HomeMy WebLinkAbout0060 CIT AVENUE - HAZMAT Lo Gf A✓e
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: ,-2 Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: '7- P.O. Box 534
Hyannis, MA 02601
CONTACT PERSON: ' `4
Does your firm ore any of the toxic or hazardous materials listed below, either for sale or for
your own use, in u tities totalling, at anytime, 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: �l71�P
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 each product that you store:
ntifreeze (for gasoline or coolant systems) Dr ' cleaners
Auto is transmission fluid Toilet cleaners
E Ine and radiator flushes Cesspool cleaners
H aulic fluid (including brake fluid) Disinfectants
otto_r oils/waste oils Road Salt (Halite)
G ne, Jet fuel Refrigerants
Die uel, keFe's-9-ne;#2-h g—o'ii 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]
Rus ofers Swimming pool chlorine
ash 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
TOWN OF BARNSTABLE C PLIANCE: CLASS: 1.Marine,Gas Stations,Repair
' satisfactory 2.Printers
BOARD OF EALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY . (see"Orders") 6.Fuel1Sup Stores
ADDRESS f lass: 7.Miscellaneous
ANTITIES AND ATORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks
IN OUTI IN I OUTI IN OUT #&gallons 777 Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel,
Heavy Oils:
waste motor oil (C) a)p
new motor oil (C) /✓
transmission hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
` Y
&A` U
MMLM
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply `
Town Sewer ublic i n '„
Town
Private
3. Indoor Floor Drains YES NO
,Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES r NO O DERS:
0 Holding tank: MDC
Catch basin/Dry well �.
O On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
YES NO
f C
�- / - i
P rso I erviewed Inspector Date