HomeMy WebLinkAbout0625 WEST MAIN STREET - Health �1625_W_ est_Main_Street,_Hyannis
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- _5I9 7 Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: K�"T"
BUSINESS LOCATION: Q _ C. m+ AaL, �'-
MAILING ADDRESS: 94&VVV1% :s Mail To:
Board of Health
TELEPHONE NUMBER: �So�77.E 3cfd 1 Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPEOF BUSINESS:
Does your firm store y of the toxic or hazardous 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 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
u store. NOTE: LIST IN TOTAL
you o e O S O L LIQUID VOLUME OR POUNDS.
Quantity Quantity
a� Antifreeze(for gasoline or coolant systems) A9J. Drain cleaners
►/ NEW USED Cesspool cleaners
Automatic transmission fluid �11&
Disinfectants
I Engine and radiator flushes /! Road Salt (Halite)
_ 9 Hydraulic fluid (including brake fluid) 0 Refrigerants
Motor oils fid. Pesticides
/NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel _ S� 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 /6s, Lye or caustic soda
Car wash detergents As, Jewelry cleaners
Car waxes and polishes /is . Leather dyes
roofing&Asphalt
As Fertilizers
--�- p g tar -�
_ 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
Floor & furniture strippers (including chloroform, formaldehyde,
/ 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 32J
(dry cleaners) -f 4c+-s
Other cleaning solvents a VJA. Gib (ter`, J`�
Bug and tar removers V
�. `�
�5. ��� ,er
WHITE COPY-HEALTH DEPARTMENT/C NARY COPY-B SINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
2. nters
BOARD OF HEALTH satisfactory 3.Auto Body Shops
0 unsatisfactory- 4.Manufacturers
COMPANY � (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
Q114 SITITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MA ERULS
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
Misce�llaneou
s -t
3 Cuuolh a3
t .
�A s !L
a-u� s,��P�C,�z e� /ao y
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
°6Town Sewer Oublic
O On-site OPrivate
3. Indoor Floor Drains YES_X'NO
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS: o
O Holding tank:MDC
�Catch basin/Dry well
On-site system
5.Waste Transporter
r
YES N0
1.
2.
Pe s n(s) Interviewed Inspector Date