HomeMy WebLinkAbout0367 YARMOUTH ROAD - Health 367 Yarmouth Road, Hyannis
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YOU WISH TO OPEN A BUSINESS? ��-3
For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you / /'✓�-
must do.by M.G.L.-it does.rfot give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to.the Town Clerk's Office,. 1 st FI., 367 Main St., Hyannis, MA 026.01 (Town Hall) and get the Business Certificate that is
required by law.
DATE:��� Fill in ple se:
ti":au <' I• ;e�dh' t�° I
APPLICANT'S YOU NAME/S: G O
I`'I BUSINESS_ _ YOUR HOME ADDRESS: Y ✓ � 171
:iLp
TELEPHONE # Home Tele hone Number �/ --3/5 3 6o
a /-
�c� EMAIL: /Uh
.�. +.
NAME OF CORPORATION: G
NAME OF NEW BUSINESS n TYPE OF BUSINES Gi e
IS THIS A HOME OCCUPATION? YES N Lj�I
ADDRESS OF BUSINESS. — 10 � MAP/PARCEL NUMBER 4 —d Q [Assessing)
When starting a new business there are several thin.gs'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 COM sID R'S OFFlPf
This individua h n in*m f s y rm*.requirements thet pertain to this type of business.
uth ized Si not
COM ENTS 0 .s � J
1
2. BOARD OF HEALTH
This individual has bee ormed ofthtpi mit re ements that pertain to this.type of business.
It it c�d'1 =c. I.,.
,Authorized Signature** Must.�OMPLY�WITN�ALL
COMMENTS: HAMR000t*TERIALS 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:
lGG, %/ /VC.lam`✓"'v`� C �L`UYG
4hx-
NUMBER FEEL.-,
THE COMMONWEALTH OF MASSACHUSETTS
116 $150.00
TOWN OF BARNSTABLE T
AGENT'S OR SELLER'S LICENSE - CLASS II
TO BUY AND SELL SECOND.-HAND, MOTOR VEHICLES
5
In accordance with th provisions of Chapter 140 of the.General Laws-with atgendments thereto
Augusfo C. NettP/ laudto A Netto DBA Hi Line Auto Sales _... ..
is hereby licensed to buy an -�e11 seVo-n-d-hand motor vehicles ............ . ... ............
367 Yarmouth Road,` flya[tnts
on premises described,as follows: s
t
Two story metal building Areas#1,#2 for parking of vehicles No use of Area#4 or Area#S on plan
included with application.
RESTRICTIONS ;Limited to.32 total vehtclks�nc[uding_26 display,3for. ustomers,1/iandicapped 4.2 for 2-employees..No
vehicles inside No washing cars or repairs.or tools or re airs on remtses r`
................. .......
Issue Date: January 1,2017 S.gnec , ..... ....... ........................
.................
Moll .�
.. ........,y.. .�
.......................... Y .` .`. ............
THIS LICENSE EXPIRES: December 31, 2017
THIS.LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES.
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: ILA414i s C4 2 16(
BUSINESS LOCATION: 'tld, �� 6,X0
Mail To:
MAILING ADDRESS: �XYI v Board of Health
TELEPHONE NUMBER: Town of Barnstable
CONTACTPERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: 90 - 13 1 - 'D-55 Hyannis, MA 02601
TYPEOF BUSINESS: U,9 CA 0S C I AS S T_(
Does your firm store any of the toxic or azardous 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 otherthan 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) Refrigerant
s
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
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc.'carbon tetrachloride)
Paint & varnish removers, deglossers Any 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
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
X3.Auto Body Shops
�L n" unsatisfactory- 4.Manufacturers
COMPANY ��'fl Ir�C Y� (see"Orders") 5.Retail Stores��,
6.Fuel Suppliers
ADDRESS CS Class: 7.Miscellaneous
QLANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS
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:
` CJ�LZnw,c�
l
DISPOSAURECLAMATION REMARKS:
1. S itary Sewage 2.W ter Supply Town nSewer ,Bublic
O On-site OPrivate
3. Indoor Floor Drains YES,,,K, N0
O Holding tank:MDC
O Catch basin/Dry well
O On-site system f'
4. Outdoor Surface drains:YES)NO ORDERS: (HSDS'S
O Holding tank:MDC 1
O Catch basin/Dry well
O On-site system
5.Waste Transporter _ t
•
YES' NO
1.
Date
rs (s) t rviewed Inspector
TOWN OF BARNSTABLE cT4PLIANCE: CLASS: 1, Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
(see"Orders") 5.Retail Stores
COMPANY C�PtQ�
1 6.Fuel Suppliers
ADDRESS '?�.o 0M S�-ICS.��Ctn Q8, tt�IblasS: SPke-S 7•Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots L)rums Above Tanks Underground Tanks
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:
Im.+
DISPOSALIRECLAMATION REMARKS:
1. Ste•itary Sewage 2.WaterSupplyC\ C �.
p Town Sewer 6 ublic V-_Z�
O On-site OPrivate AX
3. Indoor Floor Drains YES NO�L
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO.JL— ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Narne of Hauler Destination Waste Product
YES NO
1. -
2.
Person(s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH Satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY 17� (see"Orders") 5. Retail Stores
6.Fuel Suppliers
ADDRESS Z 4 0f*1 r' lass: "� 7.Miscellaneous
1
x9_1
< QUANTITIES AND ST AGE (IN= indoors;OUT=outdoors)
MAJOR M CT RUndergr' und Tanks
RIALS
IN OUT IN OUT IN OUT I#&gallons 1Age 1Test
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:
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer Public
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well a r
O On-site system
4. Outdoor Surface drains:YES �NO ORDERS:
O Holding tank:MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler'. �,Destinati
YES NO
1.
2.
r
f�- EA� Csz2s
Person s) Interviewed Inspector D to
1 f
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair �!
2.Printers
BOARD OF HEALTH satisfactory 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANYC,49 (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS �� 1 � Aa nass• � 7.Miscellaneous
.QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums
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)
L�
transmission/hydraulic
Synthetic Organics:
degreasers
Miscell eous:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
Town Sewer �ublic
0 On-site OPrivate i
3. Indoor Floor Drains YES N0�/'
0 Holding tank:MDC
s�
0 Catch basin/Dry well � �
0 On-site system
4. Outdoor Surface drains:YES VNO ORDERS:
0 Holding tank:MDC
0 Catch basin/Dry well
0 On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
2.
Person(s) Interviewed Inspector Date
Date: �J
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS. r, AR
BUSINESS LOCATION: '?� �/ '��`� 'Rom ff
Mail To:
MAILING ADDRESS:
Board of Health
TELEPHONE NUMBER: YZI 30_0 Town of Barnstable
CONTACTPERSON: 9 P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: 6 3 Y Hyannis, MA 02601
TYPEOFBUSINESS: US90 440732
Does your firm store any of the toxic Qr hazardous materials listed below, either for sale or for you own
use? YES NO Z/
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 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
Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers Any 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
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Dater
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS: A'
BUSINESS LOCATION:
MAILINGADDRESS: - Mail To:
TELEPHONE NUMBER: 77/ 2/��� Board of HealthTown of Barnstable
CONTACT PERSON: 1,4c/tl� P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: 775'3Zd, Hyannis, MA,02601
TYPEOFBUSINESS: e f �4&& de[%
Does your firm store any o 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 otherthan 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 2-6�* Road Salt (Halite)
Z44 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 —0W 6.6 USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW (�Eo USED
Degreasers for engines and metal /9&�V_6r 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 Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers
hydrochloric acid, other acids)
Metal polishes
i ayndry soil & stain removers Other products not listed which you feel
in I in I h may be toxic or hazardous (please list):
ji cud g M eac )
Spot removers & cleaning fluids �L /A���2�
(dry cleaners)
Other cleaning solvents
25d Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
. C
367 Yarmouth Road
Hyannis,MA 0�601 �040..
508 771 �185 • FAX 508 790.0790
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY. 74 p^/ (see"Orders") 5.Retail Stores
6.Fuel Suppliers
�
I'SS Class: _ 7.Miscellaneous
p tkf*e4' QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS -
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: 1
degreasers
p Miscellaneous: � �
% , 'e.,
P
-
-
v�f X
. ::........ . .. .
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply S �' S 1' Ot+ jwe
O Town Sewer §Wublic 1'2v�G
On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES X NO ORDERS: /� _ ��
O Holding tank:MDC �+ �o6r, u %`� 110
Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler
Destination Waste Product
4 "J R"
2.
e son (s) Interviewe& Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: ,% .ur- P�aq��rjA��. .-.yr Mail To:
s
BUSINESS LOCATION: 367 Board of Health
MAILING ADDRESS: Town of Barnstable
P.O. Box 534
TELEPHONE NUMBER: _0 F- —77 r-2l2-5P Hyannis, MA 02601
CONTACT PERSON: ))I+Vib
EMERGENCY CONTACT TELEPHONE NUMBER: 77.E' 33Z P
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quaptities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES rr// 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 IMIeToilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
_._[yA�!-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 ,c�rod nticides)
Degreasers for engines and metal ✓a.�5U"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)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTHQ satisfactory 2.Printers
unsatisfactory- 4.M 3. to Body Shops
COMPANY / urers
% (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS a ® Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATEVZOS" Case lots Drums Above Tanks Under�Tound Tanks
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
Syntheti rgan
de easers-.
'roo� so tv
Ain(
�qi
T X
Miscellaneous: �60
cow
KO
DISPOSAL/RECLAMATION R S'
1. Sanitary Sewage 2.Yater Supply A
k1'A.1G Im 0
Town Sewer ublic rn'srls 5_11 01\r
On-site OPrivate
3. Indoor Floor Drains YE0�_NO)( ' �L�C6_
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDER • e
O Holding tank:MDC (Aco
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
o S NO
9-1-4 E
1.
2.
6
Person (s) InterviewW Inspect ate
A
�'���
'fill-
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OFBUSINESS: Al �T < °�'' Board of Health
MAILING ADDRESS: ' c. Town of Barnstable
TELEPHONE NUMBER: 77 l ^ / P.O. Box 534
Hyannis, MA 02601
CONTACT PERSON: J (tl 9-
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
characteristics and must be registered when stored
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 denticides)
Degreasers for engines and metal --ZPhotochemicals (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) 15JA411-e-r 6411%*
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
Ps
TOWN N OF BARN►JTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2•Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPAIV � - (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS iww� C ass: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT-outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
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
e— A P-1
Miscellaneous.,F,,4,C4 v
Ito�_
`i;
04 4 lei l/
el
S A Lx�h' s -
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply r��
O Town Sewer Public
,(VOn-site OPrivate
3. Indoor Floor Drains YES NO y
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES N0 OR ERS:
O Holding tank:MDC _
Catch basin/Dry well
' V On-site system ,
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
rson (s) Interviewed Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: /P /1,1.)-7_1t.c/T-
MAILING ADDRESS: 367 I/A2v1,1acI lY #fC1A'0, 1111 1VA1`s . V7l,lf, �y�Ca
TELEPHONE NUMBER:
CONTACT PERSON: �Cab e C. -7�lvcj
Y Does your firm store any of the toxic or hazardous materials listed be ow,
either for sale or for your own use, in quantities- totalling, _at any tirr�e m ' e
. than 50 gallons liquid volume or 25 pounds dry weight? YES X NO
This form must be returned to the Board of Health regardless of a YES or NO
answer. Us-e 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 characteristics and must be registered when stored in quantities
totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put
a check beside each product that you store:
Antifreeze (for gasline or coolant systems) Refrigerants
Automatic transmission fluid Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
Hydraulic fluid (including brake fluid) tid photochemicals
Motor oils/waste oils Gasoline, Jet fuel _J�__ Printing InkWood preservatives
Diesel fuel , Kerosene, #2 heating oil (creosote)
Other petroleum products: grease, Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Degreasers for driveways & garages Leather dyes
Battery acid (electrolyte) Fertilizers (if stored
Rustproof ers outdoors)
Car wash detergents PCB' s
Car waxes and polishes Other chlorinated hydro
Asphalt & roofing tar carbons, (inc.carbon
Paints, varnishes, stains, dyes tetrachloride)
Paint and lacquer thinners Any other products with
Paint & Varnish removers, deglossers "Poison" labels (including
Paint brush cleaners chloroform, formaldehyde,
Floor & Furniture strippers hydrochloric acid, other
Metal polishes
Laundry soil & stain removers
(including bleach) HEALTH DEPT. Other products not listed
Spot removers & cleaning fl'uAasBF BARNSTABLE which you feel may be '
(dry cleaners )
toxic or hazardous (please
Other cleaning solvents
Bug and tar removers — l)RY ]O^/E� j-aiC ke
list) : �d�
Household cleansers, oven cleaners COPY/•t,"G nY?AcAfetiC S
Drain cleaners MAY 2 2 1981
Toilet cleaners
Cesspool cleaners _
Disinfectants �°T' l�Jc S%aRc ��faTochFc wi �c� �S �U7—
Road Salt (Halite) ivc If2E Iver A 6Lj.Z_/< a1eeK d�=
7lfc n, .
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
F I RM �
ADDRESS- VIV
Major typ(s)of materials: 1) .2)
4) _ 5) 6) ! a
I. Description of material(s) use: ;
II. Storage (denote product by number listed above
A. Containers meta glass jpaper pla ,tic
cans,bottles,jars o
„ ` drums,barrels
aboveground tanks
underground tanks
bags,boxes
m
open,loose,uncovered
inadequate labelling
B. Storage Facility V/or.# Remarks/Recommendations
1. Indoor
a) separato, contained room M
b) stored in general work area .
i) inadequate ventilation `
ii)._,floor drains
iii) inadequate fire protection
2. Outdoor
a) uncovered, exposed to weather
b) pervious surface/catch basins
III. Disposal
A. Reclamation/Recycling unit
B. On-site -disposal
1. Town. sewer
t 2. Regular septic system :
3. Separate holding tank
C. Off-site disposal ,
1. hauled by own./firm
2. hired hauler '
a) name of hauler
b) address or disposal site
Person(s) Interviewed t Inspecto
Date - - - -
OWN OF BA 7COMPETANCEi
ETA: E_
FF -3
Printers
satisfactory OF HEALT
:3. Au to Body Shep s, AA
4. Manufacturers COMPANY _Z tt' TR I NM N (see"Orders")l S. Retail Stores
6. Fuel Suppliers
ADDRESS Ur,^ 1_r,4_t4k Class.: 7. Mi!ice-l-laneous
QUANTITIES AND STORAGE' (l indoors; 0 UT=outdoor!
case lots Drums AboveTapks Undetgrotrad-Tanks
MAJOR MATERIALS
IIN OUT IN OUT IOUT # g2lrons A2e frest
Fuels: '
Gasoline, Je't fue I (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: 1--5ST Y,
Heavy
it (C).
new m�ot
1q ,
V! C c
Synthetic Organics
Misc!�meous*
.........
t
C�
gc I
RECLAMATION DISPOSAL/RE REWORKS:
-1. Sanitary Sewage
2. Water[Suppjy
0 Town Sewer lic
On-site private
3. In or r Floor Drains: YES NO
-Holding tank: MDC
O-Citch basin[Dry. well
ORDERS:
On-site system'
0 .
4. outdoor Surface drains-YES-NO
� L
T� ✓
Holding, tank: MDC
0 Catch basin/Dry well
CY.On.-site system
S. Waste Transporter Licensed?
Name of Hauler- J- g-stinatinn NaSte Product, YES No
2.
V
LVL LA
s
12 23 01 P qFk. it,yfil ei:y i Nt i d r I Spector Date
TOWN OF BARNSTABLELC�7satisfactory
ANCE: dr -
(see"OrdeCLASS: 1. Marine,Gas Stations,Repai.r
2. Printers
E3OARD OF HEALTH3. Auto Body Shops
isfact 4. Manufacturers
S. Retai.l Stores
COMPANY=' P - ��^ 1 t6, �c�
6. Fuel Suppliers
ADDRESS I' "A o''' v E^ y "-Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AbOveTanks Underground Tanks
IN U(T IIN IOUT IN # gallons Agerest?
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: 1
waste motor oil (C) I
new-motor- tl off( 2SII-
transmission/hydraulic
Syntfie�.c rgani :�?)��.�( t C1
degr��rs -mil Vc �
ti
Miscellaneous:
DISPOSAL RECLAMATION REW,RKS:
1. Sanitary Sewage 2. Water upply
VSewer �PSub1icite O Private
3. Indoor Floor Drains: YES NO
O Holding tank: MDC T _^
O Catch basin/Dry well
ORDE
0 On site stem con
4. Outdoor rface drains:YESV No '
0 olding, tank: MDC —
Catch basin/Dry well ��=h
OOn-site system
S. Waste Transporter Licensed?
Name ofHauler- Destination jWa_to Prod
1.
12 23 81 er n(s)�-A' :e ewed Inspector Date