HomeMy WebLinkAbout0073 THORNTON DRIVE - HAZMAT �� - Snn
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S M E A D
KFFFINQ YOU ORGANIZER
No. 10334
2-153L
MADE IN•USA
GET ORGANIZED AT SMEAD.COM
PHONE775-0623
DENNIS JONES
{ 4;
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ALL CAPE MACHINE SHOP
COMPLETE TRUCK&AUTOMOTIVE MACHINE SHOP SERVICE
COMPLETE CUSTOM ENGINE REBUILDING
FLY WHEEL GRINDING
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SPECIALIZING IN _
I VALVE JOBS 73 THORNTON DR. ,
FOREIGN AND DOMESTIC HYAN'.NIS,MA 02601
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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: Hyannis, MA 02601
a 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
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
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
d Hydraulic fluid (including brake fluid) Disinfectants
f/ Motoxoils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
V Other petroleum products: ara a 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)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
satisfactory 2.Printers
BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY y synz (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS /7 Class: 7.Miscellaneous
e1__5,-0'Z// TITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks I Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydrauli� f/
Synthetic Organi :
degreasers `
/ '
Miscellaneous:
C=�G,
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply 14,111 `
O Town Sewer Public ;
/VOn-site O Private
e�-
3. Indoor Floor Drains YES N0—V
O Holding tank:MDC
O Catch basin/Dry well q
O On-site system / Z" co, U
4. Outdoor Surface drains:YES NO y ORDERS
O Holding tank: MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
1AL6
1 YES NO
In
2.
L
Person (s) Interviewed Inspector Date
n
TOXIC AND HAZARDOUS MATERIALS REGISTRATION, FORM
Mail To:
NAME OF BUSINESS: Board of Health
MAILING ADDRESS: - / Town of Barnstable
P.O. Box 534
TELEPHONE NUMBER:
4 � Hyannis, MA 02601
CONTACT PERSON:
4,1
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 p/
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 d
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
7K Motor oils/waste oils Road Salt (Halite)
Gasoline, Jet fuel Refrigerants
Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides,
Y Other petroleum products: grease, lubricants rodenticides)
b 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)
Other cleaning solvents
Bug and tar removers
Household cleansers, oven cleaners
White Copy-Health Department/ Canary Copy-Business
- 1 { r :-..:a.� � 5.*'•.e<,...rita'4�-•rsr--+` .»r"+...�AH..w t ?'oz rf _. ,. M-,.. ,_ �,. ,,,, - .-
j
TOWN OF BARNSTABLE ,COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
A. satisfactory 2.Printers
DOARD OF HEALTH r 3.Auto Body Shops
S 3= r� unsatisfactory- 4.Manufacturers
COMPANYl .oa� ls ' . .�. J` (see"Orders") 5.Retail Stores
�.,,-v 6.Fuel Suppliers
ADDRESS -,)f"'' .�- , , � XAA,.Af C18SS: 7.Miscellaneous
� wQUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALS Case lots Drums Above Tanks Underground
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels: Ak
Gasoline,Jet Fuel(A)
w
A Diesel, Kerosene, #2 (B)
Heavy Oils: r
waste motor oil (C)
new motor oil(C)
transmission/hydraulic
Synthetic Organics: x f
degreasers --
�a
Miscellaneous:
0 .
C:
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
O Town Sewer )'Public,
01 -site OPrivate
3. Indoor Floor Drains YES NO
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
4. Outdoor Surface drains:YES NO f ORDERS:
O Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
2. V �. . �.
Person(s) Interviewed Inspectpor;'- 'Date`
1�/
TOXICi_N
N,1kME OF FIRM: A�,L dRf r Mi4aHic . Silo p
b1AILING ADDRESS: �1�D(s, �3 j HO i2NTD1� -DIO,
TELEPHONE NUMBER: 0&3`3
CONTACT PERSON: D)�/U k)!5 - -p A).�S
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 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 a 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 j
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 I
a check beside each product that you store:
Antifreeze (for gaslirie 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 Wood preservatives r
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 Leather dyes
Battery acid (electrolyte) Fertilizers (if stored
Rustproofers outdoors) r
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
Paintbrush cleaners& Varnish removers, deglossers "Poison" labels (including
chloroform, formaldehyde,
Floor & Furniture strippers hydrochloric acid, other-
_ Metal polishes acids)
- Laundry soil & stain_ removers Other products not listed
(including bleach) . * which you feel may be
Spot removers & .cleaning fluids
(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)
TOWN OF BAR N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r
satisfactory 2. 'Printers
BOARD OF HEALTH 3. Auto Body Shops
O unsatisfactory 4. Manufacturers
{ " ++ Retail Stores
COMPANY �L�— GA�� -(see Orders ) S. Retail
6. Fuel Suppliers.
ADDRESS Urn�- n fir. wont Class: _7 7. Miscellaneous
wa
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AbdveTanks Underground Tanks
IN OUT. ] IN IOUT IN UT # & gallons Age 1est?
Fuels:
Gasoline, Jet Fuel (A)
Diesel, LK=erosene, #2 (B)
f
Heavy Oils:
I 1
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
g\rfeasers
Miscellaneous:
DISPOSAL RECLAMATION REW,RKS:
1. Sanitary Sewage 2. Water Sup
C) To Seger--' ublic
On-site 0Privat
i
3. Indoor Floor Drains: YES NO'
® Holding tank: MDC
® Catch basin/Dry well
On-site system
4. Outdoor Surface drains:YES Nc/"—/<
O Holding tank: MDC —
O Catch basin/Dry well
OOn-site system
S. Waste Transporter Licensed?
Name_of-Hauler. Destination h►astq Z;o u-cct YFS1 NO
✓1 /.�i,�,,�_- ,wit � C ���
ai Person',s Interviewed Inspector Date
-- - A
- - (:T VOF - BARNSTABLE atisfactory` 2• Printers
BOARD OF HEAL"f H 3. . Auto actuBody Shops
r. unsatisfactory- 4. Manufacturers
(see"Orders") S. Retail Stores
COMPANY V ��''`<" ' 6. Fuel Supfliers
Class _ 7. Miscellaneous
ADDRESS -
QUANTITIES AND STORAGE (IN::indoors; OUT=outdoor:
Case lots
Drums AbOveTanks Undetgtound Tanks
MAJOR MATERIALS IN UT I 0 IN � ' zl
e s
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, H2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic ,;
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAL RECLAMATION LL REM1,RKS:
1. Sanitary Sewage' f' 2. Water Supply
OTown Sewer , j O Public
On-site Private
3. Indoor Floor Drains: YES N0
Q Holding tank: MDC _
O Catch basin/Dry well
OOn-site system
4. Outdoor Surface drains:YES NC 'r
J
O Holding, tank: MDC ` —
OCatch basin/Dry well �..---- ------- ---:� -
OOn-site,-system _-__ -.._—•_-
S. Waste Transporter Licensed?
�DPctination }taste Product_ N
1 ..�
1223ei
Person(s) "t-erviewed Inspector Date
,U
TC��,! N OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations`, Repair
O satisfactory 2. Printers
BOARD OF HEALTHI , 3. Auto Body Shops
O unsatisfactory- —t—Manufacturers
(see"Orders") S. Ret}4i.l Stores
COMPANY ALL- CA P f M A(E,}r&L„ 6. Fuel Suppliers
' DRESS ttom�,, 7. Miscellai.eous
-+AD � � Tf�iU 12 7 U� } � G+ i-' Class: -�
' D�. ! QUANTITIES AND JIt1KAGC Lttii=lituuvi3, vva-vut.,vv-s
MAJOR MTERIALS Case lots Drums AboveTanks Underground Tanks
II LOUT 1 IN MUT IN LOUT # g .- a-1-1 o'n illk,p,e Tres`
Fuels:
Gasoline, Jet Fuel (A) F7
+
Diesel ; Kerosene. #2 ' (B)
Heavy Oils: .
+ I
i waste motor oil (C) U
1 I new motor oil (C)
transmission/hydraulic j_q!
Synthetic Organics: ' -
degreasers I�aao`�� t' ; ! I
/ ` r
I + r 3
�;kVL�l6L� i
!c`i•r� 1 I
Miscellaneous:VAI`A_T? _1 C✓+,c �` I j
'� �ti�lc�trai� -,C-,1911,; j `'vC� 4
Di SPOSAL RECLA1MAT ION RENV F• -- -- --
1. _Sani`tary Sewage 2. Eater Supplybi
® Town Sewer Public
On-site PrivateTA
3. Indoor Floor Drains: YES NO
Holding tank: b,DC
Catch basin/Dry well � _ c'? -
O On-site system
A 4 e
4. Outdoor Surface drains:YES N^�
isldinL tank: MD . � e 1' d' �. s 4 c-< 1
Catch basin/Dry welllA,); t
0 GA-site systemlD`��
S. Waste Transporter / _ 1� . tv�- ��� �;u - , .� ttlt�A �t7� (Licensed?
Name of Haul" —1-- ���r1P?`]n11 � •' , e Prod�l �tt�; �,�J I-N�
1 �Ct [t'`1`I l j- /A (� 1�v'�r�C t:uF ' P A(45 '�
12 23 of
Person(s)"Interviewed ll" Inspector Date