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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Pae 1 of 6 <br /> I. FACILITY IDENTIFICATION <br /> FACILITY ID# 1 EPA ID#(Hazardous Waste Only) 2 <br /> Pending <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 <br /> Bay Area Circuits,Inc. <br /> II. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> please submit the Business Owner/Operator Identification page(OES Form 2730). <br /> Does ymir facility... If Yes,please com tete these pages of the UPCF.... <br /> A. HAZARDOUS MATERIALS <br /> Have on site(for any purpose)hazardous materials at or above 55 gallons for <br /> liquids,500 pounds for solids,or 200 cubic feet for compressed gases HAZARDOUS MATERIALS INVENTORY <br /> (include liquids in ASTs and USTs);or the applicable Federal threshold ®YES ❑ NO 4 -CHEMICAL DESCRIPTION(OES 273 1) <br /> quantity for an extremely hazardous substance specified in 40 CFR Part 355, <br /> Appendix A or B;or handle radiological materials in quantities for which an <br /> emergency Ian is required pursuant to 10 CFR Parts 30 40 or 70? <br /> B.UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(FormmlY mRca Foxe A) <br /> 1. Own or operate underground storage tanks? ❑YES 10 NO 5 UST TANK(one page per tank)(Formerly Form in <br /> 2. Intend to upgrade existing or install new USTs? ❑YES N NO 6 UST FACILITY <br /> UST TANK I.per tank) <br /> UST INSTALLATION- CERTIFICATE OF <br /> COMPLIANCE(one page per tank)(Formerly Form c) <br /> 3. Need to report closing a UST? ❑YES N NO 7 UST TANK(Amure porion-one page per rank) <br /> C. ABOVE GROUND PETROLEUM STORAGE TANKS(ASTs) <br /> Own or operate ASTs above these thresholds: <br /> ---any tank capacity is greater than 660 gallons,or ❑YES ® NO 8 NO FORM REQUIRED TO CUPAs <br /> ---the total capacity for the facility is greater than 1,320 gallons? <br /> D.HAZARDOUS WASTE - <br /> 1. Generate hazardous waste? ®YES ❑ NO 9 EPA ID NUMBER-provide at the top of this <br /> page <br /> 2. Recycle more than 100 kg/month of excluded or exempted <br /> recyclable materials(per HSC 25143.2)? ❑YES ® NO 10 naY RECYCLABLE MATERIALS REPORT(one <br /> par <br /> 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE <br /> N YES ❑ NO 11 TREATMENT-FACILITY(Foonedy DTSC <br /> Forms 1772) <br /> ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIT (one page per unip(Fmmerly <br /> DTSC Forma 1772 A,B,C,D and L) <br /> 4. Treatment subject to financial assurance requirements(for ®YES El NO 12 CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? ASSURANCE(Formeay Drsc Foon 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? ❑YES ® NO 13 SITE <br /> WASTE/CONSOLIDATION <br /> E ANNUAL NOTIFICATION(Formerly <br /> DTSC F.11%) <br /> 6. Need to report the closure/removal of a tank that was classified as ❑YES ® NO 14 HAZARDOUS WASTE TANK CLOSURE <br /> hazardous waste and cleaned onsite? CERTIFICATION(Formerly DTsc Form 1249) <br /> E. LOCAL REQUIREMENTS 15 <br /> Pursuant to the California Health and Safety Code Division 20, Chapter 6.95, Section 25506, this agency must obtain consent from <br /> the business owner/operator or designated business representative in order to release chemical location information to the public. <br /> This includes, but is not limited to, chemical locations provided in the chemical description section and site maps. Please circle"Yes" <br /> or"No"to indicate whether or not this information can releasee tIo th-e pu 1 an sign/print your name on the line below. <br /> Consent: Yes No Signature/PrintedName <br /> UPCF(1/99) <br />