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Home My WebLink About6501 WHITE LANEBUSINESS ACTIVITIES KERIN COUNTY ENVIRONNIENTAL BFALTH SERVICES Unified Program Consolidated Form (UPCF) FACILITY INFORMATIONDPARnIREET, SUITE 340 BAKERSFIELD, CA 93301 b61 862 -8700 Fax 661 862.8701 Page I of I. FACILITY IDENTIFICATION FACILITY ID # (AgencyUseoalp) t 9EPAID (Hazardous Waste Only) 2 CAL000370661 BUSINESS NAME {Satre as Facility Name ofDBA -Doing Business As) 3 Valvoline Instant Oil Change GN -0109 BUSINESS SITE ADDRESS 103 6501 White Lane BUSINESS SITE CITY 104 DE 105 Bakersfield CA 193309 IL ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, tease submit the Business Owner/ Operator Identification page (KC Form 2730). Does your facility... IfYes, lease con lete these ales ofthe UPCF.... A. HAZARDOUS;4TATERIALS 4 Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS EqVE,yTORY 55 gallons for liquids, 500 pounds for solids, or200 cubic feet for compressed YES El NO CHEMICALDESCRIPTION gases (include liquids in ASTs and USTs); ortheapplicableFederalthreshold quantityforan extremely hazardous substance specified in 40 CFR Part 355, CONSOLIDATED CONTINGENCY PLAN Appendix A or B; or handle radiological materials in quantities for which an SITE MAP emergency lan is required ursrrant to 10 CFR Parts 30, 40 or 70? B. REGLTLATED SUBSTANCES 4a Have Regulated Substances stored onsite in quantities greaterthan the threshold CaIARP— REGULATED SUBSTANCE quantities established by the California Accidental Release prevention Program YES X NO REGISTRATION (KC F.2736) CaIARP)? C. UhIDERGROUIVD STORAGE TANXS (USTs) 5 UST FACILITY (KCForm Own or operate underground storage tanks? YES >< NO UST TANK (owpsge pe, t *) (Kc Form B) D. ABOVE GROUND PETROLEUI4T STORAGE 8 Own or operate ASTs above these thresholds: ater than 1,320 gallons ofpetroleum products (new or used) inStoregreater YES ONO NO FORM REQUIItID TO KCEHSD aboveground tanks or containers. E. HAZARDOUS NVASTE 9 EPA ID NUMBER — pmvide at the top of Generate hazardous waste? X YES NO this page HAZ WASTEGENERATOR FORM Recycle [Wore than 100 kg /month of excluded or exempted recyclable 10 YES X NO RECYCLABLE MATERIALS REPORT materials (perHSC 25143.2)? pergl)(KCFarm273') 11 ON -SITE HAZARDOUS WASTE TREATMENT — FACE ITY (KcF. tTr2p Treat hazardous waste on -site? YES ONO ON _SITE HAZARDOUS WASTE TREATMENT — INT IT (one pap permot) C Form 177 - Treatment subject to financial assurance requirements (for Permit by Rule and 12 YES NOQX CERTIFICATION OFFINANCIAL Conditional Authorization)? ASSURANCE (KCForm 1232) Consolidate hazardous waste generated ata remote site? El YES 0 NO 3 REMOTE UASTE f CONSOLIDATION S[TE ADINTIALNOTTFICATTON Need to report the closure/removal of a tank that was classified as 14 HAZARDOUS R'ASTE TANK CLOSURE hazardous waste and cleaned on -site? YES NO CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2;200 pounds) or 14a YES ENO Obtain federal EPA IDNumber; file more offederal RCRA hazardous waste, or generate in any single calendar Biennial Report (EPAForm 8700 - month, or accumulate at any time, 1 kg (2.2 pounds) ofRCRA acute hazardous 13AtB), and satisfy requirements forwaste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quantity Generator, spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? YES X NO b NO FORM REQUIRED TO KCEHSD F. LOCAL REQUIREIVI ENTS 15 A copy ofthe facility's ContingencylEmergencyResponse Plan is to be included with the original submission of the Business Plan. KCE-ISD is to be informed ofany revisions to the plan. Please contact KCEHSD at the above number for assistance in completing the plan 05 -008 raised KC Form2729 UNIFIED PROGRAM (UP) FORM BUSINESS OWNER /OPERATOR IDENTIFICATION 0 NEW BUSINESS 0 OUT OF BUSINESS 0 REVISE /UPDATE (EFFECTIVE / / ) PAGE OF I. IDENTIFICATION FACILITY ID# HM ARP AST UST TP CUPA PA INSPECTOR DISTRICT DATE OF INSPECTION I DIVISION 1 BEGINNING DATE 100 March 1, 2012 ENDING DATE 101 BUSINESS NAME (Same as FACILITY NAME or DBA— Doing Business As) 3 Valvoline Instant Oil Change GN -0109 BUSINESS PHONE 102 661) 837 -0245 BUSINESS SITE ADDRESS 6501 White Lane 103 City Bakersfield 104 CA ZIP CODE 93309 105 DUN & BRADSTREET 106 SIC CODE (4 digit #) 7549 107 COUNTY Kern 108 UNINCORPORATED ! Yes r No 133a. BUSINESS OPERATOR NAME 109 Henley Pacific LA LLC BUSINESS OPERATOR PHONE 110 617) 243 -0404 II. BUSINESS OWNER OWNER NAME 111 Henley Pacific LA LLC OWNER PHONE 112 617) 243 -0404 OWNER MAILING ADDRESS 113 54 Jaconnet Street, Suite 100 CITY Newton Highlands 114 FSTATE MA 115 ZIP CODE 02461 116 111. ENVIRONMENTAL CONTACT CONTACT NAME 117 Keith Rondeau CONTACT PHONE 118 617) 243 -0404 CONTACT MAILING ADDRESS 119 54 Jaconnet Street, Suite 100 CITY Newton Highlands 120 STATE MA 121 1 ZIP CODE 02461 122 PRIMARY- IV. EMERGENCY CONTACTS -SECONDARY - NAME Hugo Luevano 123 NAME Steven Lynn 126 TITLE Area Manager 124 TITLE Director of Operations 129 BUSINESS PHONE (714) 376 -5266 125 BUSINESS PHONE (760) 638 -6968 130 24 -HOUR PHONE (714) 376 -5266 126 24 -HOUR PHONE (760) 638 -6968 131 PAGER # N/A 127 PAGER # NIA 132 V. ADDITIONAL LOCALLY COLLECTED INFORMATION 133 NUMBER OF EMPLOYEES 133b FEDERAL TAX IDENTIFICATION NUMBER 133c MAILING/ BILLING INFORMATION ADDRESS 133d CITY 133e STATE 133f ZIP CODE 1339 54 Jaconnet Street, Suite 100 Newton Highlands I MA 02461 Certification: Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. SIGNATURE OF OWNER/ PER R OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 Kelly-Ann Taintor NAME OF SIGNER (print) 136 Todd F. Nelson TITLE SIGNER 137 President OFFICIAL USE ONLY UP Form HW HM ARP AST UST TP CUPA PA INSPECTOR DISTRICT DATE OF INSPECTION I DIVISION BATTALION STATION UP Form (1/2000 Full Version) CONSOLIDATED CONTINGENCY PLAN COVER PAGE FACILITY IDENTIFICATION BUSINESS NAME Valvoline Instant Oil Change GN -0109 3 FACILITY ID # SITE ADDRESS 103 CITY 104 ZIP CODE 105 6501 White Lane Bakersfield 93309 Cover Page, Sections I and II, and Site Map(s) The Consolidated Contingency Plan provides businesses a format to comply with the emergency planning requirements of the following three written hazardous materials emergency response plans required in California: Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729 - 2732), a Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.52), and, a Underground Storage Tank Emergency Response Plan and Monitoring Program (23 CCR Sections 2632 and 2641). This format is designed to reduce duplication in the preparation and use of emergency response plans at the same facility, and to improve the coordination between facility response personnel and local, state and federal emergency responders during an emergency. Use the chart below to determine which sections of the Consolidated Contingency Plan need to be completed for your facility. If you are unsure as to which programs your facility is subject to, refer to the Business Activities Page. PROGRAMS SECTION(S) TO BE COMPLETED Hazardous Materials Business Plan (HMBP) Cover Page, Section I, and Site Map(s) Hazardous Waste Generator (HWG) Cover Page, Section I, and Site Map(s) Underground Storage Tank (UST) Cover Page, Sections I and ll, and Site Map(s) HMBP, HWG, UST Cover Page, Sections I and II, and Site Map(s) A copy of the plan shall be submitted to your local CUPA and at least one copy of the plan shall be maintained at the facility for use in the event of an emergency and for inspection by the local agency. Describe below where a copy of your Contingency Plan, including the hazardous material inventories and Site Map(s), is located at your business: Located in the manager's office in a file cabinet. PLAN CERTIFICATION I certify under penalty of law that I have personally examined and 1 am familiar with the information provided by this plan and to the best ofmy knowledge the information is accurate, complete, and true. Printed Name of Owner/ Operator Henley Pacific LA LLC —Todd F. Nelson, Title of Owner /Operator President Signature of Owner/ Oper or A Date J We appreciate the effort of local businesses in completing these plans and will assist in every possible way. If you have any questions, please contact your local CUPA or PA. UP Form (1/2000 Full Version) Unified Program (UP) Form CONSOLIDATED CONTINGENCY PLAN SECTION I: BUSINESS PLAN AND CONTINGENCY PLAN I. FACILITY IDENTIFICATION BUSINESS NAME Valvoline Instant Oil Change GN -0109 3 FACILITY ID # 1 SITE ADDRESS 103 CITY 104 ZIP CODE 105 6501 White Lane 1 Bakersfield 93309 II. EMERGENCY CONTACTS PRIMARY SECONDARY NAME 123 NAME 128 Hugo Luevano Steven Lynn TITLE 124 TITLE 129AreaManagerDirectorofOperations BUSINESS PHONE 125 BUSINESS PHONE 130 714) 376 -5266 760) 638 -6968 24 -HOUR PHONE 126 24 -HOUR PHONE 131 714) 376 -5266 760) 638 -6968 PAGER # 127 PAGER # 132 N/A I N/A Ill. EMERGENCY RESPONSE PLANS AND PROCEDURES A. Notifications Your business is required by State Law to provide an immediate verbal report of any release or threatened release of a hazardous material to local fire emergency response personnel, this Unified Program Agency (CUPA or PA), and the Office of Emergency Services. If you have a release or threatened release of hazardous materials, immediately call: FIRE /PARAMEDICS /POLICE /SHERIFF PHONE: 911 AFTER the local emergency response personnel are notified, you shall then notify this Unified Program Agency and the Office of Emergency Services. Local Unified Program Agency: ( ) State Office of Emergency Service: (800) 852 -7550 or (916) 262 -1621 National Response Center: (800) 424 -8802 Information to be provided during Notification: 0 Your Name and the Telephone Number from where you are calling. 0 Exact address of the release or threatened release. u: Date, time, cause, and type of incident (e.g. fire, air release, spill etc.) a Material and quantity of the release, to the extent known. 0 Current condition of the facility. Extent of injuries, if any. U3 Possible hazards to public health and/ or the environment outside of the facility. B. Emergency Medical Facility List the local emergency medical facility that will be used by your business in the event of an accident or injury caused by a release or threatened release of hazardous material HOSPITAL /CLINIC: PHONE NO: White Lane Urgent Care 1(661) 8364000 ADDRESS: 5401 White Ln CITY: ZIP CODE: Bakersfield 193309 OFFICIAL USE ONLY DATE RECEIVED REVIEWED BY DIV BN STA OTHER DISTRICT CUPA PA UP Form (1/2000 Full Version) Unified Program (UP) Form CONSOLIDATED CONTINGENCY PLAN SECTION I: BUSINESS PLAN AND CONTINGENCY PLAN C. Private Emergency Response DOES YOUR BUSINESS HAVE A PRIVATE ON -SITE EMERGENCY RESPONSE TEAM? r Yes R' No If yes, provide an attachment that describes what policies and procedures your business will follow to notify your on -site emergency response team in the event of a release or threatened release of hazardous materials. CLEANUP /DISPOSAL CONTRACTOR List the contractor that will provide cleanup services in the event of a release. NAME OF CONTRACTOR: PHONE NO: Asbury Environmental 310 - 886 -3400 ADDRESS: 2100 N Alameda Street CITY: ZIP CODE: Compton 90222 D. Arrangements With Emergency Responders If you have made special (i.e. contractual) arrangements with any police department, fire department, hospital, contractor, or State or local emergency response team to coordinate emergency services, describe those arrangements on the lines below: E. Evacuation Plan 1. The following alarm signal(s) will be used to begin evacuation of the facility (check all which apply): R Verbal Telephone (including cellular) Alarm System Public Address System Intercom Pagers Portable Radio Other (specify): 2. Evacuation map is prominently displayed throughout the facility. 3. W Individual(s) responsible for coordinating evacuation including spreading the alarm and confirming the business has been evacuated: Manager and or Assistant Manager F. Earthquake Vulnerability Identify areas of the facility where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. r Hazardous Waste/ Hazardous Materials Storage Areas r Production Floor r Process Lines r Bench/ Lab r Waste Treatment r Other: Identify mechanical systems where releases could occur or would require immediate inspection or isolation because of the vulnerability to earthquake related ground motion. Utilities r Sprinkler Systems r Cabinets r Shelves r Racks r Pressure Vessels I Gas Cylinders I Tanks r Process Piping r Shutoff Valves 1— Other: UP Form (1/2000 Full Version) Unified Program (UP) Form CONSOLIDATED CONTINGENCY PLAN SECTION I: BUSINESS PLAN AND CONTINGENCY PLAN G. Emergency Procedures Briefly describe your business standard operating procedures in the event of a release or threatened release of hazardous materials: 1. PREVENTION (prevent the hazard) - Describe the kinds of hazards associated with the hazardous materials present at your facility. What actions would your business take to prevent these hazards from occurring? You may include a discussion of safety and storage procedures. Types of Hazards are leaks ands ill oil and antifreeze). All containers are located in the basement with concrete walls. All tanks are inspected and maintained daily. 2. MITIGATION (reduce the hazard) - Describe what is done to lessen the harm or the damage to person(s), property, or the environment, and prevent what has occurred from getting worse or spreading. What is your immediate response to a leak, spill, fire, explosion, or airborne release at your business? Tanks are in the basement where there is no public access allowed. Tanks are in a closed system no manual filling or emptying. All done via remote pipe system. Immediate response is to contain hazard, call Fire Department and move to safety. 3. ABATEMENT (remove the hazard) - Describe what you would do to stop and remove the hazard. How do you handle the complete process of stopping a release, cleaning up, and disposing of released materials at your facility? All spills are contained using absorbent socks. Clean up is done w /towels that are sent for disposal or cleaned by our recycling company. Asbury Environmental. UP Form (1/2000 Full Version) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION one page per matenal per buildin orarea ADD DELETE REVISE REPORTING YEAR 200 1 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 Valvoline Instant Oil Change GN -0109 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA) ® YES NO Basement 1 MAP# (optionap 203 GRID# (optional) 204 FACILITY ID # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET (9-Yes No 206 Ethylene Glycol IfSubjectto EPCRA, refer to instructions COMMON NAME New Antifreeze /Coolant 207 EHS* Yes ® No 209 209CAS# If EHS is "Yes ", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete ifrequired by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) a. PURE ®b. MIXTURE El c. WASTE 211 RADIOACTIVE Yes ON, 212 213 CURIES N/A PHYSICAL STATE Check one item only) a. SOLID ®b. LIQUID C3 c. GAS 214 215 LARGEST CONTAINER 20 FED HAZARD CATEGORIES 216 Check all that apply) Z a. FIRE b. REACTIVE c. PRESSURE RELEASE ® d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 80 1 165 1 3000 1 133 DAYS ON SITE: 222 d. TONSUNITS` ®a. GALLONS b. CUBIC FEET El c. POUNDS El d. 365Checkoneitemonl ` If EHS amount must be in pounds. STORAGE CONTAINER [Ia. ABOVE GROUND TANK ® e. PLASTIC /NONMETALLIC DRUM I. FIBER DRUM m. GLASS BOTTLE q. RAILCAR b. UNDERGROUND TANK f. CAN j. BAG n. PLASTIC BOTTLE r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 55% 226 Ethylene Glycol 227 Yes IZI No 228 107211 229 2 7.5% 230 Diethylene Glycol 231 Yes No 232 111464 233 3 7.5% 234 Propylene Glycol 235 Yes []No 236 57556 237 4 <5% 238 Hydrated Inorganic Acid, Sodium Salt 239 Yes No 240 Propriety 241 5 50% 242 Water 243 Yes ONO 244 7732 -18 -5 245 If more hazardous components are present at greater than 1 % byweight ifnoncarcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) UP Form (1/2000 Full Version) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one page per material per building or area ADD DELETE REVISE REPORTING YEAR 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 Valvoline Instant Oil Change GN -0109 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA) ® YES NO Basement 1 MAP# (optional) 27 GRID# (optional) 204 FACILITY ID # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes ® No 206 Ethylene Glycol If Subject to EPCRA, refer to instructions COMMON NAME Waste Antifreeze /Coolant 207 EHS' Yes ® No 208 CAS# 209 If EHS is "Yes ", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) a. PURE b. MIXTURE ® c. WASTE 211 RADIOACTIVE Yes ®No 212 213 CURIES NIA PHYSICAL STATE Check one item only) El a. SOLID ®b. LIQUID El c. GAS 214 215 LARGEST CONTAINER 200 gal FED HAZARD CATEGORIES 216 Check all that apply) Z a. FIRE b. REACTIVE c. PRESSURE RELEASE ® d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 100 200 1 1 133 221 DAYS ON SITE: 222 UNITS' ®a. GALLONS b. CUBIC FEET E] c. POUNDS d. TONS 365Checkoneitemonl ' If EHS amount must be in ounds. STORAGE CONTAINER a. ABOVE GROUND TANK ® e. PLASTIC /NONMETALLIC DRUM i . FIBER DRUM m. GLASS BOTTLE q. RAILCARb. UNDERGROUND TANK Cl f. CAN j. BAG n. PLASTIC BOTTLE r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 55% 226 Ethylene Glycol 227 Yes O No 228 107211 229 2 7.5% 230 Diethylene Glycol 231 Yes No 232 111464 233 3 7.5% 234 Propylene Glycol 235 Yes No 236 57556 237 4 <5% 236 Hydrated Inorganic Acid, Sodium Salt 239 Yes No 240 Propriety 241 5 50% 242 Water 243 Yes ONO 244 7732 -18 -5 245 If more hazardous components are present at greater than 11% by weight ff non - carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets of papercapturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) UP Form (1/2000 Full Version) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one paqe Per material per building or area ADD DELETE REVISE REPORTING YEAR 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 Valvoline Instant Oil Change GN -0109 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 Basement EPCRA) ® YES NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ® Yes No 2os If Subject to EPCRA, refer to instructions COMMON NAME Waste Motor Oil 207 EHS* Yes ® No 208 209CAS# If EHS is "Yes ", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) a. PURE b. MIXTURE ® c. WASTE 211 RADIOACTIVE Yes ®No 212 213 CURIES N/A PHYSICAL STATE Check one item only) a. SOLID ®b. LIQUID c. GAS 214 215 LARGEST CONTAINER 1 OOO FED HAZARD CATEGORIES 216 Check all that apply) ® a. FIRE b. REACTIVE c. PRESSURE RELEASE ® d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 500 1 1000 1 C. 16,500 1221 221 DAYS ON SITE: 222 UNITS` Na. GALLONS b. CUBIC FEET c. POUNDS d. TONS 365Checkoneitemonl ' If EHS, amount must be in pounds. STORAGE CONTAINER ® a. ABOVE GROUND TANK e. PLASTIC /NONMETALLIC DRUM i . FIBER DRUM m. GLASS BOTTLE q. RAILCAR b. UNDERGROUND TANK f. CAN j. BAG n. PLASTIC BOTTLE r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO I. CYLINDER p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOWAMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 <.12 226 Zinc 227 Yes ® No 228 7440 -66 -6 229 2 230 Motor Oil 231 Yes NO 232 233 3 234 235 Yes NO 236 237 4 238 239 Yes NO 240 241 5 242 243 Yes No 244 245 Ifmore hazardous components are present at greater than 1% by weight if non - carcinogenic, or 0.1 % by weight If carcinogenic, attach additional sheets of paper capturing the required Information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) UP Form (1/2000 Full Version) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one paqe Per material per building or area ADD DELETE REVISE REPORTING YEAR 200 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA — Doing Business As) 3 Valvoline Instant Oil Change GN -0109 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 Basement I (EPCRA) Z YES NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ® Yes No 206 If Subject to EPCRA, referto instructions COMMON NAME Motor Oil 207 EHS' Yes ONO 206 209CAS# If EHS is "Yes ", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (Complete if required by CUPA) 210 HAZARDOUS MATERIAL TYPE (Check one item only) ® a. PURE b. MIXTURE c. WASTE 211 RADIOACTIVE Yes ®No 212 213 CURIES N/A PHYSICAL STATE 214 Check one item only) a. SOLID ®b. LIQUID c. GAS 215 LARGEST CONTAINER 372 FED HAZARD CATEGORIES 216 Check all that apply) ® a. FIRE b. REACTIVE c. PRESSURE RELEASE ® d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 216 ANNUALWASTE AMOUNT 219 STATE WASTE CODE 220 1500 1 2609 1 A. 16,000 1221 DAYS ON SITE: 222 b. CUBIC FEET c. POUNDS d. TONSUNITS' ®a. GALLONS El 365Checkoneitemonl ' If EHS, amount must be in ounds. STORAGE CONTAINER ® a. ABOVE GROUND TANK e. PLASTIC /NONMETALLIC DRUM i . FIBER DRUM m. GLASS BOTTLE q. RAILCAR b. UNDERGROUND TANK f. CAN ). BAG n. PLASTIC BOTTLE r. OTHER c. TANK INSIDE BUILDING g. CARBOY k. BOX o. TOTE BIN d. STEEL DRUM h. SILO Ell. CYLINDER p. TANK WAGON 223 STORAGE PRESSURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT 224 STORAGE TEMPERATURE ® a. AMBIENT b. ABOVE AMBIENT c. BELOW AMBIENT d. CRYOGENIC 225 WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 100 226 Motor Oil 227 Yes ® No 228 229 2 230 231 Yes NO 232 233 3 234 235 Yes No 236 237 4 238 239 Yes NO 240 241 5 242 243 Yes ONO 244 245 fm re hazardous components are present at greater than 1% by weight if non- carcinogenlc, or 0.1 % by weight if carcinogenic, attach additional sheets of paper capturing the required information. ADDITIONAL LOCALLY COLLECTED INFORMATION 246 If EPCRA, Please Sign Here Facilities reporting Chemicals subject to EPCRA reporting thresholds must sign each Chemical Description page for each EPCRA reported chemical.) UP Form (1/2000 Full Version) 10 I B C D E F G Hl J K L M N OP OR S T U V VV X Y Z AR AE AC AC AE AF AC AF AI AJ AH AL Ah AP AC AF AC A: AE AT 2 3 4 White Lane 5 6 7 Upper Bay 8 Exit Exit Exit o 1 -- 7 10 Lounge Delvac 11 SW20 ATF 12 New 13 14 185Gal 185Gal 15 Fluid Coolant i6 Customer Cashier 372Gal 17 240Gal 18 Restroom Area 19 Waste 20 21 Emp. 22 23 Restroom 24 25 180Gal 26 Used Comp. Grea. GL5 27 Oil 28 Filter 29 Drums Up 3D / Stairs 3 I15 ai 0W30j10W30I ATF 3417-1 Bin 9DGa1 900a1 900a1 90Ga1 90Ga1 ILr.,_._ 3 36 Exit 37 Valvoline Instant Oil Change GN -010938 39 6501 White Lane 40 Bakersfield, CA 93309 Lower Bay w.rr r ter Exit Exit 10W30 SW30 Delvac ATF SW20 ATF Washer New 185Gal 185Gal 120Gal Fluid Coolant 372Gal 372Gal 240Gal 120Ga1 Waste Coolant 180Gal Waste Oil Bay 1 Bay 2 Bay 3 1500 Gal Stairs to Upper Bay AU AV AW AX AY AZ