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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/14/2009-04:20:10 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 7CAL LOCATION CONFIDENTIAL EPCRA 202 <br /> RETAIL SHELVES ®YES®NO <br /> FACILITY ID# 1 jl�M R � ,/A /A /A /A 203/204 <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(1 l) ❑YES ®NO 206 <br /> R12 If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 * ❑YES ®NO 208 <br /> R12 <br /> CAS# 209 <br /> 75-71-8 *If EES is "Yes",all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by COPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS <br /> E(Check one MATEtem RIAL <br /> ®a.PURE p b.MIXTURE 13 e.WASTE 211 RADIOACTIVE O YES ®NO 212 CURIES N/A .213 <br /> PHYSICAL STATE 215 <br /> p SOLID 13 LIQUID H GAS 214 LARGEST CONTAINER 30 LBS <br /> (Check one item only) <br /> (Chc AZARD CATEGORIES ❑FIRE ❑REACTIVE ®PRESSURE RELEASE ❑ACUTE HEALTH El CHRONIC HEALTH 216 <br /> l that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br /> 120 180 N/A N/A <br /> UNITS* [3 GAL [3 CU FT ®LBS [3 TONS 221 DAYS ONSITE 222 <br /> (Check on item only *If EHS,amount must be in pounds. 1365 <br /> STORAGE ❑ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER ❑UNDER GROUND TANK p SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING p FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM p BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX ❑RAIL CAR <br /> ®CAN ®CYLINDER ❑OTHER 223 <br /> STORAGE PRESSURE ❑AMBIENT ®ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT p CRYOGENIC 225 <br /> °SWT HAZARDOUS COMPONENT mixture or waste onl EHS CAS# <br /> 100 226 DICHLORODIFLOROMETHANE 227 ❑YES ®NO 228 75-71-8 229 <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) NEPA 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? IRETAIL SALES <br /> UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br />