CONDITIONS IF ADEQUATE VENTILIATION IS USED VENTILATION: GENERAL VENTILATION PROTECTIVE GLOVES: GLOVES IMPERVIOUS TO WATER BASED MATERIALls EYE PROTECTION: SPLASH-PROOF GOGGLES OTHER PROTECTIVE.EQUIPMONT: .APRON, WORK CLOTHES, ETC. HYGIENIC PRACTICES: AFTER USING PRODUCT, WASH HANDS WITH SOAP AND WATER --------------------------------------------------------------------------------------------------------------- ® SECTION IX - SPECIAL PRECAUTIONS OR OTHER COMMENTS -------------------------------------------------------------------------------------------------------------- FOR YOUR KNOWLEDGE, THIS PRODUCT CONTAINS TRACE AMOUNTS OF AQUEOUS AMMONIA, AND SLIGHT TRACES. OF RESIDUAL ACRYLIC MONOMERS AND FORMALDEHYDE CARRIED IN WITH THE ACRYLIC LATEX POLYMER AND SURFACTANT USED. THESE TRACE LEVELS ARE BELOW REPORTING REQUIREMENTS IN THE HAZARDOUS COMPONENTS SECTION 1I. - ALTHOUGH TWSO ARE TOXIC CHEMICALS, AT THIS TRACE LEVEL THO Y SHOULb PRODUCE NO HARMFUL EFFECTS IF THIS PRODUCT IS HANDLED WITH NORMAL CARE AND CAUTION. THIS PRODUCT SHOULb EE KEPT OUT OF THE REACH OF CHILbREN. THIS PRODUCT SHOULb BEE KEPT FROM FWEIZING.DURING SHIPPING AND HANDLING.: ALTHOUGH FREEZING PRESENTS NO HAZARD, IT MAY RUIN THE PRODUCT. DEFINITIONS TLV - THROSHOLb LIMITING VALUE FOR AIRBORN CONCENTRATION OF THE SUBSTANCE; WHICH REPRESENTS CONDITIONS UNDER WHICH IT IS .BOUIEVOD NEARLY ALLI WORKERS MAY BE REPEATEDLY EXPOSED WITHOUT ADVERSE EFFECT. UNLESS OTHERWISE SHOWN, TLV VALLES ARE (TLV-TWA) - THE. TIME WEIGHTED AVERAGE CONCENTRATION FOR A NORMAL 8-HOUR WORK DAY OR 40 HOUR WORK WEEK, TO WHICH NEARLY ALL WORKERS MAY-BE] EXPOSED, DAY AFTER DAY, WITHOUT- ADVERSE EFFECT. TLV IS A REGISTERED TRADEMARK OF:THO AME)RICAN CONFERENCE OF GOVERNMENTAL INDUSTRIAL ' HYGIENISTS (ACGIH). DOT - DEPARTMENT OF TRANSPORTATION (U.S. GOVERNMENT) HAZARDOUS COMPONENT ANY CHEMICAL WHICH IS A PHYSICAL HAZARD OR A HEALTH HAZARD (OSHA DEFINITION-29CFR 1910.1200) - - PEEL - PERMISSIBLE EXPOSURE LIMIT OF OSHA. - - G1100 I s; .'Form Approved U.S. DEPARTMENT OF LABOR 1 Budget Bureau No. 44-R1387 WORKPLACE STANDARDS ADMINISTRATION Bureau of Labor Standards 1 0 20166002 MATERIAL SAFETY DATA SHEET FORMULA / TRADE SECRET SECTION MANUFACTURER'S NAME EMERGENCY TELEPHONE NO. RIDGE TOOL COMPANY 216/323-5581 ADDRESS(Number, Street, City,State and ZIP Code) 400 CLARK STREET, ELYRIA OHIO 44035 IDENTITY DATE PREPARED RIDGID NuCLEAR THREAD CUTTING OIL 9/29/87 CHEMICAL FAMILY PETROLEUM HYDROCARBON SECTION 11 HAZARDOUS INGREDIENTS HAZARDOUS COMPONENTS: OSHA PEL ACGIH TLV. PARAFFINIC MINERAL OIL CAS: 64742-50-3 5m /M3 5m /M3 SECTION III PHYSICAL DATA BOILING POINT(-F.) SPECIFIC GRAVITY(Hz0=1) 480°F. 0.87 VAPOR PRESSURE(mm Hg.) PERCENT VOLATILE 0.01 QR 20°C. BY VOLUME(%) 0 VAPOR DENSITY(AIR=1) EVAPORATION RATE 1 (BUTYL =1) 1 SOLUBILITY IN WATER'. ' NIL. ACETATE MELTING POINT. —18°C. MAX. APPEARANCE AND ODOR AMBER LIQUID WITH MILD PETROLEUM ODOR. SECTION IV FIRE AND EXPLOSION HAZARD DATA FLASH POINT(Method used) FLAMMABLE LIMITS Lel Uel 340°F. (PMCC) 385°F. ASTM D-92 NOT DETERMINED EXTINGUISHING MEDIA WATER FOG DRY CHEMICAL CO2, OR FOAM SPECIAL FIRE FIGHTING PROCEDURES WEAR SELF CONTAINED BREATHING APPARATUS. KEEP FIRE EXPOSED CONTAINERS COOL WITH WATER. UNUSUAL FIRE AND EXPLOSION HAZARDS L . SECTION V REACTIVITY DATA STABILITY UNSTABLE CONDITIONS TO AVOID STABLE X SPARKS AND OPEN FLAMES INCOMPATABILITY(!Malerials to avoid) . STRONG ACIDS AND OXIDANTS_ HAZARDOUS DECOMPOSITION PRODUCTS UPON COMBUSTION: CO, COZ, OXIDES OF SULFUR HAZARDOUS MAY OCCUR CONDITIONS TO AVOID POLYMERIZATION WILL NOT OCCUR X NONE SECTION VI HEALTH HAZARD DATA ROUTE(S)OF ENTRY: INHALATIDN? SKIN? INGESTION? X X X HEALTH HAZARDS (ACUTE & CHRONIC): CAUSES IRRITATION: MAY BE SKIN DEFATTER UPON PROLONGED OR REPEATED CONTACT. CARCINOGENICITY: NTP? IARC MONOGRAPHS? OSHA REGULATED? NOT LISTED NOT LISTED NOT LISTED SIGNS & SYMPTOMS OF EXPOSURE: OIL MIST INHALATION MAY CAUSE DIZZINESS, NAUSEA AND DIFFICULTY BREATHING. MEDICAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE: SENSITIVE DRY SKIN EMERGENCY AND FIRST AID PROCEDURES: IN CASE OF CONTACT, IMMEDIATELY FLUSH EYES WITH iPLENTY OF WATER FOR AT LEAST 15 MIN., CALL A PHYSICIAN. WASH SKIN WITH SOAP AND WATER. IF SWALLOWED, DO NOT INDUCE VOMITING.GET MEDICAL ATTENTION. REM`.OVE FLUID SOAKED CLOTHING AND SHOES.LAUNDER BEFORE REUSE. IF INHALED, REMOVE TO FRESH AIR AND GIVE ARTIFICIAL RESPIRATION IF NECESSARY. GET MEDICAL ATTENTION. , SECTION VII PRECAUTIONS FOR SAFE HANDLING USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: IN CASE OF SPILL,DO NOT USE WATER:SOAK UP WITH SAND,EARTH OR OTHER INERT MATERIAL.PUT IN A SUITABLE CONTAINER. DISPOSE OF IN ACCORDANCE WITH LOCAL, STATE AND FEDERAL REGULATIONS. WASTE DISPOSAL METHOD: BURY IN AN APPROVED LANDFILL OR INCINERATE IN ACCORDANCE WITH LOCAL,STATE AND FEDERAL REGULATIONS. AVOID CONTAMINATION OF SEWERS AND WATERWAYS. PRECAUTIONS TO BE TAKEN IN HANDLING AND STORING: y AVOID CONTACT WITH EYES,SKIN AND CLOTHING.REMOVE CONTAMINATED CLOTHING,LAUNDER BEFORE REUSE. WASH THOROUGHLY AFTER HANDLING. AVOID BREATHING MIST OR VAPORS. OTHER PRECAUTIONS: SINCE EMPTIED CONTAINERS RETAIN PRODUCT RESIDUE, FOLLOW LABEL WARNINGS EVEN AFTER CONTAINER IS EMPTIED. SECTION VIII.CONTROL MEASURES RESPIRATORY PROTECTION(Specify type) NIOSH.APPROVED RESPIRATOR IF EXPOSED TO HOT VAPOR OR MIST VENTILATION LOCAL EXHAUST SPECIAL RECOMMENDED N/A MECHANICAL(General) OTHER N/A PROTECTIVE GLOVES EYE PROTECTION NEOPRENE OIL IMPERVIOUS SAFETY GLASSES OR GOGGLES OTHER PROTECTIVE IEOUIPMENT USE AS REQUIRED TO AVOID SKIN CONTACT. HYGENIC PRACTICES: WASH AFTER HANDLING WE BELIEVE THE STATEMENTS, TECHNICAL INFORMATION AND RECOMMENDATIONS CONTAINED HEREIN ARE RELIABLE, BUT THEY ARE GIVEN WITHOUT WARRANTY OR GUARANTEE OF ANY KIND, EXPRESSED OR IMPLIED, AND WE ASSUME NO RESPONSIBILITY FOR ANY LOSS, DAMAGE,OR EXPENSE, DIRECT OR CONSEQUENTIAL,ARIS- ING OUT OF THEIR USE. 01 T-25-1991 11:27 FFOrl HLGOHQU 1 N GAS TRANS. CO. TO 91 G08-9425r.4 P.02 MATERIAL S""AFETY DATA S"' HEET, SECTION 0 474.g Texae L"astern Gas 'YlinCorn ay > �seTat9tvoc w0. ar's Ha=t Aijonquin Gas Transtef a�r�1Ac �40n (617)254-4050 Ra F e �� , ost P.A 02135 LAV.MAI" Ste' TdOA09 KAM Am �V At cA� MJa 1h P ds ( ima c onftnt) 1 rs Goaatie �Y rocarP�orls C�4 HAZARDOUS INGREOWNTS rCarb IM-SO>l. MCMC M (Latest analysis: 6f2J64 ) C,'S Red. Numbers: 7�v ne 74-84-0ana �-98-6t()(.) on Dioxide 1 4-38-9 Hitrogen 7727-37-9 Other Hydrocarbons 0. *Simple F+sph xiants f SECTION HI • PHYSICAL DATA at I atm. -258.72ftewle*AAVtTy"*oil AUTO IGNITION 00im? ('f) 1004 KWeaodT.vCLATtUg sv VCNJJMC V41I 1£vamAftK7bON RATS 4 a!9 �t.ar�a esaw� gllfter 0.0232 i SECTION tY - FIRE ANo WL0610N HAZARD DATA 3069Y open cap &.1hoirs � tama CXT8 9WI30"M W60A C5 Z or dry chemical.Water may be used to cool adjacent property trsa�,�rit�ps3oat � �� Qp c"6+ o gas. q res roar an area sa a rom vemuBwa.L tD�o4B Am*4XPJ."0 n b442A Dangerous when exposed to' heat or flame on 017-T-25-1991 11:28 FROM ALGONQUI1•1 GAS TRANS. CO. TO 915083942564 P.03 SECTION V HEALTH HAZARD DATA @wasb6®b�+tt v Natural gas i® a simple asphyxiant a Aaphyxia gugaackcy Ong FORSTa<a* Remove to fresh air. Quickly restore and/or support breathing as required: have trained Parson administer oxv eft if available. Houth to mouth resuscitation should be used fmmadiataly for a victim of as h :xi:,&:t�ion. e Mealcal l . SECTION V1 - AEACTIViTY CATA sT� T� sTas� v°a la �ame or other ignition source f>`a�CtPAYds�lbl8t� a t3 Sr3�5 EX C G �, iqu O2 OFZ � Paffi$seA C�sBa@ice oe��t1CT'B ovd08+ta09 bV f�CC4dsi CONCITIOM6 To AV I�1 WILL NOT acil 1w a X SECT VI$ • SPILL CA LEAK PROCEDURES Srt T9 TAKER M CAS MATERIAL Is 29LIASCO®e �+4."o �c3tx y emergency response ers*nnel i,mme4iate7 . L`nacuate! area. Shut off s ill or leak source if Possible. Remove sources of heat or ignition if feasible. Leak detection should be performed using N10SB, UL or PM approved combustible gas indicator operate by experienced personnel or use soap water solution. Never use flame to detect flammable gas leaks. s�aas�lR®ash�Tbso+� SECTION Vial . SPECIAL PROTECTION INFORMATION sag =n5QhffZr if Abs u'refl• SECTION IX • SPECIAL PRECAUTIONS �xe�o��oa�.�pd�le� requ�a��ons°� Labeling requirement: DOT Code Ut�1971 Flaable Gas. Cylinders of natural gas should be stertd in Well-ventilated mm areas away from heat i ignition sources and oxidizing agents. Prohibit open flaws, inspect for leakage. Da not use natural gas around sparking motors or other nonexp os on- Proof equipment. Remove ignition sources. 3 inf tioA castai C in this Uterial Safety Ida. is ftrived from al saaclfitaticeg and is lis 7 f Tt� Co�cssitiavf Of th* FM Cass �y due to swvites of $U 9sate*al are �Sooliep is wvviairq this iafcreation rdmitoniy and dog. sat ass>M Any le s It srr, �11Clt is a acrresident CO M atim iWforgitiam ab warrant + it931 ra;poltaibilit for tt* Derr Of ary r "Ortss or Mlti of �Iantibillty or Pitress for a 0vn*a or othertriss is , this Data t Wd M altaraties+ of eort.ractmal Ali lm of &JM1ie+r far is rots t by ibis fit. �rsa+s uss deli on to his t an order to c�WY mutt aogl="' leers, P"ulattons or 31�1�`&ft or ether MOuit'BOieflys; or n� do so dt 4h8ir ow risk. PA01 da TOTAL F.a3 Mobil 481119-00 Page 1 of 6 MOBIL OIL CORPORATION MATERIAL SAFETY DATA BULLETIN REVISED: 10/04/91 I. PRODUCT IDENTIFICATION MOBIL 1 FORMULA 5W-30 SUPPLIER: 24-HOUR EMERGENCY (CALL COLLECT) : MOBIL OIL CORP. (609) 737-4411 CHEMICAL NAMES AND SYNONYMS: CHEMTREC: SYN. HYDROCARBONS AND ADDITIVES (800)' 424-9300 USE OR DESCRIPTION: PRODUCT AND MSDS INFORMATION: ENGINE OIL (800) 662-4525 II. TYPICAL CHEMICAL AND PHYSICAL PROPERTIES APPEARANCE: Lt. Brown Liquid ODOR: Mild - PH: NE VISCOSITY AT 100 F, SUS: 292.0 AT 40 C, CS: 57.0 VISCOSITY AT 210 F, SUS: 57.0 AT 100 C, CS: 10.0 FLASH POINT F(C) : > 420(216) (ASTM D-92) MELTING POINT F(C) - NA POUR POINT F(C) : -60(-51) BOILING POINT F(C) : > 600(316) RELATIVE DENSITY, 15/4 C: 0.87 SOLUBILITY IN WATER: Negligible VAPOR PRESSURE-mm Hg 20C: < . 1 NA=Not Applicable NE=Not Established D=Decomposes FOR FURTHER INFORMATION, .CONTACT YOUR LOCAL MARKETING OFFICE. III. POTENTIALLY HAZARDOUS INGREDIENTS None SEE SECTIONS XII AND XIII FOR REGULATORY AND FURTHER COMPOSITIONAL DATA. SOURCES: A=ACGIH-TLV, A*=Suggest.ed-TLV, M=Mo:b.il, O=OSHA, S=Supplier NOTE: Limits shown for guidance only. Follow applicable regulations. I V. HEALTH HAZARD DATA A --- INCLUDES AGGRAVATED MEDICAL CONDITIONS, IF ESTABLISHED --- THRESHOLD LIMIT VALUE: 5.00 mg/m3 Suggested for Oil- Mist EFFECTS OF OVEREXPOSURE Slight eye irritation. Slight skin 1 irritation. , - � V.-EMERGENCY AND FIRST AID PROCEDURES --- FOR PRIMARY ROUTES OF ENTRY --- EYE CONTACT: Flush thoroughly with water. If irritation persists, call a physician. SKIN CONTACT: Wash contact areas with soap and water. INHALATION: Remove from further exposure. If respiratory irritation, dizziness, nausea, or unconsciousness occurs, , seek immediate medical assistance and call a physician. If breathing has stopped, use mouth to mouth resuscitation. INGESTION: Not expected to be a problem. However, if greater than 1/2 liter(pint) ingested, immediately give 1 to 2 glasses of water and call a physician, hospital emergency room or poison control center ; for assistance. Do not induce vomiting or give anything by mouth to an unconscious person. 4 Mobil MOBIL 1 FORMULA 5W-30 481119-00 Page 2 of 6 VI. FIRE AND EXPLOSION HAZARD DATA FLASH POINT F(C) : > 420(216) (ASTM D-92) FLAMMABLE LIMITS. LEL: .6% UEL: 7.0% EXTINGUISHING MEDIA: Carbon dioxide, foam, dry chemical and water fog. SPECIAL FIRE FIGHTING PROCEDURES: Water or foam may cause frothing. Use water to keep fire exposed containers cool . Water spray may be used to flush spills away from exposure. For fires in enclosed areas, firefighters must use self-contained breathing apparatus. Prevent runoff from fire control or dilution from entering streams, sewers, or drinking water supply. UNUSUAL FIRE AND EXPLOSION HAZARDS: None. NFPA HAZARD ID: Health: 0, Flammability: 1, Reactivity: 0 :::::::::: ::::•.„..•.,...•.•.•.•.•.•. V I I. REACTIVITY DATA STABILITY (Thermal , Light, etc, ) : Stable CONDITIONS TO AVOID: Extreme heat. INCOMPATIBILITY (Materials to Avoid) : Strong oxidizers HAZARDOUS DECOMPOSITION PRODUCTS: Carbon monoxide. HAZARDOUS POLYMERIZATION: Will not occur. VIII. SPILL OR LEAK PROCEDURE ENVIRONMENTAL IMPACT: Report spills as required to appropriate authorities. U. S. Coast Guard regulations require immediate reporting of spills that could reach any waterway 'including. intermittent dry creeks. Report spill to Coas.t Guard toll free number (800) 424-8802. In case of accident or road spill notify CHEMTREC (800) 424-9300. - - PROCEDURES IF MATERIAL IS RELEASED OR SPILLED Adsorb on fire retardant ' treated sawdust, diatomaceous earth, etc. Shovel up and dispose of at an appropriate waste disposal facility in accordance.with current applicable laws and regulations, and product characteristics at time of disposal. WASTE MANAGEMENT: Product is suitable for burning in an enclosed, controlled burner for fuel value or disposal by supervised incineration. Such burning may be limited pursuant to the Resource Conservation and Recovery Act. In addition, the product is suitable for processing by an approved recycling facility or can be disposed of at any government-approved waste disposal facility. Use of these methods is subject to user compliance with applicable laws and regulations and consideration of product characteristics at time of disposal. IX. SPECIAL PROTECTION INFORMATION EYE PROTECTION: Normal industrial eye -protection practices should be employed. SKIN PROTECTION: No special equipment required. However, good personal hygiene practices should always be followed. �« ! RESPIRATORY PROTECTION: No special requirements under ordinary 4 conditions of use and with adequate ventilation. VENTILATION: Use in well ventilated area. X. SPECIAL PRECAUTIONS •,•.•. :...•.„•. E No special precautions required. l � Mobil � ° MOBIL l FORMULA 5W-30 481119-00 Page 3 o - 6 � XI. TOXICOLOGICAL DATA ---8COTC TOXICOLOGY--- ORALTOXICITY (RATS) : Slightly toxic ---8aued oo toating of similar products and/or the components. DERMAL TOXICITY (RABBITS) : Slightly toxic Based testing ' �� y oxzc --- a�e o� eu �o� of similar products and/or the components. ` ' INHALATION TOXICITY (RATS) : Not established | EYE IRRITATION (RABBITS) : May cause slight irritation. ---Based on ' testing of similac products and/or the components. SKIN IRRITATION (RABBITS) : May cause slight irritation on prolonged or repeated contact. ---Based on testing of similar products and/or the components. ' ---SOBC8DONIC TOXICOLOGY (SUMMARY)--- Severely oolveut refined and severely bydrotreated mineral base oils have been tested at Mobil Environmental and Health Sciences " Laboratory by dermal application to rots 5 days/week for 90doys at doses significantly higher than those expected during normal industrial exposure' Extensive evaluations including microscopic ' examination of internal organs and clinical chemistry of body ' fluids, showed no adverse effects. ---C8R00IC TOXICOLOGY (SUMMARY)--- The base oils in this product are severely solvent refined and/or ' severely bydrotzeated' Chronic mouse ubiu painting studies of similar oils showed no evidence of carcinogenic effects. ' ---078ED TOXICOLOGY DATA--- ` Studies have shown that mice developed skin cancer af ter repeated ' application of used gasoline engine oil to the ubiu for the lifetime ' of the animals. No effort was made to wash the oil off between ' applications. Used oil from diesel engines did not produce this effect. Because of the effects observed in the laboratory teats, service station workers, engine mechanics, and all persons who regularly boodle used m�tor oil should take precautions to minimize . contact with the oil. Good personal hygiene practices, including washing any skin contact areas and removing nil soaked clothing, ' should be followed. � . . . . . � - ' ^ ^ . ' ` ! - | Mobil F4iL MOBIL 1 FORMULA 5W-30 481119-00 Page 4 of 6 X I I. REGULATORY INFORMATION GOVERNMENTAL INVENTORY STATUS: All components registered in accordance with TSCA and EINECS. DOT: Shipping Name: Not applicable Hazard Class: Not applicable US OSHA HAZARD COMMUNICATION STANDARD: Product assessed in accordance with OSHA 29 CFR 1910. 1200 and determined not to be hazardous. RCRA INFORMATION: The unused product, in our opinion, is not specifically listed by the EPA as a hazardous waste (40 CFR, Part 261D) ; does not exhibit the hazardous characteristics of ignitability, corrosivity, or reactivity, and is not formulated with the contaminants listed in the Toxicity Characteristic (TC) Rule as determined by the Toxicity Characteristic. Leaching Procedure (TCLP) . However, used product may be regulated. U.S. Superfund Amendments and Reauthorization Act (SARA) Title III: This product contains no "EXTREMELY HAZARDOUS SUBSTANCES". SARA (311/312 - FORMERLY 302) REPORTABLE HAZARD CATEGORIES: None This product contains the following SARA (313) .Toxic Release Chemicals: ZINC (ELEMENTAL ANALYSIS) 7440-66-6 0. 12% THE FOLLOWING PRODUCT INGREDIENTS ARE CITED ON THE LISTS BELOW: CHEMICAL NAME CAS NUMBER LIST CITATIONS ISOPROPYL ALCOHOL 67-63-0 -12 BUTYL BENZYL PHTHALATE (.50%) 85-68-7 15 ZINC (ELEMENTAL ANALYSIS) (. 12%) 7440-66-6 15' CHLORINE (.ELEMENTAL ANALYSIS) 7782-50-5 15 . (.O1%) --- KEY TO LIST CITATIONS --- I = OSHA Z,. 2 = ACGIH, I = IARC, 4 = NTP, 5 NCI, 6 = EPA CARC„ 7 = NFPA 49, 8 = NFPA 325M, 9 = DOT HMT, 10 =.;`CA RTK, 11 = IL RTK, 12 = MA RTK, 13 = MN RTK, 14 = NJ RTK, 15 = MI 293, 16 = FL RTK, 17 = PA RTK, ,, 18 = CA P65. w --- NTP, IARC, AND OSHA INCLUDE CARCINOGENIC LISTINGS --- a NOTE: MOBIL PRODUCTS ARE NOT FORMULATED TO CONTAIN PCBS. ' Mobil MOBIL I FORMULA 5W-30 481119-00 Page 5 of 6 X III. INGREDIENTS INGREDIENT DESCRIPTION PERCENT CAS NUMBER <----------------------- ------------->: <----------------- CONTAINS TWO OR MORE OF THE FOLLOWING > 75.00 BASE OILS: 1-DECENE, HOMOPOLYMER, HYDROGENATED 68037-01-4 SYNTHETIC ESTERS NJT 003066009-5352P FATTY ESTERS 16958-92-2 DISTILLATES (PETROLEUM) , SOLVENT- 64741-88-4 REFINED HEAVY PARAFFINIC , DISTILLATES (PETROLEUM) , HYDROTREATED 64742-54-7 HEAVY PARAFFINIC DISTILLATES (PETROLEUM) , SOLVENT- 64742-65-0 DEWAXED HEAVY PARAFFINIC DISTILLATES (PETROLEUM) SOLVENT- 64741-89-5 REFINED LIGHT PARAFFINIC 2-PROPENOIC ACID, 2-METHYL-, EICOSYL < 3.00 68171-46-0 ESTER, POLYMER WITH I-ETHENYL-2- PYRROLIDINONE, HEXADECYL 2-METHYL- 2-PROPENOATE, ISODECYL 2-METHYL- 2-PROPENOATE, METHYL2-METHYL- 2-PROPENOATE AND OCTADECYL 2- METHYL-2-PROPENOATE MAY CONTAIN ONE OR MORE OF THE FOLLOWING ADDITIVE COMPONENTS: BORATED OLEFIN POLYMER AMIDE < 5.00 NJT 3375770004-5019 POLYOLEFIN ESTER < 5.00 NJT 800967-5490P PROPRIETARY INGREDIENT < 2.00 NJT 80096775005P ZINC DITHIOPHOSPHATE < 2.00 NJT 800967-5439P 1,2-BENZENEDICARBOXYLIC ACID, 0.50 85-68-7 BUTYL PHENYLMETHYL ESTER ZINC 0. 15, 7440-66-6 2-PROPANOL 0.06 67-63-0 BENZENAMINE, N-PHENYL 0.05 122-39-4 BENZENE, DIMETHYL- 0.001 1330-20-7 APPENDIX FOR MOBIL USE ONLY: MCN: MHC: 1* 1* NE 1* 1*, MPPEC: A, PPEC: A, US91-572 APPROVE 10/04/91 REQ: US MARKETING Mobil MOBIL 1 FORMULA 5W-30 481119-00 - Page 6 of 6 INFORMATION GIVEN HEREIN IS OFFERED IN GOOD FAITH AS ACCURATE, BUT WITHOUT GUARANTEE. CONDITIONS OF USE AND SUITABILITY OF THE PRODUCT FOR PARTICULAR USES ARE BEYOND OUR CONTROL; ALL RISKS OF USE OF THE PRODUCT ARE THEREFORE ASSUMED BY THE USER AND WE EXPRESSLY DISCLAIM ALL WARRANTIES OF EVERY KIND AND NATURE, INCLUDING WARRANTIES OF MERCHANTABILITY AND JFITNESS FOR A PARTICULAR PURPOSE IN RESPECT TO THE USE OR SUITABILITY OF THE PRODUCT. NOTHING IS INTENDED AS A RECOMMENDATION FOR USES WHICH INFRINGE VALID PATENTS OR AS EXTENDING LICENSE UNDER VALID PATENTS. APPROPRIATE WARNINGS AND SAFE HANDLING PROCEDURES SHOULD BE PROVIDED TO HANDLERS AND USERS. PREPARED BY: . MOBIL OIL CORPORATION ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT, PRINCETON, NJ FOR FURTHER INFORMATION, CONTACT: MOBIL OIL CORPORATION, PRODUCT FORMULATION AND QUALITY CONTROL 3225 GALLOWS ROAD, FAIRFAX, VA 22037 (800) 227-0707 X3265 • ."MERICAN' MATERIAL SAFETY DATA SHEET > " -LOBRICANt •• ` ' 619 Bailey Ave rVeNaw" _ c..•fto. Buffalo, NY 14206 MI XCO O GREASE 60422-0 [mergy►none NumlDer(a t J t Cn«n/ut wit» (716) b27-8300 o a Lubricating Grease ctn.a cc a � C ynonyme CMmical family Semi Fluid Sods Grease Hydrocarbon MATERIALS OR COMPONENTS %W CAS NUMBER owe 1.A0�r' w Iwnc Sodium Stearate 4. 0 822- 16-2 No Mineral Oil 50. 0 64742-52-5 No Mineral Oil 46. 0 64741-56-6 No . • S 'w as V z - Not Restricted ' � ° b oning Point/Range tMeRing point Frwa M Ing point O Nculaa weipnl tcalcuidioul °C 700 °F °C 300°F °C 0 °F NA J W pec111C Gravity t► 20-1) �? r 6 °C r*P*t P.aawrs Imm Hill Vapor Density(Air-1) Cr °C °F . 90(PNA >. a. Solubility In M20- K V.tithes by Volume Eveporallon Rate - a Ether-1 Water 1 B'tytaca Partial 0 NA 0 U. AppeaianCit and Odor Other Semi Fluid Grease - Spapy Fiarn Pohl Teat Matnod Flammable Llmlla AutoiInnion T41iMP01111ore/fire Point °C 360°F D-92 Lprv« NA % UVOW % °C 400 °F O 7O EXTINGUIS►rING MEOiA Q Z V Wate • • QWter © kY l la Alcohol ® fdaw X Earoth a a .aY D R]CO2Chem tan WOp tog ttrearn roam (E O SPECIAL FIRE F IGMTINU PROCEOUR J Do not enter AJI:uw (We Water maY oo not teas IL building to burn ® caw"frothing vier WU14VSUAL FIRE AND EXPLOSION MAZAROS a Ov+t eeoloalon a tomJ smock � Contamination �Temperatura a Other rvrard to N«t. other None STABILITY CONDITIONS CONTRIBUTINGTO INSTABILITY 4 D Thermal QPhoto D p.)lym«Itatlon conlam,nalio,I Slabs Q Unstable dacompotltion Oepraoatlon E] INCOMPATIBILITY-Avoid COMaCI with QStrong Strong ❑ Strong Other acid• alltolla orloiae.a t1pKMy►I None Known F HAZARDOUS DECOMPOSITION PRODUCTS• THERMAL AND OTME11 (IM) CO & CO2 if incomplete combustion Q CONOITIONS 10 AVOID Q v OPen at �yJ Itamea Sp+rwa a &OUICe. (specify)! I S1Er-S TO eF TAp(N iF MATERIAL IS RrLEASft)On SnILLEC) •Turn v.lin Atsaab wrath and t�«n nr Vino p7. sle rate. 1K C. IMA mJ11"Wo Q Nwl�..,,a [) up an°r�mov� ! •.•uala encbNd a-or toil it O ]( a C).Wt' a nr Q Otne. J ( l.. .�an.lerr (specify): J u1 JIN^STE OISnOtiAL METHOD •Cor+rull /eOrra•.'auU,od Juca;aulno.,t.wr ro+p+cwr anlx,eripruteJcrrr to T n r 1 n P r R t e. r.---- 1-46'�c�mrr to• O•id OrI W Jny p/OOtrCE,l7et1 an0 1tl+;ales c:n VC I A-M WI-d pretClic/t i"on prodTt1 e�yl ms0�I&W aa area* e, None Known . O ffMAL%nCW M EXIN cOM ACT O an+as ttr..�h1 This product has been used for years with no known -ill effects. It contains no, known carcinogens or mutagens as defined by Q OSHA or_JARC. PERhrISS1eLE EXPIUSVRE LIMIT (Specify It TLVfrOVA or Gtitlnp(c)) OtI►arI ACGIH 19 NA OSHA 19 IRRITATION of Skin SevereEye Yodwe l e Ssvx• H L4�j $Aid (Iftar+stsnl) OZ O CURROSIV ITY skin 4 ML MOT) �wri• 24 b>L CfyC) fl 11 ( W Ey• MAY ours blindness p Not Corrosive SENSITIZATION 1PAIAL/1TION EFFECTS D ❑ skin None ❑ Respiratory o Y AAllergen � Eltk cy,,,,,a • _ _ Asphyxjant.. U. LUNto EFFECTS(Specifyll z W NA , 0 ¢ OTH R (Specify)% Q ❑Reveal So ConteQ: OInW /•J emin*.tall of ❑ (Saetlly)t NA = INGESTION OoNor T < ® vomuce t ng ❑ vomiting ® of we Give awnly ❑aK medical ❑Other OEQMAL ariMlbn • (speclty)r ` Flush wtln soeo pet medical Contaminated}% clot nin El she wale.- attentionnLAJ nmovs A launder slum.destroy D(W•cityll _ EYE COh ACT Flusn with plenty or water/w Get medical af,ci � of Nast Is minutes © altentb Eln - E INHALATION It not Ore•Ining, W ❑ Remove to live artificial OIV*eaolr ❑ Cel medlctl Other peen all ❑rellpn ❑_O-Y"n attention ❑(saecHy)t NA VENTILATION REQUIREMENTS—'Vwayam&,nutnof,tpoivre below permas,Otaa,lpwunl,mits ❑ or on an industrial iln spviq Lk4 wftn ede0wte ❑(heck for air contaminant a enywonmanlal nnaltn IpawHri ❑ Local i!Iheuri ® YaMlWion end•Ry""deficiency Olhow V ZO W ❑ (specifyit F EYE Fac• MANO(OLOVI TYPE) ❑rutyl ❑ Polyvinyl Other 0 4 ® s+t1e10 IUDDW a g Sr/etY alcahW Mlyvinyl .-1 0 D lI•rUs ❑ OOghtt ❑chlor too ©Neoorene ❑IIIVipt��l ©rt iyNM Q = RESPIPA TOR TYPE Liss only IVIOSH/MESA approved epuiprnenf tJ — Selr. w ❑ dontalned SuOD1110 Can.or cartridge Filter•gust. Other G. ❑ e+t ❑la$or wool ❑ (wave.mia ❑ (ro•city)l NA N OTHER PIIOTECTIVE EUVIPMENT ❑ P u00ef Other boots ❑ Apron ❑(Io.ctrr)l :None PRECAUTIONARY MOTES 01 ©wash Inorouln le ly Oo not t in eyes. De not Heaths Z •rlw handling or on ❑eUN.wswr,miss. ❑ Ks»N e*ntalner r ®Kee*aweY hOAf ❑ Store In 14"'y _J o clothing y,s t� �a cWsls contawwI Keels from contact U with clothing end (TPtY containw❑Oo not slot•near Vse 4■Ploslon . it! otnw Cor"DwIllow ray t0 catatn ❑ ❑Other 0. U COmpualtelM me1M41/ r Mo01 D. haureow to dust eeuternent (sOecNr)r s f» U) d Otne nanotrng ane @too&" condlt.ons I i 7 j None 'teO or I 1101ria a , b lug 1 t AOV'•ra V Pre sident-Tech. Director (�a i J eI Avi2 Buffalo, NY 14206 7r1617.7-8?I` ►L E ASE —The•Pnoe Imorwt;on is securer,to me tell or tw►it nov.ie." How .s w.line••A•I•,•et.ly Ita..we..ra.e•vl P—o"Wnent regulellonl w r�'�eft to ( ►COTE ci:• N and ltv eo�d•t:ons of hsndi,nl end caw,tw m,o w re beyord Out c,e„ttd lertenfeld MAIrES NO vrARRA.T..EITHER Ex/Re,. t OA lLli•LIEO.VV'TH PRE SPECT TO THE COMPLE TENESS On CONTINUING ACCUn ArY OF Tt15 Itll gt+�t.1TInN CCN'A�NEO HEREIN %NO J611 13 '92 09:©9AM 6179}29154 P.2 S ARTAN CHEMICAL. Co., INC. TERIAL_ SAFETY nRTA SHEET ! I sacrlov I PRDQJCf IOENNTIFICATION PRODUCT NAME OR NIMEER (as it appears on Ia�el) CLASS CLEANER (BULK) M14NUFACTURER'S NA1 EMEP ( Tnn4cw NO. Spartan Chemical Co., Inc. - (419) 531-5551 ADOi S (NUI,EEFt, STREET, CITY, STATE AND Z11r CODE) r~AC URERIS D4144-S NO. 110 N. Westwood Ave., Toledo, OH 43607 00-503-6728 I SECTION II It�IAZARODIS UACREDIENTS Table Z-1-A - I ICAS PE=SM NO. I Va I CHEMICAL I (S) I TWA I STET. 1 CeiIIN I CAROM +I11-76-2 3 2-Butoxyethanol 120 - - no 67-63-0 5-1Q Isopropanol 980 1225 - no *This Substance is subject tb the reporting r quirements or Section 313 of the Fmrgency Planning and Community Right-to-Know Act of 1986 (SARA) a d of 40 CRF 372. . . } =ION III PHYSICAL DATA 9011 G .POINT SPECIPI i GRAVITY (H2O = 1) 200 of OC 0.989 i VAPOR P - Unknown PERCENT SOLID BY - 0 75 OF oC artt Mg _psi %EIGHT W VATS DENSITY (AIR = 1) EVAPORATION RATE (but. SCe. Unknown <1 i SDLLIBILITY IN WATER APPEARANCE AND ODOR Complete Clear, 1I�ght blue, pH ammoniac�l 'odor IS MATERIAL: (LIQIIU) 10.0-1I.Q GAS PA_ST>~ PONE EF f SECTION IV FIW AWO OWUSION HAZARD DATA FLASH POINT - 1360F METHOD USED - ASTM i_ 092 FLAMMAALE LIMITS - Not established EXTINGULSK06 MEQIA water SPEJCIAI. FINE FIGFITDO PRDLBLRE3; None LM SUNL FIRE AND 0PLOSION NAZARUS None known a JAN 13 192 09:08AM 6179328154 P.3 WEALTH NAZARD DATA iF�TS OF OVE RE - CONDITIONS To AVOID THRESHO p LIMIT VALUE - Not established May cause skin and eye.irritation_ Avoid prolonged skin contact and inhalation of vapors or �{ mist. 6utoxvethanol is absorbed throur a skin which may affeot the liver, kidneys, lymph 4 - and blood systems; inhalation may irritat throat and respiratory system. r PRIMARY RODS OF ENTRY INHALATION SKIN CCWACT x OTHER (SPECIFY) COMMONS AGGRAVATED BY USE None known .Y AND FIRST' AID PROCMAES If swallowed, drink large quantities of w ter. In case of contact, immediately flush eyes or skin with plenty of water for at least 15 mutes_ If irritation persists, seek medical attention. ION VI - REACTIVITY DATA STASILM; LI,TABLE STYE x - T s1"RBILIT (MATBUALS TO AVOID) None known HAZARDOUS POSITION PRODUCTS None HAZARDOW IWY OCCLR POLMRIZATIM: WILL NOT OCCUR X- SECTI& VII - SPILL OR LEW f'ROCmIlRF� STEPSTO BE TAKEN IN CASE MATERIX IS OR SPIU Cri Flush with copious amounts of water into S itary sewer system. �,. WASTE DISPOSAL. NEIHW Same as above. SECTION V XI SPECM!PROTCTXN XIFORMATION RESPIRATORY PROTEITIM (SPECIFY TYPE) None required VENTILATION - Good general ventilation sh 1d be sufficient for most conditions. Local exhaust ventilation may be necessary for some oper tions. - PROTECTIVE MMES (SPECIFY TYK) EYE PRCTeMON (SPECIFY TYPE) Rubber Safety glasses OTHER PR MCTIVE EWIP:iEXT None PRECAU-TIOG TO SE TA10I IN HANDLING AND IX SPECIAL, PRECAL1rldMS Keep away from heat and flame. OTHM PREX;AIMONS None mortar Chemical Co., Im. NAME Thcow J. Mitchell a-ASS CLEANM (8") TITLE Director of Resmrch � . Ref; 29 CFR 1910:1200 (OSHA) DATE .hne 11 im SUPERCEDES AUgust 11, 1984 I i CSCC6190 Copyrighted: Spartan Chemical Co. , Inc. -� For Use Only By Authorized Spartan Distributors_ 1800219, 1300220 ��I�FRW ,l,4TTfAV,0b9R DAATitq# page 1 of , PRODUCT SAFETY DATA SHEET PRODUCT: ELECTROLYTE (ACID) BATTERY FLUID Latest Revision: September, 1985 I. PRODUCT IDENTIFICATION SUPPLIER: General Battery Corporation Telephone P.O. Box 1262, Reading, PA 19603 (215) 378-0500 Our products are shipped to our customers as foIlcga: PRODUCT NAMES Federal Department of Transportation (DOT) SHIPPED T OL COMMON NAME LABEL & CLASS I.D. NUMBER 1. Battery Starter Battery, wet, Corrosive UN 2794 wet (with battery filled with Material (8) electrolyte) acid 2. Battery, dry Dry-charge (Not subject to DOT hazardous materials regula- starter tions) battery 3. Battery, dry Dry-charge Battery fluid, Corrosive NA 2796 with con- starter acid, with bat- Material (8) tainers of battery tery electrolyte with battery fluid 4. Electrolyte .Battery Battery fluid, Corrosive UN 2796 in contain fluid; acid Material (8) ers acid Pak 5. Battery, Motive Battery, wet, Corrosive UN 2794 industrial power filled with Material (8) - or mining bat-tery acid 6. Battery, Battery Battery, wet, Corrosive UN 2794 industrial cell; filled with Material (8) or mining - "Jar" acid cell General Battery Corporation, in keeping with the battery industry position, considers starter batteries (SLI-starter, lights, ignition) intended for retail sale to be "articles" as defined by the OSHA Hazard Communication Standard at 29 CFR 1910. 1200, and therefore exempt from the provisions of the Standard "under normal conditions of use." Industrial batteries and cells, plus electrolyte sold separately or with batteries, do not fit this definition. The following safety and health information is furnished to cover the hazards associated with exposure to electrolyte and its vapors, which may be emitted during charging procedures. P.O. BOX 1262 • READING,PA 19603-1262 • TEL(215)378-05W • TWX GBC RDG 510-651-52W I LL 1''J1-1 tD1 i i ' 41 Hip.-1 t Page 2 of 7 f A further hazard exists because the operation of a battery can produce explosive hydrogen gas. An ignition source, such as an electrical spark from an improperly connecte ! electrical booster or "Jumper" cable, or from a damaged vehicle electrical system, mad—/ ignite/explode the hydrogen gas. NOTE: DISTRIBUTORS If you have purchased GBC batteries for any ,purpose other than immediate retail sale, you are advised to for:-isrd a copy of this Product Safety Data Sheet to any subsequent employer who purchases the batteries. II. HAZARDOUS INGREDIENTS/IDENTITY INFORMATION ACGIH Hazardous OSHA Recommended % in Comzonents Chemical Identity Common Names PEL TLV Mixture Sulfuric Acid Inorganic sulfuric Electrolyte, 1 mg/MS None known 32-40 @ acid, aqueous solu battery acid,' 60°F tion. H2S0 battery fluid CAS No. 7664-93-9 Other Limits: NIOSH 10-Hour TWA 1 mg/Mg; IDLH - 80 mg/M9 NIOSH Registry No. WS 56000 Wiswesser Code - WSQQ ' NOTES: PEL - Permissible Exposure Limit for 8-hour day, 40 hours per week TLV Threshold Limit Value, a guide for protection of most workers for a 40-hour TWA - Time Weighted Average exposure permitted for a specified time .period IDLH Concentration Immediately Dangerous to Life and Health OSHA = Occupational Safety and Health Act, or Administration ACGIH American Conference of Governmental Industrial Hygienists NIOSH = National Institute for Occupational Safety and Health CAS - Chemical. Abstracts Service Registry ' III. PHYSICAL/CHEMICAL CHARACTERISTICS Boiling Point (@ 14.7 psia) Approx. 203`F Specific Gravity (H�0 - 1) 1.245 to 1.293 @ Vapor Pressure (mm Hg) - 10 @ 18% F. Melting Point . -35 F to +10.6°F Vapor Density (Air '= ;1) - Greater than 1 Evaporation Rate (Ether - l) - Less than 1 % Volatile by Volume - 0 @ 70°F Solubility in Water - 100% Appearance and Odor - Clear liquid, with sharp, penetrating, punguent .odor. Other Gives off large amounts of heat when mixed with water. IV. FIRE/EXPLOSION HAZARD DATA Flash Point - Not combustibles Flammable Limits - Not combustible* Extinguishing Media - For fires in area: Dry chemical, carbon dioxide, water fog, water. Special Procedures - Sulfuric acid fume, sulfur dioxide gas or carbon monoxide may be released When acid decomposes; wear NIOSH-approved self-contained breathing apparatus. Water applied to sulfuric acid generates heat and causes acid to spatter; .wear full-cover sulfuric acid resistant clothing. I C L I`i i i �_ 1 i i <;�4 - - - IJ'-{ - _ _' 1 1 - - Page 3 of 7 IV. FIRE/EXPLOSION HAZARD DATA (Continued) Unusual Hazards - Sulfuric acid is an electrolyte. Sulfuric acid reacts violently with metals, nitrates, chlorates, carbides, fulminates, picrates and other organic materials. *Reacts with most metals to yield explosive/flammable hydrogen gas; this reaction is intensified when acid is diluted, as in electrolyte. V, REACTIVITY DATA STABILITY - 100% Stable HAZARDOUS POLYMERIZATION - Will not occur INCOMPATIBILITY - Contact of- sulfuric acid with combustibles, and organic materials such as; chlorates, ' carbides, fulminites, picrates, peroxides, nitrates, cyanides, carbides, etc. , may cause fire and explosion. Also reacts violently with strong reducing agents, metals, sulfur trioxide gas, strong oxidizers and 'water. Contact with metals may produce toxic sulfur dioxide fumes, and may also release flammable hydrogen gas; this reaction- is intensified when diluted. HAZARDOUS bECOMPOSITION OR BY PRODUCTS - Decomposition of sulfuric acid releases sulfur trioxide, carbon monoxide, sulfuric acid ' fumes, and .sulfur dioxide. Reaction witli above may release other toxic gases, such as . hydrogen cyanide or hydrogen sulfide. Decomposition also produces large quantities of heat. OTHER - Sulfuric acid will attack some forms of plastic, rubber and coatings which are not acid-resistant. = V1. HEALTH HAZARD DATA ROUTES OF ENTRY - Sulfuric acid is harmful by all routes of entry. { HEALTH HAZARDS - ACUTE Eyes - Severe burns, cornea damage and blindness. Skin - Severe irritation, burns and ulceration. Inhalation - Breathing of vapors or mists may cause severe respiratory irritation at levels of 5 mg/Mg. Inflammation of bronchial membranes may occur . at 12-35 mg/Mg. Ingestion - Swallowing even diluted sulfuric acid, as in electrolyte, may cause severe burns and ulceration of mouth, throat, esophagus and stomach. as well as kidney and intestinal damage. HEALTH HAZARDS - CHRONIC While diluted sulfuric acid produces milder results than full strength acid, lon; term exposures may produce all hazards in some degree.' Chronic ,exposures are know. to cause erosion of the teeth, inflammation of nose, throat and bronchial tubes. I C L I`{U ID f f (•:_;q 1=- D H I j 1_ - 1 .,VALa�, ,jeU0220 Page 4 of 7 VI. HEALTH HAZARD DATA (Continued) - - - - - SYMPTONS/WARNINC, SIGNS Concentrations as low as 5 mg/M3 are objectionable, causing cough, increase respiratory rate and impairment of ventilatory capacity. Droplets or mist on th skin causes an uncomfortable stinging, burning sensation. Eye irritation frequentl occurs at concentrations of I, I to 2.4 mg/M9. Teeth may become discolored. MEDICAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE Exposure to mist may cause lung damage and aggravate pulmonary conditions, ) CARCINOGENICITY No data was found to indicate sulfuric acid related,, tumors or cancers. VII. FIRST AID AND EMERGENCY CARE DATA { Begin first aid 'and send for medical assistance. ALL victims of sulfuric acid-exposure a] to be examined by a physician. T'ves Flush eyes immediately with large amounts of cool water holding both ayes (upper and lower eyelids) open. Continue for at least 15 minutes until all Graces of acid are removed. NOTE: Contact lenses are not to be worn when working with any corro- sive material. If you suspect a victim is wearin$. contact lenses, either have the victim remove them or get professional assistance, then continue flushing. . Skin - Flush with large amounts of cool water. Remove contaminated. clothing completely, including shoes. Continue for at least 15 minutes, until all traces of acid are removed. Inhalation - Remove to flesh air immediately. If breathing has stopped begin artificial respiration. Keep victim warm and at rest. If breath- ing is diff.icult, 'give oxygen. Ingestion - If victit7 is conscious, give large quantities of .water. Do not try to get victim to vomit. Wash out mouth; gargle to wash throat. If available, give milk, preferably mixed with egg . whites or vegetable oil. Rescue - Do not become a casualty; summon assistance. If there is an air concentration or continuing spi.lL of sulfuric acid, wear protective clothing covering all skin surfaces, and self-contained breathing apparatus. Remove the victim from the hazardous exposure as quickly as possible then begin emergency procedures listed above. If signs of shock appear - rapid pulse, collapse - place victim on his back and kee him warm. f NOTE: Contaminated clothing must not be reworn. Flace in closed con- tainers for storage until disposal or until acid can be removed. Person laundering such clothing should be 'Warned of hazards. ILL [.IA 1_;1 i' i 4 1•'_; D H IJ ij 1300219, 1800220 Page 5 of 7 ' VII. FIRST AID AND EMERGENCY CARE DATA (Continued) SPECIAL INSTRUCTIONS FOR PHYSICIAN If gastric lavage is performed, endotracheal or esophagoscopic control is. suggeated. Oxygen, with use of intermittent positive-pressure breathing apparatus; 57. solution of sodium bicarbonate as aerosol may be used, and broncodilators and/or decongestants. VIII. PRECAUTIONS FOR SAFE HANDLING AND USAGE Handling and Storage - Store in well ventilated area that is cool., dry and protected from severe weather. Separate from incompatible materials. Store and handle only in areas with unlimited water supply and where spills can be controlled. Avoid spills, leaks or damage to containers. When diluting always pour acid slowly and carefully . into water. Keep away from fire, sparks and heat. Keep containers tightly closed, with openings on top to prevent leakage. Loosen closures carefully. Never use air-pressure to force material out of container. Relieve internal pressure in containers when received and at least weekly afterward. Check closures before moving containers. Precautionary Labeling POISON - CAUSES SEVERE BURNS DANGER - CONTAINS SULFURIC ACID Spill/Leak-Procedures If possible, stop flow of material. Unless spill area is very well ventilated, do not permit anyone in area without respiratory protection. For large spills, weal acid-resistant clothing covering all skin surfaces. Contain/absorb small spills using vermiculite, dry sand, earth or similar materials Dike. or dam-up large spills. Never use rags, sawdust or other combustible materials If possible, neutralize with lime, soda ash, sodium bicarbonate, etc. Otherwis, dilute cautiously with large quantities of water. Do not permit excess to run int, sewer system. Waste Disposal Methods Shovel neutralized slurry into sealed containers. Dispose of in a secured, sanitar landfill if permitted. Large, water--diluted spills, after neutralization (and neutralization testing) may b handled in accordance with approved local, state or federal requirements. Consult state environmental agency. Individual state regulations vary. Reportable Spill-Quantity Consult with local, state or federal regulatory agencies. Hazardous waste spil reporting quantities vary with location. ti FEL No b.1 ( I 641'- - :; HU 11_) e J1 1._; - ._j e. r . ,_,j Page b of IX. CONTROL MEASURES Res irator Pro tection - Not re ired under normal conditions. When concentrations of re known to exceed PEL, use NIOSH-approved, fitted, full sulfuric acid in an area face respirator with: Concentration :rr-., K irator T cy A. $0 mg/Ms or. less Acid gas nysupplied-air upplied air respiratorioreself-contained filter, any supp breathing apparatus. -air respirator in positive-pressure mode, B. 140 mg/Ms or esa A Type-C supplied in positive-pressure mode. . .a C; Emergency: Self-contained breathing apparatus { �.: Any. self -contained unite;--1 sated under A. above. w` ' D • Escape' -- ' VenC lation - .Use in well ventilated area with no 'cross drafts. . , f J Local Exhaust - Preferred. rt table if concentration stays below PEL. eclianical (General)' - Acceptable Special - Ventilation components must be acid- and explosive-resistant. Other - None. - Use acid-resistant rubber or plastic (natural rubber, neoprene or Protective Gloves nitrile) gloves, with elbow-length gauntlet and rolled-over cuff. t goggles) Eye Protection - Uge approved safey glasses withther sidesequiva fieldsent (or tion~whenshandlinggthis .� and face shield (8 minimumlength) or material. Other Protection - Wear acid-resistant apron. Under severe exposure or emergency conditions, wear acid-resistant clothing and boots; cover all skin surfaces. Flushing Wherever sulfuric acid is handled in concentrations greater than 1%, Emer enc Water supply should be provide emergency eyewash and shower or similar facilities. at least 0.4 gal. per minute for eyewash and 30st 1gal. per minutesminute far body flushing, and sufficient to continue flushing for X. OTHER REGULATORY DATORE UIREMENTS listed by the following agencies or regulations A, Sulfuric acid is 1. DOT Regulations (see above) ; corrosive material label required. 2. NIOSH Criteria Document. 3. Environmental Protection Agency (EPA) (see below) . 4 OSHAct - Section 1910.1000; PEI. •• 1 mg/m . • material. $, OSHAct - Section 1910.1200 as a corrosive h euIInabilit 0. Reactivity - 2• Rating: Asa lth 3 la y 6. NFPA . Acute Hazard kj 1800219, 1300220 Page 7 of 7 X. OTHER REGULATORY DATA/REQUIREMENTS (Continued) EPA (RCRA) or Appropriate Waste Classification - "Characteristic" Waste; if spilled, EPA Hazardous Waste Number: D002. (Corrosivity Characteristic) (Note: Sulfuric acid waste may be a "listed" waste in some states) . Empty containers are to be handled as directed by state environmental agency; regulations may vary. EPA (Clean Water Act) Classification (for sulfuric acid) - "Hazardous Substance" (See tion '311)y; Reportable Quantity: 1000 lbs./454 kg. Prepared By: General Battery Corporation Environmental Resources Department In Charge of Preparation: J. A. Bitter, Vice President, Environmental Resources • r 3 ftneml Chemical PRODUCT SAFETY DATA SHEET DRY ALUM TRADE NAME(COMMON NAME) Z C A S NO ❑ ALLIED PRODUCT CODE 4 ALUM (DRY) 10043-01-3 (anhydrous) CHEMICAL NAME AND/OR SYNONYM. - - Aluminum Sulfate ` FORMULA MOLECULAR WEIGHT Al2(SO4)3 - 14 H2O (approx.) 594 (approx.) ADDRESS INo.•STREET.CITY.STATE AND ZIP CODE) General Chemical Corporation 90 East Halsey Road „ Parsippany, NJ 07054-0389 CONTACT PHONE NUMBER LAST ISSUE DATE [CURRENT ISSUE DATE Manager of Product Safety (201) 515-1840 Sept. 1986 July 1989 EMERGENCY PHONE NUMBEf�, Eyes: Flush immediately with water, continuing for at least 15 minutes. (800) HONE 50 If irritation persists, get medical attention. Skin: Flush with plenty of soap and water, removing contaminated clothing. If irritation develops, get medical attention. Inhalation: Promptly remove to fresh air. Ingestion: If conscious, immediately give a large quantity of water or milk. If not already vomiting, induce vomiting ' by touching finger.to back of throat. Get medical evaluation. HEALTH INHALATION Dust-or mist inhalation.at levels above the TLV listed below may irritate respiratory tract. INGESTION :f Ingestion may irritate gastrointestinal tract. LD550 (mouse) = approximately 10.8 g/kg (slightly toxic). — Reference.(a). May cause nausea, vomiting, or purging. Human fatal dose recorded at 30 grams (ref, c). SKIN May cause skin irritation, especially under repeated or prolonged contact, or when moisture is present. EYES ; May irritate or burn eyes. Similarly for the aqueous solution. PERMISSIBLE CONCENTRATION:AIR - BIOLOGICAL ISEE SECTION A TLV: 2 mg Al/cu.m. (OSHA and ACGIH) None. UNUSUAL CHRONIC TOXICITY None. ND=NOT DETERMINED I NA NOT APPLICABLE i . I 1 � FIRE AND EXPLOSION FL4SH�O!NT 4 OC AUTO IGNITION OC FLAMMABLE LIMITS IN AIR ;%BY VOL.) . TEMPERATURE Not flammable LOWER — N.A. ^PEN �'�'_ --]CLOSED CUP Not applicable N.A. UPPER — I UNUSUAL t IRE ANO EXPLOSION HAZARDS See Hazardous Decomposition Products, Section G. J 1 1 1 1 FIRE EXTINGUISHING AGENTS RECOMMENDED Not applicable FIRE EXTINGUISHING AGENTS TO AVOID - Not applicable . SPECIAL FIRE FIGHTING PRECAUTIONS Wear self-contained breathing apparatus approved by NIOSH. VENTILATION Local exhaust if dusty or misty condition prevails. May exceed TLV without visible indication. NORMAL HANDLING Avoid contact with skin, eyes, or clothing. Avoid breathing dust or mist. STORAGE Store in a cool, dry area. SPILL OR LEAK(ALWAYS WEAR PERSONAL PROTECTIVE EQUIPMENT-SECTION E) Shovel up dry chemical and place in empty container and cover. Spray residue with plenty of water. Neutralize any further residue with alkali such as soda ash, lime or'limestone. Adequate ventilation is required if soda ash or limestone is used, because of the consequent release of carbon dioxide gas. (See Section I for disposal methods). SPECIAL PRECAUTIONS IPROCEDURESILABEL INSTRUCTIONS SIGNAL WORD— WARNINGI ,.. 1 1 1 RESPIRATORv PROTECTION I. Where required, use a respirator approved by NIOSH for dusts or mists. rEYEES AND FACE Wear hard hat (or other head covering) and chemical safety goggles. Do not wear contact lenses. i . HANDS.ARMS.AND BODY IWear gloves.and appropriate industrial work clothing, including shirt and trousers for routine product handling use. These should be exchanged.for impervious ones if handling solutions and there is repeated or prolonged contact. IO' THF.Fi CLOTyING ANC)EOUIPM!ENT IEye-wash and,quick.drenching shower facility. ® PHYSICAL DATA ', MLATERIALIS(AT NORMAL CONDITIONS): APPEARANCE AND ODOR ❑LIQUID ® SOLID ❑GAS White or creamy white granules or powder with no odor, ❑ SPECI E IC GRAVITY VAPOR DENSITY - BOILING POINT N.A. OC (H2P= 1) (AIR - '1 C 1.61 N.A. MELTING POINT N.A.° VAPOR PRESSURE SOLUBILITY IN WATER pH Imm Hg at 2000 IVSIG: M by Weght) �50% at Oo C 1% solution; pH = 3.5 i Negligible I EVAPORATION RATE %VOLATILES BY VOLUME IButyt Acetate= 1)❑ (Ether=1)❑ IAt 200C1 N.A. N.A. STABILITY CONDITIONS TO AVOID ❑ UNSTABLE ® STABLE Temperatures above 7600 C (14000 F): yield toxic and corrosive gases. INCOMPATIBILITY(MATERIALS TO AVOID) Alkalies and water-reactive materials such as oleum: cause exothermic reactions. HAZARDOUS DECOMPOSITION PRODUCTS At temperatures cited above, sulfur oxide gases. These are toxic and are oxidizers and corrosive. The trioxide is also a fire hazard. The loss of these gases leaves a caustic -esidue. HAZARDOUS POLYMERIZATION CONDITIONS TO AVOID ❑ MAY OCCUR ® WILL NOT OCCUR N.A. • II I � MATERIAL OR COMPONENT/C.A.S. # i WT.% HAZARD DATA(SEE SECT.J1 i Not Applicable. i I r PROPRIETARY—TRADE SECRE 3 DEGF}ADABIUTV AQUATIC TOXICITY `. OCTANOL/WATER PARTITION COEFFICIENT • I Aquatic Toxicity : N.D. 14 ppm/36 hr/fundulus/fatal/fresh water 240 ppm/48 hr/mosquitofish/TLm/" "water type not specified — Reference (b) EPA HAZARDOUS SUBSTANCE' iCLEAN WATE R ACT SECT. 311! OO IF SO.REPORTABLE QUANTITY: H7OO J:]10 CFR ,YES NO 6-117 WASTE DISPOSAL METHODS IDISPOSER MUST COMPLY WITH FEDERAL.STATE AND LOCAL DISPOSAL OR DISCHARGE LAWS) Dissolve in water. Neutralize with alkali, then flush to sewer with plenty of water if permitted by applicable disposal regulations. Neutralized waste may have to be disposed of by an approved contractor. When using carbonates for neutralization, adequate precautions should be taken to minimize hazards and pressure build-up from CO2 gas evolution. RCRA STATUS OF UNUSED MATERIAL IF DISCARDED HAZARDOUS WASTE NUMBER: (IF APPLICABLE) Not a "hazardous waste 40 CFR 261 _ 1 PERMISSIBLE CONCENTRATION REFERENCES ACGIH list, "Threshold Limit Values for Chemical Substances . . .", 1988-89 REGULATORY STANDARDS - D.O.T.CLASSIFICATION: ORM-E 49 CFR 173 (If greater than 8700# ) Classification by General Chemical Corporation. GENERAL - (a) Stokinger, H. E., "The Metals", Chapter 29 in Patty, Industrial Hygiene and Toxicology, 3rd Ed., 1981, Vol. IIA, John Wiley, NYC, particularly Section 1.5.1 for aluminum. (b) Coast Guard CHRIS system form, "ALM", "Aluminum Sulfate" (-18 H20); Oct., 1978. (c) Gosselin, R.E., et. al. Clinical Toxicology of Commercial Products (Baltimore, Williams & Wilkins Co., 1976) page 89, Section 2. None. PSDS File#-GC -2001 4 NIATERIA 5AEEIY DATA SHEET . lA4B'r:' 'COFlll0nATI0N FOFT CHEMICAL E1�IETFGENC'T' P.0.`vV,-DOX 23708 ' ' ,, SPILL, LEAKI FIRE, EXPOSURE ' OR ACCIDENT —�.MILWAUKEE,::WI '..53223 + CALL CHE?vlTREQ: '.DAY OR NIGHT 1NFORP+1ATtON:°TELEpNOrr[ ; . 414-255.9500 i' ' :: r :.;..;TELEPHONE ' r~: _ ', 000-424•9300 ��'-,t�..(`'�i�r':Ili•: '�';;. I ,... .:• `. ' ':'',�';I. � • Min/: a/ PREPARATION OA1C:12121M9 I iIEPLACES BATE ta13T)9' ; PREf'�,F1F0 Ei r; I1!,1U r..vaaa em.ara wrry v.cweaaao.m.r.....wr.n.n rwr.nveo- = coe=deer-nc.....r..r.aw.bawsraa¢vet--:c-.+bv-na..n..........cr-._..-_,.-.--'rsr*= SECTION 1 - PITODUCT IDENTIFICATION Elio �•v.+............. ---* c--re_-_..........r.=----.�ca—ev—c==-aoazcca cwrvwo.....vc 1".[�L"i �ill�Zlr )lbLVl11L LITTUN UJIS COMYOR SYSTEMS V037U85. BLUE 1J is �.� ACRYLIC ENAMEL AEROSOL SPRAY PAINT,LEAD FREE r vc.v.cs c.v.. ............................a ............=----c=............ ........... SECTION II - INGREDIENTS c=_...........r ......:_c ==erect c ...wwn c.cc ac=eo,ec= cc ....... 1� WT.1 ••.••••••••••.000UPATIONAL........•...•.. VAPOR KtfOYrH ('R f- LF,00 .............EXPOSURE LIMITS.......... PRE09Unt 13UBPFCTED 5i: j; CHEMICAL NAME CAS o TIIAH TLV.TWA TLV-STEL: PEL mmHg 0 20C. CARCINOGEN 313 .............. .............— — — - ...._.._............. ....._... — — ..._._...............................__.. __.... ---- ----•----.._...----.... Pm""rYI.ENEGLYC�LMETHYLETNERACETATE 1Clo5G tDY. NONEESTA�tISHED 39 11 NO NO ACETONE 07 04.1 05% 751PPM '1005PiA 75'>?M 1A1.7 NO VE° PRGT ANE 74.03 6 te^ !DrDPiu flO PIFO 110 O WT.0 IOILENE D0 00 D• 3': K.CPPIA 100PP>1, tO;?alA 22.0 j ti:) 1"L3 N DUTANF ! •oT••^, n 000PP7A NO CFO It)N110 07DO NO N:1 L)3HT ArKXIATir SOLVVIT NAPTIM C474r'PS-G 25: so rpm NO r�'FO NO Chi 0 10.0 to r17 ACAYLIC MODFIEU AUM POLYMER IYJNE 15% NOT 14AZAi10003 0.0 NO In 2.rWTOXYETWL ACETATE 112 07.2 2',, NO 1110 fir)r%TO r In CFO 1.0 W) IfO N OUTYL ACETATE 1231Ir 4 0:: 150 PPM 900 PPM 1:,J I/M 15.0 r;G rr0 Puirrt PHIMATED(CC-011) Nor, 2•11. NUT I WARuouS 01 No 147, MNEfx8PIR1T8 G1742.47.0 2% 100PPM NO WO Ioorpm 2.4 GU NO XYI-FNF, 10.10-2D-7 16Y. 100r'PM 150T'PM 100PPM 5.1 NO YES onUAN10 A RIORWOC PKWENTO LY. NOT HAZARDOUS 010 NO NO 'THIS PRODUCT CWTA^t:ONE OR MURF..fAAT[R1n(.S SUBJECT TO THE REPOPIMG MOUtREfA:yTD OF GECTIO J 1130F TIIE EMERCtENCY PLA!ININ3 TOLD TI IE COMMUNIIY t1IGHT.70 KNOW ACTS OF I f2.0 OF 40 CFR 372 eo�sccra.ma raa.aaaraau¢Qa.r.a...r a.r.... _=ev oaav■n..ec--s--c=err_ccc=savrw e.eseecscac=a.....w...r.btece=---v-a.=-e ca . SECTION III - PHYSICAL DATA ecac_-sapavv ardor ua�caawssss.ruaan..err acz=—cz csaaaa...nrrrrvrc_ccoeecer...w.rrarc-scan aca.z¢.w s..n.evww ebvc_—vc==.-cr_�srs.• BOILING RANGE: 31.353OF VAPOR DENSITY; HEAVIER THAN AIR" SPECIFIC GRAVITY: .7452 - .7n33 FVAPOTIATION RATE: FASTER THAN N-BUTYL ACETA•(E VOLATILE BY VOLUME: E5-91% ! VOLATILE BY YPEIGH T; 92-96 o WTI: SOLVENT ODOR APPEARANCE: PIGMENTED LIQUID SOLUBILITY,. APPRECIABLE 114 H213 .r.rra.w aeawl�a'al rm•.w wlw rM rw a..r:aae ec..ra..rrF n ar.=....a.......r rr b.at_----....... SECTION IV FIRE AND EXPLOSION HAZARD DATA ; r raQ��m.aa wraa■/bara.is.........w w.,teaa=c===--aca.6Y v,pr_==C=..a...a arts by tee_=p pa�za Rw r.rM•.eaO60==OC====e.....rrn FLAMMA131LITY CLASSIFICATION: FLASH POINT: < -250F OSHA: FLAMMABLE LIQUID-CLASS IA' LOtiVER EXPLOSIVE: LIUIT: 1,0 DOT: :;I'LAMMADLE COMPRESSED GAS (Shipped unckit Consumor Commodiy ORM-U) ,; y. UPPER EXPLOSIVE LIMIT: 12.e EXTINGUISHING MEDIA: DRY CHEMICAL CARDON DIOXIDE FOAM UNUSUAL FIRE.AND EXPLOSION IIAZARUS: CONTCNTS UND>:R PRESSURE. DO NOT USE CR STORE HEAR SOURCES OF HEAT, SPARKS OR OPEN FLAME. KEEP AWAY FROM ANY SOURCE OF HEAT SUCH AS SUNLIGHT,HEATERS,OR STOVES THAT COULD CAU E THE MITAINERTO SUMT. DO NOT PUNCTURE CR INCINERATE. DO tJOT CRUSH OR PLACE IN A GV1R3,AGE C0QMPACTOR. CO NOT STORE AclrV E 120 DECREES FAHFIENHEIT. AEROSOL CONTAINERS MAY EXPLODE WHEN EXPOSED TO EXTREME HEAT. PRODUCT VAFCRS ARE HEAVIER THAN AIR AND MAY TRAVEL LONG DISTANT =TO A SOURCE OF IGNITION AND FLASH BACK. , SPECIAL FIREFIGHTING PIIOCEDUIIES- FULL PROTECTIVE EOUIPMENT INCLUDING SFL F-C�'ITMIV7D PIREATHIIIO AFPAFZATVS TO AVOID INHAL-AlION OF VAPC.*i3S SHOULD PE USED.';rATr II,FRAY 31IOULO NOT BE USED E yCEPT TU KEEP VJV414 VAF'CRS OR COCL CLOSED W41AINERS TO PREVENT BUILD-UP OF PRESSURE. IF 1WAT ER IS USED,FOG NOZZLES ARE PRE FE;iAED. . tar.roam..a.wswaw.wraaa=s=s¢a..rwrrcacr—n_cn.w..rM7occ=c_coar.rrrw.a................wa tvcvc=7 r..wrr brc=c cc=crs w.....z SECTION V- li[ALTH,HAZARD DATA yr..............n...........c.enc ran.........rc--s- ....... cc_a....wa..aan=ccc:.z-r..w•rccccc==: PRIMARY ROUIES OF ENTRY: INHALATION, DERMAL EFFECT OF ACUTE OVEREXPOSURE: INHALATION: T_XroSURE TO HIGH CONCENTRATIOrIS CF VAPORS MAY CAUSE DIz21r;Fss, 8REAT)iING DIFFICULTY,HEADACHES OR RFEPIRATORY IRRITATIONJ• EXTREMELY HIGH C'J'r'CFNTRATIONS MAY CAUSE DFIO1V3!11FS5, STAGGE11440.CONFUSION,U NOON SO IOU SNF.SS,00,1A 1 Oil DEATFI. HIGH CONCENTRATIONS OF VAI`0719 MAY BE IRRiTAT1NG TO THE THROAT ANC LUNGS. SKIN CONTACT: REPEATED AND PROLONGF D CONTACT WITH THE SKIN MAY CAUSE ALLERuIC DER`.1ATITIS. 14AY CAUSE SKIN IRRITATION. SKIN ABSORPTIOtil, PIIODUCT CONTAINS A COMPONENT WHICH CAN RE A9SORB3 D THROUGI I I HE SKIN. EXCESSWE FXPOSl1RE MAY CAUSE HEMOLYSIS(RED BLOOD CELL DAMAGE)WHICH CAN PAPAIR THE BLOODS ABILITY TO TRANSIN)RT OXYOEN. EYE CONTACT: MAY CAUSF PYF IRRITATION. INGESTION: MQUEFLAI LLY TOXIC. ,',', Y CAUSL STU.MACH D:SCOMi! ORT, NAUSEA,WMiIING,DIARRHEA,AND NARCOSIS.. ECTS OF CHRONIC OVEREXPOSURE: CHROMIC OV17.FlEXPoSURF. TO A CCI,IPOIIt-NT c;'i CCYPONF.NTS I111HIS PRODUCT HAVE r ' .N FOUND TO CAUSE THE FOLLOWING EFFECTS IN 1A130RATO(IY ANIMALS: KIDNEY DAMAGE,EYE DAMAGE,LUNG DAMAGE,LIVER ^TJAM_ AGE,SPLEEN DAMAGE,ANEMIA,AND 131 AIN UAF.1A(3r. ...,rrwrwr.e Arrz e-•.an urrapr r.r.-.•mac=c==-"•."'1.•rre rc*nr.--r-to-.:t nt M•f.nnrlc_c�vzsr!^7r1'n.raranvn an Rerw[w[.vw r.nr.a a.v r 0.0 r[[I. n . SECTION V- IIEALTIt HAZARD DATA ; .;::4 ',:'•;•:.; :. . ;:,,•;i, br•.-._c..-wwMnaw..m..r<....nc.awre...nrf--n.e>-!.-^r1'r..••••c•z•!ne---ci n><n•.rr un„r.�a-z rr.^zrsr[Cwwr�r.r,...rr-v.+rrrrw wr.wracc c.— •.. C)IMNIC OVI:Iwr,f109I Inn 1'0 A COMPONENT OR Crih1('QNFtJT;IN TI II'.i r110DI MT IIAS RFFN SIJnGE,rTL•D AR A CAU.;L()r'TI IF.r0i].071111(I EfFrC 18 IN I IUh1ANS: LIVI=n I)APIiAOC..CARDIAC ALiWUI iAM!.I tIL:I.'fir:r'(7LI IS IIAVI_A!;SOCIATEU IIEPEA I ED AND PFIOLC!NCI.0 LXPU'3UlI1 1(_1.' .,•, .I If• I jl '1.I . I;OLVENI3 WITH rEr1?AANEN I-DRAIN AND NERVOUS SY�,TEM UAhtAGE. � IALDICAL CONDITIONS PHONE TO AGGRAVATION BY EXPORUTIC•: NONE GENERALLY RECOGNIZED. EMERGENCY A14D FInST AID PROCEDUTIF-S:-. INi1ALATIOt1: '.IAOVE:'rGnSON TO FRESH AIR. IF RTIr-ATHING F?nrS, APl'P.'r ARTIFICIAL HESPIRA 1)ON AND SFEK MEDICAL ATTEN110N. FYI:CONTACT:'FLUSH WITil LARGE QUANTITICS OF WATCH rnn AT LrAT.;T 15 MINUTES. SKIN CONTACT:.WASH AFFECTED AREA IIIOROUGHLY VITA SOAI' AND WATER. SEEK 1AFDICAL AT1CHIION. IlEtAUVE CONTAMINATED CLOTHING,'LAUNDER CONTAMINATED CLOTHING BEFORE IIUUSE. INOES111011: SINCE THIS PRODUCT MAY CONTAIN WTERIALS WHICH CAN CAUSE LUNQ DAMAGE IF ASPIRATED INTO THE LUNGS,T14F DECISION WHETHER TO INDUCE VOt.11711NG OR NOT MUST ' BE FAADE BYA PHYSICIAN AFTErI CAREFUL CONSIDERATK)N OF ALL MAI ERIALS INGESTED. rwrwa[/w.wr mace--co_ceaena rrn.oa c�ac vc_--r-sc==n_-n=r r. r.•-.wa•r-'+a cc so—r.ccvo—ccc.cr.rrww.w.=<.-s ca c==cccc cawwcr[www.cec, t" SECTION VI: nREACTIVITY DATA Yr[wrwrP`wrs.T.a3cZC=s=:a.�G=cr[wn rbnnM r�N..,.ec r_IIa _ - _�-____.:^-�`Y rY111'-IPnr C�6 CCC^C�^^---=-�Cn[tlYrr[ww Pa OFa3c C�aCaa.CCw C=Ly STABILITY: THIS PFiODU,,TISSTABLE UNDER_NOnh1ALSTORAGE CONDITIONS. HAZARDOUS POLYMERIZATION- WILL NOT OCCUR UNDER NORMAL CONDITIONS. HAZARDOUS DECOMPOSITION rRODUCIS: .THERtr!fiL DECUMf'dSITIUtd MAY PRODUCE CARBON DIOXIDE, CARBON MONOXIDE, AND UNIDENTIFIAGLF-ORGAt1!C NtAIEFIIALS. .. CONDITIONS TO AVOID: AVOID CONTACT-1TH HC-AT,'SPARKS, AND OPEN FLAIAE, INCOMPATIBILITY STFIONG OXIDIZI14G AGENTS:,1'' ' ;1 ' • ;''` :. ' ':' ' ,stzan�rn nrMN►r a.r a'a.m Yr v.tJnr�a==� ��C�r'-^rh•�rr,rr...........rrrcaca L��c��caCVQs ca Lacm • SECTION VII —SPILL OR LEAK PROCEDURES ........G. .r v. ia.lrrA Hnn Nn w.R►vurnncc> �_� --c3c---�.:-:_ -==bC= c:r3�On^.CwRrww♦w.www.arnzwCZ4 Ca C===LO CCSCr.v2 nr an rP i 8TEP8 TOc-�r 13E TAKEN Itl CASE MATERIAL'IS RCLF:ARr:U on SPI1_LEt): 115MOVE-ALL SOURCES OF IGNITION. AVOID HEAT, 1 SPARKS AND ANYTHING WHICH COULD CAUSE FIRE. VENTILAI E AREA OF SPILL AND ADJACENT LOW-LYING AREAS, AVOID BREATHING SOLVEN'C VAPORS. REN'AVE WITH Il4ERTA=n2ANT MATERIAL.-,ANU NON SPAFIKING TOOLS. ; WASTE DISPOSAL Mr-T1(0T), PLACE IN CLOSED CONTAIIIERS.` DISPOsr of rilaDUCT IN ACCORDANCE WITH LOCAL,COUNTY,STA1E, AND FEDERAL REGULA1IONS. i. ;..:':'C ':., .;:. :; .�:`r.:.:.: ...• ::,., ,., ;. _ ___ ___ .: .• ^^..^.-^ ,..•.�Z�_�!r^n-.{!��w..v..larrrr..vwrrrwewrwry rrrr Pc caraes:az C.f C�nZ;rn� SECTION ,VIII; SArE .HANDLING AND USE INFORMATION -r.var wv.vrm re rmicrr�c-sc=�T=arCCT� 7;x�a� a= ': __ =c�=�►TC��"nr!:r:.th Mrn Nrrn/wrwwwv.tw►www..rrra naersoeaer-sr��` RESPII1ATORY PROTECTION IF WORKPLACE EXPOSURE L1tAITS AnE EXCECDro FOR ANY COMPONENT (SEE SECTION 2 FOl HAEII RDOUS COMPONENTS AND EXPOSURE LIMITS),A N10SH/0 HA APPROVED RESPIRATOR SUITABLE FOR COMPONENTS LISTED IS ; ' RECOMMENDED .:,. i�• j,,. �: •- ; ;'' VENTILATION: SUFFICIENT VENTILATION, IN VOLUMI! AND PATTERN, SHOULD HE PROVIDED TO KEEP Ain CONTA1. AT10N F3FIL CURRENTA('('LICAE3LE CC HAPEnMISSIELE EXPOSURE LIMIT Oil ACGIII'S-TLVLIIAIT.• ' ' "4 ':'i' ''' PROTECTIVE GLOVES: CHEMICAL RESISTANT PLASTIC On RUBBEn GLOVES ARE RECOMMENDED FOR PROLONGED OR REPEATED CONTACT. : :w•:1•, ter': .. EYE PROTECTION: CHEMICAL GOGGLES WII H SIDE SHIELDS 011 FACE SHIELD An(.RECOMMENDED IF CONTAC f WITH EYES IS LIKELY. OTHER PROTECTIVE EQUIPMENT': APPn0PRIATE IMPERVIOUS CLOTHING IS nECOMMENDED IF PROLONGED OR REPEATED CONTACT.; 13 LIKELY. HYGENiC PRACTICES: WASH HANDS 13EFORE EATING:OR SMOKE, IN DESIGNATED AREAS ONLY. rr.IW Wl,r rta►rtla ra tofracv v.tKvi:_•,s�c��s=c-'�,:r:.__. ___ ___ _^i_.__ _�- -- _ _--_ -LSC-�m�rCC rQa Crvr.f a.or6lftitrs rvo by ry ae a.Cv rc yD.' SECTION IX - SPE-CIAL. rPRECAUT1014S va v3 v.�rca-a---'•r---v-r---e----e=r-e----c-rrr-ne zee ca r.r.r.ze eou ar._ra:csanvan o........... ...ev.r.wscvene an enanr_a a-er.r.- PRECAUTIONS TO BE TAKEN IN HANDLING ACID STnHAG : 9101117-. IN A COOL DRY AREA VJITIl VENTILATION 31JITARI.F ron STCr11NG t.V11 LRIAI c t H7WN RI SL Cl IU1J II. STORE III A COUI,PI,A�:C AWAY F Iiom DIRECT SUNLIGHT Oil ANY 7..JURCE CUB-IGHI TIOtI. LYa NOT STORE ATTEMPERATURESABOVE 120 DEG,1EESF, 0711ER PRI CAUT10tM INTENTIONAL M!SUS'BY DELIBEFIATELY CONCENTRATING AND INHALING TiIE CONTENTS OF Tli!S PRODUCT CAN. '. BE HARMFUL OR FATAL, r/Y wY rrHrr.........r........n r .........cccsnn cvcc......c cs.cv var_ :. . r SECTION X - FIMIS RAT1140S c rercra rra=5�—c=e_o===: _ _ _ ='_- ===r-===z=r..cu rr acu,.uuv,,.r,vh.r•rn••rwpr►.n.w♦nrrwa rr r.rrrarr/rr.r......w.n..ea vo cove ee HEALTH: 2 :';.: ?`. FLAMMABILITY:? :4 r.`':';,; ;!; . flEACTIVITY: 0 ' Pf_RSONAL' PROTECTION: q{ G 4 r4 ww ww wrw/rwwrrwWww MN■wra[Nrr.`.1r'a Cv�mCv=Ca C�n-TTamT.c�CCC=aac3aa��ar�=tmC^_a�C:�aar39�a Q36as Cac��ca<3Suawrvanrtwra■67�ci■Or��I ' 'lY:�yttl•: y ,; - 1 .,,. .rj: :A'1•,.: .rf:. • 'It GIVI•, fill ;,I•: I' 'l':)I""ii:''15t'� .: %,;. . ;::): (.i ;ISECTIOWi X1 DISCLAIMER!, .i� :�' .nawa es.aaar n.ee-.rw...wr.r..r,...wwwnuc rr•rn ter eatean=-amcamav-�eaea................ ro=e=r_�cae an et:ma rrea rcori ca cn�':, EI. r_�.....a.� ff THE NFO(1rMTpN COtITAINfD 1rL(tERI IS,TO THE UEG T OF OUTI KNDV.'LEDGr:AND R171.TFF,ACCU(IATF.: FIOWFvrn,S1Ir_E 1HE CON71ONS OF HAN[>LINt3 A14n, 1�USE Alt-t3EYDrm OUR CONTrim.WF.MAKE NO GUARANI CC'CI-FIESULI S.At ID A3SUMI:NO LIAafLII Y FOR DAMAGES IrICURTi1:D BY U5E or-I HIS 11,ATEMAL. i • IS TIE REspcNEIBILITY OF 111E U6ER TO COMPLY WITH All AP11 ICAnt I;TTIAFIIAI.,Sl All:AND LOCAL LAWS AND REGULAI IONS.t.: ,?a'� `'•! i1L'�"''' ` ' Y •',ij}`;°.�tf rI. -., _.CST',, ,,. r.t . .11 :c',4 'r`it•5\)`1 * ct''. �..,} ) +., -fy;:L';yl. 11 !1.1,: lti,j�l b I 1 I � ti SS i j� (•}. h•.V '1 � � , al'.•:'r':-Mslr.,.�I'. .If':II'`, ..4 .r. (, .. •\I't:J1:i Y i•�/t •( t +•�' 1`Ir t '1 �I'Clr -- Page 1 SK-0989 version 1 .002 09/26/91 MATERIAL SAFETY DATA SHEET Monarch Division H. B. Fuller Company Date: 26 September 1991 . 3900 Jackson Street N.E. Minneapolis, Minnesota 55421 Prepared by: Industrial Hygiene (612) 781-8071 Telephone Number: 612/481-3300 Emergency Medical Telephone Number: 800/228-5635 PRODUCT IDENTIFICATION H. B. Fuller Company Name: SK-0989 Tradename: LOTIONIZED HAND CLEANER Product Class: Cleaning compound ' DOT Proper Shipping Name: Compound, cleaning, liquid, NOI DOT Hazard Class/I.D. Number: Not applicable DOT Label : Not required WARNING STATEMENTS No specific warnings for normal use conditions. PRECAUTIONARY MEASURES Wear appropriate protective equipment when working with this product. HMIS RATING Health-1 Flammability-O Reactivity-O See OCCUPATIONAL CONTROL. PROCEDURES for personal protective equipment recommendations. EMERGENCY AND FIRST AID PROCEDURES. FIRST AID: If in eye: Flush immediately with large amounts of water for at least 15 minutes. Call a physician. If on skin: Wash affected area with soap and water. Launder contaminated clothing .before reuse. If vapors inhaled: Remove from exposure. Restore breathing if necessary. Keep warm and quiet. Call a physician. For ingestion: If person can swallow, give one glass of water or milk. Do not induce vomiting.' Get immediate medical attention. Never give anything by mouth to an unconscious person. In case of fire: Non-flammable Spill or Leak: Contain and remove with inert absorbent. NA - not applicable NE - not established n Page 3 SK-0989 .version.-1 .002 09/26/91 PHYSICAL DATA Physical State: PINK liquid pH: 6.5 (1% solution) Boiling Range: NE SPILL, LEAK & DISPOSAL INFORMATION Spill or Leak Procedures: Contain spill , dilute if necessary and remove with inert absorbent. Waste Disposal : To the best of our knowledge, this product does not meet the definition of hazardous waste under the U.S. EPA Hazardous Waste Regulations 40 CFR 261- It does not contain any added raw materials with known levels of TCLP constituents as identified in section 261 .24 of the U.S. EPA Hazardous Waste Regulations. Leachate. tests have not been performed. State or local hazardous waste regulations may apply if they differ from the federal regulation. For additional waste disposal assistance, consult H.B. Fuller Environmental Services at 612/481-1588. STORAGE No special requirements for storage. REGULATORY INFORMATION TSCA All components of this product are registered under the regulations of the Toxic Substances Control Act. SARA TITLE III Section 313: This product does not contain regulated levels of any toxic chemical subject to the reporting requirements of section 313 of Title III of the Superfund Amendments and Reauthorization Act of 1986 (SARA) and 40 CFR part 372. STATE REGULATIONS California: Proposition 65, The Safe Drinking Water and Toxic Enforcement Act of 1986: This product does not contain known levels of any chemical known to the State of California to cause cancer or cause reproductive damage. NA - not applicable NE - not established MATERIAL SAFETY DATA SHEET ff I - PRODUCT IDENTIFICATION COMPANY NAME: Calaon Vestal Laboratories Tel No: (314)535-1810 ADDRESS: 5035 Manchester AvenueNights: (314)535-1395 _ St Louis MO 63110 CHEMTREC• (800)424-9300 PRODUCT NAME: Pol-E-Z 692 Product No.: 2F18 Synonyms: Multicomponent Emulsion II - HAZARDOUS INGREDIENTS OF MIXTURES MATERIAL• (CAS #) ' % By Wt. TLV PEL Petroleum distillate (64741-44-2) <20 5mg/m3• 1 N/A 'Air concentration for cis mist referenced by supplier (TLV 5mg/m3) . I 1 III- PHYSICAL DATA Vapor Pressure, mm Hg: Unknown Vapor Density (Air=1)60-90F: Unknown Evaporation Rate(ether=l): ,N/A % Volatile by wt <55 Solubility in H2O: Miscible pH @ Solution N/A Freezing Point F: N/A pH as Distributed: N/A PointBoiling Unknown Gravity H2O=1@25C: 1 .08 Odor: lucent Oliquid twith s trans- Specific greenish tint and slight hydrocarbon odor IV - FIRE AND EXPLOSION Flash Point F: N/A Flammable'Limits: N/A Extinguishing Media: Product is not flammable or combustible. Use media appropriate for primary source of fire. Special Fire Fighting Procedures: Exercise caution when fighting any chemical fire. A self-contained breathing apparatus and protective clothing are essential. Unusual Fire and Explosion Hazards: None known. V - REACTIVITY DATA Stability - Conditions. to avoid: None known. Incompatibility: Strong oxidizers and reducers. , Hazardous Decomposition Products: None known. Conditions Contributing to Hazardous Polymerization: N/A 5(Cont' d on Page 2) MATERIAL SAFETY DATA SHEET • '` I - PRODUCT IDENTIFICATION COMPANY NAME: Caloon Vestal Laboratories Tel No: (314)535-1810 ADDRESS: 5035 Manchester Avenue 'Nights: (314)535-1395 Saint Louis, Missouri 63110 '�CHEMTREC: (800)424-9300 PRODUCT NAME: Cat Floc K-5 1,Product No.: 2B13 Synonyms: Cationic Polymer Solution II - HAZARDOUS INGREDIENTS OF MIXTURES MATERIAL• (CAS#) (Oral LD50) (Mouse) ' % By Wt. TLV ! PEL Aluminum sulfate (10043-01-3) .6207 mg/kg >30 2mg/m3 2mg/m3 III- PHYSICAL DATA Vapor Pressure, mm Hg: N/A Vapor Density (Air=1)60-90F: N/A Evaporation Rate(ether=l): N/AV % Volatile by wt >55 Solubility in H2O: Complete pH @ Undiluted Solution N/A pH as Distribut : 1 .2-3.2 BoilinggPointtF: >212V Appearance: Clear light yellow slightly Specific Gravity H2O=1 @25C: 1 .25 Odor: viscous liquid IV - FIRE AND EXPLOSION Flash Point F: Not flammable Flammable Limits: N/A Extinguishing Media: Product is not flammable. Use water spray, dry chemicals, foam or carbon dioxide. Special Fire Fighting Procedures: Use caution when fighting any chemical fire. The use of a self-contained breathing apparatus is essential . Unusual Fire and Explosion Hazards: Emits toxic gases under fire conditions. V - REACTIVITY DATA Stability - Conditions to.avoid: Product is stable. Incompatibility: Aluminum sulfate solution is weakly corrosive to mild , steel , aluminum and zinc. Avoid contact with strong alkalies. Hazardous Decomposition Products: Thermal decomposition may generate sulfuric acid, CO, CO2, oxides of nitrogen, sulfur and aluminum. Conditions Contributing to Hazardous Polymerization: None known. (Cont' d on Page 2) rF If X-t HPa/ gZe Commonwea" �e�ai�r�zerr� o�f�iulru Daniel S. Greenbaum Commissioner ✓�'�` �, ./L"=A� OSY47 Gilbert T. Joly Regional Director i COPY July 23, 1990 Nutter, McClennen & Fish RE: BARNSTABLE--WSC-4-0937 One International Place The Cape Cod Company, Boston, Massachusetts 02110-2699 Division of Eagle Snacks Inc. , Breeds ATTENTION: Anne Smiley Rogers Hill Road, M.G.L. , Ch.21E and 310 CMR 40.000 Dear Ms. Rogers The Department of Environmental Protection, Bureau of Waste Site Cleanup, (hereafter, the "Department") , is in receipt of your July 5, 1990 letter, in response to the Department's June 19, 1990 letter, to Anheuser Busch Companies, Inc. (hereafter, "Anheuser Busch") regarding the Cape Cod Company, Division of Eagle Snacks Inc. (hereafter, the "Location") . Please be advised that •the Department continues to consider Anheuser Busch to be a Potentially Responsible Party (PRP) for the release of chloroform to the environment in the .area of the Barnstable Fire District Public Water Supply Well (BFD PWS) 12. The Department has determined that the Cape Cod Company property meets the criteria of 310 CMR 40. 521 (1) for Locations to Be Investigated. The past and present uses of the property, the conditions reported, and information provided to date indicate that the property is reasonably likely to be a disposal site within the meaning of the Massachusetts Oil and Hazardous Material Release Prevention and Response Act (M.G.L. , Chapter 21E) . As stated in the June 19, 1990 letter, chloroform contamination was found in ground water downgradient of the Cape Cod Company and because chloroform has been and--is used in the plant, the Department has determined that the Cape Cod Company property at Breeds Hill Road is reasonably likely to be a disposal site. Additional assessment work is necessary to determine whether the Location is a disposal site. The assessment data provided to the Department by the Barnstable Fire District is limited in that it fails to indicate the source and extent of the contamination. The Cape Cod Company is located Original Printed on Recycled Paper f -2- immediately upgradient of BFD PWS #2 . In your July 5, 1990 letter, you indicate that the Cape Cod Company currently uses chloroform in the plant laboratory. In theory, even a one time release of a very small quantity of chloroform to the septic system could result in contamination in groundwater at levels exceeding the Maximum Contaminant Level for drinking water, as encountered in BFD PWS #2. Regarding your concern that a Phase I report and the Interim Site Classification Form are not necessary, the Department has again reviewed all the information available and has determined that although the Preliminary Assessment (PA) Report Form has not been completed for the Location, there is enough information on file equivalent to the PA. Therefore, the Department has determined that the Phase I - Limited Site Investigation/Report and the Interim Site Classification Form are necessary for the Location. You are also concerned that the Department required extensive testing, in addition to chloroform, to be performed as part of the Phase I investigation. Because traces of another contaminant was detected in groundwater in monitoring well #6, just downgradient of the Location, the Department required the additional testing. Please be advised that the deadline of 90 days set out in the Department's June 19, 1990 letter (see item 2 .c, page 3) for the submittal of the Phase I Report and the Interim Site Classification Form will become applicable upon receipt of this letter. The Department's top priority is the protection of existing and potential water supplies. Therefore, the Department will continue to identify reasonably likely source(s) and will notify all Potentially Responsible Parties of their liability to the Department for the release under M.G.L. , Chapter 21E. Department personnel will be available to meet with you and your client to discuss this letter. Please contact Maria Pinaud at (508) 946-2869 to set up a date and time for the meeting. The Department looks forward to your cooperation in this matter. Very truly yours, M rk J. .,6egleyj::::1C'higf Waste Site Cleanup Section B/MP/rr CERTIFIED MAIL #P 707 024 578 RETURN RECEIPT REQUESTED r ram' -3- cc: DEP - BWSC - Boston DEP - SERO - Data Entry Town of Barnstable_ Town Hall Hyannis, MA 02601 , ATTN: Warren Rutherford Town Manager Hazardous Waste Coordinator Town Hall Hyannis, MA 02601 DEP - Div. of Water Supply - SERO ATTN: Larry Dayian Barnstable Fire District P.O. Box 546 Phinney's Lane Barnstable, MA 02630 ATTN: John Erickson Anheuser Busch Co. , Inc. Executive Office One Busch Place St. Louis, Missouri 63118-1852 ATTN: Glennon Martin, Jr. I 677, 1 1y Sye y`' Daniel S.Greenbaum o Commissioner Gilbert T.Joly �p �e �p fh ox/�e �Regional Director oZ.Q.'! glad , , 02347 � DEOE �^ September 6, 19891 NOWIS TsiE DEPARTMENT OF ENVIRONMENTAL PROTECT 0H Cape Cod Potato Chips RE: BARNSTABLE--Cross Connections_ Breed's Hill Road Cape Cod Potato Chips Hyannis, Massachusetts 02601 PWS ID #4024000 NOTICE OF NONCOMPLIANCE THIS IS AN IMPORTANT NOTICE. FAILURE TO TAKE ADEQUATE ACTION IN RESPONSE TO THIS NOTICE COULD RESULT IN SERIOUS LEGAL CONSEQUENCES. Department personnel have observed that on July 21, 1989, your facility at the above- address was in noncompliance of the Drinking —� Water Regulatons of Massachusetts. Attached hereto is a written description of 1. each activity referred to above, 2. the requirements violated, 3 . the action the Department now wants you to take, and 4 , the deadline for taking such action. If you fail to take any action the Department now wants you to take by the prescribed deadline, or if you otherwise fail to remain in compliance in the future with requirements applicable: to you, you could be subject to legal action, including, but not limited to, criminal prosecution, court-imposed civil penalties, or civil administrative penalties may be assessed for every day from now on that you are in noncompliance with the requirements referred to above. Very truly yours, Qawrence S. Dayian; C ief Water Supply Section . D/ROW/lm CERTIFIED MAIL #P904 977 612 RETURN RECEIPT REQUESTED Original Printed on Recycled Paper _2_ cc: Barnstable Fire District Box 546 , Phinney's Lane Barnstable, MA 02630 Barnstable Board of Health Town Hall 367 Main Street Hyannis, MA 02601 Barnstable Plumbing Inspector Town Hall 367 Main Street Hyannis, MA 02601 NOTICE OF NONCOMPLIANCE NONCOMPLIANCE SUMMARY NAME OF ENTITY IN NONCOMPLIANCE: Cape Cod Potato Chips NONCOMPLIANCE OCCURRED OR WAS OBSERVED: Breed's Hill Road Hyannis, MA 02601 DATE WHEN NONCOMPLIANCE OCCURRED OR WAS OBSERVED: July 21, 1989 DESCRIPTION OF NONCOMPLIANCE: 1. Cold water line feeding in fire sprinkler system equipped with siamese connections; ! 2 . A pressure type vacuum breaker installed on the lawn sprinkler system below the highest sprinkler head; 3 . Water line feeding domestic use including safety showers and eye washes downstream of existing reduced pressure backflow preventer's. REQUIREMENTS NOT COMPLIED WITH: 310 CMR 22 . 22 (2) (a) states that no person shall maintain on premises which they own or occupy a physical cross connection between the distribution system of a public water supply and the distribution system of an unapproved source unless the installation has been reviewed and approved 'by the appropriate reviewing authority. ACTION TO BE TAKEN, AND THE DEALINE FOR TAKING SUCH ACTION: The Department hereby requires that an approved type double check valve assembly be installed on the water line feeding the fire sprinkler system equipped with siamese connections. In addition, the Department requires that the pressure type vacuum breaker installed on the lawn sprinkler system be raised to a height of 12" above the highest outlet of the system and all domestic water use including safety showers and eye washes be relocated to the upstream side of the existing reduced pressure backflow .preventers. Plans for the necessary corrective work must be submitted to this office for approval within sixty (60) days after reciept of this communication. If you have any questions, please contact Richard 0. Wiles at (508) 946-2760. DATE: / �= - / BY: i Lawrence S. Dayian, Chi , Water Supply Section Z DARRITAft v61p. (� 36 7 Main Street, yunnie, ft w. 02601 i August 10, 1988 THE CAPE COD POTATO CHIP COMPANY INDEPENDENCE PARK Breeds Hill Road Hyannis, Ma. 02601 g Dear Sirs: We have .forwarded f our list o s r Y substances that you are now usingand storing in d g your facility to the Hazardous Waste Coordinator, Thomas McKean and to our Department of Public Works for their information also. Thank you for keeping us informed under Section 311 of Sara Title III . i f Sincerely yours, rancis I . Broadhurst, Chairman Board of Selectmen THECAPE CODIndependence Park • Breeds HiH Road POTATO CHIP Hyannis, MA 02601 508-775-3358 COIWI%TW TOWN OF BARNSTABLE SELECT I-A;1'S -F ICE 088 AUG -Z A 9 :13 July 28, 1988 Chairman, Board of Selectman Town of Barnstable Town Hall Barnstable,J MA 02630 Dear Sir: In order to maintain compliance with Section 311 of Sara Title III, I am enclosing 3 MSDS's for substances we are now using and store in our facility. They are as follows: Zep Lemonex Zep Concentrated Glass Cleaner Drierite Dessicant Also enclosed is a revised MSDS for: Zep Reach Sincerely, Kimberly Baker Quality Control Manager kb/mc Enclosures: cc: Donna Hoke 1. MATERIAL SAFETY DATA SHEET ® AND SAFE HANDLING AND DISK)SAL INFORMATION.' PAGE 1 OF 3 ZEP MANUFACTURING COMPANY DATE : 06/15/88 ZEP REACH ep. FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 05/22/86 PRODUCT NUMBER: 0725 ECTION I — E M E R G E N C Y C 0 N T A C T' S FP MANUFACTURING COMPANY NON-OFFICE HOURS, WEEKENDS, AND HOLIDAYS: AREA CODE 404 . 0. BOX 2015 435-2973, 996-0899, 252-1587, 351-2952, 445-9226 TLANTA, GEORGIA 30301 LOCAL POISON CONTROL CENTER . . . . . . . . . . . . . . . . . . . . . . . . . . ELEPHONE (404)352-1680 TRANSPORTATION EMERGENCY ET14EEN 8: OOA. M. -5: OOP. M. CHEMTREC: TOLL FREE 1-800-424-9300 ALL CALLS RECORDED ,EASTERN TIME ZONE) DISTRICT OF COLUMBIA (202)483-7616 ALL CALLS RECORDED 'EC T I ON- - - I I - H A Z A R D0 U S I N G R E D I E N T S TLV EFFECTS I lu ESIGNATIONS (PPM) (SEE REVERSE) PROD. .* LOW ODOR PARAFFINIC SOLVENT **. odorless base oil; 500 CNS CBL 30--40 ispersol; CAS# 64742-47-8; RTECS# NONE; OSHA PEL- '00 p p m. * P40flYLPHENOXYPOLY(ETHYLENEOXY)ETHANOL # N/D EIR cly (cxy-1, 2-ethanediyl ) , alpha-(nonylphenyl )-omega- ydroxy; CAS# 7016-45-9; RTECS# MD905000; OSHA PEL- 1/D - PECIAL NOTE: ADVERSE HEALTH EFFECTS WOULD NOT BE EXPECTED UNDER RECOMMENDED ONDITIONS OF USE SO LONG AS PRESCRIBED SAFETY PRECAUTIONS ARE: PRACTICED. -------------------------------------------------------------------------------- ECTION III - H E A L T H H A Z A R D D A T A CUTE EFFECTS OF OVEREXPOSURE: HIS PRODUCT IS NOT SUFFICIENTLY VOLATILE TO CONSTITUTE A SIGNIFICANT IHALATION AZARD. SEVERE OVER-EXPOSURE TO CONCENTRATED VAPOR MAY PRODUCE MILD CENTRAL NER- OUS SYSTEM DEPRESSION, CHARACTERIZED BY HEADACHE AND STUPOR. INTRODUCTION OF OLVENTS, AS IN ASPIRATION OF VOMITUS FLUIDS► MAY PRODUCE CHEMICAL PNEUMONIA. HIS PRODUCT CAN BE AN EYE IRRITANT. INFLAMMATION OF EYE TISSUE IS CHARACTERIZED Y REDNESS, WATERING, AND/OR ITCHING. I 1�m .1.7 MATERIAL SAFETY DATA SHEET jp AND SAFE HANDLING AND DISPOSAL INFORMATION PAGE 2 OF 3 ZEP MANUFACTURING COMPANY DATE 06/15/88 ZEP 'REACH FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 05/22/136 PRODUCT NUMBER: 0925 CTION III - H E A L T H H A Z A R D D A T A (CONTINUED) RONIC EFFECTS OF OVEREXPOSURE: AN WHICH IS REPEATEDLY DEFATTED BY CONTACT WITH THIS PRODUCT MAY BE MORE SCEPTIBLE TO IRRITATION, INFECTION, OR DERMITITIS. NE OF THE HAZARDOUS INGREDIENTS ARE LISTED AS CARCINOGENS BY IARC, NIP, osFi(, T 'D PEL/TLV: NOT ESTABLISHED PRIMARY ROUTES OF 'ENTRY: N/A ' IS CODES: HEALTH O; FLAM. O; REACT. O; PERS. PROTECT. . N/A; CFiROPJIC HAZ NO----------------------------------------------------- RST AID PROCEDURES: - -------------_--- ,IN : THIS PRODUCT IS FORMULATED FOR USE ON THE SKIN, BUT IT SHOULD BE RINSED OFF WITH WATER. ES IMMEDIATELY FLUSH EYES WITH PLENTY OF WATER FOR AT LEAST' 15 MINUTES, C1C- CASIONALLY LIFTING UPPER AND LOWER LIDS. GET MEDICAL ATTENTION AT ONCE. HALE: MOVE EXPOSED PERSON TO FRESH AIR. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION PROMPTLY. 'LEST: IF THIS PRODUCT IS SWALLOWED, DO NOT INDUCE VOMITING. IF VICTIM IS CONSCIOUS GIVE PLENTY OF ' WATER TO DRINK. GET MEDICAL ATTENTION AT ONCE. -------------------------------------------------------------------------------- CTION IV - S P E C I A L P R O T E C T I O N I N 'F 0 R M A T I O N OTECTIVE CLOTHING NO SPECIAL MEASURES ARE REQUIRED. E PROTECTION NO SPECIAL MEASURES ARE REQUIRED. SPIRATORY PROTECTION: NO SPECIAL MEASURES ARE REQUIRED. N TILATION NO SPECIAL MEASURES ARE REQUIRED. ------------------------------------------------------------------------------- CTION V - P H Y S I C A L D A T A ILING POINT (F) N/D SPECIFIC GRAVITY : 0. 9-2 .POR PRESSURE(MMHG) : N/D PERCENT VOLATILE BY VOLUHE (i, ) 83. S% POR DENSITY(AIR=1 ) : N/D EVAPORATION RATE( =1 ) : N/D LUBILITY IN WATER EMULSIFIES PH(CONCENTRATE) : 6. 0 PH(USE DILUTION OF ) : N/A PEARANCE AND ODOR : LIGHT GREEN GEL WITH ALMOND FRAGRANCE CTION VI - F I R E A N D E X P L 0 S I O N D A T A ASH POINT(F) (METHOD USED) : NONE BELOW 160F (TCC ) AMMABLE LIMITS LEL N/D UEL N/D TINGUISHING MEDIA : GEL STRUCTURE INHIBITS COMBUSTIBILITY OF SOLVENT. EC IAL FIRE FIGHTING: NONE USUAL FIRE HAZARDS : PRODUCT WILL NOT FLASH UNLESS HEATED ABOVE 212F. tap, MATERIAL SAFETY DATA SHEET ® AND SAFE HANDLING AND DISPOSAL INFORMATION .' PAGE 3 OF 3 ZEP MANUFACTURING COMPANY DATE 06/15/88 ZEP REAC14 FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 05/22/86 PRODUCT NU11BER: 09215 i CTION VII — R E A C T I V I T Y D A T A ABILITY : STABLE COMPATIBILITY(AVOID) : STRONG OXIDIZERS LYMERIZATION . WILL NOT OCCUR ZARDOUS DECOMPOSITION: MAY DECOMPOSE TO FORM TOXIC/CORROSIVE GASES IF EXPOSED TO HIGH HEAT. ------------------------------------------------------------------------------ CTION VIII — S P I L L A N D D I S P 0 S A L 'P R 0 C E D U R E S EPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: SERVE SAFETY PROCEDURES IN SECTION 4 & 9 DURING CLEAN—UP. ABSORB SPILL ON .ERT ABSORBENT MATERIAL (eg ZEP—O—ZORB). PICK UP AND PLACE RESIDUE IN A JITABLE WASTE CONTAINER. WASH SPILL AREA THOROUGHLY WITH A DETERGENT SOLUTION 'ID RINSE WELL WITH WATER. kSTE DISPOSAL METHOD: QUID WASTES ARE NOT PERMITTED IN LANDFILLS. PRODUCT IS NOT' CONSIDERED A HA;'- DOUS WASTE UNDER RCRA. UNUSABLE LIQUID MAY BE ABSORBED ON AN INERT ABSORBENT g ZEP—O—ZORB ) , DRUMMED AND TAKEN TO A CHEMICAL OR INDUSTRIAL LANDFILL. CONSULT CAL, STATE OR FEDERAL AGENCIES FOR PROPER DISPOSAL ME1-HOD IN YOUR AREA. RA HAZ. WASTE NOS. : N/A ----------------------------------------------------------------------------------- CTION IX — S P E C I A L P R E C A U T I O N S .ECAUTIONS TO BE TAKEN WHEN HANDLING AND STORING: ORE TIGHTLY CLOSED CONTAINER IN A DRY AREA AT TEMPERATURES BETWEEN 40 — 120 F. GREES. F_P PRODUCT OUT OF EYES. EP OUT OF THE REACH OF CHILDREN. ----------------------------------------------------------------------------------- CTION X — T R A N S P O R T A T I O N D A T A T PROPER SHIPPING NAME LONE )T HAZARD CLASS: N/A )T I. D. NUMBER : N/A DOT LABEL/PLACARD: NONE A TSCA CHEMICAL INVENTORY — ALL INGREDIENTS ARE LISTED A CWA 40CFR PART 117 SUBSTANCE(RO IN A SINGLE CONTAINER ) : NONE :. MATERIAL SAFETY DATA SHEET ® AND SAFE HANDLING AND DISPOSAL INFORMATION PAGE 1 OF 3 DATE : 06/06/88 ZEP LEMONEX ZC•P MANUFACTURING COMPANY SUPERSEDES: 03/21/88 PRUDUCI" NUMBER: 0675 FIRST IN MAINTENANCE PRODUCTS C U N T A C T S EP MANUFACTURING COMPANY NON—OFFICE HOURS, WEEKENDS, AND HOLIDAYS: AREA CODE 404 . 0. BOX 2015 435-2973, 996--0899, 252-1587, 351-2952, 445-9226 TLANTA, GEORGIA 30301 LOCAL POISON CONTROL CENTER . . . . . . . . . . . ELEPHONE .(404)352-1680 TRANSPORTATION EMERGENCY . . . . . . . . . . . . . . ETWEEN 8: OOA. M. —5: OOP. M. CHEMTREC: TOLL FREE 1-800-424-9300 ALL CALLS RECORDED EASTERN TIME ZONE) DISTRICT OF COLUMBIA (202)483-7616 ALL CALLS RECORDED ------------------------------------------- ECTION II — H A Z A R D 0 U S • I N G R E D I E N T S TLV EFFECTS % IN ESIGNATIONS (PPM) (SEE REVERSE) PROD. SODIUM METASILICATE ** silicic acid (H2—Si-03) di— N/D COR f 5 odium salt; water glass; CAS# ; 6834-92-0; RTECS# V9275000; OSHA 'Dust Limit-2mg/m3 ( for powders only ) . * NONYLPHENOXYPOLY(ETHYLENEOXY)ETHANOL ** N/D EIR 5-10 oly ( oxy-1, 2—ethanediyl ) , alpha—(nonylphenyl )—omega— ydroxy; CAS# 9016-45-9; RTECS# MD905000; OSHA PEL— /D * GcUATERNARY AMMONIUM CHLORIDES #* blend of alkyl N/D COR TOX CBL ! 5 imethylbenzyl ammonium chlorides and alkyl dimethyl thyl benzyl ammonium chloride; CAS # 5197-80-8; TECS# EI1101000; OSHA PEL—N/D TETRASODIUM ETHYLENEDIAMINE TETRAACETATE ## N/D IRR % S thylenedinitrilo tetra—acetic acid; EDTA; CAS# 4-02-8; RTECS# AH4025000; OSHA PEL—N/D. * TETRAPOTASSIUM PYROPHOSPHATE *# TKPP; diphosphoric N/D IRR 5 cid, tetrapotassium salt; CAS# 7320-34-5; RTECS# NE; OSHA PEL—N/D. ------------------------------------- ECIAL NOTE: ADVERSE HEALTH EFFECTS WOULD NOT BE EXPECTED UNDER RECOMMENDED NDITIONS OF USE SO LONG AS PRESCRIBED SAFETY PRECAUTIONS ARE PRACTICED. -------------------------------------------------------- CTION III — H E A L T H H A Z A R D D A T A UTE EFFECTS OF OVEREXPOSURE: ODUCT IN CONCENTRATED FORM IS A SEVERE EYE IRRITANT. OVER—EXPOSURE MAY LEAD TO rE TISSUE DAMAGE WHICH CAN BE PERMANENT. SKIN CONTACT MAY PRODUCE IRRITATION. geeMATERIAL SAFETY DATA SHEET AND SAFE HANDLING AND DISPOSAL INFORMATION' PAGE 2 OF 3 DATE : 06/06/88 ZEP. LEMONEX ZEP MANUFACTURING COMPANY SUPERSEDES: 03/21/88 PRODUCT NUMBER: 0675 FIRST IN MAINTENANCE PRODUCTS EC UN I - H E A . L T H H A Z A R D D A T A (CONTINUED) HRONIC EFFECTS OF OVEREXPOSURE: EPEATED OR PROLONGED SKIN CONTACT MAY PRODUCE CHRONIC INFLAMMATION OR DERMATIT- So CHARACTERIZED BY REDNESS, SCALING, OR ITCHING. REPEATED EYE EXPOSURE MAY RODUCE CHRONIC INFLAMMATION OF THE EYE OR CORNEAL DAMAGE. ONE OF THE HAZARDOUS INGREDIENTS ARE LISTED AS CARCINOGENS BY IARC, NTP, & OSHA T'D PEL/TLV: NOT ESTABLISHED PRIMARY ROUTES OF ENTRY: N/A -------------------- ----------------------------- IS CODES: HEALTH 3; FLAM. O; REACT. O; PERS. PROTECT. B ; CHRONIC HAZ. NO ------------------------------------ RST AID PROCEDURES: :IN IMMEDIATELY FLUSH CONTAMINATED SKIN WITH PLENTY OF WATER FOR AT LEAST. 15 MINUTES. GET MEDICAL ATTENTION IF IRRITATION DEVELOPS. ES IMMEDIATELY FLUSH EYES WITH PLENTY OF WATER FOR AT LEAST 15 MINUTES, OC- CASIONALLY LIFTING UPPER AND LOWER LIDS. GET MEDICAL ATTENTION AT ONCE. 4HALE: MOVE EXPOSED PERSON TO FRESH AIR. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION PROMPTLY. GEST: IF THIS PRODUCT IS SWALLOWED, DO NOT INDUCE VOMITING. IF VICTIM IS —CONSCIOUS GIVE PLENTY OF WATER TO DRINK. GET MEDICAL ATTENTION AT ONCE. -------------------------------------------- CTIGN IV - S P !E C I A L P R O T E C T I O N I N F O R M A T I O N OTECTIVE CLOTHING WEAR IMPERVIOUS GLOVES THAT HAVE DEMONSTRATED RESIST- ANCE TO THE INGREDIENTS IN THIS PRODUCT. E PROTECTION WEAR SPLASH-PROOF SAFETY GOGGLES ESPECIALLY IF CONTACT LENSES ARE WORN. SPIRATORY PROTECTION: RESPIRATORY PROTECTION MAY BE UNNECESSARY SINCE PRODUCT DOES NOT GIVE OFF SIGNIFICANT QUANTITIES OF VAPOR. NTILATION : IF VAPORS ARE DETECTED, VENTILATE WORK. AREA BY OPENING WINDOWS AND USING EXHAUST FANS. --------------------------------- ------------- CTION V — P H Y S I C A L D A T A ILING POINT (F) APPROX. 215F SPECIFIC GRAVITY 1. 06 POR PRESSURE(MMHG) : N/A PERCENT VOLATILE BY VOLUME (%) : APP. 83 POR DENSITY(AIR=1 ) : N/A EVAPORATION RATE(WATER =1 ) : 1. 0 LUBILITY IN WATER : COMPLETE PH(CONCENTRATE) : 12. 9 PH(USE DILUTION OF 1% SOLUTION ) : 10. 8 PEAR ANCE AND ODOR : BLUE-GREEN, CLEAR LIQUID WITH LEMON-CITRUS FRAGRANCE. ----------------------------------- CTION VI — F I R E A N D E X P L O S I O N D A T A ASH POINT(F) (METHOD USED) : NONE (TCC ) AMMABLE LIMITS LEL N/A UEL N/A TINGUISHING MEDIA NON-COMBUSTIBLE LIQUID. ECIAL FIRE FIGHTING: NONE USUAL FIRE HAZARDS : NONE MATERIAL SAFETY DATASHEET ' ® AND SAFE HANDLING AND DISPOSAL INFORMATION PAGE i OF 3 ' DATE : 06/06/88 ZEP CONCENTRATED GLASS CLNR ZEP MANUFACTURING COMPANY 2 ^�AN SUPERSEDES: O�/�2/87 PRODUCT NUMBER: 1052 FIRST IN MAINTENANCE PRODUCTS ECTION I - E M E R GE N C Y C- O N T A C T S EP MANUFACTURING COMPANY NON-OFFICE HOURS, WEEKENDS, AND HOLIDAYS: AREA CODE 404 . 0. BOX 2015 435-2973, 996-0899, 252-1587, 351-2952, 445-9226 TLANTA, GEORGIA 30301 LOCAL POISON CONTROL CENTER ELEPHONE (404)352-1680 TRANSPORTATION EMERGENCY ETWEEN 8: OOA. M. -5: OOP. M. CHEMTREC: TOLL FREE 1-800-424-9300 ALL CALLS RECORDED ASTERN TIME ZONE) DISTRICT OF COLUMBIA (202)483-7616 ALL CALLS RECORDED ----- ------------------------------------------ CTION II - H A Z A R D 0 U S I N G R E D I E N T S TLV EFFECTS % IN SIGNATIONS (PPM) (SEE REVERSE) PROD. ISOPROPYL ALCOHOL ## ipa; dimethylcarbinol; 2-pro- 400 IRR FBL 14-24 nol ; CAS# 67-63-0; RTECS# NTS050000 OSHA PEL 400ppm TETRASODIUM ETHYLENEDIAMINE TETRAACETATE ## N/D IRR r 5 hylenedinitrilo tetra-acetic acid; EDTA; CAS# -02-8; RTECS# AH4025000; OSHA PEL-N/D. ----------------------------------------- ECIAL NOTE: ADVERSE HEALTH EFFECTS WOULD NOT BE EXPECTED UNDER RECOMMENDED NDITIONS OF USE SO LONG AS PRESCRIBED SAFETY PRECAUTIONS ARE PRACTICED. - ----------------------------------------- CTION III - H E A L T H H A Z A R D D A T A UTE EFFECTS OF OVEREXPOSURE: E IRRITANT. EYE CONTACT MAY PRODUCE STINGING, BURNING, INFLAMMATION, AND IN TREME CASES MAY PRODUCE CORNEAL DAMAGE. EXPOSURE MAY BE IRRITATING TO SKIN, - ID UPPER RESPIRATORY TRACT. ACCUMULATION OF HARMFUL QUANTITIES OF VAPOR IS PRE- 'DED BY .SEVERE IRRITATION WHICH MAKES OVER-EXPOSURE UNLIKELY. OVER-EXPOSURE CAN ".SULT IN MILD NARCOTIC EFFECTS, INCLUDING FLUSHING, HEADACHE, DIZZINESS, AND USEA. MATERIAL SAFETY DATA SHEET ODANDSAFE HANDLING AND DISPOSAL INFORMATION PAGE 3 OF DATE : 06/06/88 ZEP CONCENTRATED GLASS CLNR ZEP MANUFACTURING COMPANY SUPERSEDES: 02/22/87 PRODUCT NUMBER: 1052 FIRST IN MAINTENANCE PRODUCTS SECTION V I I - R E A C T I V .I T Y D A T A STABILITY : STABLE INCOMPATIBILITY(AVOID) : HEAT, OPEN FLAME, SPARK, AND OXIDIZING AGENTS POLYMERIZATION WILL NOT OCCUR HAZARDOUS DECOMPOSITION: CARBON DIOXIDE, CARBON MONOXIDE, AND OTHER UNIDENTIFIEI~ ORGANIC COMPOUNDS. ---------------... SECTION V I I I - S P I L L A N D D I S P 0 S A L P R O C E D U R E S 'STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: IMMEDIATELY ELIMINATE ALL FLAME, IGNITION AND HIGH-HEAT SOURCES. OBSERVE SAFET' PRECAUTIONS IN SECTIONS 4 & 9 DURING CLEAN-UP. ABSORB SPILL ON INERT ABSORBENT MATERIAL (eg ZEP-O-ZORB ) . PICK UP AND PLACE RESIDUE IN A SUITABLE WASTE CON- TAINER OR, IF PERMITTED, FLUSH TO SEWER. THOROUGHLY FLUSH AREA WITH WATER. WASTE DISPOSAL METHOD: LIQUID WASTES ARE NOT PERMITTED IN LANDFILLS. THIS PRODUCT IS NOT CONSIDERED A HAZARDOUS WASTE UNDER RCRA. UNUSABLE LIQUID MAY BE ABSORBED 014 AN INERT ABSORB- ENT ( eg ZEP-O-ZORB ) , DRUMMED, AND TAKEN TO A CHEMICAL OR INDUSTRIAL LANDFILL. Ii SOME AREAS DISPOSAL BY FLUSHING INTO A SANITARY SEWER WITH PLENTY OF WATER MAY BE PERMISSIBLE. CONSULT LOCAL, STATE, AND FEDERAL AGENCIES FGR PROPER DISPOSAL METHOD IN YOUR AREA. RCRA HAZ. WASTE NOS. : N/A - ECTION IX - S P E C I A L P R E C A U T I O N S RECAUTIONS TO BE TAKEN WHEN HANDLING AND STORING: FLAMMABLE ! STORE AND USE AWAY FROM HEAT, SPARKS, OPEN FLAME, A14D ANY SOURCE OF IGNITION. 'STORE TIGHTLY CLOSED CONTAINER IN A DRY AREA AT TEMPERATURES BETWEEN 40 - 120 F. DEGREES. DO NOT BREATHE SPRAY MISTS OR VAPORS. KEEP PRODUCT OUT OF EYES. AVOID PROLONGED CONTACT WITH SKIN. CLOTHING OR SHOES WHICH BECOME CONTAMINATED WITH SUBSTANCE SHOULD BE REMOVED PROMPTLY AND NOT REWORN UNTIL THOROUGHLY CLEANED. ----------------------------------------------------------------------------- ECTION X - T R .A N S P 0 R T A T 1 O N D A T A DOT PROPER SHIPPING NAME NONE DOT HAZARD CLASS: N/A DOT I. D. NUMBER : N/A DOT LABEL/PLACARD: NONE EPA TSCA CHEMICAL, INVENTORY - ALL INGREDIENTS ARE LISTED EPA CWA 40CFR PART 117 SUBSTANCE(RQ IN A SINGLE CONTAINER ) : NONE NV. A. HA,MMOND DIIIEIIITE COMPANY MANYrACTURCOS DRIERITE, "The Versatile Desiccant" CONSULTING AND ENGINEERING SERVICE DRYING SOLIDS.LIOUIOS.GASES MATERIAL . SAFETY .-DATA SHEET IDENTITY: Indicating DRIERITE CONTENTS: Calcium Sulfate 97Z, ' Cobalt Chloride 3% SECTION I MANUFACTURER'S NAME: W.A. HAMMOND DRIERITE COMPANY ADDRESS: 138 Dayton Avenue, P.O. Box 460, Xenia, Ohio 45385 EMERGENCY TELEPHONE: CHEMTREC 1-800-424-9300 TELEPHONE NUMBER FOR INFORMATION: 1-513-376-2927 DATE PREPARED: 5-9-86 SECTION II - HAZARDOUS INGREDIENTS/IDENTITY INFORMATION HAZARDOUS COMPONENTS OSHA PEL ACGIH TLV (CHEMICAL_IDENTITY)_ _COMMON NAME_ _ _ _ Smg/M3Z _ _ ` _(mgLM3)_ _ _C_A_S_ NO_ 7 _ Cobaltous Chloride Cobalt Chloride 0. 1 0.05* 1332-82-7 3 (as Cobalt) * Recommended SECTION III - PHYSICAL/CHEMICAL CHARACTERISTICS BOILING POINT: N/A SPECIFIC GRAVITY (H2O=1) : 1.87 VAPOR PRESSURE (mmHG) :N/A MELTING POINT: N/A VAPOR DENSITY (AIR=1) :N/A EVAPORATION RATE: SOLUBILITY IN WATER: 0.3g/100mL (BUTYL ACETATE=1) N/A APPEARANCE AND ODOR: Blue granules, no odor SECTION IV - FIRE AND EXPLOSION HAZARD DATA FLASH POINT(METHOD) : N/A FLAMMABLE LIMITS: LEL N/A UEL N/A EXTINGUISHING MEDIA: Water SPECIAL FIREFIGHTING PROCEDURES: N/A UNUSUAL FIRE AND EXPLOSION HAZARDS: N/A SECTION V - REACTIVITY DATA STABILITY: STABLE: X UNSTABLE CONDITIONS TO AVOID: N/A INCOMPATIBILITY (MATERIALS TO AVOID) : Strong oxidizing agents HAZARDOUS DECOMPOSITION OR BY-PRODUCTS: Thermal decomposition may produce chlorine. HAZARDOUS POLYMERIZATION: MAY OCCUR: WILL NOT OCCUR: X CONDITIONS TO AVOID: N/A SECTION VI - HEALTH HAZARD DATA ROUTE(S) OF ENTRY: INHALATION X SKIN: INGESTION: CARCINOGENICITY: NTP: NO IARC MONOGRAPHS: NO OSHA REGULATED: NO HEALTH HAZARDS (ACUTE & CHRONIC) /SIGNS AND SYMPTONS OF EXPOSURE: This product contains 3% cobalt chloride which causes eye irritation and may cause skin and upper respiratory tract irritation. Overexposure to cobalt compounds may cause nose and throat irritation and an allergic skin rash. They are mildly irritating to the eyes and if ingested, may cause vomiting, diarrhea and a sensation of hotness. Excessive inhalation and/or ingestion of cobalt salts may affect the kidneys, Lungs., and thyroid. MEDICAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE: ResFirat%,ry system conditions and skin diseases. -EMERGENCY AND FIRST AID PROCEDURES: If inhaled, remove to fresh air. If not breathing, give artificial respiration, preferably mouth-to-mouth. If breathing is difficult, give oxygen. Call a physician. If swallowed, give two glasses of water-and induce vomiting immediately. Call a physician. Never give anything by mouth to an unconscious person. In case of contact, immediately' flush eyes with plently of water for at least 15 minutes. Call a physician. SECTION VII - PRECAUTIONS FOR SAFE HANDLING AND USE STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: Ventilate area of spill. Collect material into appropriate containers for reuse or disposal. Material may also be flushed with water to a wastewater treatment system. WASTE DISPOSAL METHOD: Dispose in closed containers, at an approved landfill, in accordance with local, state and federal regulations. Material may also be flushed with water to a wastewater treatment system. PRECAUTIONS TO BE TAKEN IN HANDLING AND STORING: Keep in closed containers. Avoid generating dust. OTHER PRECAUTIONS: Avoid contact with eyes, skin and clothing. Avoid breathing dust. Wash thoroughly after handling. SECTION VI II - CONTROL MEASURES RESPIRATORY PROTECTION: NIOSH/OSHA approved for dust. VENTILATION: Sufficient to maintain OSHA PEL. PROTECTIVE GLOVES: Impervious EYE PROTECTION: Side shield safety glasses or goggles. OTHER PROTECTIVE CLOTHING AND EQUIPMENT: Safety showers and eyewashes. . WORK/HYGIENIC PRACTICES: Good housekeeping procedures should be followed to minimize dust. SECTION IX - REFERENCES Shepherd Chemical Company - MSDS for Cobalt Chloride Hall Chemical Company - MSDS for Cobalt Chloride U.S. Department of Labor - OSHA form approved OMB NO. 1218-0072 OSHA Hazard Communication Standard - 29 CFR. 1910. 1200 Although the information and recommendations set forth herein (hereinafter "information") are presented in good faith and believed to be correct as of the date hereof, the W. A. Hammond DRIERITE Company makes no representations as to the completeness or accuracy thereof. Information is supplied upon the condition that -the persons receiving same will make their own determination as to its suitability for their purposes prior to use. In no event will the W. A. Hammond DRIERITE Company be responsible for damages of any nature whatsoever resulting from the use of or reliance upon information. No representations or warranties, either express or implied, of merchantability, fitness for a particular purpose or of any other nature are made hereunder with respect to information or the product to which information refers. IL THE CAPE COD TowH OF rl° S k' ence Park • Br eds Hill Road SELECT I't4,4 Hyannis, MA 02601 COMPANY � .� JX 14 ago 59 617.775-3358 (Maker of Cape Cod Potato Chips) June 8, 1988 Chairman, Board of Selectman Town of Barnstable Town Hall Barnstable, MA 02630 Dear Sir: In order to maintain compliance with Section 311 of Sara Title III, I am enclosing an MSDS for a new substance we currently use and store in our facility. Sincerely, Kimberly Ba&ler Quality Control Manager kb/mc cc: Donna Hoke MATERIAL SAFETY DATA SHEET AND SAFE.HANDLING AND DISPOSAL INFORMATION PAGE 1 OF 3 {` ! ZEP MANUFACTURING COMPANY DATE 07/24/87 ZEP FORMULA 50 FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 09/27/86 PRODUCT NUMBER: 0859 SECTION I — E M E R G E N C Y C O N T A C T S ZEP MANUFACTURING COMPANY NON—OFFICE HOURS, WEEKENDS, AND HOLIDAYS: AREA CODE 404 P. O. BOX 2015 435-2973, 996-0899, 252--1 587, 351-2952, 445-9226 . - ATLANTA, GEORGIA 30301 LOCAL POISON CONTROL CENTER . . . . . . . . . . . . . . . . . . . . . . . . . . : TELEPHONE (404)352-1680 TRANSPORTATION EMERGENCY -" BETWEEN 8: OOA. M. —5: OOP. M. CHEMTREC: TOLL FREE 1-800--424-9300 ALL CALLS RECORDED (EASTERN TIME ZONE) DISTRICT OF COLUMBIA (202)483-7616 ALL CALLS RECORDED - --------------------------------------------------------------------------------- -.. SECTION II — H A Z A R D O U S I N G R E D I E N T S TLV EFFECTS % IN ::. DESIGNATIONS (PPM) (SEE REVERSE) PROD. ## ETHYLENE GLYCOL MONOBUTYL ETHER # 2—butoxyethan— 25 TOX IRR CBL t 5 ol; butyl cellosolve; CAS# 111-76-2; RTECS# KJ857S000; OSHA PEL (SKIN)-50 ppm. ## SODIUM METASILICATE ## silicic acid (H2-Si-03) di— N/D COR 5 sodium salt; water glass; CAS# ; 6834-92-0; RTECS# VV92750G0; OSHA Dust Limit-2mg/m3 (for powders only ). ## SODIUM DODECYLBENZENE SULFONATE ## linear alkyl N/D IRR r 5 aryl sodium sulfonate; CAS#. 25155-30-0; RTECS# DB6825000; OSHA PEL N/D : 1 i ----------'----.--------------------- ----------------------------_.--.--------------- SSPECIAL NOTE: ADVERSE HEALTH EFFECTS WOULD NOT BE EXPECTED UNDER RECOMMENDED 1CONDITIONS OF USE SO LONG AS PRESCRIBED SAFETY PRECAUTIONS ARE PRACTICED. ---------------------------------------------------------- j SECTION III — H E A L T H H A Z A R D D A T A ACUTE EFFECTS OF OVEREXPOSURE: PRODUCT IN CONCENTRATED FORM IS A SEVERE EYE IRRITANT. OVER—EXPOSURE MAY LEAD TO . EYE TISSUE DAMAGE: WHICH CAN BE PERMANENT. SKIN CONTACT MAY PRODUCE IRRITATION. OVER—EXPOSURE BY INHALATION MAY CAUSE RESPIRATORY IRRITATION. INGREDIENTS IN THIS PRODUCT MAY AGGRAVATE EXISTING SKIN, EYE, AND RESPIATORY DISORDERS. Ssw MATERIAL SAFETY DATA SHEET J r p AND SAFE HANDLING AND DISPOSAL INFORMATION PAGE 2 OF 3 ZEP MANUFACTURING COMPANY DATE 07/24/87 ZEP FORMULA 50 FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 09/27/86 PRODUCT NUMBER: 0859 t SECTION III — H E A L T H H A Z A R D D A T A (CONTINUED) s. CHRONIC EFFECTS OF OVEREXPOSURE: " REPEATED OR PROLONGFD SKIN CONTACT MAY PRODUCE CHRONIC INFLAMMATION OR DERMATIT— It, CHARACTERIZED BY REDNESS, SCALING, OR ITCHING. REPEATED EYE EXPOSURE MAY PRODUCE CHRONIC INFLAMMATION OF THE EYE OR CORNEAL DAMAGE. ANIMAL STUDIES INDICATE A POTENTIAL FOR LIVER, KIDNEY, OR RED BLOOD CELL DAMAGE. ,, RELEVANCE OF THESE STUDIES OR EXPOSURE LEVELS WHICH MIGHT PRODUCE THESE EFFECTS IN HUMANS HAS NOT BEEN ESTABLISHED. NONE OF THE INGREDIENTS ARE LISTED AS CARCINOGENS BY IARC, NTP, OR OSHA. .1 _ {E-.I 'D PEL/TLV: NOT . ESTABLISHED PRIMARY ROUTES OF ENTRY: INH, SKIN. ------------------------------------- •----------------------------- HMIS CODES HEALTH 2�FLAM. O; REACT. O; PERS. PROTECT. B ; CHRONIC HAZ. YES j I -------------------- ..----------------------------------------------------- ------ FIRST AID PROCEDURES: SKIN IMMEDIATELY FLUSH CONTAMINATED SKIN WITH PLENTY OF WATER FOR AT LEAST 15 MINUTES. GET MEDICAL ATTENTION IF IRRITATION DEVEL.OPS. { EYES IMMEDIATELY FLUSH EYES WITH PLENTY OF WATER FOR AT LEAST 15 MINUTES, OC— CASIONALLY LIFTING UPPER AND LOWER LIDS. GET MEDICAL ATTENTION AT ONCE. INHALE: MOVE EXPOSED PERSON TO FRESH AIR. IF IRRITATION PERSISTS, GET MEDICAL ATTENTION PROMPTLY. INGEST: IF THIS PRODUCT IS SWALLOWED, DO NOT INDUCE VOMITING. IF VICTIM IS CONSCIOUS GIVE PLENTY OF WATER TO DRINK. GET MEDICAL ATTENTION AT ONCE. ------------------------------------- SECTIQN IV — S P E C I A L P R O T E C T 1 O N I N F O R M A T I O N ::PROTECTIVE CLOTHING WEAR NITRILE GLOVES OR USE GLOVES WITH DEMONSTRATED j RESISTANCE TO THE INGREDIENTS IN THIS PRODUCT. IEYE PROTECTION WEAR TIGHT—FITTING SPLASH—PROOF SAFETY GLASSES ESPECIALLY IF CONTACT LENSES ARE WORN. -ARESPIRATORY PROTECTION: KEEP FACE AWAY FROM SPRAY MIST AND DO NOT BREATHE VAPORS. VENTILATION IF VAPORS ARE DETECTED, VENTILATE WORK. AREA BY OPENING WINDOWS AND USING EXHAUST FANS. ---------------------------- SEC T ION V — P H Y S I C A L D A T A BOILING POINT (F) APPROX. 22OF SPECIFIC GRAVITY 1. 05 VAPOR PRESSURE(MMHG) : N/D PERCENT VO(..ATILE BY VOLUME (%) 857 VAPOR DEN IT'Y(AIR=1 ) : N/D EVAPORATION RATE(WATER =1 ) : 1. 0 SOLUBILITY IN WATER : COMPLETE PH(CONCENTRATE) 12. 5-13. 0 PH(USE DILUTION OF 1% SOLUTION APPEARANCE AND ODOR : A THIN,' DARK BLUE LIQUID WITH SLIGHT "BUTYL" ODOR. ------------------------------------------------------------------------ ------------ SECTION VI — F I R E A N D E X P L O S 1 0 N D A T A :> FLASH POINT(F) (METHOD USED) : N/D ( ) _ :`. FLAMMABLE LIMITS LEL N/A UEL N/A " EXTINGUISHING MEDIA NON--COMBUSTIBLE SPECIAL. FIRE .FIGHTJNG: WEAR SELF—CONTAINED POSITIVE PROS. BREATHING APPARATUS. UNUSUAL FIRE HAZARDS NONE a k 1 MATERIAL SAFETY DATA SHEET , .e MATERIAL SAFETY DATA SHEET AND SAFE HANDLING AND DISPOSAL INFC'RMATION PAGE 3 OF 3 ZEP MANUFACTURING COMPANY DATE 07/24/87 ZEP FORMULA 50 FIRST IN MAINTENANCE PRODUCTS SUPERSEDES: 09/27/86 PRODUCT NUMBER: 0854 ..,A SECTION V I I — R E A C T I V I T Y D A T A :.; STABILITY STABLE ' INCOMPATIBILITY(AVOID) STRONG ACIDS AND OXIDIZING AGENT'S : POLYMERIZATION WILL NOT OCCUR HAZARDOUS DECOMPOSITION: . CARBON DIOXIDE, CARBON MONOXIDE, AND OTHER UNIDENTIFIED ORGANIC COMPOUNDS. -------------------------------------- SECTIgN VIII — S P ILL AND DISPOSAL PROCEDURES STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: OBSERVE SAFETY PRECAUTIONS IN SECTIONS 4 & 9 DURING CLEAN—UP. ABSORB SPILL ON AN INERT ABSORBENT MATERIAL (eg ZEP—O—ZORB) ; PICK UP AND PLACE IN A CLEAN D. O. T. SPECIFICATION CONTAINER FOR DISPOSAL. WASH AREA THOROUGHLY WITH A DETERGENT SOLUTION AND THEN RINSE WELL WITH WATER. WASTE DISPOSAL METHOD: LIQUIDS CANNOT BE SENT TO LANDFILLS UNLESS SOLIDIFIED. U14USABLE PRODUCT AND SOME COLLECTED, SPENT USE—DILUTIONS MAY REQUIRE DISPOSAL AS A HAZARDOUS WASTE AT A PERMITTED TREATMENT/STORAGE/DISPOSAL FACILITY. IN MOST STATES HAZARDOUS WASTES IN TOTAL AMOUNTS OF 220 LBS. OR LESS PER MONTH MAY BE DISPOSED OF IN A CHEMICAL OR INDUSTRIAL WASTE LANDFILL. IF COMPANY EFFLUENT IS ULTIMATELY TREATED BY A PUBLICLY OWNED TREATMENT WORKS, NEUTRALIZATION OF SPENT TANK—SOLUTIONS WITH SUB— SEQUENT DISCHARGE TO THE SEWER MAY BE POSSIBLE. CONSULT LOCAL, STATE AND FED— ERAL AGENCIES FOR PROPER DISPOSAL METHOD IN YOUR AREA. RCRA HAZ. WASTE NOS. : D002 (SEE ABOVE) ----------------------- ?. SECTION IX - S P E C I A L P R E C A 'U T I 0 N S PRECAUTIONS TO BE TAKEN WHEN HANDLING AND STORING: STORE TIGHTtY CLOSED CONTAINER IN A DRY AREA AT TEMPERATURES BETWEEN 40 — 120 F. DEGREES. KEEP PRODUCT AWAY FROM SKIN AND EYES. -- DO NOT BREATHE SPRAY MISTS OR VAPORS. CLOTHING OR SHOES WHICH BECOME CONTAMINATED WITH SUBSTANCE SHOULD BE REMOVED : .. PROMPTLY AND NOT REWORN UNTIL THOROUGHLY CLEANED. lKEEP OUT OF THE REACH OF CHILDREN. =4 -----------------------------------'-------'-------------------------------------------- SEC T I ON X — T R A N S P O R T A T I O N D A T A IaDOT PROPER SHIPPING NAME NONE DOT HAZARD CLASS: Ni A DOT I. D. NUMBER : N/A LOOT LABEL/PLACARD: NONE EPA TSC.A CHEMICAL INVENTORY — ALL. INGREDIENTS ARE LISTED. - EPA CWA 40CFR PART 117 SUBSTANCE:(RQ IN A SINGLE CONTAINER) : SODIUM DODECYL— ,. 3, BENZENE SULFONATE, 1000# I e_1/Z4e/ CVnMt2t1"W_a&' CIc-'4L eZrICIOA� CA& a -9V.a�rnet Cl en 6,6;11 n0 en _gUaa� C� S. Russell Syl (p��ze C<Jle is Commissioner J Paul T. Anderson �� Regional Environmental Engineer .947=1231, Cfxl 6304N-4 May 20, 1986 e Cape Cod Company RE: SMAPCD--BARNSTABLE--Section 7.02, Breeds Hill Road Plan Approval, Application No. Hyannis,. Massachusetts 02601 SM-85-161-IF, The .Cape. Cod Company, Division of Eagle Snacks, Inc. , ATI=ON: Dean Wiggin Breeds Hill Road Gentlemen: The Department.of Environmental,Quality Engineering, Division of Air Quality Control, has reviewed information submitted..in_the plan application..relative to .the .installation of twelve (12)- existing; and six (6) proposed;. potato chip kettle fryers and, heating and ventilation equipment at The .Cape Cod Company,:, Breeds Hill Road.,. Hyannis, Massachusetts. The application .was submitted undercover letter. dated..December 16, 1985, over the seal and signature of, Donald.M...DeHart, .'.'Temporary Permit Massachusetts, P.E. 1985-97," and as .revised on May 14,, and May 20, 1986 over the seal. and signature of..Larry W. Keith, "Temporary P,.rmit. Massachusetts,, P.E. 1986-50.rr. A specific equipment inventory.listing. is provided on trie attached "Process Equipment Inventory Sheet." A review .of the .information subinitted.:reveals that upon .completion of the proposed plant expansion, the potato chip processing facility will consist .of eighteen (18) identical J.C.. Pitman Company Inc. ,:Model: 800 .batch.type, potato chip kettle fryers and related equipment. Each kettle fryer will have a capacity..of. 180 gallons .of cooking oil (vegetable/ cottonseed oil) which is.heated to a maximum temperature .of..3201F.by twenty eight (28)- natural gas fired burners having a total maximum energy input capacity of 900,000 Btu per hour. Each kettle fryer is or will be equipped with an Electric Control Company Model D-921 temperature controller to automatically. maintain and monitor cooking oil temperature. The potato chip frying process is initiated by a kettle fryer operator. . Upon demand, peeled, washed, whole potatoes are conveyorized from.a storage hopper, fed through a slicer and introduced to..the kettle fryer where the .slices are fried as a batch until done. The cooked chips are removed from the fryer, drained and centrifuged to remove excess oils, and transferred to a belt conveyor for inspection, seasoning, packaging and shipment. On average, six batch frying cycles are conducted.per hour, per fryer, at an average hourly production capacity of 500 pounds per hour of raw potatoes input to produce 150 pounds per hour of finished chips. t1 w -2- Each kettle fryer will be equipped with an overhead hood and ventilation system which is utilized to capture and exhaust. to the ambient air, emissions of particulates (vegetable oils), heat, and water vapor generated from the batch frying process. Each existing kettle fryer (units 1-12) will exhaust 8200 ACFM of air at 120OF by means of one (1) Greenheck Fan Corporation, Model Hp 30-50 aluminum constructed, upblast roof exhauster, the top of which is 28 feet above ground level, and which has an inside exit diameter of 4 feet. Each proposed, new kettle fryer (units 13-18) will also exhaust 8200 ACFM at 120OF by means of one (1) G.C. Breidert Company, model LO-24-13 aluminum constructed, single outlet, horizontal side.discharge power exhauster, which will be equipped with a diverter section to allow for a verticle exhaust. discharge, the top of which will be 28 feet above ground level and which has inside exit dimensions .of 1.33 'feet x 1.33 .feet. The ventilation hoods serving the new kettle fryers (units .13-18) will be equipped with Standard Keil,. Fire Fighter, dual action baffle type grease filters, to control particulate -generated from the .frying process. Each new hood will have 38 square feet of filter area. The ventilations hoods serving the .existing .kettle fryers (units 1-12) will be modified and ultimately retrofitted, by the instal lation .of Standard Keil,: Fire Fighter grease filters. Each existing hood will have 24 square feet of filter area. In addition modifications will be made to the existing fryers, air handling system components (fan wheels, drives and motors) to .provide an acceptable air flow face velocity at the .filters .in order to obtain optimum particulate removal efficiency. Particulates generated, during the frying process will be reduced by 50 percent to .15 pounds per hour by the use of the. grease. filters and air flow modifications, (.'30 pound per hour uncontrolled) per fryer as determined during the recent emission testing .program conducted on. March 13, and 14, 1986. and April 9, and 10, 1986. Based upon the above stated controlled emission rate,. assuming 8760 hours of operation, the potential annual. particulate emission. rate from the facility, after control (18 fryers) will be 11.826 tons per year. The .Department is .of the opinion that the three stage proposal to reduce particulate emissions at the facility and. entitled "Cape Cod Potato Chip Best Available Control Technology .(BACT) Evaluation" revised May 12, 1986, is acceptable-,to the Department as . representing BACT. The proposed stages are: A. Installing new,. more efficient grease filters on .all new and` existing fryers at the facility. B. . Optimizing. exhaust air flow to minimize oil particulate generation while maximizing filter media removal as indicated by manufacturers design and or demonstrated during emission testing, and C. Controlling and monitoring cooking oil temperature to a maximum temperature of 325°F to prevent overheating and a potential smoke condition. Accordingly, the Department is of the opinion that the information submitted, is in conformance with current air pollution control engineering practices and hereby approves the application with the following provisions: -3- 1. The Cape Cod Company shall at the request of the Department perform emission testing to determine the compliance status of the facility with the specified particulate emission limitations of 0.15 pounds per hour, per fryer. Such testing will be performed utilizing test methods approved by the Department. 2. As a result of the o er f.p ation o the existing twelve (12) kettle fryers (units .1-12) , the Department has observed odors approximately one quarter of a mile downwind .of the facility. Should a condition of air pollution result due to the operation .of the facility as approved (18 units) , the Cape Cod Company will implement measures (as deemed appropriate by the Department) to reduce the emission of vegetable oils and eliminate the condition of air pollution. Such measures shall .be .performed in accordance with a compliance schedule approved by the Department. 3.' The Cape Cod Company shall complete the retrofit. of the existing kettle fryers (units 1-12) to include the installation of new Fire Fighter grease filters fan wheels, drives and motors. and to provide air flows at the filter media to achieve'.and ensure optimum particulate removal no later than August 4, 1986. 4. . The..Cape Cod Company shall provide to the..Depar went, within 2 weeks from the .receipt ..of this approval,. and at 2 week intervals thereafter, a .written status of actions that have,.. or will be taken concerning the modifications to the existing kettle fryers:. (units 1-12) as mentioned.in proviso 3 above. This approval is limited.to .applicable air pollution control. "Regulations" only, and does not constitute approval as may be required by other .Department.Regulations or statutes in order for the above mentioned facility to be installed and operated. An Environmental. Notification Form for air quality. purposes was not .required for this action since it is categorically exempt pursuant. to the Regulations Governing the .Preparation..of Environmental Impact Reports adopted by,the Secretary of Environmental Affairs. This action has been determined to cause no significant damage to the environment. Very truly yours,. Paul. T. Anderson, P.E. Regional Environmental Engineer A/VMS/`Qlm Enclosures cc: DEQE - DAQC ATTN: Program Implementation Branch DEQE - DWPC Southeast Region ATTN: Philip Ripa -4- cc: Barnstable Board of Health Town Hall Hyannis, MA 02601 . ATTN: John Kelly Barnstable Fire Department Hyannis, MA 02601 Anheuser Busch Companies One Busch Place St. Louis, MO 63118-1852 ATTN: Donald..M. DeHart, .Sr. Environmental Engineer John V. Steir, Supervisor Environmental Affairs Eagle .Snacks Inc. Division .of Anheuser Busch Companies St. Louis, MO. 63118=1852 ATIN: Glen J. Martin, Vice President, Engineering The Cape Cod Company SM-85-161-IF "Process Equipment Inventory Sheet" Stack Stack Totals Stack . Description Height Dia.. Manufacturer Burner-Model Input MM Btu 1 - 12 Kettle Fryer Exhausts 28 48" Greenheck Fan --- • --- --- 1a- 12a Kettle Burner Exhausts 28 12" J.C. Pitman Pitco - B 12 @ 900,000 10.8 1b- 12b* Unheated Air Makeup 1-12., 12-Air Intakes Kees-KS-18 --- --- --- 13- 18 New Kettle Fryer Exhausts 28 16"x16" Breidert-LO-24-13 --- --- --- 13A-18A Kettle Burner Exhausts 28 12" J.C. Pitman Pitco B 6 @ 900,000 5.4 41 Hot Water Heater 28 14" Teledyne-Laars L-370 925,000 .925 45 •••• Heated Air Makeup Air Intakes Applied Air Systems Midco 9 @ 525,000 4.725 46 -47 Heated Air Makeup Air Intakes Cambridge Eng.Inc. . Maxon 2,500,000 5.0 51 -53 H.V.A.C. - Office 28 6" Lennox Lennox-GS-1105 3 @ 120,000 .360 61 -62 Space Heaters 28 4" Sterling CF - 125 2 @ 125,000 . 250 63 -66 Space Heaters 28 611 . Sterling CF - 200 4 @ 200,000 .800 71 Cleaning System 28 10" Alkota 5200'C-NG-3 490,000 .490 Hourly Gas Totals 28.75MM Outdoor. Makeup to Process Area Direct Fired Outdoor Makeup to Process Area-Combustion Gases to Process Area Natural Gas Emission Potential - AP-42 @ 8760 Hours P - . 63 TPY S - .075 TPY NOX - 12.6 TPY CO - 2.5 TPY VOC-NM .67 TPY VOC- M - .34 TPY Number Fee 1137 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that CAPE COD POTATO CHIPS 60 BREED'S HILL ROAD, BARNSTABLEXA 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 6/36/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 4/1/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 6 Town of Barnstable r Barnstable THE Regulatory Services Department ,AaAmericaCft aAB Public Health Division MAS& 200 Main Street Hyannis MA 026.01 0-59. .� Y D MA't 2007 �. Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO I Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATEJI�r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT sfmt' '7 MA ' /4-C NAME OF ESTABLISHMENT IL— -TO 'U lJl I PS ADDRESS OF ESTABLISHMENT l«�Q ►fee-IDS jC1 �'�. __ TELEPHONE NUMBER U _ ` o�l " J 5 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: 6T lq—TTAO�KF- IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION A/ FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK si�" ko qq SIGNWTURE OF APPLICAN RESTRICTIONS: TELEPHONE# — 5 JAinspection handouts\Haz Mat Application2008.DOC e S-LSnacks MA U-C List of Officers as of May 3, 2013: • Carl E.lee: President& COO ' 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Rick D.Puckett: CFO& EVP 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Margaret E.Wicklund: VP, Controller, Secretary 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Troy W. Bryce: VP and Treasurer 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 Patrick S.Mcinerney:VP of Manufacturing r 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • A.Zachary Smith III: Secretary} 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Michael C.Anderson: Assistant Secretary 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 r MAIL-IN REQUESTS Please mail the completed application form to the address below. 1A1so..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 Page JAinspection handouts\Haz Mat Application2008.DOC 1 - 4 f Number Fee 1137 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health - This is to Certify that CAPE COD POTATO CHIPS 60 BREED'S HILL ROAD, BARNSTABLE, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------------=--------7------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/15/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable °FI E, 'G Regulatory Services Richard V. Scali, DirectorBARNSTA 9 H&% Public Health Division 'Thomas McKean,Director ®�t 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. PL —d °? DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN . 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT /Q NAME OF ESTABLISHMENTS ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER;— ST SOLE OWNER: YES_XNO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: sE& )9-77-#ah 6-Z Q.S T IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. �"-S O U-9[� STATE OF INCORPORATION /VC FULL NAIL AND HOME ADDRESS OF: �• C -1�� L4 S T PRESIDENT TREASURER CLERK a e r "g S CA h0q pl om f Mi SIGNATURE OF APPLICANT RESTRICTIONS: HgMMZM=21ftS CC � 4jjjbff TELEPHONE# Q\Application FormsUiAZAPRDOC S-L Snacks MA,LLC List of Officers as of May 3, 2013: • Carl E.lee: President& COO 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Rick D.Puckett: CFO& EVP 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Margaret E.Wicklund:VP,Controller, Secretary 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Troy W. Bryce: VP and Treasurer 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • Patrick S.Mcinerney:VP of Manufacturing: _ 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 • A.Zachary Smith III: Secretary 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 x •. Michael C.Anderson: Assistant Secretary 13024 Ballantyne Corporate Place Suite 900 Charlotte, NC 28277 r k dt I co m - it "o G Ln ("0 SGJ\e x Pa3e e Goa P m ��/•/ a ` `• yet o T o Ft t<`Q�r • / FAO \ 7� / �• � 3fQ f ,�� ! ••1;�. FAQ I o ... a��ea o2 — k - (�p 5�p rope co�� o e Independence Drive l r . , . «-- tv .� J , t m f t ,i, A j A , , ji . .Y.,, T u J .. t 1.. i)J i' a. R )e. j i F J/ �` . 4 F . / K ' r . ' ..'lll . tj . . 4�� : .�'�,�' " _ . I i t / ' A •', y * .. 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