HomeMy WebLinkAbout0680 FALMOUTH ROAD/RTE 28 - Health 6�0 FALMOUTH RD, HYANNIS
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TOXIC AND HAZARDOUS MATERIALS IiEGISTRATION FORM
Mail To:
NAME OF BUSINESS: Ulm C�L s J P-L�r C Board of Health
MAILING ADDRESS: f 650 F0.1/yQce_z-_L. 14YA•1,1ArS Town of Barnstable
TELEPHONE NUMBER: 4� 2 2 l --vS-O�_S O P.O. Box 534
CONTACT PERSON:" 6Ray.,- Hyannis, MA P.O.
02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalling, at 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 fo your convenience.
If you answered YES above, please indicate if the materials are stored at a site other than your
mailing address:
ADDRESS: Ia�KQ 4lW0c1-r PY01VA(1s
TELEPHONE: 'SDT — 0
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous
characteristics and must be fWtw-
gfn put a check beside each product that you store:
j
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 �� O/Z
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 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
White Copy-Health Department/ Canary Copy-Business
I�
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH ,4 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY ANA SU QMQ "l l (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS bSSO Class: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS Sri z
IN OUT I IN 10UT IN OUT I#&gallons Age Test
Fuels: a
Gasoline Jet Fuel (A)
Diesel, e�#2 (B)
Heavy Oils: 0
waste motor oil(C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics: !
degreasers tk)D- LIO
El
!0( W4Q �.
jb(,0 1
P1laisc�llane u
calla6 0oZ_
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DISPOSALfRECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O.Town Sewer Public
.AOn-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 O ERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter p
s
s
YES NO
1.
2.
P n s) Interviewed Inspector Datcl