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Home My WebLink About0707 MAIN STREET (OST.) - HAZMAT `707 mcu� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: ' L) 241,Y71-11rG' I C Board of Health MAILING ADDRESS: �Zol 17 4-1 N S —F VAS/ Town of Barnstable TELEPHONE NUMBER: 2 CY P.O. Box 534 CONTACT PERSON: T t/` - , Hyannis, MA 02601 It 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'Lef'--- 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: -70 3 ?v 04�)'�yv S'V'- 0-S'7�'Y K LCe TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous r i rIrw characteristics and must be eg ste ed when store Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) LL 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 �/ C1ieee+-f[rel, kw Berm, #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 V— Paints, varnishes, stains,4ps 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, '�/ Lam• hydrochloric acid, other acids) (ine6d4aj 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 BARNSTABLEr_ � MPLlANCE: CLASS: 1.Marine,Gas Stations,Repair tisfactory 2.Printers BOARD OF HEALTH3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY 71��N j�jtic/N` �'�s� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 7 0'7 1" iW-T Class: —7 7.Miscellaneous O -'_-'7�4---',,(- L'WANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) ;�� eac-, #2 (B) s Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers jo Miscellaneous: Ile- DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0, O Town Sewer Public xOn-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_Y/NO ORDERS: O Holding tank: MDC Catch basin/Dry well oc O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. .f' �� - 2. Person (s) Interviewed Inspector r Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: T' &0 S- 14AItO �0'(J ` 0 C MAILING ADDRESS: 7 3 A4� t �' r �' S �v•.. ` �N A TELEPHONE NUMBER: y � 67 G 9 CONTACT PERSON: R v I ZT . d�- wok n A Does your firm-store-any of �theAoxic or:hazardous materials -1 sted 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)w 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 &-- Paints, varnishes, stains, dyes carbons, (inc.carbon. 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 (including bleach) Other products not listed Spot removers & cleaning fluids which you feel may be (dry cleaners) toxic or hazardous (please Other cleaning solvents R E C E IV E D list. ,:; Bug and tar removers HEALTH DEPT. Household cleansers, oven cleanWersF BARNSTABLE Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants MAY 1 4 1981 Road Salt (Halite)