HomeMy WebLinkAbout0358 WEST MAIN STREET - Health 358 West MBin'Street, Hyannis p
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TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
A1�' QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MA IALSUnderground 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
Miscellaneous:
DISPOSALIR.ECI.AMATION REMARKS:
1. nitary Sewage later Supply PCB R6,-(A L�bdw, A
Town Sewer Public r �'
1 On-site OPrivate � 1
)E ::Z-
3. Indoor Floor Drains YES NO,
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO
O Holding tank:MDC
O Catch basin/Dry well blval (612):Ml— Ra
O On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
4ate
2. Person (s) Interviewed Inspect r`
TOXIC AND HAZARD US 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:
EMERGENCYCONTA TELEPHONE NUMBER: 7 7
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totallin t 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 D 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
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
0 unsatisfactory- 4.Manufacturers
E
COMPANY Sp (see"Orders") 5.Retail Stores
,� � 6.Fuel Suppliers
ADDRESS �� �' �� Class: 7 7.Miscellaneous
0-tl&0 QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots 1 .,�iUnderground 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
Miscellaneous: S� y
s
s
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply '( 44
Town Sewer Ofublic u,(.x S' Q
0 On-site OPrivate / „
U l �
3. Indoor Floor Drains YES NO C
0 Holding tank:MDC
O Catch basin/Dry well S '
0 On-site system
4. Outdoor Surface drains:YES-X-NO RS:
0 Holding tank:MDC
Catch basin/Dry well
0 On-site system
5.Waste Transporter
Name of Hauler1 • '
YES NO
1.
2
`' II
son (s) Interviewed Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANYf"' a ./-�SY"� Zd�� (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS IM11V Class: 7.Miscellaneous
#,)' � L 's QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS
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:
r.4�rf
DISPOSAIIR.ECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
Town Sewer 'o ublic
O On-site OPrivate
3.Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORD RS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5. Waste Transporter
mom
7
YES NO
1. . Of
2.
7C 2-25r,q:7
Person (s) Interview d Inspector Date
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair
BOARD OF HEALTH O satisfactory 3. Printers to Body Shops
unsatisfactory- 4.Manufacturers
COMPANY TEgatAt O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS L.0 ��� �. . t�:lass: 7.Miscellaneous
QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drurns 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:
9s.I X
�} S
c.lS � s x
x
DISPOSAL RE(;LAMATION REMARKS: i C ,*
1. Sanitary Sewage 2.Water Supply
"Town Sewer 3OPublic p�_O\c
O On-site OPrivate
S-kc,(Q (1
3. Indoor Floor Drains YES NQk _ -�S
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NOZ ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Licensed?Name of Hauler Destination Waste Product
YES I NO
1.
2.
�. 6k
on (0 1n erview Inspector to