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0395 SOUTH STREET - HAZMAT
i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form X. 200 Win St., Hyannis. Take the completed farm to the Town Clerk's Office, 15t FI., 367 Nlain St., Hyannis, MA 02601 (Town Hall) and get the Business Certificale that is required by 12w. DATE: Fill in please: .. �(. APPLICANT'S YOUR NAME/S: G . BUSINESS YOUR HOME AD ej e f� i ,' i ,, ,5"Uf)'3/'�:,.�SLt'.� ✓lfrlrP Lj ruzi. ry� �ti i-',,L �`7 NAME OF CORPORATION:.. NAME OF NEW.BUSINESS Viz' TYPE OF BUSINESS �1 �Ta.1% t IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER ©� a � (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been i me the permit requirements that pertain to this type of business. Aurh_oriz d S' nature** COMMENTS: �lD f'f10 nature** 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: I L TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: 1IA Town of Barnstable TELEPHONE NUMBER: 77, P.O. Box 534 CONTACT PERSON: �°¢20 �,P 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 totalli 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 AN HAZARDOUS MATERIALS The Board of Health has determined th t the following products exhibit toxic or hazardous characteristics and must be registered when st d 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 Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants odenticides) Degreasers for engines and metal VPhotochemicals (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) � fs Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business k TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY IWk� S= � . ��i 'j 5� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 0 2 S Sazcvr� sT, Class: 7.Miscellaneous (�y14WIP�cS�,.c�� na66/ QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) wast (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers I� a Miscellaneous: DISPOSAIJRECLAMATION REMARKS: /^ t�l. Sanitary Sewage r2.Water Supply, O Town Sewer Public (/ O On-site OPrivate Indoor Floor Drains YES NOX (1 O Holding tank: MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YESTO ORDERS: 0 Holding tank:MDC tch basin/Dry well On-site system `5.Waste Transporter Name of Hauler Destination Waste ProductLicensed? ` �CD.�•t p�t�b 1G.Q2�- cv,�ST �/ � -/- YES NO Person (s) Interviewed Inspector D to