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Home My WebLink About1171 IYANNOUGH ROAD - HAZMAT { S � l �'�c�,nnclv�Q� - - `�� - -�z-drv� - - - - Y r®r S EA® (SEEPING YOU.ARCANIEE® 10334 2-153L WHIN USA CET ORGANIZED AT SMEAD.COM ram, TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: '7 --�It3/ �../ � P.O. Box 534 CONTACT PERSON: /�� Hyannis, MA 02601 Does our firm store an of the is or hazard��s materials listed belo , ither for sale or for Y Y your own use, in quan ies totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES K, 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 exhib�toxic or hazardous characteristics and must be registered w` Please put a check beside each product that you store: Antifreeze gasoline asoline or coolants stems Drain cleaners ( systems) _ Automatic transmission fluid �� Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants lr' Motor oils/waste oils Road Salt (Halite) ✓ Gasoline, Jet4ffel Refrigerants Diesel fuel, -.___ it 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, varris4ieZnW-s—,-,4-yes 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) y Other cleaning solvents \ Bug and tar removers \' Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE WOMPLIANCE: CLASS 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops l� c,Q 0 unsatisfactory- 4.Manufacturers COMPANY �� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS t f °� SS: 7.Miscellaneous 7,J5�,P.l 4 W X-V"V ��QUANTITI S AND STORAGE (IN= indoors;OUT=outdoors) MAJOR�TERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test _ v Fuels: Gasoline,d -Faei=�Aj 3 k- Diesel, Heavy Oils: waste motor oil(C) e new motor oil(C) i4fts transmission/hydraulic ~ Synthetic Organics: degreasers Miscellaneous: o �S fw-rom66r 41fle DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water.Supply 2!_z ��s:� O Town Sewer *Public On-site QPrivate 341ndoor Floor Drains YES NO J �/ 0 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 O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product •d YES NO 2. R Q Person(s) Interviewed Inspec or Dat TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: ill i 1 V j I Board of Health MAILING ADDRESS:-, (1(' Town of Barnstable TELEPHONE NU / P.O. Box 534 CONTACT PERSON: Hyannis, MA 02601 D r firm store an of the toxic or hazardous materials listed below, either for sale or for Does your , Y Y your own use, in qu les totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES aZ 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 registere Please put a check beside each product that you store: 7 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) � s 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 BOARD OF HEALTH ' A satisfactory 2.Printers3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 251-IP�i� _� �G (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 7 �rr� (;ja5S; 7.Miscellaneous QUANTITIES AND STORAGE .. (IN=indoors;OUT outdoors) MAJOR MATERIALSUnderground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline, ) Diesel, Kerosene, #2 (B) Zzw Heavy Oils: waste motor oil (C) 0 new motor oil(C) WfiW^4li transmission ydraulic ,Vex !/ Synthetic Organics: degreasers Miscellaneous: r Y DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0 Town Sewer tPublic Prin-site O O O vale -3. Indoor Floor Drains YES_jj/ NO 0 Holding tank: MDC ON �0004 O Catch basin/Dry well 00 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 14 r4";17-6 � YES NO 1. 2. Perso Inspector Date ,� COMPLIANCE: CLASS: 1. Marine,Gas Stations.Repair �a- 0,F BARNSTABLE .01 satisfactory 2. Printers QOAf�D' � OF H -ALTO-I • 4;' Ftaiufacturelrsps nsatisfactory- IMPANY ,.G�d�^ :(see"Orders") S. Retail Stores • ---�• 6. Fuel Suppliers 'DRESS O!''' "` Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUl*=outdoors) JOR FfATERIALS Gase lots - Drums • AbdveT•anks Underground Tanks 0 UI' Qy R jgE lons Age UCs t 1 Fuels: , Gasoline, Jet Fuel. (A) �Diesel,• Kerosene, IZ (B) I heavy Oils: waste motor oil •. (C) new motor oil (C) _.. _ transmission/hydraulic , :ynthetic-,Organics: , degreasers j iscelloneous: a PU:AUMUM C'Ii' Ut REMUS I Sanitary Sewage. 2. Water Supply 0 Town Sewer Public _ On-site Q Private ,Indoor Floor Drains: YES NO Q Holding,tank: MUC ® Catch basin/Uri well 'j�}�(j�!Q�� 0 On-site system Outdoor Surface drains:YES NO, lluldin`•,tank: MUC ® Catch basiniDry well 0f - ---'' On-site system Waste Transporter . • Licensed? Name of Haller r c �tla_eae Iastion , Pro , ' 7 � p c , )WN . OF" BARNSTAC3Lff COMPLIANCE: CLASS: 'L Marine,Gas Stations,Repair satisfacto 2. Printers - BOARD. OF H C �''1-� - � � 4.' Auto acturehops ®unsatisfactory- �F1pAN (see"Orders") s. Retail Stores. 6. Fuel Suppliers IURES •.,_� Class:_ 7. Miscellaneous QUANTITIES AND S70RAGB (I indoors;, OUT=outdoors) JOR MATERIALS Ctase lots Drums ' AbdveTanks Underground Tanks IN Ur 1, IN vim WL & fe l lons a Lest?_ Fuels: - , .Gasoline, Jet Fuel_ (A). Diesel * Kerosene, 12 (B) 1 heavy Oils; — waste motor :oil .. (C) new moto�c•`oil (C) , '• — — .—.�" _ r transmission/hydraulic `synthetic ,Organics: _ 3 degreasers ' iscell'aneous: , ]jl PosAURE�,�Iut - _--- MEMRKS: . Sanitary Sewage. 2. Water Supply Chown Sewer public •� - J �, ^� On-site Q Private l` . ,Indoor Floor Drains: YES 140 Holding tank: MUC ® Catch basin/Dry well 0 On-site system Outdoor Surface drains:YES NO HoldinE• tank: MUC ; ® Catch basin/Dry well ® On-site system Waste Transporter _ Licensed? -Nam e_of_Hauler_ UP-4tinafInn _ Mast a Exodiitt,• XFS_ A OWN OF BARNSTABLE COMPLIANCE: CLASS: - 1.�'Marine,Gas Stations,REpai.r satisfacto •' 2. Printers BOARD OF HEALTH ' 3. Auto Body Shops R 0unsatisfactory- 4. Manufacturers OMPANY � " � r - (see"Orders" 5. Retail Stores . � ) L� 6. Fuel Suppliers UDRESS T � _ Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) 4JOR MATERIALS Case lots Drums AbaveTanks Undetground Tanks 'IN OUT I T N e o f Fuels: 70 Gasoline, Jet Fuel (A) J a' -C, j- Diesel, Kerosene, N2 (B) Hel.96 G av,F ,Q; ls: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: ti degreasers Miscellaneous: i ;POSAL RECLAM,ATIUN RKSs r � , L. Sanitary Sewage. 2. Water Supply REM�'. OTown Sewer Public k _ ® On-site Private .. ,Indoor Floor Drains: YES NO ® Holding tank: MDC Y Catch basin/Dry well _ On-site system EitSi s r Outdoor Surface drains:YES NC t ® Holding tank: MDC ® Catch basin/Dry well O - On=site:`system Waste Transporter . Licensed,"? Name of Hauler b c ina -�.�.QIL -Waste Product 3 ei Person s) Int.erviewe Inspector Date —�- , — FO W N OF BA R N STA B L ELounsat LIANCE: CLASS: 1. Marine,Gas Stations,Repair sfactory 2. Printers BOARD OF HEALTH 3. Auto Body Shops isfactory 4. Manufacturers (see"Orders") S: Retail Stores COMPANY �'�(�-lG �' 6. Fuel Suppliers ADDRESS 7f>?>J - f°��n Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks IN IDUT IN IOUT IN tOUT # & L721lonsA e rest? )v v')o& FueGasoline Jet Fuel (A) U" 00 Di.estj Kerosene, #2 (B) He Oils: waste motor oil (C) new motor of (C) 6:: transmission/hydraulic Synthetic Organics: ! degreasersS�o't-� Z l Miscella )ous. I �2Q DISPOSAL REC :ATION REMARKS: 1. Sanit Sewage 2. Water Supply yTown Sewer Public 0 on-site ?ZN70 Pvate J 3. ,Indoor Floor Drains: YES O Holding tank: MDC t 0 Catch basin/Dry well �� L On-site system M�-7 4. Outdoor Surface drains:YES NC 1__21,1fvh 17 L 4- Holding, tank: MDC O Catch basin/Dry well OOn-site system S. Waste Transporter Licensed? Name of Hauler_ pectination Raste Product NO 1. Person s). t.erviewed Inspector Date 12 23 81 'FO N OF 8 ;, N5 8LF COMPLIANCE: CLASS: 1, tlarine,'Gas Stations,RFpai.r satisfactory 2. Printers -- BOARD Oj" HEALTH 3. Auto Body Shops Ounsatisfactory- 4. Manufacturers (see"Orders") 5. Retail Stores COMPANY 6. Fuel Suppliers ADDRESS �;i- � � � '"�� 'y Class: _ 7. Miscellaneous J QUANTITIES AND STORAGE (IN=indoors; OUT=ou;.doo' Case lots Drums AbdveTanks Undeigrouad Tanks !•4AJOR.;:MATERIALS IN PUT IN IOUT IN UT # 21lons Age ,es'`.p Fuels: V Gasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Iv�L� �(J Heavy Oils: . waste motor oil (C) U� i new motor oil (C) Tig ( �.. transmission/hydraulic s _ Synthetic Organics: _ i degreasers i a Ydi r�j1�,2�eous: DISPOSAL RECLA.M:ATION - -- "' RE�`'�dRKS 1. Sanitary_Sewage Z. Wa&Pu�blic SlyID- Town Sewer ® On-site 0 Priv to - 3. Indoor Floor Drains: YES N ® Holding tank: MDC Catch basin/Dry well 0 On-site-system ORDERS: 4. Outdoor Surface drains:YES . ; NCx" 0 HoldinL tank: MDC } i ® Catch basin/Dry well On-site system S. Waste Transporter Licensed? Name of Hauler Destination Waste Product 1. v, 1 erson(s) Interviewed 1 23 81 Inspector 'Date -- e7 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: A Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: �'� •�1 �' 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 quan ties totalling, at any time, more than 0 gallons liquid volume or 25 pounds dry weight? YES V 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 gasoline or coolant systems) Drain cleaners i� Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) V Gasoline, A+feel Refrigerants V 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 V Paint & 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 2. nters BOARD OF HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS dA A 7.Miscellaneous QU IES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER `9 Case lots Drums Above Tanks Underground Tanks ' IN OUT IN OUT IN OUT #&gallons Age Test Fuels: 10140V 94it4z, Gasoline, �dl4at Diesel, Io"aaaa2 (B Heavy Oils: waste motor oil (C) new motor oil (C) �eS transmissio_/ ydraulic /,C {� Synthetic Organics: degreasers g (/ M cell neous: ' 12i._S V V Na4 IA'a" �' Y DISPOSAUR.ECLAMATION REMARKS: 1 S rotary Sewage 2. Water Supply f `� Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES t"" NO O Holding tank: MDC 6¢110L O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. a- P/ Per on (s) terviewed Inspector Date A TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: • e��_ MAILING ADDRESS: -�, f 3 to P ses— W a y TELEPHONE NUMBER: 7 7.5— 96 d2a CONTACT PERSON: A e o far d N c fer> Does your firm store:- any, of the--t6xic or hazardous..mat-exials .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: Sa e 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 — a000'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 j Degreasers for engines and metal Jewelry cleaners Degreasers for driveways & garages Leather dyes __/'Battery acid (electrolyte) Fertilizers (if stored Rustproofers outdoors) 1 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 4- 1981 Road Salt (Halite)