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°p ENE Tpk� Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
• BARMA�BLE.�' 200 Main Street• Hyannis, MA 02601
TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT pp�]
Business Name: Date:
Location/Mailing Address:
Contact Name/Phone:
Inventory Total Amount: � O MSDS: License#: �
Tier II no Labelina: tleR Spill Plan:
Oil/Water Separator: Floor Drains: Emergency Numbers:
Storage Areas/Tanks: %Ifii�
Emergency/Containment Equipment: `� 1
Waste Generator ID: Waste Product:
Date&Amount of Last Shipment/Frequency:
Licensed Waste Hauler&Destination:
Other Waste Disposal Methods:
LIST OF TOXIC AND HAZARDOUS MATERIALS no Japae, o�jlQ� '
NOTE: Under the provisions of Ch. 111, Section 31, of the Ge raf aws of A, h rdous material use,
storage and disposal of 111 gallons or more requires a license from the Public Health Division.
Antifreeze Dry cleaning fluids
Automatic transmission fluid Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
Hydraulic fluid (including brake fluid) Windshield wash
Motor oils Miscellaneous Corrosives
Gasoline,jet fuel, aviation gas Cesspool cleaners
Diesel fuel, kerosene, #2 heating oil Disinfectants
Miscellaneous petroleum products: Road salts
grease, lubricants, gear oil Refrigerants
Degreasers for engines&garages Pesticides:
Caulk/Grout insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
Car wash detergents Printing ink
Car waxes and polishes Wood preservatives(creosote)
Asphalt&roofing tar Swimming pool chlorine
Paints, varnishes, stains, dyes Lye or caustic soda
Lacquer thinners Miscellaneous Combustible
Paint&varnish removers, deglossers Leather dyes
Miscellaneous Flammables Fertilizers
Floor&furniture strippers PCB's
Metal polishes Other chlorinated hydrocarbons
Laundry soil &stain removers (including carbon tetrachloride)
(including bleach) Any other products with "poison labels"
(including chloroform,formaldehyde,
hydrochloric acid, other acids)
VIOLATIONS:
ORDERS:
INFORMATION/RECO MENDATIONS:
Inspector-
Facility Representative: L�
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS