HomeMy WebLinkAbout0092 THORNTON DRIVE UNIT 3 - HAZMAT qa -f�'G�YYtd��J ' `ern
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NAME OF F I R:17:
h1AILING ADDRESS:
TELEPHONE NUMBER:
CONTACT PERSON:
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, p6ease indicate if the materials are stored at a
site other than your mailing address :
ADDRESS:
;. � TELEPHONE:
LIST OF TOX IC `AIVD=HA%7�RDOUS MATEIt�AI S-- - - -- - -
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:
E
Antifreeze (for gasline or coolant systems) Refrigerants
Automatic transmission fluid Pesticides (insecticides,
Engine and Radiator flushes herbicides,rodenticides )
Hydraulic fluid (including brake fluid) 1
X Motor oils/waste oils Photochemicals
Printing Ink
Gasoline, Jet fuel Wood preservatives
_ < 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
Rustproof ers ;
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
Faint brush cleaners "Poison" labels (including
. 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
Other cleaning solvents list) :
Bug and tar removers
Household cleansers, oven cleaners
Drain cleaners
Toilet cleaners
Cesspool cleaners
Disinfectants
Road Salt (Halite)
OWN OF BARNSTABLE COMPLIANCE: CLASST'1., Marine,Gas Stations,Repai.r
r.♦b,..g.., . . � •;.;�'i2�.`=Printers
O satisfactory 3. Auto Body Shops
BOARD OF HEALTH. 4. AutoManu Bodurehop
rs
Ounsatisfactory- S. Retail Stores
COMPANY �,4t. (see"Ordexs")
6. Fuel Suppliers
ADDRESS / 1/;Gt�J / Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AboveTanks Undetgrouad Tanks
IN 103LIfF IIN fOUT IN IOUT # eallons ze est?
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, #2 (B)
Heavy Oils: F 1
waste motor oil (C) (_4 E
new motor oil (C)
r
transmission/hydraulic 71
Synthetic Organics:
i
degxeast s
r
� ' 1
Misce lane s:
DISPOSAL RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Supply
OTown Sewer O Public
On-site Priva e —�
3. Indoor Floor Drains: YES NO
4 Holding tank: MDC
OCatch basin/Dry well __._._.__.____,_._,_...._.._._,._.,__....____... .._....,......._.., _ .____._._
On-site system: . 1_ORDERS: -
4. Outdoor Surface drains:YES NO
Holding tank: MDC -----
O Catch basin/Dry well
OOn-site system
S. Waste Transporter Licensed?
Name Destination Wastg Product YFS1 NO
r,r'r`�r fix` �c�•. ri � f - � � .r� _,,s� ; ....,_...
zz za. si ' Person(s) Interviewed ! / Inspector 'Date'
t J
rti`UN ®F SARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repai.r
`� Q satisfactory 2. Printers
BOARD OF HEALTH 3. Auto Body Shops
0 unsatisfactory- 4. Manufacturers
COMPANY �nn.s M�v "'t,( (see"Orders") S. Retail Stores
6. Fuel Suppliers.
ADDRESS 9Z Class: 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AboveTanks Undetgrouad Tanks
IN QLIT IIN IOUT IN tOUT # zallon Age es ?
Fuels:
Gasoline, Jet Fuel (A) ✓
Diesel, Kerosene, #2 (B)
Heavy Oils: fff f
waste motor oil (C) J !
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers ?
Miscellaneous: j
I
DISPOSAL RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water Su y
O Town Sewer �C7 �JYj'7 ( �,,e A t � --E^ Or,
ublic
6-0-n O Private
3. Indoor Floor Drains: YES NO
4 Holding tank: MDC +� ^�
® Catch basin/Dry well F7bz)jc: rojtrvc\UNIMUT
� � (_��� .,�s�? ����•
y s. stem _---._.__._.._...._..__._.___.._....._.._._
0 On site
4. Outdoor Surface drains-.YES NC�tC
Holding tank: MDC W TL 2
0 Catch basin/Dry well -�,� T, �s�� _ �_�, ��( �� ur �h �u�
oOn-site system 6�A�us:) 1��.� �Ja C�, . - U.,
S. Waste Transporter Licensed?.
Name of Hauler. Destination y
1.
_.._.-77
12 23 81 —Person(s) Int.erviewed Inspector Date