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UMFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> («w page p«numrid p«bwlNng«mu) <br /> ❑ ADD ❑ DELETE ❑ REVISE xo0 <br /> Page 2 of 2 <br /> 1.FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) <br /> 3 <br /> KINGSDOWN INC <br /> CHEMICAL LOCATION 201 CHENICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> ❑ YES ❑ NO <br /> FACILITY ID# 1 MAP#moiimuq 203 GRID#bsimo d) <br /> FA0021146 301 <br /> II.CHEMICAL INFORMATION <br /> CHEMICAL NAME 305 TRADE SECRET <br /> �r�r iDDEp ® Yes ❑No 206 <br /> MIXTURE rvb al b EPCRA rt«b mrdwu <br /> COMMON NAA gW ME 2m EHS• ❑ Yes ® No los <br /> HENKEL ADHESIVE <br /> CAS# 209 <br /> •If EHS is"Yes",all amounts below most be in lbs. <br /> FIRE CODE HAZARD CLASSES(cos kedmy,dmabycuPA) 210 <br /> HAZARDOUS MATERIAL ❑ a PURE Elb.MIXTURE El c.WASTE 211 RADIOACTIVE ❑ Yes ® No 212 CURIES 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE ❑ a SOLID ® b.LIQUID ❑ c.GAS 214 LARGEST CONTAINER 215 <br /> (Check one item only) 80.00 <br /> FED HAZARD CATEGORIES 216 <br /> (Check all that apply) ❑ a FIRE ❑ It.REACTIVE ❑c.PRESSURE RELEASE ❑ d.ACUTE HEALTH ® e CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 211 MAXIMUM DAILY AMOUNT 218 1 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 80.00 1 80.00 <br /> UNITS' ❑ a GALLONS ❑ b.CUBIC FEET ® c.POUNDS ❑ it TONS 2x1 DAYS ON SITE: 222 <br /> (Check one item only) <br /> •IfERS,amount must be in poanag. 365 <br /> STORAGE ❑as ABOVE GROUND TANK ❑ is PLASTICINONMEfALLIC DRUM ❑ i.FIBER DRUM ❑ m.GLASS BOTTLE ❑q.RAILCAR <br /> CONTAINER ❑ b.UNDERGROUND TANK ❑ f CAN [:11.BAG ❑ n.PLASTIC BOTTLE ❑ r.OTHER <br /> ❑c.TANK INSIDE BUILDING ❑g.CARBOY ® It.BOX ❑o.TOTE BBN <br /> ❑d.STEEL DRUM ❑ h.SILO ❑ I.CYLINDER ❑ p.TANK W AGON 123 <br /> STORAGE PRESSURE El a AMBIENT ❑ b. ABOVEAMBIENT ❑ c. BELOW AMBIENT <br /> STORAGE TEMPERATURE ® a AMIBIENT ❑ b. ABOVEAMBIENT ❑ c. BELOW AMBIENT ❑ d. CRYOGENIC 225 <br /> %9N'T HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 1 1.00 226 ZINC OXIDE 221 ❑ Yes ❑X No u9 1314-13-2 n9 <br /> 2 230 131 ❑ Yes ❑ No 232 233 <br /> 3 234 235 ❑ Yes E] No 236 231 <br /> 4 239 239 E] Yes No 20 241 <br /> 5 242 243 ❑ Yes ❑ No zw 245 <br /> Ifmomhmrdomcomp m=smpr tat"*rt ]%by wdght ifnan-carcimi,nic.or 0.1%by weight n caroino9eait,amich.dd'nional slwu orpaper upuning this ns,dred inkmintun. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246 <br /> If EPCRA,Please Sign Here <br /> UPCF(1/99) <br />