HomeMy WebLinkAbout0002 LONGVIEW DRIVE - Health (3) 2 L,ongview Drive
Centerville
A= 282-073
S M E A D
No.2.153LOR
UPC 12534
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Hazardous Materials Inventory Sheet Checklist.
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V 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.
isposal Information -where and who? If none, note that.
Ap scant Signature - understand what is listed and noted
taff Initial -any questions, know who to ask
V Miele Washing/Rinsing? -give a vehicle washing policy and
xplain it
Attach the Business Certificate with your sign off and comments
ventory form should explain what the business consists of and the procedures
Ning. 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:
`' �; f� ?� Fill
APPLICANT'S YOUR NAME/S: 1�W�41Z�D S G, �w� in please:
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t ,z� a?� F ,� W BUSINESS YOUR HOME ADDRESS:_ Z Ly a G u t
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TELEPHONE # Home Telephone Number_ S"4,48 Z? S- .2 z 7S-
NAME`;OF CORPORATION:
NAME OF.NEW BUSINESS Er,, C TYPE
1S THIS A HOME OCCUPATION0 YES NO: - OF BUSINESS
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ADDRESS.OF BUSINESS : .: .a 11a.;� v.t��,,,. p;x.. �', ✓a!�.L/t..MAP PARCEL'NUMBER
_ V (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
Barnstd'ble. 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 ha �imedf the it r r;� nts tha pertain to this type of business. MUST COMPLY WITH ALL
HAZARDOUS MATERIALS REGULATIONS
Authorized Sig ure*
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:
' Date: / 2- /;2ela
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: C G C 14,J OM 4
BUSINESS LOCATION: Z 1-o Or. u i D r�- INVENTORY
MAILING ADDRESS: S A »+.tis TOTAL AMOUNT:
TELEPHONE NUMBER: _5�O e Z 7 S`
CONTACT PERSON: C 3O W'9"r.0 W
EMERGENCY CONTACT TELEPHONE NUMBER: STOP 776 dN12'-/ MSDS ON SITE?
TYPE OF BUSINESS: N%' m t T*
INFORMATION/RECOMMENDATIONS: Fire District:
A).V1 S
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
isc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
1/ grPaints, varnishes, stains, dyes Other chlorinated hydrocarbons,
4
✓ acquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor&furniture strippers Other products not listed which you feel
✓ �y
L Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers Q
(including bleach) G
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS