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1-1 <br />L <br />UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 04:51:37 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 2pi <br />ICAL LOCATION CONFIDENTIAL EPCRA <br />202 <br /> <br />QX YES ® NO <br />FACILITY IDI` 1 <br />Rqt;d by Sl / <br /> <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />1 TRADE SECRET (11) ❑ YES M NO <br />206 <br />NA <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />USED LEAD WEIGHTS <br />IIIS ❑ YES ®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) <br />210 <br />LEAVE BLANK <br />HAZARDOUS MATERIAL ®a, PURE p b. MIXTURE M a WASTE 211 <br />RADIOACTIVE ❑ YES ONO 212 <br />CURIES NA <br />213 <br />TYPE (Check one item only) <br />PHYSICAL STATE NSOLM ❑LIQUID ❑GAS 214 <br />(Check one item Drily) <br />LARGEST 5 <br />1 <br />FED HAZARD CATEGORIES ❑ FIRE ❑ REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH O CHRONIC HEALTH <br />216 <br />(Check all that apply) <br />AVERA13EDAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 21 <br />ANNUAL WASTE AMOUNT 219 <br />STATE WASTE CODE <br />220 <br />20 <br />60 <br />200 <br />181 <br />UNITS* ❑ GAL ❑ CU FT 0 LBS ❑ TONS 221 1 <br />DAYS ON SITE <br />222 <br />(Check on item only * If EHS, amount must be in pounds. <br />354 <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 />10 PLASTICINONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT <br />224 <br />STORAGE TEMPERATURE 0 AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />225 <br />%WT HAZARDOUS COMPONENT or mixture or waste only <br />EHS <br />CAS# <br />100 226 LEAD, UNSPECIFIED 227 <br />0 YES ONO 228 <br />MIXTURE <br />229 <br />230 231 <br />❑ YES ❑ NO 232 <br />233 <br />234 235 <br />❑ YES []No 236 <br />137 <br />238 239 <br />❑ YES ❑ NO 240 <br />241 <br />242 243 <br />❑ YES LINO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) NA <br />246 <br />(34) WHAT IS MATERIAL <br />USED FOR? IATJTOMOTTVE MAINTENANCE <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />