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Home My WebLink About0380 BARNSTABLE ROAD - HAZMAT Sa -n 3+a b)e-. d l F - E SMEAD KEEPING SOU ORGANIZED Ma, 1033A 2453L MADE IN USA GET ORGANIZED AT SMEAD.COM TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: ,ej �� - '` Board o Health MAILING ADDRESS: Zvj Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qyapities 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 registered when stored 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) Disinfectants _ Motor oils/waste oils Road Salt (Halite) _ Gasoline,.,#e -#trei 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) 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) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business 0 TOWN OF BARNSTABLE , MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH Satisfactory 2.Printers O 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY ' (see"Orders") 5.Retail Stores 6.Fuel Suppliers 7.Miscellaneous ADDRESS Class: TAN ITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test ilff -12 Fuels: Gasoline er Diesel, Kerosene, #2 (B) Heavy Oils: - ✓a waste motor oil (C) rG new motor oil (C) 4 transmission/hydraulic j' Synthetic Organacs` degreasers Miscellaneous:Ig!,49 aji&z &-Z v DISPOSALIRECLAMATION REMA�R}K—S: �/` �J 1. Sanitary Sewage 2. Water Supplyb Y/f /�! A O Town Sewer Public O On-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well IIV` O On-site system 4. Outdoor Surface drains:YES_�_/NO ORDERS: Ap O Holding tank:MDC Catch basinADry-w-01 V On-site system 5. Waste Transporter Name of Hauler Destination Waste Product 1• `� , /a� . � YES NO 2. _T ers (s) nterviewed Inspector Date \` TOXIC AND HAZARDOUS MAT RIALS REGISTRATION FORM To: NAME OF BUSINESS: �rd of Health MAILING ADDRESS: ell, Town of Barnstable 14 TELEF.HONE NUMBER: — gd P.O. Box 534 CONTACT PERSON:: Hyannis, MA 02601 Does your firm store any of the toxic or hazardous_..materials i ed below, either for saTe or_fbT- your own use, in ntities totalling, at any time, more tfian 50 gallons iquid 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 Please put a check beside each product that you store: Antifreeze gasoline asoline or coolants stems / Drain cleaners ( systems) t Automatic transmission fluid L Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants —L -*;ter=otor oils/waste oils RR d Salt (Halite) +� Gasoline, „ t/ Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) LI Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages"*—-,, Printing ink _LZ Battery acid..(electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine C r wash detergents Lye or caustic soda r waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes 1; Paints, \r ids, Fertilizers (if stored outdoors) tZFaint & lacquer thinners': PCB's Ol F'alnt s 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): G fury cleaners) iN��., Other cleaning solvents :V141 Bug and tar removers Household cleansers, oven cleaners ¢,n l�. White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers OMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRES /;��_ Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 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 Ax/ ti Miscell neous: 41 DISPOSAL/RECLAMATION 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 INO 2. "are? erson (s) Interviewed Inspector Date TOWN OF BARNSTABLE MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH satisfactory 3.Printers dy Shops unsatisfactory- 4.Manufacturers COMPANYAsY/�f /Pr _yy (see"Orders") 5.Retail Stores 6.Fuel Suppliers 1 ADDRESS A. /� A' n. SS: 7.Miscellaneous AN AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS ase lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: /P AaV 444p� M ell Gasoline,4obAkm6 Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) � transmission/hydrau�lic Synthetic Organics: L Miscellaneous: t �'a� �� IV DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply N ,�A/ elv&VPW O Town Sewer ublic On-site OPrivate f , 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 p"h�C i LL 9_ i'z Catch basin/Dry well O On-site system ��// �i �• y �✓" 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 46 2. Person (s) Interviewed Inspector Date