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HomeMy WebLinkAbout0011 CIT AVENUE - HAZMAT �� �� ,, � �;, ,;, Q v IC !VND H_ .^=-.RDDUSZ MI-'A T L-kiALS REGISTRATION FOR°,! NAME OF FIRM: X)e J¢v�� � �r✓` � 1, ., Board Health MAILING ADDRESS: i.� . Town Off Barnstable TE,LEPHONE NUMBER: I ® P.O. Box 534 CONTACT PERSON: Hyannis, Massachusetts 02601 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. 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 wWen stored in quantities totalling more than 50 gallons liquid volume or 2S 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) raulic fluid (including brake fluid) Photochemicals Motor oils/waste oils Printing Ink Gasoline, Jet fuel Wood preservatives Diesel fuel Kerosene, #2 heating ,oil - � Other petroleum products : grease, (creosote) 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 Rustproofers outdoors) Car wash detergents PCB Is _ 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 • - Metal "olishes lore d, :� hydroch c aci ther' } acids) ' { Laundry soil. & sta_in 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 list) : s s Bug and tar removers Household cleansers,. oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants - � - Road Salt (Halite) x -. TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,RFpai.r O satisfactory 2• Printers y BOARD OF HEALTH 3. Auto Body Shops �/E " "6unsatisfactory- 4. Manufacturers COMPANY V&.S �vi ,,ce (seeOrders ) S. Retail Stores 6. Fuel Suppliers ADDRESS C ! R C4 Class: 1 7. Miscellaneous -----� QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AbOveTanks Undergrouad Tanks IN OUT IIN IOUT ( INIOUT # gallons Aze Test? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 W Heavy Oils: I\ ,,waste motor oil (C) 1 /J r�(` new motor oil (C) transmission/hydraulic Synthetic Organics: i degreasers Miscellaneo7\ DISPOSAL RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water S ply O To Sewer Public Qn-site 0 ivate 3. Indoor Floor Drains: YES V NO _ O Holding tank: MDC _ O Catch basin/Dry well On-site system li/ 4. Outdoor Surface drains:.YES NO O Holding; tank: MDC O-Catch basin/Dry well Vic^i ,�_ca ---_ _�, ,�` L {_ On-site system S. Waste Transporter Licensed? IName of - - '>�ste _Pr u tYES NO )j B1 Person(s) Interviewed Inspector Date OWN OF `'BARNSTAE�L )COMPLIANCE: CLASS: 1'.� Marine,Gas Stations,Repai.r Q satisfactory Printers BOARD. OF HEALTH 3. Auto Body Shops �� -\ unsatisfactory- 4. * Manufacturers OMPANYi �t (see"Orders") S. Retail Stores 6. Fuel Suppliers DDRESS Ml Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) WOR MATERIALS Case lots Drums - AboveTanks Undetground Tanks IN IDUT ' IN on M 6 gellonso f Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, 82 (B) 110-1 k. '� Heavy Oils: waste motor oil (C) ,� 7 - new motor oil transmission/hydraulic , Synthetic Organics: degreasers l ! 4 . nevus fj ;POS AL RECURATION -REW RKS: L. Sanitary,Sewage, 2. Water Supply 0 Town Sewer Public 'te Private ,4* _ �. --7 1-4112- urn � Indoort•Fl.00x,_Drains•:YES: NO O Holding tank: MDC �, ffi� '*./Zl ==.� � 0 Catch basin/Dry well On-site system i . Outdoor Surface drains:YES NC` O Holding tank: MDC "'' f { Catch basin/Dry well �4, �� �,. ,�1• �..• �i.. ,�..�- OOn-site systemV Waste. Transporters _._.. ,��,�.-'/ Licensed? Name of• Hauler D�est_inatiprrn� -�-- --•- { 2. \3 71 ;iq ~^ a e1: erson,(,") Ant.erviewe Lizspector . Uate i___. t TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: /'` n7 -7 P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 -�� Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qu ntities 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 gasoline asoline or coolants stems Drain cleaners ( systems) Automatic transmission fluid Toilet cleaners � Engine and radiator flushes Cesspool cleaners V7` ydraulic fluid (including brake fluid) Disinfectants otor, oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides)' Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine. Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be"toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business - " ' - '=wfF"h5 - .. .- � „ _ ._. ._ s .. �^• .fir+-�^""�..r x.+-.�5 t- cy..r�� t'M1,.{'�y�A.dMel^:`''r+we�i':'se.r,,•�,•..ram•" "{,.?•TSw'y .,kfy,;�.,.^•o-,Fa^'f`'y,�,-f�i,.,.n.0.�„r�7e...ia...''..n.-t^�.,'^w br' '�-5..`� r " -TOWN OF BARNSTABLE compDANEE: CLASS: 1.Marine,Gas Station's,Repair O satisfactory 2.Printers r BOARD OF HEALTH 3.Auto Boay.Shops w- �f O unsatisfactory- 4.Manufacturers res COMPANY f , (see"Orders") 5.FueReta'-Slip lie �y f,,� 6.Fuel'_Suppliers ADDRESS // rs. .* n�ar2 Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN`indoors;OUT=outdoors) MAJOR MATERIALS C. se lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN< OUT #&gallons Age Test Fuels: r Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil(C) /3d ; (`anew motor oil(C) � ttr_ans_missio'&hydraul i� g Synthetic Organics: degreasers i Miscellaneous: V f_ } DISPOSAURECLAMATION REMARKS: 1: Sanitary Sewage 2.Water Supplyil � �..� ' r"t�',Fs . � O Town Sewer O'Public �C.f�x# O`On-site OPrivate `'• " ' 3. Indoor Floor Drains-` YES NO O Holding tank: MDC O Catch basin/Dry well r: O On-site system _ .4. Outdoor surface drains:YES NO ORDERS. a O Holding tank:MDC r, f O Catch.basin/Dry well O On-site system )x 5.Waste Transporter Name of Hauler Destination Waste Product Licensed? e, YES NO 2. A� Person (s) Interviewed Inspector ' Date IKE T° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMASS. ' 200 Main Street• Hyannis, MA 02601 A'FOMP� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: ���av�5 t ttiV�.try Date: 6 /S Location/Mailing Address: I I + V P— w,n Contact Name/Phone: c,a,v, OS-ITO Inventory Total Amount:' SDS: License#: Tier II : D Labeling: OK —{ Spill Plan: " Oil/WaterSeparator: Floor Drains: N8 Emergency Numbers: Storage Areas/Tanks: oA 5 Emergency/Containment E ui ment: r Waste Generator ID: ® Waste Product: — Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods:LIST OF TOXIC AND HAZARDOUS MATERIALS {M 111,4 of �WI0J,,*S < V<:<-iDvS too I 1 D{ V1e�i NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, k' u i S storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: O Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS °Foy A Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMS�LE. ' 200 Main Street• Hyannis, MA 02601 o39. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: lr tmA-1, Date: P d Location/Mailing_Address: <t& lotvO .4' Contact Name/Phone: L-2 --D ?Z,0- Inventory Total Amount: 2 OL I MSDS: I VANvL 5 License#: N 10\ Tier II : N to Labeling ®a Spill Plan: 4, A — Oil/WaterSeparator. Floor Drains: N 0 Emergency Numbers: VIA StorageAreas/Tanks: . 1v1 A AU,-( 1,)5V wtdle<' vAie6 Emergency/Containment Eq ipment: Waste Generator ID: Waste Product: �A �4a,A,c, Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: �fAA_\IAN%Av<' av%lk4ri ��� Cav 1�c,�%Iv,r� wA k v L-/,k r ko '1 LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECO MENDATIONS: e -b �( by^)r X Q\v% Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 181 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Neves Auto Repair 11 CitAvenue, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health l?CO p 9S -/, ,po, ox ,ToH q t�,Ai n ' UVoll S ` EC) ssaxQc[v Uvoa�-7 alkTY KoLLTxad9aD Qr io ILTILs `oK KOLL-�-DLULa(]j T F=CFZZ 'DOLL 4� 0� SI �h`�O dd k . u _. c Q :S�ED4ILl T d V) M 0 SS QCt�UIOH CLWYco d S ' 1s10 TIOS Q.4 i Ge,6 Or Joy Jo s13THQc-f -a vt (N VZ3 "r ca f\'a N S`� LSD Io LOF DIlddI zo ZWvK T a® 5KO ICI d� T sHass��f iT0E1'06L-SRS � `gp=P-LH a-,Iqli DGG E � ,IEf52 (I f 6EFFE0 �6 ' y F-� CONTINGENCY PLAIN Emergency Coordinator,Name: .� Address: z Daytime Phone: Coco T Evening Phone: Fire Department: Barnstable Public Health Division: 508-862-4644 DEP 24 Hour Spill Hot Line: 888-304-1133 Waste Hauler. Name: Phone: Building diagram indicating hazardous matenal/waste storage area, location of absorbent scavenger materials,fire extinguishers, fire alarms (if present), and evacuation route (if applicable). a- Actions to be taken to control a spill or release and preventing it from reaching a catch basin,sewer--system or the ground. -spa � - Number Fee 181 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health ., This is to Certify that Neves Auto Repair 11 Cit Avenue, Hyannis,MA 62601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. ------------------------------------ WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI JHOMAS.A. MCKEAN,R.S.,CHO ~Y Director of Public Health �^ i I _a ►.�4 '� Town of Barnstable 11HE r � Regulatory Services Thomas F. Geiler, Director • + BARNsrABLE, ' MASS. a Public Health Division 9�o 039 `gym ArFDMA�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO._3/a-6/11 Oa b DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT IF. ��e NAME OF ESTABLISHMENT ")�b Nk y0"'," ADDRESS OF ESTABLISHMENT \ ` C�� �t�c tf'�-, \ �G:ny�tg i(1r� G440 l TELEPHONE NUMBER IS or 77/ WOO SOLE OWNER: V YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER f r,T _;.n CLERK .�,> R_. • [� �! ete, � �SIGNA�TUR;E��OFAPP�LICANT "SL tx3S. RESTRICTIONS: HOME ADDRESS t4, `-111 HbMEr1=_ELEPHONE # �- ?9 y��(�� 0,411` Haz.doc/%%p.y Number Fee 181 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Neves Auto Repair 11 Cit Avenue, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------- ------ --------- --------- --------- ---------------------------- -------------- ------------------------------------------ --------------- ----------- - ----- ---- ----------- ----------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health l a .. r: Town of arnstable l� Barnstable x ro d Regulatory Services Department: AthneftaM Public Health Division • • EARN SLE. - 9 200 Main Street Hyannis MA 02601 pT�t�A'1 A 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. �a—01 y 001) DATE�1 K19"?' APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT S a NAME OF ESTABLISHMENT \/p • ADDRESS OF ESTABLISHMENT ' vQtx p— \VN 0) TELEPHONE NUMBER S-0 $' -7 7/ — 7 700 SOLE OWNER: DYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: *� xa IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. w © r STATE OF INCORPORATION ` FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK GNAT O A LICANT. • RESTRICTIONS: HOME ADDRESS So\)OOC OJT 4 Yk�A HOME TELEPHONE # ,-or ?9Y—SG o6 QAHazmat\1-laz Mat Application200&DOC TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: /l '' Town of Barnstable TELEPHONE NUMBER: 7/-^ U P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: 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: � e 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 Please put a check beside eachproduct that you store: li Antifreeze (for gasoline or coolant systems) Drain cleaners l� Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/w�oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, v ialie itas,-C s Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN 1V OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers Q satisfactory BOARD OF HEALTH 3.Auto Body Shops � O unsatisfactory- 4.Manufacturers A COMPANY �' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS / Class: 7.Miscellaneous �;QQ ANTITIES AND STORAGE I (IN=indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAUR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply e 4,-Iz a O Town Sewer Oublic O On-site OPrivate .p 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank: MDC AA a O Catch basin/Dry well -74� O On-site system 5. Waste Transporter ,,' Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) iewed Inspector Date , TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 2Z Board of Health MAILING ADDRESS: �� - Town of Barnstable TELEPHONE NUMBER: 7,f4 " / 5�,<- P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: &2,zz /�� 1 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for " your own use, in quantities totaIli , 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel -� Refrigerants mil, ke rose n%42-heating-efl Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents i Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE ; MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair ' satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops COMPANY`- O unsatisfactory- 4.Manufacturers / (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS lass: 7.Miscellaneous �MTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drurns Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) —Dtatt Kerosene,-#2� v Heavy Oils: waste motor oil (C) i new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2ater Supply O Town Sewer CPublic O On-site OPrivate 3. Indoor Floor Drains YESJZNO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0-Z ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: v�y 4�5 Board of Health MAILING ADDRESS: r � t� rGir Town of Barnstable TELEPHONE NUMBER:_ ��/�� P.O. Box 534 CONTACT PERSON:\ /���'L. Cc_947e'1 Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalli , 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 gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) ✓ Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business ''S`- ',k'c,.-`�.��7.H%�..:,vrlif*'�'„�:'fa�:="z:.;w,'f'"r••y„a.-�r.� r'-s.:.,�'F h:x:_� r`:_ '•r �,.=.;?1.• _ s. �'r`�-- . y. "". :R"`,„.., TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH •O satisfactory 2.Printers ,�O 3.Auto Body Shops . unsatisfactory- 4.Manufacturers COMPANYlt. t' y f x (see"Orders") 5.Retail Stores • 6.Fuel Suppliers ADDRESS fuggg; / 7.Miscellaneous .QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: W Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers • J Miscellaneous: t E DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer ,kPublic ` b4.On-site Q Private 3. Indoor Floor Drains YES I/ NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES ' NO ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. w / y Person (s) Interviewed ',.. $ Inspector`" -Date'