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HomeMy WebLinkAbout0180 IYANNOUGH ROAD - HAZMAT %�D -�y��no��, �a� �l � ��ZY��A fi f K� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS:,/Ye/Sm �Qe� ©� roc. Mail To: Board of Health MAILING ADDRESS: 194D A Rd 1S Town of Barnstable TELEPHONE NUMBER: S—/l?D P.O. Box 534 CONTACT PERSON: � �� /�-e �-t Hyannis, MA 02601 S Does your firm store any of,the toxic or hazardous materials listed below, either for sale or for your own use, in qua (ties totalling, at 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: 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 Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners P� Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) t/ Gasoline,4pl4tte4 Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, E 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 ICar wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes r/ Paints, ves,..ss, dye 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 '*.s.te'c".pi".:wK.-...w#,.��'i'�.:.✓rtP\•�K•-+iT.:.�.t�J'=r�`'^'1�!•e�`"=w:,.-:*`nti��,+�.av+e;r�5•;�'°fs'� ^`"� r3;c�,: ;i�:.-�+i "�*_.`•.,w-..«'e•.��.F^:n:�v.T'-s',-�,,,;,,�,.;„c,s.ti,.. t TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair O satisfactory BOARD OF HEALTH 3.2.Printers Auto Body Shops ��+f O unsatisfactory- 4.Manufacturers COMPANY ff1/1�r a_•sYlr (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS /'e(_.,Z11,VejLj f,"f"�6 Class: �e� 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSDrums Above Tanks Underground Tanks IN OUTI IN OUT I IN OUT #&gallons Age Test Fuels: ' Ale, J Gasoline,Jet Fuel(A) Diesel,Kerosene, #2(B) J f'/0 Heavy Oils: �-.- waste motor oil(C) new motor oil (C) transmission/hydraulic,,.., Iff;V-,A �f Synthetic Organics: degreasers Miscellaneous: 4 DISPOSAIJRECLAMATION REMARKS 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic ` A ;O On-site OPrivate 3. Indoor Floor Drains YES K'NO- 0 Holding tank:lVIDC 4-1 /04 O Catch-basin/Dry well / O On-site.system 4. Outdoor Surface drains:'YES NO ORDERS: O Holding tank:MDC Of A4 z. ;'f.• AC�.�9 `. V,�'�s.%r�"✓� �- l O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 2. 1 Person (s) Interviewed Inspector �`! ' Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM /d Mail To: NAME OF BUSINESS:� �2 � Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: 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 _� 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 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 Hydraulic fluid (including brake fluid) Disinfectants otor oils/waste oils Road Salt (Halite) I Refrigerants ���asollne, ::� iesel fuel, kerosene, #2 heatin oil 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) Rustproofers Swimming pool chlorine Car wash 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 OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ���� O unsatisfactory- 4.Manufacturers COMPANY '0 e (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Clam 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATER 5 Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: asol' e det-F-uel+& �/ Heavy Oils: waste motor oil (C) new motor oil (C) �� >~ transmission/hydraulic ' Synthetic Organics: ol degreasers Miscellaneous: .� we `ll 5 DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer IVPublic ' Iq On-site OPrivate •���,�� r 3. Indoor Floor Drains YES NO c Holding tank: MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO /-' ORDERS: 0 Holding tank:MDC O Catch basin/Dry well 0 On-site system 5. Waste Transporter Name of Hauler Destination Waste Product —1 YES NO 1. 1&�& Q v 2. -Pers6n- WInterfiewed Inspec or Date r j TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: 1`�Q,bu_r) MAILING ADDRESS: Vct TELEPHONE NUMBER: to CONTACT PERSON: Does your firm-store any-of-the toxic or hazardous materials-. li..sted.: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 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, lease indicate if the materials are stored at a Y P 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 w Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) ,1 Hydraulic fluid (including brake fluid) Photochemicals J Motor oils/waste oils Printing Ink >1 Gasoline, Jet fuel Wood preservatives J 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 carbons, (inc.carbon Paints, varnishes, stains, dyes tetrachloride) Paint and lacquer thinners 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 fluids toxic or hazardous.(please (dry cleaners) R E C E I V E ® list. ; ; Other cleaning solvents HEALTH DEPT. Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants MAY 1 5 1981 Road Salt (Halite) _ e ' '� WN OF -BARNSTA BL`. �, C(MPLIANCE: CLASS:' 1 �Varin'e,Gas Stations,Repai.satisfactoy► : rinters ` EA D OF HEALTH 3. Auto Body Shops _ nsatisfactory- 4. ' Manufacturers COMPANY , (see"Orders") S. Retail Stores ADDRESS 4 ,` 6. Fuel Suppliers �� Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Undetground Tanks IN DOT IN IOUTIN IOUT N zl e Test? Fu�6`aso�fine;e_..\ It Fuel (A ; 4>�' iDiesel, Ker "e, N2 (B) , heavy oils: waste motor,.oil (C) new motor oil J, transmission/hydraulic Synthetic Organics: Q v degreasers W �tr Misceltlanedus: I rn f ISPOSAL RECLAMATION• r dP REMI,RKS: {' ' 1. Sanitary Sewage, 2. Water Supply OTown Sewer ublic a�On-site. O Private 3. .Indoor Floor Drains: YES NO Qolding tank: MDC O Catch basin/Dry well — On-site system 'DERS ---------- - -•-. ..-----...._._ _4 .�` _ !•1� 4. Outdoor Surface drains:YES NO \ " �- Q Holding tank: MDC f O Catch basin/Dry well --� OOn-site system , S. r:Waste Transporter °L' - Name of Hauler �• ed.? �1(ast . Product, ' l( r Persdn s) Int.errviewe A, �3 1 > • Inspe to at