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Home My WebLink About0795 WEST MAIN STREET - Health 795 West Main Street, Hyannis f, JAMES KOWALSKI C3 c=novCall o 7 O R Hazardous Materials Inventory Sheet Checklist Y l'/Jate /, - Physical Street Address-Check database to ensure it exists /—---Working Phone Number Z —Actual Amounts -( ie. 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. plicant Signature - understand what is listed and noted 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 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, Inforniation: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YO " you must do by M.G.L.-it does not give you permission to operate.) You must fiat obtain the necessary signatures on this form at 200 Main St.., Hydnnis. I ake the coropleted form to [lie Town Clerk's Office, 1 st. FI.; 367 Main St., Hyannis, MA 02601 (Town Hall) and gggt}ie p�ip � s Ctm-11ic.�ite�that is required by ,, DATE: 01�� I c��l L) Go� l� Fill in please ft APPLICANT'S YOUR NAME S: 5 1 c-t c� Co C 5 — ' � BUSINESS YOUR HOME ADDRESS: S W 5+ M N s � %siv-N 5- A rrg !! 4 TELEPHONE # Home Telephone Number _o - A- rani'. P• �A .- - NAME OF CORPORATION- .CS I H C o NJ f 5 C A 19 1 IQ r Q T6 N p N C C NAME OF NEW BUSINESS TYPE OF BUSINESS L.AN o 5 CAj 1 NC9- IS THIS A HOME OCCUPATION? YES NO . , .. ry N l ADDRESS OF BUSINESS: `� S u✓G s t�>° i n, � \� AS MAP PARCEL NUMBER fAssessinal 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 has pbjaen inf r d the permit requirements rements that pertain to this type of business. Authorize ignature* Ir1IiUS7 s;OMULYVNITH ALL COMMENTS: P 7/r pr) i11�L dTr_l7tllt l��rnt i nri 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of.the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: �r TOWN OF BARNSTABLE Dated Pl� / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: ES-FACE y S AQ9ScA Pl to e P-IA iti TA oj/viC-C, BUSINESS LOCATION: )()S- " A t Iry St -`\ INVENTORY MAILING ADDRESS: . 0 f3Ok - G TOTAL AMOUNT: TELEPHONE NUMBER: (550 6 ) 7 - �0 CONTACT PERSON: i C-L EMERGENCY CONTACT TELEPHONE NUMBER.Sa �� Ll 3 MSDS ON SITE? TYPE OF BUSINESS: LA QDS CA, I (2-1- 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 material 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) Miscellaneous 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 Miscellaneous 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 Miscellaneous 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 (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers /� y be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers/ -/ (including bleach) - Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash C WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials ��J TO ALL NEW BUSINESS OWNERS s, DATE:,0- Fill in please: ` APPLICANT'S YOUR NAME: 4hi.,r ®-<J BUSINESS OUR HOME ADDRESS: ir— TELEPHONE - Tele hone Number Home NAME OF NEW BUSINESS TYPE OF BUSINESS Q IS THIS A HOME OCCUPATION?_AYES -NO Have you been given approval from the building division? YES= NO ADDRESS OF BUSINESS _-)(5�5Ij• Ma I yl "—D+ MAP/PARCEL NUMBER ; y9 ®36 D o 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. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual s been i f rmed of any permit requirements that pertain to this type of business. Authorized Signa COMMENTS: 2. BOARD OF HEALTH This individual h een inf r d of th ermit r quirements that pertain to this type of business. S ho ized Sign ur ** - COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Business certificates (cost $20:00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permissiori to operate - you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. Date: o— TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: _ ('V__-k)C_ BUSINESS LOCATION::&§U) f0o Io NU(2V1Y)1S M4 O 0I MAILINGADDRESS: Mail To: TELEPHONE NUMBER: ��C��J` � o��I ' Board of Health Town of Barnstable CONTACT PERSON: P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Hyannis, MA 02601 TYPE OF BUSINESS: G Does your firm storae�y of the toxic or hazardous materials listed below, either for sale or for you own use? YES V 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(forgasoline 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 __V�.aints,-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, tlR=& 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 ✓ O �/ WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �NAME OF BUSINESS: �rneS V, -,low s I n1b` PC , Mail To:Board of Health MAILING ADDRESS: 7 �� S� t/C61n(S / Town of Barnstable TELEPHONE NUMBER: -7-77 P.O. Box 534 CONTACT PERSON: of(c� .C�c Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities tot Iling, 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 thb"materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determine that the following products exhibit toxic or hazardous characteristics and must be re ' a#+es-to.- d v _ Please put a check beside each product that you store: 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) Y Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous�� (please list): (dry cleaners) � c��-a(he Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business Hazardous chemical Inventory for the Office of James V. Kowalski, MD. ...adopted 04/01/94 Chemical Name Product Name Location in office Acetone Acetone Room 1,2 and Basement Aluminum Chloride Aluminum Chloride Room 1,2 and Basement Ammonia aromatic ampul Ammonia Room 1,2 Ammonium Sulfate Immco/Beutner IF vile Room 1,2 and Basement Anti rust powder Anti rust powder Lab and Basement Castellani Paint Casterderm, Neocasterderm Lab and Basement Detachol Adhesive remover (Detachol) Room 1,2 and Basement Dichlorotetrafluorethane Freon spray Room 1,2 and Basement Ethanol (Ethyl Alcohol) Rubbing Alcohol Room 1,2, Basement, Lab Ethanol Harvey's Vapo-steril solution Lab and autoclave Ferric Subsulfate Monsel's Solution Room 1,2 and Basement Formaldehyde or Formalin BU specimen bottles Room 1,2, Basement, Lab Formaldehyde Immco/Beutner for H&E Room 1,2 and Basement Glutaraldehyde Cidex - 7 Basement Helium Helium Tank near 1st floor slider Hibiclens Hibiclens Room 1,2 and Basement Hydrogen Peroxide HZOZ Room 1,2 and Basement Isopropyl Alcohol (Isopropanol) Alcohol Pads Room 1,2, Basement, Lab Isopropyl Ultrasonic cleaning solution Lab, Basement Jessner's Solution Jessner's Room 1 under sink Mastisol Mastisol surgical adhesive Room 1,2 and Basement Nitrogen (Liquid) Liquid Nitrogen Room 1, cryotherapy unit Podophyllum Resin Podophyllum Room 1,2 and Basement Potassium Hydroxide KOH Room 1,2 and Basement Silver nitrate Silver nitrate Lab, Basement Sodium Hypochlorite Bleach Basement Trichloroacetic Acid TCA Room 1 under sink 1,2 drawer