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Home My WebLink About0119 THORNTON DRIVE - HAZMAT �� n��, � .�t �`� � C f TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: -9 Town of Barnstable TELEPHONE NUMBER: - P.O. Box 534 Hyannis, MA 02601 CONTACT PERSON: OA&6(97�- Z- Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in qua titles 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 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: V 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 — Z 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 4/-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 a Household cleansers, oven cleaners White Copy-Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair err 2.Printers BOARD OF HEALTH 0 satisfactory 3.Auto Body Shops ,,,� 0 unsatisfactory- 4.Manufacturers COMPANY �o,.�rr�� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous _ (, QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUnderground IN OUT IN OUTI IN OUT #&gallons Age Test Fuels: Y Gasoline,Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) new motor oil (C) ` transmission/hydraulic , Synthetic Organics: degreasers f � , Miscellaneous: w a 7. DISPOSAUR.ECLAMATION REMARKS: 1.Sanitary Sewage 2.Water Supply 0 Town Sewer OPublic - (2)90n-site OPrivate ,� 3Indoor Floor Drains YES NO P O Holding tank:MDC 0 Catch basin/Dry well 0 On-site system 4. Outdoor Surface drains:YES NO I ORDERS: 0 Holding tank:MDC W"-0 Catch basin/Dry well On,.-site system 5.Waste Transporter S, Name of Hauler DestinationProduct Licensed? a 'Person(s)Interviewed Inspector ! Date {. arris Rest®ra t �� F1NAT ONqL SA< 'p,� Roy Bamford Fs F .i v 119 Thornton Dr. 508-790-2566 Hyannis,MA 02601 Fax 508-790-2339 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Board of Health MAILING ADDRESS: g Town of Barnstable TELEPHONE NUMBER: �'j -9 J 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 qua tities 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 V Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants _V Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel V11 Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) — V 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 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 10 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 OMPIJANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3 unsatisfactory- .Auto Body Shops ho COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS irj�Yr r �,y Class: 7.Miscellaneous OA.i,�t,: , UANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drurns Above Tanks Underground IN OUT IN OUT IN OUT #&gallons 777 Test Fuels: Gasoline,JetZue1.(.A1 L� 2 (B) � Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreases 6ttv^e /4 & e 411 Miscellane us: VIP id- V DI SAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Z G� . O Town Sewer Public _ Xon-site a� Q Private 3. Indoor Floor Drains YES NO 4� O Holding tank: MDC Q Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank: MDC ` `' / Catch basin/DtFftff— Aeag O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product AY YES NO 2. Person s Intervie 'd Inspec or Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM � AlMail To: NAME F BUSINESS: 1'' O Board of Health i MAILING ADDRESS: ;/ Town of Barnstable TELEPHONE NUMBER: :2: f9d s ue " 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 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 am 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 Av �:: n•r-,r.^-.�,.rr „aP°t••^.»+ i..n .,.- �, ��a° -�,.way 9_c,".„;.;,,,,,,,•,.r xwP>.,.,:•nr.'Y...3e-a'�5�....•*.^r,..:<r ^...nr;..F TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair Q I., satisfactory 2.Printers BOARD OF .HEALTH ,r 3.Auto Body Shops = 0 unsatisfactory- 4.Manufacturers COMPANY( t . ,.1 c._ (see"Orders") 5.Retail Stores ' '"� 6.Fuel Suppliers ADDRESS - Class: 7.Miscellaneous ; ,t,QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums t 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) trarismission/hydraulic Synthetic Organics, degreasers f Q Miscellaneous: ' Ar DISPOSAURECLAMATION REMARKS: L.Sanitary Sewage 2.Water Supply O Town Sewer ,OPublic O On-site OPrivate 8..Indoor Floor Drains YES NO k/ O Holding tank:MDC O.Catch basin/Dry well O On=site system 4:Outdoor Surface drains:YES NO ORDERS: i ` •O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product • �• h� ��, ,��`:fi .�`IY�,/.�s't f ,[f r ..� `/«..�"�f..-l.rfs'! '.F.€�7. ,�ll,.,t�re► � 2. s Person(s) Interviewed Inspector f Date TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM Mail To: NAME OF BUSINESS: Ariav Export Co. , Inc. Board of Health MAILING ADDRESS: 119A Thornton Drive Town of Barnstable TELEPHONE NUMBER: 508 771 6088 P.O. Box 534 CONTACT PERSON: Robert M. Jones Hyannis, MA 02601 r n of the toxic or hazardous materials listed below, either for sale or for Does your firm store any , your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NID x 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: i �I Antifreeze (for gasoline or coolant systems) /V Drain cleaners Automatic transmission fluid Y 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) 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 • .. If. nw• :•,.. .'?.��.,row.. a r-:- 1jM• _ :x�. w ''rsq�Si1w4.-y. �"'�. �' .n w �l* � . TOWN OF BARNSTABLE `COMPLIANCE: CLASS: 1:Marine,Gas Stations,Repair 1. satisfactory 2.Printers ABOARD OF HEALTH 3.Auto Body Shops /f4 / unsatisfactory- 4.Manufacturers COMPANY `' ,-,t( i.4.rr'twrl•� O (see"Orders") 5.Retail Stores ��d 4 6.Fuel Suppliers ADDRESS / i'u W?o.�.-si;� , Class: 7.Miscellaneous ; u-1- QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR.MATERIALS 1h,4 Case lots Drums Above Tanks 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) t new motor oil (C) • transmission/hydraulic Synthetic Organics: degreasers Mis cellaneous: l DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply ' O Town Sewer ,bPublic ' O On-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 _/ ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. �, s 2. Person (§)`Interviewed Inspector `Dane r ✓ l