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Home My WebLink About0640 MAIN STREET (HYANNIS) - Health (2) 640 Main Street, Hyannis A- F� Rn La Fe`mrite a Inc. Y" I l 1 j t i I t a 0 Date: I / ly / Q' TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: All G BUSINESS LOCATION: 4; INVENTORY MAILING ADDRESS: �!�Y_y ,,VlacfK Sr}- ' n+41:73 H TOTAL AMOUNT: TELEPHONE NUMBER: 77'+ 122 05:6 CONTACT PERSON: Arwnty► rw EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPEOFBUSINESS: Cra!�h-we-1-04 n INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: 6 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 Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. 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 Misc, 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 (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 NO r0,e4 r_fr4l S ,U 51J U✓1 (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS q {may. = ti. �3-.1:hY`^� itit`M"i'^�.Yiyy.( .,ri'-Syr+-:yV4fy9 v... •/Y'.:r^♦'"-^ "�'�.}� Tdgfiw..a y.'1+w."�Sf4 '.P•t._'Waw f - ^', '6 4 -•N ♦ 1' Date: Idly / c TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS` Alt Ccl e_ �_ 'te0►o�- RCMactc V� `. °~ BUSINESS LOCATION: 6 qd ( )O(h INVENTORY , MAILING ADDRESS: 6, zvlC('K S ��" :3 N yc,r�r�;s ; ' TOTAL AMOUNT: t TELEPHONE NUMBER: 77t 'aa 2520-N, C) s CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: �L ` SSA `� c)j MSDS ON SITE? TYPE OF BUSINESS: LvAS2r Ln cA 1OvN (°J INFORMATION/RECOMMENDATIONS: Fire District: P 1 Waste Transportation: 6 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 Motor Oils Pesticides { NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. 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 Misc. 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 (inc. carbon tetrachloride) -NEW -_-USED _. __ .�.._ _ _ nyotheprod-acts with"'poison labe►`s " 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, NO y►64Crt-f L45") U✓� (including bleach) �� _�g�' 54orc��Q Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents ' t /r Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Haz ous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts—(Le.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) 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?—provide a vehicle washing policy and explain it—note that it was given. 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$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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. �r DATE: Fill in please: Y APPLICANT'S YOUR NAME/S: is r' r BUSINESS YOUR HOME ADDRESS: 6� V viu;.I } PR TELEPHONE # Home Telephone Number ' - " - -NAME OF CORPORATION: - NAME OF NEW BUSINESS A a `xlei�Jr r��r��r/i+ TYPE OF BUSINESS Ccr)st,%46t ar1 IS THIS A HOME OCCUPATION? B5' NO ADDRESS OF BUSINESS c> >oaf n e 3 MAP/PARCEL NUMBER (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 make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This ndividual as med of th rmy—re 3prements that pertain to this type of business. SNOurin93asTilamvwsnoamw fill H11M AldWO0 1Sf1W Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b informed o.f,te licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: V TOXIC AND HAZARDOUS MATERIAL GISTRATION FORM NAME OF BUSINESS: t-JA _�n c Mail To: BUSINESS LOCATION: te �--O Board of Health Town of Barnstable MAILING ADDRESS: �z�y��nLs _ � C' �o l P.O. Box 534 TELEPHONE NUMBER: `7'7! - & 3-7 -7 Hyannis, MA 02601 CONTACT PERSON: Af e:c. Co 2PA. � 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 totalli , 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 White Copy-Health Department/ Canary Copy-Business Date: lO/q l TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: A rmm,�tict BUSINESS LOCATION: Q 0 '1l},ti 5-/— MAILING ADDRESS: L(0 l�14�aj 5f Mail To: TELEPHONE NUMBER: s-0 8 -7 cto f a 1 Board of Health Town of Barnstable CONTACTPERSON: �ul GtooGl P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 1S03- `ill- W 9 Hyannis, MA 02601 TYPEOFBUSINESS: L ,4 2 5,+ to o 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 `-( Oz, v Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) -Metal polishes l �l 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 1 — O YV N OF BARNSTABLE7?/ ��COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANYZ a-E�Mi4OU4 (see"Orders")" 5.Retail Stores �y(� 6.Fuel Suppliers ADDRESS C1855: ot-L 7.Miscellaneous YLI"hcS QU TITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks 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 M`s lla eous:• l �? cant Uwe odePPw b . e .z - Jo�co�- A&. *0/r 9 U ��bl.cc,�� - csl• DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer �Wublic Q On-site OPrivate 3. Indoor Floor Drains YES N0' O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES._NO ORDERS: Q Holding tank: MDC Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person(s) nterviewed Inspector Date