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r� <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 03:11:49 PM <br />Page of <br />I. FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) <br />3 <br />SEARS #128&16791 <br />CHEMICAL LOCATION 201 <br />LOCATION CONFIDENTIAL EPCRA <br />202 <br /> <br />7CAL <br />®YES[] NO <br />FACILITY ID# 1 <br />MAby #� ���203/204 <br />Requitedired by <br />H. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (I I) ❑ YES ®NO <br />206 <br />USED BRAKE FLUID <br />if Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />USED BRAKE FLUID <br />EHS* ❑ YES ENO <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 0 a. PURE ❑ b. MIXTURE 0 c. WASTE 211 <br />TYPE (Check one item only) <br />RADIOACTIVE ❑ YES IN NO 212 <br />CURIES <br />213 <br />PHYSICAL STATE <br />❑ SOLID R LIQUID ❑ GAS 214 <br />(Check one item only) <br />LARGEST CONTAINER 30 <br />215 <br />FED HAZARD CATEGORIES I$ FIRE []REACTIVE ❑ PRESSURE RELEASE M ACUTE HEALTH ❑ CHRONIC HEALTH <br />216 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 2I <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE <br />220 <br />15 <br />30 <br />60 <br />343 <br />UNITS* O GAL ❑ CU FP ❑ LBS ❑ TONS 2211 <br />DAYS ON SITE <br />222 <br />(Check on item only * If EHS, amount must be in pounds. 1365 <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 />0 STEEL DRUM ❑ BAG ❑ TANK WAGON <br />❑ PLASTICINONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE N AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE N AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />225 <br />45WT <br />HAZARDOUS COMPONENT (For mixture or waste only <br />EHS <br />CAS# <br />100 226 <br />PROPRIETARY MIXTURE 227 <br />❑ YES ONO 228 <br />MIXTURE <br />229 <br />230 <br />731 <br />❑ YES ❑ NO 232 <br />233 <br />214 <br />235 <br />❑ YES ❑ NO 236 <br />237 <br />238 <br />239 <br />❑ YES ❑ NO 240 <br />241 <br />242 <br />243 <br />❑ YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1.118 <br />246 <br />(34) WHAT IS MATERIAL <br />USED FOR? AUTOMOTIVE SERVICES <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />