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HomeMy WebLinkAbout0105 PARK STREET - Health 11105 Park St. Hyannis A� -DZ 1. Date: ~ y TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: P BUSINESS LOCATION: fOs3 Zoc✓G. c'�=, f yQ ,z „i, MAILINGADDRESS: k '5; - nip ,� d Hof Mail To: Board of Health TELEPHONE NUMBER:__. ��8"- V �f- Town of Barnstable CONTACT PERSON: T tocn r, � �,6Y^ P.O. Box arn am 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPEOFBUSINESS: i 4:::_e 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(forgasoline orcoolant 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 Floor& furniture strippers (including chloroform, formaldehyde, 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 �10 l r=1,K, �� (dry cleaners) ?0f Other cleaning solvents 1v�/ r-- Bug and tar removers �N �, -pick VP-:!� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS .,y:,.. . .s: .?, ,.per-+.%».,,, ;.::,�" � t•: Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: P-BA4 —/Xgre t 11� 176e_rive,, BUSINESS LOCATION: /O..�_ 52--1 MAILING ADDRESS: P-�vrk af- , yY,,er,rI,,5 d-e/ Mail To: Board of Health TELEPHONE NUMBER:_ _ `� �/- �� Town of Barnstable CONTACT PERSON.-,)-,, t�L ct r7 �GG 1i P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: O$- 1.2 8= Hyannis, MA 02601 TYPE OF BUSINESS: G e4�i r•�� 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 Antifreeze for asoIineorcoolants stems) - Drain cleaners ( 9 Y 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) a 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 Y' 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, Y 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 O j /Y ,��� � (dry cleaners) r��eor �PS� Other cleaning solvents Bug and tar removers U�i� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Joe C/,_e