Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0253 MILLWAY - Health
2.5361,kNkm No. 4210 1/3 BLU p a p(Blmda��� 10%1 o a o 0 ISEfok,4 Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM SSB`"E.g 200 Main Street• Hyannis, MA 02601 059. MAy TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT CFO Business Name: n cable A0.04 Se c Date: �\ Location/Mailing Address: rfea Contact Name/Phone: fi( � - e6 �, Inventory Total Amo nt: MSDS: License#: Tier II : _ Labeling: Spill Plan: CVA Oil/WaterSeparator: A11A oor Drains: Emergency Numbers: Storage Areas/Tanks: aho Emergency/Containment E ui ment: 4A W 1<4 Waste Generator ID: M ' 0 a Waste Product: Date&Amount of Last Shipment/Frequency: alil O's e L ✓ 11 Licensed Waste Hauler&Destination: 7S 0e pro-it a11Ar1G env Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Eloydraulic fluid (including brake fluid) Windshield wash otor oils Miscellaneous Corrosives ir"asoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants iscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes ye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: nbU ,S Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °p IKE roNti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-7s0-6304 ;B`"MASS. 200 Main Street• Hyannis, MA 02601 FO3p+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: .1A;1NV-AA Date: Location/Mailing Address: , A 40M, Contact Name/Phone: 162- ` qLA Inventory Total Amount: f MSDS: 3�-0Al i License#: . Tier I[ : No Labelino: Spill Plan: 41?S Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: o fnS Emergency/Containment Equipm t: ti 'k SP1,12 Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants -- Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible amt&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: " i� Facility Representative: 1' WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �OttNE ip� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9g"M s�`E�,' 200 Main Street Is Hyannis, MA 02601 �AlEOMP'�p`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 6k1livy,torkar� ,n Date: G71I Pgo Location/Mailing Address: `l wa Contact Name/Phone: S02-369IIIH Inventory Total Amount: SDS: 2 License#: Tier II : 0 Labeling: e Spill Plan: uP Oi[/Water Separator: A�� Floor Drains: Emer nc Numbers:V Storage Areas/Tanks: A Je,16K O C M, Qattorls v Emergency/Containment Equipment: ENO av 0m d t Waste Generator ID: Waste Product: I Date&Amount of Last Shipment/Frequencx: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. c Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: �aulk/Grout insecticides, herbicides, rodenticides attery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: ` i Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 260 -G2 v`°F� ►okti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9B"MASS. EOp, 200 Main Street• Hyannis, MA 02601 �p i639. leD MA'S e6,hZ. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Busiines me: `�lW 1J. A f Date: 661 I�I)C�O a` - r1 Location/Mailing Address: Contact Name/Phone: 5� �-4 501- 36a- Uit 6 Inventory Total Amount: SDS: 'License#: _ Tier II : No Labeling: Spill Plan: Oil/WaterSeparator: N Floor Drains: VO Emergency Numbers: Storage Areas/Tanks: qq W `l s Emer enc /Containment E ui met 0 h d Waste Generator ID: 6A 14 00 05 6 5 a Waste Product: Date&Amount of Last Shipment/Frequency: Lv `C J( ✓ Licensed Waste Hauler&Destination: 2 wl(cn ; Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. .V/ Antifreeze zDry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers ydraulic fluid (including brake fluid) / Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: VCaulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: tr)W2 SJrR all Wu nj Call$' Cep Inspector: ,4/ f Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number fee 892 THE COMMONWEALTH OF MASSACH.USETTS $125.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. ..•••••••••••••••••••••••••••...•••••••••••••••••••••••••••••••••••............••••••••••••......•............................... 253 Millway, Barnstable, MA ......••••••••••••......••••••••••••••••••••••••••••••••••••••••••••••••••••••......••••••......••••••••••••...........•••............•••............................... Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ••••••..................••..........................•••.....••••••••••••......•••••••••...••••••••••••••...........••••••••••....•._............................. Restrictions: .•••••....--••.:..................•••...................••••••......•••••••••••••••••••••••••••••••••••••••........•••••••••••••.................................... This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNSTABLE oFTME - ncv.NsuetE•c>:nhvtLLt•toturt•rr< ts Public Health Division PLiSRNlSNILLS•OSE0.VILLE•1'85B>W5T8LE •: 1fi39_2034 2-- BAMSr" s Thomas 1VIcKean Director �Dg pa HAS& CIO 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 101 L� IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 VVS1 t CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El ` i .l'2-3 *A late charge of$10 00 willibe assessed if.payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 300.O Z 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT.APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ►4?— 5. NAME OF ESTABLISHMENT: I I l� N� fA%I Vhn ✓1G 6. ADDRESS OF ESTABLISHMENT:"Z-S3 N i i l lyrian z✓0'4 414 MA 2(n3-b 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: Pp BOx 3 22 &Vn 8. TELEPHONE NUMBER OF ESTABLISHMENT: SO$ 9. EMAIL ADDRESS: y i Ste@�v1 i L 1 W a�+.��rYla t�� Yea . .one 10. SOLEOWNER: y YES NO IF NO,NAME OF PARTNER:. 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Mil l WW 4 IlI&A'00, JAC PRESIDEN I TREASURER I Wo CLERK 774- ft14-- k'72� 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANTIla) DATE Z� �Application FomiS�Haz Mat Appli Draft Jan2019.do Q: c, °F IKE►o�ti - Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASM. � 200 Main Street• Hyannis, MA 02601 - ,a M e,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 P'� M Business Name: ./"4 _ ► (K , G Date: C/16/ lq Location/Mailing Address: S WU-,knq S Contact Name/Phone: MCk bc)4S LVt -�qCM Inventory Total Amount: k a00d ! W SDS: e License#: GG � Tier II : Ac&I'M ,+ ��`�S Labeling: WJ Spill Plan: es Oi[/Water Separato WIA Floor Drains: Emergency Numbers: Storage Areas/7anks: I r- S Emergency/Containment Equipment: APO V -2WO 400611 Waste Generator ID: A PDDDos3�5 Waste roduct: NIA Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: hOther Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: aulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries I Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Cldl Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS °FI1 row Town of Barnstable Office:508-862-4644 BAR Public Health Division Fax:508-790-6304 MASS. 200 Main Street• Hyannis, MA 026011639. �prfDru+"�0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: aK) are Date: Location/Mailing Addre s: S O 18o3e 322. Contact Name/Phone: >4y�a 6455�-F-� So�3-3G�2-'�9�9 ('�l1 SO€�-362-y90y 5'a�k t11- ow,nor Inventory Total Amount: ^'1 Sfl 0ir�o�b qa�5 MSDS: 4 L 5 5}Q�k License#: Tier II : QS 1G.So1w t �ja �u-LS ' Labeling: Spill Plan: Oil/Water Separator: rJ C 0 Floor Drains: o Emergency Numbers: Ye- Storage Areas/Tanks: - IDD tin D<0DCtVXA- , 2.00 o 1a .A, Emergency/Containment Equipment: 1 \Oe� Acu- w. c om5 , 3 o rbc, ( cQ — Waste Generator ID: fl00 s3®0 2 Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS�o v�a\o`< CNkA S i w Kv ac s�xce- NOTE: Under the provisions of Ch. 111, Section 31, of the General Lav�fs of MA, hazardous miterial use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and mov s Hydraulic fluid (including brake fluid) Windshield wash V Motor oils Miscellaneous Corrosives �- Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road saTfs- grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: A k v t o Inspector: , I Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS IB lo Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BAR.Sq E.B- 200 Main Street• Hyannis, MA 02601 �A�FDMA�A`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: M. � y�'{a��Ka- Date: Location/Mailin Address. 2S3 NMI �qt s� l� wta,l 06 3�2 �Ks abe� _Contact Name/Phone: o�v�a ii�0.'s5�"` 08-3b---7q t q �e11 S"o8-362-49 0 4 �2 Inventory Total Amount: ^'1<0 10 MSDS: 25 License#: Ca Tier II : -t\o '"- I 'I I' yOI��Labelino: G-oo Spill Plan: Ye-5- Oil/Water Separator: dJ A Floor Drains: _N o Emergency Numbers: Ye-5 Storage Areas/Tanks: XDo�COO /0 %%&ok� % c Emergency/Containment E u' ment: 3 III ►Z4 �1 boowL. Waste Generator ID: MAV 0000 S3j?2b/J . Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: AAA w'�+e. �s 'Ltl a-�av<5p, -+b a�v�o.1�� Qc, �/• LIST OF TOXIC AND HAZARDOUS MATERIALS 0 WII� l 0d NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws or MA, hazardous mat rial use, 3 storage and disposal of 111 gallons or more requires a license from the Public Health Division. / ✓ Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash �— Motor oils Miscellaneous Corrosives / Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform,formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: 80 -,kit kopovqk 4 0 . v� v� a Inspectors 1 La�4iP. Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date:3 /zy / y TOWN OF BARNSTABLE.- ,o TOXIC AND HAZARDOUS MATERIALS *FORM NAME OF BUSINESS: M I ilk)Aq A446 via, BUSINESS LOCATION: 6-3 IA7,/11 9,t<-A5+"jer INVENTORY MAILING ADDRESS: & &:o l 322- , d�acnsta�o(� TOTAL AMOUNT- TELEPHONE NUMBER: So$ A, 17,Z 04/-Ort3 CONTACT PERSON: �>4K6t_. &55Z --4- EMERGENCY CONTACT TELEPHONE NUMBER: Cc/1 SA6-362"If6y MSDS ON SITE? TYPE OF BUSINESS: Ma.��►�, .f- off'M4�N-�e►1 .�r,�to� yes INFORMATION / RECOMMENDATIONS: '/C'1,rr,ew1- Fire District: A VL 4po S+ Q.c o bWK,�a�-- �D•t art sd-Q b�� 13/� ►�-1'1Y1 yls-t 1tP/r/G�i4— IVCjt4-l`✓ ot bt-s 04ir 4. Mattti�C.YIGIIM�"�AG�'���/ 1�: OtA,a,f V(4"� 04 S. Waste : MAfto 0538SZ Last shipment of hazardous waste: Name of Hauler: seL Fr"sA2�c1-fo Yar+tio� Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum 2 7NEW7— reeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils �t Pesticides KNEW I�° 3 /USED t o Ssn9,ok° (insecticides, herbicides, rodenticides) f b o �t����,.,� Gasoline, Jet fuel,Aviation gas -I0 Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals(Developer) lubricants, gear oil ❑ NEW ❑ USED . Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine (� Battery acid (electrolyte)/Batteries b Lye or caustic soda Rustproofers 3 Miscellaneous Combustible 3 Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes © � M n/l,a t �jDo�%E',MQIYL�-<ailac►'tl.�"r G•��f� Laundry soil&stain removers (including bleach) Spot removers&cleaning fluids 1' J (dry cleaners) ��p►w I,ti-�"a-!'t►qo�,. SQ•�� '��� In)�� IOc�orl,� Other cleaning solvents L Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials " A r02-4�i2:36p Millway Marina, Inc. 508362-4926 p.1 M ffl 0 ovayM9-ena Barnstable Harbor SPILL CONTINGENCY PLAN 253 MILLWAY, BARNSTABLE,MA 02630 508-362-4904 1. Evacuate the immediate area,,if necessary thru main entrance. 2. Shut off valves,pumps and electrical equipment as appropriate. 3. Remove or restrict any potential ignition source from the area if the material is flammable. 4. Cover the storm drains if not already covered. 5. Contain the spill by use of absorbent socks/booms,then apply appropriate absorbent material or additional absorbent socks/booms. Contact spill response firms from the Emergency contact list attached to assist in these activities. 6. Remove all absorbent material or contained liquid and package in DOT approved container. Used absorbent materials should be packaged separately from liquids. 7. Label all containers with the type of waste and the start date of accumulation. 8. Notify the appropriate agencies and Millway Marina's main office. 9. Once the spill has been controlled and materials collected and secured, inspect the area for cleanliness and decontaminate all equipment used in the clean up. 10. Replace all used materials and ensure all response equipment is in good working condition. 11. Manage and dispose of collected absorbents and liquid iri accordance with Federal and State environmental regulations. 12. Spill clean up equipment is located in rear storage room 13. The following is a list of the spill equipment on site; a. Spill response kit capable of containing a spill of at least 25 gallons. This kit includes absorbent spill pads,socks and/or booms. b. An adequate amount of nitrile gloves,nitrile or rubber boots and other personal protective equipment. c. First aid kit d. Eye wash e. Fire extincg ishers Ap ll412:36p Millway Marina, Inc. 508 362-4926 p.2 EMERGENCY CONTACT INFORMATION for 253 MILLWAY, BARNSTABLE, MA 02630 as of 411/14 Millway Marina Inc. 253 Millw - PO BOX 322 Bamstable MA 02630 508-362-4904 NTA R ._.._.._.. _.PHONE NUMBER._.._... .W. . . ..._._. _..,._., LOCAL EMERGENCY RESPONSE 911 NATIONAL RESPONSE CENTER 800-424-8802 LOCAL AGENCIES STATE POLICE 508-398-2323 � _ BOMBS UAD 508-820-2121 FIRE DEPARTMENT 508-362-3312 ' EMS 508-362-3312 HARBOR POLICE 508-775-0387 FUEL SPILL 508-362-3312 AUTO BODY SOLVENT- BILLW RIGHT 508-362-01 30 HAZMAT CONTROL 508-362-3312 SAFETY-KLEENE 800-669-5740 STATE AUTH AMES _ 508-7_75-0387_'__.....____..___._.._�_.._....., DEP ._�_.__._m.�...._�_ �.�.......�..._._.___..__..A._._. 6_17-292-5_500. ....�,_�_®.__�........._ DEPT. NATURAL RESOURCES 508-896-3491 FEDERAL AGENCIES USCG MSO 401=435-2300 USCG SEARCH & RESCUE 508-888-0335 FBI 617-742-5 533 ALCOHOL, TOBACCO, FIREARMS 617-557-1200 IMMIGRATION& NATURALIZATION 617-565-3100 CUSTOMS 617-5 65-6208 EPA 888-372-7341 FISH& WILDLIFE 508-945-0594 COMPANY EMERGENCY CONTACTS COMPANY OFFICE 508-362-7919/FAX 508-362-1732 FACILITY OFFICE 508-362-4904/FAX 508-362-4926 JACK HILL, OWNER/PRESIDENT _ C.508-648-0142/H.508-362-4951�� DANA BASSETT, FACILITY GM 1 C.774-836-2943 LISA DlMICHELE, COMPANY GM C.508-654-5782/H.508-771-5854 Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable,MA. Is Hereby Granted a License For:,Storing or Handling 111 -499 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2020 unless sooner suspended or revoked. ------------------ ------ PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. _ 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r Town of Barnstable THE Inspectional Services BARNSTABLE F Tp WDSTc'<iA'4 S OSTW UE°S7Wil,"r..c • Public Health Division 139� 4 BARNSTABLE, ' Thomas McKean, DirectorbLAM 039. t � ArEotn 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-630-4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ` " IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26-.110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 499 Gallons: $125.00 JR 5Tf CATEGORY 3 PERMIT 500.or more Gallons: $150.00 ❑ I *A late charge of$10.00 will be assessed if payment is not received by-July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3on. oz(. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS, INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES No. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: �1u) v la�l P1 A ►, L 6. ADDRESS OF ESTABLISHMENT: 253 M;1A� MA 03&30 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: Y�M 37-Z BWrZN5T-A&p_ A4 w636 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: In j) e ec Cam\ \ M CA{j)f�a , CO 1'l 10. SOLEOWNER: vl�ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME t1j\1y)m_ 1Al2�►� 11UL PRESIDENT ' TREASURER $ R CLERK '43y -994-B�zs 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE �r QA�Application Forrns\Haz Mat App Revised 09-10-18.doc 4 y ' Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable, MA -• Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ---------------------------------------------------------------------------_-------------------- ------------------------------------------------------------ - I --------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. v ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health lwofol Barnstable 3 3 9� eg atory emces Richard V. Scali,Director oFt"e Public Health Division BAMSTABLE y WNSTMLE-M EIMIIE•CONR•NYp1^115 • �ST'ABLE. Thomas McKean, DirectorK�la a 4vrm aunsineE 639- F1639. 200 Main Street, Hyannis,MA 02601 57' Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 19 V-S • CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: acbelLl 5. NAME OF ESTABLISHMENT: Nsw i t� C- 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: PC)B�l.37-7- -?:>IA QQS)-WbL& M#02630 8. TELEPHONE NUMBER OF ESTABLISHMENT: 50h- Z- `10 I 9. EMAIL ADDRESS � W(Luk (�� ,60w 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME A;�) We-Atift IQ L PRESIDENT TREASURER CLERK LE DZL3 d 12. IF PREPARED BY OUTSIDE PARTY- NAME: TELEPHONE#: • COMPANY ADDRESS h A A EMAIL: SIGNATURE OF APPLICAN DATE 5 ► I Q:\Application Forms AZMAT APP 2017 REVISED.doc I w� r� Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials_ ------------------------------------------------------------------------------------------------------ ----------------------------------------- ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and T and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JU.NICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health ow1x of Unstable g Re ulatoerces , Oy, Richard V. Scali,Director ofIHE, Public Health Division BITABLE BaRYSlaOlk..IGCYIUE•CONR•H1"4.M.15 BARNSTABLF + ncas:w.5••us•esra vu.e•ws eacns.au; Thomas McKean,DirectorMAR& 1h91`2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 'S8-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108 HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26 110 Gallons: $-50.00 " ❑ CATEGORY 2 PERMIT 111 499 Gallons: $125.00 Nf V.5 CATEGORY 3 PERMIT 500 or more Gallons: . $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July ist. - 1. ASSESSOR'S MAP AND PARCEL NO. 300- D Z(_. 2. IS THIS A PERMIT RENEWAL?-YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS, ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO: 4. FULL NAME OF APPLICANT: G-pilyca TL Wm 5. NAME OF ESTABLISHMENT: Mll, )P q 'MAP- l k-CA I M L 6. ADDRESS OF ESTABLISHMENT: 215_1,�) —�� I u t,Ul°�! _SftkI4STA 811� 9714 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: Pt)J�d 32Z _BA 9_ 5T Fz NM pj3LI 02&w S. TELEPHONE NUMBER"OF ESTABLISHMENT: Sig-3 4 Z-"O / 9. EMAIL ADDRESS: a-0.(�Ic. 4� y��►�)�rY1leX�1a, ro w� 10. SOLEOWNER: ✓YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME i l\W A V MAgjMn_JtvG PRESIDENT r - TREASURER T CLERK A S t 6 MA OQL3D 12. IFPREPARED BY OUTSIDE PARTY:.: NAME: TELEPHONE#:` • COMPANY ADDRESS I A A EMAIL: ,. SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED. o x Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS 1oo.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -----------------=------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Ali Town of Barnstable 4. Regulatory Services • Richard V. Scali,Director ' ` A ` Public Health Division ` Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ; Application Fee:$100.6Q ASSESSORS MAP AND PARCEL NO. Im 2�1 DATE z /� PERMIT TO STORE AND/OR UTILIZE MORE THAN A 1 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT i I Ul U MJIU iC l /SIC. • ADDRESS OF ESTABLISHMENT } TELEPHONE NUMBER J�bR02' pU SOLE OWNER: , -'YES NO - - IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL. PARTNERS: , _. .. . 4 IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT (&W j maim sr m pr bZ(,3t) TREASURER CLERK A / • " r �SIGTfAVU OF APPLICANT . J RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# CA=he\Temporary lntemet Files\0LKD3SAZA.PP Rev2015DOC r Ak p'i '►6�_ Town of Barnstable Office: 508-862-4644 "�. Fax: 508-790-6304 �. Regulatory Services Department enxrtsUOLK ; Public Health Division MASS. $ Thomas A. McKean,CHO 659. 200 Main Street, Hyannis, MA 02601 Payment Receipt Hazardous Materials Payment received: $100.00 (Check) on 6/17/2015 Permit number: 892 (Check number: 30878 Check amount: $100.00 Name on check: Millway Marina INC IBusiness: Millway Marina Inc. Address: 253 MILLWAY, Barnstable i • ha Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS 100.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6130/2015 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 , t Town of Barnstable °FINE lqk, Regulatory Services v ti Richard.V. Scali, Director MAE%. g Public Health Division i639. 10 a�no Thomas McKean, Director . 200 Main Street, •Hyannis; MA 02601' Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 306—0a--( DATE / APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS - FULL NAME OF APPLICANTS NAME OF ESTABLISHMENT /'I lJ I U \iM!q�2 i N w 11JL ADDRESS OF ESTABLISHMENT 26a M i I)W AV 8nJeNSWfa Mn Do630 TELEPHONE NUMBER 60 - 30 - y 9 b y SOLE OWNER:_,,,L`YES NO . IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 30 / STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK S NATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q\Application FormsVIAZAPP.DOC EMERGENCY ACTION PION' Millway Marina Inc 1 . Emergency escape procedures and routes. The escapes routes are in the front, rear and south side of building . 2 . Procedures to be followed by employees who may be required to remain in the facility to operate critical plant operations prior to evacuation . In the event of an emergency if there is a fire or chemical spill , evacuate the building and notify the proper authorities and the supervisor (Jack Hill) , In the event of a medical emergency call 911 and stay with the victim till help arrives , F 3 . Procedures to account for all employees 'after evacuation is completed . f All employees'must meet at the front gate and physically count the employees and report the count to the supervisor (Jack Hill) F 4 . Rescue and medical duties for employees who may be ' required to perform them. No medical duties are not to be performed by employees other then to call for help or comfort .. the victim: . 5 . Procedures for reporting fire and emergencies . The supervisor in charge will evacuate the building and, call 911, and then meet other employee at the front, for a headcount . 6 . Lisa DiMichele can be contacted for further information or explanation of duties under the plan. 4 4 7 FIRE PREVENTION PLAN Millway Marina Inc The fire prevention plan must be in writing unless there are 10 or fewer employees, in which case, the plan my be orally communicated to employees. The fire prevention plan must contain the following -elements: 1) There is no smoking allowed in the building. Welding and grinding are to be donewith a fire extinguisher nearby. In the event of an emergency follow the emergency action plan. 2) Dana Bassett, General Manager is responsible for maintaining fire prevention or control equipment. 3) Dana Bassett, General Manager is responsible for control of fuel source hazards. { • 4) All storage tanks containing gas shall'be kept in the fuel shed at the end of each working day. Tops or lids must be attached or tightened after. use: Tra Employees must be told of fire hazards of materials and processes to which they are exposed. This must be done initially and whenever there are new hazards or changes in procedures. All employees will be show the placement.and use of all fire extinguishers. All employees will be shown all exits. All employees will be shown where the emergency action plan is located. , sr� ' t Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable,MA 02630 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ---------------- -------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 1 Towu of Barnstable ,M Rectory Sev�cs F, Ge3 Di dur • 4 BaRNSTANF -ab c He;ai Orion MA McKean,Dlnctzr 200 Main Strz-s, Hyannis,MA 02601 F= 5o&j.90-6304 Gnca: 5084 2-4644 • A,p��i�a�iar� Fey. �'1A0.fl0 FARCEL NO. '3G0-off DATE (� I )3 TPI,ICATIO-T FOR PER.NET TG STORE AND/QR T ,T-1 MORE 111 G_ T..T.nNq OF TAY,ARDO US MATERLA-LS 7 I�A�vfE OF AT OF ESTAB7 7 N I I I ��Vlj m1wam I m ADD RESS of Esc�Bz��+T `7��J 3 M i `� (3��►1 Tyr�L� N1 )9 OZ�3 =l '=Ho_-rE SOLE 0w V YIS NO 17jZI,�{A ACID HOlySE ADDRESS OF AII� o L APPIIICAN'T IS A P__R 1�, -r� I APPT�IC IS A CORPORATION: FXDEPA IDI ICA.TSON No. STATE OF INCORPORA ON ICI ►J FAl A�HODAZ A.DDP—TSS OF: PRESID�ti T " 11 y' F i�U—N T �l RIS'I�ICI209: HORS ADDRESST T 9,, EZ�HO_ Tr I EMERGENCY ACTION PLAN Millway Marina Inc ' 1 . Emergency escape procedures and routes . The escapes routes are in the front, rear and south side of building . 2 . Procedures to be followed by employees who may be . required to remain in the facility to operate critical plant operations prior to evacuation . In the event of. an emergency if there is a fire - or chemical spill , evacuate the building and notify the proper authorities and the supervisor (Jack Hill) . In the event of a medical emergency ca11 . 911 and stay with the victim till help arrives . 3 . Procedures to account for all employees after evacuation is completed . All employees must meet at the front gate and physically count the employees and report the count to the supervisor (Jack Hill ) 4 . Rescue and medical duties for employees who may be required to perform them. .No medical duties are not to be performed by employees other then to call for help or comfort the victim. 5 . Procedures for reporting fire and emergencies . . The supervisor in charge will evacuate the building and call 911 , and then meet other employee at the front for a head count . 6 . Lisa DiMichele can be contacted for further information or explanation of duties under the plan , i • Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable : Board of Health This is to Certify that Millway Marina Inc.w 253 Millway, Barnstable,MA 02630 y p Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. - --- ----- - This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2011 .. :-.:unless sooner,suspended or revoked. - -- - -- _ WAYNE MILLER,M.D.,.CHAIRMAN PAUL J.CANNIFF D.M.D: 6/30/2010 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO ._ Director of Public`Health s I _ T6,wn of Barnstable �of1HE r � Regulatory Services- Thomas F. Geiler, Director r BARNSTABLE, MASS. a Public Health Division v�o 1639. ,gym AreornP�° Thomas McKean, Director 200 Main Street, -Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.A00 162LDATE 10 JD APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT . NAME OF ESTABLISHMENT i'1 dj1LT} MA Imc • ADDRESS OF ESTABLISHMENT _ 25 16'M By ' SA 9tJ i3(r M is bz�136 TELEPHONE NUMBER SOLE OWNER: AYES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: •FEDERAL IDENTIFICATION NO. 303'3�µi STATE OF INCORPORATION Iv t►ASS.' FULL NAME AND TAOME ADDRESS OF: PRESIDENT I)Val- TREASURER CLERK , k MY2 • SI AT E OF APPLICANT RESTRICTIONS: HOME ADDRESS � 1� HOME TELEPHONE #_,J22k�-3�,Z•Iqlf a Haz.doc;\p'y 'Town of Barnstable °F1Ne rokti Regulatory Services yP °T Thomas F.'Geiler, Director • ' BARNSTABLE. MASS. 0 Public Health Division - °lfo rna Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 0 L( DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �Ch. NAME OF ESTABLISHMENT arils.a ADDRESS OF ESTABLISHMENT 91 Barnstable Road • Hyannis, MA,02601 TELEPHONE NUMBER SOLE OWNER: —YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL' PARTNERS: • C t . IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. C)Y-16->07 V STATE OF INCORPORATION h1 FULL NAME AND HOME ADDRESS OF: PRESIDENT "D`l (' �i >.rdfij �✓,A � TREASURER . CLERK SOL • - SIGNATURE OF APPLICANT . RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# c/1-r-- Haz.docA p'y Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify,that Millway Marina Inc. 253 Millway, Barnstable,MA 02630 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------=--------------------------------------------------------------------------------------------------------------------------------- b� This license is granted in conformity with the Statutes and ordinances relating there to, and 3� gyp` and expires June 30, 2009 unless sooner suspended or revoked. -------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r j Town of Barnstable Barnstable WE r Regulatory Services Department o ;erica i • ': Public Health Division 1 BARNffPABM �.i639� 200 Main Street, Hyannis MA 02601 qj �� m �f0 MAC 2007 i Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 3Q0 Oz(o DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT /r I)UAk),%, )M4-V-1 J)i Ak NAME OF ESTABLISHMENT M 1114-Ay MwKIAIR ADDRESS OF ESTABLISHMENT 7,5E M 1 LL WA l� . -&9 leWSTR6tE 0263o TELEPHONE NUMBER SOLE OWNER:_YES . . NO 5 N IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRES , OF Aft PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 4-3o,37 STATE OF INCORPORATION M ASS FULL NAME AND HOME ADDRESS OF: PRESIDENT QepeeC �)�f /!�)13 02430 TREASURER CLERK SIGNA�j OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008.DOC �z A] Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable . Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable,MA 02630 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------ ---------------------------------------------------- .� -----------------'-------------------------------------------------------------------------------------------------------------------------------------------- 1 This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2013 unless sooner suspended or.revoked. --------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. v, 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health R Town of Barnstable 0—pSHE 7�, Regulatory Services Thomas F. Geiler,Director AS XASS. i public Health DivWon •9� 1�. 1�g Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO,51Z -6[AD�DATE APPLICATION FOR PERNUT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NA H OF;-ESTABLISHMENT, 10�?Q(J P, , ADR4 ZES&OF ESTABLISHMENT 2,53 M i1)Uj A'I A9AI,ST�1 l /Vl/q L)243 n TELEPHONE NUMBER `- 50 .3&Z-•49D co SOI OWYER r ;=s NO • ix IF AgPLI IS A MARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D -3®,371 � STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT \ 210 6 36. TREASURER CLERK SIGNATURY OF APPLICANT RESTRICTIONS: HOME ADDRESS I HOME TELEPHONE# j-o 0- 419,2 i Haz.doc/wp/q EMERGENCY ACTION PLAN Millway Marina Inc 1 . Emergency escape procedures and routes . The escapes routes are in the front, rear and south side of building . , 2 . Procedures to be followed by employees who may be required to remain in the facility to operate critical plant operations prior to evacuation . , , In the event of an ' emergency if .there is a fire or chemical spill , evacuate the building and notify the' proper authorities and the supervisor (Jack dill) . In the event of a medical emergency call 911 and stay w4th the victim till help arrives . 3 . Procedures to account 'for all employees after evacuation is completed . All employees must meet at the front gate and physically " count the employees and report the count to the supervisor (Jack Hill) 4 . Rescue and medical duties for employees who may be required to perform them. No medical duties are not to be performed by employees other then to call for help or comfort the victim. 5 . Procedures for reporting fire and emergencies , The supervisor in charge will evacuate the building and call 911,- and then meet other employee at the . front for a head count . ' 6 . Lisa DiMichele .can be contacted for further information or explanation of duties under the plan . FIRE PREVENTION PLAN Millway Marina Inc The fire prevention plan must be in writing unless there are 10or fewer employees, in which case, the plan my be orally communicated to employees. The fire prevention plan must contain the following elements: 1) There is no smoking allowed in the building. Welding and grinding are to be done with a fire extinguisher nearby. In the event of an emergency follow the emergency action plan. 2) Dana Bassett, General Manager is responsible for maintaining fire prevention or control equipment. k 3) Dana Bassett, General Manager is responsible for control of fuel source hazards. 4) All storage tanks containing gas shall be kept in the fuel shed - at the end of each working day. Tops or lids must be attached or tightened after use. Training Employees must be told of fire hazards of materials and processes to which they are exposed. This must be done initially and whenever there are new hazards or changes in procedures. All employees will be show the placement and use of all fire extinguishers. All employees will be shown all exits. All employees will be shown where the emergency action plan is located. - r ar Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, Barnstable, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted inconformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r P Town.of Barnstable • ��►+E�,,ti Regulatory Services Richard V. Scah,Director " MAS Public Health Division BARN LE w 11619. eaarsaot•mnrnvue•m,vrt•xrann.s 1639� 10� wnnsroxsrms•os*raYUF•wsraraxsae v D"1A'�p Thomas McKean,Director 1639.2014 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 .Cs. APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, . HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY"l st-JCTNE-30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 499 Gallons: $125.00 v5 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge`of$10.00 will be assessed if payment is not received by July 1st. ' ASSESSORS MAP AND PARCEL NO. �,00- p DATE p)('6 FULL NAME OF APPLICANT: QQnrQQ �1_ NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT: 7-53 M�\\yJPsv _ 3+ s �t ►� D�3b MAILING ADDRESS (IF DIFFERENT):!�;b__i!,% 3u �iA�t�s►'A ILL E rn�.p�?,n TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: Co--)__r SOLE OWNER:AYES=NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME M PRESIDENT >( TREASURER a CLERK IF PREPARED BY OUTSIDE PARTY: SIGNAT OF##INT' Name: Company Address Telephone#: Email: Q:4Application Fonns\HAZZAPP Rev16.docx Page 1 of 2 r ] �i9 of 1 Town of Barnstable office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department • en1�$rrn�t�; w Public Health Division adass Thomas A.McKean,CHO 4e3q. a` 200 Main Street, Hyannis, MA 02601 fb NUS Payment Receipt Hazardous Materials Payment received: $125.00 (Check) on 6/14/2016 Permit number: 892 i Check number: 32333 Check amount: $125.00 Name on check: Millway Marina Inc. ;Business: Millway Marina Inc. Address: 253 MILLWAY, Barnstable j ---- ------- --- —--- __._�._. . ---- ...............-......-- - ..- ............... ... _...._ ..........:....... . r Number • • • Fee 892 THE COMMONWEALTH=�'OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, MA 02630 Is Hereby Granted a License - FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ------------ ---------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. June 5, 2006 PAUL J. CANNIFF,D.M.D. -= THOMAS A MCKEAN,R.S.,CHO Director of Public Health ., Town of Barnstable va�tr+Fr Regulatory Services Thomas F. Geiler,Director ��� �' � Public Health Division ` �Av�..�� � rA �b0 ? 1�39 ti AFE Thomas McKean,Director ny P F ; 7ry; lip 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax:.508-790-6304 . Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE ' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT Mjjw)qy ►� I(y NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER -SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: w6! PQ Cj M IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. O�-3p3'7149 STATE OF INCORPORATION ( Y)SS FULL NAME D HOME ADDRESS OF: PRESIDENT 06JA3 51 TREASURER 1� CLERK SIGNATIrf APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE 4 Haz.doc/wplq G„ Y MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnsiable. Allow five to seven (7)working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page e� Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Millway Marina Inc. 253 Millway, MA 02630 Is Hereby Granted. a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. - ----------------------------------------------------------- --------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 5/31/2007 PAULJ. CANNIFF,D.M.D. ' THOMAS.A.MCKEAN,R.S.,CHO Director of Public.Health r . Town of Barnstable �oFz Regulatory Services Thomas F. Geiler,Director HABNMBLE, + . g Public Health. Division...`_ s6gq, �� 1639 r Thomas McKean,Director 200 Main Street; Office: 508-862-4644 Fax: 508-790-6304 —Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. ;500 d Z( DATE Zq APPLICATION FOR PERMIT,TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT _ (j►2( 5, i NAME OF ESTABLISHMENT M I) I W Ay, M f'F.jM A )&j C ADDRESS OF ESTABLISHMENT 2_53 M i u La PAJ- TELEPHONE NUMBERd SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: �' c -+ w co IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. D 39/ STATE OF INCORPORATIONI t7 FULL NAME AND HOME ADD SS OF: PRESIDENT 5T -TREASURER CLERK NATURE OF APPLICANT RESTRICTIONS: HOME ADDRE S HOME TELEPHONE 9 ' _ � sr.t 3 z � >l 9 i. EMERGENCY As TI,QN PLAN Mi1Im y"Marin!a 1 . Emer enc ,".esca, e rocedure8 9.,, y P p and°:routes { r The escapes routes are. in the front , rear and` saut.h' side of building . 2 . Procedures to be followed by employees who,, may `be required to remain in the facility to operate critical plant operations prio:x to sv`acuatior . I the vent. of ,a - ;eeren,cyif here 2$` a fire or chemical spill;, evacua,yt,e the building ;arid :not,ify the proper authOrit!ies.'and the supervisor (t.,Ja,ck Hill) : ;.In the event. of a medical . emergency call 9'1',1 ands st',ay with the,! victim till help arrive .: 3 Procedures to account for all employees after evacuation a. is completed . All employees must: meet' at ` .he front gate and; physical%ly count the employees and report the count to the : supervisor (Jack Hill) 4 . Rescue and medcal, dutes for employees who' `may .b'e required. to perform them,. No medical duties 'are not to he per-:formed, by employees other then to call for help ar, comfort' Me victim: 5 . Procedures for' reporting fire arid' emergencies The supervisor ip change will evacuate the building and call 911 and then meet other employee a..t the front -for I a a head count:. 6 . Lisa DiMichele :can be contacted for furt;h9,r i nf.ormation or explaria,ton of duties under`the I.plan . I Number Fee 892 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to.Certify that Millway Marina Inc. 253 Millway, Barnstable,MA 02630 Is.Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 - JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health r Town of Barnstable ' Barnstabie THEr, Regulatory Services Department o �erica • Public Health Division BARNSraei.e. 200 Main Street,Hyannis MA 02601 m lFe �a 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. /J�-�z(p DATE ki APPLICATION FOR PE&MIT TO STORE AND/OR UTILIZE MORE THAN Ill GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT �lx tt1 NAME OF ESTABLISHMENT /'l j!u)AV 11�jq j14)A W G ADDRESS OF ESTABLISHMENT T ) I I Wiqq 619/2A/STNJ& - Ain 19zb3D TELEPHONE NUMBER 5D SOLE OWNER: S NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALA s;; PARTNERS: :x C P IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATIONf _ FULL NAME AND HOME ADDRESS OF PRESIDENT IA() bk ) . MAIN 3 6AAA65 &E W 02-k3U TREASURER. , CLERK t SIGNATURE F APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE Q:\Hazmat\Haz Mat Application2008.DOC n • EMERGENCY ACTION PLAN Millway Marina Inc 1 . Emergency escape procedures and routes . The escapes routes are in the front , rear and south side of building . 2 . Procedures to be followed by employees who may be required to remain in the facility to operate critical plant operations prior to evacuation . In the event of an emergency if there is a fire or chemical spill , evacuate the building and notify the proper authorities and the supervisor (Jack Hill ) . In the event of a medical ..emergency call 911 and stay with the victim till help arrives . 3 . Procedures to account for all employees after evacuation is completed . All employees must meet at the front gate and physically • count the employees and report the count to the. supervisor (Jack Hill ). 4 . Rescue and medical duties for employees who may be required to perform them. ..No medical duties are not to be performed by employees other then to call for. help or comfort the victim, 5 . Procedures for reporting fire and emergencies . The supervisor in charge will evacuate the building and call 911 , and then meet other employee at the front for a head count . 6 . Lisa DiMichele can be contacted for further information or explanation of duties under the plan . Town of Barnstable P �4 Department of Health,Safety,and Environmental Services �Via Public Health Division Date q� 367 Main Street,Hyannis MA 02601 BARNErFASM \ .i639 �� rfp�► Date Scheduled 13 9 7 r Time /D �a Fee Pd. -#/0 O• 00 Soil Suitability Assessment for Sewage Disposal Performed By: 2t] r2 Lo Witnessed By: Jerry Qf r�•�y SGN . r04 er To.1C. LOCATION &:Gp ENERAL INFORMATION Location Address 2"yy�Y./rt ^�4. Owner's Name F�e �j,' �o r wt�rr� 3-V r,ns k le, M►q: Address 65 6 ]] N/ yarrv�o�Fl,, MA. Assessor's Map/Parcel: Mole 3 i pol rGEI 3-$ ��Engineer's Name �P_ r y e_ �b S�Hc �etd B-0 S .fN,E. NEW CONSTRUCTION- REPAIR _ Telephone# 5 O SS 2-S S— Z O Land Use Wood ei Slopes(°/.)' 0 Surface Stones NO✓t e Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line Z o ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 3�6,y3` L 04 3`5 00 200,4 #I ZL� 20�+ s' 3s If.51 - No-I' 2�.® Parent material(geologic) Oq Ci atlff W��� GIS No Depth to Bedrock � De Depth to Groundwater: Standing Water in Hole: ►V o Weeping from Pit Face No Estimated Seasonai High Groundwater" �� r± do wp'1 _ .4 . DETERMINATION F'OR SEASONAL DIGD'VC�ATER TREE XX Method Used: Q►—O � /G� � �"►� DS Depth Observed standing in obs.hole: 1 in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. .Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date 13 Time 0 3c rH Observatior. Hole# Time at 9" Depth of Perc t►kv- E" $y Time at 6" Start Pre-soak Time a (7 Time(9"-6") End Pre-soak 1 3 + D Rate Min./Inch < S Site Suitability Assessment: Site Passed- S _ Site Failed: Additional Testing Needed(Y/N) NO Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant S i DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) li "l it a y'=1o'' A i.o San loy � 2 /o✓►e- Io"- 2yl' 6 o S j 10Y s S No ,e- 2y" V r' C, Med. 5c,h j l o y 6 No✓l e- 611r71tf CZ 5;1t' Ica,m I c) YK. 6 z Nan e- �� o� Ca a�s� 71 JyS C � 10 Y(L 6 6 None DEEP OBSERVATION HOLE LOG Hole# 2 Depth from I Soil Horizon I Soil Texture i Soil Color Soil Other Su r cc(ir,.l (USDA) (Mansell) �. Mottline (Structure,Stones.Boulderes. Cgrisisteggy.° r el r O r t1! L0441,y 5AJ 10 q .2 No ri e— lo`r 2 ►► o Sao to S . Zy If' 61It Ct Md. Sc,.J It YK14 6 At.0 e- 61"-'7l'' �Z 5; �1 toYtz42 N C©ol"s�e- 71 - (5o C S IpYK 64, No DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°° ravel DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,° Gravel) i Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring_Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 2 S If not,what is the depth of naturally occurring pervious material? _ Certification I certify that on _(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature �. _ Date 2- ZJ 9 7 ,