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UNIFIED PROGRAM CONSOLIDATED FOR <br /> HAZARDOUS MATERIALS . <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 05/07/2009- 12:35:31 PM <br /> Page of <br /> L FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DSA-Doing Business As) 3 <br /> SEVEN ELEVEN#20632 <br /> CHEMICAL LOCATION 201 HEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br /> ID# 1 MAp#GRID# ��= <br /> <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> CARBON DIOXIDE If Subject to EPCRA,refer to instructions <br /> COMMON NAME 2071 208 <br /> CARBON DIOXIDE EHS* ❑YES I@ NO <br /> CAS# 209 <br /> 124.38_9 *If EHS is "Yes",all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS MATERIAL ®a.PURE p b.MIXTURE p c.WASTE 211 RADIOACTIVE❑YES ®NO 2I2 CURIES NIA 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 214 215 <br /> (Check one item only) ❑SOLID ❑LIQUID ®GAS LARGEST CONTAINER 30 <br /> FED HAZARD CATEGORIES ❑FIRE ❑REACTIVE ®PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH 215 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 200 400 <br /> UNITS* ❑GAL ❑CU FT N LBS ❑TONS 221 DAYS ON SITE 222 <br /> (Check on item only *If EHS,amount must be in pounds. 365 <br /> STORAGE ❑ABOVE GROUND TANK O CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN ®CYLINDER ❑OTHER 223 <br /> STORAGE PRESSURE ❑AMBIENT N ABOVE AMBIENT C1 BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %aWT HAZARDOUS COMPONENT For mixture or waste only EHS CAS# <br /> 226 227 ❑YES ❑NO 228 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 ❑YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1013 246 <br /> (34)WHAT IS MATERIAL L <br /> USED FOR? Soda machine <br /> t <br /> UPCF(Rev,12/2007) If EPCRA,Please Sign Here <br /> or Official Use Only: ®C ❑R ❑S Last Web Update: 08/15/2006 <br />