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IFIED PROGRAM CONSOLIDATED F <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page 1 of <br /> I. FACILITY IDENTIFICATION <br /> I. EPA ID N(Hazardous Waste Only) 2. <br /> FACILITY to# <br /> (Agency use only) — — CAL000324141 <br /> 3. <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) <br /> Valero Corner Store#3698 <br /> 03, <br /> BUSINESS SITE ADDRESS th 105 <br /> 153 E. 11 Street <br /> ,05. <br /> BUSINESS SITE CITY Tracy 06 CA ZIP CODE 95376 <br /> II. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease submit the Business Owner/O erator Identification page. <br /> Does your facility... If Yes,please complete these pages of the UPCF... <br /> A. HAZARDOUS MATERIALS <br /> Have on site (for any purpose) at any one time, hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for <br /> compressed gases (include liquids in ASTs and USTs); or the applicable N YES ❑ NO 4. HAZARDOUS MATERIALS INVENTORY - <br /> Federal threshold quantity for an extremely hazardous substance specified in CHEMICAL DESCRIPTION <br /> 40 CFR Part 355, Appendix A or B; or handle radiological materials in <br /> quantities for which an emergency plan is required pursuant to 10 CFR Parts <br /> 30,40 or 70? <br /> B. CalARP REGULATED SUBSTANCES <br /> Have Regulated Substances stored onsite in quantities greater than the Coordinate with your local agency responsible For <br /> ❑YES N NO 4e. CaIARP. <br /> threshold quantities established by the California Accidental Release <br /> Prevention Program(CalARP)? <br /> C. UNDERGROUND STORAGE TANKS(USTs) [DYES ❑ NO 5. UST FACILITY namely swncB Foran A) <br /> Own oroperate underground storage tanks? UST TANK(.nc page per tsar)(Formerly Farm B) <br /> D. ABOVE GROUND PETROLEUM STORAGE <br /> Own or operate ASTs above these thresholds: ❑YES N NO s. No form required to CUPAs <br /> Store greater than 1,320 gallons of petroleum products (new or used) in <br /> aboveground tanks or containers? <br /> E. HAZARDOUS WASTE <br /> ®YES ❑ NO 9. EPA to NUMBER-provide at[op of this page <br /> Generate hazardous waste? <br /> Recycle more than 100 kg/month of excluded or exempted recyclable ❑YES N NO m. RECYCLABLE MATERIALS REPORT <br /> (one per recycleq <br /> materials(per HSC§25143.2)? <br /> Treat hazardous waste onsite? ❑YES N NO it. ONSITE HAZARDOUS WASTE TREATMENT <br /> -FACILITY <br /> ONSITE HAZARDOUS WASTE TREATMENT <br /> —UNIT (one page per unit) <br /> Perform treatment subject to financial assurance requirements(for Permit by ❑YES N NO 12. CERTIFICATION OF FINANCIAL ASSURANCE <br /> Rule and Conditional Authorization)? <br /> Consolidate hazardous waste generated at a remote site? ❑YES N NO ls. REMOTE WASTE CONSOLIDATION SITE <br /> ANNUAL NOTIFICATION <br /> Need to report the closuretremoval of a tank that was classified as hazardous ❑YES ® NO 14. HAZARDOUS LCAT[WASTE TANK CLOSURE <br /> CERTIwaste and cleaned onsite? <br /> Generate in any single calendar month 1,000 kilograms (kg) (2,200 ❑YES N NO laa. Obtain federal EPA ID Number, file Biennial <br /> Report (EPA Forth 5700-13A/B), and satisfy <br /> pounds) or more of federal RCRA hazardous waste, or generate in requirements for RCRA Large Quantity Generator. <br /> any single calendar month, or accumulate at any time, 1 kg (2.2 <br /> pounds) of RCRA acute hazardous waste; or generate or accumulate <br /> at any time more then 100 kg (220 pounds) of spill cleanup materials <br /> contaminated with RCRA acute hazardous waste? <br /> Serve as a Household Hazardous Waste(HHW)Collection site? ❑YES N NO 14b.I See CUPA for required forms. <br /> I5. <br /> F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) <br /> UPCF Rev. (12/2007).112 www.unido".org <br />