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0157 THORNTON DRIVE - Health
157 THORNTON A= C�OqG 0/9 { i e G M P h L y�«'�J iy�� .-� � �' - - --- .„a.,�..-ems� � . � . °FIB rots Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMST�RLE,B` 200 Main Street• Hyannis, MA 02601 .639.N, TO IC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 MP'� Business Name: N o - o Date: �/I 61aido2o Location/Mailing Address: I( Contact Name/Phone: !i61Z- 719 -�iaz_ Inventory Total Amount: SDS: UP�u � License#: Tier II : Labeling: Spill Plan: d Oi[/Water Separator: Floor Drains: NO Emergency Numbers: U n Storage AreaslTanks: �' e 'Emergency/Containment Equipm t: .4ih Waste Generator ID: Waste Product: NIA 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 — V 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'+W Iftopcimif o r riomhK �o - Inspector. Facility Representative: ..) WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS fI 4 PHONE 508-775-0623 DENNIS JONES ALL CAPE MACHINE SHOP COMPLETE TRUCK&AUTOMOTIVE MACHINE SHOP SERVICE COMPLETE CUSTOM ENGINE REBUILDING FLY WHEEL GRINDING ENGINE DYNO TESTING SPECIALIZING IN VALVE JOBS 157 THORNTON OR. _ FOREIGN AND DOMESTIC HYANNIS,MA 02601 f i 1 OPYDate: 3-z�G-6V TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: 15 MAILINGADDRESS: " INVENTORY TELEPHONE NUMBER: SO 9 7-7.5 6 G Z3 TOTAL AMOUNT: CONTACT PERSON: 1)2j-� .r;c75,O� EMERGENCY CONT T TELEPHONE NUMBER: v- - FIDE p157"F<'IGT' TYPEOFBUSINESS a...� OTHER INFORMATION: Piece ka�.A arc h waste. M S l75 54r_ •r� a heru� J how Was TanortatonP�- Name of Hauler: L•. estination: Waste Product: _ Sneer Sa-I icensed? es No vf'Lv�� � �a a�5 Gr.Ylt`�ovt�y�5 - vv O LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils 20 Pesticides ANEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil. NEW USED Other petroleum products: grease, Photochemicals (Developer) (� lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt& roofing tar Fertilizers. Paints, varnishes, stains, dyes PCB's s/ Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride)- int&varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform,formaldehyde, Floor&furniture strippers Metal polishes hydrochloric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.• �( (dry cleaners) z S cry Other cleaning solvents Bug and tar removers 0 W A r Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: All Cape Machine Shop Fax: Corp Name: Mailing Address , M, ., ....... ............_.... ......._... Location: 157 Thornton Drive Street: 157 Thornton Drive _ ._.. _.._ .. _, ........ ............ mappar: 296-019-000-000 City: Hyannis Contact: Denis Jones State: Ma Telephone: 508-775-0623 Zip: 02601, Emergency: Person Interviewed: � 2 ........... .._............... .__... Business Contact Letter Date: 5/21/2004 Category: Miscellaneous Inventory Site Visit Date: Type: Auto Body Follow Up/Inspection Date: ............... __.....__ 91 public water ❑ indoor floor drains ❑ outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed ❑ town sewage ❑ indoor catch basin/drywell ❑ outdoor catch basin/drywell expir --- - -- on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: 12/1/99-recycle oil filters.Remove debri from the rear compliance: building. REMARKS:2000- Satisfactory Restroom needs window or mechanical vent. 5 6L.Az _ • ..�iiG�r,L,QTit Ll e - y . `` A Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials 4d:5jLgty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑ gty's 111 gals or more Waste Transporter: / /✓. Lf�jG��/� Fire District: Last HW Shipment Date: Waste Hauler Licensed: P� pli .......:...._.. 'A' s� r k n Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: DBA: ,Z4,6..t_Ccta , Location: 1 -s -7 , Z-,27. Date: - Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): 2. Waste storage areas: 3. Satellite accumulation points throughout: 4. HazMat stored outdoors — CHECK OUTSIDE: NO - 5. Shipping and receiving areas: 6. Run down of shop activities: 7. Housekeeping practices: HazMat On-Site Inventory/inspection: Records to Review for SQGs and CESQGs Location: /197-7 Site visit date: • Hazardous Waste / Manifests: c/ • Employee training documentation (if required): • Hazardous substance spill control and contingency plan: • MSDS on site? • HazMat Inventory records (if applicable): • HazMat Waste Shipping documentation: • Spill records (if applicable): �/ y IL5 LOCATION SEViAGE PERMIT NO. VILLAGE x INSTA LLER'S NAME i ADDRESS c cs G� R U 1 L D E R OR OWNER S 12r �y DATE PERMIT ISSUED DATE COMPLIANCE ISSUED - s r Hazardous Materials Inventory Sheet Checklist Z7 16 Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines,thinner to /clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? / If none, note that. V Disposal Information -where and who? If none, note that. -Applicant Signature -understand what is listed and noted Staff Initial -any questions,know who to ask /Vehicle Washing/Rinsing? -give a vehicle washing policy and / explain.it V/ Attach the Business Certificate with your sign off and comments ' "The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS?' For Your Information: Business certificates (cost$30.00 for 4_years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1'FL.,"367 Main Street, Hyannis, MA 02601 (Town Hall) . • DATE: 4. '0 -/d Fill in please: APPLICANT'S YOUR NAME/S:BUSINESS YOUR HOME ADDRESS: Ll S d v L AAld 41,1,gc t. TELEPHONE # Home Telephone Number Sd k- ggo —3-73 9 NAME OF CORPORATION: /'L L C.oPS;:� z,oc hjwe .Sh v.2 NAME OF NEW BUSINESS _ TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS Q ti MAP/PARCEL NUMBER , 7 -L9 O (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST`GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have'the appropriate permits and licenses required to legally operate your business in this town. 1, : BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business: Authorized:Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been ' or e of the permit requirements that pertain to this type of business. f MUST COMPLY WITH ALL . r j N'AZARDOUS MATERIALS REGULATIONIS Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the.licensing requirements that pertain to this type of business.. Authorized Signature** COMMENTS: - f ,r. Date: j�,/�,Z / ID TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: � XaoLi_ BUSINESS LOCATION/S7 % �Ltr�ti �iic.+.��. INVENTORY MAILING ADDRESS. ' TOTAL AMOUNT: TELEPHONE NUMBER: !.D"K- -77:5- c2 4.2 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS:(Au ) ftirr�- INFORMATION/RECOM MEN DATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: � ,r- ,c Aiok Destination: Waste Product: f� Licensed?�qe 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 Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides m'NEW ®'USED (insecticides, herbicides, rodenticides) � Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) ;Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) TIEW` ❑ USED - Any other products with "poison" labels '(including chloroform,fofmaldehiyde,m Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) adz, Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials I� TOWN OF BARNSTABLE OMP-[ANCE: CLASS: 1.Marine,Gas Stations,Repai satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ,� O unsatisfactory- 4.Manufacturers COMPANY;4L 1- �� � see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /yd �f2 � r.r Class: � 7.Miscellaneous QUANTITIES AND,STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUndergroundove IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers _1 > t.� scllaneous: >' x s Ira DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply '174X-1 LZ_,aZZ :_�2 O Town Sewer *Public : v ;won-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 N0-Z - O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YEs No 2. Perso ) Interviewed nspector Date f� ��pl/��S" �4R✓iG,� r. TOWN OF BARNSTABLE CO PLIANCE: CLASS: 1.Marine,Gas Stations,Re satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ,y unsatisfactory- 4.Manufacturers COMPANY <° (see"Orders") 5.Retail Stores ADDR SS 6.Fuel Suppliers 4= Class: 7.Miscellaneous 9 QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR NTERIAL��' ®�_ 0 . , G IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel (A) 71 r Heavy Oils: west motor oil (C) new motor oil(C) _. transmission/hydraulic Synthetic Organics: degreasers a tit-, /0 Miscellaneous: ' DISPOSALIRECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer &Public ::F'O On-site OPrivate - r 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 JL ORDERS: O Holding tank:MDC �- O Catch basin/Dry well q P O On-site system 5.Waste Transporter Name of Hauler Destination Waste � � ct Licensed?, At 2. Perso s) Interviewed Inspector- Date ( Date: ::i--26— vy TOXIC AND HAZARDOUS MATERIALS ON_SITE INVENTORY NAMEOFBUSINESS: Alet BUSINESS LOCATION: 15 r7 ,rrzc� sL, 1�ii,'cr-� � ar�wris .MAILING ADDRESS: it INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: .SCE S--77S'-- 6 G Z 3 CONTACT PERSON: I� �o-✓t.e� �p( �f S p� . EMERGENCY CONT T TELEPHONE NUMBER: FIDE pt 57-RICT TYPEOFBUSINESS ac OTHER INFORMATION: P( �cv arc h vv� � 'rl a aix Waste Trans ortation: /.�• r�rt,a�+, , �o Name of Hauler: a y L,•. estination: Waste Product: "-�Licensed? a"s No LIST OF TOXIC AND HAZARDOUSMATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(forgasoline or coolant systems) Drain cleaners .NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Zo Pesticides A NEW f�?A USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diese[fuel, kerosene, #2 heating oil NEW USED �. -5- Other petroleum products: grease, Photochemicals (Developer) C� lubricants, gear oil , NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda , Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers , Paints, varnishes, stains, dyes PCB's e/ Lacquer thinners Other chlorinated hydrocarbons, lAaJ NEW USED (inc. carbon tetrachloride)- cvl Pint&varnish removers, de lossers g Paint brush cleaners Any other products with "poison° labels Floor&furniture strippers (including chloroform,formaldehyde, Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids M'tsC.: a.{ (dry cleaners) ZS Other cleaning solvents &I Bug and tar removers �, O O r 15"TV TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers COMPANY (see"Orders") Retail Stores 6.Fuel Suppliers ADDRESS Class' 7.Miscellaneous �-'QU " TITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR TERS , 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) 44rl transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: Pot,e,"r,-A Z�- ' d o DISPOSALIRECI.AMATION REMARKS: 1. Sanitary Sewage 2. ter Supply �.. � Town Sewer Public 0 On-site OPrivate �. 3. Indoor Floor Drains YES NO 0 Holding tank:MDC_ 0 Catch basin/Dry well ✓" 0 On-site system 4. Outdoor Surface drains:YES N0z ORDERS: 0 Holding tank:MDC ' O Catch basin/Dry well 00( 0 On-site system 5.Waste Transporter Name of Hauler Destination Was od YES NO 2. dor P s) Interviewed Inspector' Date ..-v+ii.:,�,;j ti�"�--"�.. _ .. .... _ ..... .. ... ... .. _ _. .....st:.9eb�X�w+�'t,w'►'��`�,^"+"61 DES''f�'�C�I�Tr.�a.;m�yxWi"'s,� ii�i7�'"'tnR:3..t+iac.rs�nr+�':ay t, � ,.. a � � � i � _ _. � .; i d � � f 11 1 !� • �. w � , - � � e � ' ' ����� f'�2� ' � 9 , { � ` � a t C7 LOCATION SE1WA VILLAGE ,I I N S T A LLER`S NAME B ADDRESS B U I L D E R OR OWNER tJ 2 . DATE PERMIT ISSUED_ rV _. � . � DATE COMPLIANCE ISSUED • ! .. Y�yt`•�� 4 3q 6 Number Fee 1233 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Northeast Tool Supply Corp. "---------------------------------------------------------------------------------------------------------------------------- 157 Thornton Drive, Hyannis, MA 1s Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2620 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r Town of Barnstable Inspectional Services BARNSTABLE Public Health Division 19W0.iMISW1 OS RYILL--MgIBUAN5A6S 1639AI014 �L� t-ul BAMSTABM 1 Thomas McKean,Director ° 1639. �� 200 Main Street� Hyannis,MA 02601 RFD MiN a Office: 508-862-4644 Fax: 508-790-6304 r--• APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS . ; IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, 'a 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 9VST' - CAT:LGORX.2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT-- SOU or moreGalloris: " $150.00 EY *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 V. 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: i 6rrvt 6quo er 5. NAME OF ESTABLISHMENT: Ma eG1S � 6. ADDRESS OF ESTABLISHMENT: 15-7 —Thor-n-IVn j�nu2 ► NvlanniS i11F1 O bO j 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: fNarr�. 5 f)0 4eaS-�""+Do) • w) 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: `SaUC�:2r ✓ 11. FULL NAME,HOME ADDRESS,AND TELEPHONE.#OF: CORPORATION NAME +—FOO I S U 9l Co o, PRESIDENT i- r TREASURER CLERK � 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF A PPLICAN DATE �' IS'C�0 Q:VWpplication Forms\Haz Mat Appli Draft Jan20l9.docx Number Fee 1248 THE COMMONWEALTH OF MASSACHUSETTS $s0.00 a Jy Town of Barnstable Board of Health This is to Certify that All Cape Machine Shop .....---------------------------------------------------------------------------------------------------------------------------- 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- Restrictions: .------------------------------------------------------------------------------------------------------------------------------------------------------------------. This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health .' _ 5 , Town of BArnstable Inspectional Services BARNSTABLE R N1TABLE-CCMRALU.CONiT`NTRNNIS Public Health Division""""�1639-LLc•,.?SNAAN548LE 1639`-2014 �f BAMMBLF. Thomas McKean,Director Eps` Mt 200 Main Street, Hyannis,MA 02601 , Office: 508-862-4644 ' Fax: 508-790-6304 - k: APPLICATION FOR PERMIT,TO STORE AND/OR UTILIZE cxa5 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 Vva-r Gh --- - - _r- _ _ _ .,CATF CIItY_2.PERMIT 1._flz7,4-9,9 Gallons_ - $125.00 El CATEGORY 3 PERMIT 500 or more-Gallons: $I50:0't) ag *A late charge of$10.00 will be assessed if payrnent is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES, SKIP QUESTION 3. L ` 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: ��v � 5. NAME OF ESTABLISHMENT: nv,�X C�CkrAIC - VNXC' A9— `1� 6. ADDRESS OF ESTABLISHMENT: VS1 J v v o i h 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: �p 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: �1 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK ` 12. IF PREPARED BY OUTSIDE PARTY: NAME:-- +! TELEPHONE#: COMPANY ADDRESS ` EMAIL: SIGNATURE OF APPLICAN DATE 7 '�A—AO Q:\Application Forms\Haz Mat Appli Draft Jan2019.doex Fee• Number 1233 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Northeast Tool Supply Corp. 157 Thornton Drive, Hyannis,MA Is Hereby-Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ------------------------------------------------ ------------------------------------------------------------------------------------- ------------------------ ------- ----------- ------------------ ------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health lv V3 "A.._. .-. TOwwn.of'Barnstable oFz Inspectional Services BfCffljNS�TcfR�LE • ��' .. wn*'�pti�r'IJS 5'Stvluf+*IS UMV�riikf. Public Health D, on. BARNSTASM Thomas WkK 4t ,.Directot. . 200 Main Street, Hyannis,.MA 02601 r� Office:;5087,862-4644- Fax:. 508-790=:6304. ! , APPLICATION FOR PERMITTO:STORERAND%OR UTILIZE . HAZARDOUS MATERIALS " 1N-ACCORDANCE:WITH.THE TOWN OF BARNSTABLE GENERAL,ORDINANCE,:CHAPTER,108, HAZARDOUS MATERIALS,ALL BUSINTSSESi THAT`HANDLE OR.STORE`HAZARDOUS MATERIALS OREATER THAN HOUSEHOLD QUANTITI]ES-ARE'REQUIRED TO`,OBTAIN AN ANNUALPEkMJT(RUNS: JULY a st—JUNE 30th) CATEGORY 1 PERMIT FEES APPLICATION . ..n.�_.._._ ..:�,.�.. T 26 110 Gallons $ 50 00 ,.�_ CATEGORY 2 PERMIT I1'1 499 Gallons $125.00 Q CATEGORY 3 PERMIT 500 or,more Gallons S 150..00' o *.A late charfte of S10.00 will be'as5es8ed if pay.merit is:not:received'by July lst. T. ASSESSOR'S MAP AND PARCEL:NO: 2. IS THIS ATERMITRENEWAL?. YES NO. IF YES SKIP-QUESTMON'3,, 3. FOR ALL NEW PERMIT APPLICATIONS;INDICATE WHETHER.BUSINESS'HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIA:I S STORAGEIUSE OF • GREATER THAN HOUSEHOLD QUANTITIES:(25 GALLONS)? YES NO. 4. FULL NAME DF APPLICANT: A V_.e , f S/� 5. NAME OF ESTABLISHMENT. '6. ADDRESS OF ESTABLISHMENT, /. ///G%`n X�n r /-fV4 -A/zs 0-6 U> 7: MAILING ADDRESS (IF DIFFERENT.PRO M.,ABOVE; 8. TELEPHONE NUMBER OF,ESTABLISHMENT. 1.raf_l2F1.-As3 a 9. EMAIL ADDRESS: l� ~ 10. SOLEOWNER: YES_NO IF NO:NAME OF PARTNER: 11. FALL NAME,HOME.ADD, S;AND TELEPHONE'':#OF:; CORPORATION NAME cop-p PRESIDENT TREASURER. 7 CLERK 12..IRPREPARED BY OUTSIDE. PARTY:; NAME: - TELEPHONE:#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE / Q:v,ppiica6m rommviaz'mat App Reviscd,09-10-18.00. Number Fee _ 1248 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health - This is to Certify that All Cape Machine Shop 157 Thornton Drive, Hyannis, MA ' Is Hereby Granted a License -For: Storing or Handling 26 - 110 gallons of Hazardous Materials. (This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health y L- .10 h+ Y^4 W Town of Barnstable t nAAAu Inspectional Services BARNSTABLE OF THE Tn..� ._' - MtNSTnBIE•ururan:i•eow*•+uavr . �+Y Public Health*Division WPS�C�W�yS ,390.20E -rarRnT:,te � zs-zma his EARNSTABLE, Thomas McKean, Director MASS- 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 " APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE ' HAZARDOUS MATERIALS 3 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 1st_JUNE 30th). -- APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 1941 POl CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 El CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ �d <4 *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. o2 5&—67� 2. IS THIS A PERMIT RENEWAL? V YES NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOU&MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: ��.�cs c6,✓es 5. NAME OF ESTABLISHMENT: ✓. , . �/.1dt ,:- 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: (-6 - -7.7.S- d G 3 9. EMAIL ADDRESS: 10. SOLEOWNER: 1/ YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME A)DRESS,AND TELEPHONE#OF: CORPORATION NAME - - - PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT - DATE Q:\Application Fonns\Haz Mat App Revised 09-10-18.docx Number Fee 1233 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable .. _. Board of Health - -- - This is to Certify that Northeast Tool Supply Corp. 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health is Fr' o c-h K. 3 a0�3 Voegwr8of B rnsxable atory ervices �t"e,� Richard V. Scali,Director ' Public Health Division BARMTABLE i anxxsne •rairamue.mrvr•mumss BABNSPABM Thomas McKean, Director "'�'°�""t•�� 5" MASS. A 1639-2014 ATECta`00 200 Main Street, Hyannis,MA 02601 ��lg 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 J V S CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by 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: <S v l e/Z 5. NAME OF ESTABLISHMENT: a I- eq %ao L Si.-p p r 6. ADDRESS OF ESTABLISHMENT: /�� py/I�Uh �� , rf nN A//S 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: W_Y L 9. EMAIL ADDRESS:�i� (�/�Of-�ijeas - /, G4 10. SOLEOWNER: YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME A)&Ah�qs i i L Su PRESIDENT 1 TREASURER CLERK 12. W PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: . COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE QAApplication ForinsUiAZMAT APP 2017 REVISE gdo� r` 1-1 Number Fee 1248 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health L This is to Certify that All Cape Machine Shop 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------- ----- ------------------------------------------------- ------------- ------- ------------------------------------------------------------------------------------- ------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health F 7 R -l r, = IowtA of Bonsxable eg atory Services oF Richard V. Scali,Director t� Public Health Division BAMSTABLE t Y BANNSTMIE.GENfflNILtF.COiUR•NYgNN15 f • sAxtvsrnsrs M Thomas McKean Director U50N5MIS•osrenrue•xaeaxsrneF ,�- AM A 1639�--//2014 a - -- - - -- -- -1639- ♦0 -- - - —._. - - 0� ptfo�e 2001VIain Street"Hyanns;lVlA 02601--- ---__---------- -------���---- - -.- Office: 508-862-4644 Fax: 508-790-6304 1.1 APPLICATION FOR PERMIT TO'STORE AND/OR UTILIZE CX '-n HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). ; APPLICATION.FEES _ CATlt6GRY 1�PE'RMIT. 26 1k10 Gallons''- :"$-50 00—--- o-V' -- CATEGORY 2 PERMIT 111 499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGEIUSE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: I S—t � `y`t `, CIA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER:TYES N 0 IF NO,NAME OF PARTNER: ' 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.docx TOWN OF BARNSTABLE o BAR -W 6002 t.Y Ordinance or Regulation WARNING NOTICE �. TOWN OF BARNSTABLE Name of Offender/Manager �)ZV\VNN/> S 6%A e-S _. -- 1 PM 3- 37 Address of Offender MV/MB Reg. # Village/State/Zip /� _ Business Name �� (-4 -Z Ay�o MAG x,, mvirsm n0 pm; on 7 20 (o Business Address I 5� I D*i.�-'�"a rc—�S�v� _ Signature f nforcing Officer Village/State/Zip 4V q.v Ai 5 , ►'►�1 �'f �Z60 Location of Offense All 64,0.e, o+e e e-1A, kk— t , / Enforcing Dept/Division .Offense CXj I Ir D Facts � w 6 4& le_ I l G-e- 5.e +f4' S'�JS �S A, This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve ;? voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. W0 OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING Off' GOLD- ENFORCING DEPT. sE r Town of Barnstable Office: 508-862-4644 Fax:508-790-6304 Regulatory Services Department • sn Public Health Division Mom.. Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Hazardous Materials Payment received: $10.00 (Check) on 8/3/2018 Permit number: FY 2018 i :Check number: 4248 Check amount: $10.00 Name on check: All Cape Machine Shoff Business: All Cape Machine Shop Owner: HARRY&MARY SAUCIER Address: 157 THORNTON DRIVE, Barnstable r ;Note: Late Fee $10, paid $50.00 for Category II on 07/23/2018 i - } f - _ A s Number Fee 1233 THE COMMONWEALTH OF MASSACHUSETTS $so.00- Town of Barnstable Board of Health Y This is to Certify that Northeast Tool Supply Corp. " 157 Thornton Drive, Hyannis,.MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. --------------------------------------------------------------------------------------------- ------------------------------------- ---------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ----------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health aSO y t Number Fee 1233 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Northeast Tool Supply Corp. I57 Thornton Drive, Hyannis,MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ----------------------------------------------- ------ ------------- ---------------------------------------------- ----------------------------------------- - This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 6Z:T0Hd LTOZ 61 PIf t 4P TROwn%of B ry ces e pd �S~0 4�� eg atory erices SHE Richard V. Scah, Director Public Health Division BARNSTA ' OPRHST4bLE.iEHrEHYIL •COiUII•HY4FY.15 t< Hk951U�•:5 HILLS-051:HVILLF.•IvSt p4.+y51�46vE BARNSCABLE. Thomas McKean, Director 1639-2014 iOTen >``� 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-7901304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPT9 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY-1st—JUNE 30th). APPLICATION FEES CATEGORY I PERMIT 26— 110 Gallons: $ 50.0G CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? /YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF ' GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 5. NAME OF ESTABLISHMENT: /GQL S�. L (may 6. ADDRESS OF ESTABLISHMENT: ✓/lOt h �'3r �" dt/ s' a l 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NfJM13ER OF ESTABLISMNENT: 9. EMAIL ADDRESS: `7at-0 5. C, )-),0—A)P9�� �, GG m 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TELEPHONE#OF: CORPORATION AME Gi'�/l �qs� raoL S 1 cgot PRESIDENT 4, e j-Z/� TREASURER CLERK I2 12. IF PREPARED BY OUTSIDE PARTY: NA ME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Fonns\IAZMAT APP 2017 REVISE ocx Number Fee 1248 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that All Cape Machine Shop 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN: DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health �w of B stable egaatory%ervices Richard V. Scah, Director • Public Health Division BARNSTABLE 9PNtl5TNflk•iExrERVILLt•CONIt•HY—JS .. i EARNS"L6. w� MSWlLLS-EaVltlE•vresre4?xsrceE (.ah rsass. Thomas McKean, Director 1639-2014 fo 39. a`� 200 Main Street, Hyannis,MA 02601 575 � ao/�-aDiB 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• ANNUALPERIVIIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 v..S.. CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charize of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO.Y 2. IS THIS A PERMIT RENEWAL? V YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS • ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: uaw-*Lb 5. NAME OF ESTABLISHMENT: f�A-\ li�� Irc.Vv�rt S 6. ADDRESS OF ESTABLISHMENT: I �� �v t W �-Y\ A--kw^- 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:` r� 8. TELEPHONE NUMBER OF ESTABLISHMENT: J" � 1� �� 0 9. EMAIL ADDRESS: 10. SOLEOWNER: YES _ NO IF-NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT = t TREASURER ' CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\I-IAZMAT APP 2017 REVISED.docx r 1 Number Fee 1233 THE COMMONWEALTH OF MASSACHUSETTS $5o.00 Town of Barnstable Board of Health This is to Certify that Northeast Tool Supply Corp. ` 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. ------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------- --------------------------------------------------------- ---------------------------- f This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. - --------------------------- ----- - N 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 Cr - Town of Barnstable �tHME Regulatory Services Richard V. Scah, Director * B"M ' Public Health Division BAMSTAB AS& "L . s679. `0� �fD MA'S A Thomas McKean, Director 1639- � / �Dg , 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-V4 CQ APPLICATION FOR PERMIT.TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER6108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS- MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 499 Gallons: '`$125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: •�rr yq-ve, NAME OF ESTABLISHMENT: ADDRESS OF ESTABLISHMENT:. 1s7 '4' �� ys�n�.v�s. /YI/f ai& o i MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: EMAIL ADDRESS: Ce-,---f ao 4- ,GC SOLE OWNER: YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER 4vCi2z CLERK /4,g IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF PPLICANT s Name: Company Address Telephone#: l . Email: Q\Application Fonns\HAZZAPP Revl6.docx Page 1 of 2 Number Fee 1248 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that All Cape Machine Shop 157 Thornton Drive, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- CIA WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO (13 1 Director of Public Health Town of Barnstable FINE rqy, Regulatory Services do Richard V. Scali, Director BARNSTABLE,MASS. ' Public Health Division BARNSTABLE M 9� 039• ,e� .W�V STON�ftS- TERTUE-Ws,aau 9n U N A'EDN1P�A Thomas McKean, Director 1639-204 200 Main Street, Hyannis,MA 02601 s Office: 508-862-4644 Fax: 508-790-6304 .v r All APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 • A late charge of$10.00 will be assessed if payment is not received by Jule ASSESSORS MAP AND PARCEL NO. DATE �. FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: L074 .t�. . 0 ADDRESS OF ESTABLISHMENT: MAILING ADDRESS (IF DIFFERENT): 7 - TELEPHONE NUMBER OF ESTABLISHMENT: �� � � � 2_.-3 EMAIL ADDRESS: aiv�-C, /o/��,,t G 017'? SOLE OWNER: V YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK ' IF PREPARED BY OUTSIDE PARTY: SI ATURE O PPLICANT Name: Company Address : -- Telephone #: Email: Q:\Application Forms\HAZZAPP RaI6.docx Page 1 of 2 ' C I Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. . • 200 Main Street• Hyannis, MA 02601 039. �prFOMP'�p`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT !!r Business Name: (- eo: DQ c Date: 0 Location/Mailing Address•,` 157 Contact Name/Phone: t`l ° d Inventory Total Amount: ''`�` 0 SDS: 0 li 9 0 +t-U&K'S License#: 1�d� Tier II : Labeling: a Spill Plan: f, Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: wo Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: e Other Waste Disposal Methods: -S i a 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°1 Lye or caustic soda Lacquer thinners ✓'" Miscellaneous Combustible S- aint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers loor&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: pey#4) Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IKE►ok� Town of Barnstable Office:508-862-4644 °* Public Health Division Fax:508-790-6304 RARMS�LE.� 200 Main Street• Hyannis, MA 02601 fo + TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 61-Ke'a 1 oeq 1upiply Date: Location/Mailing Address: 4114,n,i rs �[G Contact Name/Phone: a�.52vci.e r S�— "778 y,S�2 Inventory Total.Amount: MSDS: fiKlluw License#:—Tb c�+ I Tier II : v Labeling: o Spill Plan: ak c e-16grur Oil/WaterSeparator: Floor Drains: NV Emergency Numbers: Storage Areas/Tanks: \LS 0v& 4 Emergency/Containment Equipment: t3a Waste Generator ID: v LIWO 1 Waste Product: d4ri4 E�2dHc,� Date&Amount of Last Shipment/Frequency: ;Zqjil. 8 A l 1,- eves Licensed Waste Hauler&Destination: a,F 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 1 Degreasers for engines&garages Pesticides: IS Caulk/Grout/q-Akcr5+vc.5 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) n Any other products with "poison labels" NID +'�DL �bpte �, koaVV�S (including chloroform, formaldehyde, I hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECQM MEN DATIONS: `Q, 1 ov Inspector: 9 + L,&\j 12� Facility Representative: C?,f�� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: 7/ IL /13 TOWN OF BARNSTABLE'tt—yls TOXIC AND HAZARDOUS MATERIALS FORM NAME OF BUSINESS: OAe&5-f—mil So BUSINESS LOCATION: K7 INVENTORY MAILING ADDRESS: ,S�w�c_ TOTAL AMOUNT- TELEPHONE NUMBER: S08- 1-78-ggYs L ^� /01_ s ,I CONTACT PERSON: Nei miry Saoc,.e.r EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS:oI f 5�Pe1,es Po-4a-l<-r /yos OINFORMATION / RECOMMENDATIONS: ')Alo hetamu-f bc,crese.r-ety)f Fire District: SKIS +� Z�4b�-�/w�45Ds s"-s xm� lc D oK s,f� -12 VMAKi e- Sec-ocA ox ,/��Coc ., ask vL esi y�0 a•,�, r 4bao�be s fJGk. a 1 t e� r a-vt oe 44)rto r d ,1 5 GVA.4-A,-,, Waste - edauom MAV000oo it)`f 3 1 Last shipment of hazardous waste: y 2y 13 Name of Hauler: Destination: Crews+ov- 1RT 50�' Waste Product: wasfc, coywbvs+•b1e �'1��� Licensed-(SoNo / l&48`{80Z'BY-L 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 Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED ® Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) I.( Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar 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, 2 Paint&varnish removers, deglossers hydrochloric acid, other acids) 3 Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes ,,nq /yl/se- yoc-60A+4I"yt4 ` logrtS 41gpe, f Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials i �� �'��� i I C�G� j��I�i�.P� ��19� f i °FTHE r°w� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 9 BARMA.RSRBLE.� 200 Main Street• Hyannis, MA 02601 oMIN, TOXIC AND HAZARDOUS ry DOUS MATERIALS INSPECTION REPORT Business Name: l UlG� (kk � Date: / 1 Location/Mailing Address: 15 I ornion Orivr- Contact Name/Phone: i Inventory Total Amount: ``' (� D SDS: Q License#: Tier II : 0 Labelina: PS Spill Plan: Oil/WaterSeparator: Floor Drains: 2S Emergency Numbers: J Storage Areas/Tanks: GI a %- a a r{y-- Emergency/Containment E u' ment: Qi blGt rx S Waste Generator ID: y a 7 Waste Pro ct: I r-0 r Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: e Other Waste Disposal Methods: . �� i Lmm J 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. U Antifreeze Dry cleaning fluids 10 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 e 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: n, INFORMATION/RECOMMENDATIONS: l ,r fL `, Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °pIMEr Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 &.RM `E. ' 200 Main Street• Hyannis, MA 02601 Fora9n+'�0� /�TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4/1 Ca a wc, m Date: Location/Mailing Addre s: 1521 Contact Name/Phone: La Sa8-?'7S`- d(�Z� Inventory ' Total Amount: N"I �� �� MSDS: E5 License#: Tier II : o Labeling: IEt \ of I Spill Plan: 4o 0 Oil/WaterSeparator: N A Floor Drains: Emergency Numbers: Storage Areas/Tanks: 41 W4,qe� a 1,1 Emergency/Containment E ui ment: $�-¢4-41 9,,N °vA S�ker Waste Generator ID: I Waste Product: D4v-+g e-IC.w4-6 a, Date&Amount of Last Shipment/Frequency: I L A L. I 44--c I Licensed Waste Hauler&Destination: ., Other Waste Disposal Methods: 5,Q W&Ve- 0 2G o�.1 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. I D Antifreeze a' 10 N,I&Vv� v�> Dry cleaning fluids Automatichinsmission fluid a,I � Other cleaning solvents&spot removers Engine and radiator flushes 1A00"`T 5/ Bug and tar removers 9-f Hydraulic fluid (including brake fluid) Windshield wash I p Motor oils Jr.) 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 �o Degreasers for engines&garages 2p 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/R OMMENDATIONS: I( Lbr ©VU Qks 51 r o1 2C -` awe o.m X k 5 t, b L r Inspector`s ll Facility Representative: 61 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °Ft►�r�� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. . 200 Main Street• Hyannis, MA 02601 "rEOMa+"��� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 4C MACA )"Ll-5h Date: Location/Mailing Address: I S o,r -}a„` Dr, ►e- 6t V1 V 1 15 Contact Name/Phone: -e. 2 Inventory Total A ount: 11 MSDS: License#: Al Tier II : 0 Labeling: 16��61 wkS�e.Oil Spill Plan:_ Oil/WaterSeparator: Floor Drains:. tJo Emergency Numbers: • i Storage Areas/Tanks: • f arks -P-aW cf &%vt Emergency/Containment Equipment: CI4A,n, t w a oc m �.�.� Waste Generator ID: MID I 14 2 aste Product: DC4A4 Date&Amount of Last Shipment/Frequency: 1-�- I aS al l Licensed Waste Hauler&Destinati Sac, awls w�. Other Waste Disposal Methods: -a o , 0.--V..la. Lcqk4 S -e . 6 i- V4 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 V 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 J Paints, varnishes, stains, dyes Lye or caustic soda -7— 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/RECOMMEND TIONS: 2 5 t AlvL r5 AtL R_LD D\& -¢. I J �qkt, O,v1ti, -t'`1 JJ_14- Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOWN.OF BARNSTABLE Date: Z / /2 / 13 Z.,s iok. TOXIC AND HAZARDOUS MATERIALS N FORM NAME OF BUSINESS: �f0 Ca BUSINESS LOCATION: /S 7 0� 0� �r..�T d�•vtv��S INVENTORY MAILING ADDRESS: Sari TOTAL AMOUNT: TELEPHONE NUMBER: mo ab23 < CONTACT PERSON: 3>Z-0V1 EMERGENCY CONTACT TELEPHONE NUMBER: M DS N SITE? TYPE OF BUSINESS: 2) INFORMATION / RECOMMENDATIONS: 9 00-4,yt -t lee:e,0 •ti s rl-� /�I�s�S Fire District: 3"4,5 lvvt-Z w&s +2 ,Man i: &e,-hi- z)<,P. O ry cord tt d I,J +e o11 fgkm6- 1444 vi vi I S ;�,4_6t +0 19,ti ljty, C<,,Is :' Lab<I ,k t Ge,t,�,�c-a,,�m•r Waste T pvrtatr8n: 44-4b it t'743o,'Z13"7 Last shipment of hazardous waste: 414 2ol Name of Hauler: 5&� ' fy Klee y,_ Destination: Waste Product: ,Da<-4s ,µ-e,,r Licensed? es No R► S'� 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. Obs ed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED / Miscellaneous petroleum products: grease, Photochemicals (Developer) r/ lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar 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 Laundry soil &stain removers (including bleach) Ill, ��bOaQ-fiW �'I.00 ' 5 04-6 k�<." — Spot removers &cleaning fluids (dry cleaners) �' W�S /l� Other cleaning solvents Bug and tar removers h&l—!q K01 0y Iv4o / L Windshield wash 7v� 0i1 06,U v! 14ex WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials L TOWN OF BARNSTABLE Ordinance or Regulation BAR -W 6002 WARNING NOTICE Name of Offender/Manager ` �' a Address of Offender MV/MB Reg.# Village/State/Zip / Business Name 'A 3f c e ) /4 si rt c. -c .- � �� am%pm; on -7l a 20 � Business Address t 5-7 TA Signature of Enforcing Officer Village/State/Zip. ti ►�>nl tr't c3 bCO Loca_tion of Offense j + ✓t ,4, ct Ltt• #Enforcing Dept/Division Offense X e 06 7C�4yo , 4'���(t��S � 16-t K e... e%J 1 not... Facts 0�- a - U -E'_L A\'3 A rAc,0."Zie t"J 14�1 V1S� +�;►►�e�3 � . f This will serve only as a warning. At this time no legal action.has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances; Rules.and Regulations.. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD-ENFORCING DEPT. ------------------ TOWN OF BARNSTABLE7 ��® Ordinance or Regulation BAR -W WARNING NOTICE I . Name of Offender/Manager �'�'''�' - -> dob, _Address of Offender MV/MB Reg. # Village/State/Zip SS# Name } ! Am/pm; on- y11 .% 20_ Business Address Signature`ofjLnforcing Officer Village/State/Zip ._ Location of Offense 411 4 ;> t/at�� ���• � ���� ���� t Enforcing Dept/Division Offense x49+ (e.:, ! t y EV�kr"r �' t '+nl ✓,t ' ^ �� "� r��. .� Facts lrt � f This will serve only as a warning. At this time no legal action has.been taken. It is the goal of:Town agencies to-achieve voluntary�compliance of Town Ordinances, Rules and Regulations. Education efforts Land warning-notices are attempts.to gain voluntary compliance. Subsequent.violations will result in appropriate legal action by the Town_: WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK- ENFORCING OFFER GOLD-ENFORCING DEPT. t7& 6aA& 'r /// SMtEAD KEEPING YOU ORGANIZED No. 10334 2-153L MADE W USA GET ORGANIZED AT SMEAD-COM