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Home My WebLink About0443 WEST MAIN STREET - HAZMAT C'10��-i e:r J�QP^I�\� mac,{- I�'Gz�,� Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. ....----------------------------------------------------------------------------------------------------------------------------- 445 West Main St., Hyannis, MA .----------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more 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 A� Rnw� Town of Barnstable E*: Inspectional Services W.111NIS Public Health Division t�. BAMSTABM = Thomas McKean,DirectorHAM �a 039. 200 Main Street, Hyannis,MA 02601 I:x; �'�r.1 fat �r.:'?C?`;, �,6T�'"D"s #'Fit1`n'��' a;.t 'S�vK�tti;(d,Eti,7 r�3y#.tG.��'�r9'7,.k �h€�J�3 M}r�E.,t"E µ :.' tY! ...}," x.<,i' '� i�S ea.-r.:• ..k-.4 sG ,..:r s rj•� „t,��.�.�,"'Y �.�r;;y.. �¢•F "�"�• OfGce�•°508°:.862 4644�,�s, x ;��t ` `�� ' '�'� ��. ,� �f ,, 'r}tom � `��.�Fax '�08 790 6304�'' � � �,��f' �`+..!ez r�i �i� LL.tN' k ,r._y k *�T3r ,;., � '1r �rl;Alt ''U .,�y.ti-, �'��,��' s�p•1r��N x...,y�i ,y,"fl`#�*y r ;"f.�r i �?A�.�7ra ri .a,{ �..+.P-� t r-, 'tea;x n-:.�Y��4 e APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE � `r f j �� K'��' � HAZARDOUS MATERIALS "` �t 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: $125.00vv�r G 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: 5. NAME OF ESTABLISHMENT: '74 '---0 6. ADDRESS OF ESTABLISHMENT: 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: �D 9. EMAIL ADDRESS: U V 10. SOLEOWNER: YES O IF NO,NAME OF PARTNER: �yGl7�J 11. FULL NAME,HOME ADDRESS,A ,TEL PHON #O ' CORPORATION NAME ' PRESIDENT TREASURER S CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS zoo, EMAIL: SIGNATURE OF APPLI NTot; DATE Q:\Application FormsUHaz Mat Appli Dr - J Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS loo.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- ---------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2015 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2014 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable IME T Regulatory Services Richard V. Scali, Director SS. Public Health Division qj •9 3 i 6 �� °lF ° Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE C� APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS t, FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER 5 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 110 T37 STATE OF INCORPORATION �Jv FULL NAME AND O ADDRESS OF: 1 PRESIDENT AI'I owazy— TREASURER CLERK SIGNAT E OF A L CANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE# S� 3l? V00? Q\Application FormsOAZAPP.DOC Ce • MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to: Town of Barnstable. Allow five to seven (7) working days for in- house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601, FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page i QAApplication FonnsEAZAPP.DOC Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 6/30/2013 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF, D.M.D. 6/30/2012 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable °F1HE, Regulatory Services ti Thomas F. Geiler, Director H"A'ASS.�• ' Public Health Division. 9� 63q 10� 'OrEc wa+' Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE1,��Zl APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT !/ &� 11)r—'- NAME OF ESTABLISHMENT V /1�17�/Vk ✓CM AV,i7 ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER ' SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALI i PARTNERS: d IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. &,3 7 STATE OF INCORPORATION FULL NAME AND HO ADDRESS OF: PRESIDENT TREASURER CL CLERK - /— SIN / APPLICANT 1/ RESTRICTIONS: HOME ADDRESS /Sr B��l17LGl�/J S�y7 �/!IQ HOME TELEPHONE# J/„ D SAT OZ Haz.doc/wp/q Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. 445 West Main St., Hyannis,MA 02601 y Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------- --------------------------------- ------------------------------------- -------- --------------------------- --------------------------------- ---------------------------------------------------------------------------- i This license s granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2012 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2011 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Or Town of Barnstable 6V�-*�M �tME rqy, Regulatory Services ti Thomas F. Geiler, Director BAR'ASS.M ' Public Health Division 9� .i6gq `m�' QED 39 A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 - ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS yr �o FULL NAME OF APPLICANT !i U NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT L �G�� TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS Ob ALL PARTNERS: -n ws C -sa IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 7v STATE OF INCORPORATION FULL NAME AND AQME ADDRESS OF: L � PRESIDENT TREASURER I CLERK SIGNATURE OF':0FfICANT RESTRICTIONS: HOME ADDRESS 5& HOME TELEPHONE# Haz.doc/wp/q MAIL-IN REQUESTS Please mail the completed application form to the address below. In addition, please include the required fee amount. Make check payable to: Town of Barnstable. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. For further assistance on any item above, call (508) 862-4644 Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. Gb 445 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2009 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Barnstable HWE Regulatory Services Department o i AI-AmnigacitP E Pi "-iIealth Division 1 + BARNSfABLL 9 `"A 0. . et Hyannis MA 02601 i639. ?0,g JUN , i i rj lEO �a 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. C 0 Z l 02` DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT G/ / C l�C NAME OF ESTABLISHMENTIl ADDRESS OF ESTABLISHMENT GU�tJ� r TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION i I FULL NAME AND 11 OME ADDRESS OF: L PRESIDENT � �1 TREASURER CLERK as a AP=,?J - HOMETELEPHONE# RESTRICTIONS: HOME DRESS �11e 5D0 0 QAHazmat\Haz Mat Application2008.DOC I da Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. 445 West Main St., MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ----------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 31, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN, M.S.P.H. 5/31/2007 PAULJ. CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health pf Town of Barnstable Regulatory Services Thomas F. Geiler,Director Q „sAB& Public Health Division 9�''��cr •�°ie� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Application Fee: $100.00 /7 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT J ADDRESS OF ESTABLISHMENT �o , TELEPHONE NUMBER LCCbf o SOLE OWNER: YES NO . ... .... ... .. . . .. IF APPLICANT IS A PARTNERSHIP,FULL-NAME AND HOME ADDRESS O LL N N � PARTNERS: n" i M .IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION 6"Z?� FULL NAME AND HOME..ADDRESS OF: /J 1 PRESIDENT_ �v pm&p q0 4)M,2 TREASURER CLERK A POOPL RESTRICTIONS: HOME ADDRESS Wt 0 Pf� HOME TELEPHONE# I Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $loo.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. 445 West Main St., MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. May 8, 2006 PAUL J. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health 1 f i Q �..� �' -�.r fs:•r r.�.T ��,o^..ara_..e t>r:s --1 —s� ""�' + 1\ e � 8490-S95.0w-t III BP �„- F DELIVER TO: t '� � ` /' > � / � �/ ,. i `� /' �/ r � r Town of Barnstable Q� Regulatory Services `<. Thomas F. Geiler,Director Public Health Division e" q' ` Thomas McKean,Director ' 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax:.508-790-6304 . Application Fee: $100.00 ASSESSORS MAP AND PARCEL N0. DATE / APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT C- NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT A � TELEPHONE NUMB s09 ZZ ER a Q Cl) ' -SOLE OWNER: YES NO i =Z IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL .A PARTNERS: : co r7; r- ve r:`:� IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT A/IMwym �� ZA' �� 1(fo7� TREASURER CLERK ///// e1__(//,�*kTuAbF"PCANT RESTRICTIONS: HOME ADDRESS HOME TELEPHONE € Hazdoa'wi'q I ' MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include copies of your employees food sanitation training certificates. In addition, please include the required fee amount (see fees at bottom of this page). Make check payable to: Town of Barnstable. 'Allow five to seven (7)working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAD REQUESTS Our fax number is (508) 790-6304. Please fax a completed application form. Also, please fax copies of your employees food sanitation training certificates. In addition, you must mail the required fee amount (see fees at bottom of this page). Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in- house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health 'Division Page Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that CLOUTIER SUPPLY COMPANY, INC. 445 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2014 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2013 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health r,Y i Town of Barra-stable af� Regulatory Services nomas F. Ge33er,Director 3 3AR STABL& Pubhc Health D"iau Director a�MA�a Thomasl�.�CKE2i?j . 200 Main Strut, Hyamis,MA 02601 F= 50&790-6304 O-ficz: 5084624644 Applica#ian Fen: $100.00 ASSESSORS lYIAP AID F ARCEI,NO. DATE u �v / APPIIICA'IIflN FOR PERTNET � TO STORE A �nR TTTI-'f,7�„ 1 ARE TBA� 111 GALLnNS OF TLAZA QUS MATERLkLS 7 l / 60. C Y ,7,NA ME OF APPLICANT /� NrA OF ESTABT TSEMEN'T ADDRESS OF ESTABIJSELNMN'I TELEPHONE SEA SOLE OAR: YES NO ZT APPLICANT IS A PARTNIl�S�,TULL N�� AND HOl�ADDRESS OF AT I PARTNERS: I I BRAT ID 'ICATIO�TNo. IF APPLJCANT IS A CORFOR.ATION: F STATE OF It i COAPOAATION I-=N kiNE AND O a ADDRESS OF; PRESIDENT 44141'i Y k&&iC> CIY= ,_ - 156W OF P—ESTRICTIONS: H01�ADDRESS I H01Ya TELFPHONE# 0 H.azdoc/wp/q I ` I Number Fee 136 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Cloutier Supply Co. 445 West Main St., Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. This license is granted in conformity with the Statutes and ordinances.relating there to, and and expires 6/30/2011 unless sooner suspended or revoked. - ------------------ ----- --- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2010 JUNICHI SAWAYANAGI THQMA$A.MCKEAN,R.S.,CHO �.,.- u- -- ------------ _. Director of P Public Health- Town of Barnstable 1HE Tp Regulatory Services Thomas F. Geiler, Director • ' BARNSTABLE, k .Public Health Division MASS. a 9� MASS. ° i639 'yam ATf0MA�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN III GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT / C w NAME OF ESTABLISHMENT ADDRESS OF ESTABLISHMENT � TELEPHONE NUMBER J-,V SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION No.�� T3� STATE OF.INCORPORATION ol FULL NAME AND HOIVE ADDRESS OF: PRESIDENT A " &666 a //S" �j/'fir�ilr�dD�.D ��' yGr►'rlua Lb /rIa oL�7 TREASURER CLERK— RESTRICTIONS: HOMEADDRESS HOME TELEPHONE # cSd q? Haz.dochvp!q TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: 6xit - Board of Health MAILING ADDRESS: 42'i�K 1"i},0621 Town of Barnstable TELEPHONE NUMBER: 7 7/�--- � P.O. Box 534 `A�� Hyannis, MA 02601 CONTACT PERSON: Ai�hAZ_e 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 Ions 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: WW ADDRESS— 07 IE"L €' 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 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 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) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business f ;: c`..:...ry,.-'�'•,'►•-'- d"iAs4"t- �r+,,.adr"'^.,,,;r°•^•fit:-r't'.- :�'--•+*'-'.. `"n'�SCf`' ".Y.;-,, .,r '-t`s.,r-.z«�,a:._r..j,^.'�...,; :......,.i' '+�.+'C.;•..�,.).�.. 4•"t�,,,t,},• ^.^r=r•. ,rt . TOWN,OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH ® satisfactory 2.Printers y 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY „ c� t (see"Orders") 5.Retail Stores - 6.Fuel Suppliers ADDRESS i3 t�, r• � .' ' Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUnderground 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 1 Miscellaneous: DISPOSAURECLAMATION REMARKS: 1.;Q'To Sanitary Sewage 2.Water Supply 1-11' °.4/- l z�r � 1�Z"a4A? '�� S 4.9 wn Sewer OPublicO On-site OPrivate 3. Indoor Floor Drains YES NO,r O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO V ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system �t 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. ` Person (s) Interviewed . Inspector Date