HomeMy WebLinkAbout0091 CINDY LANE - HAZMAT i �oe_ �l�
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: 61'C-604
MAILING ADDRESS: �3OX (1e
TELEPHONE NUMBER: 3(,2'_16a3
CONTACT PERSON:
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 indiyc, a a stored at a
site other than your mailing address: _
ADDRESS: d'A`(Z--� 1Ldi/ls�c Z w4. a
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:
L.— Antifreeze (for gasline or coolant systems) Refrigerants
t�Automatic transmission fluid w Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
i-- 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
iy Degreasers for engines '-and metal Jewelry cleaners
Degreasers for driveways & garages Leather dyes
L., Battery acid (electrolyte) Fertilizers (if stored
Rustproof ers
outdoors)
Car wash detergents PCB' s
✓Car waxes and polishes Other chlorinated hydro-
plt & roofing tar carbons, (inc.carbon
Paints, varnishes, stains, dyes tetrachloride)
:,___P-wtftt 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
i, Metal polishes acids)
Laundry soil & stain removers Other products not listed
(including bleach) which you feel may be
Spot removers & cleaning fluids toxic or hazardous (please
(dry cleaners ) R E C E I V E
Other cleaning solvents HEALTH DEPT. list) :
Bug and tar removers TOWN OF BARNSTABLE
Household cleansers, oven cleaners
_ Drain cleaners
Toilet cleaners
Cesspool cleaners
Disinfectants MAY 19 a/1
Road Salt (Halite ) OIL
TOWN OF BARNSTABLE
' BOARD OF HEALTH.
% CONTROL, OF TOXIC AND- HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
ADD S
T
Mafj types of maVerials: 1) 2) 3)
L
4) c 5) 6)
I. Description of material(s) use:
II. Storage (denote product by number-listed above) , 3
A. Containers
metal glass , p' as
tic
cans,bottles,jars
drums,barrels
aboveground tanks J 7 �'✓
underground tanks o /J_ ,----�r
bags,boxes y >'
open,loose,uncovered ,
inadequate labelling
B. Storage Facility ✓or:# Remark /Recommendations .
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 ��
"OWN OF BARNSTAB �L ,��.G: , � , .,�a..
Q sa'tisfactory t ; 2. •Printers
BOARD OF HEALTH .3. Auto aBodyctu Shops
•4. Manufacturers
yw.l� �� �F w i �. unsatisfactory- S. Retail Stores
,COMPANY (( 5 5 /0 t �.?-� (see"Orders") �6. Fuel Suppliers
ADDRESS (41 ,:wC>1 1 :� Class: _ 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indocrs; OUT=outdoors)
MAJOR MATERIALS ' Case lots Drums AbOveTanks Undetground Tanks
IN IDUT IN IOUT I IN IOUT N zlAye—rest?
Fuels: ti
Gasoline, Jet Fuel (A)
Di esel,�Kerosene,)N2 (B) L (j
Heavy Oils: �r
waste motor oil (C) 5
new motor oil (C)
transmission/hydraulic , X- /
Synthetic Organics: !�
degreasers
j
Miscellaneous:
DISPOSAL RECLAMATION u-REW RKSw
1'. Sanitary Sewage 2. Water Supply '
Town Sewer a Public
® On-site Q Private
3. Indoor Floor Drains: YES NO
.0 Holding tank: MDC
O !Catch basin/Dry well _.__—..—_-_:_._.._ ..-----•---.-••- -_------ —
•• .I t
On-site system �*-
C
4. Outdoor Surface drains:YES NC
0,Holding• tank: MDC C U
OCatch basin/Dry well . o-A AC)
OOn-site system ;' '._ y� ___ - ---- ----S. Waste Transporter };. -_4.> ., L; J � `- 4 „��.,-�fice sed?
Name of Hauler_ l Par;nation lQgte Product YES NO
1• "
ei (Per°o s) Interviewed 1 `L; ;� Inspector Date �
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