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UNIFIED PROGRAM CONSOLIDATED FORM JA <br /> HAZARDOUS MATERIALS SAN JOgpU)N COU <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESDlcRGENCY 'ICES(12/02/2011 -07:25:46 AM SE <br /> Page_ of <br /> ' I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> HD SUPPLY DISTRIBUTION SERVICE,LLC(CA094-6502) <br /> ' CHEMICAL LOCATION 201 rHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> HAZARDOUS WASTE STORAGE AREA AYES❑NO <br /> FACILI"fY ID# 1 I MAPey SI �203/204 <br /> 13542 Requireddbby SIC RC2 A A A A <br /> ' II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(I 1) ❑YES ®NO 206 <br /> NON-RCRA HAZARDOUS WASTE,LIQUIDS(WATER-BASED) If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 EHS' ❑YES ®NO 208 <br /> NON-RCRA HAZARDOUS WASTE,LIQUIDS(WATER-BASED) <br /> CAS# 209 <br /> ' NA If EHS is "Yes' all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> 1 HAZARDOUS MATERIAL 0 a.PURE ❑b.MIXTURE N c.WASTE 211 RADIOACTIVE 0 YES N NO 212 CURIES 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 214 215 <br /> (Check one item only) ❑SOLID N LIQUID ❑GAS LARGEST CONTAINER 30 Gallon <br /> FED HAZARD CATEGORIES ❑FIRE ❑REACTIVE ❑PRESSURE RELEASE R ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMITM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 170 510 510 291 <br /> UNITS' ❑GAL ❑CU FT O LBS ❑TONS 221 1 DAYS ON SITE 222 <br /> (Check on item only 'If EHS,amount must be in pounds. <90 <br /> STORAGE ❑ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> ' CONTAINER ❑UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING N FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG 0 TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM 0 BOX ❑RAIL CAR <br /> ❑CAN ❑CYLINDER ❑OTHER 223 <br /> ' STORAGE PRESSURE N AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE O AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> ' '7r.wT HAZARDOUS COMPONENT(For mixture or waste cat EHS CAS# <br /> 100 226 Non-RCRA Hazardous Waste.Liquids(water- 227 ❑YES ®NO 228 Mixture 229 <br /> h—al <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ONO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> ' 242 243 1 0 YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 246 <br /> ' (34)WHAT IS MATERIAL <br /> USED FOR? Waste <br /> ' UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br />