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HomeMy WebLinkAbout1445 OST.-W.BARN. RD - Health F"1445 Ost-WT Marstons Mills / ` 126-061 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �1��� . �F'S YC,J-I'1., V dLXAC`n Mail To: BUSINESS LOCATION: l 4'l 5' Oe, Q�Ae fin!-G5+ Dnfxnl;- tm j Board of Health MAILING ADDRESS: '507 M (Jr Town of Barnstable Imo,P.O. Box 534 TELEPHONE NUMBER: q 2-©— -z_.J q 3 Hyannis, MA 02601 CONTACT PERSON: k ti 4-c-\- A. ltlut-e 4,,c a\, EMERGENCY CONTACT TELEPHONE NUMBER: q2-0 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities t tal 'ng, 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: 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 '"tom— Cesspool cleaners _ Hydraulic fluid (including brake fluid) Disinfectants lV / Motor oils/waste oils / Road Salt (Halite) Gasoline, Jet fuel A//A Refrigerants Diesel fuel, kerosene, #2 heating oil IUI Pesticides (insecticides, herbicides, w®-40 rep 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 ✓J Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes N Jewelry cleaners fn � Asphalt & roofing tar Leather dyes 9! Paints, varnishes, stains, dyes /VA_ Fertilizers (if stored outdoors) Paint & lacquer thinners R-14— PCB's Paint & varnish removers, deglossers A/W_ Other chlorinated hydrocarbons, u Paint brush cleaners nr (inc. carbon tetrachloride) Floor & furniture strippers /U Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, —t_, C(0bcLaundry soil & stain removers __ rr hydrochloric acid, other acids) (including bleach) ✓U Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) N 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 r unsatisfactory- 4.Manufacturers YCOMPAN (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 1 - Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Drums Above Tanks Underground,T4nks 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: 4&AAP 1 4e ,y DISPOSAL/RECLAMATION REMARKS: ��� 1. Sanitary Sewage 2.Water Supply �1® 019'_4 � �A<2 Z.Z6_7� O Town Sewer Public On-site ()Private 3. Indoor Floor Drains YES N0� O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: () Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1. �y l 2. Persons nterviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair v BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 1 ,, �ft"47V (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS d > i- `Rd Class: 7.Miscellaneous 4911w UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 1pf�q-j—e r-, `'�' °'` � � 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: DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply - t O Town Sewer Public X(On-site OPrivate 3. Indoor Floor Drains YES N0J O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO / O ERS: O Holding tank:MDC S�� o cr O Catch basin/Dry well , O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO � 1. 01 2. �- �c. Person (s) In(Oviewed ` Inspector Date