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Home My WebLink About0165 SUDBURY LANE - Health -Sul)3 u'C y Lief /1yA-A1A-s ' EWER �..- Hazardous Materials Inventory Sheet GhecKlist r —,1-6-OrDate ,/ Physical Street Address-Check database to ensure it exists ---7--Working Phone Number Actual Amounts-(le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information-location of storage,how long is storage for? If none,note that. A/n�tl,/✓ U�✓ Disposal Information-where and who?If none,note that. j`AbC gepKi/ ✓ Applicant Signature-understand what is listed and noted i/ Staff Initial-any questions,know who to ask �—Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it-note that it was given ✓ Attach the Business Certificate with your sign off and comments "'The inventory form should explain what the business consists of and the procedures they are doing. 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 E in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at he(Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. Fill in please: APPLICANT'S YOUR NAME: C L A i Q D A 2,( BUSINESS YOUR HOME ADDRESS: S M - �3 �-i 0 160 TELEPHONE # Home Telephone Number: soa SRO 1 �µ �� s/� c y NAME OF NEW BUSINESS NGfst� - ow E,2 w 19s ri I ti G TYPE OF BUSINESS ;� wCP WA5 HI Q CD IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS t_N 4V4N t O A Q26O 1 MAP/PARCEL NUMBER --;� When starting anew 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 CO NER'S OFFIC This individ al h errinfpr ne any permit requirements that pertain to this type of business. Author' e Signature** MUST COMPLY WITH HOME OCCUPA CO ME ,! RULES AND REGULATIONSGGIVI . FAILURE TO 2. BOARD OF HEALTH This individual has en k or, ed th 2ermit requirements that pertain to this type of business. utho ' ed Signatur *_* MUST COMPLY WITH ALL COMMENTS: win �i�� , i�z {s HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the. licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE Date: OL/28 TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY +� NAME OF BUSINESS: COPE COO ?0W E12- U)PS H W G BUSINESS LOCATION: )65 Sb.0 (�U(Z,1 LN_ 'HYANN t S L L, o360 1 INVENTORY MAILING ADDRESS: I �S Dru) t-Pj �S A(A oZ6o) TOTAL AMOUNT: TELEPHONE NUMBER: -+-4q 83C r�-q. G-r) CONTACT PERSON: C L A,`/-To J\j -k�')a 2Z EMERGENCY CONTACT TELEPHONE NUMBER: (S212 u� 0 / MSDS ON SITE? TYPE OF BUSINESS: ?UEy u/RS�-lIN iiouSC 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 Lye or caustic soda Rustproofers Misc. 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 (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 -� LEPC0 (LI ) 60ta) � of t,l)f�TC�2 (including bleach) p, r=Un Z A C�)6 Q r (5/ Spot removers & cleaning fluids C�nWA9 �RL E A C 14 2C-2. .T03 (dry cleaners) 0 FOC. 3eCUO e S 12-C H0,MCS Other cleaning solvents QPe x (2100 4.F7( Bug and tar removers QQ ST(>Kg6E 0 � ppoDVcr Windshield wash "HEALTH ! c�OiJL�� TQf 2iAT"�o�/ PeOD JC'S S H DEPARTMENT/CANARY COPY-BUSINESS IRJ?-C-H AS C 41V� U$E U 45 N&E CEO a Hazardous Materials Inventory Sheet Checklist Date —7 Physical Street Address-Check database to ensure it exists —,�- Working Phone Number Actual Amounts—(i.e.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information—location of storage,how long is storage for? If none,note that. Disposal Information—where and who? If none,note that. ✓ Applicant Signature—understand what is listed and noted. Staff Initial-any questions,know who to ask. ?�!t Vehicle Washing/Rinsing?—provide a vehicle washing policy and explain it—note that it was given. Attach the Business Certificate with your sign-off and comments. "*The Inventory form should explain what the business consists of and the procedures they are doine 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, 1' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and 200 Main Street Offices at the Licensing counter. ®, DATE: 2 O ' Fill in please: APPLICANT'S YOUR NAME: C_LP I O/U BUSINESS YOUR HOME ADDRESS: 16 1 SVr_BI/Q �-t 636 R TELEPHONE # Home Telephone Number: 50 i 2 0 Q/ NAME OF NEW BUSINESS H +C�rf T' DC zuWASHiTYPE OF BUSINESS_ '?fl i'JTi N 6 / ?M,,,;c Lop�"_;/:,, S IS THIS A HOME OCCUPATION? A_YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS ( LN ANvj,'S , A MAP/PARCEL NUMBER a .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 ha een i for e of t e ermit requirements that pertain to this e of 1 T LYWITHAM I REGULATIONS Aut rized Signature COMMENTS: 9R r M T 1,J 6 i nJ Tcr.;oiz. 4). to G O� 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed,of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: / /D TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: HI(-)IJ TiOG: IWINTIN6 (ANb �DU16� lJl1AS+tiJ BUSINESS LOCATION: tE LD(6Uee ) t-N HYgNNIS MI`A QZ601 INVENTORY MAILING ADDRESS: f b'�i 3v23UA4 LA) H- AWNII S t� A' 02= / TOTAL AMOUNT: TELEPHONE NUMBER: a! Li CONTACT PERSON: 1_1 Ll 1 a 2-2— kcL w M bALZ') EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: PR,I 011 tJ 6 AN D ZWG e_WASPIVII) 6 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 O served/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 Lye or caustic soda Rustproofers Misc. 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 (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 f1)L(_AC 4 -Va(y) Cofuw. 0�_ UAC2 I M (including bleach) 0IF Of' NC-K�l Tt-12 LQr.� �Ce-,.0 Spot removers &cleaning fluids p 9 S tzC I-a(,tM rS . w sto P-A oc<w Leo Dix r (dry cleaners) L. I?AfV5 t0,12--VA1-�010 PA, )T-Iti G Other cleaning solvents A Lso tioc V DE AS L-R&oq 'ko'OUGT ) Bug and tar removers � �9 y�9ZC N RSED q NDv5Q> As NCFo Windshield wash S10QAriFi W—N—Sr 91i OF PP-17 (r,)Q AgQTC�/ WH C -HEALTH DEPARTMENT/CANARY COPY-BUSINESS r �A U �(�(✓� S N 30 IN� S nedvNS S`f