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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/21/2010-01:34:03 PM <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAM <br /> <br /> CATION 201 CAL LOCATION CONFIDENTIAL.EPC <br /> SOUTHSIDE OF SHOP BETWEEN BAYS 5&6 <br /> ❑X YES❑NO <br /> FACILITY ID# 1 RIRequi D#1/D-2 203/204 <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> ETHYLENE GLYCOL If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 <br /> ANTIFREEZE/COOLANT EHS* ❑YES ® 208 <br /> NO <br /> CAS# 209 <br /> 107-21-1 *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 O a.PURE H b.MIXTURE p c.WASTE 211 RADIOACTIVE[3 YES ®NO 212 CURIES N/A 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 214❑SOLID ®LI UID 215 <br /> (Check one item only) Q ❑GAS LARGEST CONTAINER 150 <br /> FCEhD HAZARD CATEGORIES ®FIRE ❑REACTIVE El PRESSURE RELEASE ®ACUTE HEALTH ®CHRONIC HEALTH 216 <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 105 1150 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 ❑ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> IN 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 ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> °GWT HAZARDOUS COMPONENT(For mixture or waste only ERS CAS# <br /> 5 226 DIETHYLENE GLYCOL 227 ❑YES ❑NO 228 111-46-6 229 <br /> 2 230 DI POTASSIUM PHOSPHATE 231 ❑YES ❑NO 232 7758-11-4 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 ❑YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? ENGINE COOLANT FOR TRUCKING FLEET' <br /> UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br />