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0 0 RECEI p <br /> UNIFIED PROGRAM CONSOLIDATED FORM assAUG <br /> � � 20 <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPT <br /> (One page per material per building or area) OFFICEEOFEE ERGAQUIN COU 7y <br /> MERGE RVICE8 <br /> ❑ ADD El DELETE ❑ REVISE 2oD. <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3 <br /> CRLLC/#5447 <br /> CHEMICAL LOCATION 201. CHEMICAL LOCATION CONFIDENTIAL EPCRA 20a <br /> ❑ YES ® NO <br /> FACILITY ID# 1 MAP#(Optional) 203. GRID#(Optional) 204. <br /> (Agency Use Only) - <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRET zo6. <br /> Petroleum Hydrocarbon mixture Ifsubjeetto EPCRA,mRrtoinsmuctions []Yes ®No <br /> COMMON NAME 207 EHS' 09, <br /> Spill <br /> S ill Bucket Waste ❑Yes ®No <br /> CAS# 209. 'If EHS is"Yes,'all amounts below must be in lbs. <br /> 8006-61-9 <br /> FIRE CODE HAZARD CLASSES(Complete iJregalred by CUPAJ 210 <br /> HAZARDOUS MATERIAL 211. RADIOACTIVE 212. <br /> CURIES 213. <br /> TYPE (Check one irem only) ❑a.PURE ❑b.MIXTURE <br /> ®c.WASTE El Yes ®No <br /> PHYSICAL STATE 214. LARGEST CONTAINF,R 235. <br /> (Check ane item only) ❑a.SOLID ®b.LIQUID ❑e.GAS <br /> 55 gallon drum <br /> FED HAZARD CATEGORIES zlb <br /> (Check all that apply) ®a.FIRE ❑It.REACTIVE ❑c.PRESSURE RELEASE ❑d.ACUTE HEALTH ❑e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 212 MAXIMUM DAILY AMOUNT 218. 1 ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. <br /> 1 gallon 55 gallon <br /> UNITS' ®a.GALLONS ❑b.CUBIC FEET 221. 222. <br /> ❑c.POUNDS ❑d.TONS DAYS ONSITE <br /> (Check one item only) 'If EHS,amount must be in pounds. 365 <br /> STORAGE [Ia. ABOVEGROUND TANK ❑f. CAN223. <br /> CONTAINER ❑k. BOX ❑p. TANK WAGON <br /> ❑b. UNDERGROUND TANK E]g. CARBOY ❑I. CYLINDER ❑q. RAILCAR <br /> Cie. TANK INSIDE BUILDING ❑h. SILO ❑m. GLASS BOTTLE ❑r. OTHER <br /> ®d. STEEL DRUM ❑i. FIBER DRUM ❑n. PLASTIC BOTTLE <br /> ❑e. PLASTIC/NONMETALLIC DRUM ❑I. BAG ❑o. TOTE BIN <br /> STORAGE PRESSURE ®a. AMBIENT ❑b. ABOVE AMBIENT ❑c. BELOW AMBIENT Fv- <br /> STORAGE TEMPERATURE N a. AMBIENT ❑b. ABOVE AMBIENT ❑c. BELOW AMBIENT ❑d. CRYOGENIC 225. <br /> %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1. 10% 226. Gasoline 227 EHS <br /> x29 <br /> El Yes ® No $006-61-9 <br /> 2. 90% 230. Water 231. 232. 233. <br /> Ell Yes ® No <br /> 234. 235. 236, 237 <br /> 3. ❑Yes ❑ No <br /> 218. 239. 240 241. <br /> 4. El Yes ❑ No <br /> 242. 243. 244. 245. <br /> 5• ❑Yes ❑ No <br /> If mom h..,rd a,components arc Incomes at peanr than 1%brwedsnt if non-amch oeemc,or 0.1%In,.dest if urci.....ic,.then additioom,hacts ofp.,r r.nmrine the r•q.imd information. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246, <br /> DOT Hazard Class: <br /> If EPCRA,Please Sign Here. <br /> UPCF Rev. (12/2007)-4/2 www.unidocs.org <br />