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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> LL <br /> page + a <br /> I.FACILITY IDENTIFICATION <br /> FACILITY ID# + EPA ID#(Name ovate Drxr) 2 <br /> I <br /> BUSINESS NAME (Same nFACILITY Name pDBA-)o.q tkee+eta A.) a <br /> --cSYi��ICES �S Pi r�C► I GC4� L}T 30� VVt I` NJ AM IrJ C1DL7 Q(t U � <br /> 1 II.ACTIVITIES DECLARATION 57v e TDO, CAu F <br /> NOTE: If you check YES to any part of this list, <br /> please submit the Business Owner/Operator Identification page (OES Form 2730). <br /> Does your facility... If Yes, please complete these pages of the UPCF... I <br /> I A. HAZARDOUS MATERIALS <br /> Have on site(for any purpose)hazardous materials at or above 55 <br /> gallons for liquids.500 pounds for solids,or 200 cubic feet for I' <br /> compressed gases(include liquids in ASTs and USTs);or the )YES ONO 4 ✓ HAZARDOUS MATERIALS INVENTORY- 1 <br /> I applicable Federal threshold quantity for an extremely hazardous CHEMICAL DESCRIPTION 10ES 2731) <br /> substance specified in 40 CFR Part 355,Appendix A or B;or <br /> handle radiological materials in quantifies for which an emergency <br /> plan is required pursuant to10 CFR Parts 30.40 or 70? <br /> B UNDERGROUND STORAGE TANKS(USTs) <br /> 1. Own or operate underground storage tanks? •"KYES ONO 5I ✓ UST FACILITY(Fa "sprue Form A) <br /> ..,!!! ✓ UST TANK(a+e pope pw ue+i lFpmwry Fame) <br /> 2. Intend to upgrade existing or install new USTs? L ���yYES QNO s ✓ UST FACILITY <br /> ✓ UST TANK(aae pwta*) <br /> ✓ UST INSTALLATION-CERTIFICATE OF <br /> p(ROCC Is -TD ACOMPLIANCE law pap pwIw XFWM"Fa Cl <br /> 3. Need to report closing a UST? R IOVP4 YES XO r ✓ UST TANK(ao.pw..w page per tar*) <br /> I C. ABOVE GROUND PETROLEUM STORAGE TANKS(ASTs) <br /> Own or operate ASTs above these thresholds: <br /> —any tank capacity is greater than 660 gallons,or I OYES*0 a NO FORM REQUIRED TO CUPAS <br /> —the total capacity for the facility is greater than 1.320 gallons? <br /> D. HAZARDOUS WASTE <br /> 1. Generate hazardous waste? OYES*0 s• ✓ EPA ID NUMBER—v m me top a w.cog. <br /> 2. Recycle more than 100 kg/month of excluded or exempted OYES VO 10 ✓ RECYCLABLE MATERIALS REPORT <br /> i <br /> recyclable materials(per HSC§25143.2)? (ae pw racyc ) <br /> 3. Treat hazardous waste on site? OYES Oil! <br /> lie ONSITE HAZARDOUS WASTE i <br /> I TREATMENT-FACILITY <br /> ffcai"DTSC Fpm 1772) <br /> ✓ ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIT(aro one pw pNl <br /> (Fpm"DTSC Farms+772a.B.C.O.arta LI <br /> 4. Treatment subjectto financial assurance requirements(for Permit AYES�NO 1x ✓ CERTIFICATION OF FINANCIAL <br /> by Rule and Conditional Authorization)? ASSURANCE(Fa "OTSD Foe 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? QYES,XNO u be REMOTE WASTE/CONSOLIDATION SITE <br /> ANNUAL NOTIFICATION(Fa " <br /> DTSC Form+1%) <br /> 6. Need to report the closure/removal of a tank that was classified as OYES) NO 14l <br /> ✓ HAZARDOUS WASTE TANK CLOSURE <br /> hazardous waste and cleaned onsite? CERTIFICATION lFormwh DTSC Fpm+2491 <br /> E. LOCAL REQUIREMENTS is <br /> (You may also be required to provide additional information by your COPA or local agency) <br /> i <br /> I <br /> i <br /> UPCF(1/99) 2 <br />