HomeMy WebLinkAbout0060 ROSARY LANE - HAZMAT `pf IKE lO '^+ vD° Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
a"nMA Bq $ 200 Main Street• Hyannis, MA 02601
�A t6 p M �0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT
rE0 Ay
T �
Business Name: dC&Xkf1r Date:
Location/Mailin Address>I } 0493 h�uu -, ann� ,�0 ►�e"(cc '; 1
Contact Name/Phone: EJ lailrkU NsVP4 C - -Dq oNu, mil- 71-44
Inventory Total Amount: C I I SDS: �O- License#:
Tier II : Labeling: i 1p-5 Spill Plan: N—iina %FC0
Oil/WaterSeparator: Floor Drains: NU Emercienc Numbers:
Storage AreaslTanks: 56 • , Od h
Emergency/Containment Equipment: r of Spill
Waste Generator ID: MMS73199S9 Waste Product:
Date&Amount of Last Shipment/Frequency: 0i)loll On 11 3 4
Licensed Waste Hauler&Destination: W 01 c_ liou-11111
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 C Bug and tar removers
Hydraulic fluid (including brake fluid) ✓ Windshield wash
Motor oils 3'b 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 f
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:
ORDERS:
v+ yINFORMATION/RECOMMENDATIONS: e- uM
A r s
Inspector: ALL
07
1y \cb Facility Representative:
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS
Number Fee
1259 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EJ Jaxtimer Builder Inc.
-................................................................................................................................
60 Rosary Lane, Hyannis, MA
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Is Hereby Granted a License
For: Storing or Handling 111 - 499 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
f — -
Town of Barnstable
Inspectional Services BARNSTABLE
�p 1NE T • R RYiinB E KEht awLu•c0m116 115
Public Health Division NLS--- 51639-2L%•YF_Sr80PMM9tE
ti �639-�0>4 r
., MAE& � Thomas McKean, Director
�,pT a63q A�Eon 200 Main Street, Hyannis,MA 02601 ~y
Office: 508-862-4644 Fax: 508-790-6304 t: ,
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 Vsr pole Ch
CATEGORY 3 PERMIT 500 or more Gallons: $150.00 El
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO. -05
2. IS THIS A PERMIT RENEWAL? y 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. f-5 J J A-S-440 ,,- 6 U I I d a Eo
01
5. NAME OF ESTABLISHMENT: J `,a_�L ' `(Y
DRESS OF ESTABLISHMENT: .0 a � �'�tG �04
6. AD y1 � ^ 1[
7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: '` �'t` I�1 e- 444,w 1) I�-
8. TELEPHONE NUMBER OF ESTABLISHMENT:
9. EMAIL ADDRESS: �'� ( 1 (e 60 (10 J 7
10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME tjJ J- 6 k(p4r- 6 L) 1 I CqC4—1 t]C
PRESIDENT
TREASURER
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE Q'
Q:\Application Forms\Haz Mat Appli Draft Jan2019.docx
i.
Number Fee
1259 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EJ Jaxtimer Builder Inc.
48 Rosary Lane, Hyannis, MA
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.
----------- -- ---------------------
PAULJ.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
m
Town of Barnstable
Inspectional Services BARNSTABLE
�z Public Health Division uw=*.:EKC.:fi,9 1 T'•.N
7nia K.,
• = Thomas McKean, Director
AlfG > 200 Main Street, Hyannis, MA 02601
-rt
Office: 508-862-4644 Fax: 508-790-6304 j
r.�
APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE U1
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 lst—JUNE 30th).
APPLICATION FEES
CATEGORY I PERMIT 26— 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 d f t4 0(hK4 co9F+
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. 34410S D
2. IS THIS A PERMIT RENEWAL? X 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)? X YES NO.
4. iJLL NAME OF APPLICANT: E---T V a x fi mi-q �3y t)
5. NAME,OF ESTABLISHMENT: c�QYYte Q,S abwc.
6. ADDRESS OF ESTABLISHMENT: O S" ��� N�I o���S rn A
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: SO✓ �-
8. TELEPHONE NUMBER OF ESTABLISHMENT: 505' " 7`l 4
9. EMAIL ADDRESS: 1 a y j Sc&,pe e ,' .Co w,-
10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME �=q c x li rrw bvi 13,,1 Inc.
PRESIDENT tg a," , 35o PA>A.�n SWA-e-+ a()Skrryi�U Ynrq Oak.-SS—
TREASURER—
CLERK
�Py
12. IV PREPARED BY OUTSIDE PARTY:
'NAME: TELEPHONE#:
COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE a4 2019
Q:1Application Fomis\Haz Mat App Revised 09-10-18.doc —�'
Number Fee
1259 THE COMMONWEALTH OF MASSACHUSETTS $125.00
Town of Barnstable
Board of Health
This is to Certify that EJJaxtirner Builder Inc.
48 Rosary Lane, Hyannis, MA
Is Hereby Granted a License
For: Storing or Handling 111 - 499 gallons of Hazardous Materials.
---------------------------------------------------------------------I----------------------------------------------------------------------------------------------
------------------------------------------------- ------------------------------------------------------------------------------------------------------------
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
•� >a ' towil of Barnstable
eg atory erisIces
Richard V. Scah, Director t"e rPublic Health Division :*D
ts�SrABL Thomas McKean, DirectorMAJUL �-! 10 -- — .. _ _...-- - -- - -----------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 1st-JUNE 3Oth).
APPLICATION FEES
CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑
CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 V-S
CATEGORY 3 PERMIT 500 or more Gallons: $150.00
*A late charge of$10.00 will be assessed if payment is not received by July 1st.
1. ASSESSOR'S MAP AND PARCEL NO.
2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES,SKIP QUESTION 3.
3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS
ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF
• GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: C T Saxe-, mom''
5. NAME OF ESTABLISHMENT: E-T SU`'Y may -3,0 i 1d e I►i L
6. ADDRESS OF ESTABLISHMENT: 1Z e S 0--1-1 Lzt-*,-:e a n n'► S M A b2 f.6
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: -5a''y`'` a" a`t'c5vc-
8. TELEPHONE NUMBER OF ESTABLISHMENT: Su$ - -l1 1 - `-1•'fq 1i
9. EMAIL ADDRESS: BSc,k f 0-y- n.v . Cam
10. SOLEOWNER: ✓ YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME E U 7axiiKo- 3ui ld� ►nc.
PRESIDENT E T TU ct;rrw 350 1`4a.i , 51-y c.a4 ()S-k--y 11 U T 4
TREASURER_ M,niy i e :TLl X-H Ma 35o Ma iv% Sty e 1 -i O Oc-,lit t U rn A
CLERK
12. IF PREPARED BY OUTSIDE PARTY:
NAME: A TELEPHONE#:
• COMPANY ADDRESS EMAIL:
SIGNATURE OF APPLICANT DATE
Q:\Application ForrnsUiAZMAT APP 2017 REVISE x
�►5
Number Fee
1259 THE COMMONWEALTH OF MASSACHUSETTS $125.00 +�
Town of Barnstable
Board of Health
This is to Certify that EJ Jaxtimer Builder Inc.
48 Rosary Lane, Hyannis, MA
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 06/30/2018 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 VZJON-3 LTOZ 61 Nnf
Director of Public Health
Tower, of Unstable
Regulatoervices
�t r Richard V. Scah, Director
BANTAM
Public Health Division B�
ysr:. •.�qy,�.ouR•xr4.,i:iz
� I4iR5,U'.5 IILS•OSIEiViIIL•glESI P4'.,HSi4P;E
�S•ABLE, Thomas McKean, DirectorMASS. 639-2014
200 Main Street, Hyannis,MA 02601
Office: 508-862-464-4 U' �/ ax: 508-790-6304
APPLICATION FOR PERMIT TO STORE AND/OR UTIZE
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
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 (25 GALLONS)? YES NO.
4. FULL NAME OF APPLICANT: qU�c �l Mo.,/
5. NAME OF ESTABLISHMENT: T cx x}.nri41-.173V l I d'' I►'lCr
6. ADDRESS OF ESTABLISHMENT: 6SO�..rt1 44 G,nni S (Y1 �2.b01
7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE:
8. TELEPHONE NUMBER OF ESTABLISHMENT: 50 9 ' 11 4 4
9. EMAIL ADDRESS: e AA-N-V hM)1 &-
10. SOLEOWNER: ,_YES NO IF NO,NAME OF PARTNER:
11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF:
CORPORATION NAME
PRESIDENT Yfi &r 3S o IA L'I n S OS�Gv v 1\4 O
TREASURER r uoCf Mey 350 Haan ShY.e+ 044C'VitU MA
CLERK 35z hip-jh 5bm" 05iwi Lt rn A
12. IF PREPARED BY OUTSIDE PARTY:
NAME: TELEPHONE#:
• COMPANY ADDRESS A EMAIL:
SIGNATURE OF APPLICANT?-VP DATE L 19
Q:\Application Forms\HAZMAT APP 2017 REVISED.
TOWN OF BARNSTABLE BAR-W 15151
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip f
Business Name /a_Lm;/pm, on/ /4"x 20 14:�,
Business Address ✓'".�/ ��yu' -
/ Signature of/"Enforcing Officer
Village/State/Zip 0"IR VI v1 1 ; . +t1/l 4
Location of Offense .� Cc .✓�ttsy ( v+1 n'c ! r,-Al-
Enforcing Dept/Division
Offense V101AoW o �( l�i- , . 7��(� �,�.J y'a.c. �r t 'P< +(' w yL
( ✓ J f r
Facts ' lt AA -er, � � '� A�1+�o+a•k � t�t�_�+ � t� t.r��h�"._ ��b4tath, /10,41��`,�
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
. ,. ,` y -. ry, r._, wm.-... ..... • .tn --.-rMr ^w...•..�m+.r-:. r.-4-.wr'-r'"Cf': ....MY'`w^-..,�'.._ s ... n mow. s ..-
TOWN OF BARNSTABLE BAR-W 5151
Ordinance or Regulation
WARNING NOTICE
Name of Of f ender/Manager
Address of Offender MV/MB Reg.#
Village/State/Zip
Business Name "a �. z «� •' � ..t- c . p: am/pm, on 20 /1 ;
Business Address ' ! -
1 Signature of,Enforcing Officer
Village/State/Zip •J ; +r+ Y' tV1 �.
Location of Of f ense >
Enforcing Dept/Division
Offense z� � , , y i ;; _ t �;_� t ' : �� , �, t . ,t ; � ,tom
Facts ,t 'tgtL ^..tE. .�.>. ! . t )I a'•%./ q.
This will serve only as a warning. 'At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.
WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.
�pIKE A , Town of Barnstable Office:508-862-4644
Public Health Division Fax:508-790-6304
"M�LE. ' 200 Main Street• Hyannis, MA 02601
FOMrt � TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT 6 /(7 /(,
Business Name: V,w,- 0, I d c_ Date:
Location/Mailing Address: q f p fi33 ? S Qvc t. rt rC,1 -7-71 Nyjg
Contact Name/Phone:
53SM�k��^.�� Pl2S• '^k CGl1 S' 6-7-7(0 -DQ2:3 A41 a((��v�� -'�jarw1c� NI�1 ekKse.v VNI
Invento Total mount: ^J I�� MSDS: elk 0't License#:"Vy�> ( ?-
Tier II : N o 1 Labelino: e4- 'UtA 4 Spill Plan: a5�
Oil/WaterSeparator: fQ1 I Floor Drains: . o<V-1- 1H. m r enc Numbers: e 5
Storage Areas/Tanks: 3ob &I l `�'
Emergency/Containment Equipment: �c,"II 5 i
Waste Generator ID: 1 W ste Product: 14A16 O/
Date&Amount of Last Shi ment/Fre u ti ,2 r 5 .L
Licensed Waste Hauler&Destination: 8,54i,( , 19,
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 ti Dry cleaning fluids
Automatic transmission fluid' Other cleaning solvents&spot removers
Engine and radiator flushes Bug and tar removers
to Hydraulic fluid Sincluding brake fluid)l,K (o Windshield wash (p
103 Motor oils 1 A-5.04\0*1 t 5siaagki 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:
y Caulk/Grout 11tALUA1v."7 insecticides, herbicides, rodenticides
Battery acid (electrolyte)/batteries Photochemicals(Fixers)
Rustproofers Photochemicals(Developer)
20 Car wash detergents 20 a"��S Printing ink
Car waxes and polishes �.b"' Wood preservatives(creosote)
Asphalt&roofing tar ss Xex�j�3 Swimming pool chlorine
Paints,varnishes, stains, dyes V? ' Lye or caustic soda
6 Lacquer thinners Qj* Miscellaneous Combustible 3-t 2
Paint&varnish removers, deglossers Leather dyes
I' Miscellaneous Flammables �-'j 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:
ORDERS: a5k4-.MA.VL% -e 5 U WQS��
INFORMATION/R COMMENDATIONS: C004 1 WevWt S 1v1- [.cc,- Q S S
b w , l9V4—•C Jet c.�c C. ,v", v UtAk L"'( Y""4 , v11 L 4 K L�
Inspector:�L.GL�
C0. io, k-, � ,, nn n Facility Representative:
�1F.a( QDL1( CI',,,I, St
WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESSGG�
Date: /0 l2° 113
TOWN OF BARNNSTABLE-":,,,,. , ��/� l► 3
TOXIC AND HAZARDOUS MATERIALS N FORM
NAME OF BUSINESS:
BUSINESS LOCATION: `I0 + 60 kc>5AC �.�- 'n,nrs INVENTORY
MAILING ADDRESS: `fp� TOTAL AMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON: E3' Sac-F�vke r_oi•�wa-reia "�Y,3
EMERGENCY CONTACT TELEPHONE NUMBER: c S -737MSDS ON SITE?
TYPE OF BUSINESS: Our A)a
9)
INFORMATION I RECOMMENDATIONS: Des Q,n� Fire District:
on e� l s �-a ors cl v ivy ,Qa�c. t�•art✓I 5
I ..11o� /-� �n� w�5+� n�►a���'csts -Cof Ircens�Q /
V ecw le{`S 3)/y o Dy2lvv► �'{'.�9 y rP�C i �2. WeL5+e- 0 r 1 P,1 r VK3 Cv(-e JiS D0660ea-�7- W,
f, 11& 30 4e�s
Waste Transportation: cecorl-s f-'a � Last shipment of hazardous waste:
Name of Hauler: -I&J4- bx. 5►+Q, Destination:
Waste Product: '.&Wu — Licensed? Yes No
c"04'0. Cu o o-1 D 4 1 0� It Nlneralta'�ws►3 As'Eo qLk c. o- Ilag{ lrw..NOTE: Under the provisions of Ch. 11 , Secti ;1, f the of MA, azardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed I Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
j Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils / Pesticides
aJ NEW/o CA USED S� (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
! lubricants, gear oil ❑ NEW ❑ USED
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
/p Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt&roofing tar PCB's
3(o Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Z Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach) +aAk6 1 0{ (-+0 witsL-
Spot removers&cleaning fluids
(dry cleaners) e'65 r
yl 4�gd-
Other cleaning solvents f
Bug and tar removers w I 0 6 15 CoA I U��
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials