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HomeMy WebLinkAbout0431 YARMOUTH ROAD - Health 413 Yarmouth Road (Paramount Rug Co.) Hyannis A= 344-084 Hazard us Materials Inventory Sheet Checklist 0 3 Date i. Physical Street Address-Check database to ensure it exists L--- Working Phone Number I,— Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials-no blanks) ! Storage Information - location of storage, how long is storage for? ! If none, note that. Al/ /} 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 Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it 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. r YOU WISH TO OPEN A BUSINESS? 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 not 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 Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: _Fill in please: APPLICANT'S YOUR NAME/S: �i'w��34e► i?ei'l�ra BUSINESS YOU HOME ADDRESS:o�Z2 ; l C�/G TELEPHONE # Home Telephone Number � = G NAME OF CORPORATION: NAME OF NEW BUSINESS -' C f' ' e5� !� QD TYPE OF BUSINESS c P IS THIS A HOME OCCUPATION? YES 0- -ADDRESS OF BUSINESS /3 MAP/PARCEL NUMBER (Assessing) 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 e &frme of mit it m s that pertain to this type of business. AuthoriVure* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has 644-n in d f the licensing requirements that pertain to this type of business. Qut ized Si nat r ** ,, J Wd a ( t COMMENTS: eW �GCX�/� erg .t ., Date:©r7//� / /.3 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: rce -10 ss' BUSINESS LOCATION: rI &If�VENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPH NE NUMBER: :7 -7 ���,s Y MSDS ON SITE? TYPE OF BUSINESS: l/I'PZ C.¢ ./r 'rT 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 Q Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) d Hydraulic fluid (including brake fluid) ` Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) 0 Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) �) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, L,12 Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink d Degreasers for driveways &garages p Wood preservatives (creosote) C9 Caulk/Grout a Swimming pool chlorine 0 Battery acid (electrolyte)/Batteries O Lye or caustic soda d Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes 4 Fertilizers Asphalt& roofing tar 0 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 may be toxic or hazardous (please list): 67 Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers 42 Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant' Signature Staff's Initials t Town of Barnstable Hazardous Materials On-Site Inventory and Inspection FACILITY INFORMATION: Business Name: --""/ Z2AI of 4UA'r Business Location: / Ob/1Y ITO h' Ai✓iy S Mailing Address: 45- Telephone Number: Contact Person: c3 fit/ Emergency Contact Telephone Number: Type of Business: 6�/L &RP&W7VC- �tirA /�.4R,fflWCC,1) t�oP-�•�/C� HAZARDOUS MATERIALS (CHAPTER 108) Virgin Product Total Quantity Container Size(s) Storage Location Major Materials Gallons or Pounds Quarts,gallons, Shed,retail store, drums,tank,etc... cabinet,closet,etc FL6 ail 5'-'A/WS G*UzA/G A,A+Rb W006 A,vv F.,vis� s �60 Ci��o,t/S 4,V,6 6 c,*c.tZucnETs - 1 - i Misc.�- --'�. ••,., !f. ,s ovae� 1-�.9-Rt�cvaBl� �LhMN1ABt.�� Z f�'L.[.cn1S /{-t'7POSC1er �NS ��R /��7ai Misc. Corrosives Misc.Reactive Misc.Toxics Inventory Total Amount: Hazardous Materials License Posted?Yes Contingency Plan Posted? Yes No Fire District: /kAI,,Vlf Fire Extinguisher Service Date: Metal Covered Rag Bin: Yes Ncobsorbent Material Available? Yes 00 Type of Absorbent: Speedy Dry Pads Pigs Other: MSDS on site? es No Hard Copy Computer Acces Hazardous Waste Handling Hazardous Waste Generator Identification Number: A)IA Type(s) of hazardous waste product(s): A/Y/fAi,7-#RLboctS WASTE- 6E)9&-y%M� 41- 5i7E• Date of last hazardous waste shipment,type of waste and quantity: Hazardous Waste Transporter(s): Designated Hazardous Waste Facility: Hazardous Waste Storage Area Description: Is hazardous waste storage area labeled: Yes No Are tanks/drums/containers labeled with the words "Hazardous Waste",the type of waste and the associated hazard (i.e. ignitable,corrosive,reactive or toxic) Yes No If hazardous waste is stored out of doors is it covered from the elements? Yes No Is it in 110% containment? Yes No If hazardous waste is stored indoors is it on an impervious floor? Yes No - 2 - FLOOR DRAINS (Chapter 381) Town Sewer Account Number: 414 ,4 j5W S/;'r 3j:-'nL- Indoor floor drains: Yes 0 If yes,circle one,does it discharge to a: holding tank dry well on site septic. Outdoor surface drains: Yes No If yes,circle one,does it discharge to a: holding tank dry well on site septic. FUEL AND CHEMICAL STORAGE TANKS (Chapter 326) Underground Storage Tank(s) on site? Yes 0 Age: Is removal required? Yes No If yes,when? Is testing required? Yes No If yes,when? Out of doors above ground storage tank on site? Yes& If yes,is it protected from the elements? Yes No If yes,how? Is it on a foundation larger in size than the tank? Yes No COMMENTS/RECOMMENDATIONS/CORRECTIVE ACTIONS Date: q I;&/X Public Health Inspector: Facility Representat' . - 3 - #1 PARAMOUNT ADDITIONAL NOTES Comments/Recommendations/Corrective Actions The facility stores, uses, and/or generates four-hundred, sixty-nine (469) gallons of hazardous material and is therefore subject to Town of Barnstable Ordinance Chapter• 108. The facility is to complete and submit an."Application for Permit to Store and/or. , Utilize More Than 111 Gallons of Hazardous Materials" to the Town of Barnstable; Public Health Division. (A blank"Application" was provided to Mr. Clark at the time of the inspection.) The facility is to complete and post; in the facility, a copy of the "Contingency. V Plan". (A blank"Plan" was provided to Mr. Clark at the,time of the inspection.) The facility should also have some type of absorbent material (Speedy Dry, pads, etc.) on site to contain hazardous material in the event of a spill. The hazardous.material stored at the facility is in the form of quart, gallon and five gallon containers of various floor stains an&sealers. There are approximately an " additional one-hundred gallons of various water based coatings which did not meet the definition of hazardous material. All of the material was organized in an orderly fashion, and the storage area(Hardwood Floor Department) was very clean, with the majority of material still boxed: The storage area has a concrete floor. For the record, the street number posted on the#1 Paramount building is 413 Yarmouth Road;this property is also listed as 431 and 4.17'Yarmouth Road in the towns' electronic files. �F