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v%p6NIFIED PROGRAM CONSOLIDATED FOR <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> 10/14/2009 - 04:27:52 PM <br /> Page_ of <br /> 1. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> PIZZA FACTORY <br /> CHEMICAL LOCATION 201 rHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> BY SODA MACHINE,IN WALK IN ❑X YES❑NO <br /> FACILITY ID# I MAp#GRID# 203804 <br /> 13059 Required by ) AP 1/D-5 ���� <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> CO2 If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 208 <br /> CO2 EHS* ❑YES ONO <br /> CAS# 209 <br /> CO2 If EHS is "Yes",all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS MATERIAL ®a.PURE p b.MIXTURE O c.WASTE 211 RADIOACTIVE❑YES ®NO 212 CURIES 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 0 SOLID [I LIQUID ®GAS 214 LARGEST CONTAINER SOLBS 215 <br /> (Check one item only) <br /> FED HAZARD CATEGORIES O FIRE O REACTIVE ®PRESSURE RELEASE O ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 SPATE WASTE CODE 220 <br /> SO 160 NA ? <br /> UNITS* ❑GAL ❑CU FT ®LBS ❑TONS 221 DAYS ON SITE 222 <br /> (Check on item only *If EHS,amount must be in pounds. 365 <br /> STORAGE ❑ABOVE GROUND TANK []CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER O UNDERGROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> O STEEL DRUM p BAG ❑TANK WAGON <br /> p PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN 19 CYLINDER ❑OTHER <br /> 223 <br /> STORAGE PRESSURE ❑AMBIENT ®ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE INAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT(For mixture or waste onl EHS CAS# <br /> NA 226 NA 227 ❑YES ®NO 228 NA 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 ❑YES ❑NO 214 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1013 246 <br /> (34)WHAT IS MATERIAL 1 <br /> USED FOR? ISODA FOUNTAIN AND BEER <br /> UPCF(Rev. 12/2007) If EPCRA,Please Sign Here <br /> ur Official Use Only: OC ❑R [IS Last Web Update: 04/24/2007 <br />