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UNIFIED PROGRAM CONSOLIDATED FO <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> 05/07/2009-03:48:52 PM <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> SEVEN ELEVEN#20632 <br /> CHEMICAL LOCATION 201 HEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> AYES❑NO <br /> FACILITY ID# I MAP#GRID#� /204 <br /> 5078 Required by Sj"� <br /> 1I. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(1 1) ❑YES ®NO 206 <br /> PREMIUM GASLOINE If Subject to EPCRA,refer to instructions <br /> COMMON NAME <br /> PREMIUM GASOLINE 207 EHS* [3 YES N NO 208 <br /> CAS# 209 <br /> MX8006619 *If EHS is "Yes",aH amounts must be in tbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS MATERIAL pc,WASTE 211 RADIOACTIVE❑YES ®NO 212 CURIES <br /> TYPE(Check one item only) a.PURE b.MIXTURE 213 <br /> PHYSICAL STATE 214 215 <br /> (Check one item only) [ISOLID ®LIQUID ElGAS LARGEST CONTAINER 10,000 <br /> FED HAZARD CATEGORIES N FIRE ❑REACTIVE ®PRESSURE RELEASE ®ACUTE HEALTH ®CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM.DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE' 220 <br /> 5,000 110,000 N/A N/A <br /> UNITS* O GAL ❑CU FT ❑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 []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 ❑ABOVE AMBIENT ❑BELOW AMBIENT. 224 <br /> STORAGE TEMPERATURE N AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT For mixture or waste on] 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) N/A 246 <br /> (34)WHAT IS MATERIAL VEHICLE FUELING L <br /> USED FOR. <br /> UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br /> or Official Use Only: ❑C OR ❑S Last Web Update:' 02/05/2009 <br />