HomeMy WebLinkAbout0032 LEONARD ROAD - Health 32Leonard oa est Barnstable
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: ��®�° � 5 / /J,G�xr`- is��� Mail To:
BUSINESS LOCATION:
� � -,b �--' Board of Health
��? � � LP,' Jet' ®��/�-Town of Barnstable
MAILING ADDRESS:
-� P.O. Box 534
TELEPHONE NUMBER: � � 1' Hyannis, MA 02601
CONTACT PERSON: 40,&-g" .r
EMERGENCY CONTACT TELEPHONE NUMBER: OV-1-Ve. -
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in qu tities 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 ab ve, please indicate if the materials are stored at a site other than your
mailing address: CA IIt� K/����i® �24�7
ADDRESS:
TELEPHONE: . ,ZZI' `
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
Ilia a— 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 Pesticides (insecticides, herbicides,
•�` "
Ot oPrA Q Iucts: grease, lubricants rodenticides)
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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
TOXIC" ND HAZARDOUS MATERIALS REGISTRATION FORM
r
NAME OF BUSINESS:' to
Is"Iell _,Oei nut V Mail To:
�ATION-
Board of Health
BUSINESS LOC - . &
L5 Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: 0-7/ Hyannis, MA 02601
1
CONTACT PERSON: MC14er—_
EMERGENCY CONTACT TELEPHONE NUMBER:
'-Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use in YES
gpntities totalling, at any time, more than 50 gallons liquid volumeor 25 pounds dry
weight? NO Jr7
���� ®ti ,�4fi ��s�
d-t 6 the Board of Health r' w Tfi&f6rm .mintb ' 'b��no�an 6: t b es. s fer.- Ose.tho
re urn, egardles-s"of-a y
enclosed envelope for yo6r,convenience.
If you a, -.,n. sw I*
ered YES above, please indicate if the materials are stored at a site other than your ,
mailing address:' , C'n
ADDRESS:
TELEPHONE:
41,
LIST,OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must bqregistered regardless of volume. Please estimate the quantity beside the product that
you, store:
Quantity/Case Quantity/Case
Antifreezelor gasoline or coolant systems) Drain cleaners
Adtomatic transmission fluid Toilet cleaners
and'r�cliator flu§ s Cesspool
Engine cleaners
Hydraulic fluid (including,brake fluid) Disinfectants
� Motor'dils/waste.oils , Road'Sdjt (Halite)�'
Gasoline, Jet,fuel
Refrigerants,,,'
Diesel e 'eating oil
,rp�;ene, #2�h Pesticides (insecticides, herbicides,
Othdr�- I pro eum products: grease, lubricants rodenticides)
Degreaters for engiFies and metal
Photochemicals (fixers and developers)
Degreasers for driveways & garages Printing ink
y Batter
acib (electr i. g ly,
Wood preservatives (creosote)
Rustproofers Swimming pool chlorine
•.Par wash,detergents Lye or caustic soda
?Car waxes and polishes, Jewelry cleaners
'Asphalt i4roofing.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)
A
���Floor�'-& fdrniture stripperst-, kt'
Any"other'produdts.,,.With "Poison"`labels
Metal polishes (including chloroform,, form'ldehycle,
Laundry soil &-stain removers hydrochloric acid, other acids)
11
(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 an..l tar removers
Household cleansers, oven cleaners
White Copy- Health Department Canary Copy-Business