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UPCF (1/99) <br />IFIED PROGRAM CONSOLIDATED F <br />FACILITY INFORMATION <br />BUSINESS ACTIVITIES <br />Pae 1 of _ <br />I. FACILITY IDENTIFICATION <br />FACILITY ID # <br />1 <br />EPA ID #4Razardous Waste Orly) <br />CAR000001875 <br />BUSINESS NAME (Same as Facility Name of DBA -Doing Business As) 3 <br />Kao Oil Co. #2705446 / 11192 / 05446 <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... <br />If Yes, please com Tete these pages of the UPCF.... <br />A. HAZARDOUS MATERIALS <br />Have on site (for any purpose) hazardous materials at or above 55 gallons for <br />liquids, 500 pounds for solids, or 200 cubic feet for compressed gases <br />HAZARDOUS MATERIALS INVENTORY — <br />(include liquids in ASTs and USTs); or the applicable Federal threshold <br />® YES []NO 4 <br />CHEMICAL DESCRIPTION (OES 273 1) <br />quantity for an extremely hazardous substance specified in 40 CFR Part 355, <br />(This is repoerted with the HMMP.) <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. UNDERGROUND STORAGE TANKS (USTs) <br />UST FACILITY (Formerly SWRCB Form A) <br />1. Own or operate underground storage tanks? <br />® YES ❑ NO 5 <br />UST TANK (one page per tank) (Formerly Form B) <br />2. Intend to upgrade existing or install new USTs? <br />[:]YES ❑ NO 6 <br />UST FACILITY <br />UST TANK (one per tank) <br />UST INSTALLATION - CERTIFICATE OF <br />COMPLIANCE (one page per tank) (Formerly Form C) <br />3. Need to report closing a UST? <br />❑ YES ❑ NO 7 <br />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 <br />❑ YES ® NO g <br />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? <br />® YES ❑ NO 9 <br />EPA ID NUMBER — provide at the top of this <br />page <br />2. Recycle more than 100 kg/month of excluded or exempted <br />RECYCLABLE MATERIALS REPORT (one <br />recyclable materials (per HSC 25143.2)? <br />[:]YES ONO 10 <br />per recycler) <br />3. Treat hazardous waste on site? <br />ONSITE HAZARDOUS WASTE <br />❑ YES ONO 11 <br />TREATMENT — FACILITY (Formerly DTSC Forms <br />1772) <br />ONSITE HAZARDOUS WASTE <br />TREATMENT — UNIT (one page per unit) (Formerly <br />DTSC Forms 1772 A,B,C,D and L) <br />4. Treatment subject to financial assurance requirements (for <br />❑ YES ® NO 12 <br />CERTIFICATION OF FINANCIAL <br />Permit by Rule and Conditional Authorization)? <br />ASSURANCE (Formerly DTSC Form 1232) <br />5. Consolidate hazardous waste generated at a remote site? <br />REMOTE WASTE / CONSOLIDATION SITE <br />❑ YES ® NO 13 <br />ANNUAL NOTIFICATION (Formerly DTSC Form <br />1196) <br />6. Need to report the closure/removal of a tank that was classified as <br />DYES ®NO 14 <br />HAZARDOUS WASTE TANK CLOSURE <br />hazardous waste and cleaned onsite? <br />CERTIFICATION (Formerly DTSC Form 1249) <br />E. LOCAL REQUIREMENTS 15 <br />(You may also be required to provide additional information by your CUPA or local agency.) <br />UPCF (1/99) <br />