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TOXXIC AND HAZARDOUS M.ATTERIALS REGISTRATION FORM
NAME OF FIRM: f Pe
MAILING ADDRESS: C;2J�3
TELEPHONE NUMBER: a� ® a
CONTACT PERSON:
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Does your firm.stor.e.any of the toxic--or hazardous materials_lilted-below,:
either for sale or for your own use, in quantities totalling, at a 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 add ess• lye
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ADDRESS: / �� lhl//��
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
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The Board of Health has determined that the following products exhibit toxic
or hazardous characteristics and must be registered when stored in quantities
totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put
a check beside each product that you store:
Antifreeze (for gasline or coolant systems)w Refrigerants
Automatic transmission fluid Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
Hydraulic fluid (including brake fluid) Photochemicals
Motor oils/waste oils Printing Ink
Gasoline, Jet fuel Wood preservatives
Diesel fuel, Kerosene, #2 heating oil
(creosote)
Other petroleum products: grease, Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Degreasers for driveways & garages Luther dyes
Battery acid (electrolyte) Fertilizers (if stored
` Rustproofers outdoors)
Car wash detergents PCB's
Car waxes and polishes Other chlorinated hydro-
Asphalt & roofing tar carbons, (inc.carbon
Paints, varnishes, stains, dyes tetrachloride)
Paint and lacquer thinners Any other products with
Paint & Varnish removers, deglossers "Poison" labels (including
Paint brush cleaners chloroform, formaldehyde,
Floor & Furniture strippers hydrochloric acid, other
Metal polishes acids)
Laundry soil & stain removers
Other products not listed
(including bleach)
Spot removers & cleaning fluids which you feel may be
toxic or hazardous please
(dry cleaners ) RE
Other cleaning solvents E !0 E list.
Bugand tar removers HEALTH DEPT.
Household cleansers, oven cleanersARNSTABLE
Drain cleaners
Toilet cleaners
Cesspool cleaners
Disinfectants MAY 1 8 1981
Road Salt (Halite)