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HomeMy WebLinkAbout0015 PLANT ROAD - HAZMAT J �+y � � 3 IME►okti Town of Barnstable Office:508-8624644 Public Health Division Fax:508-790-6304 BARN STABLE. ' 9 MA.3% $) 200 Main Street• Hyannis, MA 02601 i639N TOXIC AND H RDOUS MATERIALS INSPECTION REPORT RFD MP'� Business Name: c� �. te: b S I Location/Mailing Address: a 1 t'\- Contact Name/Phone: yo d \1 l Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: — O Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: — It 2 4-, Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS ° NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous 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: �S 1V�lhaalL_-Oookr)l a ORDER \�e_ INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS v°FIHEt°h� -/J + Town of Barnstable w Office:508-862-4644 Public Health Division Fax:508-790-6304 • BAHNAT,'; E.,! ` _ 200 Main Street• Hyannis, MA 02601 059. " IEOMP+ (�TOXICAN(D HAZARDOUS MATERIALS INSPECTION REPORT �Q Business Name: I c. ,7-er \ nr9 \ha f_ 1 b��,N.�� A Date: �I�l ►V Location/Mailing Address Contact Name/Phone: yl_�� b� Inventory Total Amount: SIDS: License#: Tier II : Labelina: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: n n 4 ^ 11 Emergency/Containment Equipment: klA P + oA ., I i 1 0 "1/V b — AlaS 7 Waste Generator ID: �" ` Waste Product: Date&Amount of Last Shipment/Frequency: \ n Licensed Waste Hauler&Destination: Other Waste Disposal Methods: n 1�7_ LIST OF TOXIC AND HAZARDOUS MATERIALS ° NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous 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, n hydrochloric acid, other acids) VIOLATIONS: �� �o t��r ,b�I11��C�'C_,C ��1�kL `) 0 C)K ,��V�CyI,cStL tip. 0r Ax-, 1 V)(4 �+� I r�-i�. .+ � r f IA t ORDERS . - I I J/iv fe la �`i-� � ����- LI�AR_K uV�`t_ INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY-,HEALTH DEPARTMENT/CANARY COPY-BUSINESS Number Fee 1343 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Tours, Inc BA Cape Cod Duckmobiles 15 Plant Road, Hyannis, Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health i'si-,x of Gh I--4- S"�S3 Voengatory nsxable ervices I - ��'+ IME Richard V. Scah, Director Public Health Division BARNSTABLE • bAf:NSM1ELE.LENTE<'Jlttf•CO7iIR..yy4N`IS'. • • BARNSPABLE. ' Thomas McKean Director WUIDIS 3•°SE^'D� fM1 � , NAM. 1679-IQI4 o �a` 200 Main Street,Hyannis,MA 02601 513 ,, �.r Office: 508-862-4644 Fax: 508-790-6304t•t1 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS ;�_; IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PRRMIT 1.11 —499 Gallons: $125.00 Eel Pz40 -- - CA'I`EGORY 3.PERMIT 566 or more Gallons: $150.00`-. I *A late charge of$10.00 will be assessed if payment is not received by July 1st 1. ASSESSOR'S MAP AND PARCEL NO. :? /)- 1 U 01 1 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 7 4,tv 11--e�J 5. NAME OF ESTABLISHMENT: ` - J C. r✓„� �.. 6. ADDRESS OF ESTABLISHMENT: / S'� /9/k 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 00 Y 4�3 /pia ht i 141,4 G 8. TELEPHONE NUMBER OF ESTABLISHMENT: 1�;-d F' 6 9. EMAIL ADDRESS: 10. SOLEOWNER: YES�O IF NO,NAME OF PARTNER: L L C 11. FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PT TREASURER �1 7-ty '.607 CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: M SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVIS ocx i Number Fee 1343 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that Cape Cod Tours, Inc Cape Cod Duckrnobiles 1S Plant Road, HyanrA , Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. --------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health lwofori Brnsxable egu atory ervices t"e Richard V. Scah, Director � Public Health Division BARNSTABLE • r BARNSMBLE.!• enrsnsrne r639-2.rnrurt•ntu:ru Thomas McKean, Director W45i0'S NI1616 9-20 Qo-'v8Afi4St:Ptk M,►ss 575 x639• s 200 Main Str t Hyannis, MA 1 ee , 0260 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 (t L r CATEGORY 3 PERMIT 500 or more Gallons: $150.00 PP *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. _ C) 0 I 2. IS THIS A PERMIT RENEWAL? YENO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 7 "V 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: w `Z-�� 141r4 r r 01, � 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 00 V ys 3 /7fla 8. TELEPHONE NUMBER OF ESTABLISHMENT: j CJ F- 7 6 C1&2 9. EMAIL ADDRESS: c 1v i w" �i �s�l0 0 (4� �'1 PC• 61 10. SOLEOWNER: YES�eO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME c,w ",/C PftE8tbE.1fr " 8 4' M TREASURER f14-7� CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 2 Q:\Application Forms\F-AZMAT APP 2017 REVIS ocx `°Fv+s rok$ Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 98ARMABLE,A 200 Main Street• Hyannis, MA 02601 �p t639.p�9 tFOMAIR �O I XIC AND HAZARDOUS MATERIALS INSPECTION R PORT Q Business Name: ( cO av{5 Date: �v Location/Mailing Address: Contact Name/Phone: Inventory Total Amount: A-ZdD qGl,I SDS: Bw 1 License ---- �— Tier II : v 1 Labeling: & \�a v Spill Plan: o Oil/WaterSeparator: Floor Drains: 10kVLA01Dofzmeraencv Numbers: •` Storage Areas/Tanks: g4, W k e, wk Emer enc /Containment E ui ent: �J < < oW S`-%2, IS I Waste Generator ID: Waste roduct: o Date&Amount of Last Shipment/Frequency, I x - Licensed Waste Hauler&Destination: 4 Vk-, Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze 2 Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) 4\Q '27— Windshield wash 147-- k'10 Motor oils 54- 1`{D 1 <- 1/Jk5 Miscellaneous Corrosives Gasoline,jet fuel, aviltion gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products' Road salts grease, lubricants, gear oil \ Refrigerants ` Degreasers for engines&garageV�2,\,J,4 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 Z Lye or caustic soda I Lacquer thinners f; —� Miscellaneous Combustible t 44-<D5o15 Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables#"k Fertilizers Floor&furniture strippers S\,�Xs 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: DE S: a /5. s ,-{ INFORMATION/R COM EN ATION : e„ls VCL0l t< A C) - owl t I spector: � Facility Representative: Np� WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS' r O ASSESSORS MAP NO. l PARCEL NO. ` 0o7( ADDRESS: 15 P(Ca,vit VILLAGE 4&jal vivits CONTACT PERSON PHONE NUMBER '7`7`� -� LOCATION OF TANKS: - CAPACITY: TYPE OF- FUEL AGE: TYPE: LEAK OR �HEMICAL: DETECTION CL 1 � U _ f SYSTEM! {i (4 Ck wy).(5 -=; C2 wl P l a�d ( -- a-4A L DATE OF PURCHASE OF EACH: 1. 2. 3. 4. 5. DATE OF FIRE DEPARTMENT PERMI-T. TESTING CERTIFICATION SUBM TED: D DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING THE L IO THIS CARD. e t CT UE �_ _ _—.' _ — r� — �_ i-i�wiyM"JE}.'.�.g..w�`--.--•� rs•_,._ a A...� rY �.. .ir — I—j [ L THE COMMONWEALTH OF MASSACHUSETTS FIRE DISTRICT OF HYANNIS, JtA_ FIRE DEPARTMENT { FIRE PREVENTION DIVISION PERMIT FOR STORAGE OJP FUEL OIL In accordance with provisions of Chapter 148, General Lams, and amendment-", and Regulations made under authority thereof. Name $LLZ. 'Zt-- Name T (owaier or os ccu_ppajn ) _ _� - - C (Installer) Address _........ �RQ BURNER. STORAGE . Name .._.....Will STl1S of Tank I Manufacturer __._.._..._C,apacityQQ_ gals. (or)'Size_ I i Model No. or Size I Type --•Cs.un-•..-..Mass. Approval No.�f'._ Permit .:......expires................ of b ept)t� Fee__,_ _.____..:--Paid......._............ ::....._._..... This Permit Must Be Conspicuously/ Posted on Premises MID CAPE SHEET METAL INC. � 15 PLANT ROAD P hsl HYANNIS,MASS.02601 � "EG° US�A� ..� A PR �ti i TOF DEMOCRACY E Ina , a.76 o �� �% _ .� _ ---�_ ` 1 L TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM �� Mail To: NAME OF BUSINESS: ✓ �° � �� �? � �' Board of Health MAILING ADDRESS: �-�✓ � � �� �i�9 �L1`1� Town of Barnstable TELEPHONE NUMBER: S 3 P.O. Box 534 CONTACT PERSON: 7A v C_ S- Z h Hyannis, MA 02601 Does your firm store any o the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totall' g, 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 6/ 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 t/ Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) f/ 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 ,s r^ -- .., „�,'�a.- -�..^n°^rWw:+�,;++!'�:;.:.K^JF+1,,.U<.,,i.,,;.,'�t 43e.:n.4-=.�,.-x°'' d �I1r�r.sn-. ..., ,s. %•'.-;spa•�.. _ _ ,, , k •� �►.�, .. �� _ J y, i -.:cam .ae.,,,. `r�'Jr�.wvrrx:�. ,.lt :i..Y£w«s.;.,r.�*.-. i"�• +�', •ta,.� TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 1 3.Auto Body Shops r O unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores r 6.Fuel Suppliers ADDRESS /r�/`4,v-2r IV Class: f 7•Miscellaneous `r.0 QUANTITIES AND STORAGE ` (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN . OUT IN OUT #&gallons Age Test 1 Fuels: �� '.18 Gasoline,let Fuel(A) Diesel, Kerosene, #2(B) j, Heavy Oils: ` waste motor oil (C) i new motor oil (C) / transmissiow hydraulicc Synihetic Organics: degreasers W Ir / Miscellaneousr� y ) A1,, DISPOSAL/RECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply r,Rrt. � W1 ,, 'r •,� ' w _ , / O Town Sewer fi Public { r,0 On-site OPrivate 3 r 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 i 5.Waste Transporter Name of Hauler Destination Waste Product YES NO . 2. Person (s)Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM t - � Mail To: NAME OF BUSINESS: � � �o � V��, Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: —77 9—` P.O. Box 534 CONTACT PERSON: �� v L �`r� 122V tl 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 total g, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO 11// 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 l/ Automatic transmission fluid y Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste-trils Road Salt (Halite) Gasoline, Jet fuel Refrigerants � 'Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, v 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 —Z Asphalt & roofing tar Leather dyes l/ Paints, 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 COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY s O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 12S Class: 7.Miscellaneous UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERMES Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Biese�, Kerosene, 424A3}.- I Heavy Oils: IV waste motor oil (C) new motor oil (C) LDS' transm sion/hydraulic v Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Public J'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 I cilan�"I X_/� r 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person (s),Interviewed In bedor Date