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RECEIVED <br /> UNIFIED PROGRAM CONSOLIDATED FORM SAN JUA�UIN CUUNN <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY - CHEMICAL D91F fl8 SERVICES <br /> (one page par material par buildin or area) <br /> ❑ ADD ❑ DELETE ❑ REVISE 200. Page 3 of 10 <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3. <br /> GMRI,Inc.DBA Olive Garden# 1779 <br /> <br /> <br /> <br /> # 203. GRID# 2n4. <br /> (Agency Use Only) <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRET ❑ Yes M No 206. <br /> Carbon Dioxide Refrigerated Liquid If Subject to EPCRA,refer to instructions <br /> COMMON NAME 297. ma. <br /> EBS* ❑ Yes ® No <br /> Carbon Dioxide <br /> CAS# 209. <br /> *If EHS is"Yes,"all amounts below must be in lbs. <br /> 124-38-9 <br /> FIRE CODE HAZARD CLASSES(Complete if requirm by local agency) 210. <br /> 213. <br /> HAZARDOUS MATERIAL ®a.PURE ❑Or.MIXTURE ❑C.WASTE 211. RADIOACTIVE [-]Yes O No 212. CURIES <br /> TYPE (Check one item only) <br /> 215 <br /> PHYSICAL STATE <br /> (Check one item only) Ela.SOLID ®b.LIQUID [I c.GAS 214. LARGEST CONTAINER <br /> FED HAZARD CATEGORIES 215. <br /> (Check all that apply) ❑a.FIRE ❑It.REACTIVE ®c.PRESSURE RELEASE ®d.ACUTE HEALTH ❑e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217. 1 MAXIMUM DAILY AMOUNT 218. ANNUAL WASTE AMOUNT 219, STATE WASTE CODE 220. <br /> 225 450 N/A N/A <br /> 221. DAYS ON SITE 222. <br /> UNITS* ❑a.GALLONS ❑b.CUBIC FEET ®c.POUNDS ❑d.TONS 365 days per year <br /> Check one item only) *If EHS,amount must be in pounds. <br /> STORAGE <br /> CONTAINER ❑a. ABOVEGROUND TANK ❑e. PLASTIC/NONMETALLIC DRUM ❑i. FIBER DRUM ❑m. GLASS BOTTLE ❑q. RAILCAR <br /> ❑b. UNDERGROUND TANK ❑L CAN ❑j. BAG ❑n. PLASTIC BOTTLE ❑r. OTHER <br /> ❑c. TANK INSIDE BUILDING ❑g. CARBOY ❑k.BOX ❑o. TOTE BIN <br /> ❑d. STEEL DRUM ❑h. SILO Z 1. CYLINDER ❑It. TANK WAGON 223. <br /> STORAGE PRESSURE ❑a. AMBIENT Z b. ABOVE AMBIENT ❑c. BELOW AMBIENT 224. <br /> STORAGE TEMPERATURE ❑a. AMBIENT ❑b. ABOVE AMBIENT ®c. BELOW AMBIENT ❑d. CRYOGENIC 225. <br /> % WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1. 226. 227. ❑Yes ❑ No Ms. 229. <br /> 2 230. 231. ❑Yes ❑ No 232. 233. <br /> 3. 234. 235. ❑Yes ❑ No 236. 237. <br /> 4. 238. 239. ❑Yes ❑ No 2Ao. mi. <br /> 5. 242, 243. ❑Yes ❑ No 244. 245. <br /> Harare hazardous components ere present st greater thms 1%by weight if von<arcimogenic,or o.1%by weight if ruetoolmak,attach addilioval aheeb of paper eapturing the required i adamna tion. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246' <br /> DOT Hazard Class: <br /> If EPCRA,Please Sign Here. <br /> www.unidocs.org Rev.03/02/09 <br />