HomeMy WebLinkAbout0069 CENTER STREET - HAZMAT l�9 C'errfe� �- I� n� ,
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: o-f;o S-��-e--J C��,
MAILING ADDRESS: ( 9 c�e. njLe , S4 `
TELEPHONE NUMBER: -7-71 - Al
CONTACT PERSON: ® (u 4 I !
Does-your firm-store- any. of .the toxic. or. hazardous: materials- l stied-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?
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YES V 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 : Ore
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)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 j.
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners i
Degreasers for driveways & garages Leather 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) which you feel may be
Spot removers &cleaning fluids
(dry cleaners) toxic or hazardous please
Other cleaning solvents R A E 9 `� E ® list.:
H
Bug and tar removers HEALTH DEPT.
cl�a��i Household cleansers, oven ersARNSTABLE
Drain cleaners
Toilet cleaners ,; ..
Cesspool cleaners
Disinfectants MAY 1 5 1981
Road Salt (Halite)
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHE•ET'�
FIRM . r1 :,e
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ADDRESS
Major types of materials: 1) 9i 2) , 3}
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I. Description of material(s) use: p
II. Storage (denote product by numbe fisted" above)
A. Containers
metal glass paper plastic
cans,bottles,jars AF
drums,barrels IT
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aboveground tanks
underground tanks
bags,boxes
open,loose,uncovered
inadequate labelling
B Storage Facility
✓or # Remaxks/Recommenc :,.i_ons
1. Indoor
a) separato, contained room
b) stored in general work area
i) inadequate ventilation
ii) floor drains
iii) inadequate fire protection
2. Outdoor
a) uncovered, exposed to weather ^ '
'b), pervious surface/catch basins
c
III. Disposal} a
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 ' 4
2, hired hauler
a) name of hauler "
c
b) address or dis osa'd site.
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A". IJ4
Perso (s) Interviewed Ins ecto
Date- -
6 30 81 '