HomeMy WebLinkAbout0108 PARKER ROAD - HAZMAT paxy\'o-p, good
40
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
.:
f NAME OF-FIRM: John Hinckley & Son Co.
h MAILING ADDRESS: P.O. Box. 218, Hyannis, Mass. 02601
TELEPHONE NUMBER 617-775-0700
CONTACT PERSON: Ray Carroll, Buyer
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.;anytime, 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`mu'st 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)
Hydraulic fluid (including brake fluid) Photochemicals
—1---"- Motor oils/waste oils Printing Ink
Gasoline, Jet fuel
Diesel fuel, Kerosene, #2 heating oil �L Wood preservatives
Other petroleum products: grease, (creosote)_
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-
7'—Asphalt & roofing tar carbons, (inc.carbon
P-Paints, varnishes, stains, dyes tetrachloride)
1�, -Paint and lacquer thinners Any other products with
i- Paint & Varnish removers, deglossers "Poison" labels (includingswith
Paint brush cleaners
�- Floor & Furniture strippers chloroform, formaldehyde,hydrochloric acid, other
- 171- Metal polishes acids)
Laundry soil & stain removers(including bleach) Other products not listed
which you feel may be
(/ Spot removers & cleaning fluids E C EIV E D toxic or hazardous (please
(dry cleaners ) PT, list)
DE PT.
g HEALTH :
Other cleaning solvents TOWN HEL DE TABLE
Bug and
tar removers
Household cleansers, oven cleaners
-�- Drain cleaners
1/ Toilet cleaners
Y Cesspool cleaners MAY 1 4 1981
Disinfectants
V Road Sale (Halite )
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
ADDRESS ::
Major types of materials: 1) 2) 3)
4) 5) 6)
I. Description of material (s) use:
II. Storage (denote product by number listed above)
A. Containers metal glass paper plastic
cans,bottIes,'j ars
drums,barrels _
aboveground tanks
underground tanks ems, 4
ZZ
bags,boxes "
open,I oose,uncovered
inadequate labelling
B. Storage Facility - ✓or•# . Remarks/Recommendations
1. Indoor -
- - a) separato, contained room
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 unit _
B. On-site disposal .
1. Town. sewer
2. Regular septic system
3. Separate holding tank
C. Off-site disposal
1. hauled by. own firm
2. hired hauler
a) name of hauler
b) address or disposal site
Person(s) Interviewed — _ — Inspect
Dater !—%- - - - - - - -
R
A COMMONWEALTH OF MASSACHUSETTS
11 DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING
` , DIVISION OF SOLID AND HAZARDOUS WASTE
One Winter Street
Boston, Massachusetts 02108
Pleas,print or type.(Form desicne,for use on elite(1 2-pitch)typewriter.)
UNI FORM HAZARDOUS 1.Generator US EPA IDNo. Manifest 2. Pag71l.'rif.r..tion in the shaded areas
I _ �,_� Document No.
WASTE MANIFEST of not required by Federal law.
3. Gene,atn,'s Nam=and M=icing Address A.State Manifest Document Number
ff/,vcK��'y ,�C cU,, / 1 �,e p MA c 1 n
QS7',C)R v/�4 P 1 A�7 A. eq z a 7`�� B.State Gen.ID
4.
r"1 � O
Generator s Phone 1 1 � r
5.Transporter 1 Company Name 6. US EPA ID Number C.State Trans.ID. 03
[7 E-'
7. Transporter 2 Company Name 8. US EPA ID Number D.Transporter's Phone( / 1
E.State Trans.ID
N
O 9. Designated Facility Name and Site Address 10. US EPA ID Number00
F.Transporter'sPhonel i O
00 -���`c U /NC-T-5/S-ld/)YJA/Ai SJ" n
It /� G.State Facility's ID"; --"Not.Requiied �
[i �/lCN
,O Q 1 �� o Z Li� H.Facility's Phone 1 61- 13 V
p 12.Containers 13. 14. I. W
O i 1.US DOT Description(inciuding Proper Shipping Name,Hazard Class,andlDNumber) Total Unit Waste No. ••
00 No. Type Quantity WtNol
Y a'�igST L`(�M(3�/1 J/ L G j,l r/rJ/0 Al
C
U U G D l
in G b. Z
C E fTI
a IN �
E I D
Cr R c.
A O
F,
T
Q o I
3
@ R d D
Z H
L r*1
N d
m J.Additional Descriptions for Materials Listed Above(include physical state and hazard code.) K. Handling Codes for Wastes Listed Above DID
U -<
2a. / c. a. C. --�
to ty
a -n
at b. d. b. d.
E 15. Special Handling Instructions and Additional Information
CL _ _
N 16 GENERATOR'S CERTIFICATION:I herebydeclare that the contents of this consignment are full and accurate) described above b g y y y proper shipping name and
O are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national
T
government r- - - small -
e . ., �g�l�tiors,znd all�ppiicable State laws/regulations.Unless I am a amdil yua!ttity generator who has been exempted by statute or regulation from I
;he duty to mnkz�a vraste minimization certification under Section 3002(b)of RCRA,I also certify that I have a program in place to reduce the volume and toxic)- i
m ty of waste generated to the degree I have determined to be economically practicable and I have selected the method of treatment,storage,or disposal currently
tll avilable to me which minimizes the present and future threat to human health and the environment. ___
E F Date
O —
O Printed/Typed Name r ature J l Month Day Year I
T � 1 7.Transporter 1 Acknowledgement of Receipt of Materials
U i R r— -- --------
C N "rl/Typed Name i Month Day Year
~
_ L/d/Y/V ST// tr -_ _____
0 18. Transporter 2 Acknowledgement of Receipt of Materials Date
Printed/Typed Name Simon.re Month Day Year
µ 19.Discrepancy Indication,Space
F
A
C
L 20.Facility Owner or Operator:Certification of receipt of hazardous materials covered by this r,—ifnst except as noted in Item 19.
I T Date
Iy rinte,! rvpedName Si note Mo.,th Dav Ve r '
/ c ' j 121 y yyy�(1
.proved OMB No.20 0-0404.E.pires 7: -86 L ��
EPA form 8700-22)Rev. 4-85 Previous addition is obsolete)
l�
r0WNO TIUSTA- . . �l7FTPC27VVGB:"'""" "` "' CCFCS�:S�^1 Fialllie�lia� uio�iv,. ,.' �,a
`- "L— t 2. - Printers Z,.a
BOARD OF HEALTH satisfactory 3, Auto Body Shops
unsatisfactory- 4. Manufacturers
COMPANY J�%( f (see"Orders") S. Retail Stores
6. Fuel Suppliers
ADDRESS ?j "�i 1/f'�� C- , Class: 7. Miscellaneous
�—.N I. QUANT TIES AND STORAGE (IN=indocrs; OUT=outdoor:
Case lots Drums AbdveTanks Undetgrouad Tanks
MAJOR MATERI IN JOUT IN IOUT IN IOUT # 6 gEll'onse frest
Fuels:
Gasoline, Jet Fuel (A)'
Diesel, Kerose e, #2 (B)
Heavy Oils
fi -
waste motor oiL '(C)
new motor oil (��)
transmission/hydraulic--_ M..
_ 1
Synthetic Organics: 1
degreasers
A
Mis ellaneous: ` �=
".
DISPOSAL RECLAMATION REMARKS: .
1. Sanitary Sewage 2. Water Supply c .
W Town Sewer Public
O On-site S Q Private'
.M
3. Indoor Floor Drains: YES NO•
O Holding tank: MDC �
O Catch basin/Dry well
On-site system ORDERS:
4. Outdoor Surface drains:YES NO u
O Holding, tank: MDC
O Catch basin/Dry well
0 On-site system `--
S. Waste Transporter Licensed?
Name of Hauler_ .D,s ina inn -Waste Prndurt YES NO
1,
I'v
12 23 81 erson(s) „Int.er`vi�we ector ate