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UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 04:57:35 P <br />Page of <br />1. FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 <br />SEARS #1288/6791 <br />CHEMICAL LOCATION 20l <br />LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />7CAL <br />®YES ❑ NO <br />FACILITY ID# 1 <br />MAP#GRID#�����203/204 <br />Required by SI <br />II. CHEMICAL INFORMATION <br />CHEMICALNAME 205 <br />TRADE SECRET (11) ❑YES NNO 206 <br />WASTE CORROSIVE LIQUIDS - ACIDIC <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />EHS ❑ YES ENO 208 <br />WASTE CORROSIVE LIQUIDS - BASIC <br />CAS # 204 <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 D a. PURE p b. MIXTURE ®c. WASTE 211 <br />RADIOACTIVE ❑ YES ENO 212 <br />CURIES 213 <br />TYPE (Check one item only) <br />PHYSICAL STATE21 <br />(Check one item only) ❑SOLID ®LIQUID p GAS 214 <br />LARGEST CONTAINER 18 <br />FED HAZARD CATEGORIES p FIRE E REACTIVE ❑ PRESSURE RELF-ASE R ACUTE HEALTH N CHRONIC HEALTH 216 <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 217 <br />MAXIMUM DAILY AMOUNT 21 <br />ANNUAL ,AMOUNT 219 <br />STATE WASTE CODE 220 <br />7.5 <br />18 <br />60 <br />135 <br />UNITS* ® GAL ❑ CU FT ❑ LBS ❑ TONS 221 1 <br />DAYS ON 51`1711 222 <br />(Check on item only * If ERS, amount must be in pounds. <br />365 <br />STORAGE ❑ ABOVE GROUND TANK ❑ CARBOY ❑ GLASS BOTTLE p Other... <br />CONTAINER ❑ UNDER GROUND TANK ❑ SILO ❑ PLASTIC BOTTLE <br />❑ TANK INSIDE BUILDING ❑ FIBER DRUM M TOTE BIN <br />❑ STEEL DRUM ❑ BAG ❑ TANK WAGON <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER 223 <br />STORAGE PRESSURE 0 AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT 224 <br />STORAGE TEMPERATURE E AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%WT <br />HAZARDOUS COMPONENT For mixture or waste only <br />ERS <br />CASSE <br />100 226 <br />Waste Acidic Corrosives, Unspecified 227 <br />0 YES ® NO 228 <br />Mixture 229 <br />230 <br />231 <br />❑ YES ❑ NO 232 <br />233 <br />234 <br />235 <br />® YES O NO 236 <br />237 <br />234 <br />© YES ©NO 240 <br />241 <br />238 <br />242 <br />243 <br />© YES ❑ NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS DD# (DOT) N/A 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? N/A <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />