HomeMy WebLinkAbout0006 MAIN STREET (HYANNIS) - HAZMAT a oil L" s
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: '� -- P.O. Box 534
CONTACT PERSON: Hyannis, MA 02601
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Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totalli , 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 '
Please put a check beside each product that you store:
,Antifreeze (for gasoline or coolant systems) Drain cleaners
Automatic transmission fluid x 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 V 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)
(includ' leach 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
BOA OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
q (see"Orders") 5.Retail Stores
COMP s� ^ 6.Fuel Suppliers
ADDRES / 4 Class: 7.Miscellaneous
Q ANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
FS S.
Gasoline, t Fuel (A)
Diesel, Kerosene, #2 (B)
S.
was )
new motor oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
//DISPOSAI./RECLAMATION REMARKS:
'/1. Sanitary Sewage 2. Water Supply
own Sewer >Public
O On-site OPrivate
(�. Indoor Floor Drains YES NO
Q Holding tank:MDC
O Catch basin/Dry well
O On-site system
f� 4. Outdoor Surface drains:YES NO� ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
.Waste Transporter
Name of Hauler Destination Waste Product
NO
Person (s) Interviewed Inspector Date