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HomeMy WebLinkAbout0097 BRANT WAY - Health 97 BRANT WAY Hyannis A= 251 -248 Dater ��/ % 6 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS:-/_A ZA 9.I ?A j 01'I S�GI BUSINESS LOCATION: 2 O -r WXV INVENTORY MAILING ADDRESS: Z-OK 72 ) WC_4 Q;/A , t;S r�?.Or7t-F 0' 6- OTALA OUNT- TELEPHONE NUMBER: (60 3+g +7j S CONTACT PERSON: cri-01,14co EMERGENCY CONTACT TELEPHONE NUMBER. ID c MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: / Name of Hauler: Destination: Waste Product- fVJ1} 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 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) 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 . tro )4 Laundry soil &stain removersTh (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A p cant's Signat r Staff's Initials 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, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: CL�z�10 APPLICANT'S YOUR NAME/S: SF; a Z BUSINESS YOUR HOME ADDRESS: �7 131zArJT WA /SIN 1v I S M J� bZ6 �' 'G, ;•;:5[I r ai fit. t-.r�. ,t+'iy;'.•.f�y:( ' tL:.:5;."-�;.i::U �C7 � � O .J TELEPHONE # Home Telephone Number �- ,i"Jas�rJ% y— I L_ S5 010 Ti q Rz- C©M i J NAME OF CORPORATION: L ZA94 p )N I W co• TYPE OF BUSINESS Al P-0 Ft/0 IV . NAME OF-NEW BUSINESS -5 _ IS THIS A HOME OCCUPATION? YES ND [Assessing) ADDRESS OF BUSINESS- 9 AZ,4 T i5 I� oZ6ol 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 COM SIO ER'S OFF E BUST COMPLY WITH HOME OCCUPATION This individu I ha b e Wor d an per it require erit that pertain to this type of busine RULES AND REGULATIONS. FAILURE TO Auth r d i as ** COMPLY MAY RESULT IN FINES. C MMENTUG'n; 61i 2. BOARD OF H LTH This individual has been informed of per 't uirements that pertain to this of business. MUSE to pt�y C�H ALG HAZgRDOUS MATERIALS REGULATIONS Authorized Signat e 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: