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16 <br /> UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br /> 07/23/2009- 11:07:37 AM <br /> Page of <br /> 1. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> ROCKITE CO <br /> CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> INSIDE SHOP,ALONG SOUTH AND EAST WALLS. <br /> QX YES[—]NO <br /> FACILITY ID# I I MAP#GRID# 20312C>4 <br /> 13907 Required by 3J 116-7 NIA NIA N/A NIA <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES ®NO 206 <br /> CALCIUM SULFATE If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 208 <br /> ROCKITE CEMENT EHS* ❑YES ®NO <br /> CAS# 209 <br /> 7778-18-9 *If EHS is "Yes",all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVEBLANK <br /> HAZARDOUS MATERIAL ❑s.PURE ®b.MIXTURE [3c.WASTE 211 RADIOACTIVE❑YES ONO 212 CURIES NIA 213 <br /> TYPE(Check one item only) <br /> PHYSICAL STAIN. 214 215 <br /> (Check one item only) ®SOLID ❑LIQUID ❑GAS LARGEST CONTAINER 100 <br /> FUD HAZARD CATEGORIES ❑(:IRE ❑REACH VE ®PRESSURE RELEASE ❑ACUTE HEALTH ❑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 /> 24,000 48,000 0 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. 20 <br /> STORAGE ❑ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM N BAG ❑TANK WAGON <br /> ❑PLASTICINONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ❑CAN ❑CYLINDER ❑OTHER <br /> 223 <br /> STORAGE PRESSURE M AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT 22.4 <br /> STORAGE TEMPERATURE M AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT For mixture or waste onl EHS CAS# <br /> 226 227 ❑YES ❑NO 228 229 <br /> 230 231 ❑YES ❑NO 232 233 <br /> 234 235 ❑YES ❑NO 236 237 <br /> 238 239 ❑YES ❑NO 240 241 <br /> 242 243 ❑YES ❑NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A 246 <br /> (34)WHAT IS MAThRIAL - L <br /> USED FOR? rEXPANSION CEMENT FOR ANCHORING <br /> UPCF(Rev. 1212007) If EPCRA,Please Sign Here <br /> For Official Use Only: OC ❑R ❑S Last Web Update: 07/23/2009 <br />