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r -I <br />Ah <br />NIF D PROGRAM CONSOLIDATED FORM <br />U --ff <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />one page per material g:r building or area <br />FIADD EIDELETE ®REVISE 200 Pagel 610fl 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 />I EPCF1 <br /> <br />YERA <br />S ED NO <br />MAP# (optional) 203 <br />GRID# (optional) 204 <br />FACIL <br />FACILITY ID # <br />0 <br />0 <br />4 ® <br />o <br />0�0101010101 <br />I <br />r m <br /> <br />11. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET ❑ Yes No 206 <br />New Motor Oil <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />EHS* El Yes ®No <br />New Motor Oil <br />CAS# 209 <br />*If EHS is "Yes", all amounts below must be in lbs. <br />64741884 <br />FIRE CODE HAZARD CLASSES (complete if required by CUPA) 210 <br />Flammable Liquids Class 1 <br />HAZARDOUS MATERIAL 211 <br />TYPE (Check one item only) El a. PURE 0 b. MIXTURE [I c. WASTE <br />RADIOACTIVE 0 Yes 0 No 212 <br />213 <br />CURIES <br />PHYSICAL STATE 214 <br />(Check one item only) 0 a. SOLID 0 b. LIQUID El c. GAS <br />215 <br />LARGEST CONTAINER 1 Quart <br />FED HAZARD CATEGORIES 216 <br />(Check all that apply) 0 a. FIRE 0 It. REACTIVE 0 c. PRESSURE RELEASE [:] d. ACUTE HEALTH El e. CHRONIC HEALTH <br />—7 <br />ERAGE DAILY AMOUNT 217 <br />V6 <br />MAXIMUM DAILY AMOUNT <br />ANNUAL WASTE AMOUNT 219 <br />� STATE WASTE CODE 220 <br />0 7 <br />0 <br />00 <br />221 <br />DAYS ON SITE: 222 <br />UNITS* ®a. GALLONS 0 b. CUBIC FEET El c. POUNDS El d. TONS <br />365 <br />(Check one item only) If EHS, amount must be in pounds. <br />STORAGE <br />S <br />CONTAINER ❑ a. ABOVE GROUND TANK El e. PLASTIC/NONMETALLIC DRUM [I i. FIBER DRUM El m. GLASS BOTTLE 0 q. RAILCAR <br />El b. UNDERGROUND TANK ❑ f. CAN El j. BAG ID n. PLASTIC BOTTLE OTHER <br />El c. TANK INSIDE BUILDING ❑ g. CARBOY El k. BOX [I o. TOTE BIN <br />[I d. STEEL DRUM El h. SILO El 1. CYLINDER [I p. TANK WAGON 223 <br />STORAGE PRESSURE a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 <br />STORAGE TEMPERATURE a. AMBIENT ❑ b. ABOVE AMBIENT El c. BELOW AMBIENT El d. CRYOGENIC 225 <br />%WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />CAS # <br />1 85% 226 <br />Lubricating Base Oil 227 <br />E] Yes 2 No 228 <br />64741884 229 <br />2 2% 230 <br />Zinc Alkyl Didiiophosphate 231 <br />❑ Yes 0 No 232 <br />68649423 233 <br />3 234 <br />235 <br />❑ Yes El No 236 <br />237 <br />4 238 <br />239 <br />El Yes [3 No 240 <br />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#1270 246 <br />If EPCRA, Please Sign Here <br />UPCF (1/99) OES Form 2731 <br />