HomeMy WebLinkAbout0830 WEST MAIN STREET - HAZMAT (2) eA wet+,
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S M A D
KEEPING YOU ORGANIZEP
No. 10334
2-153L
MADE IN USA
GET ORGANIZED AT SMEAR-COM
TOWN OF BARNSTABLE
UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS
NAME Y 69AI N OS f 02 Serf--(= 19v Ot _ INC '
ADDRESS e30 (t)- #216IN IS VILLAGE
LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE:
OR CHEMICAL
440
4 Jao dze o y
at wad. &C4.1 j Y,
20 a,2. 'y12u1 0�2. 3l A
(Give same information for any additional tanks on reverse side of card)
DATE OF PURCHASE OF EACH: 1. �° 4G 2. 61174 3. /°%G 4. 'O A&
DATE OF FIRE DEPARTMENT PERMIT: Cd.�bw G, i 0'jG 7�¢u 3l,i9 9Q
TESTING CERTIFICATION SUBMITTED:
PASSED DID NOT PASS
NAME IACA_ TION
OI' 01(1 st2'xL; E AY}� x7'i r
Robert H. Goodwin West Main St.
83-spring Hill"' Road Hyannl$'
East Sandwich, MA 02537
BOOK & WAGE - DATE LICENSE GRANTED AMOUNT OF STORAGE
135/14 October 6, 1976 2000 gal.
Add'1 500 gal. waste oil
tank
135/143 May 31 , 1979 3,000 addl . underground
DATE PAID
Nov. 1, 1976 FEB ? 81980 4
I 1 4n'7"7 I
� �N OF BARNBTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r
Osatisfactory 2. Printers
BOAR ® OF HEALTH 3. Auto Body Shops
unsatisfactory- 4. Manufacturers
�. (see"Orders") 5. Retail Stores
,COMP„ANY r 6. Fuel Suppliers
ADDRESS $�G�'i r ��Yrv'I S's l 7. Miscellaneous
(� , eV aG n S `'f �� QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors;
MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks
- 1 IN UT IN IOUT IN tOUT # & gallons- Age rrest?'
Fuels: !
Gasoline, Jet Fuel (A) ( ODD
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) I
Gaya d 5
new motor oil (C) ( ,b '
trans^ ,.mom iisssion hydraulic
Synthetic Organics:
a=
1
degr, aEErs �
i
Miscellaneous:
r f
i
DISPOSAL RECLAMATION REMi',RKS
1. Sanit�ownSewer*
ge 2. Water�ub
k C Y/V ��l .. c\ � ,t
Iic ) .��. — C rMMLA
O Ori=site Privat J
3. Indoor Floor Drains : YES
0 Holding tank: MDC _ _^
Catch basin/Dry well
On-site system
, -
O
4. Outdoor Surface drains:YES N0X_
,� C t.�.�. ,n f ad !c�`��r"""
0 Holding tank: —
0 Catch basin/Dry well '_ �iJiN 1( _�
On-site system
�}Jt1• MCrt�t 14 �- i4 ccw�,�r Licensed?
S. Waste Transporter jj '"M ip.C)ft,s 7ee
dame of Hauler Destinition
kUA
_ 23 81 9TW16rViewed Inspector ate
,.� A.
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
r Mail To:
NAME OF BUSINESS: A ! 1'l Board of Health
MAILING ADDRESS: a e-� Town of Barnstable
_
TELEPHONE NUMBER: a P.O. Box 534
Hyannis, MA 02601
CONTACT PERSON: S� t�(..
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 whQn.stored
lease put a check beside each product that you store:
Antifreeze (for gasoline or coolant systems) Drain cleaners
vl' 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
TOWN .OF BARNSTABLE *_ =slactory
PLIANCE: CLASS: 1.Marine,Gas Stations,Repair
nters
BOARD OF HEALTH 3.2.Auto Body Shops
unsatisfactory- 4.Manufacturers
COMPANY ���'/1'/� = (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS lass: 7.Miscellaneous
QUA ES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSCase lots Drums Above Tanks Underground Tanks
IN OUT IN OUTI IN OUT #&gallons Age Test
Fuels: i�yw
Gasoline,Jet Fuel (A) �
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (0
new motor oil (C)
r4
transmissio yd„R raulic jZS
Synthetic Organics:
degreasers
Misc llaneous:
1�
10,
DISPOSAURECLAMATION REMARKS: f U
r�
1. Sanitary Sewage 2. ater Supply
O Town Sewer Public cg14>
�On-site OPrivate 9
3. Indoor Floor Drains YES NO S
O Holding tank:MDC V
O Catch basin/Dry well
O On-site system LG c }�� fir- #ww ^
4. Outdoor Surface drains:YES V NO
O Holding tank: MDC
Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
1• � YES NO
2
2.
v
Person (s) Interviewed Inspector Date
,aTERIAL SAFETY DATA SHEET IDEQUICKNTIFIER 19
'CA
M-�)j
I y A "I I A '- I
-NILAI ' t I iN-- 0110NI- No.
J BI-3 L' C I h: L-1) -
uN E i,C s),;g L1
3ob 3;k)
F
I Y A N iN I It J11 A t, A fi k 0 V 1.E
c
u O&N
T ,ls 'A N C'S 1.A REF
E b :3/L4 25,9960
R
..C-CEI LING..MP-MAXI MUM PEAK..N/A-NOT APPLICABLE..N/K-NoT KNOWN..P-POTENTIAL..PELL-PbMfSSIBCE E)(PbSORIE Ll
I IT..PM-PENSKY MARTENS..S-SKI N..ST-SH 0 FIT TERM..TLV-THRESHOLD LIMIT VALUE..TWA-TIME WEIGHTED AVERAGE..
• COMMON NAME USED ON LABEL CODE
CHEMICAL FAMILY
A
• PRINCIPAL HAZARDOUS COMPONENTS) ,A; 'L&COMMON NAME % EXPOSURE LIMITS(TWA 8 HOUR UNLESS OTHERWISE SPECIFIED)
i 6ICL
UNITS
V
•
BOILING SPECIFIC VA
MIN; F GRAVITY PR POR ESSURE mmHg@ BY VOLUME AT CIOI'LUF
VA�K ULNbI I T EVAPORATI SOLUBILITY HL-TI ?016 REACTVITY EVO UT
IN WATFR IN WAIER ON
APPEARANCE&ODOR
FLASH FLAME -FLAMMABLE LIMITS' LOWER UPPER AUTO IGNITION
POINT F EXTENSION ;jE In. IN AIR BY VOLUME TEMPERATURE 0 F
EXTINGUISHER MEDIA j,,
FIREFIGHTING
SPECIAL PROCEDURES
UNUSUAL FIRE AND
EXPLOSION HAZARDS
• STABILITY POLYMERIZATION
• INCOMPATIBLE 'T
I.WITH j X I
DECOMPOSITION y T t Y
N C I�L I
PRODUCTS
PRIMARY ROUTES OF ENTRY INHALATION SKIN INGESTION
1.ACUTE f T Al-: :--'Y:-
SIGNS
AND
SYMPTOMS
2.CHRONIC
A T i E C;=I j OF Y J k J, i OVEREXPOSURE
MEDICAL CONDITIONS GENERALLY A T.1 v
AGGRAVATED BY EXPOSURE
LISTED CARCINOGEN 111 1-i-,i- NTP IARC OSHA
EMERGENCY AND FIRS F 11) PFi0C.-
1. INHALATION i.)N
f, r t:
2. EYES T l')i u U, I LY r I LIN IF,
3. SKIN 'M -3 .
LJ.,J, i I i A I" S 1 1)F
N'T.1 G
-1. INGIESTIC)N J".L i", u ilj!�,, T
J. vo t. iA i-
v N!, y
'o I 1 Af
RESPIRATORY PROTECTION
iJ ri
VENTILATION LOCAL
VENTILATION MECHANICAL
SPECIAL
p
PROTECTIVE GLOVES
EYE PROTECTION
1 A
OTHER PROTECTIVE
1
CLOTHING/EQUIPMENT
HANDLING "J, :'1 4
%��,,�, , , F I S: ED
j
L:
AND
N.A
it .1, A
STORAGE
RESPIRATORY
OTHER
PRECAUTIONS
IF MATERIAL IS
A,"'I ID U N T S
IQ
OWN OF BARNSTABL_. COMPLIANCE: CLASS. �}�Marine,Gas Stations,Repai.r
Z.j Printers
atisfactory 3. . Auto Body Shops
BOARD OF HEALTH
unsatisfactory- 4. Manufacturers
{ 5. Retail Stores
(see"Orders")
:OMPANY E::4� ;�..;' °� 6. Fuel Suppliers
%DDRESSaQ� 4� _' Class: _ 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
�1AJOR MATERIALS Case lots Drums AboveTanks Undetground Tanks
IN 10 UIT I 0 "-g2llons Ape s ?
Fuels: r
Gasoline, Jet Fuel (A)
;_,5-
Dies el, Kerosene, N2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil
transmission/hydraulic
Synthetic Organics:
degreasers
rdS`r
Misc klaneoust
0/�~
k'
DISPOSAL RECLAMATION REMI.RKS:
1. Sanitary Sewage 2.. Wate Supply
,"Town Sewer ublic _^
On-site Private
3. .Indoor Floor Drains: %ES NO -�
Q Holding tank: M
OCatch basin/Dry well _- -�-•- _ _--. ..-----.._.-._..-- -- —
OOn-site system
4. Outdoor Surface drains:YES NC K
O Huldink• tank: MDC
O Catch basin/Dry well
OOn-site system
S. Waste Transporter- r Licensed?
UaUler- .Destination Waste ProdUcL YES NO
12 —,,'Person Interviewed Inspector 'Date
r,r O'+�Y fV OF BARNSTABLE COMPI,LA'JCE CLASS.,-'1,:'tiar.ine-,�C�as Stations,R_7pa' dr
satisfactory- 2• Printers
BOA D OF HEALTH 3. Auto Body Shops
-�-+0 � � ;}tp 0unsatisfactory- 4. Manufacturers
} (see"Orders") 5. Retail Stores
CO'dPANY �, - 6. Fuel Suppliers
MMUMMOMM
ADDRESS t Class: 7. Miscellaneous
QUAN7' S AND STORAGE (IN=indoors; OUT=outdo3r
Case lots Drums AboveTanks Underground Tanks
f MAJOR MATERIALS {IN CUT I IN 011f IN LOUT # zelloits .4 e des*'
` •�
Fuels:
Gasoline, Jet Fuel (A)
Kerosene #? (B) { i
Heavy Oils: I
waste motor oil
new
Synt.heti.c Organics:
degreasers +
i +
Miscellaneous:
I i
I l
,T S nc 4L/RECLkk°,MON I RE NV,RKj:
1. Sanitary Sewage 2. Water Supply _
Tow Sewer uu-bl c
site ® Private
3. Ir:aodr Floor Drains: YE
Holding tank: MDC
Catch basin/Dry well y
OOn-site, system
Outdoor Surface drains:YES NC _
uoldin€ tan::: MD C_ - --
Catch basin/Dry well
On-site system.
S. Waste Transporter 4 Licensed? t
tta1?l? OT HalilE" _ne,;?,na 1 n tYaste Product V NO
.. +�� • m .ter fjt
verso s interviewed —. G
1 _.fit o
p, ) � r
_ -. r
TOWN OF BARN8T, • 2. Printers
rinters o�a�iv,i�,tccYnit
..
0 satisfactory i ,-Auto Rod Sho s
B04�RD OF HEALTH`' '
y p
11 1 0unsatisfactory- 4. Manufacturers
COMPANY b� see"Orders" S. Retai.l Stores
a , s a071ijl ( ) 6. Fuel Suppliers
ADDRESS " •
7. Miscellanepus
�..�� _�`� G1�-..�'� . � �; �.a' ' ,•..nta-->. .....Class
QUANTITIES AND,STORAGE (IN=indo�crs; OUT=outdoor!
MAJOR MATERIALS Case lots Drums Abo nA veTanks Uetground Tanks
IN JOUT IN IOUT IN IOUT I' fi-e-L-1-lons A2e rest
Fuels:
Gasoline, Jet Fuel (A) `•
Diesel, Kerosene, N2 (B)
Heavy Oils: -
waste motor oil (C)
new motor oil (C)
174
transmission/hydraulic 11C
Synthetic Organics:
degreasers
., 1^
Mxsre Ian ou' :
I
[��
{ ,' r
any/' Li
DISPOSAL RECLAMATION Rhki.RKS,:
1. Sanitary Sewage 2. Water Supply ( ✓�^ w�.� �
O Town Sewer O Public '1 '- A
On-site Private
3. Indoor Floor Drains: YES NO �-
O Holding tank: MDC.'.
r
a
OCatch basin/Dry well .._ .�_- _ - -- -- • - -- -- - `
On-site system
4. Outdoor Surface drains:YES )NO
O Holding tank: MDC
O Catch basin/Dry w 11 7
Sy
O On-site system g
S. Waste Transporter F ; Licensed?
of Uauler. natinn Waste Produnt YES NO
u' a Person In`t ve-Tr: a Inspector Date
• TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM -
N4�ME OF FIRM: A►J�11S�(ffSc,�ts �rtJ1d)t 0(ac '
RAILING ADDRESS:( ��� RNINLS , MASS-
TELEPHONE 'NUMBER: �- . '2 ( 3
CONTACT PERSON: y Does your
firm store an !�Ye toxic or hazardous materials listed below,
either for sale or for your own use, in quantities totalling, a7 any tijne, 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)
jHydraulic 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 j
-�- 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) :I
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 fluids toxic or hazardous (please
(dry cleaners) list) :-'
Other cleaning solvents _
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners
Disinfectants
Road Salt (Halite)
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
RA'�IE OF FIRM: Hyanviiz Pox6che Audi Inc. .
t
MAILING ADDRESS: P. 0. Boz 977, Hyanniz., MA 02601 .
TELEPHONE NUMBER: 617-771-1213
,CONTACT PERSON: RobeAt H. Goodwin, Pnesident
Rene A. Danzeneau, SeAvice Manag a
Does your firm store any of the toxic or hazardous materials listed below,
either for sale or for your own use, in quantities totalling, a�t/any time, more
than 50 gallons liquid volume or 25 pounds dry weight? YES e/ 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 followini"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: t
✓ Antifreeze (for gasline or coolant systems) Refrigerants I
Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
Hydraulic fluid (including brake fluid) photochemical,
Motor oils/waste oils
V Gasoline, Jet fuel Printing Ink
Diesel fuel, Kerosene, #2 heating oil Wood preservatives
Other petroleum products: grease, (creosote) I
Swimming Pool chlorine
lubricants g
Degreasers for engines and metal Lye or caustic soda
Degreasers for driveways & garages Jewelry cleaners
Battery acid (electrolyte) Leather dyes
Rustproofers Fertilizers (if stored
✓ outdoors)
Car wash detergents PCB' s , ; �
Car waxes and polishes Asphalt & roofing tar Other chlorinated hydro-
Paints, varnishes, stains, dyes carbons, (inc.carbon
Paint and lacquer thinners tetrachloride)
Paint &. Varnish removers, deglossers Any other products with
Paint brush cleaners "Poison" labels (including
Floor & Furniture strippers chloroform, formaldehyde,
Metal polishes hydrochloric acid, other
Laundry soil & stain removers acids)
(including bleach) Other products not listed
Spot removers & cleaning fluids which you feel may be
toxic or hazardous ( lease
(dry cleaners ) P �
itECEIVE ® list) :-,,--
Other cleaning solvents HEALTH DEPT.
Bug and tar removers TOWN OF BARNSTABLE
Household cleansers; oven cleaners
Drain cleaners
Toilet cleaners
Cesspool .cleaners
Disinfectants MAY 2 2 1981
Road Salt (Halite)
}
;. TOWN OF BARNSTABLE
BOARD OF HEALTH
-`CO ROL OF XIQI AN' f�A 0 TERIALS - INSPECTION SHEET
I
� FIRM !
ADDRES"
Major types of materials: 1) �� �-''`� 2) f1 3)
4) i 5) 6)
I. Description of material(s) use: %
II. Storage (denote product by number listed above)
A. Containers
,meta glass paper plastic
cans,bottles,jars
drums,barrels
aboveground tanks
underground tanks
bags,boxes r
,r.
open,loose,uncovered
inadequate labelling
B. Storage Facility
✓or # Remar.ks/Rec_cafnmeri% :::.ions
1. Indoor -
a) separate, contained room J /
b) stored in general work area
i) inadequate ventilation
ii) floor drains
iii) inadequate fire protection
2. Outdoor
a) uncovered, exposed to weather
b) pervious surface/catch basins
III. Disposal
A. Reclamation/Recycling/tlnit
B. On-site disposal,._',,. 7, _
1. Town sewer
2. Regular septic system
3. Separate holding tank
C. Off-site disposal
1. hauled by own firm "I'll, et I e�_?" A 79 !
2. hired hauler -'
a) name of hauler
b) address or disposal site
I f / 'i
Persop(s) Interviewed - - - - - - - - - - - - - - Inspectafr/, �, — — — — - — — — —
Date `s
-OWN '
OF B RNSTABLE COMPLIANCE: CLASS: 1. Varine,Gas Stations,REpair
RN STABLE
2• Printers
BOARD O EALTH 3. Auto Body Shops
Ounsatisfactory- 4. Manufacturers
COMPANY (see"Orders") S. Retail Stores
Fuel Suppliers
ADDRESS „ �h,,,, -- Class: 7. Miscellaneous
Gon_E�, C�, QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) ;
P#AJOR.MATERIALS Case lots Drums AbOveTanks Undetgroiiad Tanks
IN 13UT IIN IOUT IN 1QL1T gellons Age rest?
Fuels:
Gasoline, Jet Fuel (A)
e
Diesel,,Kerosene, #2 (B)
Heavy Oils:
a
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous: r
DISPOSAL RE LANATION REM . KS
1. Sanitary Sewage 2. Wa6=bli:
C) To Sewer . r
i
On-site o Private 11
3. Indoor Floor Drains: YES O ;T��,� �j;'
Q Holding tank: MDC Y
Catch basin/Dry well2..
On-site system ,
4. Outdoor Surface drains-.YES NC
_. � Holding tank: MDC
o Catch basin/Dry well
oOn-site system
S. Waste Transporter �. Licensed?
Name of Hauler. Destination haste Product
P27
12 23 M Pergon(s) Interviewed `" Inspector Date
j CQMPLIANCE: CLASS: 1--lllFfarine,Gas Stations,Repai.r
TOWN - OF BARNSTABL� I
I i . z.I Printers
ALTH'd Qsatisfactory ' 3, Auto Body
tuers
F ps
B,QAR D OF HE 4. Manufac r
unsatisfactory-(see"Orders") 5. Retail Stores
COMPANY fn 61 a ya a 6. Fuel Suppliers
ADDRESS `" ' may ryfj~�' Class• 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors)
Case lots ', AbaveTanks Underground Tanks
MAJOR MATERIALS IN UTn
IN OUT U #_4 g2llons_ &y_e rest?
Fuels:
Gasoline, Jet Fuel (A)'
Diesel, Kerosene, #2 (B)
Heavy Oils: ,rO
waste motor oil (C)✓
new motor oil (C
transmission/hydraulic,f
r
Synthetic Organics:
degreasers
i
Miscellaneous:
:w-v .'per
DISPOSAL RECLA.- TION REW.RKS: - N�
1. Sanitary Sewage 2. Water Supply
Town Sewer Public
OOn-site O Private
3. .Indoor Floor Drains: YE NO
Holding tank: MDC ,X-- _
O Catch basin/Dry well —
URV
On-site system
C -=---
4. Outdoor Surface drains:YES k N . ,
• tank: MDC . �
O Holding
OCatch basin/Dry well ------
OOn-site system
S. Waste Transporter Licensed?
Name of Hauler- tlPctination 1ct ProdLct '
1.
[[ffaatt/ ,.{
u23ei
�,, +Person s) °Inge "v"'sewed ' Inspector Date
COMPLIANCE__ -. CLASS: 1. Marine,Gas Stations, Repair
e ���VN Cat BARNSTA BLE� - � f------ 2. Printers
BOARD Orr- HEALTH � s isfactory 3, Auto Body Shops
unsatisfactory- 4. Manufacturers
COMPANY (see"Orders") 5. Retail Stores
Fuel Suppliers
ADD Class: 7. Miscellaneous
-�� QUANd IT1ES AND STORAGE (1N=intJ00rs; CST-cute.c-,
2•iAJOR MATERIALS Case lots Drums AboveTanks Undeigro.usd Tanks
IN OUT IN 01-JT IN LOUT # 21 Ions A e Fest?
Fue)s:
Gasoline, Jet Fuel (A)
F7
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
�.
new motor oil (C) /
transmission/hydraulic
Synthetic Organics: ;
degreasers / r_4R6-�
�+
z
as: 11,aneous
41
D;SPOSAL RECL-`V TION RE NV,RKS:
1. Sanitary Sewage 2. Water SupprLy'l _
® T - '1 Sewer ubI ic
P :rv'ate
3. IndoorrFloor Drains: YES NO
LHolding tank: MDC —
0 Catch basin/Dry well
oOn-site system Ur:.,.,..5. ----------------- --------_-__ - ---- ---._._..-4. Outdoor Surface drains:YES NO49,
Tr Ec
Holdin4_ tank '.DC —
���
Catch basin/Dry well
•
0 On-site system
S. Waste Transporter �I �. Licensed?
Name of Haulersvr
23
v
91 r � r�eriewed � ,� YsK'c�tgr Date
,_ i
COMPLIANCE: CLASSY 1;. Marine,Gas Stations,Repai.r
OWN OF BARNSTABLE � � . ,...-.2.- printers
BOARD OF HEALTH satisfactory
3. . Auio 'Body Shops
unsatisfactory- 4. Manufacturers
(see"Orders") S. Retail Stores
XMPANY 6. Fuel Suppliers
%DDRESS Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors;
�1Z*, Case lots Drums AbO.veTanks Underground Tanks
4AJOWMA4 IN IDUT IN IOUT IN IOUT q 6 gellonseTest?
Fuels:
Gasoline, Jet Fuel (A) ;
Diesel, Kerosene, N2 (B)
Heavy Oils:
waste motor oil (C) -
,-new motor oil (C)
transmission/hydraulic \
Synthetic Organics:
degreasers
w
Miscellaneous♦ r'
►ISP.OSAL RECLAMATION REWLRKS:
1. Sanitary Sewage 2. Water .Supply
Town Sewer Public
OOn-site O Private
3. .Indoor Floor Drains: YES_ NO
O Holding tank: MDC —
O Catch-basin/Dry well --
On-site system �
4.. Outdoor Surface drains:YES ,NC -
0 "'tank: MDC Haldink
O Catch basin/Dry well
0 On-site' system
ran ort rItid_
Waste T s ee .
S. t tens
P
Name- of Hauler_ Destination Easte '
t.
2.
2 ,�_ 81 erson(s) Int-ervie a Inspector ate
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: Dcol' as� T�z'��°�:s ?� -_— - Board of Health
MAILING ADDRESS: /99 A 7 6® 01'ec Town of Barnstable
TELEPHONE NUMBER: .. P.O. Box 534
`�"�irgg�-r x Hyannis, MA 02601
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 any time, more than 50 gallons liquid volume-or 25 pounds dry
weight? YES v' 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
c
lease 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
vl- 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
1 t ..'•.: .....-i-....--.,,,e.r� .;, "ir:.»r..wi,r'-'•St. ,,.,tg; y° `tiitiL^."l1�at �"+�S.i.iagrs.d-M"`�irP- .,.., r '*' - ..
C)
TOWN OF BARNSTABLE OMPIJANCE: CLASS: ` 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
[4�* o �4'!,'�; � p� p�� ��, r �,CL O unsatisfactory- 4.Manufacturers
' COMPANY r*%�,� ,r .�a (see Orders ) 5.Retail Stores
6.Fuel Suppliers
ADDRESS 4ks' �i ir�xa�7., ,' Class: 7•Miscellaneous
~ j '" ` QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors)
MAJOR MATERIALS 1Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Gasoline,Jet Fuel(A)
(
Diesel, Kerosene, #2 (B)
a Heavy Oils:
waste motor oil (C)
new motor oil(C)
4
4e w4l'f
transmission/hydraulic
Synthetic Organics:
degreasers
d'
Miscellaneous') y
Alt
DISPOSAIJRECLAMATION REMARKS:
f errs+ mow' »X• L=3
1. Sanitary Sewage 2.Water Supply A
or
,.p Town Sewer QPublic .e5 'd /I?F—
O On-site 0Private_ al
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 . ORDERS: _
Q Holding tank:MDC '*-0.,
O Catch basin/Dry well
•O On-site system 4y
5.Waste Transporter E r y
Name of Hauler
Destination Waste Product
YES NO
44.
2. T
r Person (s) Interviewed Inspector ` Date
L,
.;,n....•. '`'C�`'1t+�r•:''.�",.,ti.��,�`rr"''�"v:�`f'�i '�.�i�#t�*-.{� .'y,,.,t�`1'-:-''w^,.4..,i.�:.�,J,'��Ph.a7.�,t�+a�sF/a'^+.°- �`-.•�*+-.n:.,�F°'4'w.:.m.:w�;w*.9�'•i *�ax"3iyE.�t 'w.� '^�c.. ...� -r• a Jam-.:.
• 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 Class: 7.Miscellaneous
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)
�toril(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellanh6s:
f �
e2 y y
v
DISPOSAURECI.AMATIONr REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer OPublic
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
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 NO
1.
2.
"��" a Person W Interviewed Inspector f Date '" "