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UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> _ - - - - Page of <br /> FACILITY ID 8 - <br /> (Agency Use Only) EPA ID k(hazardous Waste Only) 2, <br /> BUSINESS NAME(Sameas Facility <br /> {NNae{ar—rD1BA-Denng Business As) <br /> �t.✓�ir/a / G I I l�/G✓/N t /7'(� 3. <br /> BUS94ES SITE DRE S ' <br /> /sit ® m. <br /> BUSINESSIT <br /> S <br /> CA Z@CODEMWE <br /> ,os. <br /> X53 �a <br /> NOT If you check YES to any part of this list, <br /> lease submit the Business Owner/O erator Identification a e <br /> Does our facili .. <br /> A. HAZARDOUS MATEIf Yes, lease cam tete these a es of the UPCF... <br /> RIALS <br /> Have on site (for any purpose) at any one time, hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for <br /> compressed gases (include liquids in ASTs and USTs); or the applicable j� <br /> Federal threshold quantity for an extremely hazardous substance specified le ❑YES `ti NO ". HAZARDOUS MATERIALS INVENTORY — <br /> 40 CFR Part 355, Appendix A or B; or handle radiological materials in OHEMICAL DESCRIPTION <br /> quantities for which an emergency plan is required pursuant to 10 CFR Parts <br /> 30 40 or 70? <br /> B. CalARP REGULATED SUBSTANCES <br /> Have Regulated Substances stored onsite in quantities greater than the <br /> threshold quantities established by the California Accidental Release ❑YES M NO N. with 5'0m local agency responsible for <br /> Prevention Pro CalARP 7 <br /> C. UNDERGROUND STORAGE TANKS(USTs) UST OPERATING PERMIT APPLICATION — <br /> Own or operate underground storage tanks? FACILITY TION <br /> .YES ❑ NO s. UST OPERATING PERMIT APPLICATION — <br /> D. ABOVE GROUND PETROLEUM STORAGE TANK INFORMATION <br /> Own or operate ASTs above these thresholds: i <br /> Store greater than 1,320 gallons of petroleum products (new or used) in ❑YES NO s. No to=required to CUPAs <br /> abov and tanks or containers? <br /> E. HAZARDOUS WASTE <br /> Generate hazardous waster ❑YES [$NO a. EPA ID NUMBER—provide at rap of this page <br /> Recycle more than 100 kg/month of excluded or exempted recyclable ❑YES <br /> Ek NO to. RECYCLABLE MATERIALS REPORT <br /> materials(per HSC§25143.2)? <br /> (anepmrarder) <br /> Treat hazardous waste onsite? ❑YES MNO it. ONSITE HAZARDOUS WASTE TREATMENT <br /> NOTIFICATION—FACILITY PAGE <br /> ONSITE HAZARDOUS WASTE TREATMENT <br /> NOTIFICATION—UNIT PAGE (anevege weea> <br /> Perform treatment subject to financial assurance requirements(for Permit by ❑YES Iq NO it CERTIFICATION OF FINANCIAL ASSURANCE <br /> Rule and Conditional Authorization)? <br /> Consolidate hazardous waste generated at a remote site? ❑YES P!r NO u. REMOTE WASTE CONSOLIDATION SCFE <br /> ANNUAL NOTIFICATION <br /> Need to report the closurdremoval of a tank that was classified as hazardous ❑YES JZ NO la. HAZARDOUS WASTE TANK CLOSURE <br /> waste and cleaned onsite? CERTIFICATION <br /> Generate in any single calendar month 1,000 kilograms (lig) (2,200 ❑YES lQ NO ran Obtain federal EPA ID Number, file Biennial <br /> pounds) or more of federal RCRA hazardous waste, or generate in Report (EPA Form 8700-13A)B), and satisfy, <br /> any Single calendar month, or accumulate at any time, 1 kg (2.2 requirements for RCRA Large Quantity Generator. <br /> pounds) of RCRA acute hazardous waste; or generate or accumulate <br /> at any time more then 100 kg(220 pounds)of spill cleanup materials <br /> contaminated with RCRA acute hazardous waste? <br /> Serve as a Household Hazardous Waste HHM Collection site? ❑YES IXNO wb. See CUPA for required forms. <br /> F. LOCALREQUMEMENTS (You may also be required to provide additional information by your CUPA or local agency.) Is. - <br /> Rwfactiv UPCF Rev. (12/2007)-I/2 w .unidoca.org Effective 01/17/08 <br />