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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/21/2010-01:34:14 PM <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAM <br /> <br /> CHEMICAL LOCATION 2p1 H ON CONFIDENTIAL EPCRA 202 <br /> SOUTH END OF SHOP ❑X YES❑NO <br /> FACILITY ID# I <br /> RMAP#GRILi#1/D-3 /A /A /A /A 203/204 <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> USED ETHYLENE GLYCOL If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 EHS ❑YES ®NO 208 <br /> USED ANTIFREEZE/COOLANT <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 [3 a.PURE ®b.MIXTURE p c.WASTE 211 RADIOACTIVE❑YES ®NO 212 CURIES N/A 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE ❑ ® UID SOLID LI <br /> (Check one item only) Q ❑GAS 214 LARGEST CONTAINER 100 1 <br /> FED <br /> heck alb lit R aCATE,GORIES ®�E ❑REACTIVE ❑PRESSURE RELEASE ®ACUTE HEALTH ®CHRONIC HEALTH 216 <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 75 100 480 134 <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 /> ®TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ®PLASTICINONMETALLIC 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 /> %WT HAZARDOUS COMPONENT or mixture or waste on] EHS CAS# <br /> 5 226 ETHYLENE GLYCOL 227 ❑YES ❑NO 228 11-46-6 229 <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 />