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F, <br />L <br />C <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />(one page Let material r building or area <br />❑ADD ❑DELETE ®REVISE 200 Page 1 3 of 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 <br />CHEMICAL LOCATION CONFIDENTIAL 202 <br />EPCRA <br /> <br />❑ YES ® NO <br />FACILITY ID # <br />0 <br />0 <br />'% 0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />1 <br />MAP# (optional) 203 <br />GRID# (optional) 204 <br />1 <br /> <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET ® Yes ❑ No 206 <br /> <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />EHS* F-1 Yes ® No <br />Mid -Grade Unleaded Gasoline 89 Octane <br />CAS# 209 <br />*If EHS is "Yes", all amounts below must be in lbs. <br />8006-61-9 <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 <br />Flammable Liquids Class 3 <br />HAZARDOUS MATERIAL 211 <br />TYPE (Check one item only) ❑ a. PURE E b. MIXTURE ❑ c. WASTE <br />RADIOACTIVE ❑ Yes E No 212 <br />213 <br />CURIES <br />PHYSICAL STATE 214 <br />(Check one item only) ❑ a. SOLID E b. LIQUID ❑ c. GAS <br />215 <br />LARGEST CONTAINER 12,000 <br />FED HAZARD CATEGORIES 216 <br />Check all that apply) E a. FIRE Elb. REACTIVE Elc. PRESSURE RELEASE Ed. ACUTE HEALTH ® e. CHRONIC HEALTH <br />VERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 2t8 <br />ANNUAL WASTE AMOUNT 219 <br />1 STATE WASTE CODE 220 <br />6 000 <br />12,000 <br />221 <br />DAYS ON SITE: 222 <br />UNITS* E a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS <br />365 <br />(Check one item only) * If EHS, amount must be in pounds. <br />STORAGE <br />CONTAINER ❑ a. ABOVE GROUND TANK ❑ e. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAILCAR <br />E b. UNDERGROUND TANK ❑ f. CAN ❑ i. BAG ❑ n. PLASTIC BOTTLE ❑ r. OTHER <br />❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ It. BOX ❑ o. TOTE BIN <br />❑ d. STEEL DRUM ❑ h. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 <br />STORAGE PRESSURE E a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 <br />STORAGE TEMPERATURE E a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 <br />%WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />CAS # <br />1 <15% 226 <br />Methyl Tert Butyl Ether 227 <br />❑ Yes ® No 228 <br />1634044 229 <br />2 <1% 230 <br />Toluene 231 <br />❑ Yes ® No 232 <br />108883 233 <br />3 <1% 234 <br />Xylene 235 <br />❑ Yes ® No 236 <br />1330-20-7 237 <br />4 <4.9% 238 <br />Benzene 239 <br />❑ Yes ® No 240 <br />71432 241 <br />5 242 <br />243 <br />❑ Yes ❑ No 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 />DDITIONAL LOCALLY COLLECTED INFORMATION DOT#1203 246 <br />If EPCRA, Please Sign Here <br />UPCF (1/99) OES Form 2731 <br />