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RECEII/Ep <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZAR➢OUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/14/2009.05:13:25 PM <br /> 1. FACILITY INFORMATION - <br /> BUSINESS NAME(Sane zs FACILITY NAME or DBA-Doing Business As) 3 <br /> ARCH ARCO AM/PM <br /> <br /> ®YES❑NO <br /> FACILITY IDP l <br /> <br /> H. CHEMICAL INFORMATION <br /> CHEMICALNAME 205 TRADE SECRET(11) ❑YES 0 N 206 <br /> CARBON OXIDE U 50jeet to PPCRA,mfev to irutructiom <br /> COMMON NAME 207 208 <br /> EHS' 17 YES ®NO <br /> CO2TANK <br /> CASA 209 <br /> 'If EHS is 'Ree",all amounts must he in Ibv. <br /> N/A <br /> FIRE CODE HAZARD CLASSES(Comptac if raquid by COPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS MATERIAL ®><PURE 11 MI RE e. <br /> b.MRC ❑ WASIC 211 RADIOACTIVE AYES ®NO 212 CURIES 0 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STATE 215 <br /> (Check one item only) ❑SOLI➢ pL1QU1D ®GAS 214 LARGEST CONTAINER 400 <br /> FED HAZARD CATEGORIES O FIRE ❑REACTIVE 0 PRESSURE RELEASE I7 ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21 ANNUAL WASTE AMOUNT 219 STATE WAM CODE 220 <br /> 125 250 N/A N/A <br /> 221 1 DAYS ON SITE 222 <br /> UNITS* O GAL []CUFF ®LBS ❑TONS 365 <br /> (Check on item only a If EHS,amount must be in pounds. <br /> STORAGE ❑ABOVE GROUND TANK El CARBOY L3 GLASS BOTTLE 0Olhm— <br /> CONTAINER ❑UNDER GROUND TANK 0 SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSWE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> O CA�IC/NONMETALLIC DRUM ®BINDER DORAILCRAR <br /> 223 <br /> STORAGE PRESSURE ❑AMBIENT ®ABOVEAMBIENT ❑EELOWAMBIENT 224 <br /> STORAGETEMPERATURE ❑AMBIENT ❑ABOVEAMBIENT 51BELOWAMBIENT CI CRYOGENIC 225 <br /> %WT I HAZARDOUS COMPONENT Par mixture or waste on] A <br /> AS# <br /> N/A 226 227 228 229 <br /> 230 231 q2 233 <br /> 234 <br /> 735 236 237 <br /> 239 240 241 <br /> 238 <br /> 242 243 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: 246 <br /> (33)UNITED NATIONS IDP(DOT) 1013 <br /> (34)WFIAT IS MATERIAL - ---� <br /> USED FOR? B FOSOr A FOUNTAIN DRINKS MACHINE <br /> ��' UPCF(Rev.12/2007) If EPCRA.Please Sign Here <br />