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THIS FORM MUST BE COMPLOED BY THE OWNER OR OPERA OF EACH BUSINESS IN ANY <br /> COUNTY WHICH, AT ANY TIME HANDLES ACUTELY HAZARDOUS MATERIAL. SUBMIT THIS <br /> FORM TO ENVIRONMENTAL HEALTH SERVICES. <br /> Business Name: USAPetroleum Gasoline Station # 65 <br /> Business Address: 2500 LODI LODI CA 96001 <br /> Business Mailing Address (if different): 30101 AGOURACT. <br /> SUITE 200 <br /> AGOURA H ILL CA 96001 <br /> Business Phone: 818 865-9200 <br /> ACUTELY HAZARDOUS MATERIALS HANDLED IN QUANTITIES EQUAL TO OR GREATER TAN <br /> THE LISTED TRESHOLD PLANNING QUANTITIES (TPQ 'S)(SEE ATTACHED LIST). (EACH MUST <br /> ALSO BE ENTERED ON A BUSINESS PLAN INVENTORY) <br /> CHEMICAL NAME MAXIMUM QUANTITY ON SITE <br /> AT ANY ONE TIME (in lbs.) <br /> Gasoline CAS# 8006.61.9 12,000 gal <br /> Gasoline CASE 8006.61.9 12,000 gal <br /> Gasoline CAS* 8006.61.9 6,000 gal <br /> Diesel CAS# 68476.34.6 1 6,000 gal <br /> .Far ai do .report only the Mm clmicd portion of tie airtam. <br /> I certify under penalty of law that the information on this form is true and accurately reflects the <br /> quantities of acutely hazardous materials handled by this business. <br /> this form must be signed by the owner or operator. <br /> Signature: Date: <br /> Print or type name: David Oldfield Title: Project Coordinator <br /> GENERAL DESCRIPTION OF HOW THE CHEMICAL IS USED OR PROCESSED AT YOUR BUSI- <br /> NESS AND THE PRINCIPAL EQUIPMENT USED IN THAT PROCESS (FOR THE CHEMICALS IN <br /> QUANTITIES GREATER THAN TPQ 5.)NOTE: DO NOT INCLUDE TRADE SECRET INFORMA- <br /> TION. <br /> NFORMATION. <br /> The 4 Products are: <br /> (1) Unleaded <br /> (2) Unleaded Plus <br /> (3) Unleaded Premium <br /> (4) #2 Diesel <br /> They are stored in underground tanks and pumped automotive vehicles as needed. The gasoline <br /> system has a vapor recovery system. All tanks have overspill and overfill devices. All tanks are <br /> monitored daily and certified yearly. <br /> WRP PG.#9 <br />