HomeMy WebLinkAbout0007 CORPORATION STREET - HAZMAT
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM:
MAILING ADDRESS:
TELEPHONE NUMBER: �2�_O O o
CONTACT PERSON:
Does your i�n store-any: of-.the -toxic:or- hazardous- materials _listed_--below.,_
either for sale or for your own use, in quantities totalling, a -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: sa&l-+'=A ;c C C.9
TELEPHONE: 7 CL�2PoJ-cT Div Yc�.v.��s . ors pro)
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic j
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) Refrigerants
Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
Hydraulic fluid (including brake fluid) Photochemicals
Motor oils/waste oils Printing Ink I
Gasoline, Jet fuel Wood preservatives
Diesel fuel, Kerosene, #2 heating oil N
(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
Battery acid (electrolyte) Fertilizers (if stored
Rustproofers outdoors)
Car wash detergents PCBs
Car waxes and polishes Other chlorinated hydro-
Asphalt & roofing tar carbons, (inc.carbon
Paints, varnishes, stains, dyes r _
Paint and lacquer thinners w—te tetrachloride)
�•�ec�9 '" _ 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 flu'
(dry cleaners) jkt C EI V E ® toxic or hazardous please
Other cleaning solvents HEALTH DEPT. list.;
Bug and tar removers TOWN OF BARNSTABLE
Household cleansers' .
oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners ��� i 1981
Disinfectants
Road Salt (Halite)
i
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TOWN OF BARNSTABLE
BOAR ® OF HEALTH
CONTROL OF TOXIC/AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
ADDRESS
Major types/of materials: 1) ; j, 2) lam- 67 � }
_ _ 7
4) ', 5) 6)
I. Description of materials use:
II. Storage denote y )g ( product b number listed above
A. Containers
metal glass, paper plastic
cans,bottles,jars
drums barrels
aboveground tanks
underground tanks
bags,boxes j
open,loose,uncovered
inadequate labelling
B. Storage Facility ✓or # Remarks/Recommenc '.i.ons
1. Indoor
a) separate, contained room
b) stored in general work area
i) inadequate ventilation
ii) floor drains 1
iii) inadequate fire protection } l
2. Outdoor
a) uncovered, exposed to weather f;
b) pervious surface/catch basins
III. Disposal
A. Reclamation/Recycling unit
B. On-site disposal .'
1. Town sewer
2. Regular septic syste -
3. Separate holding tank
C. Off-site disposal V
1. hauled by own firm ,
2, hired hauler /
a) name of hauler
b) address or disposal siteJ)
l � �
Perso.n(s) Interviewed — — . �— — s, �.` Inspector -
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Dane -l_ — — — — — — — —
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