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TOXIC AND HAZAR OUS MATERIALS REGISTRATION FORM
NAME OF FIRM: -'�/l�l�I� '�� �l /%I�J:✓' � � r
MAILING ADDRESS: I� G=
TELEPHONE NUMBER: ~I'�— � 5"
CONTACT PERSON: 67a4z �
Does your firm store any of the toxic or hazardous materials- list-ed below,
either for sale or for your own use, in quantities totalling, at any time, mor
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 i
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 j
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) which you feel may be
Spot removers & cleaning fliui
(dry cleaners) R C E I v toxic or hazardous (please
y
Other cleaning solvents HEALTH DEPT. list):
TOWN OF BARNSTABLE
Bug and tar removers
_ Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners ""Y 2 2 1981
Disinfectants
Road Salt (Halite)- , .-
r
I �
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRMztVa4,AJ
ADDRESS i
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,bottles,jars
drums,barrels
aboveground tanks
underground tanks
bags,boxes
open,loose,uncovered
inadequate labelling
B. Storage Facility.
✓or # Remar.ks jRecommenL : .%ons
1. Indoor
a) separate, 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 _ — Inspector — — — — — — —
Date _��
6 30 81