HomeMy WebLinkAbout0011 THORNTON DRIVE - HAZMAT \ �I-a`� �-rat /
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: P.O. Box 534
CONTACT PERSON: Bcc,C�u� Hyannis, MA 02601
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for
your own use, in quantities totall' , at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO V
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 i total id
t. 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
leis/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
✓ Other petroleum products: grease, lubric s 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,yzw&4sr tahs,-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)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE OMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
0 unsatisfactory- 4.Manufacturers
COMPANY a6 /Off�' s (see"Orders") 5.Retail Stores
s� 6.Fuel Suppliers
ADDRESS Glass: "L 7.Miscellaneous
a TITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels: j
Gasoline,J (/
_� T7 =, 2 (B)
c.�ici�ociic, it
Heavy Oils:
waste nab oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
�a
Miscellaneous:
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y
cz
% L.!L ah�PW
DISPOSAURECI.AMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
O Town Sewer ublic
XOn-site OPrivate
3. Indoor Floor Drains YES—No
O Holding tank:MDC
O Catch basin/Dry well CT
O On-site system
4. Outdoor Surface drains:YES NO ORDE S:
O Holding tank: MDC zj
- ,
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES NO
1.
2.
er n (s).�Inte 7
ed nspector Date
TOWN OF BARNSTABLE
BOARD OF HEALTH
CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET
FIRMI /���5
ADDRESS ::,,/ r11 /f/'T®N 1,24,
Major types of materials: 1) C"'
2) 3)
4) 5) 6)
I. Description of material (s) user p . Pr..1(A_
II. Storage (denote product by number listed above)
A. Containers
119eta gl s p per p antic
cans,bottles,jarsC /
drums,barrels -
aboveground tanks
` underground tanks t7
bags,boxes
open,loose,uncovered
inadequate labelling F_
I
B. Storage Facility ✓or:# Remarks/Recommendations
1. Indoor
- a) separate, contained room _!
b) stored in general work area A
i) inadequate ventilation _
ii) floor drains w U
iii) inadequate fire protection /
2. Outdoor
a) uncovered, exposed to weather j
b) pervious surface/catch basins I
III. Disposal i
A. Reclamation/Recycling unit
B. On-site disposal
1. Town. sewer
2. Regular septic system 4
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 1 f
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