HomeMy WebLinkAbout0038 PEARL STREET UNIT #A - Health EARL: STREET,
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TOXIC D HAZA .D -MATERIALS REGISTRATION FORM
I_ � L� Mail To:
NAM OF INESS: •�l Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: `7 7�' �lSS P.O. Box 534
Hyannis, MA 02601
CONTACT PERSON: jT 1 C e.LQ@ Bq 2.y N(o
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities to allin any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NOI
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 w t e s `t 1I " iore°et S FI> ac rid
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
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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
r .
White Copy-Health Department/ Canary Copy-Business
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
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DATE: l'�0'O Fill in please:
APPLICANT'S YOUR NAME/S: a YI
t, er , BUSIN" , YOUR HOME ADDRESS: OJ OA ail
TELEPHONE # Home Telephone Number 9p$ gd-0 0131
NAME OF CORPORATION: _ rA P o V
NAME OF NEW BUSINESS SGAo vi TYPE OF BUSINESS
IS THIS A HOME OCCUPATION. YES NO
ADDRESS OF BUSINESS to aj ✓e S 6L MAP/PARCEL NUMBER Q (Assessing)
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 for is inte` ded to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth
Rd. & Main Street) 10 &sure you have the appropriate permits and licenses required to legally operate your business in this town.
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1. BUILDING COM I I NE:4fiy=d
E
This individua h s e ` of a permit requirements that pertain to this type of business.
oNz d ignature*
COMMENTS: L
2. BOARD OF HEALTH �•
This individual has [been informed of t e pe requirements that pertain to this type of business.
Authorized Signature** %
COMMENTS:
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3. CONSUMER AFFAIRS (LICENSING AUTHORITY) j �.
This individual has been informed f the licensing requirements that pertain to this type of business.
�Dl it�1 Dom -,
Authorized Signature
COMMENTS: