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Home My WebLink About0043 JOAQUIM ROAD - Health 43-Joaqulm Road Hyannis -- -- __T- - - - — - -- A - 344.7 1 I I I� I I 1; 1 �►^ l Date Physical Street Address-Check database to ensure it exists --77—Working Phone Number Actual Amounts - ( ie. gas being used to fuel machines., thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? .. / If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted _Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -.give a vehicle washing policy and explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4'years). A business certificate ONLY REGISTERS YOUR NAME in town (which ` you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Cleric's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: f{O i s Fill in please: r'� .'�: �aT�Gsf�ir�.:, -% ; APPLICANT'S YOUR NAME/ -i,� A6�1��t fL- CAN BUSINESS YOUR HOME ADDRESS: ?U�4� Mill 02_601 TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS SAM�MM Ar .A Dr cA? TYPE OF BUSINESS LgN`tS�A Pt✓ IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS , o ;t JL NfJ15 —/`l/4 OZ 0 MAP/PARCEL NUMBER Q (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to malce sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM IS4�th ER'S OF ICE MUST COMPLY WITH HOME OfCCUP -" 0 ' This individu@ ha infor 4 f a y p rmit req irements that pertain to this typqqpfLF�t�i R�} REGULATIONS. Fl1 6i�, ** COMPLY MAY RESULT.IN FINES r' ed Signat COMMENT 61 2. BOARD OF HEALTH This individual h b en inf irm d of the pei requirements that pertain to this type of business. thorized Signature**,, COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: / / — TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOF'BUSINESS: ��A��`�f'` -- LA-0 5CA VI � BUSINESS LOCATION: ---t o A g y t M f-h - INVENTORY MAILING ADDRESS: 0 X �I A- MD L)T�l - N1A TOTAL AMOUNT- TELEPHONE NUMBER: S2 OGZG CONTACT PERSON: Ale q-N'�os EMERGENCY CONTACT TELEPHONE NUMBER: ��" Ci 2 MSDS ON SITE? TYPE OF BUSINESS: LAN DS CA Pik INFORMATION / RECOMMENDATIONS: Fire District: t Waste Transportation: P'� Last shipment of hazardous waste: Name of`Hauler: Destination: 0 Waste Product: t CA eE D t NW 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 requires 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 Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants -V/ 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 Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout 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 Other chlorinated hydrocarbons, Lacquer thinners (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 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 Applicant's Signature > Staff's Initials�4j// I YOU WISH TO.OPEN A BUSINESS. For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which YOU must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Cierk's Office, 1 FL, 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE:a }, +F' Fill in please: APPLICANT'S YOUR NAME: ItIl BUSINESS YOUR HOME ADDRESS: 5 7-W-31b-695_3 TELEPHONE # Home Telephone Number 5 098- 62 -0.� NAME OF NEW BUSINESS L.a,:,c�rra.e i�a TYPE'OF BUSINESS IS THIS.A:HOME OCCUPATION?. . YES NO �' ^ -- Have you been given.approvaf f m.the building.di'ision?. Y NO . ADDRESS OF-BUSINESS,7 vi MAP%PARCEL NUMBE When starting a new business there are several things you musVdo in order to be in compliance with the rules and regu a ions of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO NER'S OFFICE This in.divid al h� s erH oV1 f any permit requirem nts that pertain to this type of business. thoriz d na re* COMMENTS: 2. BOARD OF HEALTH This individual has n in r th erm't r uirements that pertain to this type of business. Authorized ignature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Date: TOWN OF BARNSTABLE - TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 61'4,e-I1 BUSINESS LOCATION: yZ �TnG-crk)�VA_ RC101 .i INVENTORY MAILING ADDRESS: F0 AQk. Z'11 ' I��ma.�.-�• s rKA G2G G 1' TOTAL AMOUNT: TELEPHONE NUMBER: S01? -$L Z_-o 15b CONTACT PERSON: Ij�L lMol';A EMERGENCY CONTACT TELEPHONE NUMBER: -77`f -n f- 6 9S 3 MSDS ON SITE? TYPE OF BUSINESS: Lann d e_ INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111,,Section 31, of'the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires 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) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite). Hydraulic fluid (including brake fluid) Refrigerants 6 Motor Oils 0 Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, et fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, O Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout b Swimming pool chlorine Battery acid (electrolyte)/Batteries C) Lye or caustic soda 0 Rustproofers C) Misc. Combustible Car wash detergents Leather dyes O Car waxes and polishes r�ye Fertilizers Asphalt & roofing tar v PCB's Q Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) ® Spot removers & cleaning fluids (dry cleaners) d Other cleaning solvents CO) Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS