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0 <br />E <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />FACILITY INFORMATION <br />BUSINESS ACTIVITIES <br />BUSINESS NAME (Same as racuuy num= �' <br />HOMETOWN BUFFET #707 <br />NOTEt If you check YES to any {tart of this list, <br />submit the Business Owner/Operator Identification page (4 <br />.---- - <br />Have on site (for any purpose) hazardous materials at or above 55 gallons for <br />liquids, 500 pounds for solids, or 200 cubic feet for compressed gases ® YES 0 NO 4 <br />(include liquids in ASTs and USTs); or the applicable Federal threshold <br />quantity for an extremely hazardous substance specified in 40 CFR Part 355, <br />Appendix A or B; or handle radiological materials in quantities for which an <br />emeraenev nlan is required pursuant tc I ) CFR Parts 30, 40 or 70? <br />-1. V Own or operate underground storage tanks? <br />2. Intend to upgrade existing or install new USTs? <br />3• Need to report closing a UST? <br />Own or operate ASTS above these thresholds: <br />... any lank capacity is greater than 660 gallons, or <br />... tile total capacity for the facility is greater than 1,320 gallons? <br />I. Ocnerate hazardous waste? <br />2. Recycle more than 100 kg/month of excluded or exempted <br />recyclable materials (per HSC 25143.2)? <br />3. Treat hazardous waste on site? <br />4. Treatment subject to financial assurance requirements (for <br />Permit by Rule and Conditional Authorization)? <br />5. Consolidate hazardous waste generated at a remote site? <br />6. Need to report the closure/removal of a tank that was classified as <br />hozadous waste mrd cleaned onsite? <br />Note: <br />Revised (5/03) <br />0 YES <br />0 NO 5 <br />0 YES <br />ONO 6 <br />0 YES <br />ONO <br />YES <br />® NO 8 <br />[]YES <br />® NO 9 <br />0 YES <br />® NO 10 <br />0 YES <br />® NO 1 I <br />0 YES <br />0 NO 12 <br />0 YES <br />® NO 13 <br />❑ YES <br />® NO 14 <br />OCT - 4 2010 <br />SAN JOAQUIN <br />Form <br />HAZARDOUS MATERIALS INVENTORY <br />—CHEMICAL DESCRIPTION (DES 2731) <br />UST FACR,rrY (Formerly SwRCa Form A) <br />UST TANK w- pge pert-k)TF ulyFem'n) <br />UST FACILITY <br />UST TANK (om: pert --k) <br />UST INSTALLATION • CERTIFICATE OF <br />COMPLIANCE (ora pose per unt)(Fmmedy Form C) <br />UST TANK (rlomrc poeion bne par perm") <br />AENTS <br />to question A listed above, complete and submit the Statement of Exeotption page. <br />NO FORM REQUIRED TO CUPA <br />EPA ID NUMBER—provide at the top of this <br />page <br />Complete the Ilawndoas waste Ocnerator, <br />County orRiverside Form. <br />RECYCLABLE MATERIALS REPORT (ora <br />per rep'eitt) <br />ONSITE HAZARDOUS WASTE <br />TREATMENT — FACILITY (Fomady DTSC <br />F..' 1772) <br />ONSITE HAZARDOUS WASTE <br />TREATMENT—UNIT (rrepseprunit)VF Ily <br />DTSC Form' 1771 A,a.C•D ad L) <br />CERTIFICATION OF FINANCIAL <br />ASSURANCE (Fomady DTSC Form 1331) <br />REMOTE WASTE / CONSOLIDATION <br />SITE ANNUAL NOTIFICATION (Formerly <br />DTSC Form 1196) <br />HAZARDOUS WASTE TANK CLOSURE <br />CERTIFICATION ('armedy DTSC Farm 1149) <br />