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UNIFIED PICOGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10114/2009.03:11:47 P <br />Page 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 20I <br />LOCATION CONFIDENTIAL EPCRA <br />202 <br /> <br />7CAL <br />®YES® NO <br />FACILITY ID# 1 <br />MAp�Gglp <br /> <br /> <br />1 <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (I 1) ❑ YES ® NO <br />206 <br />AQUEOUS PARTS WASHER <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 247 <br />208 <br />AQUEOUS PARTS WASHER <br />EHS* ❑ YES ®NO <br />CAS # 209 <br />N/A <br />*If EHS 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 MATERIAL ❑ a. PURE ❑ b. MIXTURE ® c. WASTE 211 <br />RADIOACTIVE YES N NO 212 <br />CURIES <br />213 <br />TYPE (Check one item only} <br />PHYSICAL STATE❑ SOLID ® LIQUID ❑ GAS 214 <br />(Check one item only) <br />LARGEST' CONTAINER 33 <br />21 <br />FED HAZARD CATEGORIES ❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE 0 ACUTE HEALTH ❑ CHRONIC HEALTH <br />216 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 2l AL WASTE AMOUNT 219 <br />STATE WASTE CODE <br />220 <br />17 <br />33 198 <br />343 <br />UNITS* N GAL ❑ CU FT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE <br />222 <br />(Check on item only * If EHS, amount must be in pounds. <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 />❑ PLASTIC/NONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER W OTHER <br />223 <br />STORAGE PRESSURE H AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE N AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />225 <br />%WT <br />HAZARDOUS COMPONENT or mixture or waste on[ <br />EHS CAS# <br />20 226 <br />SODIUM SILICATE 227 <br />❑ YES N NO 228 6834-92-0 <br />229 <br />70 230 <br />SODIUM CARBONATE 231 <br />❑ YES ONO 232 497-19-8 <br />233 <br />5234 <br />CELLULOSE, CARBOXYMETHYL ETHER, 235 <br />13YES M NO 736 9004-32-4 <br />237 <br />Cnn]TIM CAT T <br />239 <br />❑ YES ❑ NO 240 <br />241 <br />238 <br />242 <br />243 <br />❑ YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />246 <br />(34) WHAT IS MATERIAL <br />USED FOR? CLEANING AUTOMOTIVE PARTS <br />UPCF (Rev. 1212007) If EPCRA, Please Sign Here <br />