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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page 1 of_2 <br /> 1 FACILITY IDENTIFICATION <br /> FACILITY ID# F A 0 0 0 7 1 4 0 1 EPA ID#(Hazardous Waste Only) z <br /> CAL000158084 <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 <br /> Flag City New West <br /> - II ' 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 corn tete these a es of the UPCF...:' <br /> A. HAZARDOUS MATERIALS <br /> Have on site(for any purpose) hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 <br /> cubic feet for compressed gases (include liquids in ASTs . HAZARDOUS MATERIALS INVENTORY <br /> and USTs); or thea applicable Federal threshold quantity for E YES ❑ NO 4 <br /> PP q Y -CHEMICAL DESCRIPTION(OES 2731) <br /> an extremely hazardous substance specified in 40 CFR Part <br /> 355,Appendix A or B; or handle radiological materials in <br /> quantities for which an emergency plan is required pursuant <br /> to 10 CFR Parts 30, 40 or 70? <br /> B. UNDERGROUND STORAGE TANKS(USTs) • UST FACILITY(Formerly SWRCB Form A) <br /> 1. Own or operate underground storage tanks? E YES ❑ NO 5 • UST TANK(one page per tank)(Formerly Form B) <br /> 2. Intend to upgrade existing or install new USTs? ❑YES E NO 6 • UST FACILITY <br /> • UST TANK(one per tank) <br /> • UST INSTALLATION- CERTIFICATE OF <br /> COMPLIANCE(one page per tank)(Formerly Form <br /> C) <br /> 3. Need to report closing a UST? ❑YES E NO 7 • UST TANK(closure portion-one page per tank) <br /> 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 ❑YES E NO 8 • NO FORM REQUIRED TO CUPAs <br /> —the total capacity for the facility is greater than 1,320 <br /> gallons? <br /> D. HAZARDOUS WASTE <br /> 1. Generate hazardous waste? EYES ❑ NO 9 • EPA ID NUMBER-provide at the top of <br /> this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted <br /> recyclable materials(per HSC 25143.2)? ❑YES E NO 10 • RECYCLABLE MATERIALS REPORT(one <br /> per recycler) <br /> 3. Treat hazardous waste on site? • ONSITE HAZARDOUS WASTE <br /> ❑YES E NO 11 TREATMENT-FACILITY(Formerly DISC <br /> Forms 1772) <br /> • ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIT (one page per unit) <br /> (Formerly DTSC Forms 1772 A,B,C,D and Q <br /> 4. Treatment subject to financial assurance requirements(for ❑YES E NO 12 • CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? ASSURANCE(Formerly DTSC Form 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? a REMOTE WASTE/CONSOLIDATION <br /> ❑YES E NO 13 SITE ANNUAL NOTIFICATION (Formerly <br /> DTSC Form 1196) <br /> 6. Need to report the closure/removal of a tank that was ❑YES E NO 14 • HAZARDOUS WASTE TANK CLOSURE <br /> classified as hazardous waste and cleaned onsite? CERTIFICATION (Formerly DTSC Form 1249) <br /> E. LOCAL REQUIREMENTS 15 <br /> (You may also be required to provide add'Rional information by your CUPA or local agency.) <br />