Loading...
HomeMy WebLinkAbout0548 BEARSE'S WAY - Health FillI,�' �56. Bearse's W Y) - - aka 560`Bearse',s Way and aka 558 BearseIs Way 293-007 Hyannis � - i ° ° t b ° o ° o- ° i .'Cape Cod Storage - Eldredge a Moving & Storage Page 1 of 1 .�1,•D RED G•� .,.. _ �. �. ` � -M SINCE P�1918 v..raw i u & BOURNE 'k MOVlNQ 8 STORAGE .6•,,,_ - `� a ' 800-439-5521 - - `' �,- a. 114 538 BEARSES WAY,HYANNIS,M StorageA ' 15 GIDDIAH HILL.ORLEANS,MA Eldredge and Bourne offers INFO©ELDREDGEBOURNE.COM convenient storage for your prized possessions at our Hyannis and IN Orleans facilities. ° 11 'o HOME We invite and encourage potential storage clients to visit our facility and 4. ABOUT US see for themselves the care and t� respect with which we treat the HOW TO CHOOSE A belongings entrusted to us. MOVER We offer our storage clients: GREEN MOVING Modern Climate Controlled DET#1230 Warehouse ICC#190287 �a USDOT#562772 LOCAL MOVING • Ali upholstered furniture �..,� stretch-wrapped NANTUCKET MOVING Centrally monitored fire and burglar systems it f INTERSTATE MOVING Palletized storage # • Clean pads DECORATOR SERVICES Replacement value insurance available : PACKING Warehouse inspection is -, welcome and encouraged! ' STORAGE Accurate color coded and numbered inventories protect CONTACT US against loss. Do not store your furniture without seeing where it will be held. RELATED RESOURCES Stretch Wrap Program I Palletized Storage I How to Store I What Not to Store home I about us I how to choose a mover I green moving I local moving I nantucket moving I interstate moving I packing I storage I contact us 2011 O Eldredge I7 Bourne Moving&Storage.Cape Cod Massachusetts.All Rights Reserved. mat http://eldredgeboume.com/self-storage-cape-cod.php (10/28/2011 ASSESSORS MAP N 0; No. 9 PARCEL NO: �L}. Fee i _. r...�.o is THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for Iigpool *pe;tem Construction Permit i Application is hereby made for a Permit to Construct( )or Repair(,f S an On-site Sewage Disposal System at: Location Address or Lot No. 614{Q ?�5,e14_9yl Owner's Name,Address and Tel.No. Cam.. N C%A QCUCSZ t'1 G Uf Installer's Name,Address,and Tel.No. r, Designer's Name,Address el.N . ��t GC-��. taw ass Type of Building: Dwelling No.of Bedrooms '`S Garbage Grinderf Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title i Description of Soil 1 Nature of Re airs or Alterations(Answer when applicable) e-K(Z)hl to Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i d by this Board a t Signed Date CI Application Approved by Application Disapproved for the following reasons Permit No. % �'`� / L�U Date Issued Z,Za � � No. _ -�� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE. MASSACHUSETTS gippYication for-]Digpooal bpttem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(L.4 an On-site Sewage Disposal System at: y Location Address or Lot No. f da 7V BRly/0 X P"- R� Owner's Name,Address and Tel.No. J S�� GSl3Z,S cam. N ao QN�. G f Installer's Name,Address,and Tel.No. _ Designer's Name,Address an9rei.N . ao\\ C1' GCCVW_ LkxVk..-,o Type of Building: Dwelling No.of Bedroomsa Dr . 00r"S Garbage Grinderloa Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Re airs or Alterations(Answer when applicable) e to Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Board a t Signed Date Application Approved byjo f Application Disapproved for the following reasons Permit No. �4 / Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System ' stalled( )or repaired/replaced(✓)on by �-c(ML,(, for flX.Q. Cl rtc,tl r ( ',i cc{x) cc d i�.-br e v�� —hag beA constructed in accordance with the provisions of Title 5 and the for Disposal ystem Construction Permit No. Afs dated Use of this system is conditioned on compliance with the provisions.set forth bel--------------------------------------- No. ��/ 'J Fee -A7�.�,.7 r Y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migozai 6petem Construction Permit Permission is hereby granted to 0 arG V_ to construct( )repair( Van On-site Sewage System located at -.5y-sir G,<C fSe S %is and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: / i'- �T Approved b <5�,, 03 r �.r LOCATION SE AGE PE MI,J ;NO• VI L AGE . STA LLEW& NAME ADDRESS _S U E It OWNER DATE P EMA IT ISSUED DATE COMPLIANCE ISSUED 2 7.., An �S L - um6�� LOCATION SEWA PERMIT NO. VILLAGE 0-7 INSTA LLER'S NAME L ADDRESS �Y1 �s�a ,►cam CNATO A M GUILDER OR OWNER 121'(s'j - '4 "DATE PERMIT ISSUED ig LrL a DAT E COMPLIANCE ISSUED �� / i � •� 5�� (��tA(2.5� s �A Q (3�yc TA oj K r WAY & No..ai..:.y Fxs..c .�......... THE COMMONWEALTH OF MASSACHUSETTS j. o BOAR® OF HEALTH � W� Jam...........:.....OF..... ..................•-- r rafton for Bi-quiff al Works Tonstrurtiun rautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r-� 1 i Location-Address ----or Lot No. !s� NIP-�a�? �'11 . . .. .................................. ......................... ................ Owner Address W //�I:Fg n ll�g tri�J.V11 eTasis�, ..._ �.GeA...U!.......t'.10PI FAIN.---- Ins aller Address d Type of Building Size Lot............................Sq. feet V Dwelling—No. of Bedrooms________________________________ _____Expansion Attic ( ) Garbage Grinder ( ) U 'W Other—T e of Building ' No. of persons" ________________________ Showers — Cafeteria Other fixtures -•�a c 1>E<s_.._ _.. it!D %l!d � a ---------------------------•----..._...--••--------•....---• W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capadtyh ®__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. _________Q_b_.A�. Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No.....OV-15__ lll meter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-------------------------------------------------------------------•......................................................................................... ODescription of Soil......................................................................................................................................................................... x -------•---•------------------------•------------------•--------------------•----------••••••••----•----•-- ----------•---••••--_-•-•- ------------------ - U Nature of Repairs or Alterations—Answer when applicable_._..—!Mp..... Poet`....................... R� f'+ �!i! ►li �f-�o.....------ Agreement:' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT11.2 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n issued by the board of health. Signed--- -- :••- kk........................ ----max= �1-...--.... Application Approved By......... -�= ' ....__...... ��' a e • Date Application Disapproved for the following reasons---------------•--•----•---•--••----•------------•------------•----------------•----------•-••---------......._. --------------------•---......---------•-----•----•--••----------•---•----....---•------------.._...._.....----------------------------------•---••-----------------------------••-------------•...._.... Date Permit No................................•••--•-----•-••-----_..� Issued---------••--••••-••---•••• • .......................•--- Date No:: .l.. THE,COMMONWEALTH OF-MASSACHUSETTS BOARD OF-HEALTH ...:. OF....: { lutttiian Ott Fermi# =Appheatton ><s;hezeby made for'a Permit to Construct, { ) or Repair ( ) an Individual Sewage Disposal System at 0�ra-�s -•--•-- -- ...... S' s l,) -•..... s ` 1 -�� Location Address ---- - or Lot No 1 ` r�;tuft ... f...........�:�........... a Ownerp/�� Address 11 ._.:. !oi...�G1:,L i_W e TOfs�, � � ex. ./3Z C l YPt =s d Instaaller. Address q� Type of Rpilding` Size Lot.........................Sq. feet Dwelling—�No of� Bedrooms ...............Expansion Attic ( ) Garbage Grinder ( ) a ,Clther—Type'of Bullduig fp1�4@A E> C p �IAk 5 ...._ .-• -� ) ( ) a Other,fixtures ..................., l Anil � • .. : -... •• -•-•-----....... No of persons_.._ Showers Cafeteria DePign Flow ... gallons-,per ,person per day. Total daily flow ....._. gallons. Se tic Tank Liquld capac>ty✓.•A� _.gallons Length........ ameter ............ Depth................ 'x osal Trench---IN Width...:.... .....:.:. Total Lengthidth , Total leaching area...................sq. ft. DSee a a i . •--:-• De th below inlet.............:..... Total leaching area____..............s- ft. P page Pit No...��1�:..��Dlameter.._ p g q. ! Z. ,.r Other aDlstrlbution?box ( ). Dosing tank ( ) Percolation Test:Results Performed by..........:............... .. ... Date:::...: aTest''Ptt'No.; 1 ...._.._ __:_minutesperinch Depth of:Test Pit...................., Depth to ground water-_:__:.................. f Test Pit No. 2......... _minutes per inch Depth of Test Pit.................::. Depth to ground water....................... �+ ... .............. ................ s Description;of Soil ........ --- . U -••••-.....-•.................... .............................................................. W ...................................................... ••.... ` a ` V Nature of-Repairs or Alterations—Answer.'when.applicable V!?S:'�:�:._q: Qf---0 0.06 0 M. 0_ Cep x . :l_nr n'Uli, L kP 0 i m'', ft<:.. :�.-_4Jax...�l .: /®l�Q tat? �/'- r�rq �rlQf�/� A �l ���0.......... Agreement Fi;_ The :undersigned' agrees,to install. the'aforedescribed .Individual:Sewage Disposal-System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned'further,agrees not•to'place the system in r;= operarion until a.Certificate of'compliance has been issued by the board of health. Si: gned... w ' } .. ..:.., ... 1.: � �...._.... Date /� �i', Application Approved 'By .••- ..................... .......................................... Application Disapproved for the.f ollounng r`easons:...._ ._...._ ................... _.. ...................................._ Date - t .tgl�I'i f ..` ........ ................ - _ — Date PermitNo.. ..........................................».._ Issued... ........ ................................... Date i TH'E:iCOMN10NWEALTH'OF MASSACHUSETTS BOARD OF HEALTH ................................ .OF................11.................................................... ........ f�rrt�f eau of (g�rnt�rfianr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ........P... . .....................................................----........ ......._. . ----- . -------•-•-- ---... Installer at ......................... f ••. .:7-- ---•-----•-- - ' 1 ....�. .__:. � �, :........_. has.been ins talled. in-accordance-with'the,provisions of TITLE 5 of The State'Sanitary Code as described in the apphcatiori for Disposal;Works:Construction Permit.No.. ��_%��.0............. dated................................................ THE;ISSUANCE; OF THIS,.CERTIFICATE 'SHALL NOT BE CONSTRIIEMAS A GUARANTEE THAT THE SY.STEIOA WILL FUNCT10Ni SATISFACTORY' _DATE................... ....... _-..................................... Inspector...........1 ..�..._.AR-cr............................................. THE,COMMONWEALTH OF MASSACHUSETTS BOARD OF. HEALTH ���.........OF...._..r4 r.r .............................. 1� FEE..... 5.............. ;a tt1 irk undrudwn..pier, Permission.is he_reby an`t.e✓, ........ ..........................•-----------•---.......-•--•---............. toonstruc or air »».... an Individual Sewage Disposal System 5 reet as shown:,on''the application n' Jor'Disposal Works Construction Permit No.... .............. Dated.......................................... rd of Hea... ..... lth DATE . ......... .......................... FORM.A2gs 'I4OBBs a WARREN, INC., PUBLISHERS COMMONWEALTH OF MASSACHUSETTS x _ _ EXECUTIVE OFFICE OF ENVIRONMENTAL YFATRR J DEPARTMENT OF ENVIRONMENTAL PRO SOUTHEAST REGIONAL OFFICE COPY y 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 50.8-946-2700 i JANE SWIFT BOB DURAND Governor Secretary LAUREN A.LISS Commissioner March 22, 2002 Jim Goode, General Manager RE: HYANNIS—BWP/HW Eldredge &Bourne 538'Bearses Way 538 Bearses Way Eldredge &Bourne, Hyannis,Massachusetts 02601 FIELD NOTICE OF NONCOMPLIANCE FNON-SE-02-R001-2 RETURN TO COMPLIANCE Dear Mr.Goode: On January 18, 2002, the Department of Environmental Protection(the "Department") issued a Hazardous Waste Field Notice of Noncompliance("NON') to you concerning: noncompliance issues that were observed by the Department during an inspection of the above. referenced property on January 11, 2002. The issues of noncompliance pertained to the Massachusetts Hazardous Waste Regulations (310 CMR 30.000). The NON required you to perform necessary actions in order to achieve compliance with applicable environmental regulations. On February.26, 2002, the Department conducted a compliance inspection of the property.During the inspection, the Department determined that you have complied with the.. terms and conditions of the NON and that no further actions are required to be taken. The Department appreciates your prompt attention to this matter. If you have any questions regarding this matter,please contact Edward Burke at the letterhead address or by calling (508) 946-2768. This information is available in alternate format by calling our ADA Coordinator at (617) 574-6872. DEP on the Wodd Wide Web: http://www.state.ma.us/dep Za Printed on Recycled Paper r • ` • 2 Very truly yours, Spence T. Brennan, Chief I Regional Enforcement and Compliance Team (REACT) B/EMB/ka cc: Board of Selectmen Town Hall 367 Main Street Hyannis,Massachusetts 02601. ATTN: Chairperson Public Health Division P.O. Box 534 Hyannis, Massachusetts 02601 ATTN:.Chairperson Fire Department 95 High School Road Hyannis,Massachusetts 02601 ATTN: Chief DEP/SERO ' Attn: David Johnston,Deputy Regional Director BWP Christopher Tilden, Regional Engineer BWP ' Dan d'Hedouville, Esq. Regional Counsel Regional Enforcement Office(2 copies) Massachusetts Partment of Environmental Protection Hazardous Waste.Notice of Noncompliance Enforcement Notice: . M.G.L. c. 21A sec. 16 and 310 CM 5.00 MON b6- 02- - 001-2— General Information Note: lilr/ Ry l-P 20LJ , A Copy of this form Facility Information: will be mailed to the f Time Date of Issuance permittee/owner. 1_ 45dw✓F411- X Company Name Issued by(pdnt) Address Signature City/rown- 21p.Code Tllle O Status: Air iWW :rrxx� L'OO,5 AIM-EL 1�1L, Receimd by(print) NW TURA J` C C ✓ �� GL' �I t Source Information: Title Signature(acknowledges receipt only) FMF! AFS! �rO(�' 7 1OS Telephone Number including Area Code MADr Permit/ By:❑ Hand ail Description of Violations under M.G.L. c.21 C On �� G -DEP personnel observed o .Note:A follow-up- the following violatio s a the a facility: inspection may be" performed to assess �" �'� t� 5 compliance'status. ✓' In order to reduce the potential for ;/a � � �o 2� Within days: O correct violation; O submit plan' future violations < involving the use of Within ❑ toxlcs,DEP strongly days: orrectviolation; ❑submit plan' encourages you to 0 contact the Office of Technical Assistance for free and '> confidential advice and help. See Within days: ❑correct violation; ❑submit plan' section E for contact Within 7 days: rect violation; ❑submit plan' Information. ❑ Comments: - CC: Board of Health _ Within days: rrect violation; ❑submit plan' OF Reglooa ngineer Important Information Please read carefully. This is an important notice with potential legal consequences. DfPDlrice olfnlorcement An administrative penalty may be assessed for every day from now on that you are in noncompliance with the requirements described in this NON.Notwithstanding this NON,the Department reserves the right to exercise the full extent of its legal authority L•esalbNCCoordinalor -.— in order to obtain full compliance with all applicable requirements including,without limitation,criminal prosecution,civil action, D�=Q/, including court-imposed civil penalties,or administrative penalties assessed by the Department. Office ofTechnicalAsslstance 'Following this inspection and within the deadline(s)established in section B you shall either:a)correct all violations or b) submit a written proposal for coming into pliance.Within�days following this FIELD NON inspection,submit confirma- tion in writing to the . .� r Regional Office that you have corrected the above violations. If you have any questions abo t this FIELD NON please contact of the .5?1;'%wrT Sl--Regional Office at (- d, The regional office addresses are listed on the back for your convenience. Rev.4/95 WHITE:On-Site Representative of Licensee/Permittee/Owner YELLOW:DEP PINK:Licensee/Permittee/Owner Page 1—of 1— s TOXIC AND HAZARDOUS ERIALS RE ISTRATION FORM NAME OF BUSINESS: A & O Services !dlbaldred a > Bourne Mail To: BUSINESS LOCATION: 538 Bearses Way. H nnis MA 02601 Board of Health Town of Barnstable MAILING ADDRESS: Same P.O. Box 534 TELEPHONE NUMBER: (508) 775-1050 Hyannis, MA 02601 CONTACT PERSON: Jim Goode EMERGENCY CONTACT TELEPHONE NUMBER: (508) 539-3110 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 ,gallons liquid volume or 25 pounds dry weight? YES C NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: � ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants o�� Motor oils/waste oils Road Salt (Halite) x P6j Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways& garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes 2-3 CJ Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paintbrush cleaners--`" - (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY ' (see"Orders") 5.Retail Stores -" � 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QU TITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERMLS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT &gallons Age Test Fuels: ies ) Heavy Oils: waste motor oil (C) J` winotor oil (C) ansmiss_ i�on/hydraulic Z Synthetic Organics: degreasers Miscellaneous: DISPOSAL/REC;LAMATION REMARKS: 1. Sanitary Sewage 2ater Supply O Town Sewer rublic 6AS`'°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 RS: O Holding tank:MDC Catch basin/Dry well On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1. •°� /' !L��1fiJy{,g�� j�, ���"`' YES NO 2. �" __7 if Person (s) Interviewed Inspector Date �m ELDREDG€ &-:BOURNE RS S WAY 538 BEA J=� �. HYANNIS,MA 02601 ALLIED VAN LINES JIM CONNOLLY ' Sales Manager ' (800)439 5521 HYANNIS(508)775-1050 FAX(508)790-2456 FALMOUTH(508)548-1188 email:a-o@cape.com ORLEANS(508)255-7745 www.eldredgebourne.com TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair ALTH satisfactory 2. Printers BOARD OF HE 3.Auto Body Shops O unsatisfactory- 4.Manufacturers' yj (see"Orders") 5.Retail Stores COMPANY 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUA ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots . . . 1)1-ums Above Tanks Under&n-ound Tanks IN OUT IN OUT IN OUT #&gallons 1 Age 1 Test Fuels: Gasoline e Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 1 - R t` . s7a DISPOSALIRECI.AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer P_ublic `On-site OPrivate , 3. Indoor Floor Drains YES--NO 0 Holding tank:MDC O Catch basin/Dry well " 0 On-site system 4. Outdoor Surface drains:YES ZNO RD : �p o O Holding tank:MDC Catch basin/Dry well ) 0 On-site system / 5.Waste Transporter Name of Hauler Destination Waste Product . , YES NO 2. Person(s) terviewed Date Inspector �- Date. MATERIALS REGISTRATION FORM TOXIC AND HAZARDOUS NAMEOFBUSINESS: h au ruc - z Mail To: BUSINESS LOCATION: 5 Board of Health MAILINGADDRESS: Go=2 Town of Barnstable TELEPHONE NUMBER: P.O.Box 534 CONTACTPERSON: <<p 3110 Hyannis,MA02601 EMERGENCY CONTACT TELEPHONE NUMBER` TYPE OF BUSINESS: poi, Does your firm store any of the to or hazardous materials listed below,either for sale or for you ow use? YES J/ NO This form must be returned to the Board of Health regardless of a yes or no answer.Use the enclosed han your mailing If you answered YES above,ple envelope for your convenience. ase indicate if the materials are stored at a site other c address: f.td o�p goy-�^" c�p lie '+ ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS products exhibit toxic or hazardous r duct that The Boarharacter- d of Health has determined that the following p uanti beside the p istics and Must TE:LIST IN TOTAL lessLIO D VOLUotvolume.ME OR POUNDS please estimate the q ty you store.N Quantity Quantity Drain cleaners Antifreeze(for gasoline or coolant systems) Cesspool cleaners NEW —USED Disinfectants Automatic transmission fluid Road Salt(Halite) Engine and radiator flushes Refrigerants Hydraulic fluid(including brake fluid) —pesticides Motor oils (insecticides,herbicides,rodenticides) NEW _L USED Photochemicals(Fixers) Gasoline,Jet Fuel NEW _USED #2 heating oil :_ 1M-•reloper) _Diesel fuel,kerosene, Other petroleum products:grease, ;ED , (I N 1 lubricants,gear oil' V•" C n Ga- Degreasers for engines and metal V n J V (creosote) Degreasers for driveways&garag, JJJ�� O rine Battery acid(electrolyte) �)'�S 1 Rustproofers Car wash detergents I�rod Car waxes and polishes d fp�3C Asphalt&roofing tar l�vt,cV Paints,varnishes,stains,dyes 1drocarbons, Lacquer thinners loride) _NEW _USED with°poison"labels Paint&varnish removers,deglos: .•• - _Paint brush cleaners (including chloroform,formaldehyde, Floor&furniture strippers hydrochloric acid,other acids) _Metal polishes Other products not listed whi lease list)h you feel _Laundry soil&stain removers may be toxic or hazardous(p (including bleach) Spot removers&cleaning fluids (dry cleaners) _Other cleaning solvents _Bug and tar removers WHRE COPY.HEALTH OEPANTWENT/CANARY COPY.BUSINESS os �decv� off' v Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: lUAu-tuc 5+u rc BUSINESS LOCATION: 5' 4 %5 MAILING ADDRESS: Sa,r•Q Mail To: Board of Health TELEPHONE NUMBER: 5a12 775- 1 C) 5 0 Town of Barnstable CONTACT PERSON: ? t vaa-- P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: SAP 552 3f i o Hyannis, MA 02601 TYPEOFBUSINESS: moms 4 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 Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: Sam• f. - TELEPHONE: tcL�� 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 �i NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) r n Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides �TTI� V NEW V 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 q Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers 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 Date: T3- 2 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: fay Ak.-, EltL,6 Lc 9 BUSINESS LOCATION: MAILING ADDRESS: , ,,, Mail To: Board of Health TELEPHONE NUMBER: -775-Prrn eQ Town of Barnstable CONTACTPERSON: CnOC-14 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: s02- 535- 3 06 Hyannis, MA 02601 TYPEOFBUSINESS: OINQ004 +—S=aA3GV 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 Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: s 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 55C-AI Antifreeze(forgasoline orcoolant systems) Drain cleaners V NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants 15 Gak Motor oils Pesticides _ NEW VUSED (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 Paint brush cleaners Any other products with "poison" labels . (including chloroform, formaldehyde, Floor & furniture strippers 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 y