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Home My WebLink About3901 WIBLE ROAD (2)BUSINESS ACTIVITIES KERN COUNTY EWIRONNIENTAL HEALTH SERVICES Unified Program Consolidated Form (UPCF) DEPARTMENT FACILITY INFORMATION270011STREET, SGTTE 300 BAKERSFIELD, CA 93301 661 862-8700 Fax 661 862 -8701 Page I of I. FACILITY IDENTIFICATION FACILITY ID # o4axyuseo*) t EPAID 4(xa ardous Waste Only) 2 CAL004374660 BUSINESS NAME Same as Facility Name ofDBA -Doing Business As) 3 Valvoline Instant Oil Change GN -0108 BUSINESS SITE ADDRESS 103 3901 Wible Rd Ste 8 BUSINESS SITE CITY 104 ZIP CODE 10 Bakersfield CA 93309 IL ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, lease subinit the Business Owner/Operator Identification page (KC Form 2730). Does your facility... IfYes. lease con fete these pages of the UPCF.... A HAZARDOUS MATERIALS 4 Have on site (for any purpose) at any one time, hazardous materials at or above HAZARDOUS MATERIALS INVENTORY 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed YES NO CHEMICALDESCRIPTION gases (include liquids in ASTs and USTs); or the applicable Federal threshold quantity for an extremely hazardous substance specified in 40 CFRPart 355, CONSOLIDATED CONTI 3GENCY PLAN Appendix A or B; or handle radiological materials in quantities for which an SITE MAP enieragency plan is re aired pursuant to • 10 CFR Parts 30, 40 or 70? B. REGULATED SUDSTANCES Have Regulated Substances stored onsite in quantities greater than the threshold CaIARP- REGULATED SUBSTANCE quantities established by the California Accidental Release prevention Program YES X NO REGISTRATION = F.273,6) CalARP)? C. UNDERGROUND STORAGE TANKS (USTs) 5 UST FACUJT-Y (KC Form?J Own or operate underground storage tanks? YES X NO UST TANK (one pageper talk) (KC FarmB) D. ABOVE GROUND PETROLEUM STORAGE e Own or operate ASTs above these thresholds: Store greater than 1320 gallons ofpetroleum products (newor used) in YES NO NO FORM REQUIRED TO KCEHSD aboveground tanks or containers. E. HAZARDOUS NVASTE 9 EPA ID NUMBER- provide at the top of Generate hazardous waste? QX YES NO HAZ WASTE GENERATOR FORM Recycle more than 100 kg1month of excluded or exempted recyclable 10 I YES QX NO RECYCLABLE MATERIALS REPORT materials (per HSC 25143.2)? pareqydu) (KCF -mrM) 11 ON -SITE HAZARDOUS WASTE TREATMENT - FACILITY (Kc Form tn2t) Treat hazardous waste on -site? YES 0 NO ON-SITE HAZARDOUS WASTE TREATMENT - UNIrtwepageper mdt) CFarm1773:) Treatment subject to financial assurance requirements (for Permit by Rule and YES QX NO12 CERTIFICATIONOFFINANCIAL Conditional Authorization)? ASSURANCE (KcForm w2) Consolidate hazardous waste generated at a remote site? El YES X NO 3 REMOTE WASTE i CONSOLIDATION SITE ANNUALILTOTffICATION Need to report the closwefremoval ofa tank that was classified as 14 HAZARDOUS WASTE TANK CLOSURE hazardous waste and cleaned on -site? YES El NO CERTIFICATION Generate in any single calendar month 1,000 kilograms (kg) (2,200 pounds) or 14a YES ® Obtain federal EPA ID Number, file more offederal RCRA hazardous waste, or generate in any single calendar NO Biennial Report (EPA Form 8700 - month, or accumulate at any time, 1 kg (2.2 pounds) ofRCRA acute hazardous 13A/B), and satisfy requirements forwaste; or generate or accumulate at any time more than 100 kg (220 pounds) of RCRA Large Quarrtity Generator. spill cleanup materials contaminated with RCRA acute hazardous waste. Household Hazardous Waste (HHW) Collection site? C] YES rOb NO FORM REQUIRED TO KCEHSD F. LOCAL REQL0RE IMTS 15 A copy ofthe facility's ContingencyfEmergency Response Planisto be included with die original submission ofthe Business Plan- KCEHSD is to be informed ofany revisions to the plan. Please contact KCEHSD at theabove number for assistance in completing the plan. 01,2008wvmd KCFmm2e 9 UNIFIED PROGRAM (UP) FORM BUSINESS OWNER /OPERATOR IDENTIFICATION NEW BUSINESS OUT OF BUSINESS REVISE /UPDATE (EFFECTIVE / / ) PAGE OF I. IDENTIFICATION FACILITY ID# HM ARP AST UST TP CUPA PA 1 BEGINNING DATE 100 March 1, 2012 I ENDING DATE 101 BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 Valvoline Instant Oil Change GN -0108 BUSINESS PHONE 102 661) 833 -1995 BUSINESS SITE ADDRESS 3901 Wible Rd, Ste 8 103 City Bakersfield 104 CA ZIP CODE 93309 105 DUN & BRADSTREET 106 SIC CODE (4 digit #) 7549 107 COUNTY Kern 1 06 UNINCORPORATED LYes 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 STATE MA "5 ZIP CODE 02461 116 III. ENVIRONMENTAL CONTACT CONTACT NAME 117 Keith Rondeau CONTACT PHONE 116 617) 243 -0404 CONTACT MAILING ADDRESS 119 54 Jaconnet Street, Suite 100 CITY Newton Highlands 120 STATE MA 12' 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 1 PAGER # N/A 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 1338 54 Jaconnet Street, Suite 100 Newton Highlands 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 /O ERA R OR DESIGNATED REPRESENTATIVE DATE 134 NAME OF DOCUMENT PREPARER 135 Kelly-Ann Taintor AME OF SIGNER Tint) 136 Todd F. Nelson ITLE SIGN R 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 -0108 3 FACILITY ID # SITE ADDRESS 103 CITY 104 ZIP CODE 105 3901 Wible Rd, Ste 8 Bakersfield 93309 Cover Page, Sections I and II, and Site Map(s) L -- 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: 0 Hazardous Materials Business Plan (HSC Chapter 6.95 Section 25504 (b) and 19 CCR Sections 2729 - 2732), 0 Hazardous Waste Generator Contingency Plan (22 CCR Section 66264.52), and, 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 II, 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 l 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 Title of Owner /Operator Henley Pacific LA LLC — Todd F. Nelson, President Signature of Owner/ Op for Date 2-- l7 L -- 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 -0108 3 FACILITY ID # 1 SITE ADDRESS 103 CITY 104 ZIP CODE 105 3901 Wible Rd, Ste 8 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 NIA I N/A III. 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. Date, time, cause, and type of incident (e.g. fire, air release, spill etc.) 0 Material and quantity of the release, to the extent known. 0 Current condition of the facility. a Extent of injuries, if any. s 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) 836 -4000 ADDRESS: 5401 White Ln CITY: ZIP CODE: Bakersfield 193309 OFFICIAL USE ONLY DATE RECEIVED I REVIEWED BY DIV I BN STA I OTHER DISTRICT I 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. r 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 r Gas Cylinders Tanks r Process Piping r Shutoff Valves r 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 material per building or area 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 -0108 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA) ® YES NO Basement 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 Il. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ® Yes No 206 Ethylene Glycol If Subject to EPCRA, refer toinstructions COMMON NAME New Antifreeze /Coolant 207 EHS' Yes ONO 206 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) El 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 El c. GAS 214 215 LARGEST CONTAINER 120 FED HAZARD CATEGORIES 216 Check all that apply) ® a. FIRE b. REACTIVE c. PRESSURE RELEASE Z d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 80 1 165 1 133 221 DAYS ON SITE: 222 UNITS` Na. GALLONS b. CUBIC FEET 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. 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 Z 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 ® No 229 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% 239 Hydrated Inorganic Acid, Sodium Salt 239 Yes No 240 Propriety 241 5 50% 242 Water 243 Yes ONO 244 7732 -18 -5 245 Ifmore hazardous components are present at greater than 1 % by welght if non - carcinogenic, or 0.1 % by weight if carcinogenic, attach additional sheets ofpaper capturingthe 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 matena per buildin 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 -0108 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA) ® YES NO Basement 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET Yes ® No 206 Ethylene Glycol If Subject to EPCRA, refer toinstructions 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) 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 0 d. ACUTE HEALTH e. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 STATE WASTE CODE 220 100 1 200 1 B. 3000 1 133 221 DAYS ON SITE: 222 UNITS' Na. GALLONS b. CUBIC FEET 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. 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 Z 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 ® 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 []No 244 7732 -18 -5 245 if more 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 (112000 Full Version) UNIFIED PROGRAM (UP) FORM HAZARDOUS MATERIALS INVENTORY — CHEMICAL DESCRIPTION one a e ermaterial per buildin or area ADD DELETE REVISE REPORTING YEAR 20 1 Page of I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 Valvoline Instant Oil Change GN -0108 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 Basement EPCRA) ® YES NO 1 MAP# (optional) 203 GRID# (optional) 204 FACILITY ID # I 1 II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ® Yes No 206 If Subject to EPCRA, refer to instructions COMMON NAME Waste Motor Oil 207 EHS' Yes ® No 206 269CAS# 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) El 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 00 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 DAYS ON SITE: H2 d. TONSUNITS' ®a. GALLONS b. CUBIC FEET El c. POUNDS El d. 365Checkoneitemonly) ` 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 [11. 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 <,12 226 Zinc 227 Yes Z No 226 7440 -66 -6 229 2 230 Motor Oil 231 Yes No 232 233 3 234 235 Yes No 236 237 4 236 239 Yes No 240 241 5 242 243 Yes -[]NO 244 245 If more hazardous components are present at greater than 1% byweight ifnon - carcinogenic, or0.1 % 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 oaae Der matenal per buiIdin or area 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 -0108 CHEMICAL LOCATION 201 CHEMICAL LOCATION CONFIDENTIAL 202 EPCRA) ® YES NOBasement 1 MAP# (optional) onal) 204 FACILITY ID # 77o II. CHEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET ® Yes El No 206 If Subject to EPCRA, refer to instructions COMMON NAME Motor Oil 207 EHS' Yes ® No 208 201 CAS# 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 [:1 c. WASTE 211 RADIOACTIVE Yes ®No 212 213 CURIES NIA PHYSICAL STATE Check one item only) a. SOLID ®b. LIQUID c. GAS 214 215 LARGEST CONTAINER 240 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 218 ANNUAL WASTE AMOUNT 211 STATE WASTE CODE 220 1500 1 2609 1 A. 16,000 1221 221 DAYS ON SITE: 222 UNITS' ®a. GALLONS b. CUBIC FEET 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. 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 P43 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 O No 228 221 2 230 231 Yes No 232 233 3 234 235 Yes No 236 237 4 238 231 Yes NO 240 241 5 242 243 Yes ONO 244 245 Ifmore hazardous components are present at greaterthan 1 % by weightif non - carcinogenic, or 0.1 % by weight If carcinogenic, attach additionalsheets 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 0 R Room 15140 350 gal. Lounge Dex 240 gal. . Office 1 OW30 500 gal. Stairway R 5W30 Room Stairway 500 gal. 5W20 GL5 500 gal. 240 Gal Compr. Waste oil WANE 1000 gal. Valvoline Instant Oil Change GN -0108 E 3901 Wible Rd., Suite 8 N + S Bakersfield, CA 93309 W