HomeMy WebLinkAbout0012 ENTERPRISE ROAD - HAZMAT ,J� ,�i?�raorJS� /2ac�o(
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: �� 'h k `� 2 a wt a
MAILING ADDRESS: l- E"Tww -prigq- Qd 1-4 y a .1
TELEPHONE NUMBER:: 9 7 3�1d.-a-
CONTACT PERSON: CL r- �; !/n 1 S
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 1N0
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 stbred 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 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, (creosote)
Pool chlorine
lubricantsSwimming
Degreasers for engines and metal Lye or caustic soda
Degreasers for driveways & garages Jewelry cleaners
Battery acid (electrolyte) Leather dyes
Rustproof ers
Fertilizers (if stored
Car wash detergents outdoors)
Car waxes and polishes PCB' s
Asphalt & roofing tar Other chlorinated hydro-
Paints, varnishes, stains, dyes carbons, (inc.carbon
Paint and lacquer thinners tetrachloride)
Paint & Varnish removers, deglossers Any other products with
Paint brush cleaners "Poison" labels (including
Floor & Furniture strippers chloroform, formaldehyde,
hydrochloric acid, other
Metal polishes K acids)
Laundry soil & stain removers Other products not listed
(including bleach) which you feel may be
Spot removers & cleaning fluids
(dry cleaners ) E p toxic or hazardous(please
Other cleaning solvents RE I:
DEPT. list) :
Bug and tar removers HEALTH
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Household cleansers, oven cl��a'�'iers S ���S er• r'S
Drain cleaners
Toilet cleaners �"-
Sr- ^- Say
Cesspool cleaners
Disinfectants JUN 2 3 1g81 9
Road Salz (Halite)
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2. Printers
satisfactory BOARD OF HEALT un sfactar _ Auto Body Shops
" 4. Manufacturers
fvmy 5 Retail Stores
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, 1 dens
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K ��
�� Suppliers
COMPANY •6. Fuel S pF
ADDRESS . %• �- Class: 7. Miscellaneous
t UANI'ITIES AND STORAGE (IN=indoors; OUT=outdoor.
MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks
M I N UT I A z e rest
Fuel s"t'... .
Gasoll:de, Jet Fuel (A)
Diesel, Kerosene, 82 ,(B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
-_transmission/hydraulic
L.""Synthetic Organics ti
degreasers
:Misce n ous:..� x.
DI-SPOSAL RECLAMATION REM US:
1. San Vary Sewage 2. Water Supply
own Sewer �Public
_ F 1
-site O Private
.3. Indoor Floor Drains: YES N0
O Holding, tank: MDC
O~Catch basin/Dry well
On-.site system
4. Outdoor.Surface drains:YES NC
• Holding- tank: MUC
OCatch basin/Dry well - --- -
OOn-site system
S. Waste Transporter Licensed?
Product
D ctinat;on HaStp. ;
Name of Hauler_ � -
Person s) lnt:erviewe Inspector U to
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