Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page 1 of 1 <br /> 1 EPA ID#(Hazardous Waste Only) 2 <br /> FACILITY ID# 0 0 0 0 0 0 0 0 0 0 1 0 CAR000124420 <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 <br /> Chevron Station #209167, 1234 YOSEMITE AVENUE, MANTECA CA 95336 <br /> A. HAZARDOUS MATERIALS <br /> Have on site (for any purpose) hazardous materials at or <br /> above 55 gallons for liquids, 500 pounds for solids, or 200 <br /> cubic feet for compressed gases (include liquids in ASTs . HAZARDOUS MATERIALS INVENTORY <br /> and USTs; or the applicable Federal threshold quantity for ®YES ❑ NO 4 —CHEMICAL DESCRIPTION(OES 2731) <br /> an extremely hazardous substance specified in 40 CFR Part <br /> 355, Appendix A or B; or handle radiological materials in <br /> quantities for which an emergency plan is required pursuant <br /> to 10 CFR Parts 30,40 or 70? <br /> B. UNDERGROUND STORAGE TANKS(USTs) • UST FACILITY(FormerlyswRCB Form A) <br /> 1. Own or operate underground storage tanks? ®YES ❑ NO 5 • UST TANK(one page per tank)(Formerly Form B) <br /> 2. Intend to upgrade existing or install new USTs? ❑YES ® NO 6 • UST FACILITY <br /> • UST TANK(one per tank) <br /> • UST INSTALLATION- CERTIFICATE OF <br /> COMPLIANCE(one page per tank)(Formerly Form <br /> C) <br /> 3. Need to report closing a UST? ❑YES ® NO 7 • UST TANK(closure portion—one page per tank) <br /> C. ABOVE GROUND PETROLEUM STORAGE TANKS(ASTs) <br /> Own or operate ASTs above these thresholds: <br /> ---any tank capacity is greater than 660 gallons,or ❑YES ® NO 8 • NO FORM REQUIRED TO CUPAs <br /> ---the total capacity for the facility is greater than 1,320 <br /> gallons? <br /> D. HAZARDOUS WASTE <br /> 1. Generate hazardous waste? ®YES ❑ NO 9 • EPA ID NUMBER—provide at the top of <br /> this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted <br /> recyclable materials(per HSC 25143.2)? ❑YES ® NO 10 <br /> • RECYCLABLE MATERIALS REPORT(one <br /> per recycler) <br /> 3. Treat hazardous waste on site? • ONSITE HAZARDOUS WASTE <br /> ❑YES ® NO 11 TREATMENT—FACILITY(Formerly DTSC <br /> Forms 1772) <br /> • ONSITE HAZARDOUS WASTE <br /> TREATMENT—UNIT (one page per unit) <br /> (Formerly DTSC Forms 1772 A,B,C,D and Q <br /> 4. Treatment subject to financial assurance requirements(for ❑YES ® NO 12 • CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? ASSURANCE(Formerly DTSC Form 1232) <br /> 5. Consolidate hazardous waste generated at a remote site? • REMOTE WASTE/CONSOLIDATION <br /> ❑YES ® NO 13 SITE ANNUAL NOTIFICATION(Formerly <br /> DTSC Form 1196) <br /> 6. Need to report the closure/removal of a tank that was ❑YES ® NO 14 • HAZARDOUS WASTE TANK CLOSURE <br /> classified as hazardous waste and cleaned onsite? CERTIFICATION(Formerly DTSC Form 1249) <br /> E. LOCAL REQUIREMENTS 15 <br /> (You may also be required to provide additional information by your CUPA or local agency.) <br /> UPCF(1/99) HMP 1 <br />