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Home My WebLink About0061 FALMOUTH ROAD/RTE 28 - Health S pa.)9, Auto Smart 61 Falmouth Rd Hyannis �f'=.�!% �"= o8 j l nazaraous aterials Inven ory meet C:neck ist Date Physical Street Address-Check database to ensure it exists �— Working Phone Number L_ Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Z— Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. j� Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy-and "'��explain it L,-Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME i,n the Town (WHICH YOU MUST DO according to 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, 15t F1., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME B SINESS TYPE: BUSINESS YOUR HOME ADDRESS: 73 TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS Have you been given approval from t e building divi ion? YES NO ADDRESS OF BUSINESS 61 uZ OZ . MAP/PARCEL-NUMBER C3 1 AS`l . 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 CO ISSIONLS FIThis individ al has be an p rmit equirements that pertain to this type of business. Authn ur MMENTS: Q 2. BOARD OF HEALTH Stir Vis1`r VZ-Z/,Cieh N6 f-Ast /30US This individual has-beqp informed of Pe permit°re uirements that pertain to this type of business. �{-i �• Authonzed Si nature*" C LOT O/v 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: ;a Date�eO 2 3//r TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY AME OF BUSINESS: e,4l;v�0 (f&16 e BUSINESS LOCATION: INVENTORY MAILING ADDRESS: Katt"\5; M4 dMI TOTAL AMOUNT- TELEPHONE NUMBER: 2S -DS' 5_ CONTACT PERSON: EMERGENCY CONTACT TELEP ONE NUMBER: 8S7—/Y83 MSDS ON SITE? TYPE OF BUSINESS: Usd ea. Scr_e�� INFORMATION/RECOMMENDATIONS: 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 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 Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Staff's Initials YOU WISH TO OPEN A BUSINESS? G ��I✓�O��C For Your Information: Business certificates (cost$30.00 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.)., Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: / o r Fill in please: APPLICANT'S YOUR NAME: f t Q.YLI e BUSINESS YOUR HOME ADDRESS: WIWI u 2alvu�e!-I �(.QyG�crus � ® / _. TELEPHONE # Home Telephone Number--CO-9-6 9,K-/cl9 3 NAME OF NEW BUSINESS fhtTQ -S M/9 /R-7- 41-C, TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been given appro al from the building divis'on? YES V NO { ADDRESS OF BUSINESS / / W a!ex c-i �l 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has beeDpfformed ofthe-permit requirements that pertain to this type of business. Aut orized Signature** COMMENTS:XJ c fiin c,a„ � �SC�(n-e..-g (&:JR Sig112f 3. CONSUMER AFFAIRS(LICENSING AUTHORITY This individual has info d of the li ` iry }e i ements that pertain to this type of business. (� n ��th=rriize�dSigmture** Deet& COMMENTS: -� (� J n, Date: S /fZ/a TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _< M-F I Zel BUSINESS LOCATION: L M� INVENTORY MAILING ADDRESS: s4/me- TOTAL AMOUNT: TELEPHONE NUMBER: S�6d `7� ,2rJQ CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: SAMe As A&Ile- MSDS ON SITE? TYPE OF BUSINESS: �S e Sr4 S INFORMATION/RECOMMENDATIONS: 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 or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive Nj 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 Misc. 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 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 polishes may be toxic or hazardous (please list): Laundry soil & stain removers 1pl4�� n� ,A?--z � (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS (508)778-1270 Mom 61 FALMOUTH RD. HYANNIS,AAA 62601 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops �f O unsatisfactory- 4.Manufacturers- COMPANYLG �� (see"Orders") s.Retail Stores 6.Fuel Suppliers _7 Miscellaneous ADDRESS U�/ '� Class: 7.Miscellaous_ 9&TITIES AND S�E (IN=indoors;OUT=outdoors) I MAJOR MAT�E.RIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline Jet Fuel(A) Dies e #2 (B) Heavy Oils: waste motor oil new otor o' (C) trans sion/hydraulic Synt etic Organics: greasers I Miscellaneous: t DISPOSAURECLAMATION REAURKS: 1. Sanitary Sewage 2.W ter Supply r ?Town Sewer ublic - O On-site OPrivate 3. Indoor Floor Drains YES N0 O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0JZ ORD S: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Purs—on (s) Interhdewed In pec or Date L. ,�-7 7�5 TOXIC AND HAZARDOUS nMATERIALS REGISTRATION FORM NAME OF BUSINESS: (�nGem� Mail To: BUSINESS LOCATION: Cp /. 44 Board of Health ��^�� Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: 7 -7 —7 70 Z"1 Hyannis, MA 02601 CONTACT PERSON: �- n'1 err;cK EMERGENCY CONTACT TELEPHONE NUMBER:'?`71 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 . 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: ``// ll° ADDRESS: TELEPHONE: `hof2,2/ a�0'3 (264,2 -,,�A7® 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 0 C 2,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 2Motor oils/waste oils /Road Salt`(Halite) asolin , Jet fuel Refrigerants Diesel fuel, erosen , #2 heating oil Pesticides (Insecticides, herbicides, —,-�410ther petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink attery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine _��Car wash detergents Lye or caustic soda ar waxes and polishes Jewelry cleaners As halt & roofing tar Leather dyes Eints, r ni sh stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels i ++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 1 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, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: ' (I l Fill in please: L� APPLICANT'S YOUR NAME/S: E € BUSINESS YOUR HOME ADDRESS: � k cv v1 C) I TELEPHONE # Home Telephone Number 7z,1 SDI ?(/2 NAME OF CORPORATION NAMEOF'NEWBUSINESS'. ' 5'c�� c. g TYPEOF„BUSINESS 13;THIS A HOME OCCUPATION X YES NO Y: MAP/PARCEL NUMBER �l f ?. [Assessing)."! s. ADDRESS OF BUSINESS �,�� F : . 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has,beenrJrrr�vI-Othe permit requirements that pertain to this type of business. AuthorizedSgn a�t( r * COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individg1j,Ihgs%;en�Lbrjtb,d of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: gf 1 }'��'� J- 0 Wht0i TOWN OF BARNSTABLE Date: 6/ / /of !/ TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: l Ga�,AA n«S INVENTORY MAILING ADDRESS: _,moo /��y Cow",�" s�r� 3�" TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: .iI2 Y?? Fe) 07 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: - 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 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 c>°�i tN�-� {p®cam_ � r• Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials i -