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Home My WebLink About0004 HINCKLEY ROAD - HAZMAT }�1n�K ) e� ��d+ COMPLIANCE: CLA 1. Marine,Gas Stations,Repai.r SC TOWN OF BARN•STABLE =y2,: printers BOARD F O satisfactory »3. Auto Body Shops unsatisfactory- 4. Manufacturers COMPANY (see"Orders") 5. Retail Stores 6. Fuel Suppliers ADDRESS _ / t� f � \ Class:_ 7. MiscellaneousRM j QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS �- Case lots Drums AbOveTanks Undeig=ouad Tanks IN 1XIT IN O• IN IOUT # gEllons &g-e rest? Fuels: Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) r' new motor oil. . transmission/hydraulic Synthetic Organics: f degreasers 421��3_�U' � lk �a Miscellaneous: r_� DISPOSAL RECLANAATION REW,RKS: 1. Sanitary Sewage 2. Water Supply '� ^ OTown Sewer O Public -•fin on-site .,Pr'v to e.. e✓� 3. .1/ door Floor Drains: YES NO O Holding tank: MDC _ O Catch basin/Dry well ORDERS On site system _ 4...Outdoor Surface drains:YES NC Holding tank: MDC r - LAtr v .0 Catch basin/Dry well LI OOn-site system S—Waste Transporter Licensed? Destination j�[,1ste Prgduct ' Deis : Iry rviewed `! Inspecto"r�,, , Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: `7��'" P.O. Box 534 CONTACT PERSON: V o kj4g7A/ Ajry 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 quan es totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES 1,1 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 store Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Z (2�5_ Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners —j� Hydraulic fluid (including brake fluid) Disinfectants V Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, �L Other petroleum products: grease, lubricants rodenticides) f/ 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 _/V Asphalt & roofing tar Leather dyes Paints, wars, 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 ra, TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY ,� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ass: 7.Miscellaneous Q0QiA�TITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drunis Above Tanks Underground Tanks y' IN OUT IN OUT IN OUT #&gallons 777 Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) I lev new motor oil (C) v transmission/hydraulic ip Synthetic Organics: /,� degreasers GeP t.- Miscell neous: J DISPOS ECLAMATr REMARKS: 1. Sanitary Sewage 2.Water Supplyr` �.�✓ � °: . I �L�1 O Town Sewer R On-site Private (, df 3. Indoor Floor Drains YES NO_Jel O Holding tank: MDC O Catch basin/Dry well O`On-site system 4. Outdoor Surface drains:YES NO /1 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. e c� 2. 2 k erson (s) Intervie�We__d inspector Date i I U V V N Vt- t�Nt-�N5 IAULL e� satisfactory 2. printers BOARD OI; ' H BA LT H J 3. Auto rody Strops -� (unsatisfactory- 4. • Manufacturers COMPANY f+.. 4�/ �t � � �f'{� (see"Orders") S. Reta).1 Stores ADDRESS !-_` G� '� 6. Fuel Suppliers �� '��'ti � �A t-��'-�'� Class. r 7. Misc llaneous QUANTITIES AND S70RAGE (IN--indoors; OUT=outdoor Case lots Drums AbdveTanks Undet round Tanks hU1JOR hfATERIALS � 1N ] 1' g Fuels: U I N 6 gallons aUes, — Gasoline, Jet. Fuel (A) L � ' Dips el, Kerosene, 92 (B) Heavy Oils: waste motor oil (C) ,.new motor.oil (C) transmission/hydraulic .. Synthetic Organics: degreasers . Miscellaneous: 1 UISPUSAL FtE- LAR Jj'I'IU REhiI.RKS: � 1. Sanitary Sewage 2. Water Supply 0 Town Sewer O-Public 0 On-site Q Private l 3. Indoor Floor Drains: YES NO _ Q Holding tanks , MUC O Catch basin/Dry well On-site system -- 4. Outdoor Surface drains:YES NO X\ 0 lluldin`• tank: MUC Catch basin/Dry well -- On-site system �• —1 IL S. Waste Transporter Licensed? Name of Hauler ,_Ue;sjaInatnn -Waste Prodr � NO 1. LjOu Person(s) nt.ery ewe r: et `. . Inspector `Date r - TOXIC AND HAZARDOUS MATERI�LS REGISTRATION FORM Mail To: NAME OF BUSINESS- Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: -- 77tV— - P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 i Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities tot alli'g, at any time, more than 50 gallons Ions liquid volume or 25 pounds dry weight? YES NO V/ 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 tWd 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 _Z Hydraulic fluid (including brake fluid) Disinfectants raids/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, _t 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 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 COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANYe,, r� .: O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ZZ Class: / 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATE Case lots Drums Above Tanks Underground 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/hvdraulic Synthetic Organics: degreasers 41AW , Ara f -o t(_IfR6 Miscellaneous: t, ISPOS ECLAMATION REMARKS:-, �'r ��lara_ 1. Sanitary Sewage 2.Water Supply � - O Town Sewer OPublic On-site /Vrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC 'f O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO X ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES IN101 f�_ a erson s) Interviewed Inspec or 9a e