Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br />10/14/2009 - 04:57:36 PM <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 10, <br />HEMICAL LOCATION CONFIDENTIAL EPCRA 202 <br /> <br />®YES® NO <br />FACILITY ID# 1 <br />pD# 203(204 <br />RequiredM ! <br />� <br />II. CHEMICAL INFORMATION <br />CHEMICAL NAME 205 <br />TRADE SECRET (i 1) ❑ YES C9 NO 206 <br />WASTE TOXICS <br />If Subject to EPCRA, refer to instructions <br />COMMON NAME 207 <br />208 <br />WASTE TOXICS <br />EHS' ❑ YES 12 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 p b. MIXTURE <br />TYPE (Check one item only) 0 c. WASTE 211 <br />RADIOACTIVE ❑ YES IN NO 212 <br />CURIES 213 <br />PHYSICAL SPATE❑ SOLID 0 LIQUID ❑ GAS 214 <br />(Check one item only) <br />215 <br />LARGEST CONTAINER 18 <br />FED HAZARD CATEGORIES ❑ FIRE IR REACTIVE ❑ PRESSURE RELEASE ® ACUTE HEALTH216 <br />®CHRONIC HEALTH <br />(Check all that apply) <br />AVERAGE DAILY AMOUNT 277 <br />MAXIMUM DAILY AMOUNT 21 <br />ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 <br />13.5 <br />136 <br />108 133 <br />UNITS* H GAL ❑ CU IT ❑ LBS ❑ TONS 221 <br />DAYS ON SITE 222 <br />(Check on item only * If EHS, amount must be in pounds. <br />1 365 <br />STORAGE ❑ ABOVE GROUND TANS ❑ CARBOY ❑ GLASS BOTTLE ❑ Other... <br />CONTAINER ❑ UNDER GROUND TANK ❑ SILO ❑ PLASTIC BOTTLE <br />❑ TANS INSIDE BUILDING ❑ FIBER DRUM 19 TOTE BIN <br />❑ STEEL DRUM ❑ BAG ❑ TANK WAGON <br />❑ PLASTIC/NONMETALLIC DRUM p BOX ❑ RAIL CAR <br />❑ CAN ❑ CYLINDER ❑ OTHER <br />223 <br />STORAGE PRESSURE ® AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT 224 <br />STORAGE TEMPERATURE O AMBIENT ❑ ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC 225 <br />%WT HAZARDOUS COMPONENT (For mixture or waste only <br />EHS <br />CAS# <br />100 226 Waste Toxics, Unspecified 227 <br />❑ YES ® NO 228 <br />Mixture 229 <br />230 231 <br />❑YES ❑ NO 232 <br />233 <br />234 235 <br />❑ YES ❑ NO 236 <br />237 <br />238 239 <br />❑ YES ❑ NO 240 <br />241 <br />242 243 <br />❑ YES 0 NO 244 <br />245 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) N/A 246 <br />(34) WHAT IS MATERIAL <br />USED FOR? <br />UPCF (Rev. 12/2007) If EPCRA, Please Sign Here <br />