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Alk a <br /> UNIFIED PROGRAM CONSOLIDATED FOIM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page 1 of <br /> I. FACILITY IDENTIFICATION <br /> FACILITY ID# 77 I EPA ID#(Hazardous Waste Only) 2 <br /> (Agency Use Only) CAL000324088 <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3• <br /> Valero Corner Store#3641 <br /> BUSINESS SITE ADDRESS 1210 E. Hammer Lane los. <br /> BUSINESS SITE CITY Stockton 104. 1 CA ZIP CODE 95210 105. <br /> H. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease submit the Business Owner/O erator Identification page. <br /> Does your facility... If Yes,please complete these pages of the UPCF... <br /> A. HAZARDOUS MATERIALS <br /> Have on site (for any purpose) at any one time, hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for <br /> compressed gases (include liquids in ASTs and USTs); or the applicableHAZARDOUS MATERIALS INVENTORY — <br /> Federal threshold quantity for an extremely hazardous substance specified in ®YES ❑ NO a. CHEMICAL DESCRIPTION <br /> 40 CFR Part 355, Appendix A or B; or handle radiological materials in <br /> quantities for which an emergency plan is required pursuant to 10 CFR Parts <br /> 30,40 or 70? <br /> B. CalARP REGULATED SUBSTANCES <br /> Have Regulated Substances stored onsite in quantities greater than the Coordinate with your local agency responsible for <br /> threshold quantities established by the California Accidental Release ❑YES ® NO aa. CaIARP. <br /> Prevention Program(CalARP)? <br /> C. UNDERGROUND STORAGE TANKS(USTs) ®YES ❑ NO 5. UST FACILITY(F'ormeriy SWRC13 Foran A) <br /> Own oroperate underground storage tanks? UST TANK(one page per tank)(Formerly Form n) <br /> D. ABOVE GROUND PETROLEUM STORAGE <br /> Own or operate ASTs above these thresholds: <br /> ❑YES ® NO a. No form required to CUPAs <br /> Store greater than 1,320 gallons of petroleum products (new or use in <br /> aboveground tanks or containers? <br /> E. HAZARDOUS WASTE <br /> Generate hazardous waste? ®YES ❑ NO 9. EPA ID NUMBER—provide at top of this page <br /> Recycle more than 100 kg/month of excluded or exempted recyclable ❑YES ® NO to. RECYCLABLE MATERIALS REPORT <br /> materials(per HSC§25143.2)? (one perreeycler) <br /> Treat hazardous waste onsite? ❑YES ® NO I1. ONSITE HAZARDOUS WASTE TREATMENT <br /> —FACILITY <br /> ONSITE HAZARDOUS WASTE TREATMENT <br /> —UNIT (one page per unit) <br /> Perform treatment subject to financial assurance requirements (for Permit by ❑YES ® NO 12. CERTIFICATION OF FINANCIAL ASSURANCE <br /> Rule and Conditional Authorization)? <br /> Consolidate hazardous waste generated at a remote site? [:]YES ® NO Is. REMOTE WASTE CONSOLIDATION SITE <br /> ANNUAL NOTIFICATION <br /> Need to report the closure/removal of a tank that was classified as hazardous ❑YES ® NO 14. HAZARDOUS WASTE TANK CLOSURE <br /> waste and cleaned onsite? CERTIFICATION <br /> Generate in any single calendar month 1,000 kilograms (kg) (2,200 ❑YES ® NO 14a. Obtain federal EPA ID Number, file Biennial <br /> pounds) or more of federal RCRA hazardous waste, or generate in Report (EPA Form 8700-13A/B), and satisfy <br /> any single calendar month, or accumulate at any time, 1 kg (2.2 requirements for RCRA Large Quantity Generator. <br /> pounds) of RCRA acute hazardous waste; or generate or accumulate <br /> at any time more then 100 kg (220 pounds) of spill cleanup materials <br /> contaminated with RCRA acute hazardous waste? <br /> Serve as a Household Hazardous Waste(HHW)Collection site? ❑YES ® NO 14b.I See CUPA for required forms. <br /> F. LOCAL REQUIREMENTS (You may also be required to provide additional information by your CUPA or local agency.) 15• <br /> UPCF Rev. (12/2007)-1/2 www.unidocs.org <br />