HomeMy WebLinkAbout0497 WEST MAIN STREET - HAZMAT 9 � W , rVk,.insfr�g-
TOWN � ' t3ARNSTA[3LE COMPLIANCHI �•i" CLASS: 1. Marine,Gas Stations,R(pair
!`Q satisfactory 2. Printers
C ARD OF HEALTH 3. �uco P.ody Slops
Q unsatisfactory- 4. lanufacturers
COMPANY /�l� �!/�!l.�Lr (see"Orders") S. Retail Stores
Y 6. Fuel Suppliers
ADDRESS Class:Class:M,
7. Miscellaneous
f VAff1V1J A QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor.
MAJOR MATERIALS • Case-lots Drums AboveTanks Undetgr.ohed Tanks
I� �t In— Qu gallons AM
Fuels:
• Gasoline, Jet Fuel (A)
Diesel, Kerosene, 02 (B)
Heavy Oils: r
waste motor oil - (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers •
•miscellaneous:
(cLo"eOxi�
c
ISPOSAL RECL MAT ON REMARKS:
1. Sanitary Sewage 2, Water Supply �) +� ��J`/ [A /I t �n
Q Town Sewer 0 Public _,1�� �' _//d/I !/Df`yI � ✓ .
QOn-site O Private
3. Indoor Floor Drains: YES NO _� V �• t 1v�a l/�r�
Q [folding tank: MDC ��, �21X�-� � % .
O Catch basin/Dry well
On-site system U U �_. ._...-.._
4. Outdoor Surface drains:YES NO
Q HoldinL tank: MDC .
O Catch basin/Dry well
0 On-site system
S. Waste Transporter Licensed?
11jim"LEaulnr- ,_Ruing inn jjasta Product- YES No
Yj
e�
u 23 ftPerson(s) Int.erviewed ••Inspector Date 1
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: �f�� `�l/N1)��/ / ice
MAILING ADDRESS: 4�';7 A 3-T
TELEPHONE NUMBER: ,,` Z.7 /
CONTACT PERSON:
Does your- firm- stare 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 (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
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 Jewelry cleaners
Degreasers for driveways & garages 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) which you feel may be
Spot removers & cleaning flui-s E e E ' toxic or hazardous (please
(dry cleaners) HEALTH DEPTE. D list),,;-
AL -
Other cleaning solvents TOWNAL DE TABLE
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 1 5 19)1
Disinfectants
Road Salt (Halite)