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UNIFIED PROGRAM CONSOLIDATED FORM <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY-CHEMICAL DESCRIPTION <br /> 10/14/2009-02:20:13 P <br /> Page of <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as FACILITY NAME or DBA-Doing Business As) 3 <br /> SEARS#1288/6791 <br /> CHEMICAL LOCATION 201 IIEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br /> 1 MAp#G)Hp# �- 203/204 <br /> Required by SI <br /> H. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205 TRADE SECRET(11) ❑YES 0 NO 206 <br /> MOTOR OIL If Subject to EPCRA,refer to instructions <br /> COMMON NAME 207 ❑YES ONO <br /> 208 <br /> EHS <br /> MOTOR OIL ` <br /> CAS# 209 <br /> MIXTURE *I€EHS is "Yes",all amounts must be in lbs. <br /> FIRE CODE HAZARD CLASSES(Complete if required by CUPA) 210 <br /> LEAVE BLANK <br /> HAZARDOUS <br /> Y E RDOU on MATERIAL <br /> .e.PURE 0 b.MIXTURE 13 c.WASTE 211 RADIOACTIVE❑YES N NO 212 CURIES 213 <br /> PHYSICAL STATE ❑SOLID 19 LIQUID ❑GAS 214 215 <br /> LARGEST CONTAINER 250 <br /> (Check one item only) <br /> FED HAZARD CATEGORIES ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ®ACUTE HEALTH ❑CHRONIC HEALTH 216 <br /> (Check all that apply) <br /> AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 21 ANNUAL WASTE AMOUNT 2119 STATE WASTE CODE 220 <br /> 250 S00 N/A NIA <br /> UNITS* ®GAL ❑CU FT ❑LBS ❑TONS 221 DAYS ON SITE 22 <br /> (Check on item only *If EHS,amount must be in pounds. 365 <br /> STORAGE ®ABOVE GROUND TANK ❑CARBOY ❑GLASS BOTTLE ❑Other... <br /> CONTAINER Q UNDER GROUND TANK ❑SILO ❑PLASTIC BOTTLE <br /> ❑TANK INSIDE BUILDING ❑FIBER DRUM ❑TOTE BIN <br /> ❑STEEL DRUM ❑BAG ❑TANK WAGON <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BOX D RAIL CAR <br /> []CAN ❑CYLINDER ❑OTHER <br /> 223 <br /> STORAGEPRESSURE ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT 224 <br /> STORAGE TEMPERATURE 09 AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ®CRYOGENIC 225 <br /> %WT HAZARDOUS COMPONENT ffor mixture or Waste only EHS CAS# <br /> 95-98 226 PETROLEUM OILS 227 DYES N NO 228 229 <br /> 230 231 D YES D NO 232 233 <br /> 234 235 D YES D NO 236 237 <br /> 238 239 ❑YES D NO 240 241 <br /> 242 243 D YES D NO 244 245 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1270 246 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? AUTOMOTIV6MAINTENANCE <br /> UPCF(Rev.12/2007) If EPCRA,Please Sign Here <br /> i <br /> i <br /> i <br /> i <br />