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�fRIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br /> («c page p«met«iel per building«w) <br /> ❑ ADD ❑DELETE ❑ REVISE 200 Page 1 of 1 <br /> 1.FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> TACO BELL#19206 <br /> CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> [:] YES ❑NO <br /> FACILITY ID q FA0007575 I MAP#mp6nnap 203 ORID#(nptimw) 2a <br /> II.CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET ❑ Yes ® No 206 <br /> CARBON DIOXIDE Ifaub)sttoEPCRAmferto <br /> COMMON NAME <br /> °' Exs• ❑ Yes ®No Zoe <br /> CARBON DIOXIDE <br /> CAS# 209 <br /> 124-38-9 If EHS is"Yes",all amounts below must be in lbs <br /> FIRE CODE HAZARD CLASSES(Comptek irreenbm by COPA) 210 <br /> HAZARDOUS MATERIAL ❑ a PURE ❑ b.MIXTURE ❑ e WASTE 311 RADIOACTIVE ❑ Yes ® NO 212 CURIES 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE ❑ a SOLID ® b.LIQUID ❑ c.GAS 214 LARGEST CONTAINER 215 <br /> (Cheek one item only) 400.00 <br /> FED HAZARD CATEGORIES 216 <br /> (Cheek ell thin apply) ❑ a FIRE ❑b.REACTIVE ❑ e.PRESSURE RELEASE ❑ d.ACUTE HEALTH ®e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT "I ANNUALWASTEAMOUNT 219 STATE WASTE CODE 220 <br /> 240.00 400.00 <br /> UNITS' ❑ e GALLONS ❑ b.CUBIC FEET ® c.POUNDS ❑ d.TONS 221 DAYS ON SITE: 222 <br /> (Check one item only) <br /> •BEDS,amount must be in pounds 365 <br /> STORAGE ❑ a ABOVE GROUND TANK ❑ e PLASTICNONMETALLIC DRUM ❑ i.FIBERDRUM E] in GLASS BOTTLE ❑q.RAIL CAR <br /> CONTAINER ❑ b.UNDERGROUND TANK ❑ t CAN ❑j.BAG ❑ n.PLASTIC BOTTLE ❑ r.OTHER <br /> ® C.TANK INSIDE BUILDING ❑ It CARBOY ❑ k.BOX ❑ o.TOTE BIN <br /> ❑ d.STEEL DRUM ❑ h.SILO ❑ I.CYLINDER ❑ p.TANK WAGON 223 <br /> STORAGE PRESSURE ❑a AMBIENT ® b. ABOVEAMBIENT ❑ c. BELOW AMBIENT 224 <br /> STORAGETEMPERATURE ❑a AMIBIENT ❑ b. ABOVEAMBIENT ® c. BELOW AMBIENT ❑ d. CRYOGENIC 225 <br /> %pWT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1 226 227 ❑ Yes No 228 229 <br /> 2 230 231 ❑ Yes ❑ No 232 233 <br /> 3 234 235 ❑ Yes E] No 236 237 <br /> 4 238 239 ❑ Yes ❑ No 240 241 <br /> 5 242 243 ❑ Yes ❑ No 244 245 <br /> Ifm re hazardouscomponents,are present at 8n4ter thm 1%by neieht if nn nogeni4 or 0.1%by weight ifn nogen ,saaeb additional sheeb orpepoeapturing the nouired information. <br /> ADDITIONALOCALLY COLLECTED INFORMATION n 246 <br /> If EPCRA,Please Sign Here <br /> UPCF(1/99) <br />