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Home My WebLink About0461 MAIN STREET (HYANNIS) - Health 061 MAIN ST. A= D 0 Date: r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: vu BUSINESS LOCATION: MAILINGADDRESS: Mail To: Board of Health TELEPHONE NUMBER: Town of Barnstable CONTACT PERSON: 1 - P.O. Box 534 EMERGENCY CONTACT TELEPHO E NUMBER: / ® Hyannis, MA 02601 TYPEOFBUSINESS: 1,t-" Does your firm store any of the toxic or hazardous 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 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. 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 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 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 (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2. nters - BOARD OF HEALTH O satisfactory 3.Auto Body Shops 0 O unsatisfactory- 4.Manufacturers COMPANY &MIA11 �� (see"Orders") 6.Fuel Su pliers ADDRESS s1 n !' I/l�/SCIass: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 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: X F i DISPOSAIJREC;LAMATION REMARKS: � 1. §anitary Sewage 2. ater Supply ffi�'QdOC/J i AIMC�n:z A Town Sewer 3RPublic On-site OPrivate 3. Indoor Floor Drains YES NO k SV- g4 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of ilauler Destination Waste Product YES No 1. — k I / b 2. G.1 AAA& Person (s) I rvie e Inspe t r at � I C -�'a 80 PT L�7 I T SL5 _is P �q° �CQ,C5 .� � � � � j i � ` ' ` � � I 1 � i ` � � � # y ; 3 � ,, i i j � � � } i 44 Iff j � 1 � i � # � � � I i F i I ,� � � � � � � � � a � f � � 4 q � i � � � . � � � � � � � � � � I + � � � � , � � � � � � I � � � � { � � � � , i � � � � � � � � � f 4 � i � j + � f ` 4� t � � � � � � � � t � � � � � � � � � � i � # ' i I � �� i � � � � � � � ` � � � � � � � � � I � � � � � a � � { � r � � � � � � � `' k I TOX-IIC^ AND HAZARDOUS MATERIALS REGISTRATION FORM �N. ME OF BUSINESS: To- w+ i•� It �t �� o�►a Mail To: BUSINESS LOCATION: 4 6 I Board of Health MAILING ADDRESS: S4, o � Town of Barnstable "'�� P.O. Box 534 TELEPHONE NUMBER: S 67$ — 7�1- " �f Hyannis, MA 02601 CONTACT PERSON: Ryh EMERGENCY CONTACT TELEPHONE NUMBER: S0:3 3`1 y --'6R Z }tome-4. Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in q�u�t hies totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES V 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: Sww•a cz-s CL i6 ve 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 White Copy- Health Department/ Canary Copy-Business