HomeMy WebLinkAbout0100 MEADOWLARK LANE - HAZMAT I OD NNE anu- Q-(-V-
i
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: •S MeS 'VOC,001C R 06 ` o l'\
MAILING ADDRESS: lei tj 0,0 l rk RA kA d S(
TELEPHONE NUMBER: L4 1. &-" - > i I tw�-h _ 13��
CONTACT PERSON: �
Does your firm store any of the toxic or hazardous materials 3s.ted 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, '
lubricants Swimming Pool chlorine
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 PCBs
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)
Spot removers & cleaning fluids which you feel may be
toxic or hazardous (please
(dry cleaners)
Other cleaning solvents
Bug and tar removers RECEIVED
—
Household cleansers oven cleanerNSALTH DEPT.
Drain cleaners TOWN OF BARNSTABLE
Toilet cleaners
Cesspool cleaners
Disinfectants
Road Salt (Halite) JUL 1 1981
TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,RFpai.r
2. Printers
BOARD OF HEALTH .� satisfactory 3, Auto Body Shops
Q unsatisfactory 4. Manufacturers s
COMPANY .
(see"Orders") 'S. Retail Stores
6. Fuel Suppliers.
ADDRESS Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=inddors; -OUT=outdoors)
MAJOR MATERIALS Case lots Drums AbpveTanks Undetgrouad Tanks
IN UT IN IOUT IN OUT & gallonserest?
Fuels,
Gasoline, Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: ,.
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
u6greeaers
Miscellaneous:
-DISPOSAL RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
OTown Sewer O .public
OOn-site. O Private
.3. Indoor Floor Drains: YES NO _
Q Holding tank: MDC
O Catch basin/Dry well
OOn-site system
4. Outdoor Surface drains:,YES NO
O Holding tank: MDC --
O Catch basin/Dry well
OOn-site system
S. Waste Transporter Licensed?
Name of Hauler_ Aas in ion ..Waste Product
2.
12 -� 81 Persons Interviewe Inspector Date
I'�I icy 'Rye .. _ Pm^^a kl �--�A �;e •