HomeMy WebLinkAbout0577 MAIN STREET (HYANNIS) - HAZMAT 577 .MAIN ST, ,HY Q
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a Complete items 1,2,and 3.Also complete `Signature.
item 4 if Restricted Delivery is desired. X c ❑Agent
io Print your name and address on the reverse �Y` l/"— ❑Addressee.
so that we can return the card to you. B.fceivedly(Printed Name) C1_Q4e of D live
o Attach this card to the back of the mailpiece, Y�
or on the front if.space permits.
D. Is delivery address different from item 1? ❑Y
1, Article Addressed to: If YES,enter delivery address below:., 13 No
Adam"Hostetter .
770A Main Street '
Osterville, MA 02655 4 s. se ' eType ,
ertified Mail �Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2:-Article Number r 's i7p12 '1010 1 D000'`285058678''
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Form 3811t"February 2004"{ Domestic Return Receipt +02595-02-M-1540
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UNITED STATES POSTAL SERVICE r First-Class Mail
Postage&Fees Paid
USP,.PerniM,G-10
' aen'
Sender: Please print our name address„ d ZIP+4 6phis WM
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Town of
j Health Barnstable I
20 Division �- I
Main-Street ''J"
Hyannis
I I , MA 02601 I
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��t =ayti Town of Barnstable
Regulatory Services
BARNbTABLE. '
'"9. ,�� Public Health Division
AlFA,MA'S A
Thomas McKean, Director
I
200 Main Street, Hyannis, MA 02601
Office:; 508-862-4644 Fax: 508-790-6304
August 11, 2014
Adam Hostetter
770A Main Street
Osterville, MA 02655
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE A ER 170.
The property owned by you located a 557 Main Street nits 12, & 14), Hyannis, was
inspected on August 11, 2014 by Timo O'Co 1 R.S., Health Inspector for the
Town of Barnstable. This inspection was conducted in accordance with the 2006
Barnstable rental registration ordinance requiring yearly inspections of all rental
properties.
I A
The following violations of the State Sanitary Code were observed:
105 CMR 410.500—Owner's Installation and Maintenance Responsibilities:
Apartment#12— Gabel vent in disrepair and must be replaced.
Apartment#14—Brick steps leading into apartment missing bricks.
i
You are directed to correct State Sanitary Code violations listed above within thirty
(30) days of your receipt of this notice.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
.result in a fine of$100.00 per violation. Each day's failure to comply with an order shall .
constitute a separate violation. Should you have any questions regarding the above
violations, please contact the Town Health Division and ask to speak with the inspector
who performed thle-INspection.
R ORDER OFT E BOARD OF HEALTH
ma ,A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
i
SENDER: C COMPLETE THIS SECTION ON DELIVERY
OMPLETE THIS SECTION
■ Complete items 1,2,and 3.'AIso complete A. Sign ure
item 4 if Restricted Delivery is desired., ` X ,�,, O. ent
■ Print your name and;address o7,the reverse ❑Addressee
so that we can return the card to you. B Received b (Printed Name) C.Date of Delivery
■ Attach this card to the back of the mailpiece, ]v
or on the front if space permits. v
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
��ctvY� S� e �
3. Service Type
U Certified Mail O Express Mail
❑-Registered 0 Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes I
2. Article Number` t ; I I Iti 7 p 0°37 68 0 4; 5 4 5`$ 519 4 -I
(Transfer from.servfce IabeQ
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-10-1e40
UNITED STATES POSTAL SERVICE ,I
First-Class Mail I
Posta &Fees;Paid
'USPSge
Permit No.G-10
• Sender. Please print.your name, address,andZIP+4:in this box-•
I
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.'� Town of Barnstable
Health Division
Nlie
g 200 Main Street
Hyannis,MA 02601
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Certified Mail#7003 1680 0004 5458 5194
BIKE r Town of Barnstable
P� ti
O•
Regulatory Services '
6 �� Thomas F. Geiler, Director C <
F39.
" Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
August 7, 2007
Adam Hostetter
770A Main Street
Osterville, MA 02655
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 557 Main Street Unit 5 Hyannis, was inspected
on August 6, 2007 by Don Desmarais, Health Inspector for the Town of Barnstable. This
inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
Smoke Detectors and Carbon Monoxide Alarms. No carbon monoxide
alarm provided.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by installing CO alarms within ten (10) feet of
bedrooms in accordance with Mass State Fire Codes.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Q:\Order 3etters\Housing violations\Rental ordinance\557 Main Street Unit 5.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER OYIbER OF THE BO O EALTH
TJmas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Don Desmarais, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\557 Main Street Unit 5.doc
9
FORM30 C � HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
_ OARD F H ALTH
CITY/TOWN
DEPARTMENT
� 1 Sye� ADDRESS / V�r q/ t
TELEPHONE
Address_G ? kn6? )N /�„l _ Occupant_
Floor___Apartment No. 5J No. of Occupants
No.of Habitable Rooms No.Sleeping Rooms__
No. dwelling or rooming units_ No. Stories
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimnevs:
Central Y_o N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
IELJ10 ❑ 220 Fusing,Grnd.:
MP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Lo
Kitchen r�
Bathroom
k-
Pantry
Den
Living Room ✓'
Bedroom 1 1�
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. ---- u .Ter..,Gas,Oil, Elect.-.-
%acks, Flues,Vents,Safeties:
Kitchen Facilities Si p k
t ve
Bathing,Toilet Facil VVe t., Plumb.,Sanit'n.:
ash Basin,Shower or Tub.-
Infestation Rats, Mice, Roaches or Other:
Egress ual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PEN OF RY."
INSPEC TITLE `
DATE 'b TIME
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger orlmpair Health or Safety
The following conditions, when found to exist in residential premises,shall be deemed'conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public_. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitatlon, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254. ,
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a'sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
-to remedy said condition within the time so ordered by the-Board of Health.
_
FORM30 C&W HoessaWnr eNTh" THE COMMONWEALTH OF MASSACHUSETTS
BOARD �aF HEALTH
CITY/TOWN
DEPARTMENT
ADDRESS T ( e-i [f
TELEPHONE
Address � L 14! — Occupant ` 4 0 ! r *gin
Floor Apartment No.-,_of Occupants_
No.of Habitable Rooms No.Sleeping Rooms_
No.dwelling or rooming units_ No.Stories
Name and address of owner
Remarks Reg. Vio.
YARD Out Bid s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows: '
Roof
Gutters, Drains.-
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hallall,, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ N Equip. Re air
TYPE: Stacks,.Flues,Vents:
PLUMBING: Su ply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
j DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Lockq_
Kitchen �,' Co.' t...- .. �.. �✓ t. 1,. u
Bathroom t-^' {,� t.. t, �" .. ✓ U,
F Pantry
Den
Living Room ! r/' lE t,f' �--` L
Bedroom(I)- L.-'' l/ v'° �'" L -- v -
Bedroom 2 , ) C`CT'
Bedroom 3
Bedroom 4
Hot Water Facil. --Sup. en.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities P Sink
1 Stove
Bathing,Toilet Facil. /Vent., Plumb.,Sanit'n.:
[,,Wash Basin,Shower or Tub:
'- - Infestation - Rats, Mice;�Roaches or Other:
Egress y`Dual and Obst'n:
General Building Posted ,
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT. AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENAL-TIES OFPERdU- AY."
INSPECOR '^`"�' TITLE
A.M.
DATE TIME P.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: Mail To:
"BUSINESS LOCATION: Board of Health
- Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: . �/'�/�/���� Hyannis, MA 02601
CONTACT PERSON: 7mg 0/ data
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,cgentities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES d NO of')1 0c� i' GAu le' �r6 u
This formmust b6returned 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
Auto matic'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
q k� 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,
_V Laundry soil'& stain removers hydrochloric acid, other acids)
(includin lea Othe r ducts not listed which you feel may
Spot removers & cleaning fluids a toxic or hazardous (please list):
(dry cleaners) d15A Lanhp� n
Other cleaning solvents
Bug and tar removers aMAN
fl Household cleansers, oven cleaners
White Copy- Health Department/ Canary Copy-Business
r,,i.Y f++v.� •. r,.S:-LG•t N1^i.4'r+.:r.yt+,�i•^1' `gin- — .. 1w.y..2 .r.:7c4^a• «:.kt'.....« .�T•`...r!++.-s .:e v .. w...•„ ri,,.., a.. �-/kw. -•r,.,,� 1
TOXIC`AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: a Sf C. 41' ✓ Mail To:
l .Board-Board Health
` BUSINESS LOCATION 5� fn ��f � �<4�� � F Town of Barnstable
fit, }, -:.,_
MAILING ADDRESS:; t P.O. Box 534
TELEPHONE NUMBER: Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: A00 `I 1G 30
li Does your'firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in gyantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES '� NO r
pN I Dc� t tj cv �.
x of Health regardless of ayes-or no answer Use the.: .
Thls form must b returned toithea oard f mat '. � ql 1 ,. -
enclosed env'elop'e:for y6,'u' nvenlence.
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 bb 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 . ,„ w , .� •�
Automatic transmission fluid Toilet cleaners
Engine and radiator flushes Cesspool cleaners
Hydraulicifluid (including brake fluid) Disinfectants
i
•.x )
F °"Mofor oils/waste oils Road-Salt(Ratite -
f Gasoline, Jet fuel Refrig erants
t
" k 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 (creosoterx�""
£; Rustproofers Swimming pool chlorine '`'" _
Car wash detergents Lye or caustic soda
t
Car wax
esand polishes ' Jewelry cleaners
�,. ' ,
Asphalt-&Proofing tar ' Leather dyes
Akt Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
Paint & lacquer thinners PCB's
Paint & varnish removers, deglossers Other chlorinated hydrocarbons,
m -
Paint brush,cleaners p (inc `carbonitetrach'loride) -
Floor &furniture strippers Any other products with "Poison" labels
Metal polishes (including chloroform, formaldehyde,
'ice Laundry soil & stain removers. hydrochloric acid, other acids)
(including l5 each- Ot o ucts not listed which you feel may
Spot removeraning fluids be toxic or hazardous (please list):
(dry cleaners) � � a/
Other cleaning solvents
l � _
Bug and tar emovers 4 .a.._ • ; E a.,:�. .. : .,
i r P Household cleansers, oven cleanersrn ,!��
^ White Copy- Health Department/ Canary'Copy-Business
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