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UNIFIED PROGRAM CONSOLIDATED FOR <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION <br />,I <br /> 05/07/2009-03:48:53 PM <br /> f Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or D13A-Doing Business As) 3 <br /> F SEVEN ELEVEN#20632 <br /> CHEMICAL LOCATION 201 HEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br /> ID# I I MAP#GRID#, <br /> <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> WASTE ABSORBENT&DISP.FUEL FILTERS If Subject to EPCRA,refer to instructions <br /> COMMON NAME <br /> WASTE ABSORBENT& DISP.FUEL FILTERS 207 EHS* ❑YES ®NO 208 <br /> CAS# 209 <br /> NIA *If FHS 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 3 a.PURE p b.MIXTURE Be.WASTE 211 RADIOACTIVE❑YES ®NO 212 CURIES 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE <br /> (Check one item only) ®SOLID ❑LIQUID El OAS 214 215 <br /> LARGEST CONTAINER 55 <br /> FED HAZARD CATEGORIES ®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 /> 25 55 25 352 <br /> UNITS* H GAL ❑CU FT ❑LBS []TONS. 221 1 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 [3 TOTE BIN <br /> ®STEEL DRUM C3 BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN ❑CYLINDER ❑OTHER 223 <br /> STORAGE PRESSURE ®AMBIENT ❑ABOVE AMBIENT. ❑BELOW AMBIENT <br /> 224 <br /> STORAGE TEMPERATURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %)47 HAZARDOUS COMPONENT For mixture or waste onl EHS CAS# <br /> 226 227 ❑YES ❑NO 228 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 <br /> 235 ❑YES_El NO 236 237 <br /> � , <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 0 YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) NIA 246 <br /> (34)WHAT IS MATERIAL L <br /> USED FOR? ABSORB LIQUID SPILLS <br /> UPCF(Rev,12/2007) if EPCRA,Please Sign Here <br /> or Official Use Only: 0 C ❑R [IS . Last Web Update: 02JO512009 <br />