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UNIFIED PROGRAM CONSOLIDATED FO <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY- CHEMICAL DESCRIPTION <br /> 10/14/2009- 02:53:43 PM <br /> Page_ of <br /> L FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> APPLEBEE'S NEIGHBORHOOD GRILL/BAR <br /> <br /> ❑X YES❑NO <br /> FACILITY ID# 9298 <br /> <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(I 1) O YES R NO 206 <br /> CARBON DIOXIDE If Subject to EPCRA,refer to instmcGons <br /> COMMON NAME 207 208 <br /> CO2 EHS* ❑YES M NO <br /> CAS# 209 <br /> 12438-9 *If EHS 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 ®e.PURE 13 b.MIXTURE <br /> TYPE(Check one item only) c.WASTE 211 RADIOACTIVE O YES ®NO 212 CURIES N/A 213 <br /> PHYSICAL STATE 214 215 <br /> (Check one item only) ❑SOLID O LIQUID ®GAS LARGEST CONTAINER 400 <br /> FED HAZARD CATEGORIES O FIRE O REACTIVE ®PRESSURE RELEASE O ACUTE HEALTH O 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 /> 240 400 N/A N/A <br /> UMTS* ❑GAL ❑CU FT O 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 [3 Other... <br /> CONTAINER 13 UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ®TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> O STEEL DRUM O BAG ❑TANK WAGON <br /> O PLASTIC/NONMETALLIC DRUM O BOX O RAIL CAR <br /> O CAN R CYLINDER p OTHER <br /> 223 <br /> STORAGE PRESSURE O AMBIENT M ABOVE AMBIENT O BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE O AMBIENT O ABOVE AMBIENT N BELOW AMBIENT O CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT For mixture or waste on] EHS CAS# <br /> 226 227 ❑YES ❑NO 228 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 247 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 ❑YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1013 246 <br /> (34)WHAT IS MATERIAL 1 <br /> USED FOR? Dispensing soft drinks <br /> UPCF(Rev. 12/2007) If EPCRA,Please Sign Here <br /> 'or Official Use Only: 9 C ❑ R ❑ti Last Web Update: 12/13/2006 <br />