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RECEIVE[) <br /> UNIFIED PROGRAM CONSOLIDATED FORM Apg <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCROM&JCACUIN CEM�CeNCp T Y <br /> 03/29/2011-02:43:12 PM <br /> Page_ of <br /> L FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> EDDIE'S PIZZA CAFE(EL DORADO) <br /> CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> YES QX YES❑NO <br /> FACILITY ID# I MAP#GRID# 203/204 <br /> 9343 Required by Sl 2 /A /A /A /A <br /> 11. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES N NO 206 <br /> CARBON DIOXIDE If Subjecuo EPCRA,refer to instructions <br /> COMMON NAME 207 OYES ®NO 208 <br /> CO2 EHS' <br /> CAS# 209 <br /> 12438-9 xIf EHS is "Yes",all amounts must be in Its. <br /> FIRE CODE HAZARD CLASSES(Complete if required by COPA) 210 <br /> LEAVEBLANK <br /> HAZARDOUS MATERIAL ®,.PURE ❑b.MIXTURE O e,WASTE 211 RADIOACTIVE O YES ®NO 212 CURIES N/A 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 215 <br /> (Check one nem only) ❑SOLID ❑LIQUID ®GAS 214 LARGEST CONTAINER 400 <br /> FED HAZARD CATEGORIES O FIRE ❑REACTIVE IR 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 /> 3.88 1,404 N/A N/A <br /> UNITS" ❑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 ❑UNDERGROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ❑PLASTICMONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN ®CYLINDER ❑OTHER 223 <br /> STORAGE PRESSURE ❑AMBIENT ®ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE ❑AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ®CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT For mixture or waste on[ EHS CAS# <br /> 100 226 C 227 ❑YES ®NO 228 124-38-9 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 0 YES 0 NO 240 241 <br /> 242 243 ❑YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) UN1013 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? SODA FOUNTAIN <br /> UPCF(Rev,12/2007) If EPCRA,Please Sign Here <br />