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HomeMy WebLinkAbout737B MAIN STREET (COTUIT) - Health 737B MAMSTREET,,-COTUIT�'-1[]-- bN A WHIM HANDPAMTE FURNITURE I f r I HERB RICE P.O.Box 89 HERBCCOTUITSOLAR.COM COTUIT,MA + 508-428-8442 02635 1 � V- 1, ��. COTUIT SOLARLLC SOLAR THERMAL•PHOTOVOLTAIC•WIND W W W.COTU IT50 LA R.COM Town of Barnstable A'qo ✓�aS�,�� Regulatory Services ti Thomas F. Geiler, Director y BARNSTABLE. MASS. g Public Health Division Lazrl �AT 039. �0 Fowa'�° Thomas McKean, Director �J 200 Main Street, Hyannis, MA 02601 / Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT CQTV 1 7- a Lr Z i4tyz,6 NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT 7 3 7 /14Aw S 1 C.d 1- /t 1— Vil 4- vZ& Ism TELEPHONE NUMBER 9 I Y Z� SOLE OWNER: YES NO G 5 � IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: . IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 3 L STATE OF INCORPORATION c+� FULL NAME AND HOME ADDRESS OF: PRESIDENT 4 t tv.r orp-Z _ C W(Z-W ( S -ylc 0 t .O .5lJaZf 90 TREASURER J Tv( M'�- a ZZ 2,r Z CLERK cell '1�0.1G� �D��,���7 *44, '� ? &�V 7 SIGNATUR PLICANT ((��C 5 O� 4 RESTRICTIONS: �,a�� iS H ME ADDRESS —TTAa*s l'J1 HOME TELEPHONE# Haz.doc/wp/q Sierra Material Safety Data Sheet Effective Date: 03110100 PRODUCT IDENTITY.- SIERRA ANTIFREEZE-COOLANT 1. SUPPLIER OLD WORLD INDUSTRIES,INC. 4065 COMMERCIAL AVENUE NORTHBROOK,ILLINOIS 60062 PHONE: 847-559-2000 EMERGENCYPHONE: 1-800-424-9300(CHEMTREC) 2. INGREDIENTS MATERIAL CAS# WT % PEL MIST PEL VAPOR Non-Hazardous Ingredients Propylene Glycol 57-55-6 94-96 None Established None Established Water 7732-18-5 3 Proprietary Additives 1-3 (Does not contain IARC,NTP,OSHA and ACGIH listed carcinogens greater than 0.1%). 3. HAZARDS IDENTIFICATION NFPA: HEALTH.0 FLAMMABILITY.•1 REACTIVITY.0 HMIS. HEALTH.0 FLAMMABILITY. I REACTIVITY:0 KEY: 0-Least, 1 -Slight, 2-Moderate, 3-High, 4-Extreme POTENTIAL HEALTH EFFECTS Routes of Exposure: Eye Contact, Skin Contact, Inhalation, Ingestion, Signs and Symptoms of Overdose EYE: May cause minor eye irritation. SHIN: No significant adverse effects are expected under anticipated conditions of normal use. Repeated, prolonged exposure may cause slight flaking,tenderness,and softening of skin. INHALATION:No significant adverse effects are expected.under anticipated conditions of normal use. If effects do occur,refer'to FIRST AID section. INGESTION: No significant adverse effects are expected under anticipated conditions of normal use. Excessive ingestion may cause central nervous system effects. SIGNS AND SYMPTOMS OF OVEREXPOSURE: Same as above. MEDICAL CONDITIONS GENERALLY AGGRAVATED BY EXPOSURE: Material and/or its emissions may aggravate preexisting eye disease. OTHER HEALTH INFORMATION: None. 4. FIRST AID MEASURES Eyes:Immediately rinse eyes with clean water for 20-30 minutes. Retract eyelids often. Obtain medical attention if pain,blinking,tears or redness persist_ Skin:Product is not expected to present a significant skin hazard under anticipated conditions of normal http://www.sierraantifrL-eze.com/sierra_msds.html[9/26/2012 1:14:04 PM] ` Sierra Material Safety Data Sheet use. +� Inhalation: If overcome by exposure,remove victim to fresh air immediately. Give oxygen or artificial respiration as needed. Obtain emergency medical attention. Prompt action is essential. i Ingestion: If large quantity is swallowed,give a pint of lukewarm water if victim is completely conscious and alert. If large quantities are consumed,induce vomiting. Obtain emergency medical attention . 1 5. FIREFIGHTING MEASURES FLAMMABLE PROPERTIES FLASH POINT: (deg F): 211 i i Flammable or Explosive Limits(approximate%by volume in air)LEL:2.4 UEL: 17.4 EXTINGUISHING MEDIA: Carbon dioxide,dry chemical,alcohol type foam,water spray,water fog. i . SPECIAL FIRE FIGHTING PROCEDURES: Wear positive pressure,self contained breathing apparatus and other protective apparatus as warranted. Fight fire from distance or protected location-heat may build up pressure and rupture closed containers. Liquid may form slippery film- Use water spray or fog for cooling,solid stream may spread fire as burning liquid will float on water. Avoid frothing/steam explosion. i Notify authorities if liquid enters sewers/public waters. i UNUSUAL FIRE AND EXPLOSION HAZARDS: Heat from fire can generate flammable vapor. When mixed with air and exposed to ignition source,vapors can burn in open or explode if confined.Vapors may be heavier than air and travel long distances along ground before igniting and flashing back. Fine sprays and mists may be combustible at temperatures below normal flash point. 6. ACCIDENTAL RELEASE MEASURES I STEPS TO BE TAKEN IN CASE MATERIAL IS RELEASED OR SPILLED: Prevent flow to sewers and public waters as it may contaminate said water. Restrict water usage to prevent slip/fall hazard. Soak up small spills with inert solids. Dike and recover large land spills. Notify appropriate authorities if product enters any waterway. } i 7. HANDLING AND STORAGE PRECAUTIONS TO BE TAKEN IN HANDLING AND STORAGE: Store in tightly.closed and properly vented containers,away from heat,sparks,open flame,and strong oxidizing agents. j& EXPOSURE CONTROLS/PERSONAL PROTECTION Respiratory Protection: No special respiratory protection equipment is recommended.under normal conditions of anticipated use with adequate ventilation. Ventilation:Adequate general ventilation is required,local exhaust is recommended if possible. j Protective Gloves:Not required.' i i Eye Protection: Chemical splash goggles or full face shield must be worn when possibility exists for eye contact due to splashing or spraying liquid,airborne particles,or vapor. Contact lenses should not be worn. i • Other Protective Equipment:None., i I , Work Practices/Engineering Controls: Keep containers closed when not in use. ' f http://www.sierraantifreeze.Com/sierra_misds.html[9/26/2012 1:14:04 PM] Sierra Material Safety Data Sheet Personal Hygiene: If product-handling results in skin contact, wash hands and other exposed areas with mild soap and water before eating, drinking, smoking, or using toilet facilities. Promptly remove soiled clothing and wash thoroughly before reuse. 9.PHYSICAL PROPERTIES BOILING POINT(deg F): 365 SPECIFIC GRAVITY(Water=1): 1.04 VAPOR PRESSURE(mm of Hg) <0.1 VAPOR DENSITY(air--I): 2.6 FREEZING POINT: Product will not freeze WATER SOLUBILITY: Complete EVAPORATION RATE(n-butyl acetate=l): Slight MELTING POINT.(deg F): -76 APPEARANCE: Green ODOR: Slightly viscous,almost odorless liquid 10. STABILITY and REACTIVITY STABILITY: Stable CONDITIONS TO AVOID: Heat,sparks,open flame. MATERIALS TO AVOID: Strong alkalis,strong oxidizing agents. HAZARDOUS DECOMPOSITION OR BY PRODUCTS: Carbon monoxide and other toxic vapors. HAZARDOUS POLYMERIZATION:Not expected to occur. 11. TOXICOLOGICAL INFORMATION SKIN: The LD50 for skin absorption in rabbits is>10,000 mg/kg. INGESTION: The oral LD50 for rats is 20,000-34,000 mg/kg. MUTAGENICITY: In vitro mutagenicity studies were negative. Animal mutagenicity studies were negative. 1Z ECOLOGICAL INFORMATION MOVEMENT & PARTITIONING: Based largely or completely on information for similar material (s), i.e. propylene glycol. Bioconcentration potential is low (BCF less than 100 or Log Pow less than 3). Log octanol/water partition coefficient (log Pow) is - 0.92. Henry s Law Constant(I)is 1:2E-8 atm.m3/mole. DEGRADATION&PERSISTENCE: Based largely or completely on information for similar material(s),i.e.propylene glycol. Biodegradation under aerobic static laboratory conditions is high (BOD20 OR BOD28/Th0D greater than 40%). Biodegradation is expected to be achievable in a secondary wastewater treatment plant. 5-Day biochemical http://www.sierraantifreeze.com/sierra_msds.html[9/26/2012 1:14:04 PM] i Sierra Material Safety Data Sheet oxygen demand (BOD5) is 1.16 p/p. 20-Day biochemical oxygen demand (BOD20)is 1.45 p/p. theoretical oxygen demand (ThOD) is calculated to be 1.68 p/p. Inhibitory concentration (IC50) in OECD Activated Sludge Respiration Inhibition Test(OECD Test No. 209)is greater than 1 gm/L. Degradation is expected in the atmospheric environment within minutes to hours. I ECOTOXICITX: Based largely or completely on information for similar material (s), i.e.propylene glycol. Material is practically non-toxic to aquatic organisms on an acute basis(LC50 greater than 100 mg/L in most sensitive species). i f Acute LC50 for fathead minnow(Pimephales promelas)is 4600-54900 mg/L. I Acute LC50 for guppy(Poecilia reticulata)is greater than 10000 mg/L. Acute LC50 for water flea Daphnia magna is 4850-34400 mg/L. Acute LC50 for rainbow trout(Oncorhynchus mykiss)is 44mL/L(about 44000 mg/L). j 13. DISPOSAL CONSIDERATIONS 1 I ' WASTE DISPOSAL METHOD: Landfill solids at permitted sites using registered transporters. Bum concentrated liquids, avoiding flameouts, and assuring emissions comply with applicable regulations. r Diluted aqueous waste may biodegrade, but avoid overloading plant biomass and assure effluent complies with applicable regulations. I 14. TRANSPORT INFORMATION I This product is not regulated by DOT. ; f, IS..REGULATORYINFORMATION Superfund Amendments and Reauthorization of 1988 (SARA), Title.III Section 302/304 Requires emergency planning based on Threshold Planning Quantities (TPQs) and release reporting based on Reportable Quantities(RQs) of Extremely Hazardous Substances (EHS) listed in Appendix A of 40'CFR 355. There are no components of this material with known CAS numbers that are on;the EHS list. F i I Section 311 and 312 Based upon available information,this material and/or components are not classified as any of the specific health and/or physical hazards defined by Section 311 &312. Section 313 The material does not contain any chemical components with known CAS numbers that exceeded the De Minimis reporting levels established by SARA Title III, Section 313 and 40 CFR 372_ Comprehensive Environmental Response,Compensation and Liability Act(CERCLA) No chemicals in this,material with known CAS numbers are subject to the reporting requirements of CERCLA. ! OSHA Regulations 1 Chemical-specific U.S. Occupational Safety and Health Administration (OSHA) regulations (1910.1002 to 1910.1050) presented under 29 U.S. Code of Federal Regulations(CFR) 1910 do not apply to this material or its components. j Department of Transportation(DOT) Other than the normal shipping instructions and information given in this MSDS,there are not other specific U.S. Department of Transportation(DOT) regulations governing the shipment'of this material. I http://www.sierraantifreeze.com/sierra_msds.html['9/26/2012 1:14:04 PM] ( Sierra Material Safety Data Sheet State Regulations: California Safe Drinking Water and Toxic Enforcement Act of 1988 Proposition 65. This material is not known to contain any chemicals currently listed as carcinogens or reproductive toxins under California Proposition 65 at levels which would be subject to the proposition. California South Coast Air Quality Management District (SCAWMD)Rule 443.1 (VOCs) A Volatile Organic Compound (VOC) is.any volatile compound of carbon excluding methane, carbon monoxide, carbonic acid, metallic carbides or carbonates,ammonium carbonate, 1, 1, 1-trichlorethane, methylene chloride (FC-23), (CFC-113), (CFC-12), (CFC-11), (CFC-22), (CFC-114) and (CFC-115). By this definition; this,is a VOC material. Massachusetts Right to Know Substance List(MSL)(105 CMR Section 670.000) Extraordinarily Hazardous Substances (MSL-EHS) must be identified when present in materials at levels greater than state specified criterion. The criterion is >=0.0001%. Hazardous Subsrtances (MSL-HS) on the MSL must be identified when present in materials at greater than the state specified criterion. The criterion is>=1%. Components with CAS numbers present in this material,at levels specified in Section 9 Components do not require reporting under the statute. New Jersey Registration The New Jersey Registry I Registration law does not apply to this material,as none of its components are trade secrets.1 Pennsylvania Right to Know Hazardous Substance List Hazardous Substances(PA-HS)must be identified when present in material at levels greater than the state specified criterion. The criterion is >=I%. Components with CAS numbers in this material at a level which could require reporting under the statue are: CHEMICAL CAS No. Propylene Glycol 57-5506 Special Hazardous Substances (PA-SHS) must be identified when present in materials at levels greater than the state specified criterion. The criterion is >=0.01%. Components with CAS numbers in this material, at levels specified in Section 9 Components do not require reporting under the statute. UNITED STATES-TSCA-Inventory: Listed WHMIS classification for product: n/a This product has been classified in accordance with the hazard criteria of the CFR and the MSDS contains all the information required by the CFR. Old World Industries, Inc. makes no warranty, representation or guarantee as to the accuracy, sufficiency or completeness of the material set forth herein. It is the user's responsibility to determine the safety, toxicity and suitability of his own use, handling and disposal of this product. Since actual use by others is beyond our control, no warranty,expressed or implied,is made by Old World Industries, Inc.,as to the effects of such use,the results to be obtained or the safety and toxicity of this product, nor does Old World Industries, Inc. assume liability arising out of the use by others of this product referred to herein. The data in this MSDS relates only to the specific material designated herein and does not relate to use in combination with any other material or in any process. HomeStores Benefit Other Products Technical Data E-Mail http://www.sierraantifreeze.com/sierra_insds.html[9/26/2012 1:14:04 PM] may- a ar..w Sierra Material Safety Data Sheet x I a _ I d http://www.sierraantifreeze.com/sierra_msds.html[9/26/2012 1:14:04 PM] Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: CCTV I T Sot-A-Y2, BUSINESS LOCATION: 737 /Y1m w &T- CoTV17' /,7/1` INVENTORY MAILING ADDRESS: Pd 6-�I< d rV i T tW c/ 3 57 TOTAL AMOUNT- TELEPHONE NUMBER: yu Z CONTACT PERSON: I-Ir`�b r EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 50t 11V �T-A-CL C--ZS y INFORMATION / RECOMMENDATIONS: vv t: vSE -PdA"L( , Fire District: /-V,rVTI Int -,'tat.la& t4,0 i (Al(t17:4Z 5-ylS (6-70 5, yv k� w v�'y l` 14`\.SJ'�Yt i; 5S G. C7 F 1 G Waste Transportation: '�J �y Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: �f� �` 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 re uires 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 t Disinfectants Engine and radiator flushes d 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 u Printing ink Degreasers for driveways&garages 0 Wood preservatives (creosote) Caulk/Grout `S 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'v Other chlorinated hydrocarbons, Lacquer thinners I (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 J may 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS vA plicant's nature r Staff's Initials A-�Ahd aliveem -fo E�2L-It Pall re6f,1& ,52q-Zl-I J (C� Town of Barnsta 1 P# 3 Department of Regulatory Services • aAntvsrAste, Public Health Division Date MASS i63¢ ,6�� � 200 Main Street,Hyannis MA 02601�ED MJK Date Scheduled Q\ Time_ Fee Pd. �V Ld Soil Suitability Assessment for S age Disposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address —7 7 k1A,t.," fV1` 1 t Owner's Name �v Address ,O. �J= �f3Jk 7- $- 4PAI,Y- 7-C 17 Assessor's Map/Parcel: ® ?` 4 ��o Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use GD v� +@✓G A Slopes(%) ®— Surface Stones 111e t Distances from: Open Water Body 11 ft Possible Wet Area,� ft Drinking Water Well --�ft Drainage Way '7 ft Property Line %YO, ft Other ft SKETCH:(Street name,dimensions of lot,exact'locations of test holes&perc tests,locate wetlands in proximity to holes) ' a r - _ Z ■ rn ai.oa , B. F - . p O 2* 9.M p� �. J I EiD 290.00' .�. " WA!l AMC N-A�a�n s /RI YM 5"V i Parent material(geologic) ©y&,V-a/J 1^ Depth to Bedrock ? . O Depth to Groundwater. Standing Water in Hole: r Weeping from Pit Face Estimated Seasonal High Groundwater / 2 i (, 44 c x Y© DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method Used: d; EV-F 1 Depth Observed standing in obs.hole: in. Depth to Sall mottles: ��`'e in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment f[. Index Well# Reading Date: In ex Well level Adj,factor— Adj.Groundwater Level PERCOLATION TEST -Data ''>t'lnte Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-611) End Pre-soakA474k C y � ch Rate MinJlnch V - '� #1 9,7? Site Suitability Assessment: Site Passed_ Site Failed: Additional'Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Coml.)leted on Back----------- ***If percolation test is to be conducted within 100' of wetland,you riust first notify the. Barnstable Conservation Division at least one (1)week"prior to beginning. Q:\SEPTICAPERCFORM.DOC DEEP'OBSERVATION HOLE LOG Hole# f Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. on istenc %Gravel) 37-5'7 Ab 2/-Z- 7-99 (5' L /0 3'2 s// ..�� C19~1 q C I sue.,,.d 2=51% .rid Sevt. /e 4 DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,`toGravel) v-3� F,I/ 3t -5-y ZA 17 T-Iyy C y elf C) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel i I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to 1 t Flood Insurance Dale Map: Above 500 year flood boundary No_ Yes Y- ` Within 500 year boundary No Within 100 year(::"d boundary No. Yes Depth of Naturally Occur rind Pervious Material Does at least four feet of,naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absog)tion system? If not,what is the depth of natuaally occurring pervious material? T , Certification I certify that on .f7 L _(date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai in expert:is d per' ce described in 310 CMR 15.017. Signature - Date i Q:\SEPTICVERCFORM.DOC Date: TOXIC AND HPAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: Plfi ou BUSINESS LOCATION: 1 '131 13 I1kc e kytt MAILINGADDRESS: Mail To: �� Board of Health �TELEPHONE NUMBER: i� �lD-93 Town of Barnstable CONTACT PERSON: <6 ASf--4 `/ P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: yxkaL MA 02601 TYPE OF BUSINESS: Pyannis, � Does your firm store any of the toxic o 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 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 Antif reeze(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 ants, varnishes, stains, dyes PCB's " Lacque inners Other chlorinated hydrocarbons, EW USED (inc. carbon tetrachloride) 6 nt & varnish removers, deglossers Any other products with "poison" labels V 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) Q Other cleaning solvents l Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Date: k TOXIC AND HPAZARDOUS MATERIALS REGISTRATION FOR I NAME OF BUSINESS: BUSINESS LOCATION: -7 r� h !!'I I �� !�,�� /-/ M/,— Mail To: MAILINGADDRESS: ( rr� � TELEPHONE NUMBER: A v Board of Health Town of Barnstable CONTACTPERSON: \ -n�c/ SS�-�f P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: A -1 ��,�i -56 annis, MA 02601 ' k � vl/ �r� ti TYPEOFBUSINESS: ­��"( �, � Ts.S , A — Does your firm store any of the toxic o 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 I� you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity I Antifreeze(for gasoline or coolant systems) Drain cleaners� NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants f Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants - _ ... Motor-oils . Pesticides NEWy 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 ANEW 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 LacNEW liinners Other chlorinated hydrocarbons; y USED (inc. carbon tetrachloride) /Paint & varnish removers, deglossers Any other products with "poison" labels �./ Paint brush cleaners (includingchloroform, formaldehyde, Floor & furniture strippers y ' Metal polishes hydrochloric acid, other acids) 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 I Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/,CANARY COPY;BUSINESS..,., °F IKE r°k, Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BAR STA`E; 200 Main Street• Hyannis, MA 02601 �"tEDMA�a` TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: C OLC-W, Date: k / Location/Mailing Address: 7 S'7 A,,vt, S+ Q,&4.j `t' Contact Name/Phone: 17,�Ll / Inventory Total Amount: �2s MSDS: License#: N ►�' Tier II : Labelino: r-,-+A-I 1 Spill Plan: Oil/Water Separator: Floor Drains: ko Emergency Numbers: Storage Areas/Tanks: Fei 5 Emer enc /Containm t E i ment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: f Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil �— Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers 1-Z a 1 (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INF RM TI N/R MME DATIONS: o erg- D " , v 5 2_— �ZI 1 o t W Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS