HomeMy WebLinkAbout3219 MAIN ST./RTE 6A(BARN.) - HAZMAT _n
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TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: /r/ J / /V p L► S C 12 ` / C r/
MAILING ADDRESS: 3�,/ a� G�„7 / �/ .S' %- /.�� wS ? '/9 ;L/=.
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TELEPHONE NUMBER:
CONTACT PERSON: f► c,
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 �i'�^ 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 Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides)
-� Hydraulic fluid (including brake fluid) Photochemicals
-� Motor oils/waste oils Printing Ink
Gasoline, Jet fuel A, es-s 7-AA %7 v-9104* Wood preservatives
Diesel fuel, Kerosene, #2 heating oil (creosote)
�.� Other petroleum products: grease, Swimming Pool chlorine
lubricants Lye or caustic soda
Degreasers for engines and metal Jewelry cleaners
-� Degreasers for driveways & garages
cam- Batter acid (electrolyte) Leather dyes
Y Y Fertilizers (if stored
Rustproofers outdoors)
Car wash detergents PCBs
-Car waxes and polishes c/ Other chlorinated hydro-
Asphalt & roofing tar carbons, (inc.carbon
-�-Paints, varnishes, stains, dyes tetrachloride)
4," -Paint and lacquer thinners Any other products with.
Paint & Varnish removers, deglossers "Poison" labels (including
Paint brush cleaners R E V ® chloroform, formaldehyde,
Floor & Furniture strippers HEALTH DEPT. hydrochloric acid, other
Metal polishes TOWN OF BARNSTABLE 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) list)*,:,
Other cleaning solvents 1981
Bug and tar removers MAY 2 2 —
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners � ���
Disinfectants 011-R-
Road Salt (Halite)
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL TOXIC AN HAZARDOUS MATERIALS - INSPECTION SHEET
FIRM
Ai)DRES-S-'-..
Major types of materials: 1) 2) 3)
4) S) 6)
I. Description of material(s) use:
II. Storage (denote product by number listed above)
A. Containers metal glass paper plastic
cans,bottles,jars
drums,barrels
dot
aboveground tanks
underground tanks \1.
bags,boxes
open,loose,uncovered
inadequate labelling
B. Storage Facility Vor•# Remarks/Recommendations
1. Indoor
a) separate, contained room
b) stored-in general work area
-i) inadequate ventilation- _
ii)JIoor drains
ii)- inadequate- fire- protection
2. Outdoor
a) uncovered, exposed to weather '
b.) pervibus-surface/cat�--.Ha.liasihs -
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 / "� - - - - - —