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C <br />El <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 04:22:05 PM <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 2p1 <br />CAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />E YES[—]NO <br />FACILITY ID# 1 <br />�� b# / 203/204 <br />y SX <br />11. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (11) ❑ YES ® NO 206 <br />HELIUM <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />HELIUM <br />EHS* ❑ YES ONO <br />CAS # 209 <br />7440_$9-7 <br />*If EHS is "Yes", all amounts must be in lbs. <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 2I0 <br />LEAVE BLANK <br />HAZARDOUS MATERIAL ®a. PURE p b. MIXTURE O c. W ASTE 211 <br />TYPE (Check one item only) <br />RADIOACTIVE ❑ YES IM NO 212 <br />CURIES 213 <br />PHYSICAL STATE ❑ SOLID ❑ LIQUID N GAS 214 <br />(Check one item only) <br />LARGEST CONTAINER 244 21 <br />FED HAZARD CATEGORIES ❑ FIRE ❑ REACTIVE 0 PRESSURE RELEASE ❑ ACUTE HEALTH CHRONIC HEALTH 216 <br />13 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE 220 <br />122 <br />488 <br />N/A <br />N/A <br />UNITS* ❑ GAL IM CU FT ❑ LBS ❑ TONS 221 <br />1 DAYS ON SITE 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 ❑ SELO ❑ PLASTIC BOTTLE <br />❑ TANK INSIDE BUILDING ❑ FIBER DRUM ❑ TOTE BIN <br />❑ STEEL DRUM ❑ BAG El TANK WAGON <br />❑ PLAS'TICINONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN Il@ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE ❑ AMBIENT IM ABOVE AMBIENT ❑ BELOW AMBIENT 224 <br />STORAGE TEMPERATURE IRAMBIENT ❑ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%WT <br />1HAZARDOUS COMPONENT For mixture or waste on[ <br />EHS <br />CAS# <br />226 <br />227 <br />❑ YES ❑ NO 228 <br />229 <br />230 <br />231 <br />❑ YES ❑ NO 232 <br />233 <br />234 <br />235 <br />❑ YES ❑ NO 236 <br />237 <br />2.38 <br />239 <br />D ❑ NO 240 <br />241 <br />242 <br />243 <br />❑ YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) 1046 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? FILLING BALLOONS <br />UPCF (Rev. 1212007) If EPCRA, Please Sign Here <br />