HomeMy WebLinkAbout0110 ROSARY LANE - Health 110 Rosary Lane, Hyannis,
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TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS L Class' e1 7.Miscellaneous
01-4/ TITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS ,
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline J �(Ae 7
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
�J Miscellaneous:
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer 'ublic "
X-On-site OPrivate r
3. Indoor Floor Drains YES NO'I-'
O Holding tank:MDC_
0 Catch basin/Dry well 1,41,1
0 On-site system
4. Outdoor Surface drains:YES1,'�NO ORDERS:
0 Holding tank:MDC
)ftatch basin/Dry well
On-site system
5.Waste Transporter
Name of Hauler Destination od
YES NO
2.
Person(s) Interviewed Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: �"a � Mail To:
BUSINESS LOCATION: tom= Kk Board of Health
b Town of Barnstable
MAILING ADDRESS:
P.O. Box 534
TELEPHONE NUMBER: r---1 din 60 11 N �' Hyannis, MA 02601
CONTACT PERSON: l`l1 m QLYL�_S
EMERGENCY CONTACT TELEPHONE NUMBER: c77I
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your 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:
Quantity/Case Quantity/Case
Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
S_6A� Hydraulic fluid including brake fluid) Disinfectants
SS Motor oils waste oil 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
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