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Home My WebLink About0118 THORNTON DRIVE - HAZMAT -- I 18 rth�n ��✓� � - -N� rrx� / \ 1 I�� ®r MEAD v FP'NG SOU ORG4NIZED No. 10334 2-1531- MADE IN USA GET ORGANIZED AT SMEAD.COM "2' TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF FIRM: _Pic r1H�PUr l� �/tS�ii ,5 b MAILING ADDRESS: TELEPHONE NUMBER: 7 7? CONTACT PERSON: /e C� e, " 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 , N0 _ 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 gasline 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 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) 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 „ i Poison labels (i .:cluding Paint brush cleaners chloroform, form, dehyde, 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 ) M E C E I V E ® toxic or hazardous (please Other, cleaning solvents HEALTH DEPT. list) Bug and tar removers TOWN OF BARNSTABLE Household cleansers, oven cleaners Drain cleaners Toilet cleaners Cesspool cleaners MAY 1 4 1981. Disinfectants Road Salt (Halite) TOWN OF BARNSTABLE BOAR ® OF HEALTH CONTROL OF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET FIRM C,� � 1 ADDRESS . Major types of materials: 1) 2) 3) 4) 5) 6) I. Description of material(s) use: m II. Storage (denote product by numb,.7 listed bove) A. Containers metal glass paper plastic cans,bottles,jars drums,barrels aboveground tanks underground tanks bag ,s boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or # Remarks/Recommenc�,.i_ons 1. Indoor a) separatb, contained room b) stored in general work area i) inadequate ventilation ii) floor drains iii) inadequate fire protection 2. Outdoor a) uncovered, exposed to weather b) pervious surface/catch basins III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town sewer 2. Regular septic system 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 _ c. _ _ 7A Date 7 l 6 30 81 TO N' OF BARNSTABLE T� BOARD OF HEALTH &ONTL OFIRMF TOXIC AND HAZARDOUS MATERIALS - INSPECTION SHEET ADDRESS Major types of materials: 1) --2) 3) 4) 5) 6) I. Description of materials) use: a9 D._ 9A II. Storage (denote product by number listed a ove) A. Containers f;netal glass paper plastic cans,bottles,jars -� 1 drums,barrei Ss aboveground tanks a J � t_ underground tanks bags,boxes open,loose,uncovered inadequate labelling B. Storage Facility ✓or=# Remarks/Recommendations 1. Indoor - a)' separatt, contained roomA A A b) stored in general work area !i' d- r:, i) inadequate ventilation 5 /1 ii) floor drains ►�� 4 6� iii) inadequate fire protection c j 2. Outdoor .a) uncovered, exposed to weather b) pervious surface/catch basins 3 III. Disposal A. Reclamation/Recycling unit B. On-site disposal 1. Town. sewer 2. Regular septic system 3. Separate holding; tank C. Off-site disposal 1. hauled by own firm 2. hired hauler a) name of hauler b) address or disposal siteLIZ , . Person.(s) Interviewed �0 U> L Inspect Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ` Mail To: NAME OF BUSINESS: `� � Board of Health MAILING ADDRESS:- O v Town of Barnstable TELEPHONE NUMBER*: — '77/— P:O. Box 534 CONTACT PERSON: 4-C Hyannis, MA 02601 Does your firm store yane"ttoxic or hazardous materials listed below, either for sale or for your own use, in quantitiesa 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 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 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 Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, Fertilizers (if stored outdoors) i/ 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 MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS, - Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drunis Above Tanks 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/hydraulic Synthetic Organics: degreasers Miscellaneous: L mr !� DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer ,Wublic { *On-site O Private 3. Indoor Floor Drains YES—No 0 Holding tank: MDC 0 Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s) Interviewed Inspector Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: �U� Board of Health MAILING ADDRESS: �w. 44",`m MA . Town of Barnstable TELEPHONE NUMBER: P.O. Box 534 CONTACT PERSON: Mz�* s 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' g, 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 registere 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 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) t 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 O WARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH IV satisfactory 2.Printers 3.Auto Body Shops / O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ;,i Class: 7.Miscellaneous � 4t q /Z1 UANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MATE IALS Case lots Drums Above Tanks 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) ,�',lQ I trans�mission/hydraulic Synthetic Organics: degreasers v M cellfa;#1ous: � >a DISPOSAL/R.EC TION' REMARKS: 1. Sanitary Sewage 2. Water Supply O Town Sewer Public AOn-site OPrivate a� 3. Indoor Floor Drains YES N0_1/ O Holding tank: MDC O Catch basin/Dry well O On-site system 11 4. Outdoor Surface drains:YES /NO ORDERS: O Holding tank:MDC 0 Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person (s) Interviewed Inspector ate 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 Does your firm stor any of the toxic or hazardous materials listed below, either for sale or for your own use, in quanti ' s 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) ain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes esspool cleaners Hydraulic fluid (including brake fluid) Disinfectants 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 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 ' c. carbon tetrachloride) Floor & furniture strippers (/ Any other products with "Poison" labels �r etal polishes (including chloroform, formaldehyde, aundry 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 8k "TOWN OF BARNSTABLE ,.COMPLIANCE CLASS: 1.Marine,Gas Stations,Repair ,Q satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops ..� 0 unsatisfactory- 4.Manufacturers COMPANV,,4,.4le-we;r�`lo-.r (see"Or_ders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 'd �" � �% Class: / 7:Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel,-Kerosene, #2 (B) Heavy Oils: r waste motor oil (C) .w , " new motor oil (C) transmission/hydraulic ` Synthetic Organics: degreasers ,, .. Miscellaneous: 4 , 1 _ LI DISPOSAIJRECLAMATION ° REMARKS: 1. Sanitary Sewage ' 2.Water Supply • - 4 � O Town Sewer loPublic ®'On-site OPrivate �Y 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 ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person"(s) Interviewed Inspector' ' " Date L u TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: Town of Barnstable TELEPHONE NUMBER:W9 27i 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 >K_ 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 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 Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) y _ 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 3 .� lk+ 6. .�:;,�"`�4ok;�`n#�+'. . fix' 3 �t �� T �t`"T"--...a. ,t;Ye'.^� 4- -�•",�.'�. r�i:N «'-+,. . TOWN OF BARNSTABLE COMPLIANCE: CLASS: . 1.Marine,Gas Stations,R ,air 1 satisfactory '�2.Printers BOARD OF HEALTH . O �' 3.Auto Body Shops «`• 'r O unsatisfactory- 4.Manufacturers COMPANY J'Pe (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ' Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN ' OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) 5 4 Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) r new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers s Miscellaneous: 4( m DISPOSALJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town SewernPublic O On-site O Private 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 ORDERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste ProductLicensed?,�° YES NO 2• 41 Date �" "P'erson"�(s) Irate q 'ewed Inspector - - - .. Towni�oF-BfiRNs�rAT® � `Uj111r!wpji r. _.. .. a.a...vl,.it . .. . -satisfactory •. 2• printers B OA O H 3. Auto Cody Shops . e Q unsatisfactory- 4.' Manufacturers ? �--- (see"Orders") S. Retail Stores COMPANY �3�=r 6. fuel SupFliers ADDRESS �✓�"' Class: 7 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor MAJOR MATERIALS Case lots Drums AbdveTanks Undetgroued Tanks IN Up IN 1OLrf UT 16 gellons a Fes?! Fuels: Gasolinet Jet Fuel (A) Diesel, Kerosene, A2 (B) Heavy Oils: waste motor oil (C) new motor oil transmission/hydraulic Syn ihetic Organics:- degreasers , i Miscei aneous: UISPUSAL I REGUP TIUN a 1. Sanitary Sewage 2. Water Supply �Q Town Sewer public _ } On-site Q Private •3. Indoor Floor Drains: YES NO Q Holding tank: MDC Catch basin/Dry well On-site system 4. Outdoor Surface drains:YES NO • . 0 Holdink• tank: MUC O Catch basin/Dry well _ - - OOn-site system S. Waste Transporter Licensed? ]daRle of Hauler_ Dent nation HaStC Product ' ! v u xr et Person(S) .Int.erviewe Inspector Date 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 Hyannis, MA 02601 CONTACT PERSON: 1 1A Does o firms ore a�the toxic or hazardous materials listed below, either for sale or for o y y 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 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 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 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 . O satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY '�.,t-** �, � . O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 7A 7 �- Class: 7-Miscellaneous -� QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Underground 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/hydraulic- Synthetic Organics: degreasers Miscellaneous: V rl DISPOSALIRECLAMATION REMARKS: / 1. Sanitary Sewage 2.Water Supply �t7�% O Town Sewer OPublie F O On-site /1st` .Z 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 _/V/ _ ORDERS: O Holding tank: MDC le4l� O Catch basin/Dry well O On-site system r y{ ' !�01 U 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2' 7 %_/f " Person (s) Interviewed Inspector ' Date