HomeMy WebLinkAbout0725 WEST MAIN STREET - Health 725 Nest Main Streta
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Date: &ItIld—
TOXIC AND HAZARDOUS MATERIALS RE STRATION FORM
NAMEOFBUSINESS: 71A4MO KJ f dj� Jr. M•1.
BUSINESS LOCATION: 7c�S� �.1�¢b¢ Maims ST. yanl1s
MAILINGADDRESS: Mail To:
TELEPHONE NUMBER: s Board of Health
77 Q 7 G q'
Town of Barnstable
CONTACTPERSON: Sce, P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601
TYPE OF BUSINESS:
Does your firm store ny of the toxic or hazardous materials listed below, either for sale or for y o®n
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. 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 Pr ..
chemicals Fixers)
Diesel fuel, kerosene, #2 heating oil NE USED
Other petroleum products: grease, 3 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 e-,.s VAny other products with "poison" labels
Paint brush cleaners (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 ;o�a S _ e_," 44, Lx c
(dry cleaners) u,., sc►� — l b.
Other cleaning solvents I _
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF EA Lj 3.Auto Body Shops
II O unsatisfactory- 4.Manufacturers
COMPANY I W (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS r7A Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATES ,• - ,
IN OUT IN OUT IN OUT #&gallons 7,77 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:
DISPOSAURECLAMATION REMAR.KSA
. anitaI'Y Sewage,e A 2. ter Supply k6f �2 ek L7�, 35
PP Y
own SewerA`1 ((� ublic
-site D\"�� Private
3. Indoor Floor Drains YES NO C
O Holding tank: MDC�— �7
O Catch basin/Dry we1P
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
Name of Hauler Destination Waste Produci
�
O YES N0
1. 6L Sa&_Wad
2.
Person (s) Interviewed Insp r 4ap