HomeMy WebLinkAbout0200 THORNTON DRIVE - HAZMAT moo ` i��,�
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TOXIC AND HAZADOJS�IIA'�IALS REGISTRATION FORM
0?�o rI /7 r, T�
/� �� Mail To:
NAME OF BUSINESS: � �' (� s Board of Health
MAILING ADDRESS: �� .,o Town of Barnstable
TELEPHONE NUMBER: '7 " $ <'5 P.O. Box 534
CONTACT PERSON: D ky;t e 114 x ty-eL.-L.
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 total ' g, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NO AV
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
V del, kerosene, #24ieefiftnil 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
�Q Household cleansers, oven cleaners
( (►� I+JlDe�r
White Copy-Health Department/ Canary Copy-Business
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH X�' atisfactory 2.Printers
3.Auto Body Shops
ems. O unsatisfactory- 4.Manufacturers
COMPANY '� 1�'e c LL�Ci4�'S (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Glass: 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERUXO� Drums Above Tanks Underground Tanks
IN OUT IN OUT IN OUT #&gallons Age Test
Fuels:
Gasoline,Jet Fuel (A)
Pies-el, Kerosene,4*-EB4 1jW Pl'
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
I
Miscellaneous:
DISPOSAL/RECLAMATION REMARKS:
1. Sanitary Sewage 2. Water SupplyTi� '°��� v
O Town Sewer OPublic ,� 611. 14, �,VS�f L A"T7 � 5�
Von-site OPrivate /V
lylt
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.
n
Person (s) I terviewe Inspector Date
W OF A-pLL
�tZ�C�V83�iac-svra�-rccpa�:
2. Printers
BOARD OF HEALTH satisfactory 3. Auto Body Shops
n,G � unsatisfactory- 4. Manufacturers
COMPANYr} 9 (see"Orders' ) S. Retail Stores
P.n'l 1 a n. i1 J(11.'��
r 6. Fuel Suppliers
_ 7. Miscellaneous
ADDRESS � .', �� ,,,,_(�.�,, At � Class:�
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoo
MAJOR MATERIALS Case lots Drums AboveTanks Undetgro.und Tanks
IN IOUT IN IOUT INIOUT N & gellonse s
Fuels:
Gasoline, Jet Fuel (A)
Diesel, Kerosene, 02 (B)
Heavy Oils:.
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
degreasers
t
Miscellaneous:
DISPOSAL RECLAMATION REW,RKS:
1. Sanitary Sewage 2. Water Supply
OTown Sewer 0 Public
On(site Q Private
3. Indoor Floor Drains: YES NO
O Holding tank: MDC _
OCatch basin/Dry well _._._...._. .._____..._.._.._._.__ _
0 On-site system ORDERS:
4. Outdoor Surface drains:YES NC'\
O Holding, tank: MDC
O Catch basin/Dry well
OOn-site system
5. Waste Transporter Licensed?
Name of Hauler_ Destination_ ,Walt P((rffod � - . '
2.
J �
u 81 .er �w �.i: i '
,i 'Inspector D ate
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
ii Mail To:
NAME OF BUSINESS: � lc _ Board of Health
MAILING ADDRESS: NC[UZ Town of Barnstable
TELEPHONE NUMBER: , Ot DI S-Sng- P.O. Box 534
CONTACT PERSON: U:Lf=— 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
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
� y
satisfactory x 2.Printers
-BOARD*OF HEALTH O r 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers "
COMPANY �, � � '" �' (see"Orders",), 5.Retail Stores
} 6.Fuel ne 7.Miscellaneous
iers
ADDRESS . �.�.s ��,,�.�_ `�1..� y Cllass:
• QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors)
MAJOR MATERIALSUnderground Tanks
„ IN OUT IN OUT.. IN OUT #&gallons Age Test
k
„Fuels: A
` Gasoline Jet Fuel (A)
�Die.sel,'Kerosene, #2 (B)
- Heavy,Oils: '
waste motor oil(C)
x; new motor-oil(C)
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
�!
' r
tt ''
. i
DISPOSAURECI:AMATION REMARKS.
1:.Sanitary Sewage 2.Water Supply
O Town Sewer OPublic
_ Q On-site fQPrivate
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 l/ ORDERS:
Q Holding tank:MDC
O Catch basin/Dry well
O On-site system
5.Waste Transporter
iName of Hauler Destination Waste Product
2. � � � (
`Person(S-) Interviewed v Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: -ZVG Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: (1-21 P.O. Box 534
CONTACT PERSON: 4Q ,y -5,04--X<3
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: 466),P
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the f II wing Products exhibit toxic or ha
zardous
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
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
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 C MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
BOARD OF HEALTH satisfactory 2.Printers
✓ 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS 6' Class' 7.Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERL AS 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)
transmis'sion/hydraulic
Synthetic Organics:
�.
degreasers
Miscellaneous:
DISPOSAIJRECLAMATION RE S:
1. Sanitary Sewage 2. Water Supply
Town Sewer 6Public
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.
2.
Persons nterviewed Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
Mail To:
NAME OF BUSINESS: -Zow ��'� ���� Board of Health
MAILING ADDRESS: Town of Barnstable
TELEPHONE NUMBER: '77/ —/'7 `2l P.O. Box 534
CONTACT PERSON: �,,p s , 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 totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry
weight? YES NOS
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)
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
+s..tC:.j;r;;�S .YF�r�'M�"';"'�rf`.`"�,-.=�'r-'�$"�•v-^"'�'�^��'.�+'^-�Ta.r�T*,�,,.�7.Tt� $1":' .1�"'' -`�"':``.v"'4r'*=,+,-,,,.:y'�""'q".y„���./"��i`7`�Tr.`:j°k�.."'-" ;r'T.-_a.�"t,r`�y��'1``Y'^''.1�7'. .� -...�-,+.
x ti
TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair
"�''- O satisfactory 2:Printers
.z BOARD OF HEALTH 3.Auto Body Shops
O unsatisfactory- 4.Manufacturers
COMPANY , . f �/fi, �., ,�,, (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS �f' .�z. " ra,�.E
*� C183S: 7.Miscellaneous
I - o 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)
Heavy Oils:
waste motor oil (C)
/ r
new motor oil(C) ! /
transmission/hydraulic
Synthetic Organics: `.
degreasers
Miscellaneous: -
err ,• '
Y
J
Y
DISPOSAURECLAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply
ATown Sewer QPublic
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: �y
O Holding tank:MDC "taA fr. & 'a,-,
O Catch basin/Dry well
O On-site system v r.
5. Waste Transporter
Name of Hauler Destination Waste ProductLicensed?
• YES NO
2.
AA 0
•,Person(s) Iritervie'e6&'4N,, Inspector` 'Date
TOWN OF BA R N STA B L E COMPLIANCE: CLASS: 1. Marine,Gas Stations,RFpai.r
O satisfactory 2. Printers
BOARD Auto Body Shops
Q unsatisfactory- 4. Manufacturers
COMPANY . ., � (see"Orders") ._S. Retail Stores
6. Fuel Suppliers.
ADDRESS Class: / 7. Miscellaneous
QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors)
MAJOR MATERIALS Case lots Drums AbbveTanks Undetground Tanks
IN OUT IN [OUT ( IN OUT gallons Ave ?
Fuels:
Gasoline, Jet Fuel (A)
Ptesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C)
new motor oil (C)
transmission/hydraulic
Synthetic Organics:
E
degreasers
" 4{
Miscellaneous:
DISPOSAL RECLAMATION REMARKS:
1_ Sanitary Sewage 2. Water Supply
OTown Sewer O.Public ,
OOn-site. O Private-
, �
.3. Indoor Floor Drains: YES NO ,
Holding tank: MDC •--___y____......_..._._.__` __.__
O Catch basin/Dry well
On-site system
4. Outdoor Surface drains-.YES NO _
O Holding tank: MDC
O Catch basin/Dry well
V On-site system
��"�
S. Waste Transporter ! Licensed?
Name of filer_ t Dg:tinatinn ..W ste Product YES NO
{ 1.
t
i2 23 81 Person(s) Interviewe ? , Inspector Date
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF FIRM: MORSE AUTO SUPPLY
MAILING ADDRESS: 121.6 IYANOUGH RD.
TELEPHONE NUMBER: HYANNIS, MA 02601
CONTACT PERSON: TEL- 775-7552
775-7553
Does your firm store any of the toxic or hazardous materials listed belpw,
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: 0#v,?,
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
Diesel fuel, Kerosene, #2 heating oil Wood preservatives(creosote)
Other petroleum products: grease,
lubricants Swimming Pool chlorine
e or caustic soda
Degreasers for engines and metal Lye
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 Metal polishes hydrochloric acid, other
_ — Laundry soil & stain removers acids)
(including bleach) Other products not listed
which you feel may be
Spot removers & cleaning fluids(dry cleaners) toxic or hazardous (please
list) :
_ Other cleaning solvents
Bug and tar removers R E C E I V E
Household cleansers, oven cleaners HEALTH DEPT.
Drain cleaners TOWN OF BARNSTABLE
Toilet cleaners
Cesspool cleaners
Disinfectants
Road Sal (Halite) MAY i 3 1981
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
.��c 4_ct, C-��. 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
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,
--L,ff,'��6ther 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)
_41f��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
unsatisfactory- 4.Manufacturers
COMPANY (see"Orders") 5.Retail Stores
6.Fuel Suppliers
ADDRESS Class: 7.Miscellaneous
/16& ' ANTITIES 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)
Diesel, Kerosene, #2 (B)
Heavy Oils:
waste motor oil (C) '2G
new motor oil (C) � $
transmission/hydraulic
Synthetic Organics:
degreasers
Miscellaneous:
DISPOSAURECIAMATION REMARKS:
1. Sanitary Sewage 2.Water Supply a
O Town Sewer Public
On-site OPrivate
3. Indoor Floor Drains YES N0
O Holding tank:MDC
O Catch basin/Dry well 0&0-6/2/Jr�
O On-site system �' <
4. Outdoor Surface drains:YES-NO—kl'
ESN0—kl' ORDERS:
O Holding tank:MDC �i
O Catch basin/Dry well
O On-site system
5.Waste Transporter
Name of Hauler Destination Waste Product
YES 1110
2.
—A6t&
Pers (s) Interviewed Inspector Date