Laserfiche WebLink
UNIFIED PROGRAM CONSOLIDATED FORM <br />HAZARDOUS MATERIALS <br />HAZARDOUS MATERIALS NVENTORY -- CHEMICAL DESCRIMON <br />esus .► w a. <br />ADD ❑DELETE ❑ REVISE page -of- <br />L FACILITY INFORMATION <br />BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3. <br />E <br />CHEMICAL LOCATION 201 <br />CHEMICAL LOCATION CONFMENTIAL EPCRA zo2 <br />❑ YES ®NO <br />FACILITY D# <br />1. <br />MAP # 2IXi. <br />GRID # 2" <br />(4-WU-O*) IF <br />-JAM( <br />3]'r <br />IL CHEMICAL INFORMATION <br />CHEMICAL NAME <br />TRADE SECRET Yes No w6 <br />RF_®® g y� q ®®p ` �y G res. <br />CA L 1 ` M M L E: y f± vO U RI <br />IfSnbjaet to BPCRA, rimer to m0mdiamt <br />COMMON NAME 2W. <br />Yom. <br />8-7 & A S O L.1 M 0 <br />EMs 0 Yes ❑ No <br />CAN 209. <br />® (o ` - <br />*1f EHS is -Yes," all amounts below must be in lbs. <br />FIRE CODE HAZARD CLASSES (caaplata ifea""d by "cd rgmoy) 210. <br />C=LA p LE: Lt tct <br />HAZARDOUS MATERIAL <br />TYPE (Chock ow Ilam only) ❑ a PURE Elb. MIXTURE ❑ m WASTE 211. <br />RADIOACTIVE ❑ Yes JUNo 212 <br />213. <br />CURIES <br />PHYSICAL STATE <br />215. <br />(Check one item only) ❑ a. SOLID Rb. LIQUID ❑ c. OAS 214. <br />LARGEST CONTAINER 151 0 I4 L. <br />FED HAZARD CATEGORIES 216 <br />(Check ell that apply) lg a. FIRE M b. REACTIVE ❑ c. PRESSURE RELEASE Rd ACUTE HEALTH e. CHRONIC HEALTH <br />AVERAGE DAILY AMOUNT 217. <br />DAILY AMOUNT 218 <br />ANNUAL WASTE AMOUNT 219. <br />STATE WASTE CODE 7 22o. <br />t ` <br />[ t <br />1 <br />UNITS. 19 a. GALLONS E3b. CUBIC FEET ❑ c. POUNDS E3d TONS 221. <br />DAYS ON SITE 232. <br />- <br />Clack me item * NEES amowt must be in potaxis. <br />36 57 <br />STORAGE <br />CONTAINM ❑ a ABOVEGROUND TANK ❑ a. PLASTIC/NONMETALLIC DRUM ❑ i. FIBER DRUM ❑ m. GLASS BOTTLE ❑ q. RAIL CAR <br />Qb. UNDERGROUND TANK ❑ E CAN Eli. BAG ❑ a PLASTIC BOTTLE Q r. OTHER <br />❑ c. TANK INSIDE BUILDING ❑ g. CARBOY ❑ k. BOX ❑ o. TOTE BIN <br />❑ d STEEL DRUM ❑ h SILO CIL CYLINDER ❑ p. TANK WAGON 223. <br />STORAGE PRESSURE tffa. AMBIENT ❑ b. ABOVE AMBIENT ❑ c. BELOW A14BEENT 224. <br />STORAGE TEMPERATURE 'a a. AMBIENT Q b. ABOVE AMBIENT 0 c. BELOW AAMENT ❑ d CRYOGENIC Its. <br />% WT <br />HAZARDOUS COMPONENT (For mixture or waste only) <br />EHS <br />CAS # <br />i.i\c 226 <br />227. <br />Yea [3 No 225. <br />) ^/1 <br />y® I ® 229. <br />2 CIA.4123a <br />,ry <br />^ v t� l 231. <br />(� Yes ❑ NO 232 <br />/y` - B 233. <br />VCO �p <br />3. 234. <br />235. <br />❑ Yes ❑ No 236. <br />237. <br />4. 238 <br />239. <br />❑Yea ❑ No 240. <br />Zai. <br />5. 242 <br />243. <br />❑ Yes ❑ No 244. <br />zas. <br />If rare bwardom cauqKmaaaft are present at gsator ehr I% byweight p e, or 0.14E by wef t H atm additloaei rhe®ts of paper aptarmg fho regahad <br />ADDITIONAL LOCALLY COLLECTED INFORMATION 446 <br />DOT Hazard Class: _ C bt tit %-a o <br />XEPCRA, Plesse Sign Hate. <br />UN-020UPCF - 7/13 www.un"o-om Rev. 01/1682 <br />