The URL can be used to link to this page

Home My WebLink About0075 PERSEVERANCE WAY - HAZMAT � .. `e / a 0;7 y\\ =-Jrl. // J/J�✓` " T` f . t V m i 1 , _ rt { Po 1 463 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Aa&4i'o (mil kt Board of Health MAILING ADDRESS: 75 he_cerv{► 0jc4 WMIL' Town of Barnstable TELEPHONE NUMBER: 50R — 9 79-- /2649;, P.O. Box 534 CONTACT PERSON: l�c�'fcY E1-waW4(a �0aN /t�gTv Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered t. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) � �. �, �� , Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners I White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ,—' unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous 10 Q I N ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MA RIALSUnderground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Mis llaneous: l 1 � D POSAL/REc TION REMARKS: 1. Sanitary Sewage 2. Water Supply t - O Town Sewer �ublic `On-site OPrivate s J." 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC Catch basin/Dry well O)LC O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO of 2. s(w erson Interviewed Inspector VDate TOWN OF BARNSTABLE OMRUANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF H AqH 0 3.Auto Body Shops �� unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores -Ad! �[ 6.Fuel Suppliers ADDRESS � lam' ass: 7.Miscellaneous S QUANTITIES AND STORAGE (IN=indoors; OU MAJOR MAT �S J T=outdoors) UndergroundCase lots Drums Above Tanks IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAL/RECLAMATION R MARKS: 1. Sanitary Sewage 2. ater Supply C O Town Sewer Public 47 *on-site 0P ' ate e a 3. door Floor Drains YES NO �� J LP, Holding tank: VV Catch basin/Dry well a 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product o e YES Liz I 2. Pe. Ph (s) Interviewed Ins ct e i L _ 3 m TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers satisfactory BOARD OF HEALTH 3.Auto Body shops unsatisfactory- 4.Manufacturers COMPANY a (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS u^�G Class: 7.Miscellaneous QU ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers iscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply - O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person ) In erviewed Inspector Date Commonwealth of Massachusetts Executive Office of Environmental Affairs . Department of Environmental Protection ' Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas B. Powers Acting Commissioner URGENT LEGAL MATTER: PROMPT ACTION NECESSARY CERTIFIED MAIL: RETURN RECEIPT REQUESTED November 15, 1994 Safety Kleen RE: BARNSTABLE-BWSC/ER 50A Brigham Street 75 Perseverence Way Marlboro, Massachusetts 01752 Hyannis RTN: 4-10888 NOTICE OF RESPONSIBILITY M.G.L. c. 21E. 310 CMR 40. 0000 ATTENTION: Randy Goyette On November 10, 1994, ' at 1: 15 p.m. , the Department of Environmental Protection (the "Department") received oral notification of a release and/or threat of release of oil and/or hazardous material at the above referenced property which requires one or more response actions. In addition to oral notification, 310 `CMR 40. 0333 requires that a completed Release Notification Form (BWSC-003 , attached) be submitted to the Department within sixty (60) calendar days of the date of the oral notification. The Massachusetts Oil and Hazardous Material 'Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan (the "MCP") , 310 CMR 40. 0000, require the performance of response actions to prevent harm to health, safety, public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility, the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. The Department has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. The Department also has reason to 20 Riverside Drive 0 Lakeville,Massachusetts 02347 a FAX(508)947-6557 9 Telephone (508) 946-2700 -2- believe that you (as used in this letter, "you" refers to Safety, Kleen) is/are a Potentially Responsible Party (a "PRP") with liability under M.G.L. c.21E §5, for response action costs. This liability is "strict", meaning that it is not based on fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c.21E §5. This liability is also "joint and several", meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. The Department encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the Department in taking such actions. You . may also avoid the imposition of, the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. At the time of oral notification to the Department, the following response actions were approved as an Immediate Response Action (IRA) : • Deployment of Absorbent/Containment Materials. • Removal of Tanks/Drums/Containers. • Removal of Other Contaminated Media. • Proper Storage/Disposal/Recycling of all Contaminated Media. • All Remediation Waste must be properly handled and disposed of within 120 days from the date of generation per 310 CMR 40. 0030. Specific approval is required from the Department for the implementation of all IRAs, with the exception of assessment activities, the construction of a fence and/or the posting of signs. This site shall not be deemed to have had all the necessary and required response actions taken for it unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. -3- Additional submittals are necessary with regard to this notification including, but not limited to, the filing of an IRA Completion Statement and/or a Response Action Outcome (RAO) statement. The MCP requires that a fee of $750.00 be submitted to the Department when an RAO statement is filed greater than 120 days from. the date of initial notification. You must employ or engage a Licensed Site Professional (LSP) to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of the names and addresses of these licensed professionals from the Board of Registration of Hazardous Waste Site Cleanup Professionals at (617) 556-1145. If you have any questions relative to this notice, please contact Leonard Pinaud at the letterhead address or at (508) 946- 2859. All future communications regarding this release must reference the. following Release Tracking Number: 4-10888. Very truly yours, Richard F. Packard, Chief Emergency Response Section P/LP/jt CERTIFIED MAIL #Z235 539 872 RETURN RECEIPT REQUESTED Attachments: Release Notification Form; BWSC-003 and Instructions Summary of Liability under M.G.L. c.21E cc: Board of Selectmen 367 Main Street Hyannis, MA 02601 ATTN: Warren E. Hansen, Chairman Board of Health 367 Main Street Hyannis, MA 02601 ATTN: Brian R. Grady, R.S. , Chairman Fire Department 3249 Main Street Barnstable, MA 02630 DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director iuuu oj—., naiwan hoaa IVIAPWAL Uribc-ri k-UrflVf (UZ)t 01 1 I-i i hA'-,KII,4u rurim 1,4u. ijoU) Elgin, Illinois 60123-7857 B 33 3 D-U-N-S 05106-0406 FED.ID NO.39-6090019 n, I SKDOTNO.1 MANIFEST NO. IL jaj;3 73,7] C -7;�' 77 U S CUSTOMER NUMBER CUSTOMER NUMBER T 0 NAME NAME M .t�R E • ADDRESS Aw ADDRESS CITY/STATE zip- CITY/STATE ZIP SERVICE DATE SALESMAN'S NO. CUSTOMER P.O.NUMBER SALES TAX EXEMPTION NO. NEXT SERVICE SERVICE TERM CHANGE SERVICE TERM (WEEKS) (INITIAL) .'V; 4t AM, QUANTITY' UNIT OF PRICE LINE TOTAL NUMBER IMEASURE SERVICE DESCRIPTION SERVICE TAX CHARGE 040 USED OIL PICK UP , 050 OILY WATER DISPOSAL -12— 51 -7"P- 10066 WASTE ANTIFREEZE — All a"a TOTAL ; CASH El TOTAL RECEIVED APPLY PAYMENT TO: CHARGE MY ACCOUNT FOR THIS TRANSACTION UNLESS OTHERWISE INDICATED IN THE PAYMENT RECEIVED SECTION. CHECK NUMBER TODAYS SERVICE/SALE INVOICES REFLECTING CHARGES TO CUSTOMER ARE SUBJECT TO AN INTEREST RATE OF THE LESSER OF 1'h% PREVIOUS BALANCE AS FOLLOWS PER MONTH(18%PER ANNUM)OR THE MAXIMUM RATE ALLOWED BY LAW ON ANY INVOICES THAT ARE NOT PAID WITHIN 30 DAYS. IN THE EVENT OF DEFAULT, SAFETY-KLEEN SHALL BE ENTITLED TO RECOVER'COSTS OF COLLECTION,INCLUDING REASONABLE ATTORNEYS FEES. INV.# AMOUNT$ IN THE EVENT THE CREDIT CARD ISSUER REFUSES TO ACCEPT THE CREDIT CARD CHARGE FOR THIS PREVIOUS TRANSACTION,YOU ARE AUTHORIZED TO CHARGE THE AMOUNT OF THIS TRANSACTION TO MY SAFETY KLEEN CREDIT CARD NO. ACCOUNT. GENERATOR WARRANTS AND REPRESENTS THAT THE MATERIALS PROVIDED SAFETY-KLEEN CORP.HEREUNDER CREDIT CARD NO EXP.DATE AMEX HAVE NOT BEEN MIXED,COMBINED,OR OTHERWISE BLENDED IN ANY QUANTITY WITH MATERIALS CONTAINING VISA POLYCHLORINATED BIPHENYLS(PCB)OR ANY OTHER MATERIAL DEFINED AS A HAZARDOUS WASTE UNDER MC = APPLICABLE LAWS,INCLUDING BUT NOT LIMITED To 40 CFR PART 261.GENERATOR AGREES TO INDEMNIFY AND --1 SAFETY-KUEEN CORP.HARMLESS FOR ANY DAMAGES,COSTS,ATTORNEY'S FEES,ETC.ARISING OUT OF OR IN ANY WAY RELATED TO A BREACH OF THE ABOVE WARRANTY BY THE GENERATOR. INFORMATION FFFM PERMITTED TO ACCEPT,STORE AND RECLAIM THE SPENT MATERIALS CONSUMER REFERENCE SAFETY-KLEEN HAS THE CAPACITY AND IS DESCRIBED ON THIS DOCUMENT. P6nt -G 'i • Name x GENERATOR CUSTOMER SIGNATURE PAPT IAIs 11n1QA% GUIUIIVIUNVVLAi_I;-I Ui- IVIN 0_),',l,f 1Uol, i 1 ;� lugDEPARTMENT OF ENVIRONMEN`I AL PROTECTION —=: f DIVISION OF HAZARDOUS MATERIALS ;a "^ y One Winter Street Boston, Massachusetts 02108 , h.. Please print or type. (Form designed for use on elite(12-pitch)typewriter.) UNIFORM HAZA enerator's US EPA ID No.. Manifest Document No. 2. Page 1 Information in the shaded areas WASTE MANI€ EST � �;� xt., t;,'i.il...� e' j.�' of r' snot required by Federal law. 3. Generator's Name and fJlailing Address :r ✓ r, LL A. State Manifest Docume t I Lliwprr G ':.a ! B. State Gen.ID y 4. Generator's Phone( - `'...) " ! fit, F. rfA C_ ranspocte a Co�npanr Name 6... USE A D N ber,_ C.State Trans.ID 5 .eta'~4 .... r. ', umt A w,; r ° 1: , o r� } Y. g i?i M,w, ,c. 7. Transporter 2 Compare Name 8. US EPA ID Number D.Trans porter's Phone w E.State Trans.ID -J 9. Desicned Facility Nam and Site Address r Fc;` `t 1:c?''. 10. US EPA ID Number cV1 F.Transporter's Phone( ) O • 00 G.State=Facility's ID NOT REQUIRED'. O N I f*r' .w i(!b''.. :'r'; MA 01752 A.110 0Elell1'i �r1At 3 H.FaCili sP . fk.� 4 : -- �O ty' hone( `• j ti� v 12.Containers 13. 14. I p- 0 11. US DOT Description(Including Proper Shipping Name,Hazard Class and!D Number) Total Unit Waste No. O No. Type Quantit WUVol a. { �� >,�a ti Y. 1 rev 3.rs°� r'. t"�5• };<t"' � wti1u T ,._ ��.. X M G Tf D O E b. Re ?t' b t t r ✓ �{ ✓r —1 !n N u.�i ,S� oS_...;" a...1,a. e.''1;` .,%., s:�:<' �'✓ O C E s N A C '"� v 'FrA rFr✓ ,fn' er' D T r7- _ O R r. ✓ rr r. �... � l. Vl i� d. O Z e a) M J Additional Desgrtphons fol Materials Listed Above(include physical state and hazard code.) " K. 'Handling,Codes for Wastes Listed Above H ti., H &? Z cu b. d. _ b. cl. E 15. Speglal Handl)ilQ hishu,.hp.ns,and Additional 10formatlon vl E 1,.L.i�{lan 1./a .P$.,b:X '�>ri.'�•,'Ir L7..�,di itS.. \.� N. .. EL : 16. GENERATOR'S CERTIFIG?1 ION:I hereby declare that the contents of this consignment are fully and accurately described above by O proper shipping name and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway >1 according to applicable inlemalional and national government regulations. U If I am a large c uantit c nrzr.rtor.I cerlil that I have a program in lace to reduce the volume and toxicity of waste generated to the degree I have determined to be economical) C 9- I Y 1^ Y P 9= P Y 9 9 Y Practicable. N and that I have selected tYvt t'rar.licrible method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environ- 21 meat;OR,if I am a small It;::rli1v generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is available to ran and that I O can afford. E DATE PrintedlTyped Name Signature Month Day Year N m r 17. Transporter 1 Acknowledgement of Receipt of Materi61s DATE (� R v A Printed Typed Narrre Signature Month Day, Year C tJ / P 0 18. Transporter 2 Acloao. L-hiement o1 Receipt of Materials DATE T Printed/Typed Name Signature Month Day Year R 19. Discrepancy Indication;;pace, F A C 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in item 19. T _ DATE PontedTyped Name Signature Month Day Year Form Approved.OMB No.2050-003'' 1_xpires 9-30-96 EPA Form 8700-22(Rev.9-88)Prewnuc cdlions are obsolete. COPY>6: GENERATOR MAILS TO DESTINATION STATE TOWN OF BARNSTABLE C BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIR/Q �r V�r ADDRESS--_ Major types of materials: 1) 2) 3) 4) - S) 6) I. Description of material(s) use:/ W " II. Storage (denote product by number listed above) _ A. Containers metal glass paper plastic cans,bottles,jars w ` drums,barrels { aboveground tanks - underground tanks `..\. bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility Vor•# Remarks/Recommendations 1. Indoor a) separate, contained room b) stored ih general work area -i) inadequate ventilation- _ ii)..floor drains ii ) inadequate- fire protection 2. Outdoor a) uncovered, exposed to weather _ b) perviaus=surface/catch .basins- III. Disposal- A. Reclamation/Recycling unit B. On-site disposal 1. Town. sewer 2. Regular septic system - 120' , 4 3. Separate holding tank C. Off-site disposal f r49 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site : Pe s n s Interviewed U Inspector Date — - - — w �s c f i a� AUBURN WIRE, INC. A Subsidiary o1.•*`� 1 lL I.U(ilrPi//IZ!i Pete Ernenwein General Manager 75 Perseverance Way • Hyannis, MA. 02601 Ph: (617) 77&1266 TOXIC AND HAZARDOUS hATERIALS REGISTRATION FORM NAME OF FIRAi: A_Lt6aitU 0P K To G MAILING ADDRESS: �75 /'�c�s�v-'►aAjc� Board Of Health TELEPHONE NUMBER: `�'7� -/ 2G C � 'town of Barnstable P.O. Box 534 9 CONTACT PERSON: ��•f-e y- yN',e NW C Hyannis, Massachusetts 02601 Does your firm store any of the toxic or hazardous materials isted below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be.-returned to the Board of Health regardless of a YES or NO answer. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of 'Health- has determined that the following products exhibit toxic or hazardous characteristics and must be registered when stored in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: Antifreeze (for gasl n'e or coolant systems) T Refrigerants Automatic transmission fluid Pesticides (insecticides,- - Engine and Radiator flushes herbicides,rodenticides ) Hydraulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink ' Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants _Degreasers for engines and metal �� Lye or caustic soda Jewelry cleaners Degreasers for^ driveways & garages Leather dyes Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s _ Car waxes and polishes Other chlorinated -hydro- carbons,& roofing tar ' . carbons, (inc.carbon Paints, varnishes, stains, -dyes tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers lip oison"labels (including Paint brush cleaners chloroform formaldehyde Floor & Furniture strippers hydrochloric acid, other �t> Metal polishes �µ { acids) Laundry soil & stain_ removers (including bleach) . ` ~ Other products not listed which' you feel may be Spot removers & .cleaning fluids toxic or hazardous (please (dry cleaners) s _ list) : Other cleaning solvents Bug and tar removers `� � � pawl C,.J l Household cleansers oven cleaners �r 2J�Q. Drain cleaners , L, - Toilet cleaners - -Cesspool cleaners zyla�l9 °'"c (�-ti"''y Fl"sc Disinfectants t - Road . Salt - (Halite) _ TOWN OF BARNSTABLE CO PLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r satisfactory 2• Printers BOARD OF HEALTH 3. .Auto Body Shops O unsatisfactory- 4. Manufacturers COMPANY „,� iJ,� r C' (see"Orders") S. Retail Stores 6. Fuel Suppliers ADDRESS Class: y 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetgrouad Tanks IN IDUT. IIN IOUT I IN IOUT # & izallons Aee rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: uwaste motor oil (C) I 1 7 - transmission/hydrakc L I t I Synthetic Organics ff/_U Cc) a degreasers (DIL- , s Miscellan us: e. i -DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water `Supply 0 Town Sewer Public �- /On-site O Private 3. Indoor Floor Drains: YES NO o Holding tank: MDC` , _ T— Catch basin/Dry well ° , On-site system 4. Outdoor Surface drains:YES • C J o Holding tank: MDC T_ \ atch basin/Dry .well ;�,�?VLI =� c, i/ �,�� r _�� „ . << �• On-site system S. Waste Transporter llJ' r<< Licensed? Nang of Hauler. Destination Waste Product YFS1 NO 1. .,a 1 ,?n (A 1,(�w�,r:� Can 1-r C11u _ - 12 23 81 Person(s) Interviewed .a. Inspector 'Date