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Home My WebLink About0395 SOUTH STREET - Health 395 SOUTH ST. - Gen ER I _i V/ TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH Satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY , (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS L q b Class: 7.Miscellaneous �V J QUANTITIES AND ATORAGE (IN=indoors;OUT=outdoors) MAJOR MATIALS 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 Miscellaneous: Q C DISPOSALIRECLAMATION RE �5: 1. Sanitary Sewage 2 ater Supply O d DeJ80 1.e Town Sewer OkPublic � n AM 0A6ACALo, On-site O rivate r, 2 3. Indoor Floor Drains YES NO O Holding tank: MDC 16 '" r/ AU / 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 i 1 ' � uct 1. YE NO. 2. JN l.r r ewed Inspecto. ate TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: GLhtl ® Mail To: BUSINESS LOCATION: Board of Health Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: _D Hyannis, MA 02601 CONTACT PERSON: 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: 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) _Y Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business v. 1 .. r M HAS AN APPOINTMENT ON DAY MONTH DATE AT A.M. P.M. IF UNABLE TO KEEP APPOINTMENT.KINDLY GIVE 24 HRS.NOTICE 1 i I -QenIle -(henlal Care +♦ll MARK S. FERRIERO, D.D.S. a 395 SOUTH STREET. HYANNIS, MASS 02601 (508) 775-1883 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: AeK S, �1 �, Z?.as, Mail To: BUSINESS LOCATION: �;-7 56C4_1-7-� 51-1 , Board of Health MAILING ADDRESS: 'y �U./JQ`a, ( O a/' Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: �D�'s3® /$$�3 Hyannis, MA 02601 CONTACT PERSON: ,�� ; /��o_ 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 totallin , 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 ou store: uantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Dr ' -cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) y Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, 11_ Other petroleum products: grease, lubricants rode .ticides) greasers for engines and metal c/ 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 As ,halt & roofing tar Leather dyes Paints.varnishes, stains, dyes Fertilizers (if stored outdoors) CIaint 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 Me I polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) �"', ing bleach) Other products not listed which you feel may removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents �, ►g —.�c � ccc��u,3 Bu nd tar removers goner *q— 1_� T Household cleansers, oven cleaners �,,eLo,� 45�re_� White Copy- Health Department/'Canary Copy-Business