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21 <br /> ti <br /> HECE <br /> UNIFIED PROGRAM CONSOLIDATED FORM IVEo <br /> MAR — 5 20gACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> 'itfluE OFEMESWI SEFi{ 00 Page 1 of_ <br /> TEY <br /> T. <br /> f1FtGi4�"��3i:`: <br /> FACILITY'15'# 1 - <br /> EPA ID#(Hazardpus Waste Only) 2 <br /> CAD981466584 <br /> BUSINESS NAME(Same as Facility"Name of DBA-Doing Business As) 3 <br /> 7-Eleven Store#20632 <br /> "GTitITi „ . <br /> NOTIE' '. 1t yob I od YI, ""' of tf� Must <br /> " . � <br /> phase slL�tmit theus�r�; v3rneC4petrl. if +an"page" CJES Form 2730 <br /> D4e� nurfact :.�. Ilea , ..q6a. s .c rr� le# ,th se:` a es of1he UPCF.. <br /> A. HAZARDOUS MATERIALS <br /> Have on site (for any purpose) hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 <br /> cubic feet for compressed gases (include liquids in ASTs ®YES ❑ NO 4 • HAZARDOUS MATERIALS INVENTORY <br /> and USTs); or the applicable Federal threshold quantity for —CHEMICAL_DESCRIPTION(OES 2731) <br /> an extremely hazardous substance specified in 40 CFR Part <br /> 355, Appendix A or B; or handle radiological materials in <br /> quantities for which an emergency plan is required pursuant <br /> to 10 CFR Parts 30,40 or 70? <br /> B. UNDERGROUND STORAGE TANKS(USTs) • UST FACILITY(FormertySwRCBForm A) <br /> 1. Own or operate underground storage tanks? E YES ❑ NO 5 • USTTANK(one page per tank)(Formerly Form 0) <br /> 2. Intend to upgrade existing or install new USTs? ❑YES E NO 6 • UST FACILITY <br /> • UST TANK(one per tank) <br /> • UST INSTALLATION- CERTIFICATE OF <br /> COMPLIANCE(one page per tank)(Formerly Form <br /> C) <br /> 3. Need to report closing a UST? [:]YES E NO 7 • UST TANK(closure portion—one page per tank) <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 E NO 8 • NO FORM REQUIRED TO CUPAs <br /> ---the total capacity for the facility is greater than 1,320 <br /> gallons? <br /> D. HAZARDOUS WASTE <br /> 1. Generate hazardous waste? E YES ❑ NO 9 • EPA ID NUMBER—provide at the top of <br /> this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted <br /> recyclable materials (per HSC 25143.2)? ❑YES ® NO 10 • RECYCLABLE MATERIALS REPORT(one <br /> per recyder) <br /> 3. Treat hazardous waste on site? • ONSITE HAZARDOUS WASTE <br /> ❑YES ® NO 11 TREATMENT—FACILITY(Formerly DTsc <br /> Forms 1772) <br /> • ONSITE HAZARDOUS WASTE <br /> TREATMENT—UNIT (one page per unit) <br /> (Formerly DTSC Forms 1772 A,B,C,D and Q <br /> 4. Treatment subject to financial assurance requirements(for ❑YES E NO 12 • CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? ASSURANCE(Formerly DTSC Form 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? • REMOTE WASTE 1 CONSOLIDATION <br /> ❑YES E NO 13 SITE ANNUAL.NOTIFICATION(rormerly <br /> DTSC Form 1196) <br /> 6. Need to report the closure/removal of a tank that was • HAZARDOUS WASTE TANK CLOSURE <br /> classified as hazardous waste and cleaned onsite? E]YES ENO 14 CERTIFICATION(Fomrerly DTSC Fort 1249) <br /> E. LOCAL REQUIREMENTS 15 <br /> (You may also be required to provide additional information by your CUPA or local agency.) <br /> UPCF(1199) HMP 1 <br />