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HomeMy WebLinkAbout0450 OLD STRAWBERRY HILL ROAD - Health (2) 19, Seaterri Way.v' Hyann.s-iw'rl u SEWER A= 25.1__251- t� I d e 1 a k i i d e Hazardous Materials Inventory Sheet Checklist Date Physical Street Address--Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? If none, note that: Disposal Information -where and who? If none,note that. 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 ��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. ..•ram Date: o-7 / ZI/ f 0 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Zl.,,ADW0r BUSINESS LOCATION: 15 Se-Iqe�� �,�s�� I ,,,.,,�ST[AA-6 INVENTORY MAILING ADDRESS:TT U aAec-n wv y ,aTQ� E f ,�LQ o`7 Ln� + TOTAL AMOUNT- TELEPHONE NUMBER: Ct CONTACT PERSON: , nT7_C� rx-z N Tg;Q_0 EMERGENCY CONTACT TELEPHONE NUMBER: !D2 f Q3 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 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 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 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ao TO ALL NEW BUSINESS OWNERS DATE: Fill in please: APPLICANT'S YOUR NAME: 7K0QGE Ec-1Z4 h01\fTL_?_0 BUSINESS YOUR HOME ADDRESS: I q S EA` -9 2N wA 9 502- 2,(, ArJ 0 LS 1'lA O 2& -0 1 TELEPHONE Telephone Number Home oc 2 DL71 al NAME OF NEW BUSINESS Low tR OT"c�t�_: ©2 S"i". TYPE OF BUSINESS t_, i\J0SCeR .9} N C-�acUt IS THIS A HOME OCCUPATION? YES NOLILL Have you been given approval from the buildin division? YES NO ADDRESS OF BUSINESS S _CflT L"e PiJ S Z MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be incompliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall)or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 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 individuaThMeen, i=rmof 2tq perm& requirements that pertain to this type of business. Authorized ignature" ell 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: Business certificates (cost $30.00 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. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. Y Date: z e o:4- 9-o D.S- TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: -�--Low 62 p. 7�AS-_ v2c S"F BUSINESS LOCATION: N-I A k a. , M, MAILING ADDRESS: jT ,a �2� tAR,4y lyi��;,c n��,� /L� Mail To: TELEPHONE NUMBER:, (-12� -)--Ast ` Board of Health Town of Barnstable CONTACT PERSON: �"�24� o(z n ems,/ rLflwcTL::-,e0 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 5 ea2 G n tAonK4 �t�c o Hyannis, MA 02601 TYPE OF BUSINESS: 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 otherthan 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 9J 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 rl 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 thinnersIV Other chlorinated hydrocarbons, NEW USED I (inc. carbon tetrachloride) Paint & varnish removers, deglossers d2 Any other products with "poison" labels Paint brush cleaners Floor& furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) / Laundry soil & stain removers ___4_ Other products not listed which you feel may be toxic or hazardous (please list): (including bleach) Spot removers & cleaning fluids kn,tit (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 'I