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Home My WebLink About0041 ROSARY LANE - HAZMAT J \ Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping .--------------------------•--....------......------......---...-----...----....------......------......------------............. 41 A Rosary Lane, Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health rt 4 Town of Barnstable Inspectional Services BARNSTABLE Public Health Division ��"15��`�`��'��" 1639-7014 I 1 BAMBrABM Thomas McKean,Director _, ' 16s9. s9. 200 Main Street, Hyannis,MA 02601 r` C3 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 DULY I st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 &(VST FA C h CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 . 1) _ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ � - *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTI.TjI�ES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:. 5. NAME OF ESTABLISHMENT: �~ el-6n kamL& 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE. MWA & M ILia 8. TELEPHONE NUMBER OF ESTABLISHMENT: (� 9. EMAIL ADDRESS: -h Chn of dom u V �/�l 10. SOLEOWNER:$ES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY:. NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE a a 6 J o Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $ro.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping 41 A Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 Cd ry Town of Barnstable Inspectional Services BARNSTABLE THE Tp� W..ST.e_=•�:r=.i1:i-loam•.nnis o Public Health Division WFSiC<N1 5.'i91Zn SAR i eR4K 'sE • 'w NSfABLE. ,�� AY. 9 $ Thomas McKean, Director, Em ec � CD 200 Main Street, Hyannis,M 02601 �ni A f -k. Office: 508-862-4644 Fax: 5AL790-6304 4 r� 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 �Val- CATEGORY 2'PERMIT 111 -499 Gallons: $125.00 ❑ f �:w4 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ I(e S( *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 34q-0a(3 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: ^++� oT4 cad^J S. NAME OF ESTABLISHMENT: ,t- e-�b+J f Gw Pl v \ ;� ► L, 6. ADDRESS OF ESTABLISHMENT: y A I a S A-il- 7. MAILING ADDRESS (IF?DIFFERENT FROM ABOVE: a3a 1v//i ne on << Ti2,/4 l'L Ce v e�Zvild� 8. TELEPHONE NUMBER OF ESTABLISHMENT: tS-0 k " 12 - �`� 9 0 9. EMAIL ADDRESS: Ac,!— „i Lq fc-/I 10. SOLEOWNER: / YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICAN DATE S 1,S-- Q:\Applicatiion Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping 41 A Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 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 ` Voegulatoryw of nstable ervices ✓ t►+e r Richard V. Scah,Director ® "o Public Health Division BARNSTABLE • y MUMS LE•[FSOSMLLF.COMT•iIY STU BARNSTABLE, Thomas McKean, Director "�DHS"'�i�42014xd 8iFNSi46E 9`b- 1 659- e.`0� 200 Main Street, Hyannis,MA 02601 �77� 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 3 Oth). APPLICATION FEES CATEGORY 1 PERMIT 26— 1-10 Gallons: $ 50.00 s ' CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 3L/Y/oj 8 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONINGBUMDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF ® GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT:u 44 4 CT� to 5. NAME OF ESTABLISHMENT: It 6. ADDRESS OF ESTABLISHMENT: L11 IJA,,•z Lr+�j 6 l�y K�,MS. 1-�A 6�6-01 Obi 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:03a f-uA-11e Off.K T'i� 8. TELEPHONE NUMBER OF ESTABLISHMENT: �S 61'- 9. EMAIL ADDRESS:--' `+i A c o r,) (,e„V CA?i 10. SOLEOWNER: _NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLIC DATE /4' Q:\Application Forms\HAZMAT APP 2017 REVISED.docx 111 'Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping 41 A Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 110 gallons of Hazardous Materials. ----------------------------- ---------------------- --------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06130/2018. unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $50.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping 41 A Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. - ------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Tow of B stable -Regu�l. atorySemces Richard V. Scali, Director �tMME rq� o Public Health Division E � • [*L— :156ARN3I'ABI.E, Thomas McKean, Director 4bt F� `0200 Main Street, Hyannis,MA 02601 —n Office: 508-862-4644 F& 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 0.1 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 lst-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 U'S CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 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 (25YGALLONS)? YES NO. 4. FULL NAME OF APPLICANT: M 5. NAME OF ESTABLISHMENT: �� / l Adon 1,4ari�scao r 6. ADDRESS OF ESTABLISHMENT:" G ` I D 5a 46I1'r-1 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:0 0� 8. TELEPHONE NUMBER^OF ESTABLISHMENT: n c d , . 9. EMAIL ADDRESS: l c �� 1 0"', Accra, t- ae 10. SOLEOWNER: -XYES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS _ EMAIL: SIGNATURE OF APPLICA DATE �� ? Q:\Application Forms\HAZMAT APP 2017 REVISED. ocx Number Fee 1227 THE COMMONWEALTH OF MASSACHUSETTS $so.00 Town of Barnstable Board of Health This is to Certify that Tim Acton Landscaping 41 A Rosary Lane, Hyannis, MA Is Hereby Granted a License For: Storing or Handling 26 - 100 gallons of Hazardous Materials. --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. -------------------- �`' WAYNE MILLER,M.D.,CHAIRMAN \T� PAUL J.CANNIFF,D.M.D. 06/30/2016 JUNICHI SAWAYANAGI THOMAS A. MCKEAN,R.S.,CHO Director of Public Health .r Town of Barnstable Regulatory Services Richard V. Scali, Director ` Z *]: BLE '" MASS. ` Public Health Division �. 1 6 9. 0� 1� •wawns3 ra�cxsru�Thomas McKean, Director �~ C 200 Main Street,Hyannis,MA 02601 it C Office: 508-862-4644 CD Fax: 508-790-6304 N m 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 1st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ • A late charge of$10.00 will be assessed if payment is not received by July 1st. ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: V M fTcjv� s NAME OF ESTABLISHMENT: T/M ADDRESS OF ESTABLISHMENT: 1 �rr 6Sar �- l ' 14 fit S � MAILING ADDRESS (IF DIFFERENT): 3 AJ 2 TELEPHONE NUMBER OF ESTABLISHMENT: 90 '— EMAIL ADDRESS: -o (o lima a / dam SOLE OWNER: /YES NO IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME PRESIDENT TREASURER CLERK • IF PREPARED BY OUTSIDE PARTY: SIGNATURE OF APPLICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Rev I6.doex Page 1 of Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 Ba"STAB = Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Hazardous Materials Payment received: $50.00 (Check) on 6/1/2016 � (Check number: 13387 Check amount: $50.00 Name on check: Tim Acton Landscaping_ Business: Tim Acton Landscaping Address: 41 Rosary Lane, Hyannis .Note: Category I Permit i ,---- -- - -.............. .... .... ........... . . . ......._..__ ......... ......................... ----} li • °Ft r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMA.Bq • 200 Main Street• Hyannis, MA 02601 Eo'eA9A TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT � nn Business Name: I wt, ACC ova- Date: Location/Mailing Address: I W&SqXVa»n�5 Contact Name/Phone: - + Alzx -A0'0<e-f,90MJd I �D Inventory Total Amount: I pr--,-t-7'70 MSDS: &e-0 License#: � Tier II : Labelina,�k �o `�y ill Plan:+ Oil/WaterSeparator: Floor Drains: v Emergency Numbers: --o Storage Areas/Tanks: 5 4&A u>LtOL—'VI . eo k44- TA4X 1 VAV W, Emergency/Containment quipment: 5 % N �y��aaale.ov, g�� , �►Opaw�-S ,atn 5��e. Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: QCL C4-4 Cc, xk- v t,\0,^, VA,;-,CcC u6}z, Col PaXovt- e{ LIST OF TOXIC AND HAZARDOUS MATERIALS ' Q�6��Lti k NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. 2 Antifreeze 'P Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash �} Motor oils$p� a� Warrtt o 1 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 v Refrigerants �1 Zo\� Degreasers for engines&garages ►�t,2 �7Pesticides:%D� 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 I Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes "1 Miscellaneous Flammables SRa I't Fertilizers -15 D�b Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers (including carbon tetrachloride) / (inclWling bleach) Any other products with "poison labels" L t I V' L'm, (including chloroform, formaldehyde, .I hydrochloric acid, other acids) VIOLATIONS: J't�(�.ao,( S'[OtaS,(, aK ��5 W��t� '�� (°Dul�at�v�ywe.Vi.�, ORDERS: #\.L& Ok5 © v` o C \,5 kj6e 0it S \M.a INFORMA ION/R COMMENDATIONS: a� �- S• . Iti . n pk Avg OGG2S5•/ �/�-140K J5 'f ' �04 OW&'4 � Inspector: V1Kn� DS�' �1� �orvL-l-�v`��C Facility Representative: 11�� lJ� p p g � WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: ` - Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: 72 6—"' =3 P.O. Box 534 CONTACT PERSON: M gig •1/2 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 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: �er1u 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 Read Salt (We4te) Gasoline, Jet fuel Refrigerants f 1ps LWdk a, #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 BOARD OF HEALTH satisfactory 3. Body Shops unsatisfactory- 4.Manufacturers COMPANY 41114 9/- (see"Orders") 5.Retail Stores 6.Fuel Suppliers ' ADDRESS ! Class: 7.Miscellaneous UANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERTATIAZ Case lots Drurns Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) 2 (B) y Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: I DISPOSAUREC;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public � �On-site OPrivate r 3. Indoor Floor Drains YES NO O Holding tank:MDCs �Cj'' 0 Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Pers Int6'ev'ieNf ed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Oc.3ofnr t C �� Mail To: # , NAME OF BUSINESS: Board of Health MAILING ADDRESS: yf OSAW '-N Town of Barnstable TELEPHONE NUMBER: 7 75 igz 213 P.O. Box 534 �� ✓� "� Hyannis, MA 02601 CONTACT PERSON: 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 gasoline asoline or coolants systems)Y ) 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) WA `®IV f-S evwi0sVA" Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business i•wr�.�;...-�•w-••�"'�Y"�.�."'�y-�r'�.T.-'.^r+...-..s,..�:.�.,,,n�yrF-.i ..r«ta,a-„��s �.�•... r .,�.y:{ .,�..., - - _ .,.. I ..:•n.i►� :.'Sly..,w+._i ,,,, y-..m-.. �..4+.-.' �`- .e.'i?'4ar `� .",TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfacto 3.AuPrito �0 o =1 �' .Auto Body Shops ,f O unsatisfactory 4.Manufacturers COMPANY •n �A (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS '/ ' 44 e Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT outdoors) MAJOR MATERIALSUndergroundove Tanks ,.' y 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 IWA V ` Miscellaneous DISPOSAIJR.ECLAMATION REMARKS: �a / 1, Sanitary Sewage 2.Water Supply `. , � � 1ar , O Town Sewer ®Public f('� Q On-site OPrivate { 3. Indoor Floor Drains YES NO y. :A� Q Holding tank:MD.0 F. . 'Catch basin/Dry well - �O On-site system 4.. Outdoor Surface drains:YES G"'NO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES I NO �JA' �"'_ ,f'`.�'R�,�,e,•�-,�°,•_ F•'• {e..._ ��ti'"7r�.d.�.�.,�./s' F'/'1/_��s` .l-- "`.� ..,rr+�" Person,,(s) Interviewed Inspector /, Date ,r