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Home My WebLink About0160 WEST MAIN STREET - HAZMAT Iy1�w�nt,lea��M4ur Y. TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: _ Board of Health MAKING ADDRESS: Town of Barnstable TELEPHONE NUMBER: %� "'0 � P.O. Box 534 CONTACT'PERSON: 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: 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 i. 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 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 _le� 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 V 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 r a TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS l 6o Gt/' A,4,,N 5<7' Class: 7.Miscellaneous A�'.44-4-4/QUANTITIES AND STORAGE (IN-indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 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 PlaA-& ascell neo s: 0�J I c av j::EL,&r_ // DISPOSAL/RECLAMATION REMARKS: / 1. Sanitary Sewage 2.Water Supply AF Town Sewer OPublic - i f O On-site OPrivate 3. Indoor Floor Drains YES--NO O Holding tank: MDC COU Mv'rVi,4 O Catch basin/Dry well O M,e ?'d O On-site system r*u4 N 4. Outdoor Surface drains:YES 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 11TU-1 2. Person ? Interviewed Inspector Date 1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: Doane, Beal & Ames, Incorporated MAILING ADDRESS: Post Office Box 486 (160 West Main Street) Hyannis, Mass. 02601 TELEPHONE NUMBER: 775-0684 CONTACT PERSON: Robert L. Studley 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 f than 50 gallons liquid volume or 25 pounds dry weight? YES NO XXX I i 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 j totalling more than 50 gallons liquid volume or. 25 pounds dry weight. Please put �I 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 j Gasoline, Jet fuel Wood preservatives Diesel fuel, Kerosene, #2 heating oil (creosote) Other petroleum products: grease, ` Swimming Pool chlorine lubricants Lye or caustic soda Degreasers for engines and metal Degreasers for driveways & garages Jewelry cleaners Leather dyes 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 "Poison" labels (including Paint brush cleaners chloroform, formaldehyde, Floor & Furniture strippers hydrochloric acid, other Metal polishes acids) Laundry soil & stain removers Other products not listed (including bleach) Spot removers & cleaning fluids which you feel may be , (dry cleaners), toxic or hazardous please l i s t. .< Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants Road Salt (Halite) COMPLIANCE: CLASS: , Printers OWN OF BARNSTA BL ' Stations.Repair BOARD OF HEALTH ;Q satisfactory 3. .'Auto Body Shops Qunsatisfactary- 4. Manufacturers ti,, _ (see"Orders") S. Retail Stores ,OMPANY j� 6. Fuel Suppliers ram°. 7 Miscellaneous %DDRES � ( �af� � � Class: QUAN 'ITIES AND STORAGE (IN=indoc• s; OUT outdoors) Case lots Drums , AboveTanks Unde ro anks 4AJOR MATERIALS IN I 0 e s ? Fuels: Gasoline, Jet Fuel (A) t Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil. . , . (C} , transmission/hydraulic Synthetic Organics: ,degreasers Au x��r i t + liscellaneous: DISPOSAL RECLIINATION REW RKS: 1. San'tary Sewage 2. Wat r Supply Town Sewer 0— Public tin-site Private 3. .Indoor Floor Drains:YES NO O Holding tank: MDC O Catch basin/Dry well OOn-site system 4. Outdoor Surface drai ns:YES Na. O Holdink tank: MDC O Catch basin/Dry well OOn-site system Licensed? S. Waste Transporter Destination N,W, 4 ,{• �r 12123 ft Person(s) In d'Vviewed kryspector Date TOWN OF BARNSTABLE BOARD OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM p t _ AD.DRESS - ,.•' Major types of materials: 1) 2) , A Aa 4) _ 5) 6) I. Description of material (s) use: II. Storage (denote product by number Yisted above) A. Containers metal glass paper plastic cans,bottles,jars r . drums,barrels aboveground tanks ' underground tanks(. bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility for # Remarks/Recommendations 1. Indoor a) separate, contained room b) stored in general work area i) inadequate ventilation Al ii) . floor drains ri iii) inadequate fire. protection lu 2. Outdoor, a). uncovered, exposed to weather of b) pervious surface/catch basins III. Disposal 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 b) address or disposal site Person(s) Interviewed (1 y y�nspector ` ` C � ! — - — — - - - - - Date