Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Pae I of I <br /> I. FACILITY IDENTIFICATION <br /> FACILITY ID NI I EPA ID I(Hazardous Waste Only) 2 <br /> FA0021146 <br /> BUSINESS NAME(Same w Facility Name of DBA-Doing Business As) 3 <br /> KINGSDOWN INC <br /> II. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> please submit the Business Owner/Operator Identification page(OES Form 2730). <br /> Does your facility... If Yes,please complete these pages of the UPCF... <br /> A.HAZARDOUS MATERIALS <br /> Have on site(for any purpose)hazardous materials at or above 55 gallons <br /> for liquids,500 pounds for solids,or 200 cubic feet for compressed gases <br /> (include liquids in ASTs and USTs);or the applicable Federal threshold YES NO 4 HAZARDOUS MATERIALS INVENTORY <br /> quantity for an extremely hazardous substance specified in 40 CFR Part 355, -CHEMICAL DESCRIPTION(DES 273 1) <br /> Appendix A or B;or handle radiological materials in quantities for which an emergency <br /> plan is required pursuant to 10 CFR Parts 30,40 or 70? <br /> B.UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(Formar>swaCB Fenn A) <br /> 1. Own or operate underground storage tanks? ❑ YES ® NO 5 UST TANK(orc was w unk)(Ponnrry Form m <br /> 2. Intend to upgrade existing or install new USTs? <br /> ❑ YES NO 6 UST FACILITY <br /> UST TANK(.w utld <br /> UST INSTALLATION-CERTIFICATE OF <br /> 3. Need to report closing a UST? ❑ YES NO 7 COMPLLINCE(orcpageparank)(Famry FormQ <br /> UST TANK o".ram.-are page per ma) <br /> C ABOVE GROUND PETROLEUM STORAGE TANKS(ASTs) <br /> Own or operate ASTs above these thresholds: <br /> ---any tank capacity is greater than 660 gallons,or ❑ YES ®NO 8 NO FORM REQUIRED TO CUPAs <br /> ---the total capacity for the facility is grater than 1,320 gallons? <br /> D HAZARDOUS WASTE <br /> EPA ID NUMBER-provide at the top of this <br /> I. Generate hazardous waste? <br /> ❑ YES ®NO 9 page <br /> RECYCLABLE MATERIALS REPORT(arc <br /> 2. Recycle more than 100 kg/month of excluded or exempted v <br /> recyclable materials(per HSC 25143.2)? YES ®NO 10 ONNSITESIIIE <br /> HAZARDOUS WASTE <br /> TREATMENT-FACILITY(Famwy oTsc <br /> 3. Treat hazardous waste on site? <br /> El YES ®NO 11 Ns Int) <br /> O <br /> ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIT(am pose w east(Four rly <br /> 4. Treatment subject to financial assurance requirements(for DTSC Fame VR A,B,C,D and L) <br /> Permit by Rule and Conditional Authorization)? CERTIFICATE OF FINANCIAL <br /> ❑ YES El NO 12 ASSURANCE(Form y,DTSC Form 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE/CONSOLIDATION <br /> ❑ YES ® NO 13 SITE ANNUAL NOTIFICATION(Fornmdy <br /> DTSC F.1196) <br /> 6. Need to report the closure/removal of a tank that was classified as HAZARDOUS WASTE TANK CLOSURE <br /> hazardous waste and cleaned onsite? YES ®NO 14 CERTIFICATION(Formuly mw Form 1249) <br /> ❑ <br /> I:,LOCAL REQUIREMENTS Is <br /> (You may be required to provide additional information by your CUPA or local agency.) <br /> UPCF(1/99) <br />