HomeMy WebLinkAbout0690 YARMOUTH ROAD - Health 690 YARMOUTH RD., HYANNIS
Cape Cod Fireplace Shop Inc.
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM n
NAME OF BUSINESS: C1,_n Mail To:
BUSINESS LOCATION: Board of Health
Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: Hyannis, MA 02601
CONTACT PERSON'.
EMERGENCY CONTACT TELEPHONE NUMBER:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in q4antities tot I ' gat 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 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 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 Other products not listed
( 9 ) p sted 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 I
White Copy- Health Department/ Canary Copy-Business
(508)775.2511
1-800-439-2511
CAPE COD FIREPLACE SHOP INC.
YOUR FIREPLACE HEADQUARTERS
j 690 YARMOUTH ROAD
BOB JONES HYANNIS,MA 02601
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH /W 3.Auto Body Shops
fact
COMPANYv l<-e O unsatisfactory- 4. urers
Manu C -Q (see"Orders") 5.Retail Stores
AV
6.Fuel Suppliers
ADDRESS D AV.Class: 7.Miscellaneous
l� QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors)
MAJOR MATERIALS Case lots Drunis Above Tanks Underground Tanks
IN OUT IN OUTI 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
SM=ellaneous:� z f X
AoLo ali�uw
P✓tGAqhQ a G
S-(of1c Pa love /
52 /C.l o cv4 a, o Z l
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DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer &ublic
,Von-site OPrivate
3. Indoor Floor Drains YES NO X
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES �( NO ORD RS:
O Holding tank: MDC 'y
Catch basin/Dry well 1 v►r
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
erson nterviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
Q unsatisfactory- 4.Manufacturers
COMPANY Q2 �U� �� / (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 4 d , Ctk" U'kA Class: 7.Miscellaneous
ff�"P QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
S�
Diesel, Kerosene 2 (B T7 pC �d
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous: ZGf
Gam, � �,►=•e S�-�,�
ICS K
l c S ac
DISPOSAL/RELLAMATION REMARK
� ) S:
1. Sanitary Sewage 2.Water Supply �"�( of �-" °G' ` �° Ak a-° f 4-
0 Town Sewer &Public It-1 (C-ex ¢) �, -a,,.e,�,rr f-�,` e�p
',O-On-site OPrivate
( H Lay- 7�-a i• e,-� A"' jJ keel
3. Indoor Floor Drains YES NO
O Holding tank:MDC_
O Catch basin/Dry well
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� od
YES NO
1.
2.
erson s)Interviewed riispecft Date
TOWN OF BARNSTABLE- 5 _2
' LOCATION 0"�P 1- ► rf�-/h SEWAGE
'y VILLAGE ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY OD a
,LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER .
BUILDER OR OWNER r 41 e i a
DATE PERMIT ISSUED: / / ® P/ fd- 3
DATE COMPLIANCE ISSUED: / / u
VARIANCE GRANTED: Yes No
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