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Home My WebLink About0010 SEABOARD LANE - Health IO.-.Seaboar'd Lane �",: Hyannis .. a r A 269—254 , 1 d 9 r 1 Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 6 NAMEOFBUSINESS: 7�e Swez a/S -9hGt2rd Z-,qy-Q- BUSINESS LOCATION: ,/D[yGZr-d Lay MAILINGADDRESS: c ZzIn e— Mail To: TELEPHONE NUMBER: Board of Health Town of Barnstable CONTACTPERSON: Q +°e/U —aL'�tSS� P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER:(Pdc' �7✓`�� Hyannis, MA 02601 TYPEOFBUSINESS: INVICL S,'qlaINI G(/ i3d-1 Does your firm store any of the toxic or ha ous 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 gasoline or coolant 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 Paint brush cleaners Any'other products with "poison" labels (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 Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name / Date i Business Telephone Location Ld `C n ) n • �1 � Time: In Out Jam. t�g, �T`� JO!-?e Person in Charge ( � �S S '' — Purpose Routine Follow-up Inspector's Name Complaint Initial REGIIIATION. COMPLIANCE Remarks or. Yes NO Recvmmendatlons Signs Posted [MGL 270/61 Permit Posted [VIIa] D.O.R. License Employee Signed Forms Kept On File [VIIb] Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] No. Floor Displays [VIId] No Tobacco Products Free of Charge [VIIc] Inspector: / Person Interviewed• g1ealth:tobinsp ' Ic 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) GATE: + VI ZoT a Sa.k p�yud BNJ+In d"i4P�"" . i 1t u3 f} p Fill in pleace: u& ati V h ka 9 Ct ,fit, t` 1 APPLICANTS YOUR NAME: Gil _s Cx "` '�` 9USINESS YOUR HOME ADDRESS: J 1C✓) lr it." TELEPHONE # Home Telep one Number NAME.OF NEW BUSINF55 7- -5 %n feu m TYPE OF BUSINESS: Sri ce_, ll, 1S THIS A HOME OCCUPATION? YES NO cam. Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS �C1 ��cc. Ci Ccr �-0 .C)^ T":MAP/PARCEL NUMBER 2 6ci' 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 informed. f ny permit requirements that pertain to,this type of business. Aut ri.ed Signature* COMMENTS: 2. BOARD OF HEALTH This individual has b6nin Lor:med of the 0yrit requirements that pertain to this type of business. Authorized Signature** COMMENTS: . ~c J2i 'L ' -L,;cZc�? �r `c 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.* COMMENTS: 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 D2601 (Town Hall) DATE: 03 ®/ 0 r Fill in please: , APPUCAN FS YOUR NAIVE: / �'cx S �S /u kce-s BUSI SS YOUR HONE ADDRESS: TELEPHONE # Home Tel phone Number/.S-0,F) 920 03 6 2 NAME OF NEW BUSINESS `T oQ%5 /°1 10-1's TYPE OF BUSINESS Au f0-_Zect,6 ra IS THIS A HOME.OCCUPATION? YES -NO I/- Have you been given:approval from the building division? YES NO �( ADDRESS OF BUSINESS /� S� -_ MAP/PARCEL NUMBER �� l 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 OFFICAThis individual has been informs f any permit requirements that pertain to this type of business. Aut orized Signatur COMMENTS: 2. BOARD OF HEALTH This individual has beE ormed of the p r quirements that pertain to this type of business. Autho zed Si nature** COMMENTS: D �� 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: . �..� 73 6 Gam �N TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH -satisfactory 2.Printers 3.Auto Body Shops 3�7unsatisfactory- 4.Manufacturers COMPANY T (see"Orders") 5.Retail Stores / 6.Fuel Suppliers ADDRESS (� 24.b C1SSS: 11� 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) ove- MAJOR MATERIALS 1 , , T.nks au 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 Misc llaneous: S o f�f l DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply tAjc�g% S4o�4-/641_ O Town Sewer WubliC 41 '�r On-site OPrivate 3. Indoor Floor Drains YES N0-1 O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES , NO OR )E S: O Holding tank: MDC fy\ Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler 1 ' od YES NO 1. 2. erson(s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: j 1 4--s Mail To: BUSINESS LOCATION: 1QSea1oatd Ick-e- Board of Health MAILING ADDRESS: Town of Barnstable _�® ca � _ �/�a ✓j'�i4 ,� P.O. Box 534 TELEPHONE NUMBER: $'- 7 -2 > 1iro Hyannis, MA 02601 CONTACT PERSON: ootd EMERGENCY CONTACT TELEPHONE NUMBER: Al"77- 9YS72 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: 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 �T 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 Y detergents Lye or caustic soda 9 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 111,01(including chloroform, formaldehyde, Y 41 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) ,�av-, oug Sr—I Q0 i F—,s �l�t Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY �IR I" I S O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 10 _ JEMMEo UN, Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS 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 y �►�ecru�� (.o � Miscellaneous: CO�bl-TIMCF-- 2- wI - m FaM-Ws, Co 0 1 I6 �-lS� 9O fiD l.o-n o�,3 SuOxen N DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Nyater Supply \ Town Sewer PPublic 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 IN S `S O Catch basin/Dry well O On-site system 5.Waste Transporter YES NO 1. 2. Y_� Person(s) Interviewed Inspector 'Date f TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 0 satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers l ue COMPANY BO-WJ ��0-C1� S (see"Orders") 5. Stores 6.Fuel Suppliers ADDRESS CC-" Class: 7.Miscellaneous o?76 -:E�n h QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS & r 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 r Miscellaneous: DISPOSALIRECLAMATION REMARKS: 1 .SSG itary Sewage 2. ater Supply own Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES N0—\,Z— O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES—XNO ORDERS: O Holding tank:MDC QL416LAr Q S' O Catch basin/Dry well O On-site system 5.Waste Transporter YES NO 1. 2. tgn (s) nterviewed Inspector Date r�