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NIFIED PROGRAM CONSOLIDATED FORMOW <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> 01/05/2010- 11:01:24 AM <br /> Page_ of_ <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> DANS TIRE AND AUTO REPAIR LLC <br /> CHEMICAL LOCATION 201 HEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> INSIDE STORAGE ROOM E-6 [F]YESQNO <br /> FACILITY ID# 1 MAP#GRID# �*p <br /> 14236 Required by SJ6203/204 <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> NEW OIL <br /> If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 <br /> ENGINE OIL EHS* ❑YES ®NO 208 <br /> CAS# <br /> 209 <br /> MIXTURE *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 /> HAZARDOUS MATERIAL I7 a.PURE M b.MIXTURE <br /> TYPE(Check one item only) Oc.WASTE 211 RADIOACTIVE❑YES ®NO 212 CURIES N/A 213 <br /> PHYSICAL STATE 214 <br /> (Check one item only) ❑SOLID ®LIQUID ❑GAS LARGEST CONTAINER 55 215 <br /> FED HAZARD CATEGORIES ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGED! AMOUNT 2I7 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 40 55 N/A N/A <br /> UNITS* ®GAL ❑CU FT ❑LBS ❑TONS 221 1 DAYS ON SITE 222 <br /> (Check on item only *If EHS,amount must be in pounds. 365 <br /> STORAGE IN ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK [3SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN ❑CYLINDER ❑OTHER <br /> 223 <br /> STORAGE PRESSURE H AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> 224 <br /> STORAGE TEMPERATURE IN AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT(For mixture or waste onl) EHS CAS# <br /> 226 227 ❑YES ❑NO 228 229 <br /> 230 231 ❑YES r❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 [:]YES ❑NO 244 <br /> 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1270 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR9 oil change I <br /> UPCF(Rev. 12/2007) If EPCRA,Please Sign Here <br /> Fr Official Use Only: ®C ❑R [IS Last Web Update: 12/28/2009 <br />