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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates[cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the'Town Clerk's Office,.1st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: _` `Z I 1 J Fill in please:
APPLICANT'S YOUR NAME/S: kA14Leen/ V,'O LA
do�� BUSINESS YOUR HOME ADDRESS:SAD Fi /d I P f S �I T2G I P /4 w NN 1 "1¢ n Leo O l
TELEPHONE # Home Telephone Number -5M 775-
VAME pF CQRPORAl'ION ;
NAME.OF NEW BUSINESSING j �/ fhe Si�� fYPE QF BUSINESS fISSi�'Ge
IS THIS,A HOME OCCUPq IQN� ES, NO X �r /¢' Gc r
ADDRESS OF:BU511yESS' ': :Z . �. pG ./3'� II MAP%PAR.CEL NUMBER �U � � [Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - [corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
2. BOARD OF HEALTH
This individual has been" rm d of the permit requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: 10 Uj 4 Mail To:
BUSINESS LOCATION: 70 ' 1V1 Board of Health
Town of Barnstable
MAILING ADDRESS: P.O. Box 534
TELEPHONE NUMBER: Hyannis, MA 02601
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: q7q-
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 character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store:
Quantity/Case Quantity/Case
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
Car waxes and polishes Jewelry cleaners
Asphalt &roofing tar Leather dyes
Paints, varnishes, stains, dyes Fertilizers (if stored outdoors)
X _E)& laeq tier i"n4efs 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 COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY aL+:-� 3�-&-y 57�y, (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS �usZL�'IfW Class: 07
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)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
Net, l
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply zf ` � w�
O Town Sewer OPublic r
O On-site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank: MDC
Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES VINO ORDERS:
Q Holding tank:MDC
0 Catch basin/Dry well
O On-site system
5. Waste Transporter
Name of Hauler Destination Waste Product
1 YES" NO
.
2.
rson (s) n rviewed Inspector Date
_ 1