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FIED PROGRAM CONSOLIDATED FOjv <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MAI ERIALS INVENTORY - CHEMICAL DESCRIPTION <br /> E]ADD DELETE REVISE Page_of <br /> 1. FACILITY INFORMATIOff- <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> Jackpot Food Mart,Manteca <br /> CHEMICAL LOCATION 2ol CHEMICAL LOCATION CONFIDENTIAL 202 <br /> EPCRA <br /> Underground storage tanks ❑ YES ID NO <br /> (optional) (optional)FACILITY ID# <br /> U.CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET E]Yes ®No 206 <br /> Petroleum Hydrocarbon If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 208 <br /> Unleaded Gasoline EHS' []Yes ®No <br /> CAS# 209 'If EHS is"Yes,all amounts below must be in lbs. <br /> 8006619 <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> HAZARDOUS MATERIAL 211 212 213 <br /> TYPE(Check one item only) ❑a.PURE X�b.MIXTURE ❑c.WASTE RADIOACTIVE Yes X]No CURIES <br /> PHYSICAL STATE 214 215 <br /> (check one item only) Da.SOLID ®b.LIQUID E]c.GAS LARGEST CONTAINER 12000 gallons <br /> FED HAZARD CATEGORIES <br /> (Check all that apply) ®a.FIRE [:]b.REACTIVE [:]c.PRESSURE RELEASE Ela.ACUTE HEALTH Ele.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 20000 30000 N/A N/A <br /> 221 DAYS ON SITE 222 <br /> UNITS' Ea.GALLONS 1:1b.CUBIC FEET Elc.POUNDS E]d.TONS 385 <br /> (unei one Item only) <br /> STORAGE <br /> CONTAINER Da.ABOVE GROUND TANK Ile.PLASTICINONMETALLIC DRUM []I.FIBER DRUM [:]m.GLASS BOTTLE [:]q.RAIL CAR <br /> flb.UNDERGROUND TANK [:]f.CAN [:]j.BAG 1:1n.PLASTIC BOTTLE E]r.OTHER <br /> F1c.TANK INSIDE BUILDING [:]g.CARBOY [-]k.BOX Elo.TOTE BIN <br /> E]d.STEEL DRUM [-]h.SILO [-]I.CYLINDER [-]p.TANK WAGON 223 <br /> STORAGE PRESSURE X❑a.AMBIENT 11b. ABOVE AMBIENT Ile.BELOW AMBIENT 224 <br /> STORAGE TEMPERTURE El a.AMBIENT [-]b. ABOVEAMBIENT 1:1c.BELOW AMBIENT [-]d.CRYOGENIC 225 <br /> 0/.WT HAZARDOUS COMPONENT(For mixture orwasteonly) EHS CAS# <br /> 22b 221 Yes ®No 8006-61-9 229 <br /> 1 100 Unleaded Gasoline <br /> Yea [—]NO zuz 233 <br /> 2 <br /> 234 235 236 237 <br /> DYe6 []NO <br /> 3 <br /> 239 239 240 241 <br /> Yes [:]NO <br /> 4 <br /> 243 Yes [—]NO <br /> 5 <br /> If more hazardous components are present at greater than 1%by weight if non-carcinogenic,or 0.1%by weight if carcinogenic,attach additional sheets of paper capturing the required information. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION <br /> If EPCRA,Please Sign Here <br /> UPCF(1199) OES FORM 2731(1/99) <br />