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HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />(one gage =material r buildin or are. <br />❑ADD ❑DELETE ZREVISE 20o Pagel 7 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 <br />CHEMICAL LOCATION CONFIDENTIAL 202 <br />EPCRA <br /> <br />❑lYES Z NO <br />r1 <br />MAP# (optional) 203 <br />GRID# (optional) 204 <br />FACILITY ID # <br />0 <br />0 <br />z 0 <br />0 <br />0` <br />x <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />j; <br />1 <br /> <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET ❑ Yes Z No 206 <br />Automotive Car Wash Drying Agent and Shine Enhancer <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />EHS* El Yes Z No <br />ECOLAB Cold Wax <br />CAS# 209 <br />*If EHS is "Yes", all amounts below must be in lbs. <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 <br />N/A <br />HAZARDOUS MATERIAL213 <br />TYPE (Check one item only) ❑ a. PURE Z b. MIXTURE El c. WASTE 211 <br />RADIOACTIVE ❑Yes ®No 212 <br />CURIES <br />PHYSICAL STATE <br />(Check one item only) ❑ a. SOLID ® b. LIQUID El c. GAS 214 <br />215 <br />LARGEST CONTAINER 30 <br />FED HAZARD CATEGORIES 216 <br />(Check all that apply) ❑ a. FIRE ❑ b. REACTIVE ❑ c. PRESSURE RELEASE ® d. ACUTE HEALTH ❑ e. CHRONIC HEALTH <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE 220 <br />5 <br />60 <br />221 <br />DAYS ON SITE: 222 <br />UNITS* ® 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. RAIL CAR <br />❑ b. UNDERGROUND TANK ❑ f. CAN ❑ j. BAG [In. PLASTIC BOTTLE ❑ r. OTHER <br />❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ d. STEEL DRUM ❑ It. SILO ❑ 1. CYLINDER ❑ p. TANK WAGON 223 <br />STORAGE PRESSURE ® a. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW AMBIENT 224 <br />STORAGE TEMPERATURE Z 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 6% 226 <br />Butoxyethanol 227 <br />❑ Yes Z No 228 <br />111-76-2 229 <br />2 30% 230 <br />Mineral Seal Oil 231 <br />❑ Yes Z No 232 <br />64742-80-9 233 <br />3 1-5% 234 <br />Surfactants 235 <br />❑ Yes Z No 236 <br />61789-40-0 237 <br />4 238 <br />239 <br />❑ Yes ❑ 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 I% 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# none 246 <br />If EPCRA, Please Sign Here <br />7 <br />UPCF (1/99) OES Form 2731 <br />