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UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/202009 -10:14:46 AM <br />Page of <br />L FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 <br />SEARS #1288/6791 <br />CHEMICAL LOCATION 201 <br />Iffiv1ICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />[EYES[:] NO <br />FACIIJTYID# 1 Mgi Sj / <br /> <br />H. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />1 TRADE SECRET (I 1) ❑ YES ® NO 206 <br />WASTE FLAMMABLES <br />if Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />WASTE FLAMMABLES <br />EHS* ❑ YES M 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 13 a PURE 13 h. MIXTURE g e. WASTE 211 <br />TYPE (Check one item only) <br />YES N NO 212 <br />RADIOACTIVE [3CURIES <br />213 <br />PHYSICAL STATE ❑ SOLE[) N LIQUID [3 GAS 234 <br />(Check one item only) <br />LARGEST CONTAINER 65 21 <br />FED HAZARD CATEGORIES IM FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH ❑ CHRONIC HEALTH 216 <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 />33 <br />65 <br />195 <br />214 <br />UNITS* ® GAL ❑ CU FT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE 222 <br />(Check on item only * If ERS, amount must be in pounds. <br />365 <br />1 <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 />N PLASTIC/NONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE fid AMBIENT ❑ ABOVE AMBIENT ❑ BELOW,AMBIENT 224 <br />STORAGE TEMPERATURE IS AMBIENT ❑ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%wr <br />HAZARDOUS COMPONENT or mixture or waste only <br />EHS <br />CAS# <br />100 226 <br />WASTE FLAMMABLES, UNSPECIFIED 227 <br />❑ YES ONO 228 <br />MIXTURE 229 <br />230 <br />231 <br />❑ YES ❑ NO 232 <br />233 <br />2.34 <br />2.15 <br />❑ YES ❑ NO 2.36 <br />237 <br />238 <br />239 <br />❑ YES ❑ NO 240 <br />241 <br />242 <br />243 <br />❑ YES ❑ NO 244 <br />245 <br />ADDTTIONALLOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? NIA <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />