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UTWED PROGRAM CONSOLIDATED <br /> FACILITY INFORMATION c 1 , <br /> BUSINESS ACTIVITIES C�VED <br /> - Page Iof ( <br /> I. FACILITY IDENTIFICATIOPeVpIRONMEN7. <br /> FACILITY ID N <br /> (Agency Use Only) ' [e Only) a <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) DOLLAR GENERAL 913357 AL00 <br /> BUSINESS SITE ADDRESS 1201 MAIN STREET 3 <br /> 103 <br /> 104 ZIP CODE ios <br /> BUSINESS SITE CITY RIPON CA 95366 <br /> 1L ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease submit the Business Owner/O erator Identificationa e. <br /> Does your facility... If Yes,please com tete these pages of the UPCF.... <br /> A. HAZARDOUS MATERIALS <br /> Have on site(for any purpose)at any one time,hazardous materials at or above <br /> 55 gallons for liquids,500 pounds for solids,or 200 cubic feet for compressed HAZARDOUS MATERIALS <br /> gases(include liquids in ASTs.and USTs);or the applicable Federal threshold ❑YES X NO 4 INVENTORY—CHEMICAL <br /> quantity for an extremely hazardous substance specified in 40 CFR Part 355, DESCRIPTION <br /> Appendix A or B;or handle radiological materials in quantities for which an <br /> emergency lan is required pursuant to 10 CFR Parts 30,40 or 70? <br /> B. REGULATED SUBSTANCES <br /> Have Regulated Substances stored onsite in quantities greater than the <br /> threshold quantities established by the California Accidental Release []YES X NO 4, Coordinate with your local agency <br /> prevention Program(CalARP)? responsible for CaIARP. <br /> C.UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(Formerly SWRCB Fomr A) <br /> Own or operate underground storage tanks? p°g❑YES X NO $ (UST TANK oar e per rank)(Formed y <br /> D. ABOVE GROUND PETROLEUM STORAGE Form B <br /> Own or operate ASTs above these thresholds: <br /> Store greater than 1,320 gallons of petroleum products(new or used)in ❑YES X NO a NO FORM REQUIRED TO CUPAs <br /> aboveground tanks or containers. <br /> E.HAZARDOUS WASTE <br /> Generate hazardous waste? X YES ❑ NO y EPA ID NUMBER—provide at the <br /> Recycle more than 100 kg/month of excluded or exempted recyclable top of this page <br /> materials(per HSC 25143.2)? ❑YES X NO to RECYCLABLE MATERIALS <br /> REPORT(one per re yd") <br /> Treat hazardous waste on-site? ON-SITE HAZARDOUS WASTE <br /> ❑YES X NO II TREATMENT—FACILITY <br /> ON-SITE HAZARDOUS WASTE <br /> Treatment subject to financial assurance requirements(for Permit by Rule and TREATMENT—UNIT (one page per endo <br /> Conditional Authorization)? ❑YES X NO 13 CERTIFICATION OF FINANCIAL <br /> ASSURANCE <br /> Consolidate hazardous waste generated at a remote site? REMOTE WASTE/ <br /> ❑YES X NO 13 CONSOLIDATION SITE ANNUAL <br /> NOTIFICATION <br /> Need to report the closure/removal of a tank that was classified as <br /> hazardous waste and cleaned on-site? ❑YES X NO 14 HAZARDOUS WASTE TANK <br /> CLOSURE CERTIFICATION <br /> Generate in any single calendar month 1,000 kilograms(kg)(2,200 pounds)or <br /> more of federal RCRA hazardous waste,or generate in any single calendar ❑YES X NO is Obtain federal EPA ID Number, <br /> month,or accumulate at any time, I kg(2.2 pounds)of RCRA acute hazardous file Biennial Report(EPA Form <br /> waste;or generate or accumulate at any time more than 100 kg(220 pounds)of 8700-13A/B),and satisfy <br /> spill cleanup materials contaminated with RCRA acute hazardous waste. requirements for RCRA Large <br /> Quantity Generator. <br /> Household Hazardous Waste(HHW)Collection site? ❑YES X NO 14b See CUPA for required fors. <br /> F. LOCAL REQUIREMENTS <br /> Ig <br /> (You may also be required to provide additional information by your CUPA or local agency.) <br />