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Home My WebLink About0195 RIDGEWOOD AVENUE - Health 195B Ridgewood The Color Studio Hyanni s ""' EWER A= 328 - 073 t3;v 1 a Hazardous Materials�lnventory Sheet Checklist 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. t�isposal Information-where and who?If none,note that. C7Appiicant 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 thev are doino. Notes need to be left to explain what you discussed with them. 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, 11°FL,367 Main Street,Hyannis, MA 02601 (Town Hall) DATE: y �� sopFill in please: APPLICANT'S YOUR NAME_�c- r_ - a/ BUSINESS YOUR HOME ADDRESS: 5 New H&at Qu-2 TELEPHONE # Home Telephone Number uer�r U bvSIros � NAME OF NEW BUSINESSTYPE OF BUSINESS IS Tja§A.-HOME OCCUPATION? YES Have ydu bean given.appro"l from tho'building.divisi YE S NO- 5, cc 2(0o MAP/PARCEL NUMBER 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 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 individual h#thorized i formed y�emit re wire ents that pertain to this type of business. J�-- t� a� Signature* COMM S: J 1� W,0. OL wf 3. CONSUMER-AFFAIRS LLICENSING AUTHORI This individual hask for f the lic in r ' e, ents that pertain to this type of business. vp Authorized SJ'gnature** COMMENTS:_� LLJL- .e/� l A Cif I A �r Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: �� Q INVENTORY MAILING ADDRESS: ald GDTOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: / L EMERGENCY CONTACT TELEPHONE NUMBER: MA? �L 11A 7 7 MSDS ON SITE? TYPE OF BUSINESS: �T 42 salop'%_ 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 - yQstic soda Rustproofers a4 7Leatheodyes mbustible Car wash detergents 01-1,Vr�,yTl_ 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) _ �� ✓e Spot removers &cleaning fluids _ �,-v,,, aVer Ill o4 j (dry cleaners) aZ+ W Other cleaning solvents ) Bud and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS