HomeMy WebLinkAbout1118 MARY DUNN ROAD - Health `!l� ��ry ���y ���
���������� ��� o��
i
f
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: �3 Board of Health
MAILING ADDRESS: SS 41�0 44, Town of Barnstable
TELEPHONE NUMBER: 130 P.O. Box 534
CONTACT PERSON: Hyannis, MA 02601
IrrLo�jt
Does your firm s re any of the toxic or hazardous materials listed below, either for sale or for
your own use, in qua Ities 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 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 d Salt (Halite)
Gasoline, Jet fuel 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) -ZZ
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
'"„7 "''-'b"''• vIvl '<. r► :+sr"�i n.►end+ : - ^° +=frt`v. i «�K F -v'i�t+µw .k"a""p,..tiA � r- "ee,Q ;r�:s,�,§" 'tia ;�. i� ^j
}
TOWN OF BARNSTABLE , COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
X satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
unsatisfactory- 4.Manufacturers
4
COMPANY " f� (see"Orders") 5.Retail Stores
'' � '` Q"°'' 6.Fuel Suppliers
ADDRESS 4 Zi �0, 1-2r (;lass: t 7.Miscellaneous
WA*,)P�QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSCase lots Drums Above Tanks UndergroundTanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
(X Gasoline
Jet Fuel(A)
Diesel., Kerosene,42(B) �'
Heavy -Oils: �` �p
<.7 = —Z
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic.Organics:
aaA Gdeg e sAy:Al` r
LP_ ...
Miscellaneous: {
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply 9_014 W /�.z�,
,O'Town Sewer- - QPublic J' `
O On-site f OPrivate P
3:Indoor Floor Drains YES NO
O'Holding tank:MDC
O Catch basin/Dry well e,4 "!;r 7�
• r
O On-site system
4. Outdoor'Surface drains:YES NO ORDERS:
O Holding,tank:MDC
O Catch basin/Dry well
O On-site system Ale
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
>5
` '`Person Wl Eiterviewed V Inspector / '✓Date