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Home My WebLink About4495 FALMOUTH ROAD/RTE 28 - HAZMAT i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: MAILING ADDRESS: VY9 TELEPHONE NUMBER: CONTACT PERSON: V e fa C)a�u Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities 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 above, please indicate if th& 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 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)_ Refrigerants Automatic transmission fluid _�` Pesticides (insecticides, -� Engine and Radiator flushes herbicides,rodenticides) t/ 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 Leather dyes Battery acid (electrolyte) —Fertilizers (if stored r Rustproofers outdoors) Car wash. detergents PCB' s Car waxs 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) which you feel may be Spot removers & cleaning fluids toxic or hazardous (please (dry cleaners ) list) :' Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants Road Salt (Halite) LOME ......... . 4495 ROUTE 28 INCORPORATED COTUIT, MA 02635 TEL: (617) 428-4272 Board of Health of Barnstable 1) Malathion (Wetable Powder) and also 50 gallon drum 2) Methoxychlor (Wetable Powder) and also 50 gallon drum 3) Sevin (Wetable Powders) and also Portable and liquid 4) Captan (Wetable Powder) 5) Lindane 6)Oeazinon (liquid) 7) Zineb (wetable Powder) $) Benlate (Wetable Powder) 9) Cygon 10 ) Pyronone 11 ) Orthene 12) Gas 13) Antifreeze x NOTE: Quantity of The above mentioned may vary at any one time during the year. All of them have been registered with the town (labels) NOTE: All of the above mentioned are not stored over the winter. "The Finest in Arborist and Landscaping Services since 1926" TOWN OF BARNSTABLE , BOARD OF HEALTH CONT�OLO'F--aOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET rT- FIRM V ADDRESS-_.. Major types of materials: 1) -1 2) 3) nis . I. Description of material(s) use: 7 .. II. Storage (denote product by number li ted above) A. Containers metal glass paper plastic 1 cans,bottles,jars drums,barrels aboveground tanks underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility Vor•# Remarks/Recommendations 1. Indoor a) separate, contained room i - b) stored-iri.general work area i)� inadequate ventilation= _ i` ►)- floor drains _ inadequate: fire protection h � 2. Outd1.00r a) ?gncovered, exposed to weather _ (- b) pervibus-surface/catichsbasins3- III'. Disposal (f A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system 3. Separate holding tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal site Person(s) Interviewed "- — — — — _ _ _ — Inspectaor� / 1 t �o �j �- ate - � - - - ---- -------- (:UMi'LIAIVGC: I:LAJJ: t. riari��c,vas ocn�ivw ..��•�•.• TOJA4 OF BARNSTABLE 2. Printers satisfactory ;3, Auto Body Shops 'BOARD . OF HEALTH Q unsatisfactory- 4. Manufacturers `kk,", see"Orders" (, ( ) S. Retail Stores V) g COMPANY - 6. Fuel Suppliers ADDRESS `_lii1 i Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor: Case lots Drums AboveTanks Underground Tanks MAJOR MATERIALS IN UT IN IOUTN. 6 gellons- Age rest Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) r Heavy Oils: w�s e motor.o (C) J new motor (C) �� • transmission/hydraulic Synthetic Organics: degreasers Li MiscO anneeous: celk DISPOSAL RECLAMA- TION REWORKS: 1. Sanitary Sewage 2. Wate Supply ' t s.. '�l ��` Town Sewer ublic On-site O Private ! _ -3. Indoor Floor Drains: YES NO O Holding tank: MDC O Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO ' O Holding tank: MDC OCatch basin/Dry well - ---�-_ OOn-site system Licensed? S. Waste Transporter 1j,ZsiP Product YES NO W 0 r/ u 81 Person(s) Int.erviewe � Inspector Date i I TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAML OF FIRM: v 21 MVILING ADDRESS: TELEPHONE NUMBER: �( I ��. S CONTACT PERSON: `l�,'�� . �J '�'-• � Q U 6 Does your firm- store any of the-- toxic- or_hazardous materials listed below,, either for sale or for your own use, in quantities 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 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 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 ' asline or coolant systems)w Re rigerants 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, lubricants Swimming Pool chlorine Lye or caustic soda �- Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Batter acid (electrolyte) Leather dyes yFertilizers (if stored Rustproofers outdoors) Car wash detergents PCBs Car waxes and polishes Asphalt & roofing tar Other chlorinated hydro,- Paints, varnishes, stains, dyes carbons, (inc.carbon 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 (dry cleaners) toxic or hazardous (please Other cleaning solvents R E C E I V E ®list) :y Bug and tar removers HEALTH DEPT. Household cleansers, oven cleanerUWN OF BARNSTABLE Drain cleaners Toilet cleaners Cesspool -cleaners Disinfectants 1981 Road Salt (Halite) MAY 3 TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repa'.r atisfactory 2• Printers BOARD OF HEALTH 3. Auto Body Shops O unsatisfactory- 4. Manufacturers COMPAiY tj 'ly (see"Orders'i) S. Retail Stores �" 6. Fuel Suppliers ADDRESS Class 7. Miscellaneous QUAN 'ITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetgxouad Tanks 1IN IOUT tIN IOUT IN OUT eallons AL7eTest? Fuels: / Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) ! � AA f Heavy Oils: waste motor oil (C) new motor oil (C) f 47 transmission/hydraulic / f ' Synthetic Organics: I demos p1 Mi4el l/aneous: tad J DISPOSAL RECLAM--ATION REMARKS: 1. Sanitary Sewage 2. Water Supply r V Town Sewer Q_'Public / � �� t r 06"ite Private 3. Indoor Floor Drains: YES NO _ 4 Holding tank: MDC /; -yJ _ ® Catch basin/Dry well _ OOn-site system 4. Outdoor Surface drains:YES NO OHolding; tank: MDC --------- O Catch basin/Dry well �_tlt OOn-site system . S. Waste Transporter Licensed? ,Namg of.H=jej D in ion taste Product YES1 NO /Z, 12 SI Person s) nter ed , Inspector at f TOWN OFRARNSTA[3LE COMPLIA►�CE: -P CLASS; 1. Marine,Gas Stations,Repair. ' Q satisfactory 2. Printers .� R Q ..' OF= HEALTH 3: nuto Body Shops Qunsatisfactory- 4. Manufacturers see"Orders")J S. Retail Stores r'1 COMPANY ��_ t 6. Fuel Suppliers ADDRESS L�Q ~ Classt 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OU1'=outd6or MAJOR MATERIALS � Case lots Drums AbOveTanks Undetgr.otmd Tanks ;; IN QM U & gallons &M Fuels: • Gasoline, Jet Fuel (A) Diesel, Kerosene,. 12 (B) , Heavy Oils: ,- waste motor oil - (C) new motor oil (C) transmission/hydraulic - '-SynthetIc Organics: degreasers • Miscellaneous: { DISPOSAL RCCL FIAT ON REMUS: 1. Sanitary Sewage 2. Water Supply 1 Q Town Sewer Q Public —_--- Q On-site Q Private `�) P M_4�19 r� ��, 111 j�IC5 Ff/l i-- 3. Indoor Floor Drains: YES NO A A1.n A F) ( T/v [folding tank: MDC ,j�(',K �' Ip f O Catch basin/Dry well _ _ _ h;r' �` �j% �AVK� ' _ on-site systemI)t}`1 ( 1V' Ae 0 ��c' q. Outdoor Surface drains:YES NO � (� _Alt AV � 0 ffolding tank: MDC � , Catch basin/Dry well A&,O •7;(7A 'A (OP•N rORL'/ Q On-site system ��t)'ek) A ►2OP S. Waste Transporter Licensed? N In �llakl�� Dectinsi_nn Waste Product YES �-LU— 2. 0..--Y i �',fI I! ', � � ! !.� J'a:l�l� 10 W �1 Person(s) Interviewed Inspector Date ---- - -