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Home My WebLink About0052 THORNTON DRIVE - Health (2) �=r d TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: "� Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: �7 P.O. Box 534 CONTACT PERSON: 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 totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO i i 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 - 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 Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diese LfLke kemsap , #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 V Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes t� Paints, ve7ais#es, %ta+ns,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 & cleaningfluids be toxic or hazardous lease list): (p ) (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners I White Copy- Health Department/ Canary Copy-Business v TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory BOARD OF HEALTH 2.Printers3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY M (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS .. ..... (:lass: /� 7.Miscellaneous 4c��' W04kJANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALSCase lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) ov oow ie, #2 (B) j Heavy Oils: waste motor oil (C) new motor oil (C) �� v a-x 1/ 'transmissio" n/hydraulic Synthetic Organics: degreasers � � yow to/ Miscellaneous: e o DISPOSAURECLAMATION REMARKS: Ll 1. Sanitary Sewage 2. Water Supply O Town Sewer Public YOn-site OPrivate <--� 3. Indoor Floor Drains YES N0X— O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0 ORDERS: 004, O Holding tank: MDC O Catch basin/Dry well O On-site system Gc4 5.Waste Transporter Name of Hauler Destination Waste Product 1 c, YES I NO 2. Person (s) Interviewed Inspector Date yv..a TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER: ?/-' ;�' F-7 P.O. Box 534 CONTACT PERSON: '�t�� 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 quan (ties 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 b, Motor oils/waste oils Road 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 V Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes 1' 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 k V 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 Wpt ;a..:. ,h!TMrn; �.w•.w^ .nr,�-.HA.e..r;:na� ^�;...r ..iM,w,-g+'ya,:.' �a;.�.-.:f wr+�,::si:.. �y..,,- ,1 `Lori ` j:�T OWN OF BARNSTABLE COMPLIANCE: CLASS:,,!..Marine,Gas Stations,Repair 2.Printers O satisfactory, BOARD OF HEALTH a.-Auto Body Shops O unsatisfactory- 4.Manufacturers . !COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS r ; � ,►7'" Glass: -, 7•Miscellaneous ;•_�:- QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test " Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) fF Heavy Oils: l waste motor oil (C) new motor oil(C) f transmission/hydraulic" Synthetic Organics: degreasers .. J•'/1 ll�..� ,I-UAs?R./i�I.,/Ly'f./1 '",N`l.��frl,/ MJ'��"� E' Miscellaneous:r ., � .. 8y�` . ... - . ; `4 •+ by ....x.# _ ..N v_. '� .. �40 x4.1_1 s f' 1 3 DISPOSAL/RECLAMATION. REMARKS: ' 1. Sanitary Sewage 2.±Water Supply ` O Town Sewer' OPublic On-site QPrivate 7 3. Indoor Floor Drains YES NO O Holding tank:MDC 4' O"Catch basin/Dry well O On-`site system ; 4. Outdoor-Surface drains:YES NO ORDERS: O Holding tank: MDCF O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES_,l NO 2. Person (s) Interviewed Inspector Date ' {iriS STI101C ND _ PI AC f'0!:_ki N.k,4E• OF F I Rk1: t4% 2-W MAILING ADDRESS: q Q� ` �✓V I ��+ ` `� � 1 1 1 1 l V Y TELEPHONE NUMBER: —7 S(49-7 CONTACT PERSON: `t Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities- total ling, at any time, more than 50 gallons liquid- volume or 2S 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 i0quantities j totalling more than 50 gallons liquid volume or 25 pounds dry weight. Please put a check beside each product that you store: r Antifreeze (for gasline or coolant systems ) Refrigerants � Automatic transmission fluid w Pesticides (insecticides, Engine and Radiator flushes herbicides,rodenticides) , Hydraulic fluid (including brake fluid) cals Motor oils/waste oils Pk Prrintinginting i Ink f Gasoline, Jet fuel Wood preservatives j Diesel fuel , Kerosene, #2 heating oil (creosote) Other petroleum products: grease, Swimming Pool chlorine lubricants Lye or caustic soda j Degreasers for engines and metal Jewelry cleaners Degreasers 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- Asphalt & 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 which you feel may be (dry cleaners ) toxic or hazardous (please list) : Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners Disinfectants Road Salt (Halite) r 4 COMPLIANCE: CLASS: 1, Marine Gas Stations Re air`' TOWN OF. B IRNSTABLE p . y� 2. Printers BO/a1 t�D o �- EA LT factory 3. Auto Rody Shops ®unsatisfactory 4. Manufacturers (/..e- (see"Orders'!) S. Retail Stores COMPANY f r'uC V.-- -� 6. Fuel Supr-liers !iADDRES.%!,,, T�i�r� �, 1�1 X Class:_ 7. Miscellaneous QUANTITIES AND STORAGE (IN=_indoors; OUT=outdoors) MAJORMATERIALS Case lots r Drums AboveTanks Undetgrouad Tanks IN IDUT IIN IOUT IN IOUT Lallonse ? _Fuels: Gasoline, Jet Fuel (A) ' Diesel, Kerosene, #2 (B) _ Heavy Oils: - M _�L �r waste -motor oil (C),. new motor oil (C) j \ transmission/hydraulic Synthetic Organics: ; .degreasers -. ��Pc r� Cj- �,�v 1,n�' -- - _-• - � _ � -� - - �- - - - - -__.__ Miscellaneous: } DISPOSAL RECLAMATION . REMARKS: I.- Sanitary Sewage 2. Water Supply - - ® Town wer 0 Public -site &I-rivate, 3. Indoor Floor Drains: YES NO �( ® Holding tank: MDC " �.. 0 Catch basin/Dry well r --- ------------ -------�.� On-site system 4. Outdoor Surface drains:YES No w _ ""- ® Holding tank: MDC Catch basin/Dry well ® On-site system _ S -`Waste _Transporter - - - - - • �- . _ Licensed? . I z Name of Hauler- Dpstinat=ion Waste Product YES NO ��l. on z: 9'N�5un son �c U { _ Persons Interviewed . _ ti `. : +' - Inspector TOWN OF BA�R@1ST�B � : GLAJJ: t.'riariiiG�va5ai.iii.i'viwinc�aaa LE: 2. ,Printers , t _ l t satisfactory s.h,4h . .'. 3. Auto Body Shops BOARD OF HEAL H 4.• Manufacturersy unsatisfactory- �.'% � (see"Orders") S. Retail Sores COMPANY � ' r{`'"�r- '` 6. Fuel..SupF-1 iers Class:_ 7. Miscellaneous ADDRESS ._ 3`V? QUANTITIES AND STORAGE (IN--;indoors; OUT=outdoor: Case lots Drums AboveTanks Underground Tanks MAJORS MA7ERIALS IN 0 IN OUT IN OUT 1 Age rest 4 Fuel ss dasoline, Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) - transmission/hydraulic + -74 �. Synthetic Organics. - degreasers Miscellaneous: :x DISPOSAL RECLAMATION REM1.RKS: k 1. Sanitary Sewage 2. Water Supply OTown Sewer O Public On-site ` Private J .3. Indoor Floor Drains: YES N0 ® Holding tank: MDC Catch basin/Dry well O -•--------•---:..._. ..-----....__._...-- ------- -= On-site system .4. Outdoor Surface drains:YES NC� ' O Holding- tank: MUC o Catch,basin/Dry well 0 ,On-site system Licensed? S. Waste Transporter ' Name of Hauler_ -nAntination 11L,ZqtP Product— 1 •z l P�'& y` IL ' u ei a son(s) nt.erviewe Inspector Uate