HomeMy WebLinkAbout0319 BARNSTABLE ROAD - Health . �ff X` M`S 1�:�. R _ r' Ly•�_J 'JlL'. U.a Y4J,
319.Barnstable Road Sewer Acct #0319
Hyannis
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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" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
«r DATE: Z , b
Fill in please: .
APPLICANT'S YOUR NAME: ( �S C.CCtSS `�Zj(� j �/� (n C
BUSINESS Y UR HO E ADDRESS:
Aso -7-7 t- ���� '?- -7
ELEPHONE # Home Tele hone Number:
NAME OF NEW BUSINESS TYPE OF BUSINESS c
IS THIS A HOME OCCUPATION? YES NO S
Have you been given approval from the b '[ding division?.YESX___b10
_ ADDRESS OF BUSINESS A MAP/PARCEL NUMBER
When starting a new business there are several things you must do i ord r 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.
i
Authorized Signature**
COMMENTS:
i
2. BOARD OF HEALTH
This individual has been RrTedo the permit requirements that pertain to this type of business.L: C1! MUST COMPLY WITH ALL
Authorized Signature**
kiAZARDOUS MATERIALS REGULATIONS
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING THORITY)
This individual has b1�in for e o h licensing requirements that pertain to this type of business.
Au horized Sign ture**
we�
(�COMMENTS: �1 C�Q LQQI� ou,4 ll./
I �
'ry
t.�: .J7. _M+� s y � x _ y. )•t- mot. v�✓_..-++._�••-+_. .- 'w f . -�`r - - �• '.t»: _ ., ` .t .+.
Date: (�S / Z / ;201 c7
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OFBUSINESS: r rts7 C655 kromoTr✓e %t, PRACq�rCcd 6;(rs04d T?vtK5
BUSINESS LOCATION: (' r,,src16LJ2- I+yaHn:s,AA-4- 0ZCno( INVENTORY
MAILING ADDRESS:-<bl"ICL TOTAL AMOUNT:
TELEPHONE NUMBER: 505
CONTACT PERSON:
TQA-D 1010-r4cs-
EMERGENCY CONTACT TELEPHONE NUMBER: �� ' �32C7 MSDS ON SITE?
i
TYPE OF BUSINESS: dCIss IT D2es1eC
INFORMATION/RECOM-MENDATIONS: 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
F or hazardous characteristics and must be registered regardless of volume.
} Observed/Maximum Observed/Maximum
;I
Antifreeze (for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
� 00� Automatic transmission fluid � C�uc..z$ Disinfectants
Engine and radiator flushes Road Salts (Halite)
H draulic fluid (including brake fluid) ( •, Refrigerants
Y P
i Motor Oils Pesticides
-NEW USED I? �jtTS (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
I
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 I CC4c i r: i
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
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer 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
Metal polishesrr�ay-b oxic or hazardous (please list):
Laundry soil & stain removers
r:�� I J�)Cw✓+tY1 G
o
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents ,
Bug and tar removers
Windshield wash ? 0110hS
`WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Mike Walsh
Sales
319 Barnstable Road
Hyannis,MA 02601
(508)771-8881 Cell(508)317-2869 AdIllb
Buy'Sell`Trade'Custom Buying*Consignment'Referral Program$
i *•Premiiin Cars•s "Pntctical Pricesi*'
, l
i
TOWN OF BARNSTABLE C- MPUANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
0 unsatisfactory- 4.Manufacturers
l Stores
COMPANY-tea.` 4 a ,�cte (see"Orders") s.Fuel Suppliers
ADDRESS �/ j83S; 7.Miscellaneous V
UANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MAT R� ove ,. -
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)
j transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous: ,
s
DISPOSAL/RECLAMATION R��EQQMARKS:
1 S itary Sewage 2.Water Supply AeZ
.Town Sewer OPublic
O On-site OPrivate
3. Indoor Floor Drains YES ` N0
0 Holding tank:MDC A .,
O Catch basin/Dry well '4111e Ow
0 On-site system
4. Outdoor Surface drains:YES NO ORD RS:
O Holding tank:MDC
0 Catch basin/Dry well 43�11> 1
0 On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
J/Y /;a �y
Pe son TsYln rviewed Ilfspector Date
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Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: •--V ,5 'r 1, �✓
BUSINESS LOCATION: zz 1 Z! fao?"Sol C1-e
MAILING ADDRESS: �G- �e� �C G► _ A t,,,� X/O Y Mail To:
TELEPHONE NUMBER: o -9- S6�' 3d Board of Health
{ Town of Barnstable
CONTACT PERSON: % �Po/ P.O. Box 534
-E MERGENCY CONTACT TELEPHONE NUMBER: 1-018 Hyannis, MA 02601
Ir
TYPEOFBUSINESS:
i
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the koard of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
i
If you answered YES above, please indicate if the materials are stored at a site other than your mailing
address:
ADDRESS:
r TELEPHONE:
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. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
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 Pesticides
i
NEW 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
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde, 1
Floor & furniture strippers
J , hydrochloric acid, other acids)
Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail $bereq,
6.Fuel Suppliers
ADDRESS IAZ ass: 7.Miscellaneous
UANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MANOR MATERIALS Case lots 13)runis Above Tank,-, Undergn-ound Tanks
IN OUT IN OUT IN OUT #&gallons I 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:
DISPOSALIRECLAMATION REMARKS:
1.janitary Sewage 2.Water Supply
Town Sewer Public -
O On-site OPrivate
3. Indoor Floor Drains YNO
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 Licensed?
YES NO
2. 17
Person(s) InteHiewed Inspector Date