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Home My WebLink About0192 IYANNOUGH ROAD - HAZMAT a r J Cl%I OCR. y TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: -S� �'y S '�� 20 �'42`�G Board of Health MAILING ADDRESS: f2 el /24 Town of Barnstable TELEPHONE NUMBER: .�d�- �'°7l- 3 P.O. Box 534 CONTACT PERSON: S1'L"7�l� �v /�, Cady 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 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 Hid vp t. 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 Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating 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 ite Co alth Department/ Canary Copy-Business TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: A-1 4 P �`� ��'`? ✓`'« 'tZ2 Board of Health MAILING ADDRESS: / �- q,4 ao Town of Barnstable TELEPHONE NUMBER: 7 -7 ' P.O. Box 534 CONTACT PERSON: - � � �� 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 quantities t t (ling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO, llx 1�/ 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 tt .e-following_p.r._oducts exhibit toxic or hazardous characteristics and must be registered ns-liquid_ 'T 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 Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating 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 4 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory BOARD OF HEALTH 2.Printers3.Auto Body Shojis ,p O unsatisfactory- 4.Manufacturers COMPANI' e (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT-outdoors) MAJOR MATERIAL Case lots Drums 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/hydraulic Synthetic Organics: degreasers Miscellaneous: j DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply - � " "I" Z�- La�G O Town Sewer Public �YOn-site OPrivate 3. Indoor Floor Drains_. --YES N0� O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO—Z 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. 2. Person(s) Interviewed Inspector Date • •L TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �� Mai l To: NAME OF BUSINESS: ��L C�� 1� �l�'e1�ujje 5 /jur Board of Health MAILING ADDRESS: /9AA &ANQQPW 9® Town of Barnstable TELEPHONE NUMBER: v d7— 776 41a5'9 P.O. Box 534 p --, Hyannis, MA 02601 CONTACT PERSON: /�G,BFif'� G�J jT c l? 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 registered1 �t - Please put a c eck 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 Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating 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 t •-•. .>�i' .--a..�.,:7,h._,.,,!'"".. <:r'.i.,;l.`f;�4.,�`�'v!-•-.;..•r..�..;a'+.{+ro....siew.•'r,+Fw�^tiw?�::,�•^w.•'g-:•.-„'^",...•.e<.+c.•�.��r-..•�.•�- '•..-..+•...-r..ry.� ., .-.:..I^$•.-.. ..,s.y�:a"rn^ -. TOWN 1V OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 3.Auto Body Shops ,O unsatisfactory- 4.Manufacturers C0MPANYW1A"'4'-L_A w4lo1+/P 0 (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ./lZ ' 0PP Clask 7.Miscellaneous OF A /,4UANTITIES D rAD .STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS � Case lots Drums Above Tanks Underg-round 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/hydraulic Synthetic Organics: degreasers Miscellaneous: /ofI DISPOSAUR•ECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply. �( •!`-r` - . �.a ,` + '. r / . ' ' 0 Town Sewer &Public tQ On-site &Private , 3. Indoor Floor Drains YES NO r 0 Holding tank:MDC 0 Catch.basin/Dry well '. O On-site system 4. Outdoor Surface.drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO } r S.. 2 n Date /Person(s) Interviewed Inspector `f a TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: Ch*c ic!-t /zcfP�N ('l, s� r/ �D✓f�, MAILING ADDRESS: I TELEPHONE NUMBER: 7 7 - 3 2 7 7 a CONTACT PERSON: G L p r� .Z .4 w is Does your firm store-any-of the-toxic-or---hazardous- materials. 1= stsd-b�e1-0_a,;_- 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 in quantities f 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)w Refrigerants Automatic transmission fluid Pesticides (insecticides, j 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 (creosote) Other petroleum products: grease, p p g 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 I 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 hydrochloric acid, other Metal polishes acids) . Laundry soil & stain removers Other products not listed (including bleach) Spot removers & cleaning fluids which you feel may be (dry cleaners ) R E C E IV E D toxic or hazardous (please Other cleaningsolvents list.,: HEALTH DEPT. Bug and tar removers TOWN OF BARNSTABLE — Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners 4 1981 Disinfectants MAY 1 Road Salt (Halite)