Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> ,.� HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> (10/05/2011- 12:40:02 PM <br /> Page_ oP- <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME oc DBA•Doing Business As) 3 <br /> ARCH ARCO AMTM <br /> <br /> ®YES❑NO <br /> FACILITY][)# 1 <br /> <br /> <br /> 11. <br /> CHEMICAL INFORMATION <br /> CHEMICALNAME 205 TRADE SECRET(I I) O YES 0 N 206 <br /> UNLEAD,MIDGRADE,PREMIUM GASOLINE if subject to EPC'RA,refer to inswcuons <br /> 208 <br /> COMMON NAME EHS* OYES ONO <br /> GASOLINE <br /> CAS# 209 <br /> If FHS is "Yore",all amounts must be in lbs. <br /> N/A 210 <br /> FIRE CODE HAZARD CLASSES(Complete if req.irrd by COPA) <br /> LEAVE BLANK <br /> 213 <br /> HAZARDOUS MATERIAL <br /> TYPE(Check one item only) ®`PURE ❑h.M3ETURE Oe.WASTE 211 RADIOACTIVE 0YES ®NO 212 CURIES U <br /> 215 <br /> PHYSICAL STATE ❑SOLID ®LIQUID OGAS 214 LARGEST CONTAINER 20,000 <br /> (Check ane item mrly) 216 <br /> FID HAZARD CATEGORIES H FIRE O REACTIVE O PRES5URE RELEASE O ACUTE HEALTH Q CHRONIC HEALTH <br /> (Check all that apply) 20 <br /> AVERAGE DAILY AMOUNT 217 MA XIMUMDAILYAMOUNT 218 N/A AL WA57E AMOUNT 219 NATE WASTE CODE 2 <br /> 15,000 22,000 220 <br /> 221 DAYS ON SITE <br /> UNITS' ®GAL O CU FT O LBS O TONS 3155 <br /> (Check on Item only •Tf EHS,amount must be in Pounds. <br /> STORAGE O ABOVE GROUND TANK OCARBOY C3 GLASS BOTTLE 0Other... <br /> CONTAINER ®UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> E BIN <br /> O TANK INSIDE EUILDiNG []BACADRUM OOTANKWAGON <br /> ❑STEEL DRUM RAIL <br /> ❑PLASTIC/NONMETALLIC DRUM [O CYLINDER OO OTHER 223 <br /> ❑CAN <br /> STORAGE PRESSURE O <br /> AMBIENT OABOVEAMBIENT ❑BELOWAMO T 224 <br /> STORAGE TEMPERATURE O AMBIENT OAHOVE AMBIENT O BELOW AMBIENT ❑CRYOGENIC <br /> z2s <br /> T, HAZARDOUS COMPONENT For mixture or waste onl YES NO 22g 229 <br /> NIA <br /> 226 227 <br /> C3 YES 12 NO 232 233 <br /> 230 <br /> 231 <br /> 235 OYES ❑NO 236 237 <br /> 294 <br /> 239 (3 YES ❑NO 240 241 <br /> 238 245 <br /> yO ❑1tE5 ❑NO 244 <br /> 242 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION' 39)UNIIm NATIONS ID#(DOT) <br /> 1203 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR, [retailF <br /> �,. <br /> If EPCRA,Please Sign Hurt <br /> UPCP(Rev.IJ2O07) <br />