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C <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 03:11:46 P <br />Fage of <br />I. FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) <br />3 <br />SEARS #1288/6791 <br />CHEMICAL LOCATION 201 <br />CAL LOCATION CONFIDENTIAL EPCRA <br />202 <br /> <br />®YES[] NO <br />FACILITY ID# I RlcAP* RIW �' <br />203/204 <br />H. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (11) ❑ YES ® NO <br />206 <br />USED MOTOR OIL FILTERS <br />If Subject to EPCRA, refer to instructions' <br />COMMON NAME 207 <br />208 <br />USED MOTOR OIL FILTERS <br />EHS# ❑ YES 11NO <br />CAS # 209 <br />MIXTURE <br />*If FHS is "Yes'. all amounts must be in lbs. <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) <br />210 <br />LEAVE BLANK <br />HAZARDOUS MATERIAL13 a. PURE r3 b. mixTURE ® c. WASTE 211 <br />TYPE {Check one item only) <br />RADIOACTIVE ❑ YES R NO 21TC <br />IES <br />213 <br />PHYSICAL STATE [3 SOLID 19 LIQUID ❑ GAS 214 <br />(Check one item only) <br />LARGEST CONTAINER 55 <br />215 <br />FED HAZARD CATEGORIES ® FIRE ❑ REACTIVE ❑ PRESSURE RELEASE W ACUTE HEALTH ❑ CHRONIC HEALTH <br />216 <br />{Check alt that apply) <br />AVERAGE DAILY AMOUNT 217 <br />DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219STATE <br />WASTE CODE <br />220 <br />55 <br />1110 <br />2000 <br />221 <br />UNITS* ® GAL ❑ CU FT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE <br />n2 <br />(Check on item only * If ERS, amount must be in pounds. 1 <br />365 <br />STORAGE ❑ ABOVE GROUND TANK ❑ CARBOY ❑ GLASS BOTTLE ❑ Other... <br />CONTAINER ❑ UNDER GROUND TANK ❑ SILO ❑ PLASTIC BOTTLE <br />❑ TANK INSIDE BUILDING ❑ FIBER DRUM ❑ TOTE BIN <br />® STEEL DRUM ❑ BAG ❑ TANK WAGON <br />❑ PLASTICINONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE 19 AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />225 <br />%WT <br />HAZARDOUS COMPONENT For mixture or waste oni <br />EHS <br />CAS# <br />100 226 <br />WASTE PETROLEUM HYDROCARBONS 227 <br />❑ YES ONO 228 <br />MIXTURE <br />229 <br />230 <br />231 <br />0 YES 0 NO 232 <br />233 <br />234 <br />235 <br />0 YES ❑ NO 236 <br />237 <br />238 <br />239 <br />❑ YES ❑ NO 240 <br />241 <br />242 <br />243 <br />DYES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1270 <br />246 <br />(34) WHAT IS MATERIAL <br />USED FOR? AEITOMOTNE SERVICES <br />UPCF (Rev. 1212007) If EPCRA, Please Sign Here <br />