HomeMy WebLinkAbout0102 CENTER STREET - HAZMAT /ca Cenfer ,}frE �}
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: c�?64M13 PAO 1O F01 5HrNC,.. �N C
MAILING ADDRESS: /®)- Cgs le►e t5//?E1-5-7
TELEPHONE NUMBER: 1717 / c9(o3 3
CONTACT PERSON: Gr-AAt.10 1 SCIftye1tA aq L8e 10fP, 151C '7 W a_ 1;-�7 2
Does your firm-_store--any.-<of-the toxicor-=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: . I
ADDRESS: N o
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
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Degreasers for driveways & garages Leather dyes j
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) C I V ® which you feel may be
Spot removers & cleaning fluids R
(dry cleaners) HEALTH DEPT, i°StY w°r hazardous (please
TOWN OF BARNSTABLE 1'
Other cleaning solvents ,
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners MAY j' 4' "1981
Cesspool cleaners
Disinfectants
Road Salt (Halite)
TOWN OF BArII V r 1 /AU1F , ��'11�r LlANI.CI. 1:1;R53y l: NdI' t cY .t
` �' r/ Prin satisfactory AutotRody Shops
BOARD OF HEALTH`
Q unsatisfactory- 4. Manufacturers
COMPANY SD.,eA_n !.4 " _ ('14f (see"Orders") S. Retail Stores
i 6. Fuel Suppliers
ADDRESS v Z r `� 'i '� "�%�- Class• ~— 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors
MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks
I N OUT IN IOUTINIOUT M gellons Ape ffest
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, 02 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
0
Synthetic Organics:
degreasers
L
Miscella�-n�e"ous�: /
4 A LLL
DISPOSAL RE LAYAATION
1. Sanitary Sewage 2. Water S y
Town Sewer Sewer ublic ' y
O On-site 8Private
3. Indoor Floor Drains: YES _ NO
Q Holding tank:_:MDC
O Catch basin/Dry well
.0 On-site system + UKUbKb'
4. Outdoor Surface drains-.YES NO
Q Holding- tank: MDC
O Catch basin/Dry well
0 On-site system
S. Waste Transporter Licensed?
Name of Hauler_ jjcjj:ination Waste Prod i _t No
1.
2.
' ,-�"y�r/� f� -.. E..a:_ �L ,� ' �,4 .mil` i ! � i�•- � �+ � i ���
u �23 el Persori� Int.erviewe� � � Inspector Date