Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY— cHEMIcAL DEscRIPTION <br /> (one page per material per building or area) <br /> ❑ADD ❑DELETE ❑REVISE 200 <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME 3 <br /> S-Mart#655 <br /> CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> Refrigeration and Air Conditioning Systems—Throughout store ❑ YES ® NO <br /> FACILITY ID# 1 I MAP#(optiow) 203 GRID#(optiosmp 204 <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET El Yes ® No 206 <br /> GENETRON 404A or HFC 404A IfSubject mEFc ,Mi to0.wmcdom <br /> COMMON NAME 207 208 <br /> FREON 404A EHS* ❑ Yes ® No <br /> CAS# 209 <br /> Various *If EHS is"Yes",all amounts below must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete drequn>i by COPA) 210 <br /> 213 <br /> HAZARDOUS MATERIAL 211 RADIOACTIVE ❑Yes MNo 212 CURIES NA <br /> TYPE(Check one item only) ❑a.PURE ®b.MIXTURE ❑C.WASTE <br /> 215 <br /> PHYSICAL STATE <br /> (Check one item only) ❑ a.SOLID [I b. LIQUID Z ..GAS <br /> 214 LARGEST CONTAINER 1400 lbs <br /> FED HAZARD CATEGORIES - 216 <br /> (Check all that apply) ❑ a. FIRE ❑b. REACTIVE ® c.PRESSURE RELEASE ❑d. ACUTE HEALTH ❑ e. CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 1 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> N/A N/A <br /> 221 DAYS ON SITE: 222 <br /> UNITS" ❑a.GALLONS [I b. CUBIC FEET ® c.POUNDS ❑d.TONS 365 <br /> Check one item only) "If EHS,amount must be in pounds, <br /> STORAGE <br /> CONTAINER ❑a.ABOVE GROUND TANK ❑e.PLASTIC/NONMETALLIC DRUM ❑ I.FIBER DRUM ❑m.GLASS BOTTLE ❑ q.RAILCAR <br /> ❑b.UNDERGROUND TANK ❑E CAN ❑ j.BAG ❑n. PLASTIC BOTTLE N r.OTHER <br /> ❑c.TANK INSIDE BUILDING ❑g.CARBOY ❑ It.BOX ❑o. TOTE BIN <br /> ❑d. STEEL DRUM ❑It.SILO ❑ 1. CYLINDER ❑p. TANK WAGON 223 <br /> STORAGE PRESSURE ❑ a. AMBIENT ® It. ABOVE AMBIENT ❑ c. BELOW AMBIENT 221 <br /> STORAGE TEMPERATURE ®a. AMBIENT ❑ b. ABOVE AMBIENT ❑ a BELOW AMBIENT ❑d. CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1 44% 226 CHF2CF3 (GENETRON 125) 227 ❑Yes ® No 228 354-33-6 229 <br /> 2 52% 230 CH3CF3 (GENETRON 143a) 231 ❑Yes ® No 232 42046-2 233 <br /> 3 4% 234 CH2FCF3 (GENETRON 134a) 235 ❑Yes ® No 236 811-97-2 237 <br /> 4 238 239 ❑Yes ❑ No 240 241 <br /> 5 242 243 ❑Yes ❑ No 244 245 <br /> If more haordone components are prevent at grewter than 1%by weight if non-oweinogeob,or aI%by weight acareinogenie,attach additional sheets of paper capturing the required information. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246 <br /> H EPCRA,Please Sign Here <br /> S-Mart#655 Page 4 of 18 March 2011 <br />