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HomeMy WebLinkAbout0705 MAIN STREET (OST.) - HAZMAT ���/�u�� � c��� �/ i TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: r�N7-e���nsfer V I ) I Q.) Board of Health MAILING ADDRESS: 7©S /+�,q//1/ ` Q-S' �wi//� Town of Barnstable TELEPHONE NUMBER: �fL�'- �l 2— P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: r 9no�ie w- �i ti�/fie,. Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your-own use, in quantities to ailing, at any time, more than 50 gallons liquid volume or 25 pounds dry/ weight? YES NO f 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' 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 odenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages L___�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 1 FTOWN 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 0J' gg: 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: as e ) �7 new motor oil (C) h transmission/hydraulic Synthetic Organics: degreasers Miscellaneou /n.Z DISPOSALIREC;LAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer q.Public ,,�On-site O Private 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 i 2.Z r vA`11 a ! Pers (s) Intervie ed Inspector Date TOWN OF BARNS l>At3LL 5 `'`,,�'r`'."'.`'`'. �`" .. � 2 Printers BOARD OF HEAL. {'� � Q satisfactory , � •� 4, .-Manufacturersps unsatisfactory- j/� y see"Orders" 5. Retail Stores COMPANY ;l `./ ' `�'--� �```�'t ( ) 6. Fuel Suppliers ADDRESS �,;,., � 'i Class 7. Miscellaneous : QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor: Case lots Drums AbOveTanks Undetgrouad Tanks MAJOR MATERIALS IN OUT IN IOUT IN A6 Rell6nse rest Fuels: Gasoline, Jet Fuel (A) �Diesel, Kerosene, N2 (B) - Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: "A 4,� rTj I DISPOSAL RE LAMA` tLJ 1 1. Sanitary Sewage 2. Water Su Pub 1].c pply ' OTown Sewer On-site O Private 3. Indoor. Floor Drains: YES NO — rur—f n, O Holding tank: , MDC Catch basin/Dry well O } On-site system ,z-- -y ORDERS:� 4. Outdoor Surface drains:Y'ES NOER — O Holding, tank: MDC _ ~' O Catch basin/Dry well On-site system S. Waste Transportesr Licensed? Name of Hauler_ ,�ctination Watee Product- ' ]l a 12 ei"" �P�fq 's,} ,i. Inspector 'Date