HomeMy WebLinkAbout63 A ENTERPRISE ROAD - Health 63-A-Enterprise-Road;, yannis C
A=
Cape Cod Collision
i
Date: 5-&-oy
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAMEOFBUSINESS: Cct-,ram. ( Ce,-tS�trr►
BUSINESS LOCATION: 3 A R A • INVENTORY
.MAILING ADDRESS: TOTAL AMOUNT:
TELEPHONE NUMBER: 5-6$--77 5/— 7 '�7
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER:
TYPEOFBUSINESS: Ace FIDE Ut57 AICT
OTHER INFORMATION: /fegf • tee. dw ��,�? scats
avn.l. s ze _
-1.
J-"~ v at &u.W ba eook__. : C4,IA ,24 vCAs. oGLa A
�—• oz ��ryr-aYe ut-. '� -E� {����-��a-h�niters '�I Pit- .
Wast Transportation:
Name of Hauler: Cite .,n s Destination:
Waste Product: _� �y,,��h,-rem Licensed? a No
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. .
NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Observed (gallons):
Antifreeze(for gasoline or coolant systems) Drain cleaners
5. .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
,,AA 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•(electrolyteVba> de,,•e. 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
�1� Lacquer thinners Other chlorinated hydrocarbons,
NEW 'jkd ,QJSED (inc: carbon tetrachloride)
/D 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 Misc.:
(dry cleaners) /hi5e• �rfa.�i/yia�c� G, �'
Other cleaning solvents
U Bug and tar removers
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
dd O unsatisfactory- 4.Manufacturers
COMPANY cs ' (�.% 1 i St(A' (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 6 %Pmbciass: _ 7.Miscellaneous
QUANTITIES AND 5 ORAGE (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: l
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply )-^
4R Town Sewer Public
O 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 NO ' ORDERS:
Q Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
S NO
1. Vi
2.
rs ) Interviewed Inspector Date
i� SENDER: . •N COMPLETE THIS,SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. D e of Delivery
item 4 if Restricted Delivery is desired. 0 (/(off
■ Print your name and address on the reverse
so that we can.return the card to you. C. Signature
■ Attach this card to the back of the mailpiece, X J ❑Agent
N or on the front if space permits. Nv 0 Addressee
D. Is delivery address differellfrom item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑ No
0 �lit
U3 Of I}-�,/nn l/1 3. Service Type
r 1(Xj( V1'1 YYY... ''Certified Mail ❑ Express Mail
cc ❑registered ❑ Return Receipt for Merchandise
wV I 1 d ��O ❑ Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number(Copy from service label) ''nn
Ili I i i x l 1 !� U!0d 0 �V
PS Form 3811,July 1999 q f Domestic Return Receipt 102595-00-M-0952
I h f i tiii 11W (i lilii
f -
UNITED STATES POSTAL SERVICE First-Class Mail
I Postage&Fees Paid
LISPS
I Permit No.G-10
I
• Sender: Please print your name, address, and ZIP+4 in this box •
i
I
I
Public Health DIvbEa
ATown of Bamstable
I 200 Main St.
i
Hyannis, Massachusetts 02601
I
I 9
fliilli1 i111 fill III 111111111
11ff111[Hil lIi-1111111?fi111ildi f
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Q' Postage $
CO
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Certified Fee �
N --0 g
mRetu )ere
rn Receipt Fee rn (Endorsement Required)p Restricted Delivery Feep (Endorsement Required)
O Total Postage&Fees
Sent To
i ---------- -------- ----------� � h
M St et, t.lyp.1or F ox No.-
O C� fate,ZIP+4
IYJ O ? 0 J
fCertified Mail Provides: '
o A mailing receipt o
o A unique identifier for your mailpiece
c A signature upon delivery
o A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail.
n Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS postmark on your Certified Mail receipt is
required. .
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mal
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
PS Form 3800,May 2000(Reverse) 102595-99-M-2087
oFt„E r Town of Barnstable
Regulatory Services
* BA ASS.LE, f
M ' Thomas F. Geiler,Director
9 MASS. $
16319.
n Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
March 4, 2002
Bo Willey
Cape Cod Collision
63 A Enterprise Rd.
Hyannis, MA 02601
NOTICE TO COMPLY WITH THE AIR POLLUTION CONTROL
REGULATION,310 CMR 7.09
Under The Massachusetts Department of Environmental Protection Air Pollution
p ,
Control Regulation 310 CMR 7.09(4),no person shall cause, suffer, allow or permit the
handling, transportation, or storage of any material in a manner that results or may result
in emissions therefrom which cause or contribute to a condition of air pollution. On
February 27, 2002, Health Inspector Lee McConnell,received a complaint about
particulate and dust being released into the environment from 63A Enterprise Rd.,
Hyannis. You are directed to correct the following:
■ Vehicles shall not be painted at 63A Enterprise Rd. Hyannis, unless, they are in an
approved spray booth or room.
■ Paint particulates and dusts must be properly vented and filtered before being
released into the environment.
You are ordered to correct the above listed violations within twenty-four(24)hours of
receipt of this letter.
You may request a hearing before the Board of Health if written petition requesting same
if received within ten(10) days after the date the order is served.
q
Non-compliance could result in a fine of up to $500.00. Each day's failure to comply
with.an order shall constitute a separate violation.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O
Director of Public Health
Town of Barnstable
CC:
Larry Mahan
737 Race Ln.
Marston Mills, MA
02648
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
satisfactory 2. Printers
BOARD OF HEALTH 3.Auto Body Shops
(V unsatisfactory- 4.Manufacturers
COMPANYCCkC� ( 0 (see"Orders") 5.Retail Stores
�\ 6.Fuel Suppliers
ADDRESS �`� Ei��erf�`s�' �C iJ :lass: 7. Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors)
MAJOR MA*cxnnt
R.IALS Case lots Drums Above Tanks Vriderground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: g5prn
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECLAMATION REMARKS: i 1
1. Sanitary Sewage 2.Water Supply u d19� x TL
,Town Sewer Public l�(o
O On-site OPrivate
3. Indoor Floor Drains YES NO� �o
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NOY ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product .d
p YE NO
2.
OL
Person(sTInterviewed Inspector Date
• C � ' CCOMPLIANCE:
2. Printers
: • � ' � • satisfactory
• isfactory- 4.Manufacturers
• ;
ers") 5.Retail Stores
Miscellaneous
• �.�1 f9.Fuel Suppliers
%N 1113 lie]to
let mgmal"I
A
• • lC:i_ �, . :�"' ti41�-7 r .� '>a ..., _ i ter- .�
( ise otS F •« �Ihyumti x AUoveWTinks j U- der��ound Ta
..r
• • 010001pAgampm
l�,.
pp
r .. Al
Dole
WA
W rp q i s ;ass7R
ie
nof�H<iu x lc r esti nittion g Wast! 1Yrodu�t �� Licensed';
I �r
TOWN OF BARNSTABLE C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
n unsatisfactory- 4.Manufacturers
COMPANY Amr ,o `,F& (see"Orders") 5.Retail Stores
—, 6.Fuel Suppliers
ADDRESS 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJORMATERULS 1Above Tank Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils: '
waste F=M)
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
ai2
v t
DISPOSAUJRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply 4� fW7
Town Sewer Public
O On-site Private
3. Indoor Floor Drains YES_—NO / .Q!s°` � � A L
O Holding tank:MDC
O Catch basin/Dry well
O On-site system4 ' z
4. Outdoor Surface drains:YES N0-Z ORDERS:
O Holding tank:MDC
O Catch basin/Dry well r
O On-site system ,
v '
5.Waste Transporter
Na
1 • Product •d
1.
2.
Person(syInterviewed Inspector -- Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,G*s,Btations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY 64C 6 d &11hJ/Gv� (see"Orders") 5.Retail Stores
_ 6.Fuel Suppliers
ADDRESS C Class: --3 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS am== ,• -
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
'fit jo 9�
Miscellaneous: !-7
gal"
t'"1 aL-�s clt c�Yc.ww► �p r, Si oLD
DISPOSALIRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply ✓Q®� �"l r dam-• Qn/0/® k
OTown Sewer Public �f (, �(,�d . L4a_*� , Cg
O On-site OPrivate /
3. Indoor Floor Drains YES N0�
O Holding tank:MDC_ (�d alb p
O Catch basin/Dry well L„ ky ctrtw t,-C. 49/ �C�11 . , 4 f 61 a�a% ak6 dew
O On-site system t t
d'J
4. Outdoor Surface drains:YES NO_4_ ORDERS:
O Holding tank:MDC dN q4,t�weir e.0-V ,,.j &L,,
O Catch basin/Dry well
O On-site system
5.Waste Transporter
YES 0
1. Adakceg4 ck ,c es r"w Vie: ,
2.
f 1,11t191
erson - e'rfe ed Inspect Da e
a�,
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops —�
0 unsatisfactory- 4.Manufacturers
COMPANY r� CA COG �fe� (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS _ aSS: 7.Miscellaneous
' QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS ,. . ,
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
1 1
Diesel, Kerosene, #2 (B)
' Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
80K
Miscellaneous:
aAy-
V t"lug s
-7
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
0 Town Sewer -4Q?ublic S
On-site OPrivate
3. Indoor Floor Drains YES NO
0 Holding tank: MDC
0 Catch basin/Dry well
O On-site system G
4. Outdoor Surface drains:YES—KNO ORDERS:
0 Holding tank:MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
YES NO
2.
_!71- " �
erson s) Interviewed Inspector l Date
HAZARDOUS MATERIALS REGISTRATION FORM
DBA: :Cape Cod Collision fax:
........................ .................................... .... .........
corp name: Mail Addr
........ ........... ........... .........
location: 63 A Enterprise Road street .63A Enterprise Road
y
mappar: city 'Hyannis
........ ....... .....................
contact: Antone Fajao state: Ma
...... ................. .. .........
telephone: 771-7597 zip 02601
....
emergency: 771 7597 erson
e
interviewed �t f(77
Business: -
inspection date 1 2/23/95
category: 'Vehicle Maintenance -
type: Auto Body inspection date 2
inspection date 3
public wate [7. indoor floor drain IRK outdoor surface drain license required
private wate 177 indoor holding tank and 17, outdoor holding tank and 177. currently licensed
town sewag Q. indoor catch basin/drywel 19. outdoor catch basin/drywel expir
on-site sewag FJ indoor on-site syste outdoor onsite syste date:
notes:
3 gallons windshield adhesive. MSDS SHEETS NOT ON SITE. OUTSIDE compliance:
HYD/ELECT. LIFT(2 YEARS). W,'OIL&PAINTS IN NE 55 GAL DRUM Unsatisfactory
OUTSIDE. HAZ WASTE#MAMA2089CD. SPRAY BOOTH ROOM.
REMOTE FRESH AIR SUPPLY. MAINTAINS OWN GVN CLEANER.
PAINTS IN STEEL CABINETS. ORDERS: MUST HAVE WASTE
MANIFESTS AND MSDS SHEETS ON SITE. SIX YEARS AT THIS
LOCATION.
Chemicals' M. gty's > 25 Ibs dry or 50 gals liquid
descri tiow t : unit of measure
r roofers 2 gallons
car waxes and polishes 2 gallons
paint &lacquer thinners 275 gallons
household cleaners 1 gallons
toilet cleaners 5 gallons
disinfectants 1 Igallons
......... ...............
waste transporter HAZCO
.........
waste transporter
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM_
NAME OF BUSINESS: CA.Zr_ COC Mail To:
BUSINESS LOCATION: �
Board of Health
MAILING ADDRESS: w�, - , � A Cj d2 ors f Town of Barnstable
TELEPHONE NUMBER: _ P.O. Box 534
CONTACT PERSON: 73 Hyannis, MA 02601
EMERGENCY CONTACT TELEPHONE NUMBER: --1-1 l
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, '
T
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 our
mailingaddress: y
nv
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
1 (`�l-�--Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) 6An
1 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)
- LA Rustproofers -Aere-so I CAr5 Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes (-rur-vAe_to") Jewelry cleaners
Asphalt & roofing tar Leather dyes
� t�ints, varnishes, stains, dyes Fertilizers (if stored outdoors)
_ Paint & lacquer thinners PN m- -h-nncl 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):
I (dry cleaners) 12
C7�rr+ . DrO�
Other cleaning solvents ��� � �A-1 . ( t+f-_;
�,tC, f A t ,lsh►o Bug and tar removers , eve
( Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy- Business
1
TOWN OF BARNSTABLE coMPLIANCE: cLASS: I. Marine,Gas Stations, Repair
BOARD OF HEALTH 0 satisfactory 2. Printers
3.Auto Body Shops
�. . unsatisfactory- 4.Manufacturers
COMPANY (see Orders ) 5.Retail Stores
ADDRESS r' 6.Fuel Suppliers
lass: 7.'Miscellaneous
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:
degreasers
Miscellaneous:
/n �
to — 6 V n V
C-) — IN
f a
DISPOSAIJRECLAMATION RErA 1- 1 L)
1. Sanitary Sewage 2. Water Supply I`L V
O Town Sewer Public
19(On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank: MDC p
O Catch basin/Dry well '
O On-site system O C
4. Outdoor Surface drains:YESNO ; c
X-
0 Holding tank: MDC
Catch basin/Dry basin/Dry well 11
� � � ^r
On-site system � S /
5.Waste Transporter `S
1. jL "A/� _ YE NO
2.
C
erson (s) Interviewed I s ector ate
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations, Repair
BOARD OF HEALTH o satisfactory 2. Printers
3.Auto Body Shops
Ce"
0"XI'l,
satisfactory- 4.Manufacturers
(sCOMPANY7'\(see"Orders") 5.Retail Stores
96.Fuel Suppliers
ADDRESS lass' 7.Miscellaneous
QUANTITIES AND STORAGE (IN- indoors; OUT-outdoors)
MAJOR AMTE I Case lots Drums Above 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: 1 T�D-P
DISPOSAURECLAMATION RE S:
1. Sanitary Sewage 2. Water Supply V 1 J
O Town Sewer OPublic
0 On-site OPrivate
3. Indoor Floor Drains YES NO ri v
0 Holding tank: MDC
0 Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
0 Holding tank: MDC
0 Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES I NO
1.
2.
ers n (s) Interviewed Ins.. or. #at
�I
od
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH O satisfactory 2.Printers
3.Auto Body Shops
r unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 18SS' 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS Case lots 1 ,- -
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:
'AIN
i601
DISPOSAU✓RECLAMATION RE 5I L e e,
1. SanitarySewage 2. Water Supply ® V
g W
O Town Sewer Public
)(On-site O Private AO C
3. Indoor Floor Drains YES NO l.J
O Holding tank: MDC B
0 Catch basin/Dry well
O On-site system 0 � 6
4. Outdoor Surface drains:YES NO I�/v 7�6 OA 6l OC
0 Holding tank:MDC
Catch basin/Dry well a �� S
On-site system
S 6; ON S G
5.Waste Transporter
Name of Hauler Destination Waste Product
l. �
2. ,
erson (s) Interviewed I s ect , 01jute*
NOV
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
O satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
IDW (unsatisfactory- 4.Manufacturers
COMPANY O r\\(see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS lass: 7.Miscellaneous
�°°��I N QUANTITIES AND STORAGE (IN=indoors;OUT_outdoors)
MAJOR MATERIAS 1 ,• ,
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: o
DISPOSALlRECLAMATION RE S:
1. Sanitary Sewage 2.Water Supply Skil, WV 16MO UJ
O Town Sewer OPubliciftg�& 36"'-
O On-site OPrivate
3. Indoor Floor Drains YES NO "' o
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 Product
YES NO
1.
2.
ers n (s) Interviewed Ins V10i #ate
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 0 _ r'�u�I Ca l bs►c)n Mail To:
BUSINESS LOCATION: Board of Health
MAILING ADDRESS: �� Town of Barnstable
�C���-1�--� P.O. Box 534
TELEPHONE NUMBER: 1 S 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, ' ,
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: r\0
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 C�-�-Toilet cleaners " A
G
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 -Aubso I C,5 Swimming pool chlorine
Car wash detergents Lye or caustic soda
Car waxes and polishes (TU.r+tL t"_?") Jewelry cleaners
Asphalt & roofing tar Leather dyes
P ints, varnishes, stains, dyes Fertilizers (if stored outdoors)
I
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) i 2 a 6 411. Ce:)Y-%+ . PQD 10-e
Other cleaning solvents - Q� f��,i_1 � �hle 0:��_Ccjhestivle
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
FEB-23-95 THU 14 :57 CWM VIRGINIA TRANSP. + P. 02
COMMONWEALTH OF MASSACHUSETTS'
DEPARTMENT OF ENVIRONMENTAL PROTECTION
DIVISION 0E HAZARDOUS WASTE
One Winter Street
Boston, Massachusetts 02108
pie ass print or type,(Form designed for use on elite(12•pitch)typewriter.) Manifest 2,PaBe 1 Information In the she ed areas
UNIFORM HAZARDOUS 1,oeneretorus EPA IGNo. Doc rtj@ �a
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15.GENERATOR'S GEATIFICATION:I hereby declare that the Consents of this consign Iy and accurately p¢scribed above
�k; ri and are Crassified pecked.marked,end labeled.and are in all lespecli In Proper condwon for trani0on by hi
prvp�r PP' g name �
` according to eppncable.mernauo„al and natlonai gvve,nment reauladone,
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1(I am a Iarge gvenuTv ps„Qralo�,I Port,ry that t n m u
nave a prograj plate to red�Ice the velunte and lorlUty of waste 9e�'o�eted to the degree I nave determined to be econo
loally preC Ica e
C end that I have seiecte0 lfia PrBpUcable method of t•¢i'•ment,9lora8e,or dispczel Currently evaitaDl Pnc BUan an
f1Imjgq5 the recent end(inure thrivl to hvman he911 and the environ-
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leCL the bail waste management Molhod that is avail bte t0 me and thal I
CV7A mans,OR,it I am a emar quentiW Qenerator.I have made a good Ia.lh effml io miningue my waste g DB[e
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T 17,Trene orter 1 AbknowledgementorFteceipto(Materials —' -- `71"; onto Day Ye
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R18.Tran porter 2 Acknowiedgement of Fieceipl?[.Materials �_••, --• on(h Day Year
T Printed/TypedName Signature
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19,Discrepancy indication Space
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1 20,Focrilty Owner or Operator.CertMcatlon of receipt of hezardous materlals covered by thle manllast except as noted In item 18- -- -Date
-"l'" gnth Day Year
T Pnnted/TypedNeme a^i nature '•
far- App,Qved OMB No 2050.0039 E>P"ea 9 30 94
EPA Form 8700-22 (Rev. 9-88) Previous editions are obsolete. TRANSPORTER b R E T A I N S
COPY>S