HomeMy WebLinkAbout0484 SOUTH STREET - HAZMAT �'f`f' Scu\(fi SIf
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: /,ram
MAILING ADDRESS: �� S � ' SN'
TELEPHONE NUMBER:� '� A�S -A \ ^� -?— (,
I
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 aq 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 m terials are stored at a
site other than your mailing address:
ADDRESS: D v
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 cc ck beside each product that you store:
t/ Antifreeze (for asline or., coolant systems)g Y Refrigerants
—,Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
701 Hydraulic fluid (including brake fluid) Photochemicals *
Motor oils/waste oils Printing Ink
ne, Jet fuel Wood preservatives
esel fuel, Kerosene, #2 heating oil
Other petroleum products: grease, (creosote)
Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
Jaegreasers for driveways & garages Leather dyes
c/Battery acid (electrolyte) Fertilizers (if stored
Rustproofers outdoors)
Car wash detergents PCB' s
Car waxes and polishes Other chlorinated hydro-
Asphalt & roofing tar 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
.
Floor & Furniture strippers chloroform, formaldehyde,hydrochloric acid, other
Metal polishes acids)
Laundry soil & stain removers
(including bleach) Other products not listed
Spot removers & cleaning fluids which: you feel may be
(dry cleaners ) toxic or hazardous (please
�.E
Other cleaning solvents C E IV Elist) :
Bug and tar removers HEALTH DEPT.
Household cleansers, oven cleane TRWN OF BARNSTABLE
Drain cleaners
Toilet cleaners
Cesspool cleaners -
Disinfectants MAY ��
Road Salt Malite )
TQ1NN. • .OF BARNSTABLE-
'� BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
ADDRESS5`�
r
Major types of materials: 1) 2) 3)
4) `
S) 6)
I: Description of material(s) use:all
`
II. Storage (denote product by number liste6 above)
A. Containers
etal If gla s .aper plastic
cans,bottles,jars r
drums,barrels
aboveground tanks
underground tanks
bags,boxes
open,loose,uncovered
inadequate labelling
B. Storage Facility .
✓or # Remarks/RecommeTu:: L ions
1. Indoor
a) separate, contained room ---
b) stored in general work area
i) inadequate ventilation G'S
ii)--floor drains,—
iii)=inadequate-:fire fire--
2: Outdoor-
4 a) uncovO d, exposed to weather
Zip A
b) pervioulls,_sur_face/cat�_ch-:basins p j -
III Disposa41-A. Reclamatioecycling unit f
B. On-site disposal
(:; 1�..
k�
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'
b) address or disposal site
r
� f j
Person(s) Interviewed — — — — — Inspecto
— /- - / — �- - - - - - - - -
30 81 Date
6 —f—®f J- - - -6 — — — —
SOWN OF BARNSTABL '
O satisfactory 2. . Printers
,BOARD ''. OF HEALTH 3. Auto Body Shops
unsatisfactory 4. Manufacturers
- 9 (see"Orders") 5. Retail Stores
COMPANY �- X 'i 1 �u c= ;: `,:,n
�� I 6. Fuel Suppliers
ADDRESS .y��;� t . '_- Class:
7. Miscellaneous
QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoor;
Case lots Drums AboveTanks Undergrouad Tanks
MAJOR MATERIALS
IN OUT IN OUT IN UT � 211 Age s
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: tjbL
waste motor oil (C) -• ",
I
new motor oil (C) ,
rtransmis�sizo)n�hydraulic 10
Synthetic Organics:
degr_easers� L. I-) ��l-c.�. l�D ✓(,
dID
Misce-llaneous:-
' DISPOSAL RECLAMATION KS:
1. Sanitary S age 2. - Water Supply
On-site C1Private
3. Indoor Floor Drains: YES
O Holding tank: MDC �2 i Lil�j �i ` . � e � 6J
Catch basin/Dry wel
O
On-site system 1- C �j�� ram,, �• ,
4. Outdoor Surface drains:YES NC 1r
4_ O Holding- tank: MDC ( ,
O Catch basin/Dry well -
OOn-site system C.
S. Waste Transporter 6 ,i (�,:rn W,.-{-"� n '� - �"��� Licensed?
lHauleX Destination_ as ti
S, NO
�/111a
Person Ts) Interviewed Inspector D to
TOWN OF BARNSTABLEe— s
MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
nters
BOARD OF HEALTHtisfactory 3.2.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY 4 S Al® 6.Fuel Suppliers(see"Orders") 5.Retail Stores
ADDRESS - Class' 6 7.Miscellaneous
C '
QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATEOLIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels: 8v
Gasoline Jet Fuel (A)
#2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic•-:�,
Synthetic Organics:
degreasers
Miscellaneous:
DISPO SAL/RE(,LAMATION REMARK S.
1. Sanitary Sewage 2.Water Supply To b CV I 1 l l a- �
0Town Sewer )(VPublic L76 o-71* ftAnee {
0 On-site OPrivate ®
3. Indoor Floor Drains YES NO k/
0 Holding tank: MDC
-1 -
i
0 Catch basin/Dry well
0 On-site system
4. Outdoor Surface drains:YES NO ORDERS:
0 Holding tank:MDC
O Catch basin/Dry well
0 On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
2.
Person (s) Interviewed Ins"Pector Date
f A