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HomeMy WebLinkAbout0080 FIRST AVENUE (HYANNIS) - HAZMAT �� ace —► - © 3� TOWN OF BARNSTABLE � ILVC IAG UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS .ASSESSORS MAP NO. PARCEL N0. © b ` ADDRESS: � 't VILLAGE Ageg. ` )I ( 5 .0r)� NAME' �'-,cj l u a dL. CONTACT PERSON �hw� G S 1 4,-u� PHONE NUMBER ? LOCATION OF TANKS: CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM' DATE OF PURCHASE OF. EACH: 1. I 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS -PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. 0` kk .. r rr, -, PERMIT FOR STORAGE OF -FUEL OIL 'n -.;tBhYi2 Name =- (Owner or Occup.) Installer) Address ----- -.- s a ` Address 3=u J i k 7 7� Certif. Co Phone No. m71 -- - - - ------�Phone No. - (BURNER) �' -'•. -� --- --= ('STORAGE)ue A3a-� � .Namej3V andt-r € :.---Type -- K: of )'&n ---------- -Manufacturer N ---. —Capacity gals. (or) Size- Model No. - Size _ __- Location Typed Mass. Approval No. `--- ----- Permit Issued %;of Carbon Dioxide-A ----------- Draft -�'�--- -- ---------- Smoke Density Stack Temp ___ 10. Nozzle Size(—Q----- Appl. Ree'd _ --- -- e d f epartment) x., Issued By: — -- - --- -----=- --— TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: bV slE L1,Vtz; h A CT2 Z7�� MAILING ADDRESS: .74l TELEPHONE NUMBER: 7 7S-- e l 7 CONTACT PERSON: 2 o /L. Dee 2) � Does your firm store any of the toxic or hazardous--materia.l5---1 sted-below; either for sale or for your own use, in quantities 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: 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) 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 Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) Car wash detergents PCB' s Car waxes and polishes Other chlorinated hydro- Asphalt & roofing tar Paints, varnishes, stains, dyes carbons, (inc.carbon tetrachloride) Paint and lacquer thinners Any other products with Paint & Varnish removers, deglossers "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers a/ hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) ich you feel may be Spot removers & cleaning fluids R E C E I V Exic or hazardous (please (dry cleaners ) HEALTH DEPT.1l z Other cleaning solvents TOWN OF BARNSTA3L�Est) Bug and tar removers Household cleansers, oven cleaners Drain cleaners Lam- Toilet cleaners / Game- a4 Cesspool cleaners JUN 2 1,91 !r- Disinfectants 1 C"e Road Salt (Halite) �V