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HomeMy WebLinkAbout0066 BARNSTABLE ROAD - Health 66 Barnstable Road . Sewer`Acct # 0051 Hyannis - - cry-' A = 327 -061 j �. i Y � Hazardous Materials Inventory Sheet Checklist 01 Date _ ysical Street Address-Check database to ensure it exists J ,--Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials) Storage Information - location of storage, how long is storage for? If none, note that. 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? -provide a vehicle washing policy and explain it- note that it was given Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures .V arP rininn Nntac nacrl +n_h- -" I- - - YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 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) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to.the Town Clerk's Office, 1 st FI., 367 Main St,, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. 7 DATE: +I �/ / Fill in please: APPLICANT'S, YOUR NAME/ : p BUSINESS YOUR HOME ADDRESS: q3 TELEPI ZONE # Home Telephone Number NAME OF'CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? Y NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER (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 s be n inform of 1te per requ nts that pertain to this type of business. Aut orized nature *` 7. NIUS ,OMPLY VViT►°l���+_i._ COMMENTS: ,. - - , 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b n i forme of lice ing requirements that pertain to this type of business. ized gnat e** —' COMMENTS.: ,� Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM P;/ NAME OF BUSINESS: BUSINESS LOCATION: r6 INVENTORY MAILING ADDRESS: `T/cKg.. _Ad TOTAL AMOUNT- TELEPHONE NUMBER: V V / CONTACT PERSON: EMERGENCY CONTACT TELEPHONE jN UMBER. MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: PJA Last shipment of hazardous waste: Name of Hauler: f-)h�- Destination: Waste Product: r j yt4r 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 Antifreeze(for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners I Automatic transmission fluid 16�L Disinfectants Z&pal, Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants 9 it ftI$ Motor Oils Pesticides ❑ NEW ❑ USED NIA (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) NO Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, 0 Photochemicals (Developer) lubricants, gear oil N ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives(creosote) NIA Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda N Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes AA Car waxes and polishes Fertilizers A 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): A Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids N (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A lic is Si Staff's Initials 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 the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St.,-Hyannis. Take the completed form to the Town Clerk's Office, 1" Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. z r DATE: Fill in please: APPLICANT'S YOUR NAME: Zu! rf 0--k10� r ' `' BUSINESS YOUR HOME ADDRESS: f -/(-5 oil S )-2f--) c) J ,-4rw 66CX") TELEPHONE # Home Tele hone.Number: t i/ NAME OF NEW BUSINESS AG(. in�7,�r5 , �;tc,S YPE OF BUSINESS CCL t_ Sc, / IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS G. n < MAP/PARCEL NUMBER .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. i' 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 f This individual has be . finfornyd th ermi irements that pertain to this type of business. Authon ed.Signature** COMMENTS:— Sim Le5S 7W%1A-) %// QX-"o.cJ9 e/r fJALfIgAaaS 3. CONSUMER AFFAIRS(1-1 ENSI G AUTHORITY) This individual has n i f r of the licensing requirements that pertain to this type of business. thorized S19VEture** COMMENTS: 1 . yuu U1O%,UzOZ; Hazardous Materials Inventory Sheet Checklist - -/D 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 Fong is storage for? If none, note that. Disposal Information -where and who? If none, note that. q,/- Applicant Signature -understand what is listed and noted V Staff Initial -any questions, know who to ask .N /a. Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it ✓ 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 Px„l in %Aihat vat 1 .+rz,, -- Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Ak.,Q PUE S BUSINESS LOCATION: � �-'�s�'u� ��-� - INVENTORY MAILING ADDRESS: A 011j N A n2(;o I TOTAL AMOUNT- TELEPHONE NUMBER: r©S" 111 6600 CONTACT PERSON: S Pr ,Aa`^ g-Q Z EMERGENCY CONTACT TELEPHONE NUMBER: > 8" 3 �' - Q- MSDS ON SITE? TYPE OF BUSINESS: V,56- C#,9hi'L-5 S e.Us INFORMATION%RECOMMENDATIONS: Fire District: 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) n' Misc. Corrosive NEW USED Cesspool cleaners �t 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 Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink ti Degreasers for driveways & garages /)--,.Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine ✓L Battery acid (electrolyte)/Batteries Lye or caustic soda. Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes 2 `Fertilizers Asphalt & roofing tar 'PCB,S C. Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners ,,/ (inc. carbon tetrachloride) / NEW USED v '� Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) i Floor &furniture strippers Other products not listed which you feel Metal polishes e toxic or hazardous (please list): Laundry soil & stain removers f (including bleach) Spot removers &cleaning fluids .(dry cleaners) Other cleaning solvents A""' ''* Bug and tar removers 16,1 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 'Wil ou ox TO ALL N W USINESS OWNERS DATE: ® l\/6e/ Fill in please: APPLICANT'S YOUR NAME: 10A1, 10D .S r' _ r OME ADDRESS: � B SINESS �, YOUR H � � N � 6509 775a &62 gn 0 s . 0,,-�10,0/ TELEPHONE Tele phone Number Home SD8 NAME OF NEW BUSINESS - Q VfS COI`719 i' TYPE OF BUSINESS LL-5 C Q Mlt- IS THIS.A HOME OCCUPATION?� YES I NO Have you been given approval from the building division? YES= NO.L= ADDRESS OF BUSINESS MAPIPARCEL NUMBER. 3o2 1 fJ i!i 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 i4ormation you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall)or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.— (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 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 en informed of th er requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) E This individual h een•in ".he ' e sing requirements that pertain to this type of business. 9uthori Signature** COMMENTS:. .(u CC S Q�k btalik Lr hala Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. YOU WISH TO OPEN A BUSINESS? =Yourmation: Business.certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town which y M.G.L, it doesnot give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"`FL.(367 yannis, MA 02601 (Town Hall) DATE: /(-©`Y- Zoo S Fill in please: APPLICANT'S // �� w.. .. YOUR NAME: Cgr�a /�cl BUSINESS YOUR HOME ADDRESS: — /Z Alf 11• p TELEPHONE # Home Telephone Number NAME TS A NEW BUSINESS ����� TYPE-OF BUSINESS: ,8 f/ t� IS THIS A HOME OCCUPATION?_ YES NO. .. ( J� Have you been given approval from the building division? YES: NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER 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 bee nformed of a y permit requirements that pertain to this type of business. Authprized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been rm of thepermit requirements that pertain to this type of business. Au horized Si nature* COMMENTS: . oLo L 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has �infor f the Ijs' r irements that pertain to this type of business. ` Aut oriz d Si COMMENTS: �--e-�) #U4-_h �u. j ��e� . TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 3. Printers to Body Shops O unsatisfactory- 4.Manufacturers COMPANY,j �`�'1 (see"Orders") 5. Retail Stores 6.Fuel Suppliers ADDRESS It :lass: 7.Miscellaneous 4 cyQUANTITIES 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 61 V� Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. ater Supply Town Sewer Public tSC O On-site OPrivate CIA- 3. Indoor Floor Drains YES N0� , w O Holding tank:MDC At AD O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO !L ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1• YES N0 2. Person(s)ffnterviewed Inspector ate gY Buying&Se/ling Quality Pre-owned Vehicles .TERRY REARDON 66 Barnstable Rd. •Hyannis,MA 02601 •Tel/Fait(508)790-8181 ' I TOWN OF BARNSTABLE , coMPLIaNCE: class: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 1� Satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY.11. �i'A�,ems`" (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS �'2��� �� Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Under&n-ound 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 )4r4 Z Miscellaneous: DISPOSAL1RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 'Town Sewer Ofublic -- 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_// O ERS: O Holding tank:MDC .� O Catch basin/Dry well O On-site system 5.Waste Transporter Narne of Hauler Destination Waste Product Licensed?� 1,4 e� YES NO 1. 2. � l Person(s) Interviewed Ifispe&or / Date� . t � : Fit son 1 1. pig ij Oki all 1 c r e z r � t e - ; F i v x ' - r � ' a x > _ f - .... .. '. - _.. }- _ i•' f \ E } t s i t z- S 4 a € its VIA z a 4 o . Buying&Selling Quality Pre-owned Vehicles .TERRY REARDON 66 Barnstable Rd. •Hyannis,MA 02601 •Tel/Fax(508)790-8181 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers satisfactory BOARD OF HEALTH 0 3.Auto Body Shops unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores .Ab40 I COMPANY M-5 AM &a(MI tly- 6.Fuel Supplier ADDRESS Lb -6ftyp l2P)� F-D Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: 0 Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSALIRECLAMATION REMARKS: 1 S. itary Sewage 2.Water Supply f own Sewer .Public (rat Q 0 On-site OPrivate 3. Indoor Floor Drains YES—No ot, 0 Holding tank:MDC 0 Catch basin/Dry well ALt" 0 On-site system 4. Outdoor Surface drains:YES N0_)�_ ORDERS: O Holding tank:MDC . O Catch basin/Dry well 0 On-site system 5.Waste Transporter 1. C 2. Person(s) Interviewed Inspector Date