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0 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALSA, <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION° 2 6 2 1 <br /> (One page per material per building or area) SANJC <br /> Ty <br /> WI j1hil <br /> Ty <br /> ❑ ADDCIVI❑ DELETE ® REVISE 200- Page o ENCy E VICES <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> CRLLC/76#5447 <br /> CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br /> # 1 MAP#(Optional) 263. 7D#(Optimoli 2U. <br /> (Agency Use Only) - - <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRET 706. <br /> Petroleum Hydrocarbon ffsubjeatoEPCM.refer toinsuuchons 11 Yes ZNo <br /> COMMON NAME 207. EHS* 208. <br /> Diesel Fuel No. 2 ❑Yes ENo <br /> CAS# 209. *If EHS is"Yes,"all amounts below must be in lbs. <br /> 68476-34-6 <br /> FIRE CODE HAZARD CLASSES(Complete ijregairedby CUPA) 2m. <br /> HAZARDOUS MATERIAL 211. RADIOACTTVE212. CURIES 213. <br /> TYPE (Check one item only) Ela.PURE S b.MIXTURE E]c.WASTE 1:1 Yes S No <br /> PHYSICAL STATE 214. LARGEST CONTAINER -2-15- <br /> (Check <br /> 15(Check one item only) ❑a.SOLID E It.LIQUID ❑c.GAS 9,728 gallons <br /> FED HAZARD CATEGORIES 216, <br /> (Check all that apply) E a.FIRE ❑b.REACTIVE ❑c.PRESSURE RELEASE S d.ACUTE HEALTH <br /> E e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT ns. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 22° <br /> 5,000 - 6,000 gallons 10,000 allons <br /> UNITS* Z a.GALLONS ❑b.CUBIC FEET ❑c.POUNDS ❑d.TONS 221. DAYS ON SITE 222. <br /> (Check ane item only) *If EHS,amount most be in pounds. 365 <br /> STORAGE ❑a. ABOVEGROUND TANK ❑E CAN ❑k. BOX ❑It. TANK WAGON 223. <br /> CONTAINER E b. UNDERGROUND TANK ❑g. CARBOY [:11. CYLINDER ❑q. RAIL CAR <br /> ❑c. TANK INSIDE BUILDING ❑h. SILO ❑m. GLASS BOTTLE ❑r. OTHER <br /> ❑d. STEEL DRUM ❑i. FIBER DRUM ❑n. PLASTIC BOTTLE <br /> ❑e. PLASTICINONMETALLIC DRUM ❑j. BAG ❑o. TOTE BIN <br /> STORAGE PRESSURE Ea. AMBIENT ❑b. ABOVE AMBIENT ❑c BELOW AMBIENT 224. <br /> STORAGE TEMPERATURE Z a. AMBIENT ❑It. ABOVE AMBIENT ❑c. BELOW AMBIENT ❑d. CRYOGENIC 225. <br /> %W T HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> I. 100% 226_ Diesel Fuel No. 2 231 ❑Yes E No 228, 68476-34-6 229. <br /> 2. <1% 230. Naphtalene 231 ❑Yes Z No 232 91-20-3 233. <br /> 3. <br /> 214. 235. El Yes [I No 236. 239. <br /> 238. 239. 24h. 241. <br /> 4. ❑Yes El No <br /> 5• <br /> 242. 243. EJ Yes [_1 No 244. 245. <br /> If marc hmrdou compmmY am present at greeter than 1%by weight if non<arefmgenip or 0.1%bywesght if ermine eaiq attach additional sheets of paper capmrine Ne mquimd inrorvution. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246. <br /> DOT Hazard Class:3 (Flammable Liquid) UN y2d� <br /> If EPCRA,Please Sign Here. <br /> CPCF Rev. (12/2007).2/2 www.unidocs.org <br />