HomeMy WebLinkAbout0037 BARNSTABLE ROAD - HAZMAT J _ _
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: r
MAILING ADDRESS: aptallin
TELEPHONE NUMBERCONTACT PERSON:Does_you-r---firm--store-any--of -the_-toxic.or.-hazaed==beloweither for sale or for your own use, in quantitiesim mothan 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)_ 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, 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-
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 fluids E C E I V E D toxic or hazardous (please
(dry cleaners) s
Other cleaning solvents HEALTH DEPT. list)
TOWN OF BARNSTABLE
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 1 4 1981
Disinfectants
Road Salt (Halite)
T OF BARNSTABLE` ` COMPLIANCE: CLASS:' l "'Marine,Gas Stations,Repai.r
...Printers
BOARD OF HEALTH O satisfactory y p
3. •Auto Prod Shops
O unsatisfactory- 4. Manufacturers R
(see"Orders") S. Retail Stores
COMPANY i f~//,% f�U� e �/. 19 IIr 6. Fuel Suppliers
ADDRESS �j� ln,,., „ . '� 6� Class: / 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors).
MAJOR MATERIALS Case lots Drums AboveTanks Undetgrouad Tanks
IN IOUT IIN IOUT IN UT # & zallons ALyerest?
Fuels:
Gasoline, Jet Fuel (A)
r
Diesel, Kerosene, #2 (B) Jam,
Heavy Oils: I
", waste motor oil (C) I '
i
new motor oil (C)
1
transmission/hydraulic /
jSyntheti.c Organics: ,•: V
degreasers
i
Miscell nevus:
I
`' .1
DISPOSAL RECLAMATION REMAR S:
1. Sanit ry Sewage 2. Water Supply ) i - 444,e .4 .fir,s�� i r7V D/
Town Sewer O Public _ lJ7t` ergs" 7
OOn-site O Private
3. Indoor Floor Drains. YES NO
4 Holding tank: MDC _ " -
0 Catch basin/Dry well
0 On-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. Destination ,Waste Product _YFS1 NO
1.
12 z3 ai Person(s) Interviewed / �f' Inspector Date
T.
Q R� uOF BARNSTABLE I+ I COMPLIANCE: CLASS � .''hlarine,Gas Stations,Re pair
O satisfactory Printers
BOARD OF• HEALTH 4.3. . Auto rods Shops
t satisfactory- Manufacturers
(see"Orders") S. Retail Stores
:r '�
COMPANY `" ~ - ` 6. Fuel Suppliers
'` 7. Miscellaneous
ADDRESS ( ";.�, '" I Clans
tj'/ � j�'1/ QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors)
Case lots Drums AboveTanks Underground Tanks
MAJOR MATERIALS IN OUT IIN IOUT I INIOUT N 6-921lonse rest?
Fuels:
Gasoline, Jet Fuel (A)
r �
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) U /
i
new motor oil
transmission/hydraulic /
Synthetic Organics: ; 1
degreasers
b
ti
Miscellaneous:
C'Irl LL L,
-'
DISPOSAL RECLA A- TION REW.RKS: 1-
1. Sani ry Sewage 2. Water Supply `
T wn Sewer blic
OOn-site Y Private
3. .Indoor Floor Drains: YE NO A-
Holding tank: MD �`1���. n•C '�.�. 4 ' '' �
0 Catch basin/Dry well
On-site system
4. Outdoor Surface drains:YES - NC
. O Holding• tank: MDC �-
0 Catch basin/Dry well
0 On-site systemyY
S. Waste Transporter Licensed?
Oxoduct NO
2.
u z3 ei Person Interviewed
Date
s) In