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Home My WebLink About0040 LEWIS BAY ROAD - Health 40 LEWIS BAY ROAD Cape Cod Sur alA ID ss ca e Ell Iff mom _ T 0 0 D HAZARD MATERIALS REGISTRATION FORM)v TOXIC AN HAZARDOUS �` NAME OF BUSINESS: Cape Cod Surgical Associates Mail To: BUSINESS LOCATION: 40 Lewis Bay Road Board of Health Town of Barnstable MAILING ADDRESS: Hyannis, MA 02601 P.O. Box 534 TELEPHONE NUMBER: 775-0800 Hyannis, MA 02601 CONTACT PERSON: LOrraine Weir EMERGENCY CONTACT TELEPHONE NUMBER: 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: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS _ p 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 Motor oils/waste oils Road Salt (Halite) 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 Paints, varnishes, 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 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 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: CAPE Con SURGICAL ASSOCIATES Board of Health MAILING ADDRESS: 40 uxis BAY Roo Hums. tKA 0260.L Town of Barnstable TELEPHONE NUMBER: 775-0800 P.O. Box 534 CONTACT PERSON: SANDY LEAVELL Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totaling, 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: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered er5trdinuantiti°etota#NiPno.reOrtan fl ailton liquid v�olreor25patn Please put a check beside each product that you store: 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 Motor oils/waste oils ✓ Road Salt (Halite) 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 Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners c. carbon tetrachloride) v' Floor & furniture strippers _ ny 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 Hazardous Chemical Inventory Record ^ , X /V S - Category -o rn r_ _cc Chemical ii `o Brand Abstract m ' ` cc s or Service LL Safety Location of y 5 Product Number a Target Organs Location(s) of Equipment Safety Date O' 1 Name of Chemical a m cR Name if known z -� Affected Chemical Required Equipment X i21A //ve b / 1yP.O / R w I /) N !1 MS Sl.v Jt/�A C04-4-0IIION f-Lr X/cf�.r /` A� (� �p 7 /6- cEa�-S, /'I ALLInI CC QUO I L!V t�� /M L (�pG(>C.� ZSA S/iV� C3 P/L.b PAN o[_ X SGcRG I/ Trr 11 A ,5 A,1 ,4 /: AJS' (0 /VS M 7-7 r lnc_.4 T x L_�I�BrE�/ ----------- -- -----'x'�r r - ,-- — 'v't r' catg..yrr' NIA / / Y4MO o,ox! 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