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HomeMy WebLinkAbout672-680 MAIN STREET (HYANNIS) - Health 672-680 MAIN STRE y D ro I Date: 1 l O /0 -> AU \1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: LA InY1(ZTtf 101J I J rMp ✓q-L_ BUSINESS LOCATION: 6 *7 )- MINI ..r "7 MAILINGADDRESS: it Mail To: TELEPHONE NUMBER: .SO 8 771 /(,/ 3 Board of Health CONTACT PERSON: Jv C 14V&14�'S Town of Barnstable P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: y ��� a 77G Hyannis, MA 02601 TYPEOFBUSINESS: 1�41X _PA L,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 otherthan your mailing address: � m 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) Q 01- Drain cleaners NEW USED O Cesspool cleaners V Automatic transmission fluid O-r Disinfectants O Engine and radiator flushes ® Road Salt (Halite) C9 Hydraulic fluid (including brake fluid) d Refrigerants d Motor oils 4 Pesticides NEW USED (insecticides, herbicides, rodenticides) ® Gasoline, Jet Fuel Photochemicals (Fixers) el 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 0 Degreasers for driveways & garages d Wood preservatives (creosote) U 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 O Fertilizers aS O Z Paints, varnishes, stains, dyes PCB's QT_ Lacquer thinners a Other chlorinated hydrocarbons, NEW USED� (inc. carbon tetrachloride) Paint & varnish removers, deglossers e7 Any other products with "poison" labels 0 Paint brush cleaners (including chloroform, formaldehyde, 4 Floor & furniture strippers hydrochloric acid, other acids) O Metal polishes 644 Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Sot removers & cleaning 9 fluids NA/g e010 e. (dry cleaners) _SS7>Z�FI�HT�`� f f 0? .Y®z UT)vsv-7' 7 ® Other cleaning solvents Ace unS. 4 Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �Tfi'M4 ( Date: 1 o s TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: LA M r4(ZV Lo,-J 1,J naiv 4-L BUSINESS LOCATION: 71- onvd ,I' MAILINGADDRESS: �� �i Mail To: TELEPHONE NUMBER: -70 8 77/ /6/ 3 Board of Health v�L Town of Barnstable CONTACT PERSON: J NUG1�L-'S t P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 7 71/ 72.1 a -7 7 G Hyannis, MA 02601 TYPE OF BUSINESS: 1�41(Z .SA 1_0"/ Does your firm store any of the toxic or hazardous materials listed below,either for sale or for you own use? YES G✓ 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 otherthan your mailing address: SW11 . 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 0 Antifreeze(for gasoline or coolant systems) -1 dr Drain cleaners NEW USED O Cesspool cleaners l? Automatic transmission fluid d�' Disinfectants O ... Engine and radiator flushes 0 Road Salt (Halite) D Hydraulic fluid (including brake fluid)' _ C.._ =Refrigerants- d Motor oils ® Pesticides ~ NEW USED (insecticides, herbicides, rodenticides) 0 Gasoline, Jet Fuel C9 Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer)~ a lubricants, gear oil NEW USED Degreasers for engines and metal © Printing ink w D Degreasers for driveways & garages � Wood preservatives (creosote) 0 Battery acid (electrolyte) d Swimming pool chlorine O Rustproofers Lye or caustic soda 0 Car wash detergents ' `� Jewelry cleaners 0 Car waxes and polishes 0 Leather dyes 4 Asphalt & roofing tar CO Fertilizers dS D Z Paints, varnishes, stains, dyes © PCB's a OT Lacquer thinners O Other chlorinated hydrocarbons, _- ��`� ✓ NEW U �, SED - . . _ . :.. _ (inc. carbon tetrachloride_ ) Paint & varnish removers, deglossers r Any other products with "poison" labels 4 Paint brush cleaners (including chloroform, formaldehyde, D Floor& furniture strippers 0 Metal polishes hydrochloric acid, other acids) GA I- Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Ag tZ co o ct e7 (dry cleaners) _S A/G yfi'� / (�E GZ� So L LT)yAi r 7 Other cleaning solvents O Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS