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Home My WebLink About0083 BASSETT LANE - Health 83 " BASSET LN. , HYANNIS _ --- --- - A= :Sunderland Printers . a k` i S ( n o a e •E } 0 }r e a �� Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM_ NAMEOFBUSINESS: S'/S�o�Ly CE?F97-n C U BUSINESS LOCATION: Y3 13,y-sS'�e rr z-k . MAILING ADDRESS: 1,3.oy 2vl 15,7,! . d2 e 6.Z Mail To: TELEPHONE NUMBER: 5"0 - 7 7 / • D 7 ,f .2 Z V 7 - 9,VV 4 Board of Health � Town of Barnstable CONTACT PERSON: �_,rl-MF_S Co�2 A,'o Y P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: S'a13 d? Y 7 - 9S/S/6 Hyannis, MA 02601 TYPE OF BUSINESS: od5kbOVC7-7oa> Does your firm store any of 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 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 cl aners Automatic transmission fluid Disinfectan Engine and radiator flushes Roa al lite) Hydraulic fluid (including brake fluid) R ran Motor oils ticide NEW USED (insecticides, h r e rodenticides) Gasoline, Jet Fuel Photoclie ( ix Diesel fuel, kerosene, #2 heating oil Other petroleum products: grease, P. tochem' I veloper) lubricants, gear oil NE USED Degreasers for engines and metal Pri ng Degreasers for driveways & garages W d p eservatives (creosote) Battery acid (electrolyte) S imming 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 & ��'�-� Any other products with "poison" labels Paint brush cleaners , Floor & furniture strippers (including chloroform formaldehyde, 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 dvs e e (dry cleaners) � � s e74c,Other cleaning solvents j Bug and tar removers �'� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r Date: ' TOXIC AND HAZARDOUS MATE RIALS'REGISTRATION4FORM NAME OF BUSINESS: OF LY f CErzH771Irc � BUSINESS LOCATION: Y3 �61f-ss e 7-r L N . 'MAILING ADDRESS: /6.0 �/ S• 02 Lt�t,U J /'�'I�l . OZ6 62 Mail To: TELEPHONE NUMBER: 5-08 7 7 7 S" Z y - 9 UU d- Board of Health Town of Barnstable CONTACT PERSON:'"'-'`" 154M, E S Cov/z,v 0 y 2 P.O. Box 534�- EMERGENCY CONTACT TELEPHONE NUMBER: Sad a L/ 7- fVV 6 Hyannis, MA 02601 TYPEOFBUSINESS: Ce�er?Mic ��epvc77o� Does your firm store any of 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 j Automatic transmission fluid Disinfecta s Engine and radiator flushes_ _ _ " _ - - Roa Sa Mite) Hydraulic fluid (including brake fluid)' R ran Motor oils ticide NEW USED (insecticides, h r ' e , rodenticides) Gasoline, Jet Fuel Photocfiie (Fix Diesel fuel, kerosene, #2 heating oil Other petroleum products: grease, P tochem'c I eve per) lubricants, gear oil N USED. Degreasers for engines and metal Pri ng n Degreasers for driveways & garages W d p eservatives (creosote) Battery acid (electrolyte)'' S imming pool.chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners n _ 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) V Paint &AwAis Z1- A��-� An other r "y 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 r IJJw�L �?vvs P ln lw (dry cleaners) C h d rv0,w s �e `✓ Other cleaning solvents Bug and tar removers. v� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD 2•Printers F HLT satisfactory 3.Auto Body Shops �U �li� / !� O unsatisfactory- 4.Manufacturers C py (see"Orders") 5.Retail Stores 6.Fuel Suppliers DRESS 45s Class: 7.Miscellaneous BUWIVLIG jV 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) lllPC n� nrnc one �� X Heavy Oils: waste motor oil (C) a u new motor oil (C) transmission/hydraulic Synthetic Organics: .de eas r mil/-i4_)4� �rp� �o � � - - rx Miscellaneous: X I vAe -a,9z P 04e 6 �!- I ) S V / aa�b, "'31 0--t- - w 1 -v�-b0 �ti - 5 Tw/ j` - Cg-k- daao DISPOSAI✓RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply r !c j �t Town Sewer OPublic .� O On-site OPrivate Qc/ 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—KNO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. lu Person (s) Interviewed 111bli, ctor Date V�6, XT