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Home My WebLink About0043 LEWIS BAY ROAD UNIT BLDG C UNIT 1 - Health 43 Lewis-Bay,Road_ v ,Hyannis a.. A��. 327T,225 Units G, H, I, J, K & L TOXIC AND HAZARDOUS MATERIAJXREGISTRATION FORM Mall To. NAME OF BUSINESS:,1 h . I t• 23EQC�LLr3. — Board of Health MAILING ADDRESS: 43 U� � 82A 4P42( h0L�,�� Town of Barnstable TELEPHONE NUMBER:_? (cYl f n 026C+ P.O. Box 534 CONTACT PERSON: 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 t talling, 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 ,. ,d6. 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 (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 9 ` Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: va)-jaS CS BUSINESS LOCATION: wi s 9CLI, a . Chi( Ic7� Ia MAILINGADDRESS: Agwf, Aau ad, � Mail To: TELEPHONE NUMBER: - 6 - 5 5 p Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: 1"-4ofo? 4.ecoq,&tj1 S�cr1� ��,:-,f:.c ` e„lo� �v,s«,!/ • 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 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 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 Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint &varnish removers, deglossers Any other products with "poison labels Paint brush cleaners (including chloroform, formaldehyde, U Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids l (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TO ALL NEW BUSINESS OWNERS Fill in please: YOUR NAME: 1/cviday ahkauSkJ Pt APPLICANT'S N� �i5 � YOUR HOME ADDRESS ESS y TELEPHONE Tele hone Number Home NAME OF NEW BUSINESSa � ® TYPE OF BUSINESS IS THIS A HOME OCCUPATION? MAP/PARCEL NUMBER —tea ADDRESS OF BUSINESS 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 to assist you in obtaining the information you may need. Once you have obtained the required of Barnstable. This form is intended for a business certificate at the Town Clerk's Office (Ist floor. - Town Hall) or if you get the business low you may apply . signatures, fisted be , y Y pp Y certificatefirst you"MUST'go to the following office to make sure you have all the required permits and licenses.. GO TO 2Q.0.Mam:St t a,(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1 BUILDING INSPECTORS OFFICE This.,irdivid''ual,has been informed of any permit. requirements that pertain to this type of business. 4 Authorized. Signature COMMENTS ` r i 2 .BOARD',OF HEALTH ` This individual§hMa bee rmed of the permit requirements that pertain to this type of business. kAuthonze gnat ure NTPES �,rr .. a«i 3 CONSUMEWAFFAIRS (LICENSING AUTHORITY) yk ,,,t n ••x ,M .r.t This indi-d`ual:.has been informed of the licensing requirements that pertain to this type of business. t ; Authorized Signature . 7 COMMENTS Business certificates (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L.,- it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: !n M C CLC a P&90C_ 1 � C . Mail To: BUSINESS LOCATION: �/3 L�7.�1I Sy �'09� , b`y�V/S Board of Health MAILING ADDRESS: y3 1_�/5 1Ay 4� �jS 4 .026 Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: 9 771 320 Hyannis, MA 02601 CONTACT PERSON: V EMERGENCY CONTACT TELEPHONE NUMBER: (S06 -771 -- V3-)-() Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totallyng,,at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO J 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 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 '?®0:& Toilet cleaners r 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, /ao Z X 2-0 Other petroleum products: grease, lubricants V rodenticides) /00*-' Degreasers for engines and metal 5-8 0-1 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) Ain�nm Other cleaning solvents 5g 5®-1 X I® Bug and tar removers Q U1. Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business 1 TOXIC AND HAZARDOUS MATERIALS REG TRATION FORM Mail To: NAME OF BUSINESS: '1kWM=ffM0F%M0»M Board of Health �tewia�grAod MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: s8W7n4M P.O. Box 534 CONTACT PERSON: )4 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 totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO X _ 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 re i tered�v ..n,-st d vo#Ir == , eight 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) I--- 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 & cleanin g 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