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HomeMy WebLinkAbout0112 MAIN STREET (OST.) - Health (2) 112 MAIN STREET, OSTERVILLE UNIT 12 M 0 p o s [9 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: -;7 /x/ W covaSi2CJ�"/Of✓ Mail To: BUSINESS LOCATION: Board of Health MAILING ADDRESS: �© /3d ?�� ��i��i� �} Town of Barnstable r P.O. Box 534 TELEPHONE NUMBER: 1Z Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER:" �a y20 �ZCOa3S-3c�3S Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, 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: 92F 76o/ 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 / .r Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners SSW Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) _ /04�� Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, '21r's 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 �f Car wash detergents Lye or caustic soda ofW Car waxes and polishes Jewelry cleaners 06AL Asphalt & roofing tar Leather dyes '7S-ILZ&L 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 Ar P TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH Xsatisfactory 2.Printers 3.Auto Body Shops O, unsatisfactory- 4.Manufacturers COMPANII� �� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS L f /11 Class: 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drums "ove Tanks Underground Tan 'IT N OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Ii*xe4rene; Heavy Oils: waste motor oil (C) new motor oil (C) K. 19-3eltvAlf tzeftsminivnfhydraulic Synthetic Organics: degreasers Miscellaneous: d4 6,4 u AO y rz DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.iublic er Supply fzltl O Town Sewer On-site QPrivate 3. Indoor Floor Drains YES N0J� O Holding tank: MDC Q Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES 111NO O ERS: ID Q Holding tank: MDC d- AY Catch basin/Dl O On-site system 5.Waste Transporter ...��Name of Hauler Destination Wa i ste Product YES NO a � - 2. P rson(s) InterAewed Inspector Date