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7524-4180 UNIFIED PROGRAM CONSOLIDATED FOR <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> P IL <br /> N O <br /> FACILITY IDENTIFICATION <br /> -AGILITY ID# 1EPA ID# (Hazardous Waste Only) 2 <br /> 3USINESS NAME (Same as FACILITY NAME or DBA-Doing Business AS) 3 <br /> 99 Shell <br /> I. ACTIVITIES DECLARATION <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.. <br /> A HAZARDOUS MATERIALS <br /> Have on site(for any purpose)hazardous materials at or above 55 <br /> gallons for,iquids,500 pounds for solids,or 200 cubic feet for <br /> compressed gases(include liquids in ASTs and USTs); or the YES NO a HAZARDOUS MA rERIALS INVENTORY- <br /> applicable Federal threshold quantity for an extremely hazardous CHEMICAL DESCRIPTION(OES 2731) <br /> substance specified in 40 CFR Part 355,Aappendix A or B;or <br /> handle radiological materials in quantities for which an emergency <br /> plan is required pursuant to 10 CFR Parts 30,40 or 70? <br /> B UNDERGROUND STORAGE TANKS(USTs) I � – <br /> 1. Own or operate underground storage tanks? F71YES u NO 5 UST FACILITY (Formerly SWRCB Form A) <br /> UST TANK (One page per tank)(Formerly Form B <br /> 2. Intend to upgrade existing or install new USTs? YES F, 6 ✓ UST FACILITY <br /> UST TANK (One per tank <br /> UST INSTALLATION-CERTIFICATE OF <br /> COMPLIANCE(ore page per tank)(Forrmerly Form C <br /> 3. Need to report closing a UST? L__I YES[ZNO 7 f✓ UST TANK (dosure porton-one page per tank <br /> C ABOVE GROUND PETROLEUM STORAGE TANKS (AST§) <br /> Own or operate ASTs above these thresholds: <br /> —any tank capacity is greater than 660 gallons, or DYES� rNO s I✓ 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? �/ YES❑NO 9 I,/ EPA ID NUMBER-provide at the top of this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted YES❑✓ NO 10 RECYCLABLE MATERIALS REPORT <br /> recyclable materials(per HSC §25143.2)? (one per recycler) <br /> 3. Treat hazardous waste on site? ❑YES[ZNO 11 I, ONSITE HAZARDOUS WASTE <br /> TREATMENT-FACILITY <br /> (Formerly DTSC Form 1772) <br /> ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIY(one page per unit) <br /> (Formerty DTSC Form 1772A,B,C,D,and Q <br /> 4. Treatment subject to financial assurance requirements(for Permit 1:1 YES ElNO12 CERTIFICATION OF FINANCIAL <br /> by Rule and Conditional authorizaton)? ASSURANCE(Formerly DTSC Form 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? 1:1YESaN013 REMOTE WASTE/CONSOLIDATION SIT <br /> ANNUAL NOTIFICATION(Formerly <br /> DTSC Form 1232) <br /> 6. Need to report the closure/removal of a tank that was classified as O YES❑✓ NO 14 i✓ HAZARDOUS WASTE TANK CLOSURE <br /> hazardous waste and cleaned onsite? CERTIFICATION(Formerly DTSC Form 1249) <br /> LOCAL REQUIREMENTS 15 <br />