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REQ ZEn <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS AUG 2 S 2011 <br /> HAZARDOUS MATERIALS INVENTORY— CHEMICAL DESCRF�'�ON <br /> (One page per material per building or area) OFFICE 'I 9 IN COUNTY <br /> ❑ ADD ❑ DELETE E REVISE 20 <br /> . <br /> Page of <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 /> ❑ ves E No <br /> FACILITY ID# _ i MAP#(Optional) Zea, GRID It(Optimal) 204. <br /> (Agency We Only) <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRET los. <br /> Petroleum Hydrocarbon Mixture IfeubjectinEPCRA,refertoinstrucions El Yes 9 N <br /> COMMON NAME 209. EHS- 209, <br /> Gasoline ❑Yes E No <br /> CAS# los -If EHS is"Yes,'all amounts below must be in lbs. <br /> 8006-61-9 <br /> FIRE CODE HAZARD CLASSES(Complete frequiredby CUPA) z1o. <br /> HAZARDOUS MATERIAL 211. RADIOACTIVE 212 <br /> TYPE Check one item onl O a.PURE b.MIXTURE CURIES v3. <br /> ( Y) ® ❑c.WASTE ❑Yes E No <br /> PHYSICAL STATE 214. LARGEST CONTAINER 7175. <br /> (Check one item only) ❑a.SOLID E b.LIQUID ❑c.GAS <br /> 12,068 gallons <br /> FED HAZARD CATEGORIES tis <br /> (Check all that apply) E a.FIRE ❑b.REACTIVE ❑C.PRESSURE RELEASE E d.ACUTE HEALTH E e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21L. 1 ANNUAL WASTE AMOUNT 219. <br /> STATE WASTE CODE xzo. <br /> 15,000 -19,000 gallons 1 31,500 gallons <br /> UNITS- E a.GALLONS ❑b.CUBIC FEET ❑c.POUNDS ❑d.TONS 22' DAYS ON SITE 222. <br /> (Check one item only) -If EHS,amount must be in powds. 3655 <br /> STORAGE ❑a. ABOVEGROUND TANK ❑f CAN Elk. BOX ❑p. TANK WAGON 223 <br /> CONTAINER E b. UNDERGROUND TANK ❑g. CARBOY <br /> [IL CYLINDER ❑q. RAIL CAR <br /> ❑c. TANK INSIDE BUILDING ❑It. 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 E a. AMBIENT ❑b. ABOVE AMBIENT ❑c. BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE E a. AMBIENT ❑b. ABOVE AMBIENT225. <br /> ❑c. BELOW AMBIENT ❑d. CRYOGENIC <br /> %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1. 100% 226. Gasoline 229 ❑Yes E No 228, 8006-61-9 <br /> 8006-61-9 <br /> 230. 231, 232. 233, <br /> 2. ❑Yes [I No <br /> 3- <br /> 234. 235, 236. 239. <br /> 1:1 Yes El No <br /> 4• <br /> ng. 239. zoo. 241. <br /> 11 Yes El No <br /> 242 243. 244. 245. <br /> 5. ❑Yes ❑ No <br /> Ifnearthtemdom component,me Inman,at greater than 1%byweiebtifnan-caninopme,or0.1%byweiot ifaninogemc,attach additional sheets of turin <br /> paperxaP L therequired information. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246. <br /> DOT Hazard Class: 3 (Flammable Liquid) UN 1203 <br /> If EPCRA,Please Sign Here. <br /> UPCF Rev. (12/2007)-12 www.unidocs.org <br />