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L <br />UNIFIED PICOGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 04:22:05 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 20[ <br />LOCATION CONFIDENTIAL EPCRA <br />202 <br /> <br />rMICAL <br />®YES® NO <br />FACQTTYTD# 1 <br />MAPedbySJ�����203/204 <br />Requited by S] <br />I <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (11) ❑ YES ® NO <br />206 <br />CASTROL SUPER CLEAN TOUGH TASK (FLOOR DEGREASER) <br />If Subject to EPCRA, refer to instntctiow <br />COMMON NAME 207 <br />208 <br />CASTROL SUPER CLEAN TOUGH TASK (FLOOR DEGREASER) <br />EHS p YES ONO <br />CAS # 209 <br />N/A I <br />*I€ 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 E3 a. PURE N b. MIXTURE 0 e. WASTE 211 <br />RADIOACTIVE ❑ YES N NO 212 <br />CURIES <br />213 <br />TYPE (Check one item only) <br />PHYSICAL STATE p SOLID 13 LIQUID ❑GAS 214 <br />(Check one item only) <br />GEST CONTAINER 5S <br />1 <br />FED HAZARD CATEGORIES ❑ FIRE ❑ REACTIVE []PRESSURE RELEASE O ACUTE HEALTH ❑ CHRONIC HEALTH <br />216 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 21? <br />MAXIMUM DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE <br />220 <br />28 <br />55 <br />N/A <br />N/A <br />UNITS* O GAL ❑ CU FT ❑ LRS ❑ TONS 221 1 <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 p 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 ❑ OTHER <br />223 <br />STORAGE PRESSURE 10 AMBIENT ❑ ABOVE AMBIENT p BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE IRAMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />225 <br />%WT HAZARDOUS COMPONENT (For mixture or waste only <br />EHS <br />CAS# <br />5-10 226 2-BUTOXYETHANOL 227 <br />® YES ® NO 228 <br />111-76-2 <br />229 <br />1-5 2.30 SODIUM XYLENESULFONATE L31 <br />DYES 19 NO 232 <br />1300-72-7 <br />233 <br />1-5 234 SODIUM HYDROXIDE 235 <br />❑ YES ONO 236 <br />1310-73-2 <br />237 <br />1-5 238 NONYLPHENOL ETHOXYLATE 2_39 <br />© YES ONO 240 <br />127087-87-0 <br />241 <br />1-5 242 SODIUM METASILICATE 243 <br />❑ YES ONO 244 <br />6834-92-0 <br />245 <br />PENT A T -TV T)P ATF <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A <br />2445 <br />(34) WHAT IS MATERIAL <br />USED FOR? IFLOOR CLEANER <br />UPCF (Rev. 12/2007) I€ EPCRA, Please Sign Here <br />