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'TNIFIED PROGRAM CONSOLIDATED F <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page.l. of <br /> I. FACILITY IDENTIFICATION <br /> FACILITY ID# 7 1 I EPA ID#(Hazardous Waste Only) 2 <br /> (Agency Use Only) <br /> .0 <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) Convenience Retailers,LLC #2705446 3 <br /> BUSINESS SITE ADDRESS 1403 COUNTRY CLUB BLVD 103 <br /> BUSINESS SITE CITY STOCKTON 104 CA ZIP 95204 105 <br /> II.ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease submit the Business Owner/O perator Identification page. <br /> Does your facility... If Yes,please co m 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 HAZARDOUS MATERIALS <br /> 55 gallons for liquids,500 pounds for solids,or 200 cubic feet for compressed ®YES ❑ NO 4 INVENTORY—CHEMICAL <br /> gases(include liquids in ASTs and USTs);or the applicable Federal threshold DESCRIPTION <br /> quantity for an extremely hazardous substance specified in 40 CFR Part 355, <br /> Appendix A or B;or handle radiological materials in quantities for which an <br /> emergency plan 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 ❑ NO 4a Coordinate with your local agency <br /> prevention Program(CalARP)? responsible for CaIARP. <br /> C.UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(Formerly SwRCB Form A) <br /> Own or operate underground storage tanks? ®YES ❑ NO 5 UST TANK(one page per tank)(For nerly Form B) <br /> D. ABOVE GROUND PETROLEUM STORAGE <br /> Own or operate ASTs above these thresholds: <br /> Store greater than 1,320 gallons of petroleum products(new or used)in ❑YES ® NO s NO FORM REQUIRED TO CUPAs <br /> aboveground tanks or containers. <br /> E.HAZARDOUS WASTE <br /> Generate hazardous waste? ®YES ❑ NO 9 EPA ID NUMBER—provide at the top of!'. <br /> this page <br /> Recycle more than 100 kg/month of excluded or exempted recyclable RECYCLABLE MATERIALS REPORT <br /> materials(per HSC 25143.2)? ❑YES ® NO 10 <br /> (one per recycler) <br /> Treat hazardous waste on-site? ON-SITE HAZARDOUS WASTE <br /> ❑YES ® NO 11 TREATMENT—FACILITY <br /> ON-SITE HAZARDOUS WASTE <br /> TREATMENT—UNIT (one page per unit) <br /> Treatment subject to financial assurance requirements(for Permit by Rule and <br /> Conditional Authorization)? ❑YES ® NO 12 ASSURANCE CERTIFICATION OF FINANCIAL <br /> Consolidate hazardous waste generated at a remote site? REMOTE WASTE/CONSOLIDATION <br /> []YES ® NO 13 SITE ANNUAL NOTIFICATION <br /> Need to report the closure/removal of a tank that was classified as <br /> hazardous waste and cleaned on-site? [:]YES ® NO 14 HAZARDOUS WASTE TANK <br /> CLOSURE CERTIFICATION <br /> Generate in any single calendar month 1,000 kilograms(kg)(2,200 pounds)or Obtain federal EPA ID Number,file <br /> more of federal RCRA hazardous waste,or generate in any single calendar []YES ONO 14. Biennial Report(EPA Form 8700- <br /> month,or accumulate at any time, 1 kg(2.2 pounds)of RCRA acute hazardous 13A/B),and satisfy requirements for <br /> waste;or generate or accumulate at any time more than 100 kg(220 pounds)of RCRA Large Quantity Generator. <br /> spill cleanup materials contaminated with RCRA acute hazardous waste. <br /> Household Hazardous Waste(HHW)Collection site? ❑YES ® NO 14b See CUPA for required forms. <br /> F. LOCAL REQUIREMENTS 15 <br /> (You may also be required to provide additional information by your CUPA or local agency.) <br /> UPCF Rev.(12/2007) <br />