HomeMy WebLinkAbout0767 INDEPENDENCE DRIVE - Hazmat 767 INDEPENDENCE DRIVE
- ` Barnstable
A= 332 -010 -001
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you
must do by M.G,L.-it does not give you permission to operate.)'You must first obtain the necessary signatures on this form at 200 Main St., Hyannis.
Take the completed form to the Town Clerk's Office, "I st F1., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is
required by law.
DATE: Fill in please:
APPLICANT'S YOUR NAME/S: CAI /7r% (', nn D bell
BUSINESS YOUR HOME ADDRESS: :7D =r,�12_flcar -�o,cP )S r_ I CL2
On if IN
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TELEPHONE # Home Telephone Number '7'—
NAME-OF_CORPORATION-
NAME-OF NEW BUSINESS e i13F TYPE OF BUSINESS PR)n i nz
IS THIS A HOME,OCCUPATION? YES NO 22
ADDRESS OF BUSINESS ro7� Snc\ Drive- i u7 MAP/PARCEL NUMBEQJ: 61o'O� [Assessing)
When starting a new business there are several things you must do in order to be in compliance with-the rules and regulations of the Town of
Barnstable. This form is intended to assist you.in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING CO ISSIO ER'S OF E
This individ al h n rn-fPr ed a er ire itr nts that pertain to this type of busind&ST COMPLY WITH HOME'OCCUPATION
4 u RULES AND REGULATIONS. FAILURE TO
thoriz Sin a** COMPLY MAY RESULT IN FINES.
ffMMEN
M 1T I _ - -
f 2. BOARD OF HE TH `
This individual has been nfor ermit requirements that pertain to this type of business. MUST COMPLY WITH ALL
Authori ed tur ** �0 HAZARDOUS MATERIALS REGULATIONS
COMMENTS: 7,1
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
r COMMENTS:
Hazardous Materials Inventory Sheet Checklist
Date
Physical Street Address-Check databasekto ensure it exists
Working Phone Number
Actual Amounts -( ie. gas being used to fuel machines, thinner to;
clean brushes all.count as hazardous materials-no blanks)-
,--,"Storage Information - location of storage,,how long is storage for?
If none, note that.
Disposal Information-where and who? If none, note that.
-----Applicant Signature - understand what is listed and noted
Staff Initial -any questions, know who to ask.
Vehicle.Washing/Rinsing? -give a vehicle washing policy and
h explain it o
Attach the Business Certificate with your sign off and comments
**The inventory form should explain what the business consists of and the procedures ,
they are doing. Notes need to be left to explain what you discussed with them.
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TOWN OF BARNSTABLE Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF"BUSINESS: May V e.,IbcLs Prof�ss;ono-j Poory-- ir)12
BUSINESS LOCATION: 1670 \(1epen6o nce_ Dyr INVENTORY ,..
MAILING ADDRESS: S4:,Mi TOTALAMOUJ]T:
TELEPHONE NUMBER: 619 '749- (.Or7 '2-
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SILT?
TYPE OF BUSINESS: P0,-1 1+- 3 n94
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts(Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
U(NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals(Developer)
lubricants, gear oil ❑ NEW . ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways &garages Wood preservatives(creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison"labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash °
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials _