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Home My WebLink About0066 LEWIS BAY ROAD - HAZMAT � �� a� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: Pa,,<, MAILING ADDRESS: (o(. s TELEPHONE NUMBER: -7-71 7;k S� CONTACT PERSON: "K(., Does your firm..store any of: the toxic or hazardous materials listed4below., 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 gasline or coolant systems) Refrigerants 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 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) Other cleaning solvents HEALTH RECEIVED DEP T list. : HT. 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) TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM : Mail To: NAME OF BUSINESS: 4lyg7� q46> lue- Board of Health MAILING ADDRESS: L, /-Gina ✓3,f 77/?� �- ffN�/�s��9,g Town of Barnstable TELEPHONE NUMBER: s"d�- - 7�16s 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 tot V99 , 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: - 2 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 store Please put a check beside each pro uct tha�you store: 1.e 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) tom` �d c �G, U Other cleaning solvents -S' �'a 2-5 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 satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers OMPANY (see"Orders") 5.Retail Stores spy 6.Fuel Suppliers ADDRESS Class• / 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALSCase lots Drurns Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test s: Gas i ,Jet Fuel (A) Diesel, #2 (B) i' envy Oils: waste motor oil (C) n w motor oil (C) tran mission/hy4- aulic Synth is Org nics. degre sers Miscella ous: DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply Town Sewer 10 Public O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter I Name of Hauler Destination Waste Product YES I NO 2. o / /� Person (s) Intervie Inspector Date l TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: � Board of Health MAILING ADDRESS: p�j f' 7V eeZ Town of Barnstable TELEPHONE NUMBER: '7�:,? 10- 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 totalli g, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO 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 the following products exhibit toxic or hazardous characteristics and must be registered when store on- OF 1111P 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 Cesspoo�'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 tr removers Household leansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q satisfactory 2.Printers -BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class:, 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 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: DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply '� '" I �¢a 0a se Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC A14 V ,v e O Catch basin/Dry well " O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter DestinationName of Hauler YES NO �' 1. •— � 5'e {� ,�/r9 ��et.✓% tiU e.5`" 5 w �e�ei � •�� v 2. Person (s) Interviewed Inspector Date V TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: s 5 )n� Board of Health MAILING ADDRESS: C06 -k=i Town of Barnstable TELEPHONE NUMBER: ? 3s-/ J P.O. Box 534 CONTACT PERSON: AI, _ a Hyannis, MA 02601 Y � Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totaling, 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 i - 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 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 / e (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 3 lass' 7.Miscellaneous � QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Underground IN OUT IN OUT IN OUT #&gallons Age Test F ls. Gas et Fuel (A) Diesel, Kero , #2 (B) V,1t�rt. H C ls: �,rn waste zc ) j �/4 b V� new ) if3 transmission/hydraulic. Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1mown itary Sewage 2. Water Supply � - D 3 Sewer JWPublic O On-site OPrivate 3. Indoor Floor Drains YES NO `y O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Person'(s) Interfiewed Inspector ate r