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UNH)OCS <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> (One page per material per building or area) <br /> ❑ ADD ❑ DELETE El REVISE 200. <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> S-Mart #209 <br /> CHEMICAL LOCATION 201. 1 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202. <br /> Refrigeration and Air Conditioning S stems-Throu hout ❑ YES ® NO <br /> FACILrrY ID# 1 MAP#(optimal) 203. 1 GRID#(Optional) 204. <br /> (Agency Use Only) <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRETa 206. <br /> Chlorodifluoromethane Ifsubjen EP <br /> m CRA,re& O <br /> rto instructions ❑Yes No <br /> COMMON NAME 207. EHS- 208. <br /> Freon R22 El Yes ®N° <br /> CAS# 209. *If EHS is"Yes,"all amo0nts below most be in lbs. <br /> 75-45-6 <br /> FIRE CODE HAZARD CLASSES(Complete lerequtred by CUPA) 210. <br /> HAZARDOUS MATERIAL 211. RADIOACTIVE 212. CURIES 213. <br /> TYPE (Check one item only) ®a.PURE ❑b.MIXTURE ❑c.WASTE ❑yes ®No <br /> PHYSICAL STATE 214. LARGEST CONTAINER 215. <br /> (Check one item only) ❑a.SOLID ❑It.LIQUID ®c.GAS 3200 I bs <br /> FED HAZARD CATEGORIES 216. <br /> (Check all that apply) ❑a.FIRE ❑b.REACTIVE ®c.PRESSURE RELEASE ❑it.ACUTE HEALTH ❑e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217. MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. <br /> 3325 lbs 3325 lbs NA NA <br /> UNITS- ❑a.GALLONS ❑b.CUBIC FEET ®c.POUNDS ❑d.TONS 221. DAYS ON SITE 2n. <br /> (Check one item only) a If ENS,amount must be in pounds. 365 <br /> STORAGE ❑a. ABOVEGROUND TANK ❑E CAN ❑k. BOX ❑p. TANK WAGON n3. <br /> CONTAINER ❑b. UNDERGROUND TANK ❑g. CARBOY [:11. CYLINDER ❑q. RAILCAR <br /> ❑c. TANK INSIDE BUILDING ❑It. SILO ❑m. GLASS BOTTLE Mr. OTHER <br /> ❑d. STEEL DRUM ❑i. FIBER DRUM ❑n. PLASTIC BOTTLE <br /> ❑e. PLASTICINONMETALLIC DRUM ❑I. BAG ❑o. TOTE BIN <br /> STORAGE PRESSURE ❑a. AMBIENT ®It. ABOVE AMBIENT ❑c. BELOW AMBIENT 224. <br /> STORAGE TEMPERATURE ❑a. AMBIENT ❑b. ABOVE AMBIENT ®c. BELOW AMBIENT ❑d. CRYOGENIC <br /> %WT HAZARDOUS COMPONENT(For mixture or haste only) EHS CAS# <br /> 1. 99.5 226. Chlorodifluoromethane 220_ ❑Yes ® No 228. 229. <br /> 75-45-6 <br /> 230. 231. 232. 233. <br /> 2. ❑Yes ❑ No <br /> 234. 235. 236. 237. <br /> 3. ❑Yes ❑ No <br /> 236. 239. 240, 241. <br /> 4. ❑Yes ❑ No <br /> If more haare ous components are present at grater than 1%by weight if non-carcinogenic,or 0.1%by weight if carcinogenic,attach additional sheets ofpaper aP to h the red information. <br /> g rtqui <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246. <br /> DOT Hazard Class: <br /> IfEPCRA,Please Sign Here. <br /> If this facility is subject to Federal Emergency Planning and Community Right to Know Act(EPCRA)reporting requirements,a signature is required at the <br /> bottom of the form if the page lists an Extremely Hazardous Substance(EHS)handled at or above its Federal Threshold Planning Quantity (TPQ)or 500 <br /> pounds,whichever is less. <br /> S-Mart#209 Page 3 of 16 March 2011 <br />