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HomeMy WebLinkAbout1220 IYANNOUGH ROAD - HAZMAT 7 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS:-7 k v?-s F <,4AU 42c,J Board of Health MAILING ADDRESS: 61)4"F �Foj-@ (3:;�7 A,-jr s- 111A Town of Barnstable TELEPHONE NUMBER: /-=5 -°4 Y"-- -77­3_—/5� / P.O. Box 534 CONTACT PERSON: zT �V Hyannis, MA 02601 Does your fi 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 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 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, 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 rwv''"*..,/"�."'"�*LeL°•t"1M„ri'.-y�,[x"++�.^•w;.r+',p" '',«f�„{,',.:,,,.., n �`° .ir..+4.r-a.•-"��'''.4iH�, . .. r ...F..ar,....+•.'TOXIC, AND HAZARDOUS MATERIALS REGISTRATION, FORM Mail To: .. NAME OF BUSINESS:-Y ',v,'f s o C"#9 }4 Board of Health MAILING ADDRESS: » ' '� j 0'4 6',al Town of Barnstable P.O. Box 534 TELEPHONE NUMBER: Hyannis, MA 02601 CONTACT.PERSON: A i- •, ,dtt " f h toxic or hazardous materials listed below, Does your firm store any o the to , either for sale or for your own u'se, 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: R q.4 Ili - sw 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 uantities totallingmore than 0 allons liquid g q — q volume or 25 pounds dry. weight. 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) e,*' Gasoline; Jet fuel _r 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 Y- +Any"other:product' 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 `V Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business