HomeMy WebLinkAbout0013 MAIN STREET (HYANNIS) - Health 13 Main Street, Hyannis
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS:
BUSINESS LOCATION: 1-3IlitJ Nl
MAILINGADDRESS: �" Mail To:
TELEPHONE NUMBER:
Board of Health
Jam" _�- �`�f--��9 Town of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUM,,PER: 'I`?/—5�5� Hyannis, MA 02601
TYPEOFBUSINESS: e
Does your firm store any of the toxic o azardous 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 indica if the materials are stored at a site other than your mailing
address:
ADDRESS: A 7o,
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
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
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink j
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) 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
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint & varnish removers, deglossers An other products "
Paint brush cleaners y p with poison" labels
Floor& furniture strippers (including chloroform, formaldehyde, �I
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
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
�mO A0 Sfa AKO E4hES
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ]
NAME OF BUSINESS: U P l CSC i y o Mail To:
BUSINESS LOCATION: 13 f'tA► Lk ST ovaA?��.f, mv,�, c5jx, Board of Health
°t Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: `7'? 1& — (0-10 Hyannis, MA 02601
CONTACT PERSON: _MA C k A.-1 C_2sDTc "
EMERGENCY CONTACT TELEPHONE NUMBER: 31?,E 710 51 Z 77,�-1®Z 0
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 K
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 coolants stems rain cleaners
9 systems) D
'�utomatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulic fluid (including brake fluid) Disinfectants
_/ftg lotor 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
ON1Y RRcko-,rz-& AS iNeP-ru1ED grow, 9,upplteA1
White Copy- Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH �K satisfactory 2.Printers
O 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY Q (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class:
7.Miscellaneous
` 19 QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MA��R S Case lots 1 ove --
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel(A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
Cew motor oil (C),
transmissio ydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECLAMATION RE RKS: 0aa
1. Sanitary Sewage a 2. ter Supply
g
O Town Sewer XPublie
O On-site Q rivate
i� 3. Indoor Floor Drains YES_NOx_ r—ilA/V,� S Mat
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank:MDC /X
O Catch basin/Dry well
O On-site system
5.Waste Transporter
iof Haulerestinatioxi Waste Pro uctense
YES NO
2.
Perso ervie ed Inspecto at