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RECEIVED <br /> UNIFIED PROGRAM CONSOLIDATED FORM G r <br /> HAZARDOUS MATERIALS t' j 3 2011 <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/21/2009- 10:16:38 AW <br /> Page-Dl�q 19!QUIN COUNTY <br /> �BFE RGENCYSERVICEg <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> ARCH ARCO AM/PM <br /> <br /> ❑X YES❑NO <br /> FACILITY ID# .1 <br /> <br /> U. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) AYES 0 N 206 <br /> PROPANE if Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 208 <br /> PROPANE EHS' DYES ®NO <br /> CAS# 209 <br /> 'If EHS is "Yes",all amounts must be in lbs. <br /> N/A <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS MATERIAL ®e.PURE Cl h.h.MIXT ❑c.WASTE 211 RADIOACTIVE O YES 19 NO 212 CURIES 0 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 215 <br /> (Check one item only) ❑SOLID ❑LIQUID ®GAS 2l4 LARGEST CONTAINER 1$ <br /> 216 <br /> FED HAZARD CATEGORIES ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 40 50 N/A N/A <br /> 221 1 DAYS ON SITE 222 <br /> UNITS' 0 GAL 0 CU FT 0 LBS 0 TONS 365 <br /> (Check on item only 'If EHS,amount must be in pounds. <br /> STORAGE 0 ABOVE GROUND TANK 0 CARBOY 0 GLASS BOTTLE 0 Other... <br /> CONTAINER 0 UNDER GROUND TANK 0 SILO 0 PLASTIC BOTTLE <br /> 0 TANK INSIDE BUILDING 0 FIBER DRUM 0 TOTE BIN <br /> 0 STEEL DRUM 0 BAG 0 TANK WAGON <br /> 0 PLASTICINONMETALLIC DRUM 0 BOX 0 RAIL CAR <br /> O CAN 0CYLINDER OOTHER 223 <br /> STORAGE PRESSURE 0 AMBIENT N ABOVE AMBIENT 0 BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE 0 AMBIENT 0 ABOVE AMBIENT N BELOW AMBIENT 0 CRYOGENIC 225 <br /> rp234 <br /> HAZARD77% <br /> EHS CA # <br /> YES D NO 228 229 <br /> DYES C NO 232 233 <br /> D YES D NO 236 231 <br /> D YES ONO 240 241 <br /> 242D YES ONO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? PROPANE CYLINDER SOLD OR EXCHANGE TO CUSTOMERS <br /> If EPCRA,Please Sign Here <br /> UPCF(Rev.12/2007) <br />