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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
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NAME OF FIRM: Barnstable Marine Service, INC.
MAILING ADDRESS: Off Millway, Barnstable, Mass. 02630
TELEPHONE NUMBER: 36 2-3 811
CONTACT PERSON: F. Van Duzer,
Does your firm store any-of the toxic or. hazardaus material's- 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 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 w 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) it
Other petroleum products: grease, ' Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
yDegreasers 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-
Asplialt & 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(including bleach) Other products not listed
Spot removers & cleaning fluids E D which you feel may be
(dry cleaners ) R E CEIV toxic or hazardous (please
Other cleaning solvents HEALTH DEPT. list.1M
TOWN OF BARNSTABLE
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners MAY 4 �981
Disinfectants
Road Salt (Halite)
"' COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r
Tt�V1�1 OF BARNSTABLE z. Printers
BOARD OF HEALTH O satisfactory 3. Auto Body Shops
0 unsatisfactory- 4. Manufacturers
^� jf �o % (see"Orders") S. Retail Stores
COMPANY ,� ' ` �,a c,c� ._ ,,,,,. 1 6. Fuel Suppliers
ADDRESS � Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AboveTanks Underground Tanks
IIN OUT IIN IOUT IN OUT # gallons Age es
Fuels: ,20 �j7i
Gasoline, Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) t I
new motor oil (C)
transmission/hydraulic V
Synthetic Organics: !
degreasers
V A 36/AJ-_
Miscellaneous:
DISPOSAL RECLAN.ATION REMARKS:
1. Sanitary Sewage 2. Water Supply
Q(Town Sewer O Public
0 On-site Or Private
3. Indoor Floor Drains: YES NO ✓
O Holding tank: MDC
4 Catch basin/Dry well
0 On-site system '
1W_el16.��f�CStdl d.��_�2f2Jd 1Qy
4. Outdoor Surface drains:YES NO
O Holding tank: MDC
O Catch basin/Dry well Amllq_ yks4.. : f :Q._.-,) 'VA5-.7, re I?L—A`:?_! .r
OOn-site system
S. Waste Transporter Licensed?
Name of Hauler. Destination _ Xastc Eroduct NO
f dc"',
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12 23 81 Person(s) Interviewed ' Inspector ate
Y' � 1 • 1. J• • 7�t iu , <.iww ..r-+.
o C)�NN OF BAR ?. Printers
B �� satisfactory
OARD OF HEALTH 4. Auto Body Shops
satisfactory-
Retail
COMPANY <. i } (see"Orders") S. Retail Stores
(�` '�q$ ���% 6. Fuel Suppliers
r, ADDRESS dl-- +�. ! ire Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor:
Case lots Drums AbOveTanks Underground Tanks
MAJOR MATERIALS IN OUT IN IOUT IN OUT # 6 L721lonsAve rest
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Fuels:
k. Gasoline, Jet Fuel (A)
;
}
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
' new motor oil (C)
j transmission/hydral4lic
F .
Synthetic Organics:
:c
de greasers
Miscellaneous:. .
DISPOSAL RECLAMATION REW RKS:
{i.
rA
1. Sanitary Sewage 2. Water Supply
OA
Town Sewer aPublic _ "' `' ' �;s` ^'
OOn-site O Private
' 3. Indoor Floor Drains: YES NO __�
4 Holding tank: MDC _
O Catch basin/Dry well
0 On-site system
4. Outdoor Surface drains:YES NO
O Holding tank: MDC
O Catch basin/Dry',we l l
OOn-site system
S. Waste Transporter
�� Licensed?
v
: JaS ,
Name Hauler- Desn
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' fia'�
u ei Pdrson: s) dnt.e,'rviewe � . I s ct r ^�°~ Date