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UNIFIrD PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />(one a e rr material per building or area) <br />❑ADD ❑DELETE ®REVISE 200 Page 1 2 1 of 1 9 <br />I. FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 <br />Chevron Station #94275 <br />CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 <br /> EPCRA <br />❑ YES ® NO <br />FACILITY ID # 0 0 <br />c 0 0 0 ' �, / a 0 0 0 0 0 0 1 MAP# (optional) 203 GRID# (optional) 204 <br /> <br />II. CHEMICAL INFORMATION <br />MAXIMUM IJA1LT AMUUINI <br />34,000 <br />CHEMICAL NAME <br />205 <br />TRADE SECRET ® Yes ❑ No <br />206 <br /> <br />UNITS* ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS <br />(Check one item only) * If EHS, amount must be in pounds. <br />If Subject to EPCRA, refer to instructions <br />1 DAYS ON SITE: <br />365 <br />COMMON NAME <br />207 <br />EHS* ElYes ® No <br />208 <br />Regular Unleaded Gasoline 87 Octane <br />224 <br />STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT <br />CAS# <br />209 <br />225 <br />%WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />*If EHS is "Yes", all amounts below must be in lbs. <br />CAS # <br />8006-61-9 <br />I <15% 226 <br />Methyl Tert Butyl Ether <br />227 <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) <br />228 <br />210 <br />Flammable Liquids Class 3 <br />2 <1% 230 <br />Toluene <br />HAZARDOUS MATERIAL <br />TYPE (Check one item only) ❑ a. PURE ® b. MIXTURE <br />211 <br />❑ c. WASTE <br />RADIOACTIVE ❑ Yes ® No 212 <br />CURIES <br />213 <br />PHYSICAL STATE <br />(Check one item only) ❑ a. SOLID ® b. LIQUID <br />❑ c. GAS 2l4 <br />LARGEST CONTAINER 12,000 <br />215 <br />FED HAZARD CATEGORIES <br />1330-20-7 <br />216 <br />(Check all that apply) ® a. FIRE ❑ b. REACTIVE <br />❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ® e. CHRONIC HEALTH <br />239 <br />VEKAUE DAILY AMUUNI ZI <br />7,000 <br />MAXIMUM IJA1LT AMUUINI <br />34,000 <br />a.o <br />HIV IV UAL WHJ1C ntvivvtva <br />"' <br />— <br />UNITS* ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS <br />(Check one item only) * If EHS, amount must be in pounds. <br />221 <br />1 DAYS ON SITE: <br />365 <br />222 <br />STORAGE <br />CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAILCAR <br />® b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER <br />❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON <br />223 <br />STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT <br />❑ c. BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE ® a. AMBIENT ❑ b. ABOVE AMBIENT <br />❑ c. BELOW AMBIENT <br />❑ d. CRYOGENIC <br />225 <br />%WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />CAS # <br />I <15% 226 <br />Methyl Tert Butyl Ether <br />227 <br />[:]Yes ® No <br />228 <br />1634044 <br />229 <br />2 <1% 230 <br />Toluene <br />231 <br />❑ Yes ® No <br />232 <br />108883 <br />233 <br />3 <1% 234 <br />Xylene <br />235 <br />❑ Yes ® No <br />236 <br />1330-20-7 <br />237 <br />4 <4,9% 238 <br />Benzene <br />239 <br />❑ Yes ® No <br />240 <br />71432 <br />241 <br />5 242 <br />243 <br />❑ Yes ❑ No <br />244 <br />245 <br />If more hazardous components are present at greater than 1 % by weight if non -carcinogenic, or 0.1% by weight if carcinogenic, attach additional sheets of paper capturing the required information. <br />ADDITIONAL LOCALLY COLLECTED INFORMATION DOT#1203 <br />246 <br />If EPCRA, Please Sign Here <br />UPCF (1/99) OES Form 2731 <br />