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Home My WebLink About0010 BROOKSHIRE ROAD - Health 10 Brookshire Road -r. f ,a, 'Sewer.Acct#0984_ Hyannis A = 328 -037 1 1 k �1 V i IV V. L0. LVVU IL: V)rIVI IVIM00 ucr IV0 COMMONWEALTH OF MASSACHUSETTS FU In ExEcuTivE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 Riverside Drive, Lakeville, MA 02347 508 946-2700 MITT ROMNEY Governor ROBERT W.GOLLEDGE,Jr. Secretary XERRY HEALEY ARLEEN O'DONNELL Lieutenant Governor Commissioner _ FAX COVER SHEET FAX # (508) 946-2865 TELEPHONIC # (508) 946-2851 DATE: November 29, 2006 FROM: Roberta Edwards PLEASE PELIVER TO: Barnstable Town Manager and Board of Health 508 790 6304 TOTAL NUMBER OF PAGES: 4 (INCLUDING COVER PAGE) PLEASE CALL IF YOU DO NOT RRCBIVE COMPLETE FAX. Notice of Responsibility, Patrick Costa ?bra inrormadon Is available In alternate format.Call Donald M.Gomc%ADA Coordinator at 617-5561057.TDD Service-1.900-298.2207. MassDEP on the Wodd Wide Web: nlip:/A~.mam.govldep 0 Panted on RecKled Paper Nov, 28. 2006 12: 04PM MASS DEP No. 0713 P. 2/4 G ,per �\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AF DEPARTMENT OF ENVIRONMENTAL PRO Copy SOUTHEAST REGIONAL OFFICE 20 Riverside Drive, Lakeville, MA 02347 (508) 94 Iv=ROMNEY ROBERT W.GOLLEDGE,Jr. Governor Secretary KEG'HEALEY ARLEEN OSONNELL Lieutenant Governor Commissioner URGENT LEGAL MATTER:PROMPT ACTION NECESSARY November 17,2006 Mr.Patrick Costa RE: BARNSTABLE-BWSC 10 Brookshire Rd. 10 Brookshire Rd. Hyannis,MA 02601-3021 RTN#420107 NOTICE OF RESPONSIBILITY M.G.L a 21E,310 CAR 40.0000 ATiEbMON:Mr.Costa On October 12, 2006 at 11:10 am the Department of Environmental Protection ("MassDEP") f� received notification indicating that a release of oil and/or hazardous material has occurred at the location f � referenced above. An undetermined quantity of#2 Fuel Oil was released from an underground fuel feed 9 dim line attached to an Above-ground Storage Tank (AST). The release impacted the basement of the residence. --The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.21E, and the Massachusetts Contingency Plan(the "MCP"),310 CMR 40.0000,require the performance of response actions to prevent harm to health, safety,public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility,the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. MassDEP has reason to believe that the release and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. MassDEP also has reason to believe that you(as used in this letter, "you"refers to Patrick Costa)are a Potentially Responsible Party(a "PRP")with liability under M.G.L. c.21E §5, for response action costs. This liability is "strict",meaning that it is not based an fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L.c.21E§5. This liability is also "joint and several",meaning that you maybe liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. Thh information 19 avallahle In alternate format.Call Donald M.Gomea,ADA Coordinator at 617.W&1057.TDD Service.1-00.2W2207. MasOEP on the Wald Wide Web. http)Mww.rnass.9ov1dep Printed on Recycled Paper Nov, 26. 2M 11. 04FM M 6 ULP No. U/ Ij V. j/4 2 ` MassDEP encourages parties with liabilities under M.G.L. a.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the MassDEP in taldng such actions. You may also avoid the imposition of,the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L.c1lE is attachedto this notice. You should be aware that you may have claims against third parties for damages,including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. MassDEP encourages you to take any action necessary to protect any such claims you may have against third parties. D MEDIATE RESPONSE ACTIONS At the time of notification,MassDEP provided verbal approval to conduct the following Immediate Response Actions: • Continued assessment, In addition to oral notification, 310 CMR 40.0333 requires that a completed Release notification Form (BWSC-103, attached) be submitted to MassDEP within sixty (60) calendar days of October 12, (_ 2006. You must employ or engage a Licensed Site Professional(LSP)to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of names and addresses of LSPs from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling (617) 556-1091 or visiting b=://www, tate.ma.usAsv. MassDEP has no LSP-of-Record for this release. A homeowner who is conducting response actions at his or her residence to address a release of oil and who meets the definition established in 310 CMR 4.02 qualifies for reduced permit and annual compliance fees. A homeowner per 310 CMR 4.02 is an owner occupant of a residential one to four family structure used exclusively as a residence(s) throughout his or her ownership, where the owner's unit is the owner's principle residence for six or more months of the year and where the owner is conducting response actions. A completed Homeowner Certification Transmittal Form (BWSC120, attached)must be submitted to be eligible for the reduced fees. Additional submittals are necessary with regard to this notification including,but not limited to,the filing of a written IRA Plan, IRA Completion Statement and/or a Response Action Outcome (RAO) statement. The MCP requires that a fee of $1200.00 be submitted to MassDEP when a RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the MassDEP for the implementation of all IRAs pursuant to 310 CMR 40.0420. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. Unless otherwise provided by MassDEP, potentially responsible parties ("PRP's") have one year from the initial date of notification to MassDEP of a release or threat of a release,pursuant to 310 CMR 40.0300,or from the date MassDEP issues a Notice of Responsibility,whichever occurs earlier,to file with MassDEP one of the following submittals: (1) a completed Tier Classification Submittal; (2) an RAO Nov, 28, 2006 12: 04FM MASS UEN No, U /13 N. 4/4 3 Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is October 12, 2007. If required by the MCP,.a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. MassDEP prepared the Homeowner Oil Spill Cleanup Guide to assist homeowners m understanding the legal requirements and step-by-step cleanup procedures of the MCP. The Guide will familiarize you with the terminology,parties involved, cleanup technologies etc. The Guide is available at the Regional Office or at http://mass.gov/dep/bwsc/files/homeownr/homeownr.htrn. If you have any questions relative to this Notice,please contact Andrew L. Jones at the letterhead address or at (508) 946-2785. All future communications regarding this release must reference the following Release Tracking Number: 4-20107. Very truly yours, Richard F.Packard,Chief Emergency Response/Release Notification Section P/ALJhe P:M-20107 NORdoc Attachments: Summary of Liability under M.G.L. c,21E Homeowner Certification Transmittal Form(BWSC120) MassDEP's guide to hiring a Licensed Site Professional. cc: Board of Selectmen Board of Health Fire Department COLER & COLANTONIO Z ENGINEERS AND SCIENTISTS May 16, 2007 Mr. Thomas A. McKean r Barnstable Board of Health _ 200 Main Street `` Hyannis, Massachusetts 02601 RE: Release Notification & Notification Retraction Form Submittal 10 rol:�hire Roan _. CIDB Hyannis, Massachusetts RT 4-20107 Dear Mr. McKean: Coler & Colantonio, Inc. is writing to notify you, in accordance with 310 CMR 40.1403(3)(h) of the Massachusetts Contingency Plan (MCP), that a Release Notification & Notification .,Retraction Form (BWSC 103) has been ,submitted to the Massachusetts Department of Environmental Protection .{DEP) Southeast Regional -Office (SERO) for the Release which oceurred'at :10`.Brookshire Road in Hyannis, Massachusetts.. A copy of.this.,form is attached. If you have any questions regarding this matter, please contact me, William Hoyerman - Licensed "Site Professional (LSP) for the Site, at (781) 982-5476. Sincerely, COLER & COL NTONIO, INC. U� Y _ W.111am I:. Hoy un, LSP Assistant Division Manager—Environmental Services Cc: Mr. Donald Grissom—Administrator of the Barnstable Town Council 367 Main Street Hyannis,.Massachusetts 02601 101 Accord Park Drive 781 982-5400 Norwell, MA 02061-1685 Fax:781 982-5490 1100 recycled paper Massachusetts Department of Conservation and`Recreation Office of Water Resources Q�-��9 152925 TYPE OR PRINT ONLY Well Completion Report 1.•WELL LOCATION GPS (Required) North " West. n 7 O Address at Well.Location: Property Owner/Client: 0&C .Subdivision Name: ° 0 61',nek-44L Aad Mailing Address: Cirylfown: City/Town: t.� D fie" `a Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot.# mandatory if no street address available Board of Health permit obtained. Yes.E] Not Required DO, Permit Number Datb.lssued' .2.WORK PERFORMED 3.°WELL TYPE'- 4. DRILLING METHOD' 6. CASING Overburden Bedrock From (ft) .To (ft) ype Thickness Diameter 5.WELL LOG. OVERBURDEN Extra Y Water Loss or Drop in Fast or ` El❑❑ LITHOLOGY Bearing Addition Drill From (ft) To (ft) Code Color Comment Zone of Fluid Stem Drslow Rate 7' SCREEN Y. / N Y / N F / g _From (ft)"T6'(ft)° " Typ Slot Size Diameter s.� ., w. . # Y / N Y / N F / S ❑❑❑ RT Y. / N Y / N F / S F1 n F1 - - - Y / N Y % N F / S &ANNULAR-SEAL/FILTER PACK/ABANDONMENT MTL. Y ! N Y / N F /.S From'(ft) To (ft) Material Description FM ose Y / N Y / N F /,gS` 17 6 Y / N Y / N�,' 'FJIS( ❑❑. ❑❑ d Y / N Y /.,N- �,F_/,S r ❑El - El❑ WELL L`OO't BEDROCK Extras �:'� 9. ITE SKETCH Water Drop in Extra . Visible Loss or #of ? ' Fast or, r �a LITHOLOGY Bearing Drill Large Slow 'Rust Addition Fracture e From(ft)'To'(ft) Code ; Comment Zone Stem Chios,Drill Rate Staining of Fluid per foot \� 16 Y / NY F / S Y / N Y / N - u Y / NYa/`N F / S Y / N Y / N Y/ NYN F / S Y / N Y / N 1PY-;/`N.Y %N F / S Y / N Y- / N LL N F / S Y / N Y7N ram ' Y,/eN Y / N F / S Y / N Y / N i Yam'/ NY / N SJY Y / N Y / N NY / N F / S Y / N Y / N g � 1 Y / NY / NF / SY / NY / N ' Y / N Y / N F / S Y / N.Y N 10.WELL TEST DATA,(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 11. STATIC-WATER LEVEL(ALL':WELLS) Yield Time Pumped Pumping Level Time to Recover Recovery. Depth Below `` Date Method (GPM) A,6is& min)` (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) 12.PERMANENT PUMP(IF AVAILABLE) rQisinf�ected AL WELL INFORMATION• Pump'tescription \"[0'❑ ❑ Horsepower / N.�Fracture Enhancement Y / N Pump Intake Depth �-_�`�� (ft) Nominal Pump Capacity (gp'm) / N.t Surface Seal-Type14. COMMENTS /� th Depth to Bedrock 15. WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision,°according'to applicable rules and regulations, and this report is complete and correct to the best of my knowledge. Driller: '. _ .��- Supervising Driller Signature: � �-~ % Registration #:I5I W I I Firm: Tom`v `l � (� f/ / t �/ t T Date Complete. � U Rig Permit#: I I I I I NOTE: Well Completion Reports must be filed by.the registered well-driller within 30 days of well completion. - BOARD OF HEALTH COPY Well Completion Report Codes Section 2 a' Section 3 y Section 4 .-Work t + �, _ Well l.�. ,., Drilling Work Performed Type ,o'. w Method Performed _ Code Well Type Code Drilling Method Code Decommission DC Cathodic Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed:Loop GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive.and Wash DW Monitoring MONT "` t)ug 4 , DG. + , Public Water Supply PBWS Mud Rotary MR Recovery RCVR Reverse Rotary RR J Test Wells TSTW Sonic SN 4 Section 5 Section 6 Overburden Casing Lithology Overburden, Overburden Overburden Bedrock Type ;..,- Thickness Name (OB)Code Color Color Code Bedrock Name (BR Code) Casing Type Code: 'Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 Clay CL Brown �BR -Conglomerate/Breccia CG/BR .- Galvanized Pipe GLP Schedule 40 Coarse Sand CS Dark Gray DG `,Diorite DI _ HDPE HDP Schedule 80 Cdbbles C , Greenish Gray ; GG `_ t Gabbro GB NSF Coated Steel NCS Schedule 160 Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 ' Fine to Coarse Sand FCS Reddish Brown RB Granite GR Stainless Steel SST' SDR 17 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 Medium Sand MS Marble MA SDR 26 1 Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel SG Rhyolite RH SDR 40 r __ n Silt SI Sandstone SS 17# Silty Clay SICL Schist SC 19# Silty Sand SIS -, Shale SH Silty Sand&Gravel . SISG Slate/Phyllite SL/PH Till T Pegmatite PM 'Section 7 Section'8 Section 10 ' Annular Seal/Filter Screen Annular Seal/Filter -Pack/AbandonmentPurpose Method Screen Type`,, Code Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel.' CST Bentonite Chips/Pellets BC Fill FL Air Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete CT Constant Rate Pump CR Pre-pack PVC - PPP Sand SD Variable Rate Pump VR Pre-pack Stainless PPS Native Material NM Slug SG Slotted PVC SLP Stainless Steel Vee Wire SSV Stainless Steel Well Point !•SSP., Section 12 Section 13 x. Pump 1 Description Well Seal Pump Description, *-« Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 Cement/Bentonite CB Constant Speed Submersible Turbine CSST 1 30 Concrete CT•- _„ Variable Speed Submersible Turbine VSST '1 1/2 40 None NO t.Jet JET 2 50 , Line Shaft Turbine LST 3 60 - Centrifical CENT 5 75 ,. 15 150 200 r yi► �G1922 u 1 10/12/2006 1 001 1 A261064 1 00 JI ❑ Change NFIRS - 1 State r/L-, Incident Date Station Incident Number Exposure ❑ No Activity Bask ❑ Check this box to indicate that the address for this incident is provided on the Wildland Fire B Location a Module in Section B"Alternative Location Specification".Use only for wildland fires. Census Tract 4 ® Street Address ' 10 �� BROOKSHIRE RO A RD ❑ Intersection �-' IL __ JI ❑ In front of Number/Milepost Prefix Street or Highway ��- \ Stree Suffix ❑ Rear of I I Hyarmis �J � ,�'� L MA I I 02601 ❑ Adjacent to Apt./Suite/Room City State ❑ Directions Zip Code Cross street or directions,as applicable C Incident Type E, Dates&Times Midn(gpris 0000 E2 Shifts&Alarms 413 IOil or other combustible Local Option Incident Type iQU1Cl Spill Check boxes if Month Day Year Hour Min dates are the I p Aid Given—Received same as Alarm ALARM always required A Still " Date. Alarm 10 12 2006 11:20 shirt or No OfAlarmOistrict platoon 1 ❑ Mutual aid received I I I I ARRIVAL required,unless canceled or did not arrive 2 ❑ Automatic aid recv. weir D ThI I eir ® Arrival '10 12 2006 11:22 E3 Special Studies 3 ❑ Mutual aid given State Local Option 4 ❑ Automatic aid given ��/// CONTROLLED optional,except forwildland fires 5 ❑ er at given ® Controlled 10 12 2006 �J J N ® None Their Incident Number ® Last Unit LAST UNIT CLEARED,required except wildland fire Spedal Spec al Cleared 10 12 2006 11:52 StudyID# Study Value E Actions Taken �G, Resources G2 Estimated Dollar Losses &Values i LOSSES: Required for all fires if known. Optional for non fires. 1 86 l Investigate I Check this box and skip or Personnel this section if an l form is used. q Primary Action Taken(1) Apparatus Personnel I I None Property Suppression J J Contents Add ti—Donal Action Taken(2) EMS 0— x _1 J PRE-INCIDENT VALUE: optional u I , I I I �J I Other 1 L J 1 Property Additional Action Taken(3) Check box if resource counts include aid ❑ received resources. Contents El Completed Modules Hi Casualties ® None H3 Hazardous Materials Release � Mixed Use Property Deaths Injuries 1 ❑Fire-2 Fire N❑ None NNE] Not mixed ❑Structure-3 Service I n I I n I 1 ❑ Natural gas:slow leak,no evacuation or HazMat actions 10 ❑Assembly Use_. _ ❑Civilian Fire Cas.-4 2 ❑ Propane gas:<21 Ib:tank(as in home BBQ grill) 20 ❑ Education use ❑Fire Serv. Casualty-Civilian 0 J 0 3 ❑ Gasoline:vehicle fuel tank or portable container 33 ❑ Medical use ❑EMS-6 4 ❑ Kerosene:fuel burning equipment or portable storage 40 ❑ Residential use ❑HazMat-7 5 ® Diesel fuel/fuel oil:vehicle fuel tank or portable storag 51 ❑ Row of stores Detector 6 Household solvents:Home/office spill,cleanup only 58 ❑ Enclosed mall ❑Wildland Fire-8 H2 Required for confirmed fires. ❑ P P y ❑ Business&residential ❑Apparatus-9 7 ❑ Motor oil:from engine or portable container 59 ❑ Office use 1 ❑ Detector alerted occupants 8 ❑ Paint:from paint cans totaling<55 gallons 60 ❑ Industrial use El Personnel-10 p 2❑:Detector did not alert them 0 ❑ Other:Special HazMat actions required or spill>55 gal., 65 ❑ Farm 63 ❑ Milita usus e e U❑I Unknown Please complete the HazMat form 00 ❑ Other mixed use Property Use Structures 341 ❑ Clinic,Clinic Type infirmary rY 539 ❑ Household goods,sales,repairs 131 ❑ Church,place of worship 342 ❑ Doctor/dentist office 579 ❑ Motor vehicle/boat sales/repairs 161 ❑ Restaurant or cafeteria 361 ElPrison or jail,not juvenile 571 ❑ Gas or service station 162 ❑ Bar/tavern or nightclub 419 ❑ 1-or 2-family dwelling 599 ❑ Business office 213 ❑ Elementary school or kindergart. 429 ❑ Multi-family dwelling 615 ❑ Electric generating plant 215 El High school or junior high 439 [1Rooming/boarding house 629 ❑ Laboratory/science lab 449 ❑ Commercial hotel or motel 700 [1Manufacturing plant 241 ❑ College,adult ed. 311 ❑ Care facility for the aged ❑ Residential,board and care 819 ❑ Livestock/poultry storage(bam) 1 331 ❑ Hospital 464 ❑ Dormitory/barracks 882 ❑ Non-residential parking garage 519 ❑ Food and beverage sales 891 ❑ Warehouse j Outside 124 ❑ Playground or park 936 ❑ Vacant lot 981 ❑ Construction site rf 655 ❑ Crops or orchard 938 ❑ Graded/cared for plot of land 984 ❑ Industrial plant yard j 669 ❑ Forest(timberland) 946 ❑ Lake,river,stream 807 ❑ Outdoor storage area 951 ❑ Railroad right of way 1 919 ❑ Dump or sanitary landfill 960 ❑ Other street Look up and enter a Property Use j ❑ Hi hwa /divided highway Property Use code only if 419 931 ❑ Open land or field 961 g y g y you have NOT checked a 962 ❑ Residential street/driveway Property Use box: 1 or 2 family dwelling NnRS-1RevsbnoYt7/99 11261064 - EXP 0, 1011212006 PAGE 1 OF 2 01922 u 10/12/2006 I :' 001�J A261064 L 0 J ❑ Delete NFIRS - 1S -� State r1L Incident Date r/h Station Incident Number -A, � El Change SU lementaI j� jam( j� Exposure pp K2 Remarks 10 BROOKSHIRE ROAD :y Received a call from Speedy Oil Company p y ( oil Express ) for an oil spill at # 10 Brookshire Road. The Oil Company states an approximately 5 to ten gallon spill and that the oil truck driver applied speedy-dri to 10 :.the spill area. �. 1 1-..Response: Car 805 Upon Lt. Hublers arrival he found no oil company personal or occupants at the roe p ocked up. property rty and the house was A follow-up call to the oil company advises that the spill was cleaned up and that the DEP and Board of Health was notified -nth e home owner advised of the situation. Eric Farrenkopf captain � 10/12/06 �`!' Cj _ .............................................. a 4 i A261064 - EXP 0, 1011212006 HYANNTS FTRF IIFDADTAACAr'r AA=r Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: jE5SC_-07%6C. 76✓C# J94-\t J'f d\JCj BUSINESS LOCATION: oft I o t319ODr,SA4;Rf. 'OR. MAILINGADDRESS: 0—D 60 ► Mail To: TELEPHONE NUMBER: � og �� (� b Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: cJ 08 64'F OS 79 Hyannis, MA 02601 TYPEOFBUSINESS: C 1,4-_Nk-�fJ q 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 Y envelope for our 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. 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 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 G l Paints, varnishes, stains, dyes PCB's f G l Lacquer thinners Other chlorinated hydrocarbons, x NEW USED (inc. carbon tetrachloride) .5- rQL Paint &varnish removers, deglossers Any other products with "poison" labels CC L Paint brush cleaners (including chloroform formaldehyde, �� Floor & furniture strippers ( g Y ' Metal polishes hydrochloric acid, other acids) 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