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Hazardous Materials Registration Form

  1. Hazardous Materials Registration Form (HMRF)

    A hard copy of your invoice has been mailed out on 1/21/22 to the addresses that the Board of Health has on file. 

    If you have not received your invoice yet and wish to calculation your registration fee invoice amount, please see the below fee amounts:

    • Hazardous Waste Generator: VSQG = $50, SQG = $50, LQG = $100
    • Underground Storage Tanks; Number of tanks: $50 per tank
    • Chemical Storage Amounts: Less than 300 gallons = $50, Greater than 300 gallons= $100

    If you have any questions or if you do not receive your invoice in the mail, please contact the Board of Health office at 781-270-1955.

  2. HMRF Preparer Information

  3. List TWO emergency contact personnel for your facility.

  4. Registration Fee Calculation (Please check all that apply to your facility)

  5. Hazardous Waste Generator*
  6. If yes, check all that apply
  7. Underground Storage Tanks*
  8. Chemical Storage Amounts*
  9. If yes, check all that apply
  10. Hazardous Waste Generator Status

  11. Does your facility generate chemical or hazardous waste? (If no, skip to Chemical Storage section)*
  12. Indicate your generator status
  13. Chemical Storage

  14. Does your facility handle, use or store chemicals (e.g., oils, solvents, acids/bases, cleaning agents, fuels or compressed gas cylinders)?*
  15. If, in the last calendar year, you stored greater than 10,000 pounds of any hazardous chemical for which you are required to maintain a Safety Data Sheet (SDS) or 500 pounds of an Extremely Hazardous Substance, your facility is required to file a Tier II Emergency and Hazardous Chemical Inventory in accordance with US EPA Emergency Planning and Community Right-to-Know ACT (EPCRA) requirements. 

  16. Will your facility be filig a Tier II form for last year?*
  17. A copy should also be sent to the Burlington Fire Department.

  18. Does your facility store compressed gas cylinders?*
  19. Does your facility store flammable materials?*
  20. Does your facility have any ABOVE GROUND storage tanks?*
  21. Underground Storage Tanks

  22. Does your facility have any UNDERGROUND storage tanks?*
  23. Sewer Discharge Permit

  24. Does your facility have any of the following types of permits for the Massachusetts Water Resources Authority (MWRA) Group, General or Sewer Use Discharge Permit?*
  25. General Facility Information

  26. List spill clean-up materials and equipment present on-site
  27. List potential spill pathways for chemicals to enter the environment (e.g. floor drains, dry wells, cracked pavement, loading docks)
  28. Facility Maps

  29. Leave This Blank:

  30. This field is not part of the form submission.