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Home My WebLink About0735 ATTUCKS LANE - HAZMAT�I I I i I I I it I I i ij E Ili KEEPING YOU ORGANIZED N®.10334 2-153L MADE IN USA GET ORGANIZED AT SMEAD.COM ��- C-) IKE r° Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • sa MASS. ASS LE. • 200 Main Street• Hyannis, MA 02601 FoM9n+'�0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: kfg= C OJQ Qe-"l Date: 10 3 ,(o Location/Mai ling Address: -73 s- *ve k w- a»,1► S 6V>V,!5 Contact Name/Phone: .cic- Q moo.,✓ o -7 8-4- 64> Inventory Total Amount: 4 2`� �� MSDS: ` eS t '5-6A S,VS License#: Tier II : 1 Labeling: Ok qroelSpill Plan: Oil/Water Separator: Floor Drains: 1151 Emergency Numbers: Storage Areas/Tanks: 59a \DVA'k VA-,,x u!L Very v 7w �\ aw k�s o►� S�}e- Emer enc /Containme ui ment: Waste Generator ID: nt Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives ` Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil l Disinfectants I Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes . �}- Wood preservatives(creosote) Asphalt&roofing tar O t rj Swimming pool chlorine $��`�" ��-5 Paints, varnishes, stains, dyes Lye or caustic soda ft� ej\ Lacquer thinners Miscellaneous Combustible 5'o lb,VCo""� Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: e�' S `� vl R\k V-AP k k,pin. c X v a. _ "J,r kk v%, Inspector: — 1 , Facility Representative: o WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Date: `{ I,28 /ty -� .��ow TOXIC AND HAZARDOUS MATERIALS flEAUSTFUORM FORM NAME OF BUSINESS: Ca ri Pe✓4&. ,(.�a+jpvt, BUSINESS LOCATION: "735 Al c ,s Lomc. N a s INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER:� 0 -�� Opp G Ill CONTACT PERSON: 0:ke L COwk ► g w 2�nane� EMERGENCY CONTACT TELEPHONE NUMBER: a.j D1`' MSDS ON SITE? TYPE OF BUSINESS: GVVW 4e (- ftykNo lnoyp��a� e INFORMATION pp / RECOMMENDATIONS: C -Gv%rP Mo Fire District: Waste Transportation: N JA Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts(Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 'I lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Shock- - (� �j4,� Spot removers&cleaning fluids (dry cleaners) W< Other cleaning solvents Bug and tar removers ,1 Windshield wash J WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Sig ature Staff's Initials -� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM I To: NAME OF BUSINESS: .l�v Ply"'" �� "" �' si% '��f Board of Health MAILING ADDRESS: ¢7 �Z� A'� � ' `�% �� Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: Z2 Hyannis, MA 02601 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 characteristics and must be registeredItt - d> Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes _ Cesspool cleaners Hydraulic fluid (including brake fluid) �Islnfectants Motor oils/ems ✓ Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products:, 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) 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, 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) V/zrdA Other cleaning solvents r 7-14YL- KF1_0A/1= Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business A + TOWN 1V OF BARNSTABLE . OMPHANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF H AL 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores ^� 6.Fuel Suppliers ADDRESS Class: YL 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUndergroundove Tanks 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 iscella o :P. 0.ld f o Al DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Pers ) IntervWwed Inspector Date TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF EALTH 3.Auto Body Shops �� "`�'�'� O unsatisfactory- 4.Manufacturers COMPANY '�� ,� �< r� � �- (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous �<04QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUTI 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: de r..—fie-s Miscellaneous: Ste- X44 des i - DISPOSAIMECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Town Sewer XPublic O On-site OPrivate 3. Indoor Floor Drains YES NO !/ O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product LicensedT YES NO 1. 2. Pe \ ) I rviewed "Inspector Date