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• i <br /> t � <br /> *, . NIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br /> .10/1412009- 05:11:39 PM <br />{ Page of <br /> t <br /> j I. FACILITY INFORMATION <br /> F BUSINESS NAME(Satre as FACILITY NAME or DBA-Doing Business As) <br /> QUALITY TUNE UP SHOP#11 <br /> CHEMICAL LOCATION 201 HEMICAL LOCATION CONFIDENTIAL FPCRA 202 <br /> I <br /> . ❑X YES❑NO <br /> FACILITY Ill# 1! GRID# <br /> yJ�13066 A203/204 <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(1 1) ❑YES 0 NO 206 <br /> I MOTOR OIL If Subjeer to EPCRA,refer to instructions <br /> COMMON NAME 207 208 <br /> MOTOR OIL FHS* DYES ®ILIO <br /> CAS# 209 <br /> t MIXTURE *If EHS is "Yes all amounts must be in lbs. <br /> w <br /> FIRE CODE HAZARD CLASSES(Comple(e if required by COPA) 210 <br /> LEAVE BLANK <br /> 111 HAZARDOUS MATERIAL ,a. PURE ®h.MIXTURE ❑e.WASTE 21 1 RADIOACTIVE❑YES ONO 212 CURIES 0 213 <br /> TYPE(Check one iter[only) <br /> PHYSICAL STATE 214 215 <br /> {i (Check one item only) (jSOLID ®LIQUID ElGAS LARGEST CONTAINER 254 <br /> J FEED HAZARD CATEGORIES ®FIRE [:]REACTIVE []PRESSURE RELEASE .❑ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> 1 (Check all that apply) <br /> i <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT' 218 ANNUAL WASTE AMOUNT 219 S"1"ATE WASTE CODE 220 <br /> 500 700 NIA 221 <br /> UNITS* O GAL :❑CU FT ❑LBS ❑TONS 221 DAYS ON SITE 222 <br /> (Check on hent only *If EHS,amounrmust 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 ❑TIBER DRUM ❑TOTE BIN <br /> ®STEEL DRUM ❑BAG ❑'TANK WAGON <br /> ❑PLASTICINONMETALLIC DRUM 'I]BOX ❑RAIL CAR <br /> ❑CAN ❑CYLINDER ❑OTI4ER 223 <br /> t STORAGE',PRESSURE, ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> i STORAGE:TEMPERATURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> k %WT HAZARDOUS COMPONENT(For mixture or waste only EHS GAS# <br /> 75.85 226 BASE LUBRICATING OII_ 227 ❑YES ®NO 228 MIXTURE 229 <br /> f5-15 230 DETERGENT/INHIBITOR 231 ❑YES ONO 232 MIXTURE 233 <br /> © <br /> � <br /> 10-15 234 VISCOSI`['Y INDEX IMPROVER 235 . YES ONO 236 MIXTURE 237 <br /> [ ❑YES �O NO <br /> ¢1 238 POUR POINT DEPRESSANT 239 240 MIXTURE 241 <br /> <l 242 ANTI-FOAM ADDITIVE 243 ❑YES ®NO 244 MIXTURE 245 <br /> t - <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1270 246 <br /> ` (34)WHAT IS MATERIAL — I <br /> USED FOR? AUTO LUBRICATING FLUIDS OF VARYING VISCOSITIES(MOTOR OIL) <br /> i UPCF(Rev. 1212007) If FPCRA,Please Sign]-fere <br /> or Official Use Only: ®C ❑R ❑S Last Web Update: 03/12/2009 <br />