HomeMy WebLinkAbout0015 CHARLES STREET - Health 15 Charles Street Sewer Acct # 1314
Hyannis
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LOCATION S G ,�-� ST SEWAGE # 917
VILLAGE 1-k" ASSESSOR'S MAP & LOT ;L)- v�
INSTALLER'S NAME PHONE NO.
SSPZIC TANK CAPACITY 1 m
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL LIC WATER
BUILDER OR OWNER 0-i-A`Oyj--c ?��
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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Date:
Td- IC AND HAZARDOUS MATERIALS REGISTRATION FORM
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NAMEOFBUSINESS: c'l ct) f G
BUSINESS LOCATION: tT` 1
MAILINGADDRESS: S-61-M Mail To:
TELEPHONE NUMBER: Board of HealthTown of Barnstable
CONTACT PERSON: !!.-K' 0-7 P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOFBUSINESS: M -IV TtJAe�
Does your firm store anyof 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: N G
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
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Antifreeze(for gasoline or coolant systems) �2 rain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid ;�d Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED insecticides herbicides,
( e blades, rodentiades)
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
_ O 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
La stain removers Other products not listed which you feel
p (including bleach may be toxic or hazardous (please list):
�-.
m Spot reovers & cleaning fluids
t}Y: /(dry cleaners)
V Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
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TOWNOF BARNSTABLE COMPLIANCE: CLASS: . 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY `tOJIIDc,,.� f Pe_C (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS �K Class' or2L 7.Miscellaneous
l2 cS ' QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALSove _ , ,
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
Miscellaneous:
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DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply s' e
(Town Sewer PEublic
0 On-site OPrivate
3. Indoor Floor Drains YES NO
0 Holding tank:MDC
0 Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES_YNO ORDERS:
0 Holding tank: MDC
Watch basin/Dry well
0 On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
s
YES NO
2.
k4/4 ill I
erson s) Interviewed Inspector Date