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HomeMy WebLinkAbout0024 PLANT ROAD UNIT UNIT 1 - Health 6A24 Plant Road, Unit 6&7, Hyannis = i. i E YOU WISH TO OPEN A BUSINESS? Cam/ or Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you lust do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. ake the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is !quired by law. , l�- T - - _ << fz-ems DATE: Fill in please:- ��11. 11 til 4 APPLICANT'S YOUR NAME/S: -6-Q 14 C-f±j !A- (.t , - � q BUSINESS YOUR H E ADDR SS: P w e OSv� L � c— .�CWi{IIllh + TELEPHONE # Home Telephone Number T Z/-� S� IAIVIEi DECORPORATION 'n r IAIIAE OF NEW BUSINESS t212 v!. a� aITHISAj?HOME OCCUPAT O� ��� TYPE OF BUSINESS yK r YES J a NO 4 G bl�J .-.r a:,•. „_ 7i r! k�19'i19.. ._ f. ..� k 4 1 DDRSS OF;BUSINESSEd .T:, ° "!c�-:'ICrC�c. r�2 ;s" WPARCEL.NUMBER ✓hen 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 j arnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 MairrSt:=(corner f YaTe�nip_uth d. &Main Street) to make sure you have the appropriate permits and licenses required to legally opera our business in this town. BUILDING COMMISSIONER'S OFFICE This individual has been infor d of any equirements that pertain to this a of busin ss. ( 1 P type Authorize at OMMENTS: ,� i 11 BOARD OF HEALTH This individual has been ' r. d of the permit requirements that pertain to this type of business. OMPLY WITH ALL (� f'Gl � I/) '*7ARDOUS MAT_. Authorized Signature** OMMENTS: CONSUMER AFFAIRS (LIC SING TH RITY) This individual has beer{i�lform djf t censing requirements that pertain to this type of business. Authohi ed Signature* ]MMENTS: _ � � t ^ TOWN OF BARNSTABLE Date: Zl el TOXIC AND HAZARDOUS MATERIALS ON/-SITE INVENTORY NAME OF BUSINESS: i BUSINESS LOCATION: _DLY aan-7Z INVENTORY MAILING ADDRESS: 6,k- 3a6 �'"40TAL AMOUNT: I TELEPHONE NUMBER: . 6UF /:3 9 CONTACT PERSON: 6olq5' EMERGENCY CONTACT TE EPHONE NUMBER: �Y-a-"f7— MSDS ON SITE? TYPE OF BUSINESS: /,t ) e) S'�� 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 material 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 healt;i 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) Miscellaneous Corrosive 0'fV' EW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants 5 ,M,,ottor Oils Pesticides L�"NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline,Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED / Miscellaneous petroleum products: grease, Photochemicals (Developer) ps—. J��''�- 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 RLstproofers . Miscellaneous 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 (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (,ncluding bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield.wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS opfrint' i a re Staff's Initi Is YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:l Q �v o�d I ) [ Fill in please: hl ; � APPLICANT'S YOUR NAME/S: �y ?' USI ESS q YOUR HO ADDRE S: a o eCo W tsa, „� J tlf C O )6 TELEPHONE # Home Telephone Number NAME OF CORPORATIONS NAME:OF:;NEW BUSINESS ltrrQ.�� �)'y�M 1( . TYPE BUSINESS. . Cal IS THIS A HOME OCCUPATIONS YES NO r ; :ADDRESS OF`13USINESS v :'MAP' PARCEL NUMBER— ADDRESS Z:. 17'.O6 (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 form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of.Yarmouth Rd. &Main Street) to lnak7sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ' MISSIONSR'S OFFIC This individual ' be n inform e of per t re uirements that pertain to this type of business. ut orized Signature* COMMENTS: , 2. BOARD OF HEALTH This individual.has een rm f the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LI NSI�7JT ORITY]This individual hasb�infoo licensing requirements.that pertain to this type-of-business.- Authorized Signature* COMMENTS: l YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the.Town Clerk's Office..I st FI:, 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. , � rF. DATE: rL� !�I Fill in please: try 4 �° I APPLICANT'S YOUR NAME/ � WA#rkA 5,.ti 4 � BUSINESS YOUR HOME ADDRESS /G�( G/� / - 6 d Z1 (, ! p+ TELEPHONE # Home Telephone Number NAME OF CORPORATION ati f 'NAME OF NEW BUSINESS•; N�s, ,�' vm TYPE OF BUSLNESS IS TH.IS,A HOME OCCUPATI,ON� YES , NO I AO.DRESS O.F"BUSINESS. 7 MAP/PARCEL NUMBER . � j L ' �0 (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 form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ION R'S OF E This individu I ha b i or edt Tan pe i requirements that pertain to this type of business. .Ruth ized-,9ig a COMMENT / , 2. BOARD OF HEALTH This individual has be n in ed . f the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: _.3:_CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been-inf6rmed of the licensing requirements that pertain.to this_type of business, Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BAR-w 4100 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager TI? Address of Offender MV/MB Reg.# X Village/State/Zip AA,A .0 2,) Business Name 1,3,0 am/pm, /on 414,,120a? I Business Address T4 P1.4,A 01 A.MAA-*� Un,4 -7 f),.- Ssrgnature' a'f_ `Enforcing Officer Village/State/Zip Location of Offense 2q (211 .1 RIP A1,&A. 1 1/�;J -7 Je 4U)M+01-W I ktol� 11 V, Enforcing 6e, f/Div' ision Offense L Facts oF(obAj RofA&P ToAr 4AA-11 This will- 'se;np only as a warning:Ae'this _'t'imd-no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W ' ' Ordinanceor Regulation WARNING NOTICE Name of offender/Manager IQ),r' i rt f1r 7!? Address of Offender A MV/MB Reg.# Village/State/Zip M A Business Name am pm-j, on 2 0,­_? ri Business Address ),I, 9It-.44 fq 4 7 xk Signature of Enforcing Officer Village/State/4ip Location of Offense )q fte,Al �qj P40AA.( 11,, 7 �t Enforcing bdpt/Division Offense 90 4 tilt _T 7727 Facts f //'q; fit This will serve only as a Warning. At 'this time no legal action has been taken. It is the goal of Town agenciei to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG;,,_,'P!NK-.ENFORCING OFFICER:.,,GOLD-ENFORCING DEPT. '"..+,....-..w *-,.y.1j,�.,-.-......."�.r�^--+-.'..�^...,i'tiw�'�;`,....--^..-.-✓`'^«.,..,.J` .._ n,^.T.....+.,�•4rf.:.. ire'y�l.er.-t`-'"`r.rY'"r3..r"'^+.'..t�.,."�.."""_...-mil. TOWN OF BARNSTABLE P Ordinance or Regulation WARNING NOTICE Name of Offender 'Manager t / Address of Offender � 3/ } � MV/MB Reg.# Village/State/Zip 1 "'.1' 1 , MA �/ , Business Name /ppmm,/ one , 2090 Business Address �` ✓ Signature .of Enforciing Officer j Village/State/Zip lJ "" Location of Offense 19 je� pmfif &G-1 Z 1. ) Enforcing Deppt/Division rTr- Offense / ��r' G' (,. � •l. ( T Facts ( _ w F . , OLD 6�rd (,bPA 1 MA r -t Z�'� `6S J 40 This will serve only as a 'warning. At this time no `legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, . Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance: Subse(Tuent violations will result in appropriate legal action by the Town. /V 491 nn 0). � ... _. .- .,::, ,,r,;i•�.r.n,+� - ..,. . -'•-, : .�y.`...'\.,,v"'}6'C.l'^�'yw'"�T.w+r..^�;,rti'k'4,-^""X"..'^'e`�"`"''."�`' . TOWN OF BARNSTABLE4 BA W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Ia 'fill j Address of Offender MV/MB Reg.# Village/State/zip Village/State/zipM Business Name ' .am/p on, �t 20_ Business Address .! 9 A ' } I Signature .of Enforcing Officer ' Village/State/Zip j Location of Offense /.L # Af,,l � �L✓ 'l yj Enforcing Dept/Division 0 Offense . All 1 -�` Facts � r orX M I C k/4/N 0,�7A r /P 1),-�-r ()0 This will serve only as a `warning. At this time rid'legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subseguent violations will result in appropriate legal action by the Town. ' c �` , 00 ,� - , Inspector's Action/Comments Date: D R— Inspector• 7 c: --c < Ga) f a) •• �d Additional Info.Attached CD � r— rn Q:forms:complaint TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY SS (Q/�- O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 2Lt Cta.w6• V Uw'_f 7 Class: 7.Miscellaneous -SC,V#- F,-aA lc QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS C. se lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: / vS waste motor oil (C) 3 K 1 S3 pt new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers 6-,,u f_a- l GS 0K Miscellanfous: f ,,,y s ecrwL, /mob.-1. t � '9 t r_�S cal�I DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply A4 �-JV r77SS—U% e :4 Town Sewer Oublic f&4f L S i 10LOn-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC_ r S l O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_X_NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name f Hauler Destination Waste Product Licensed? oNAM V Q,,,, YES NO 2. Person(s) Interviewed Inspectof Date TOWN OF OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH & satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY S (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class' 7 7.Miscellaneous V dtw f Z Q ANTITIES AND.STORAGE (IN=indoors;OUT=outdoors) IA MAJOR MATERLS1 .Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) S� new motor oil (C) f f transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 'I E DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublicjs' O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter NameDestination Waste Product aced, Y_ NO � , 2. f • � �� � it Person (s nterviewed Inspektor Date `y TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: Mail To: Board of Health BUSINESS LOCATION: (o A 7 Town of Barnstable MAILING ADDRESS: r ,�® P.O. Box 534 TELEPHONE NUMBER: SZ3W`1 Hyannis, MA 02601 CONTACT PERSON: r EMERGENCY CONTACT TELEPHONE NUMBER: 5�M -)-7 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in gyntities 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: CA�la��Le TELEPHONE: f 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 Ck -Antifreeze (for gasoline or coolant systems) Drain cleaners A�� GCALAutomatic transmission fluid �� _ Toilet cleaners Engine and radiator flushes Cesspool cleaners U_ Hydraulic fluid (including brake fluid) Disinfectants = Motor oils/waste oils Road Salt (Halite) ,101 Gasoline, Jet fuel Refrigerants tJ Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, a CcOC-S Other petroleum products: grease, lubricants rodenticides) ,N0 Degreasers for engines and metal "� Photochemicals (fixers and developers) JJO Degreasers for driveways & garages Printing ink •�J Battery acid (electrolyte) Wood preservatives (creosote) _ RustproofersF Swimming pool chlorine Q 0 Car wash detergents Lye or caustic soda _ Car waxes and polishes ® Jewelry cleaners NO Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) No Paint & lacquer thinners PCB's Paint & varnish removers, deglossers 1J 0 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) dV® Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business . 4, ' oAl a TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops (� nsatisfactory- 4.Manufacturers COMPANY a +d� i � l� l� �/ P (see"Orders") 5.Retail Stores u 6.Fuel Suppliers ADDRESS j Class: 7.Miscellaneous �� (� QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERL S Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) waste motor oil new motor oil transmission/hydraulic Synthetic Organics: degreasers i Miscellaneous: oPf. S©L,V1Vr OKI$Pr r l )( H YD M UUC� M, X E DISPOSAURECLAMATION REMARKS' a 1. Sanitary Sewage 2, k ater Supply P -rsTai-,-w Town Sewer ublic '` On-site OPrivate 3. Indoor Floor Drains YES N0 O Holding tank: MDC E O Catch basin/Dry well ' O On-site system 4. Outdoor Surface drains:YES NO s r' O Holding tank: MDC E *gin: O Catch basin/Dry well " a0 On-site system 5. Waste Transporter Name of Hauler /� nN Destination Y Product oYES NO 2. ACM6 4 - d1 _)tQ4,4A'a.' ILQ:��-&L erson s) Interviewed V Insp,,i Dat 'Ar 'Y -H��Al I f �47 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM t NAME OF BUSINESS: - ��Q CC`��� ln(_ Mail To: . BUSINESS LOCATION: '.sr mk Board of Health ; �± MAILING ADDRESS: �G �: Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: �5A ? Hyannis, MA 02601 CONTACT PERSON:' Sco &.�V`= 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: LQ6MI-e— ,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 Cam(, Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners 6-ci(Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) I 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) RustproofersI 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 I i White Copy- Health Department/ Canary Copy-Business I TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH )2� satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATE IALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2'�(B) Heavy Oils: �p waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: f f � DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage '2.Water Supply O Town Sewer 'Public O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0_X ORDERS: Q Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 4 YES NO 1. _ 2. I , Per oNs)'Iffte,rviewed ; InspectoY Date I f -, Date: — TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: (... � BUSINESS LOCATION: 7" U,07- MAILING ADDRESS: I Mail To: !, TELEPHONE NUMBER: c)&4 Board of Health Town of Barnstable CONTACTPERSON: ,i P.O. Box 534 EMERGENCY CONTACTTELEP E NUMBER: A9 Hyannis, MA 02601 TYPE OF BUSINESS: _ L0o(; Does your firm sto a 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: I 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: LIST1N TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW I 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 f Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers I 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 A«v e Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, .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 (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS f i I I - Specializing in TIG Welding Aluminum•Stainless Ste:l.-Tool Steels,•White Metal Cape Shores Welding I 508490-2648 Rich Zamachaj 24 Plant Road•Unit 7•Hyannis•MA•02601 { i I TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY ems° �S�'1.�1-eg Ode) (see"Orders") 5.Retail Stores r` 6.Fuel Suppliers ADDRESS - lass: 7.Miscellaneous U T ES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics degreasers Ace4o PA " eAUI:� 16 � Miscellaneous: DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 1 Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES N0>C__ 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES,-NO ORDERS: 0 Holding tank:MDC §W atch basin/Dry well On-site system 5.Waste Transporter Name of Hauler,, I Destination Waste Product YES i NO 1. 2. Per n s) Interviewe Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM CX NAME OF BUSINESS: �l�F_ Se' eq Uu& tAA6 . Mail To: BUSINESS LOCATION: / /_)r 9V�,_)tS l&- l9(ow/ Board of Health MAILING ADDRESS: Town of Barnstable - P.O. Box 534 TELEPHONE NUMBER: — - Hyannis, MA 02601 CONTACT PERSON: R EMERGENCY CONTACT TELEPHONE NUM R: Ste'-3&.2 403.E 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 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 j Specializing in TIG Welding Aluminum•Stainless Steel•Tool Steels•White Metal Cape Shores Welding 508-790-2648 Rich Zamachaj i 24 Plant Road•Unit 7•Hyannis MA 02601 I TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 02. satisfactory Printers 3.Auto Body Shops � unsatisfactory- 4.Manufacturers COMPANY 1�J1v. ,S � '� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Zy 19�. �' ��0 �- Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil X) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous. _ �3 rRCA, L3 2-3 �S DISPOSAURECLAMATION REMARKS: / /� 1. Sanitary Sewage 2.Water Supply S�d" i"` �'' �� as O Town Sewer Public e v,$_e_S A a",-Off k-IfIlf 61h r �(On-site OPrivate _ _s 3. Indoor Floor Drains YES NO--,&- v O Holding tank:MDC_ (90—C Ld L O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0-K— ORDERS: O Holding tank:MDC O Catch basin/Dry well l O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product, YES NO 1. 2. Person IS Interviewed Inspecto Date