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11 <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />1{/21(2009 -1:14:46 AM <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 20l <br />IIEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />®YFS❑ NO <br />FACIIITYID# 1 <br />MAP#ORID#����203l204 <br />Required by SJ �'� <br />11. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />{-RADE SECRET (11) ❑ YES 11 NO 206 <br />NA <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />WASTE AEROSOLS <br />gI5 p y ®NO <br />CAS # 209 <br />MIXTURE <br />*If EHS is "Yes", all amounts must be in lbs. <br />FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 <br />LEAVE BLANK <br />HAZARDOUS MATERIAL ❑ a PURE ® b. MIXTURE ® c. WASTE 211 <br />RADIOACTIVE E3 YES 0 NO 212 <br />CURIES 213 <br />TYPE (Check one item only) <br />PHYSICAL STATE ® SOLID ❑ LIQUID ❑ GAS 214 <br />(Check one item only) <br />LARGEST CONTAINER 215 <br />65 <br />FED HAZARD CATEGORIES ® FIRE []REACTIVE 19 PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH 216 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 218ANNUAL <br />WASTE AMOUNT 219 <br />STATE WASTE CODE 220 <br />33 <br />65 <br />1195 1612 <br />UNTTS* H GAL ❑ CU FT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE 222 <br />(Check on item only * If EHS, amount must be in pounds. <br />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 />❑ STEEL DRUM ❑ BAG ❑ TANK WAGON <br />H PLASTIC/NONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE ❑ AMBIENT ® ABOVE AMBIENT ❑ BELOW AMBIENT 224 <br />STORAGE TEMPERATURE M AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%WT <br />HAZARDOUS COMPONENT For mixture or waste onl <br />EHS <br />CAS# <br />100 226 <br />WASTE AEROSOL CANS, UNSPECIFIED 227 <br />❑ YES ONO 228 <br />MIXTURE 229 <br />230 <br />231 <br />❑ YES ❑ NO 232 <br />233 <br />234 <br />235 <br />❑ YES ❑ NO 236 <br />237 <br />238 <br />2-;9 <br />❑ YES ❑ NO 240 <br />241 <br />242 <br />243 <br />❑ YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS TD# (DOT) 1950 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? COLLECTED FROM PUBLIC/DAMAGED GOODS FOR RECYCLING OFF SITE <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />