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0443 WEST MAIN STREET - Health
[=E,44-65-West-Main Street-;-Hyannis Clout r u p,y„C•. '1 I I� Date: /�-//a /� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: , '�`- �3T Nlt��,r�ST �y.o-.✓,dl/s INVENTORY MAILING ADDRESS: A� A-earc TOTAL AMOUNT: TELEPHONE NUMBER: J2 3-6/00 V Cpft"AfS AA0 CONTACT PERSON: ,C� WDO'2SWAe--A ` `""1'�✓ /3i 8�' Poet�5 EMERGENCY CONTACT TELEPHONE NUMBER:Waoau/Ae-b/h1YE 17L 2W feo MSDS ON SITE? TYPE OF BUSINESS: I�FC7A/L G-Kok/.VL, SUPPL/L-S fES INFORMATION/RECOMMENDATIONS:('-6R P--C--n\IC Ar"IoLJSo ` Fire District: A440 Pbsr A Ft 0" ti4& 1A 5 UC Q5C ) A-0 b POSi ,4 A/A//J A Coo-nQ(! TP-C M St_>5 91W>&1Z IS. TV (3E U PI)kTE-D W e 7 5 DUt'TS S t c6 5t ©e Pri E Ex-n iSNt� A-PEvP7aDA�; KC, FLoo(Z DR-�1tSS D" AV'A1LA&.6 l=br,SPILLS, I'► D0CTS STDC4D��,JoKI� Waste Transportation:I//A 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 �auT�� nB� Wood preservatives (creosote) �S Caulk/Grout Uk�ouscy�cae- Pouw�s A� 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 strippers, Other C+-�as�u� Other products not listed which you feel Sri"'R, Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) �y p.LyG,vS G� V /Dus �+I�Nt�/yc S Spot removers &cleaning fluids �Nh CC"CAJ7S. (dry cleaners) ;}PE IY AFQ P2oDuCTS; Other cleaning solvents eo _zoo N /o 4,er v.r Ce,tvssa�- Bug and tar removers /"A-9boaj, Windshield wash S� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ! - Town of Barnstable °FTME r Regulatory Services Thomas F. Geiler,Director . • AB Public Health Division 9� ib 9. Argo nea+°' Thom !f as McKean,Director- P� 200 Main Street, Hyannis, MA 0.2601 Office: 508-862-4644 Wayne Miller,M.D. Fax: 508-790-6304 CLOUTIER )UPPLY CO Sumner Kaufman,M.S.P.H. 445 WEST MAIN STREET Paul J.Canniff,D.M.D. -HYANNIS *AA 0260' CLOUTIER $UPPLY CO. NOTICE 445 WEST MAIN STREET HYANNtS. h:A.A BALL BUSINESS OPERATORS WITH HAZARDOUS MATERIALS IN BARNSTABLE The Town oP'Barnstable Town Council ado ted Cha ter 108: Hazardous G p p Materials, a requirement for each business operator to obtain an annual permit and to remit a fee of$100.00 if one-hundred and,eleven (111) gallons or more of Hazardous materials are stored, transported, utilized, and/or disposed of ara articular site Please complete the attached apphc"ation form and submit it along with the required fee of$100.00 to this-office on or before June 30, 2006. A late charge of$10.00 will be assessed if payment is not received by July 1, 2006. Checks should be made payable to the: Town of Barnstable. Upon receipt of the fee and a completed application form, an inspection will be performed by the Hazardous Materials Specialist to complete the Hazardous Materials On-Site Inventory. A permit will be issued once the inspection is completed and has passed. • e h Please feel free to view the above Code; Chapter 108: Hazardous Materials on the Town Website,'www.town.barnstable.ma.us which his located under,the E;CPOd *; :section if you should have any questions or concerns. Q:\Hazmat\Haz Mat Permit Letter.DOC MAPEI® Material Safety Data Sheet (MSDS)-North America Read complete MSDS prior to using product. Product Name: Ultrabond ECOTm 200 Product Description: Performance-Grade Multipurpose Adhesive IN THE EVENT OF A CHEMICAL EMERGENCY INVOLVING A SPILL,LEAK,FIRE,EXPLOSION,EXPOSURE OR ACCIDENT CONTACT THE FOLLOWING NUMBERS: EMERGENCY 24 HOUR NUMBER (USA)CHEMTREC 1-800-424-9300 (Canada)CANUTEC 1-613-996-6666 CONSUMER STATEMENT: CAUTION - EYE IRRITANT. NON-TOXIC. WORK AND HYGIENE PRACTICE: Remove contaminated clothing immediately. Wash hands,after each use and before eating,drinking,or using toiletries. Minimize contact of product on skins. I-GENERAL INFORMATION 11-PHYSICAL CHARACTERISTICS MANUFACTURER: Calculated VOC(See below.) 0 g/L USA and Puerto Rico Canada Boiling Point >212°F(>100°C) MAPEI CORPORATION MAPEI INC. Vapor Pressure(mmHg) 1,0 1144 East Newport Center Drive 2900 Francis-Hughes Avenue Vapor Density(AIR=1) 1,10-1,20 Deerfield Beach,FL 33442 Laval,QC H7L 3J5 Specific Gravity(H2O=1) 1,00-1,30 Ph: (954)246-8888 Ph: (450)662-1212 Melting/Freezing Point(F) N/E MSDS PREPARED BY: Evaporation Rate(Butyl Acetate=1) Same as water. Regulatory Affairs Department-MAPEI North America Solubility in water Soluble REVISION DATE(YYYY/MM/DD): 2005/07/15 pH(paste/liquid) 8,0-10,0 For most current MSDS,download document from: www.mapei.com Appearance and Odor Beige paste. Slight odor of latex. (IOC per CA Soath Coast Air Qnaliry Management District,Rude 1168) III-HAZARD ASSESSMENT Hazardous Components ACGIH(TLV- %Percent (specific chemical identity;common names): OSHA(PEL) TWA) Other Limits Recommended (Optional) THIS PRODUCT CONTAINS NO HAZARDOUS INGREDIENTS AS DEFINED BY US OSHA HAZARD COMMUNICATION STANDARD-29 CFR 1910.1200 OR SECTION 13 OF THE CANADIAN HAZARDOUS PRODUCTS ACT. For California(Proposition 65): This product contains no chemicals reportable under Proposition 65. All ingredients are listed within or exempted from US TSCA and Canadian DSL. (USA)-HMIS(Hazardous Materials Identification System)Rating: Health-1 Fire-0 Reactivity-0 Protection-B "*'=chronic effect (Canada)-WHMIS(Workplace Hazardous Materials Information System)Classifications: Not regulated under WHMIS. IV-TRANSPORTATION By GROUND-USA and Puerto Rico(DOT): By SEA(IMDG): Not Regulated Not Regulated By GROUND-Canada(TDG): By AIR(IATA): Not Regulated Not Regulated V-FIRE AND EXPLOSION HAZARD DATA Flash Point: >212°F(>100°C) Lower Explosive Limit(%) N/E Upper Explosive Limit(%) N/E Unusual Fire and Explosion Hazards- Some decomposition products may be harmful. Extinguishing Media: Will not burn except under extreme temperatures. Water spray,carbon dioxide,dry chemical or foam. Special Fire Fighting Procedures: Wear standard fire fighting gear with self-contained breathing apparatus. ` VI-REACTIVITY DATA Stability:Stable Conditions to Avoid: None known. I English Version on pages 2 and 3. Ultrabond ECOTm 200 Page 2 of 7 Version Frangaise a la pages 4 et 5. Page 2 de 7 La versi6n en Espanol en las paginas 6 y 7. MSDS Paginas 2 de 7 Incompatibility(Materials to Avoid): Strong oxidizing agents,strong acids,and strong bases. Hazard Decomposition of By-products: Carbon monoxide,carbon dioxide,oxides of nitrogen,and other unidentified organic compounds. Polymerization: Will Not Occur Conditions to Avoid: None known. VII-HEALTH HAZARD DATA Routes of entry during normal usage: Inhalation? YES Skin? YES Ingestion? NO Health Hazards: Acute: No effects are suspected under normal professional use. Chronic: None known. Carcinogenicity: NTP-NO IARC- NO OSHA- NO Signs and Symptoms of Overexposure: No effects are suspected under normal professional use. Medical Conditions That Can Be Aggravated by Exposure: Allergies,skin and respiratory disorders. Product sensitivity. Vlll-EMERGENCY AND FIRST AID PROCEDURE Eyes: Flush with cool water for 15 minutes while holding eyelid open. If irritation persists,seek medical attention immediately. Skin: Avoid contact with skin. Remove contaminated clothing. Wash affected area thoroughly with soap and water. If irritation persists,seek immediate medical attention. Inhalation: Remove to fresh air if allowable concentrations of any of the hazardous ingredients are exceeded. If not breathing,trained personnel should initiate artificial respirations and immediate medical attention should be obtained. Ingestion: Do not induce vomiting. Do not give anything by mouth to an unconscious person. Seek medical attention immediately. IX-PRECAUTIONS FOR SAFE HANDLING AND USE Steps to be taken if Material is Leaked or Spilled: Wear protective equipment.Contain by diking with inert absorbent materials and put into an approved waste container. Waste Disposal Method: Dispose in accordance to local environmental regulation. Precautions to be taken during Handling and Storage: Keep container closed when not in use. Store at 60-95°F(15-35°C)and out of the sun. Use adequate ventilation to avoid breathing vapors when cover is removed. Other Precautions: Avoid prolonged skins contact. X-CONTROL MEASURES Respiratory Protection: If workplace exposure limit of product is exceeded,a NIOSH/MSHA approved air supplied respirator is required in absence of proper environmental control. Engineering or administrative controls should be implemented to reduce exposure. Ventilation: Local Exhaust- Use in WELL VENTILATED areas only. Mechanical- Use only intrinsically safe devices. Special- N/A Other- N/A Eye Protection: Safety glasses or goggles as necessary to prevent eye contact. Protective Gloves: Impervious. (Nitrite,rubber,or better) Other Protective Equipment: As needed to minimize contact with skin. N/A="Not Applicable" N/E="Not Established" The information contained herein is based on data considered accurate.However,no warranty is expressed or implied regarding the accuracy of these data or the results to be obtained from the use thereof.MAPEI assumes no responsibility for personal injury or property damage to vendees,users,or third parties caused by the material.Such vendees or users assume all risks associated with the use of the material. English Version on pages 2 and 3. UltrabOnd ECOTm 200 Page 3 of 7 Version Frangaise a la pages 4 et 5. Page 3 de 7 La version en Espahol en las paginas 6 y 7. MSDS Paginas 3 de 7 /'/M1T�ERIALKSWHO 'R �FETY;1 ,,�,511 �1 re nano „f i Z sue%G �2y/ ydi ' �i a ' NQtt/fQ�Look enetratrngeue1 r , ,mla� ts,c�, Osha's Hazard Communication Standard Emergency and First Aid procedures. U.S.Department Of Labor Eyes:In case of contact,immediately Flush eyes with plenty of water for at 29 CFR 1910.1200 OMB No.1218-0072 least 15 minutes.Get medical attention if irritation persists. Identity No: Name:511 Impregnator Skin:Remove contaminated clothing and launder before reuse.Wash with Section i soap and water.Get medical attention if irritation persists. Manufacturers Name: Miracle Sealants Company Ingestion:If swallowed,do not induce vomiting.Get medical attention. Address: 12318 Lower Azusa Road Never give anything by mouth to an unconscious person. Emergency Phone: 800-350-1901 City: Arcadia Inhalation:If inhaled,remove to fresh air.If breathing is difficult,give oxy- State: CA gen.If not breathing,give artificial respiration.Seek medical attention. Phone: 626-443-6433 Section 7-Precautions for Safe Handling and Use Date Prepared: January zoo? Steps to be taken in case material is released or spilled:wipe,scrape or Section z-Hazardous Ingredients/Identity Information soak up in an inert material and put in a container for disposal.Wear proper Hazardous Components CAS# OSHA PEL ACGIH TLV protective equipment.Remove sources of ignition.Increase area ventila- Petroleum Distillate 64741-65-7 iooppm 1501)pm tion. VOC:Less than or equal to 400 g/L Waste disposal method:disposal should be made in accordance with fed- Section 3-Physical/Chemical Characteristics eral,state and local regulations.Incineration recommended in approved Boiling point:355-395°F Specific gravity:o.8o incinerator according to federal,state and local regulations. Vapor pressure(200 C):.5 mm hg Melting point:Not Available Precautions to be taken in handling and storing:use a ground strap.Store Vapor density(Air-1):5.3 Evaporation rate:<o.1 upright in a cool place below 77°F(40°C).Keep container closed when not Solubility in water:Insoluble Density:798 Kg/M3 in use.Avoid breathing vapors.Combustible. Appearance and odor:Clear,colorless,aromatic liquid. Other precautions:KEEP OUT OF REACH OF CH ILDREN.Follow directions on Section 4-Fire And Explosion Hazard Data the container for proper use of this product. Flash Point:125°F(PCC) Flammable limits: Section 8-Control Measures LEL:i UEL:7 pH:Neutral DOT#:Not Available Respiratory protection:Ventilate by opening all doors and windows.If NFPA Hazard rating H F R S(o-Least,4-Extreme):12 0 0 exposure above the TLV or PEL require a NIOSH approved respirator Extinguishing media:Dry chemical,CO2,water fog equipped for the exposure or suitable respiratory protection per Special fire fighting procedures:Combustible,wear bunker gear and NIOSH 29 CFR 1910.134 is required. approved breathing apparatus. Protective gloves:Rubber or plastic,chemical resistant. Unusual fire and explosion hazards:Cool exposed containers with water to Eye protection:Tight fitting,splash proof safety glasses or goggles. prevent rupturing.Heat will cause phosgene gas. Other protective clothing or equipment:Chemical resistant clothing. Section 5-Reactivity Data Work hygienic practices:Wash hands thoroughly before handling food Stability:Stable stuffs,liquids or tobacco products.Use common sense and care around Conditions to avoid:Keep away from sources of ignition such as heat, chemicals.Never mix this product with other chemicals.Consult your super- sparks or open flames. visor for all other hygienic and safety practices.All practices depend on Incompatible materials to avoid:Oxidizing agent. your specific business.Directions for use normally found on label which wilt Hazardous polymerization:Will not occur. dictate engineering and control measures. Hazardous decomposition products:Carbon monoxide,carbon dioxide,sili- cone dioxide,fumes of xylene,aromatic and aliphatic hydrocarbons. Section 9-Shipping&Regulatory Classification Section 6-Health Hazard Data DOT Shipping Name:Please refer to the Bill of Lading receiving/documents Routes of entry: for up-to-date information. Inhalation-Possible DOT Hazard Class: N A Skin-Possible / Ingestion-Possible OSHA Hazard Class: N/A Health hazards-Same as signs and symptoms of exposure UN/NA Number: N/A OSHA carcinogenicity-None;NTP-None;IARC monographs-None EPA Hazard Waste:D ooi,Ignitible Signs and symptoms of overexposure CPSC Classification:Combustible liquid Eyes:Causes severe eye irritation Transportation Class:55 Skin:Causes mild skin irritation,drying of the skin.May cause an allergic Toxic Substances Control Act(TSCA):This product and/or all the skin reaction. ingredients contained in this product have been registered under the Ingestion:Harmful if swallowed.Causes vomiting,nausea and diarrhea. Toxic Substances Control Act. Inhalation:Excessive inhalation causes headache,dizziness,nausea and in- coordination.Harmful if inhaled. SARA:No SARA 313 chemicals identified. Medical conditions aggravated:Respiratory,pulmonary,liver and kidney NOTE:Miracle Sealants believes the data set forth are accurate.Miracle disorders.Central nervous systems disorders.Gastrointestinal disorders. Sealants makes no warranty with res ects thereto and disclaims all liability or reliance thereon.Such data are offered solely for consideration,investi- gation and verification.Also,the data set forth is for the concentrated fin- ished product.All lab samples are for experimental purposes only and used at the customers discretion. Warranty Caution Instructions are a condensed guide and should not be considered com- 5u Impregnator contains combustible petroleum distillates.All solvents ptete.In the event of failure,the only obligation of Miracle Sealants must be considered toxic and must be used in a well ventilated area.Good Company shall be to replace such products proven to be defective.Before ventilation means that fresh air is flowing in such a way as to feel a slight using,user shall determine the suitability of the product for their intended breeze.Open windows and use fans to circulate air.Continue to ventilate use.User assumes all risks and liability whatsoever in connection therein. until vapors are eliminated.Exposure to high vapor concentration must be Neither seller nor manufacturer shall be liable for any injury or inability to avoided.Inhaling the vapors can be harmful.Keep away from heat and use this product. open flames.Avoid prolonged contact with skin.Chemical resistant gloves should be worn at al times.Keep small children and pets out of the area until product or surface has thoroughly dried.Refer to the MSDS for addi- tional information. MATERIAL SAFETY DATA SHEET WMIRACLE ealants Company MiraClean #1 S www.miractesealants.com Osha's Hazard Communication Standard Emergency and First Aid Procedures: US.Department Of labor Eyes:Flush with water for 15 minutes.If irritation persists,call a physician. 29 CFR 1910.1200 OMB No.1218-0072 Identity No:L0323012 Name:Mira Clean#i Skin:Wash off with soap and water. Section i Ingestion:Do not induce vomiting.Call physician or Poison Control Center Manufacturers Name: Miracle Sealants Company immediately. Address: 12318 Lower Azusa Road Inhalation:Remove to fresh air. Emergency Phone: 800-350.1901 Section 7-Precautions For Safe Handling And Use City: Arcadia Steps to be taken in case material is released or spilled:Soak up with State: CA inert,absorbent material.Scoop up and place in a proper waste disposal Phone: 626-443-6433 container. Date Prepared: January zoo? Section s-Hazardous Ingredient/Identity Information Waste disposal method:Dispose of in accordance with federal,state and local regulations. Hazardous Components:None VOC:4%by weight before dilution Precautions to be taken in handling and storing:Store in a cool,dry place, Note:Non-carcinogenic out of direct sunlight.Do not freeze less than or equal to 32°F or heat Section 3-Physical/Chemical Characteristics above uo°F. Boiling point:>ziz°F Specific gravity:1.020 Other precautions:KEEP OUT OF REACH OF CHILDREN.Fallow directions on Vapor pressure:Not tested Melting point:Not tested the container for proper use of this product. Vapor density:Not tested Evaporation rate:Not tested Section 8-Control Measures Solubility in water:i00% Respiratory protection:Ventilate by opening all doors and windows. Appearance and odor:Brown,color liquid with floral fragrance. Ventilation: Section 4-Fire And Explosion Hazard Data Local exhaust-If available Special-None Flash Point:Not Available Flammable Limits:Not tested Mechanical-If available Other-None LEL:Not tested UEL:Not tested Protective gloves:Plastic or rubber,chemical resistant. pH:7—8 Eye protection:Tight fitting,splash proof safety glasses. NFPA hazard rating (o=Least,4=Extreme) Other protective clothing or equipment:None. Health:1 Fire:o Work hygienic practices:Wash hands thoroughly before handling food Reactivity:o Other:o stuffs,liquids or tobacco products.Use common sense and care around HMIS Hazard Rating: chemicals.Never mix this product with other chemicals.Consult your super- visor for all other hygienic and safety practices.All practices depend on Health:t Fire:o your specific business.Directions for use normally found on label which will Reactivity:o dictate engineering and control measures. Extinguishing media:CO2,dry foam Section g-Shipping&Regulatory Classification Special fire fighting procedures:None DOT Shipping Name:Please refer to the Bill of Lading receiving/documents documents Unusual fire and explosion hazards:None pp g g g/ for up-to-date information. Section 5-Reactivity Data Stability:Stable DOT#:Not Available DOT Hazard Class:Not Available Conditions to avoid:None Toxic Substances Control Act(TSCA):This product and/or all the ingredi- Incompatible materials to avoid:Strong oxidizers ents contained in this product have been registered under the Toxic Hazardous decomposition or byproducts:CO,CO2 Substances Control Act. Hazardous polymerization:Will not occur SARA:No SARA 313 chemicals identified. Section 6-Health Hazard Data NOTE:Miracle Sealants believes the data set forth are accurate.Miracle Routes of Entry: Sealants makes no warranty with respects thereto and disclaims all liability Eyes-Possible or reliance thereon.Such data are offered solely for consideration,investi- Inhalation-Possible gation and verification.Also,the data set forth is for the concentrated fin- Skin-Possible ished product.All lab samples are for experimental purposes only and used Ingestion-Possible at the customers discretion. Health Hazards-Same as signs and symptoms of exposure. Carcinogenicity: OSHA:None NTP:None IARC Monographs:None Note:All chemicals incorporated into this product are found on the TSCA inventory list. Signs and Symptoms of Over Exposure: Eyes:Burning sensation Skin:Slight irritation Ingestion:Nausea Inhalation:Not expected to be a problem Medical conditions generally aggravated by exposure-None known. s LLLU Osha's Hazard Communication Standard US Dept of Labor Ventilation: Identity No: Name:511 Seal&Enhance Local exhaust-if available Special-none Section i Mechanical-if available Other-None Manufacturers Name: Miracle Sealants Company Protective gloves:Plastic or rubber,chemical resistant Address: 12318 Lower Azusa Road Eye Protection:Tight fitting,splash,proof safety goggles. Emergency Phone: 800-350-1901 Other protective clothing or equipment:chemical resistant clothing. City: Arcadia Work hygienic practices:wash hands thoroughly before handling food stuffs, State: CA liquids or tobacco products.Use common sense and care around chemicals. Phone: 626.443-6433 Never mix this product with other chemicals.Consult your supervisor for all Date Prepared: January zoo7 other hygienic and safety practices.All practices depend on your specific busi- Section s-Hazardous Ingredient/Identity Information ness.Directions for use normally found on label which will dictate engineering Hazardous Components CAS# OSHA PEL ACGIH TWA and control measures. Solvent Naphtha(Petroleum) 64742.88.7 500 ppm 100 ppm Section 9-Shipping Medium Aliphatic U.S.Department of Transportation Classification(49CFR) Section 3-Physical/Chemical Characteristics ID#U N1993 Proper Shipping Name PETROLEUM DISTILLATES,N.O.S. Boiling Point:Appx N2000 C Specific gravity(H20=1) 1.25 Class/Division 3 Vapor pressure:Not Determined Melting point:Not Determined Packing group III Vapor density(air=i):Heavier than air Evaporation rate(Butyl):61 Marine Pollutant:No Solubility in water:None Transportation Class:55 Appearance and odor:Clear,Colorless to amber Liquid. IMDG VOLATILE BY VOLUME:6 60-70% ID#U N1268 VOC CONTENT:690 g/L Proper Shipping Name:PETROLEUM DISTILLATES,N.O.S. Section 4-Fire and Explosion Hazard Data Class/Division 3 Packing group III Flash point:1450 F Method:Pensky-Martens IATA(Country variations may apply) Flammable limits:Not tested closed cup ASTM D 93 Section io-Regulatory Information: -- LEL:not tested UEL:Not tested Toxic Substances Control Act(fSCA):This product and/or all the ingredients pH:Not Applicable DOT#:UN 1268 contained in this product have been registered under the Toxic Substances NFPA hazard rating-HFRS(o-Least,4-Extrerne):2 Control Ad. HMIS hazard rating-HFR(o-Least,4-Extreme):2 SARA:No SARA 313 chemicals identified. Extinguish media:Foam,water spray or fog.Dry chemical powder,CO2,sand or Section 3os-Extremely Hazardous Substances earth may be used for small fires only.Do not discharge extinguishing waters Substances- into the aquatic environment. None. Special fire fighting procedures:wear full protective clothing and self-contained Section 394-CERCLA Hazardous Substances: breathing apparatus. Cas# Appx.Wt.% Component name Unusual fire and explosion hazards:none 1330-20.7 4.5 Xylene Section 5-Reactivity Data 100-41-4 1.3 Ethylbenzene Stability:Conditions to avoid:extreme heat and open flames 108-88-3 Trace TolueneSection 312-Hazard Class: Hazardous Combustion products: Burning can produce the following combustion products: Acute:Yes Chronic:Yes Fire:Yes Oxides of carbon Oxides of nitrogen Pressure:No Reactive:No Oxides of silicone Traces of Hydrogen Fluoride Section 3a3-Toxic Chemicals: Carbon monoxide is highly toxic if inhaled;carbon dioxide is sufficient concen- Cas# Appx.Wt.% Component name trations can act as a asphyxiant.Acute overexposure to the products of combus- 1330-20-7 4.5 Xylene tion may result in irritation of the respiratory tract. 100-41-4 1.3 Ethylbenzene Section 6-Health Hazard Data Supplemental State Compliance Information Harmful or fatal if swallowed California: Causes eye and skin irritation Warning:This product contains the following chemical(s)listed by Harmful if swallowed the state of California under the Safe Drinking Water and Toxic Enforcement Act Harmful if inhaled of 1986(Proposition 65)as being known to cause cancer,birth defects or other Harmful if absorbed through skin reproductive harm. Aspiration may cause lung damage Cas# Appx.Wt.% Component name May cause allergic skin reaction 1o8-88-3 Trace Toluene May cause dizziness and drowsiness Massachusetts: May cause liver and kidney disorders Cas# Appx.Wt.% Component name Medical conditions generally aggravated by exposure-same as signs and 1330.20.7 4.5 Xylene symptoms of over exposure. 100-41-4 1.3 Ethylbenzene Emergency and First Aid Procedures: New Jersey: Eyes:Flush with water for 15 minutes.If irritation persists call a physician. Cas# Appx Wt.% Component name Skin:wash off with soap and clean water for 15 minutes.If irritation persists call 1330-20-7 4.5 Xylene a physician. 100.41-4 1.3 Ethylbenzene Ingestion:Drink large amounts of water.Call Physician 68988-56-7 4-8 Trimethylated silica Inhalation:Remove person to fresh air.If not breathing,administer artificial res- 3555-47.3 Trace Tetra(trimethoxysitoxy)silane piration including oxygen.Provide medical attention. Pennsylvania: Section 7-Precautions for safe handUng and use Cas# Appx.Wt.% Component name Steps to be taken in case material is released or spilled:soak up with inert 68988-56-7 4.8 Trimethylated silica absorbent material. 1330-20-7 4.5 Xylene Scoop up and place in a proper waste disposal container. EPA Hazard Waste:Not Available Waste disposal method:Dispose of in accordance with state and local NOTE:Miracle Sealants believes the data set forth are accurate.Miracle regulations. Sealants makes no warranty with respects thereto and disclaims all Precautions to be taken in handling and storing:store in a cool,dry place,out of liability or reliance thereon.Such data are offered solely for consideration, direct sunlight. investigation and verification.Also,the data set forth is for the concentrated Do not freeze less than or equal to 321 F or heat above 1io°F. finished product.All lab samples are for experimental purposes only and Other precautions:KEEP OUT OF REACH OF CHILDREN.Follow directions on the used at the customers discretion. container for proper use of this product. Section 8-Control Measures Respiratory protection:Ventilate by opening all doors and windows.If exposure above the TLV or PEL require a NIOSH approved respirator equipped for the exposure or suitable respiratory protection per 29 CFR 1910.134 is required. s ate: TOWN OF BARNSTABLE G�( TOXIC AND HAZARDOUS MATERIALS ON-SIT INVENTORY NAME OF BUSINESS: r BUSINESS LOCATION: INVENTORY MAILING ADDRESS: rt '' TOTAL AMOUNT: TELEPHONE NUMBER: 5V9-7 5 1120 A, dlt" CONTACT PERSON: (Jh hr) Ci i/P EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: �' �� Fire istrict: ��S b, nkf - Lb t1 ' % , 0 nbtM P - Waste Transportation: �� 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 I 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 (including bleach) GLPsi kV2 Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �Y �V Town of Barnstable �FTHE tp� Regulatory Services P� ti Thomas F. Geiler,Director Public Health Division * BARNSTABLE, * Thomas McKean,Director 63. ' 200 Main Street, Hyannis,MA 02601 ArFD AAA A Phone: 508-862-4644 Email: health@town.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 March 6,2007 Mr.John Civetti Cloutier Supply Co. 445 W.Main Street Hyannis,MA 02601 Dear Mr. Civetti: - Thank you for your time and cooperation during the hazardous materials inventory and site visit at Cloutier Supply Co. on March 5,2007. This letter contains information from that visit that will help you become compliant and remain compliant with the Town of Barnstable Code Chapter 108:Hazardous Materials. Enclosed you will find copies of the Toxic and Hazardous Materials On-Site Inventory form from the visit, the Chapter 108:Hazardous Materials Code,and information on fiiel tanks. Please note the observations identified at your place of business during the hazardous materials inspection listed below: OBSERVATIONS: • Facility is clean and organized • Most products carried are water based and environmentally friendly,with the quantities on hand,it is necessary to inventory the products at a total. • Hazardous Materials Permit for 2006-2007 has been obtained • Fuel tank in basement is in great condition,please inspect the tank frequently to avoid a release On Site Inventory Total The Toxic and Hazardous Materials On-Site Inventory from March 5,2007 shows that you have approximately 503 gallons of toxic and hazardous materials being used, stored, generated and disposed of at 445 West Main St.,Hyannis,MA(Please see enclosed Toxic and Hazardous Materials On Site Inventory sheet). If you have any questions about these problems,the orders and recommendations,or you need further information, guidance or assistance,please do not hesitate to contact the Public Health Division. AeelyL.Uer Hazardous Materials Specialist Enc. On-Site Inventory(copy) Chapter 108(copy) Fuel tank information Town of Barnstable Ali / Regulatory Services �© S o ;;,;<t , 0: iST�tBLE ZD s Thomas F. Geiler,Directo � 9 139B`�g Public Health Dii� g P i 35 HIED MA'S IN Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 DIVISION Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE ,5A110 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER c< `�� SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: . l PRESIDENT /}iif6�y'% ��L l� /S f fm),)vI JW U(�/�i6u�1�6 jw 0 7� TREASURER CLERK w S GNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# Haz.doc/wp/q copy; Date: S—t 1--o_-{ (Y' TOXIC AND HAZARDOUS MATERIAL ON-SITE IN NTORY NAMEOFBUSINESS: eell .St6V0404 BUSINESS LOCATION: q/ W. I-Am MAILING ADDRESS: '' 4- INVENTORY TOTAL AMOUNT: TELEPHONE NUMBER: 5703— -7'75-— 0/00 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMB R: FIRE p(57vICT TYPEOFBUSINESS: C-er ct,fyr2e: v OTHER INFORMATION: IJ M 506 or) .:5;rf_" 9C%G Waste Transportation: 'Name of Hauler: AJIA Destination.- Waste Product: Licensed? Yes No 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline orcoolantsystems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes o)*75 2eoad Salt (Halite)/!�r_�/l! - Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesq!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 waxes and polishes(��O Leather dyes Asphalt& roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's .5— Lacquers sea-Ae-- Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride)- Paint&varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners:E%g Floor.&furniture strippers (including chloroform,formaldehyde, Metal polishes � hydrochloric acid, other acids) Laundry soil &stain removers Other products not listed which you feel (including bleach) may be-toxic or.hazardous (please list): Spot removers & cleaning fluids Misc.: c. /_?S ate. (dry cleaners) 3 !�O Other cleaning solvents - a Bug and tar removers 5 7. Hazardous Materials On-Site Inventory/Inspection For ALL Shops and Businesses: Location: `/mil 5 �I�n Date: Physical Features to Inspect: 1. Hazardous waste generation sites (production/manufacturing areas): odA 2. Waste storage areas: n ��A 3. Satellite accumulation points throughout: 4. HazMat stored outdoors — CHECK OUTSIDE: Ada 5. Shipping and receiving areas: IV 6. Run down of shop activities: Ak J A 7. Housekeeping practices: e HazMat On-Site Inventory/Inspection: Records to Review for SQGs and CESQGs D BA: Location: Site visit date: • Hazardous Waste Manifests: WJ A • Employee training documentation (if required): • Hazardous substance spill control and contingency plan: • MSDS on site? • HazMat Inventory records (if applicable): JAC • HazMat Waste Shipping documentation: MIA • Spill records (if applicable): Iy A s Town of Barnstable-Health Department Page 1 HAZARDOUS MATERIALS INVENTORY SITE VISITS DBA: Cloutier Supply Co. Fax: Corp Name: Mailing Address Location: .445 West Main Street,Hyannis Street: 445 West Main Street mappar: City: Hyannis Contact: My-Lee Cloutier State: Ma Telephone: (508)775-6100 Zip: 02601 Emergency: `;same Person Interviewed: Business Contact Letter Date: __..- ...... .. . _._ ..... Category: Retail Store Inventory Site Visit Date: .......... ... ._....._ ......... Type: Follow Up/Inspection Date: ❑� public water ❑ indoor floor drains outdoor surface drains ❑ license required ❑ private water ❑ indoor holding tank mdc ❑ outdoor holding tank mdc ❑ currently licensed W town sewage ❑ indoor catch basin/drywell outdoor catch basin/drywell expir -- -- - - - ❑ on-site sewage ❑ indoor on-site syste ❑ outdoor onsite system date: Orders:3/25/97 MSDS sheets on site. compliance: REMARKS: 1999-Have MSDS sheets on site. Satisfactory 1 A S-71 5 c . -7s 9 5 at, / -7 2� . Page 2 Town of Barnstable-Health Department HAZARDOUS MATERIALS INVENTORY Chemicals: ❑ Zero Toxic Waste Materials ❑ gty's>25 Ibs dry or 50 gals liquid but less than 111 gals ❑d gty's 111 gals or more description:= gty: unit'of measure Adhesives 15 units ___._.......................__..........__... .... .._. .. ... - _.._...._.......... ........... _...._.. other cleaning solvents 11!units degreasers for driveways and garages 7lgallons floor waxes and polishes ! 6 gallons -___._.._.._._............_._.___..._ _......_..___......_..._..__._.._..........................._............._..._._...._......._._........___.............._.........._..;_..._..._....._......__......_......___.....__..._............,..._. Adhesives I 5cases other cleaning solvents 2cases _ _ ......................_....__..___-----.------ . floor waxes and polishes 1 4 cases Adhesives . .... .........._..._......_........._._.------ Adhesives 13.quarts _...__. ......... Waste Transporter: Fire District: Last HW Shipment Date: Waste Hauler Licensed: No ALA, Date: 5-4/•-o`f ARD MATERIALS TOXIC AND HAZARDOUS MATER S ON-SITE INVENTORY NAMEOFBUSINESS: &u,*i e-q-) BUSINESS LOCATION: ku a�Ir s INVENTORY MAILINGADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: SUS- -7 7 - a/'0 Z) CONTACT PERSON: a a of f�, 5-L($ oo,�, EMERGENCY CONTACT TELEPHONE NUMBER: TYPEOFBUSINESS: �-e� vv � I=��E U157�ICT' OTHER INFORMATION: r`�''` LI'Ce4-1 S-4e_ CL, S,a \5 0,5 orJ .5ife c �S 'TL �' , Waste Transportation: Name of Hauler: AJ IA Destination: - Waste Product: Licensed? Yes No 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. . NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Observed (gallons): Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes O"75a oad Salt (Halite)/_7—ce— Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Piesel 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 waxes and polishes<�tO-� Leather dyes 4 Asphalt& roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's q ', Lacquer.thtmwssir 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.&fumiture strippers etal polishes hydrochloric acid, other acids) M Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids Misc.: c. P . /_?576,�,Zt. (dry cleaners)'� � ���• ate[ Other cleaning solvents a Bug and tar removers G 5-? Date: "TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: CL1)1.rr1reSoPPLy ro BUSINESS LOCATION: 41 _ �0 MAILINGADDRESS: Mail To: s - Board of Health TELEPHONE NUMBER: /(� CONTACT PERSON: Town of Barnstable Y 2-E d77��� arn P.O. Box 534 am EMERGENCY CONTACT TELEPHONE NUMBER _/0E �7��1d Hyannis, MA 02601 TYPEOFBUSINESS: aoee r6um aj Does your firm store a 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 e&�� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair - BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops //�.7� 0 unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS y SLd .'lass: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums IN OUT IN OUT IN OUT #&gallons 177 Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic S th is ga degre er bL to d j,,,l v� QG 2 6 Misce7laneous: u/ a)7�0� y l / DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply XTown Sewer OPublic 0 On-site OPrivate 3. Indoor Floor Drains YES NO.y 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES-NO ORDERS: 01 Holding tank: MDC Catch basin/Dry well 0 On-site system 5.Waste Transporter DestinationName of Hauler YES NO 1. 2. x r ' � erson (s) Interviewed Inspector Date TOWN OF BARNSTABLE CoMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH X Satisfactory 2.Printers 3.Auto Body Shops �'2 O unsatisfactory- 4.Manufacturers COMPANY Q(,f . ` �1 C� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /n. Class: 7.Miscellaneous TITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MA RIALSDrT IN OUT IN OUT IN OUT #&gallons Age Test � � 3 F�ls: ts2 Gasoline,Jej Fuel (A) C,14P 4 &71,-he, ,-R � [ per,#2 (B) !i Heavy Oils: waste motor oil (C) new motor oil (C. transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: ff e /ev 57 �n DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES NO {/ O Holding tank:MDC O Catch basin/Dry well O On-site system ry 4. Outdoor Surface drains:YESJNO O RS: -,A— :-Yw O Holding tank:MDC xn Catch basin/Dry well On-site system 5.Waste Transporter YES NO 1. All �o 2. Person(s) Interviewed In bector 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 COMPANY z SmeLw (see"Orders") 5.Retail Stores t 6.Fuel Suppliers ADDRESS lL - I �� Class: � 7.Miscellaneous i QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MANOR MATERIALS EMMM 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:T-f Er r COT Twe Yob ►ve �a a h _ < /oo S I l u U►"t- ROOF C&j:)PePS . yO 2AI 5S VF 8 - 'l � i KYS j A rKrg i v b I. rzoph -r N . - v DISPOSAL/RECLAMATION REMARKS: 1 S itary Sewage 2.Water Supply 1 O ) Town Sewer Public . O On-site OPrivate 3. Indoor Floor Drains YES NO,, —( �O � O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0 ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter YES i NO 1. 2. 71 Pe o (s) Interviewed Inspector �- Da e