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Home My WebLink About0001 LEWIS BAY ROAD - Health 1 Lewis Bay Road, VANCED FAM F a i I a i i 66 3 I Q TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: /&l0A116CEb Mn1,y Mail To: BUSINESS LOCATION: / ke-Gc/r s J4,4 Board of Health Town of Barnstable MAILING ADDRESS: �itlitll S ,C�f,�j Da�6o P.O. Box 534 TELEPHONE NUMBER: l 5-08- S o Q 6 Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: lqq Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totallin , 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 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: Quantity/Case Quantity/Case 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 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 I White Copy- Health Department/ Canary Copy-Business TO ALL NEW BUSINESS OWNERS: Fill in below: NAME OF NEW BUSINESS: 1.�„" /&m144 TYPE OF BUSINESS �;Y/i✓oDl� di CA— IS THIS A HOME OCCUPATION? N y ADDRESS OF BUSINESS MAP/PARCEL NUMBER f I business there are quite a few things you need to do in order starting a new b If you are g to be in compliance with all rules and retulations of the Town of Barnstable. Once you have been checked off on this sheet you may apply for a business certificate at the Town Clerk's office(Ist floor-Town Hall). 1. GO TO 1 DING IN OFFICE(4TH FLOOR TOWN HALL) This indi is ' o Ian an has been explain d the procedures needed to start a businessG �— Bui ing I spe ture - 2. GO TO BOARD 0 HEALTH(3RD FLOOR TOWN HALL) This individual has b n informed of any permit quirements that pertain to this type of business. Health Inspector's gignature 3. GO TO CONSUMER AFFAIRS(LICENSING AUTHORITY) (3RD FL SCHOOL ADMINISTRATION BUILDING This individual has been informed of any licensing requirements that will pertain to this type of business Licensing Authority Signature After being checked off by all of the above-remember to return to the Town Clerk's office to actually obtain your business certificate. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: `, /` , r. Mail To: BUSINESS LOCATION: Board of Health MAILING ADDRESS: I ?cR/16 �J? /r �c3�rra; �1�1. � � Town of BarnstableP,O. Box 534 TELEPHONE NUMBER: '71r- 7-,b Hyannis, MA 02601 CONTACT PERSON: Pt- /-Urj- C:-� CA .-7Zbr_jn4n 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, 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 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: Quantity/Case Quantity/Case 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 I 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 �aTc� l�r ntininkyo} `�� cic��z`a��cy�i�`,+��)C"nf-c,� 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 Paints varnishes,.stains, dyes Fertilizers (if stored outdoors) 1 t;-A(10 ri iota 6-, i� Pv1 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