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HomeMy WebLinkAbout0067 CAPTAIN COOK LANE - HAZMAT P*-oYi�S s r r �R SIA- CHUSETTS FIRE INCIDENT REPORT IJ DEPARTMENT Revis A 10 922 Haunts Fire Department Report Form Incid t If Date Da Alarm Arrival n Service .001244 Fire 0012/5/95 Y ITuesday � 113:58 114:01 r14:21 SITUATION FOUND •••••••••••. ACTION TAKEN . :::; MUTUAL AID B Spill, Leak w/ No Ign ,;4 1 Remove Hazard FIXED PROPERTY USE (OCCUPANCY) IGNITION FACTOR :-......0 0 C Uncovered Parkin Area I n Factor Undetermined OCORRECT ADDRESS ZIP CODE CENSUS TRACT D 67 CAPTAIN COOK CIR. 02601 000010 O 11 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. SANFORD,PATRICA N/A 012OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE SANFORD,PATRICA 67 CAPT. COOK CIR. C-VILI J G 13 METHOD OF ALARM CO. DIST. PERSONNEL .........-- ENG RESP. AERIALS RESP. ...... 3 © RESP. a O SHIFT HAZ MAT PRESENT? Y TANK. RESP. �JOTHER RESP. ;C � 0 i Telephone (Direct) No. SUBSTANCE 12 0 2 1202 11 SPEC. EQUIP. USED? 0.5 GAL. JAN-SOLV. O 20 FIRE OTHER SERVICE ::> O MOBILE PROPERTY TYPE VEHICLE STOLEN? ESTIMATED TOTAL INSURANCE CO. DOLLAR LASS TOTAL INS. CLAIM PD 0 < 0 0 YEAR MAKE MODEL COLOR LICENSE NO. VIN# 30 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO. IN IGNITION K COMPLEX AREA OF ::EQUIP INVOLVED IN IGN. OORIGIN ................ FORM OF HEAT IGNITION MATERIAL FORM TYPE © «.::IIGNITED METHOD OF •LEVEL OF ORIGIN Number of Stories CONSTRUCTION TYPE OEXTINGUISHMENT EXTENT OF DAMAGE Flame Smoke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE COOP ... Ll E Material generating FORM TYP ® most smoke AVENUE OF SMOKE TRAVEL R WEATHER CONDITIONS Officer in Charge: Date ROBERT K.PICKERING LIEUTENANT 1 2/5/9 5 ? Comments for this incident have been printed on an additional comments page. Comments for Incident: 95 001244 Exposure: 00 Date: 12/5/95 THIG,,, EPT.RECEIVED A CALL FROM THE COMM F.D. REPORTING A GAS SPILL AT 67 CAPT.COOK CIR. ENG.822 WENT STILL ALARM. OON ARRIVAL WE FOUND A TOYOTA THAT LEAKED A SMALL AMOUNT OF FUEL.(LESS THAN ONE GAL.) COVERED WITH JAN-SOLV. DAVIS AAA TOWING REMOVED THE VEHICLE. ENG.822 TO QTRS.AT 14;28 HRS. 1984 TOYOTA CAROLLA MA. REG. 370-ACG VIN. JT2AE8653E0053059 R.K.PICKERING/LIEUT. III • TOWN OF BARNSTABLE Date:L / j / 0 _ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: It -f � BUSINESS LOCATION: Zc ti e INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: O�rj CONTACT PERSON: e- EMERGENCY CONTACT TELEPHONE NU R: MSDS ON SITE? TYPE OF BUSINESS: . INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: 0u-4v J/) Last shipment of hazardous was Name of Hauler: Destination: Waste Product: Licensed? Y its f No l �t NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers J (including bleach) TL Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials