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UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEWCAL DESCRIPTION <br />10/14/2009 - 04:57:34 PM <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 />LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />rHEMICAL <br />®YES® NO <br />FACILITY TD# I <br />MAP# ?#�� 203/204 <br />Required by $J <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (1 t) [3 YES ®NO 206 <br />WASTE CORROSIVE LIQUIDS - BASIC <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />WASTE CORROSIVE LIQUIDS - BASIC <br />EHS* ❑ YES 01 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 <br />TYPE (Check one item only) ❑ a. PURE E3 b. MIXTURE ® c. wAsm 211 <br />RADIOACTIVE E3YES 0 NO 212 <br />CURIES 213 <br />PHYSICAL STATE ❑ SOLID IR LIQUID ❑ GAS 214 <br />(Check one item only) <br />LARGEST CONTAINER 1 <br />18 <br />FED HAZARD CATEGORIES ❑ FIRE ® REACTIVE ❑ PRESSURE RELEASE 19ACUTE 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 />75 <br />jig <br />60 <br />123 <br />UNTTS* N GAL ❑ CU FT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE 222 <br />(Check on item only * If EHS, 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 N TOTE BIN <br />❑ STEEL DRUM ❑ BAG ❑ TANK WAGON <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE 19 AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT 224 <br />STORAGE TEMPERATURE 0 AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%WT <br />HAZARDOUS COMPONENT For mixture or waste on] <br />EHS <br />CAS# <br />100 226 <br />WASTE BASIC CORROSIVES, 227 <br />❑ YES ® NO 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 />239 <br />❑ YES [3 NO 240 <br />241 <br />242 <br />243 <br />® YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS IDR (DOT) N/A 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? N!A <br />UPCF (Rev. 1212007) If EPCRA, Please Sign Hcre <br />