HomeMy WebLinkAbout2482 MEETINGHOUSE WAY/RTE 149 - Health a4�a Roue. 14l
F
No. 4210 1/3 BLU
ESSELTE
10%
O 0 O O
LOCATION / SEWAGE PERMIT NO.
VILLAGE S �..
A & B CESSPOOL SERVICE
128 BISHOPS TERRACE, HYANNIS, MA 02601
BUILDER OR OWNER
DATE PERMIT ISSUED
C-
DATE COMPLIANCE ISSUED
r -
D
�! k®
1
hf
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: ' Mail To:
BUSINESS LOCATION:
�-- and of Health
/� z�z® TS� L� E�` p . own of Barnstable
MAILING ADDRESS:
P.O. Box 534
TELEPHONE NUMBER: Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: <c ®"77 0 3GZ— 36'97'
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalli , at any time, more than 50 gallons liquid volume or 25pounds 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 materia[s 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 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,
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
Car wash detergents Lye or caustic soda
Car waxes and polishes Jewelry cleaners
Asphalt & roofing tar Leather dyes
L Paint , varnishes stains dyes Fertilizers (if stored outdoors)
! aint lacquer thinner PCB's
�. aint & varnish remover deglossers Other chlorinated hydrocarbons,
aint 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
y
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMP� �II cS�G� z� (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESSES Class: *7 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIAL / Underground
3 2— �6—Z-7 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:
v Z
441
DISPOSAL/RECI.AMATION REMARKS:
1. Sanitary Sewage 2. Water Supply Tb z ( P
O Town Sewer OPublic
If On-site Private
3. Indoor Floor Drains YES NO
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO ORDERS:
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
"Y V_7�41 g-!�_
Pers s) Interviewed Inspector Date
/ !7
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH Jr satisfactory 2.Printers
3.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY'ar,V-��,dzd O (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS V V$'l '`4K_ Class: f 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
.�?ICZ - 454'0777 IN OUT IN OUTI IN JOUT #&gallons _777 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:
DISPOSAI✓RECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply ,6 _
O Town Sewer OPublic _
,vOn-site *rivate
3. Indoor Floor Drains YES NO X
O Holding tank: MDC ?
O Catch basin/Dry well
O On-site system r.0 de",
4. Outdoor Surface drains:YES N0_Y— OR RS:
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter a sporter
Name of Hauler Destination
1. YES INO
2.
Pe on (s) Interviewed nspector Date
,T