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UNIFIED PROGRAM CONSOLIDATED FORST <br /> FACILITY IN -1ION ' <br /> BUSINESS ACTIVITIES I <br /> Paelof <br /> =FacJityNmc <br /> . FACILITY IDENTIFICATION <br /> FACILITI EPA ID p f}lararduus Waste ONy) , <br /> CAT 000 646 182 <br /> BUSINEA-Doing Business As) <br /> Sil <br /> 11. ACTIVITIES DECLARATION <br /> NOTE: If you check YES to any part of this list, <br /> lease Submit the Business Owner/O razor 7ficatnoOES Form 2730). <br /> Does Your facility... m Tete these pages of the UPCF.... <br /> rU�NDERGROIJND <br /> ZARDOUS MATERIALS <br /> n site(for any purpose)hazardous materials at or above 55 gallons <br /> ids, 500 pounds for solids, or 200 cubic feet for compressed gases <br /> liquids in ASTs and <br /> US <br /> or the applicable Federal threshold HAZARDOUS MATERIALS INVENTORY <br /> for an extremely hazardous substance specified in 40 CFR Part -CHEMICAL DESCRIPTION(DES 2731) <br /> pendix A or B; or handle radiological materials in quantities for <br /> n emergency plan is required pursuant to 10 CFR Parts 30, 40 or <br /> ERGROUND STORAGE TANKS(USTs) UST FACILITY(Formerly swacB Form A) <br /> Own or operate underground storage tanks? ❑YES Ci} NO 5 UST TANK(om pare per sot)(Fmely Farm B) <br /> ntend to upgrade existing or install new USTs? ❑YES ER NO 6 UST FACILITY <br /> i <br /> UST TANK(m per off) <br /> UST INSTALLATION- CERTIFICATE OF <br /> COMPLIANCE(om pup per uric)(Formerly Form <br /> n <br /> 3. Need to report closing a UST? ❑YES JU NO 7 UST TANK Moose portion- page per ort) <br /> C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) <br /> Own or operate ASTs above these thresholds: <br /> ---any tank capacity is greater than 660 gallons, or ❑YES lI NO g NO FORM REQUIRED TO CUPAs <br /> —the total capacity for the facility is greater than 1,320 gallons? <br /> D. HAZARDOUS WASTE <br /> i <br /> I. Generate hazardous waste? ®YES ❑ NO 9 EPA ID NUMBER-provide at the top of <br /> this page <br /> 2. Recycle more than 100 kg/month of excluded or exempted RECYCLABLE MATERIALS REPORT om I <br /> recyclable materials(per HSC 25143.2)? ❑YES j NO 10 per reey W) <br /> 3. Treat hazardous waste on site? ONSITE HAZARDOUS WASTE <br /> [�YES 0-- NO I 1 TREATMENT-FACILITY(F.iy orsc <br /> Farm 17n) <br /> ONSITE HAZARDOUS WASTE <br /> TREATMENT-UNIT (om page per unid <br /> (Fo yDTSC F.IM A.B.C.D and <br /> 4. Treatment subject to financial assurance requirements(for CERTIFICATION OF FINANCIAL <br /> Permit by Rule and Conditional Authorization)? ® YES ❑ NO 12 ASSURANCE(Formerly DTsc Form Int) <br /> 5. Consolidate hazardous waste generated at a remote site? REMOTE WASTE/CONSOLIDATION <br /> ❑YES ® NO 13 SITE ANNUAL NOTIFICATION(Fo ny <br /> DTSC Fs 1196) <br /> 6. Need to report the closure/removal of a tank that was classified as ❑ YES C1 NO 14 HAZARDOUS WASTE TANK CLOSURE <br /> hazardous waste and cleated onsite? CERTIFICATION(Fwmedy DISC Form 1249) <br /> E. LOCAL REOUIREMENTS 15 <br /> (You may Also be required to provide additional infortnanon by your CUPA or local agency.) <br /> UPCF(1/99) 2 <br />