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AOL <br /> UNIFIED PROGRAM CONSOLIDATED FORM e <br /> FACILITY INFORMATION <br /> BUSINESS ACTIVITIES <br /> Page 1of5 <br /> I. FACILITY IDENTIFICATION <br /> FACILITY ID# 1 EPA ID#(Hazardous Waste Only) 2 <br /> BUSINESS NAME(Same as Facility Name of DBA-Doing Business As) 3 <br /> LensCrafters-Store Number 135 <br /> H. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease submit the Business Owner/Operator Identification page (OES Form 2730). <br /> Does your facility... If Yes,please com Tete these pages of the UPCF.... <br /> A. HAZARDOUS MATERIALS <br /> Have on site(for any purpose)hazardous materials at or above 55 gallons <br /> for liquids,500 pounds for solids,or 200 cubic feet for compressed gases <br /> (include liquids in ASTs and USTs;or the applicable Federal threshold ❑YES ® NO 4 HAZARDOUS MATERIALS INVENTORY <br /> quantity for an extremely hazardous substance specified in 40 CFR Part -CHEMICAL DESCRIPTION(OES 2731) <br /> 355,Appendix A or B;or handle radiological materials in quantities for <br /> which an emergency plan is required pursuant to 10 CFR Parts 30,40 or <br /> 70? <br /> B.UNDERGROUND STORAGE TANKS(USTs) UST FACILITY(Formerly SwRCB 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 /> Q <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 gallons? <br /> D.HAZARDOUS WASTE <br /> I. Generate hazardous waste? EPA ID NUMBER-provide at the top of <br /> El YES ® NO 9 this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT(one <br /> recyclable materials(per HSC 25143.2)? ❑YES ® NO 10 per reeycler) <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 azul L) <br /> 4. Treatment subject to financial assurance requirements(for CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? <br /> El YES ® NO 12 ASSURANCE(Formerly DISC 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 classified as [:]YES ® NO 14 HAZARDOUS WASTE TANK CLOSURE <br /> 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) <br />