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Home My WebLink About0592 MAIN STREET (HYANNIS) - Health 592 MAINS ., Unit 4, _y_annis Sty' i De_sig 1 i7 I 1 0 0 YOU WISH TO OPEN A BUSINESS? A . sa For Your Information.: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the 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" Ff., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE. � t Fill in please: 1^ APPLICANT'S YOUR NAME: K0 L4VG - Ew BUSINESS YOUR HOME ADDRESS: a - n ALL TELEPHONE # Home Telephone Number: O 2 NAME OF NEW BUSINESS, — 10 k40 VA44YPE OF BUSINESS 0? IS THIS A HOME OCCUPATION? NO Have you been given appro>al from the building division? YES NO ADDRESS OF BUSINESS ._ 2 441dLkj i* MAP/PARCEL NUMBER 001 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 individual as been ' ed of the p"e it it Pments that pertain to this type of business. MUSTCOMpL1/H►(TH C� HAZARDOUS MATERIALS REG TIOntS ALL Authorized Sign re** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 1 �/ ]� / TOWN OF BARNSTABLE Date: ID TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: �� 0L 1,4 ykq BUSINESS LOCATION: 5-1 �' ��/NVENTORY MAILING ADDRESS: Lt TAL AMOUNT- TELEPHONE NUMBER: — 2 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBBExR: ��` �� MSDS ON SITE? TYPE OF BUSINESS: V I C ts INFORMATION/RECOMMENDATIONS: Fire District: 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 VIA, 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 1 (( Road Salts (Halite) Hydraulic fluid (including brake fluid) 10 7Refrigerants 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 (including bleach) I Spot removers &cleaning fluids (dry cleaners) Otherlcleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS I $ �prhtJl a 1 Arad✓` f" �'`Date: _V TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: y��S �W BUSINESS LOCATION: 547c� Irmlh/ je- do nneebo'I U h 1t MAILINGADDRESS: Nejd,� _ Mail To: TELEPHONE NUMBER: -3 d'ST' Board of Health c Town of Barnstable CONTACTPERSON: e-rr < <vioS , _ P.O. Box 534 EMERGENCY CONTACT TELEPHON NUMBER: 7S'-/�l Hyannis, MA 02601 TYPEOFBUSINESS: �1RTZN Does your firm store any of the to r 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: 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 Rustpro,ofers 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 Paint brush cleaners Any other products with "poison" labels (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 �&XW (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS "k - New q_1 4T`l.-Jv Date: AJ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM -NAME OF BUSINESS: T��SZ!�w BUSINESS LOCATION: 5'%� / NIV .�4- c?v nnee- 0n U h 1t j lG 6+ MAILINGADDRESS: 4T�4' Mail To: T�TELEPHONE NUMBER: Board of Health �'7�1-3�S Town of Barnstable CONTACTPERSON: ..r.krrY Ill l (oloS! P.O. Box 534 EMERGENCY CONTACT TELEPHON FNUMBER: -77S_1401 Hyannis, MA 02601 TYPE OF BUSINESS: Does your firm store any of the toxic r hazardous materials listed below, either for sale or for you own use? YES NO t 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 registeredxregardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity r 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) I f. 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, d glossers 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 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 O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores ® 6.Fuel Suppliers ADDRESS f fK lass: 7•Miscellaneous gqEk]RaI (J QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR ALS ,• - 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: tcj DISPOSAL[RECLAMATION REMARKS: , 1. S nitary Sewage 2. ter Supply G�n� Town Sewer 1Nublic `� tvi 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,,X',-NO ORDERS: !Z�Jlolding tank: MDC atch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler . 1 � YES NO 1. 2. Person (s) Intervie Inspector Date