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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/14/2009-04:20:12 P <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> PEP BOYS #711 <br /> CHEMICAL LOCATION 201 rCAL LOCATION CONFIDENTIAL EPCRA 202 <br /> RETAIL SHELVES QX YES®NO <br /> FACILITY IDS 1 M 11GRIDA�� 203/204 <br /> Required by SJ /A /A /A /A <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) p YES ®NO 206 <br /> CAR WAX If Subject to EPCRA,refer to instmctions <br /> COMMON NAME 207 EHS p YES ®NO 208 <br /> CAR WAX <br /> CAS# 209 <br /> MIXTURE If EHS is "Yes'.all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> .fel'E(Duk one TEEtem IAL p a.PURE ®b.MIXTURE O c.WASTE 211 RADIOACTIVE p YES 13 NO 212 URIES CNIA 213 <br /> PHYSICAL STATEp SOLID ®LIQUID ❑GAS 214 LARGEST CONTAINER 21 <br /> (Check one item only) 10.5 OZ <br /> (F k all tl atD CATEGORIES <br /> T GOA ®FIRE <br /> (3 �E p PRESSURE RELEASE ®ACUTE HEALTH p CHRONIC HEALTH 216 <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 931 20 N/A N/A <br /> UNITS* ®GAL ❑CU FT p LBS p TONS 221 1 DAYS ON SITE 222 <br /> (Check on item only *If EHS,amount must be in pounds. 365 <br /> STORAGE p ABOVE GROUND TANK ❑CARBOY p GLASS BOTTLE ❑Other... <br /> CONTAINER p UNDER GROUND TANK ❑SILO p PLASTIC BOTTLE <br /> p TANK INSIDE BUILDING O FIBER DRUM p TOTE BIN <br /> E3 STEEL DRUM p BAG p TANK WAGON <br /> p PLASTIC/NONMETALLIC DRUM p BOX p RAU,CAR <br /> ❑CAN p CYLINDER INOTHER <br /> 223 <br /> STORAGE PRESSURE ®AMBIENT p ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE ❑AMBIENT OABOVE AMBIENT O BELOW AMBIENT p CRYOGENIC 225 <br /> %Wr HAZARDOUS COMPONENT mixture or waste onl EHS CAST' <br /> 6-10 226 PETROLEUM DISTILLATES(KEROSENE) 227 ❑YES ®NO 228 800&,20-6 229 <br /> 3-6 230 PETROLEUM DISTILLATES 231 ❑YES ®NO 232 8052-41-3 233 <br /> IRTfVIT TIARTI CfIT.VFWT <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)UNTIED NATIONS ID#(DOT) NI TA 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? RETAIL SALES <br /> UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br />