The URL can be used to link to this page

Home My WebLink About0436 YARMOUTH ROAD - HAZMAT 43Crmcu� ¢.6.� " n's 3y { Uo9 fla�ivna� Town of Barnstable oF1NE rosti Regulatory Services Thomas F. Geiler, Director BARNSTABLE, MASS. (X Public Health Division a i639, `q oOrF0 reap" Thomas McKean, Director 200 Main. Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.3CN/?S, [ DATE ►` `� 6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT /i ADDRESS OF ESTABLISHMENT O(J -f ( W1—S • 'TELEPHONE NUMBER 771 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.® fq 39,)._ STATE OF INCORPORATION FULL NAME AND AOME ADD SS F: n PRESIDENT — TL"-�e� 11� d' ,j jg-Sr VwjmotPr9-19e---T— TREASURER CLERK • SIGNA APPLICANT 1 Q RESTRICTIONS: HOME ADDRESS &r, HOME TELEPHONE # � Haz.dochcp/q �I CAFE IVE 17 41 `COOPERATIVE BANK �YARMOUTH PORT,MA 02675 . : . 63-7164/2113 Townjax{�of-.Gape Cod,.9nc. 01 g = '436%Yarmouth" Road =. 6/15/2010 a � - _MA anrns MA ;02601-2045 ` � � Y m oR�E°.oFE. Town of Barnstable I **100:00 0 One Hundred and-00%1.00,********** *«************* ***,* ,**,,******x****** * * *. DOLLARS TOWN OF BARNSTABLE HEALTH DEPT 200 MAIN ST LL MEMO a HYANNIS, MA 02601 1360. �. hazardous waste.permit �. bill ii' Ob74L ' i; 2 , R � 5000,� 30�i' Number Fee 197 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health • This is to Certify that Hyannis Auto Center(Town Taxi) .....- -- 436 Yarmouth Road, Hyannis,MA 0260.1 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and • and expires June 30, 2009 unless sooner suspended or revoked.. ------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/08 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health " � l f ' Town of Barnstable Barnstable INKE Regulatory Services Department ky-I&TA M�ftsiea Cifv Public Health Division • tARN31'ASLE. 0 •n Street, Hyannis MA 02601 .63q. �0� 200 Mal Str , y 2007 m Office: 508-862-4644 'Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO.,;q 0 DATE < �a APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT ��T��2L yi+ z Y ADDRESS OF ESTABLISHMENT TELEPHONE NUMBER SOLE OWNER: 10 YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: - IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. DaS3g9oZ. STATE OF INCORPORATIONt✓s FULL NAME AND HOME "nDRESS OF: PRESIDENT TREASURER CLERK IGNATURE OF T ` / RESTRICTIONS: HOME ADDRESS A) /NE ST. Y�l-✓�0" 4)t HOME TELEPHONE# Q:\Hazmat\Haz Mat Application2008 r- g HYANNIS AUTO CENTER, INC. SPILL CONTINGENCY PLAN 1) Evacuate the immediate area, if necessary 2) Shut off valve,pumps, and electrical equipment as appropriate 3) Restrict or remove any potential ignition source from the area if the material is flammable 4) If not already covered, cover or dike all existing sumps and storm drains. 5) Contain the spill by used of absorbent socks/booms,then apply appropriate absorbent material or additional absorbent socks/booms. Contact spill response firms in Appendix E, if necessary to assist in these activities. 6) Remove all absorbed material or contained liquid and package in DOT approved Container. Used absorbent materials should be packaged separately from liquids. 7) Label all containers with the type of waste and the start date of accumulation. 8) Notify the appropriate agencies and JLI corporate eontacts as prescribed in Section IV. 9) Once the spill has been controlled and material collected and secured, inspect the area for cleanliness and decontaminate all equipment used in the clean up. 10) Replace all used materials and ensure all response equipment is in good working Condition 11) Manage and dispose of collected absorbents and liquid in accordance with Federal and State environmental regulations. 12) For any spill greater than the reportable quantity (see Section IV) or 25 gallons, Which ever is less,this plan shall be implemented and proper records of action Shall be kept on-site as prescribed in Section IX. 13) Spill cleanup equipment is located in the garage, in the yellow tub, in the spill tray area 14) The following is a list of the spill equipment on site: a. Spill response kit capable of containing'a spill of at least 25 gallons. This kit includes absorbent spill pads, socks, and/or booms b. An adequate amount of nitrile gloves,nitrite or rubber boots and other Personal protective equipment. c. First Aid Kit d. Eye wash e. Fire extinguishers HYANNIS AUTO CENTER, INC SPILL CONTINGENCY PLAN APPENDIX` E EMERGENCY SERVICES PHONE NUMBERS FIRE DEPARTMENT 508-775-2323 POLICE DEPARTMENT 508-775-1212 AMBULANCE SERVICE 508-775-2323 NATIONAL RESPONSE AGENCY 800-424-8802 ENVIRONMENTAL PHONE NUMBERS LOCAL DEP OFFICE 508-946-2850 ADVANCED LIQUID RECYCLING 203-238-6771 CLEAN HARBORS 617-849-1800 617-935-9066 JIFFY LUBE CO"ORATE OFFICE 617-878-9121 GA'FNER ENVIRONMENTAL 800-442-7637 PENNZOIL INGjf)ENT REPORTING 800-848-7525 JLI ENVIRQNMENTAL COORDINATOR 713-546-8512 J41 POBLIC RELATIONS(MICKEY GENTRY) 713-546-8538 CAPE COD COOPERATIVE BANK' - - 1275 YARMOUTH PORT,MA 02675 53-7164/2113 Town Taxi of Ca a Cod, Inc. 01 H annis, MA 02601 2045 6l19l2008 ORDER OF Town of Barnstable $**100.00 One Hundred and 00l100**,.******,.******,,,***********«*«***,*.*******,,,***,.******..******,.*********.***********************� - DOLLARS TOWN OF BARNSTABLE P.O. Box 1360TC HYANNIS, MA. 02601-1360 MEMO CHECK /�,4Z MA NYf}NA/I fro eeNT� -- - -- -- - ------------"" T a 4JN 1 AXI 000 L 2 7 5ii'. 1: 2 L L 3 7 L 6►- 1,1: 90 L 50008 3011' F Number Fee 197 THE COMMONWEALTH OF MASSACHUSETTS $1oo.00 Town of Barnstable Board of Health • This is to Certify that Hyannis Auto Center(Town Taxi) 436 Yarmouth Road, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS.OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires June 30, 2008 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. 7/1/2007 PAULJ. CANNIFF,D.M.D. THOMAS A. MCKEAN,R.S.,CHO Director of Public Health 15° tlti �r P ,�,i,,A,� DATE�" map ' naY\� pk � •03 O �� y tA �"''F t#kt r � "ADDRESS { '1 x •^� r" a �y4,t r C DOLLARS$ gm w:a a ❑FOR RENT FOR TIP ® r ;`m 4� "^k "off" ` -.. r m ;a .• ,° qua_ ,��' y�1w�a�31, { §�kf ",�',�'`\�... IIIIII sY ACCO�NT CASH s skak ask t x CHECK .4 K Y"i; BALANCE MONEY -= DUE ORDER i . Town of Barnsta Re Regulatory Services Thomas F.Geiler,Director t ' , Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 50&--790-04 Application Fee: $100.00 i �J ® :K U) f, / jo ASSESSORS MAP AND PARCEL NO. "Jq(/ q'I 0 DATE r- rn APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT cu:r� NAME OF ESTABLISHMENT V)0 0 CDC AO-M ADDRESS OF ESTABLISHMENT ) OU rJa��S TELEPHONE NUMBER SOLE OWNER: YES NO IF APPLICANT.IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.? STATE OF INCORPORATION FULL NAME AND HOME A D SS OF: �^ PRESIDENT D 4a,�� ST OVA TREASURER CLERK SIGNA PLICANT RESTRICTIONS: HOME ADDRESS �® IJ� 14OcT�1-t HOME TELEPHONE# —3 r ' ` I HYANNIS AUTO CENTER, INC. SPILL CONTINGENCY PLAN 1) Evacuate the immediate area, if necessary 2) Shut off valve,pumps, and electrical equipment as appropriate 3) Restrict or remove any potential ignition source from the area if the material is flammable, 4) If not already covered, cover or dike all existing sumps and storm drains. 5) Contain the spill by used of absorbent socks/booms,then apply appropriate absorbent material or additional absorbent socks/booms. Contact spill response firms in Appendix E, if necessary to assist in these activities. 6) Remove all absorbed material or contained liquid and package in DOT approved Container. Used absorbent materials should be packaged separately from liquids. 7) Label all containers with the type of waste and the start date of accumulation. 8) Notify the appropriate agencies and JLI corporate eontacts as prescribed in Section IV. 9 Once the spill has been controlled d and material collected and secured, inspect the area for cleanliness and decontaminate all equipment used in the clean up. 10) Replace all used materials and ensure all response equipment is in good working Condition 11) Manage and dispose of collected absorbents and liquid in accordance with Federal and State environmental regulations. 12) For any spill greater than the reportable quantity(see Section IV) or 25 gallons, Which ever is less,this plan shall be implemented and proper records of action Shall be kept on-site as prescribed in Section IX. 13) Spill cleanup equipment is located in the garage, in the yellow tub, in the spill tray area 14) The following is a list of the spill equipmept on site: a. Spill.response kit capable of contain' a spill of at least 25 gallons. This kit includes absorbent spill pads, sods,and/or booms b. An adequate amount of nitrile glove$: nitrile or rubber boots and other Personal protective equipment. c. First Aid Kit d. Eye wash e. Fire extinguishers } Number Fee 197 THE COMMONWEALTH OF MASSACHUSETTS $11o.00 Town of Barnstable Board of Health This is to Certify that Hyannis Auto Center(Town Taxi) 436 Yarmouth Road, MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. - -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and • and expires June 30, 2007 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN SUMNER KAUFMAN,M.S.P.H. July 31, 2006 PAUL J. CANNIFF, D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health TOWN TAXI OF CAPE COD, INC. 30162 Town of Barnstable 7/26/2006 6500 Licenses and Permits HAZARDOUS MATERIALS PERMIT APPLICATION 110.00 Checking Hazardous Materials Permit 11.0:00 := Town of Barnstabl$ oF1HE ray, Regulatory-Services ✓G ti o� Thomas F. Geiler, Director swtuvsrns[.e. g Public Health Division �9 Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO..'-'�1 9 '4 (0 DATE k lo6 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 111 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT �-- ADDRESS OF ESTABLISHMENT '-136 "IG)r mc,-A-h ,�.. I c�c�.� VAA CQ z6(n� TELEPHONE NUMBER 508 - 7 7 1-55 5 SAt -77)- 7 t 22 SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION \A SSAC.�(1vSC }S aw FULL NAME HOME ADDRESS OF: PRESIDENT ✓� C-,.)A!e r- 10 �rce- ar Ma G 75 ' TREASURER c10 urmo,, o, Oa6715 CLERK to S�e-cc �1 E--rr 1 l o 7s� OF APPLICANT RESTRICTIONS: HOME ADDRESS 10 art,N -C�aG7 HOME TELEPHONE#,Zg- a;,2 oa 1 5' Q:\Application-Forms\HAZAPP.DOC MAIL-IN REQUESTS Please mail the completed application form to the address below. Also include a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please include the required fee of$100. Make check payable to:Town of Barnstable. Allow five to seven(7) working days for in-house processing. Our mailing address is: Town of Barnstable Public Health Division 200 Main Street Hyannis,MA 02601 FOR FAXED REQUESTS Our fax number is (508) 790-6304. Please fax a.completed application form. Also, please fax us a copy of your contingency plan (to handle hazardous waste spills, etc). In addition, please mail the required fee amount of$100.00. Please make the check payable to: Town of Barnstable. The check must be mailed to the address listed above. Allow up to four days for in-house processing. For further assistance on any item above, call (508) 862-4644 Back to Main Public Health Division Page Q:\Application Forms\HAZAPP.DOC Number Fee 197 THE COMMONWEALTH OF MASSACHUSETTS $100.00 Town of Barnstable Board of Health This is to Certify that Hyannis Auto Center (Town Taxi) 436 Yarmouth Road, Hyannis,MA 02601 Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. ------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------..----------------------------------------------- ----------------------------------- ------------------------------------ This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 6/30/2010 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER, M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 6/30/2009 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health 4 F. Town of Barnstable Barnstable o T M Regulatory Services Department A"mericaCfty i } Public Health Division BARNSTWOM 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. JW -I-f 10 DATE APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN 1 i 1 GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT NAME OF ESTABLISHMENT AIW6 4UID�E�%�� GtJN �C D�Ce. � ADDRESS OF ESTABLISHMENT 96 ARMOUr,4 TELEPHONE NUMBER 6"O7 77 '71d-J-- SOLE OWNER: AYES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS'�F ALL- PARTNERS: = R IF APPLICANT IS A.CORPORATION: FEDERAL IDENTIFICATION NO. d ,,3 9,j STATE OF INCORPORATION FULL NAME AND 410ME AD�D}� OF: PRESIDENT � 1'C TREASURER CLERK NIL i • GNATURE O A LI ANT RESTRICTIONS: HOME ADDRESS — HOME TELEPHONE# �$ 6®Z O Q:\Hazmat\Haz Mat Application2008.DOC .i • HYANNIS AUTO CENTER, INC. SPILL CONTINGENCY PLAN 1) Evacuate the immediate area, if necessary 2) Shut off valve,pumps, and electrical equipment as appropriate 3) Restrict or remove any potential ignition source from the area if the material is flammable, 4) If not already covered, cover or dike all existing sumps and storm drains. 5) Contain the spill by used of absorbent socks/booms,then apply appropriate absorbent material or additional absorbent socksibooms. Contact spill response firms in Appendix E, if necessary to assist in these activities. 6) Remove all absorbed material or contained liquid and package in DOT approved Container. Used absorbent materials should be packaged separately from liquids. 7) Label all containers with the type of waste and the start date of accumulation. 8) Notify the appropriate agencies and JLI corporate eontacts as prescribed in Section IV. 9) Once the spill has been controlled and material collected and secured, inspect the area for cleanliness and decontaminate all equipment used in the clean up. • 10) Replace all used materials and ensure all response equipment is in good working Condition 11) Manage and dispose of collected absorbents and liquid in accordance with Federal and State environmental regulations. 12) For any spill greater than the reportable quantity (see Section IV)or 25 gallons, Which ever is less,this plan shall be implemented and proper records of action Shall be kept on-site as prescribed in Section IX. 13) Spill cleanup equipment is located in the garage, in the yellow tub, in the spill tray area 14) The follov'ng is a list of the spill equipme})I on site: a. Spill.response kit capable of contairij} g a spill of at least 25 gallons. This kit includes absorbent spill pads, sods, and/or booms b. An adequate amount of nitrile glove;nitrile or rubber boots and other Personal protective equipment. c. First Aid Kit d. Eye wash e. Fire extinguishers c - I GAPE Coo` 15�2 5 coo PERATIVE.BANK - �"�Y YARMOUTH PORT.NIA 02675 111 53-71.64/2113: Town i of Cape Cod, Inc: 01 armouth.:Rd, 6720/2009 . is, MA - 045, Y. m ORDER THE Town of Barnstable **100 00, 0 "*******'******** ******************************************* **, ********************�*************w One Hundred and 00/100 , ,. ;DOLLARS 6. v 70WN OF BARNSTABLE 200'MAIN ST HYANNIS; MA. 02601-1360_ .MEMQ.� ` ATTN:PUBLIC,HEALTH DIVISION ` AUTHORI� D ATURE ►1'00'I•5 2SO �:,2 L L.3,7.164 Li:` 9O,1,50008 30ii■' TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM t Mail To: NAME F BUSINESS: C S^' �e O US SS' L Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: -7" P.O. Box 534 CONTACT PERSON: 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_ g .---.- 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 i Please put a check beside each product that you store: Antifreeze (for gasoline or ) coolants stems Drain cleaners systems) Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners V Hydraulic fluid (including brake fluid) Disinfectants f� Motor oils/waste oils Road Salt (Halite) 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 V1, 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 •_� r TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair O satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY S O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ' Class: / 4'7 1 7.Miscellaneous "ANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline, ) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) Z?� new motor,oil (C) transmission/hydraulic-;-!, /�85 Synthetic Organics: degreasers _ 1 Miscellaneous: 3 � avz e; ` DISPOS ECLAMATION REMARKS: 1. Sanitary Sewage 2.W ter Supply !� O Town Sewer Public " �' *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 INO ORDERS: O Holding tank:MDC ✓� Catch basin/Dry well / U On-site system eV 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. f .� son (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: i r-ld e F —04,,h Board of Health MAILING ADDRESS: k l k c e`r10 % Town of Barnstable TELEPHONE NUMBER: q o- -006 P.O. Box 534 CONTACT PERSON: '�T"� r, p ��P�e7�® 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 quan ' ies 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 in quantities totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: t, 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, I 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 ug and tar removers Household cleansers, eartefs White Copy-Health Department/ Canary Copy-Business +' .'a, . t"a �yR '+ y'y'.'�Tr''i' fw4 i... •;:?,far'' H.t n `fY?x n'+ ,-.M r+r:.,":. y►.t:,a m«> y,,,h^"' ub'!..°,''lD ►,�;k h,ve'.lt.+#` -..'y::t 4. •,=h'^ rg.. . TOWN OF BARNSTABLECOMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers i BOARD OF HEALTH , ® satisfactory 3.Auto Body Shops ,,,� �,,�� O unsatisfactory- 4.Manufacturers- COMPANYS�,4e., 1 T�+' ` �'fQ ,� „ (see"Orders") 5.Retail Stores , r 6.Fuel Suppliers ADDRESS 4.4 II.6 P; cr jSSS !' 7.Miscellaneous , #;tea�` ,V/;fQUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drums Above Tanks Underground IN . OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) - ' piesel; Keroserre;#2T(B=)> Heavy Oils: waste motor.oil (C) 76W, .new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers ;Miscellaneous40 v DISPOSAL/RECIA ATION' ` REMARKS: 1. Sanitary Sewage 2. Water Supply �` '� O Town Sewer OPublic O On-site OPrivate �� 3. Indoor Floor Drains YES 11;0 O Holding tank: MDC 1 O Catch basin/Dry well r^r ki� 0" c� O On-site system 4. Outdoor Surface drains:YES NO 1 ORDERS: `,b Holding tank:MDC O Catch basin/Dry well O On-site system .5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. i!?i G'�.,errs i, ' ✓''c,�ir / // Person(s) Interviewed Inspector Date' TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: MhIA Town of Barnstable TELEPHONE NUMBER: S^G�� 7 f® "' Oa P.O. Box 534 CONTACT PERSON: �0�-�3�- S S$'d� Hyannis, MA 02601 Does your firm sto ny of the toxic or hazardous materials listed below, either for sale or for your own ,,17IJ ies 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 storer site other than your mailing address: /_ ADDRESS: K� V ++ � - 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: x Antifreeze (for gasoline or coolant systems) Drain cleaners X Automatic transmission fluid Toilet cleaners X Engine and radiator flushes Cesspool cleaners x Hydraulic fluid (including brake fluid) Disinfectants x Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, x Other petroleum products: grease, lubricants rodenticides) x 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 Y ( ) 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