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� EVA._ t: <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />(one Daae net material net buildine or area) <br />[-]ADD[:]DELETE ®REVISE 27 <br />Page 4 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 />s I MAPF/ (optional) 203 GRID# (optional) 204 <br />FACILITY ID # 0 0 %iz 0 0 0 0 0 0 0 0 0 <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* El Yes ® No <br />Supreme Unleaded Gasoline 91 Octane <br />CASfi 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 <br />TYPE (Check one item only) El a. PURE ®b. MIXTURE El c. WASTE 211 <br />RADIOACTIVE ❑ Yes ®No 212 <br />213 <br />CURIES <br />PHYSICAL STATE <br />(Check one item only) Ela. SOLID ® b. LIQUID ❑ c. GAS 214 <br />215 <br />LARGEST CONTAINER 12,000 <br />FED HAZARD CATEGORIES 216 <br />(Check all that apply) ® a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ® e. CHRONIC HEALTH <br />VERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE 220 <br />0®® <br />1 12,000 <br />1 <br />221 <br />DAYS ON SITE: 222 <br />UNITS* ® a. GALLONS ❑ b. CUBIC FEET ❑ c. POUNDS ❑ d. TONS <br />365 <br />1 <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 />® 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 223 <br />STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 <br />STORAGE TEMPERATURE ® 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 />ADDITIONAL LOCALLY COLLECTED INFORMATION DOT#1203 <br />Lon <br />If EPCRA, Please Sign Here <br />UPCF (1/99) OES Form 2731 <br />