HomeMy WebLinkAbout0024 PLEASANT STREET - HAZMAT " Z -
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
ASSESSORS MAP NO. PARCEL N0.
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ADDRESS,' VILLAGE' /Y'f✓,y,(jc�rl'
�AR.,�sT,a��.2 (��'TRIbT P/?�,sS, iIVL? �N � �
NAME,'_ ,
CONTACT PERSON I G N2D PHONE NUMBER k7 `7
LOCATION OF TANKS: CAPA ITY: TYPE OF FUEL AGE: TYPE: LEAK .
OR CHEMICAL: DETECTION
�f« c-P. 13V/L.I)L 0 _D 'I Ia ? SYSTEM!
DATE OF PURCHASE OF. EACH: 1. 2. 3. 4. 5.
DATE OF FIRE DEPARTMENT PERMIT:
TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS
F.PLEASE PROVIDE A SKETCH SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD.
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RETURN IN FIVE DAYS TO
THE PATRIOT PRESS
�iinte�s�or al[ o�cape coc�
P. 0. Box x
HYANNIS. MASSACHUSEWS 02601
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
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NAME OF FIRM: `i-l-t - �'/��-2� D i� Ross
MAILING ADDRESS. p O 30X X �-`� PL�v{-sPrfL)7" Sl`�. ,1��/'3N N l5 Af 01-S5
TELEPHONE NUMBER: 7 7 S _ ZS` 4?"-5
CONTACT PERSON: 'R, 0b , Nl�SK/Aj
Does your firm 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 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,lubricants Swimming Pool chlorine Degreasers for engines and metal Lye or caustic soda
Jewelry cleaners
Degreasers for driveways & garages Leather dyes
Battery acid (electrolyte) Fertilizers (if stored
Rustproofers
Car wash detergents outdoors)
Car waxes and polishes Asphalt & roofing tar Other chlorinated hydro-
carbons, (inc.carbon
Paints, varnishes, stains , dyes tetrachloride)
. Paint and lacquer thinners Any other products with
Paint & Varnish removers, deglossers Paint brush cleaners "Poison" labels (including
chloroform, formaldehyde, �
Floor & Furniture strippers hydrochloric acid, other
_ Metal polishes acids)
Laundry soil & stain removers(including bleach) Other products not listed
which you feel may be
Spot removers & cleaning fluids(dry cleaners ) toxic or hazardous (please Other cleaning solvents RECEIVED list) :
Bug and tar removers HEALTH DEPT.
Household cleansers, oven cleanT69-WNW OF BARNSTABLE
Drain cleaners
Toilet cleaners
Cesspool cleaners
Disinfectants
Road Salt (Halite) ��� 1� ^�
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TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET'
FIRM Pt ,.4
ADDRESS $ rts, •.
.�
Major types of materials: 1) y � � a'" 2) Qe' � �, tl3)
4) r 5) 6)
I. Description of material(s) use:
II. Storage (denote product by number listed above)
A. Containers
metal glass paper pla#stic �
cans,bottles,jars
R *4
4J
drums,barrels. #
Ad-
aboveground tanks "
underground tanks
bags,boxes
open,loose,uncovered #
inadequate labelling
B. Storage Facility ✓or # Remarks/Recommenc :Li_ons
1. Indoor ——"
a) separate, contained room
b) stored in general work area
i) inadequate ventilation
ii) floor drains '
iiT), inadequate fire protection
2. Outdoor
a) uncovered, exposed to weather °
b) pervious surface/catch basins
III. o Dis sall
P
A. Reclamation/Recycling unit
B. On-site disposal
1. Town sewer
2. Regular septic system
3. Separate holding tank
C. Off-site disposal
1. hauled by own firm ✓ .
2, hired hauler
a) name of hauler
f
b) address or disposal site
Persons Interviewee
O — — — —`( — — 4— — — Inspectors
Date - - - - - - - -
_ _..^.•.
6 30 61 �
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I A
m / LI
DATA
_ a
satisfacto 2• Printers
BOARD OF H EA LT 1-1 �' 3. . Apt o . f.ody Shops
'� Q unsatisfactory- 4. Manufacturers
COMPANY'fr- t-" '� (see"Orders") S. Reta).1 Stores
ADDRESS �C � 6. Fuel Suppliers
Class: 7. Misullaneous
QUANTITIES AND STOWAGE (IN-indoors; OUl'=outdoor
MAJOR MATERIALS Case lots Drums AboveTanks Undetground Tanks
IN )UT I A f; gellons a Les+
Fuels: i
Gasoline, Jet Fuel (A)
Diesel, Kerosene, 12 (B)
Heavy Oils: '—
waste. motor all (C)
new.motor oil (C41
transmission/hydraulic
Synthetic Orgenics:
*greasers
. titscellaneous:
// .�
J�, f i
WSPOSAL REEL hVON s ` F
1. Sanitary Sewage 2. Water Supply �l
Town Sewer public:
0 On-site Q Private
3. Indoor Floor Drains: YES NO _
V [folding tanks, MUC
O Catch basin/Dry well10
Un-site system `
4. Outdoor Surface drains:YES NO
O Ifoldink,- tank: MUC
O Catch basin/Dry well _
On-site system S. Waste Transporter Licensed?
Name of Hauler _IZpst.Ina Inn
�t(aste Products �L
,.�/1 l.•L�/`,(l✓e. l tit : ���� ,.« • L, ! t--1:,�'�t �•V�..•''"�
tz to !1 CISOIt s) nt.ery eW�f'
Inspector Uate
I
)V'dN 01= E3ARNS`�AC3L -' iCOMpLIANCE: ' CLASS: 44(f1, Marine,Gas StationstRepair
3OARD- OF I-ICAUf1-I Osatisractory� ''.3: np�tatcody shrer UPS
Y t 3
unsatisfactory-�� 4. Retailanu cStores
(see Orders ) S.
9
6. Fuel Suppliers
MESS �. r'� n y?�., r em Claw 7. Miscellaneous
QUANI'ITICS AND SIORAGB (I indoors; OUtroutdoors)
'OIL MAIERIALS Gase lots Drums * Abdvel'anks Underground Tanks
_ IN l� . ML QU;L 16 fie!lops 9,�� I es t 1_
uels:
Gasoline, Jet Fuel. (A) Aly
Diesel,' Kerosene, 12 (S)
envy Oils:
s i s
d
waste motor oil .. (C) �
new motor nil (C)
transmission/hydraulic
•nthetic ,Organics: 4 ;
degraeasars
3cellaneouss
I
i Ti7i'tE"EWAIIU REMARKS:
Sanitary Sewage. 2. Water ,Supply '
Town Sewer ! -
1 public
_ . 4 n",
• � r ZT---�----- -
On-bite
private '
Indoor Floor Drains: YES 141 f
Q Ilolding tank: MUC f -U�
0 Catch basin/Dry well • j
URVE
0 -site system • ' Y
)utdoor Surface drains:YES NU
IluldinL• tank: MUC
O Catch basin/Dry well
C1 On-site system Ee
''
aste Transporter '•• Licensed?
Name-of Hauler waste rXnJilEt • • � ,U