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Home My WebLink AboutBUSINESS PLAN (2) Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE Thi~ permit is issued for the followin_a: [] Hazardous Materials Plan ti [] Underground Storage of HazardOus Materials [] Risk Management Program '. [] Hazardous Waste On-Site Treatment 'i PERMIT ID # 015-021-002163 AIR CONTROL' .~,' LOCATION 3101 C~ ~301 ..5t~¢~*':.. :. ~., *. . OFFICE OF ENVIRONMENTAL SER VICES ' · ~ ~ DE C 1 4 ?000 1715 Chester Ave., 3rd Floor Approved by: "(~Ralpi~Huey.~) Issue Date Bakersfield, CA 93301 OfficeorEvirohmenml~ervices Voice (661) 326-3979 FAX (661) 326-0576 Expiration Date: ' Ju~e 30.. 2003 ITE DIAGRAM [~] FACILITY'DIAGRAM BUsiness Name: Air Control Services Business Address: 310! 16th Street #107 KAISER BXI KAISER' 1 RAGE KAISER KAISER'~ ~ R~frige~ants .... KAISER AIR CONTROL SERVICES Oxygen 1 - Electrical 2 Gas 3 - Water 4 - Fire Hydrant S:\PRO~EDUI~.J MANU~fie~t.wpd SIT~ OIAGRA~ !~;~! FACILITY'DIAGRAM [,~.1 Business Name: Air Control Services Business Address: 3101 16th Street ~)107 KAISER BXI KAISER I RAGE KAISER KAISER :~e~rants - KAISER AIR CONTROL SERVICES Oxyger .A.. 3 1 - Electrical 2 - Gas 3 - Water 4 - Fire Hydrant - 8:\PROC£DURE MANUAL\~a~t.~d AIR CONTROL SERVICES SiteID: 015-02I~-002163 + Manager : BusPhone: (661) 327-8755 Location: 3101 16TH ST 107 Map : 102 CommHaz : Moderate City : BAKERSFIELD Grid: 25C FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 01 SIC Code: EPA Nu~: DunnBrad:91-189-1274 ~.,+------ ~ .... ----~ Emergency Contact / Title Emergency Contact / Title BEN WAGONER / OWNER ROGER NOBLE / GENERAL FOREMAN .Business Phone: (661) 327-8755x Business Phone: (661) 327-8755x 24-Hour Phone : ( ) - x 24-Hour Phone : ( ) - x Pager Phone : (661) 394-4952x Pager Phone : (661) 394-3076x Hazmat Hazards: Fire Press ImmHlth DelHlth I Contact : Phone: (661) 327-8755x MailAddr: PO BOX 10595 State: CA City : BAKERSFIELD Zip : 93389 Owner BEN WAGONER Phone: (661) 327-8755x Address : PO BOX 10595 State: CA City : BAKERSFIELD Zip : 93389 Period : to TotalASTs: = Gal Preparer: . ~ TotalUSTs: = Gal Certif'd: RSs: No Emergency Directives: += +=' Hazmat Inventory One Unified List + +== Alphabetical Order All Materials at Site + .... · ............................. + ....... + ........... + ..... + .......... + .... +- - -+ Hazmat Common Name... ISpooHazlEPA HazardsI Frm I DailyMax IUnitlMCPI ..... · ............................ + ....... + ........... + ..... + .......... + .... +- - -+ ACETYLENE E F P IH G 250 00 FT3 Hi CARBON DIOXIDE F P IH G 489 00 FT3 Min GENETRON MP39 E F P IH G 300 00 FT3 Low NITROGEN F P IH G 330 00 FT3 Min OXYGEN F IH DH G 300 00 FT3 Low R-11 F P IH G 300 00 FT3 Min R-12 G 400 00 FT3 Min R134A I,~~.._ DO he.by ¢0~i~ tha~ I%a¥0 300 oo PT3 UnR -- (~of~)_ ~/ it along with . a leteandcorre~man- +: ~=pkan=k~'~&ac~J~ ...... -1- 03/21/2002 + AIR CONTROL SERVICES SiteID: 015-021-002163 += Inventory Item 0003 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME + ACETYLENE I Days On Site 1365 Location within this Facility Unit Map: Grid: + ................ WAREHOUSE I CAS# 74-86-2 + ----+ ----+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE I Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER +------======~ =+== =4 4 + AMOUNTS AT THIS LOCATION ..... Largest Container Daily Maximum I Daily Average 250.00 FT3 250.00 FT3 250.00 FT3 4 ~ +== ------+ 4 4 HAZARDOUS COMPONENTS ---+===~ ~-+ 100.00 Acetylene Yes 74862 4 ~ ---+===~ + +===4 ~ HAZARD ASSESSMENTS ===+= ~ +===== ITSecretl RStBi°HazIRadi°active/Am°unt EPA Hazards NFpANo No No No/ Curies F P IH / / / USDOT# I MCPHi += Inventory Item 0004 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME = =+-~ CARBON DIOXIDE I Days On Site 365 Location within this Facility Unit Map: Grid: + ................ WAREHOUSE I CAS# 124-38-9 + += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE IGas I Pure I Above Ambient I Cryogenic I INSUL.TANK / CRYOGENIC + + AMOUNTS AT THIS LOCATION .... Largest Container I Daily Maximum I Daily Average 163.00 FT3I 489.00 FT3 I 163.00 FT3 += + ~---- += ~ HAZARDOUS COMPONENTS ==+===+ 100.00 Carbon Dioxide 124389 4 ~ ==+===+ 4 +===+ + HAZARD ASSESSMENTS ===4 ~ ~ ..... ITSecret] RSIBioHazI Radioactive/Amount EPA HazardsI NFPA USDOT# MCP No No No No/ Curies F P IH / / / Min + ~===+ + 4 + ~ +=====+ -2- 03/21/2002 AIR CONTROL SERVICES SiteID: 015-021-002163 + += Inventory Item 0005 ..... Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ~ ..... + GENETRON MP39 Days On Site 365 Location within this Facility Unit Map: Grid: + ................ + WAREHOUE CAS# += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE Gas I Mixture I Ambient I Ambient I PORT. PRESS. CYLINDER ~ AMOUNTS AT THIS LOCATION Largest Container Daily Maximum I Daily Average 300.00 FT3 300.00 FT3 I 300.00 FT3 +=---- ~ + ....... HAZARDOUS COMPONENTS ......... 4 + %Wt. RS CAS# 53.00 Chlorodifluoromethane No 75456 13.00 1,1-Difluoroethane Yes 75376 34.00 Chlorotetrafluoroethane No 63938103 -===4 + .... ~ 4-- HAZARD ASSESSMENTS ===+ ......... ~ + ..... + TSecret RSIBioHazI Radioactive/Amount ! EPA Hazards NFPA USDOT# I MCP No No No No/ Curies F P IH / / / Low 4-===4 ~ 4 ~= 4-========+=====+ += Inventory Item 0002 Facility Unit: Fixed Containers at Site + +== COMMON NAME / CHEMICAL NAME ~ ~ NITROGEN Days On Site I 365 Location within this Facility Unit Map: Grid: + ................ + WAREHOUSE I CAS# I 7727-37-9 =+ += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+==== CONTAINER TYPE ..... + Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER I ~ 4-= 4 4- =+ +__ + AMOUNTS AT THIS LOCATION =+ Largest Container Daily Maximum I Daily Average I 255.00 FT3 330.00 FT3 255.00 FT3 +------ 4- =+ =4 HAZARDOUS COMPONENTS +===4 ........ + 100.00 Nitrogen No 7727379 ~ .... +===4 + ~===4 ~ HAZARD ASSESSMENTS ===+ ~ + ..... + [TSecretI RSIBioHazI Radioactive/Amount I EPA Hazards NFPA USDOT# I MCP No No No No/ Curies F P IH / / / Min +===4 4- ~ 4---- ===================== 3 03/21/2002 AIR CONTROL SERVICES SiteID: 015-021-002163 += Inventory Item 0001 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME + OXYGEN I Days On Site 1365 Location within this Facility Unit Map: Grid: + ................ WAREHOUSE I CAS# 7782-44-7 += ~= += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER ~ AMOUNTS AT THIS LOCATION = Largest Container Daily Maximum I Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 .......................... .4 ~= .4 HAZARDOUS COMPONENTS .... +===.4 I sl 100.00 Oxygen, Compressed No 7782447 +===4 ~ HAZARD ASSESSMENTS ===.4 4 +===== ITSecretlNo NoRSIBi°HazINo Radi°active/Am°unt I EPANo/ Curies F Hazards IH DH NFPA/// USDOT# I MCP +===4 ~ ~ ~ 4 +=====+ += Inventory Item 0007 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME ==+ ................ R-11 I Days On Site GENETRON 22 I 365 Location within this Facility Unit Map: Grid: + ................ WAREHOUSE I CAS # + += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE IGas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDER 4 += =4 =+ + ---- + + AMOUNTS AT THIS LOCATION ..... Largest Container Daily Maximum I Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 + ~ HAZARDOUS COMPONENTS ~-+===~ 100.00 Trichlorotrifluoroethane No 76131 + ~===.4 ~= HAZARD ASSESSMENTS ===+ ~ ~===== [TSecretINo NoRSIBi°Haz[No Radi°ac~ive/Am°unt I EPANo/ Curies F P HazardsIIH NFPA/// USDOT# I MCP + t-===.4 .k===== ~ + ~- l- 4 03/21/2002 AIR CONTROL SERVICES SiteID: 015-021-002163 += Inventory Item 0008 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME + ---+ R-12 I Days On Site I GENETRON 12 365 Location within this Facility Unit Map: Grid: + ................ WAREHOUSE I CAS# += STATE =+= TYPE ===+== PRESSURE ===+ TEMPERATURE==+==== CONTAINER TYPE Gas I Pure I Ambient I Ambient I PORT. PRESS. CYLINDER ~ AMOUNTS AT THIS LOCATION = Largest Container Daily Maximum Daily Average 400.00 FT3 400.00 FT3 400.00 FT3 ........ 4 ~ HAZARDOUS COMPONENTS 4-===+ .... 100.00 Dichlorodifluoromethane No 75718 +===4 4- HAZARD ASSESSMENTS ===4 4 + ..... ITSecretl RSIBioHazl Radioactive~Amount I EPA Hazards NFPA USDOT# I MCP No No No No/ Curies / / / Min ~===4 4- ~ t 4 +=====+ += Inventory Item 0006 Facility Unit: Fixed Containers at Site +== COMMON NAME / CHEMICAL NAME ==+ R134A I Days On Site GENETRON 134A I 365 Location within this Facility Unit Map: Grid: +- WAREHOUSE I CAS # 811-97-2 + += STATE =+= TYPE===+== PRESSURE ===+ TEMPERATURE ==+ .... CONTAINER TYPE IGas I Pure I Ambient I Ambient I PORT. PRESS. CYLINDER + + ~ -+== +== + + AMOUNTS AT THIS LOCATION ~==+ Largest Container Daily Maximum I Daily Average 300.00 FT3 300.00 FT3 300.00 FT3 + 4-= =4 ~+ + ~ HAZARDOUS COMPONENTS +===~ 100.00 Tetrafluoroethene Yes 116143 + { ~ + ~==+ + 4-===+ += HAZARD ASSESSMENTS ===+ ~ ~ ..... ITSecretlNo NoRSIBi°HazINo Radi°active/Am°unt I EPANo/ Curies Hazards I NFPA/// USDOT# I MCP + 4-===+ 4-= ~ + t ~- -5- 03/21/2002 AIR CONTROL SERVICES == SiteID: 015-021-002163 + -~ Fast Format + += Notif./Evacuation/Medical == Overall Site + +== Agency Notification = 12/13/2000 + NO LEAK DETECTION DEVICES INSTALLED. MECHANICS ARE SKILLED MECHANICS THAT ARE TP~AINED THROUGH LOCAL 409. THE MAJORITY OF THE MATERIAL STORED IS IN SMALL QUANTITIES. LARGER VOLUMES ARE ONLY HERE FOR A SHORT PERIOD, PURCHADED FOR A SPECIFIC PROJECT. +=== Employee Notif./Evacuation == 12/13/2000 + 911, THE OWNER IS ON SITE DAILY OR IS REACHABLE BY RADIO AND PHONE NUMBERS ARE POSTED IN CASE.OF AN EMERGENCY. =+ ..... Public Notif./Evacuation 12/13/2000 + THE OWNER WOULD BE NOTIFIED FIRST. IF IMMEDIATE CONTACT IS NOT MADE, ROGER NOBLE WOULD BE NOTIFIED. IRIS PARSONS IS THE OFFICE MANAGER AND WOULD BE RESPONSIBLE FOR MAKING THE PROPER TELEPHONE CALLS DURING BUSINESS HOURS.AT THE DIRECTION OF THE OWNER. ~+ Emergency Medical Plan 12/13/2000 + PHONE NUMBERS POSTED. -- -6- 03/21/2002 AIR CONTROL SERVICES SiteID: 015-021-002163 + Fast Format + += Mitigation/Prevent/Abatemt -- Overall Site + +== Release Prevention -- 12/13/2000 + CART RACKS ARE USED FOR ALL SMALL BOTTLES CONTAINING GASES. REFRIGERATION CONTAINERS ARE STORED ON THE GROUND, UNDER A RACK TO PREVENT OBJECTS FROM STRIKING THEM. PRODUCTS ARE SEGREGATED. INFORMATIONAL BULLETINS ARE POSTED. FIRE EXTINGUISHERS ARE IN BOTH THE OFFICE AND WAREHOUSE. EXCAPE ROUTE IS POSTED. +___ +=== Release Containment - 12/13/2000 + WEEKLY REVIEW OF HAZARDOUS MATERIALS FOR QUANTITY AND USE. .... Clean Up 12/13/2000 + IF A SPILL IS DETECTED, THE CONTAINER WOULD BE ISOLATED AND PUMPED DOWN TO CONTAIN THE GAS. THE DEFECTIBE CONTAINER WOULD BE PROPERLY DISPOSED. NOTIFICATION OF THE SPILL WOULD BE DOCUMENTED IN A DAILY REPORT. =+ ..... Other Resource Activation == =+ -7- 03/21/2002 + AIR CONTROL SERVICES SiteID: 015-021-002163 + + Fast Format + += Site Emergency Factors Overall Site + +== Special Hazards + + +=== Utility Shut-Offs 12/13/2000 + A) GAS - NE SIDE OF W BLDG B) ELECTRICAL - NW CORNER OF W BLDG C) WATER - NE SIDE OF W BLDG D) SPECIAL - NONE E) LOCK BOX NO + ----+ + .... Fire Protec./Avail. Water - 12/13/2000 + PRIVATE FIRE PROTECTION - FIRE EXTINGUISHERS IN WAREHOUE AND OFFICE. NEAREST FIRE HYDRANT - AT NW CORNER OF E BLDG. + Building Occupancy Level += -8- 03/21/2002 CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. To avoid further action, return this form within 30 days of receipt. 2. TYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be as brief and concise as possible. 5. You may also attach Business Owner / Operator Form and Chemical Description Form(s) to the front of this plan instead of completing SECTION I. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA BUSINESS NAME: AIR CONTROL SERVICES LOCATION: 3101 16th Street #107 MAILING ADDRESS: P.O. Box 10595 CITY: Bakersfield STATE: CA ZI~3~Sq PHONE: 327-8755 PRIMARYACTIVITY: Heatin~ .Air Conditioning OWNER: Ben Wagoner PHONE:327-8755 MAILING ADDRESS: Same as above EMERGENCY NOTIFICATION CONTACT TITLE BUS. PHONE 24 HR.. PHONE Ben Wagoner Owner 327-8755 Same 1. 2.Roger Noble Foremat Smme HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II. l: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITOKING PROCEDURES:. No leak detection devices installed. Mechanics are skilled mechanics that are trained through Local 409. The majority of the material stored is in small quantities. Larger volumes are only here for a short period - purchased for a specific project. B. EMPLOYEE AND AGENCY NOTIFICATION: 1. 911 2. The owner is on site daily or is reachable by radio 3. Phone numbers are posted in case of an emergency. · " C. ENVIRONMENTAL RESPONSE MANAGEMENT: The owner would be notified first. If immediate contact is not made, Roger Noble would be notified. Iris Parsons is the office manager and would be responsible for making the proper telephone calls during business hours at the direction of the owner D. EMERGENCY MEDICAL PLAN: Phone numbers are posted 2 IIAZARDOUS MATERIALS MANAGEMENT,PLAN SECTION III: TRAINING NUMBER OF EMPLOYEES: 7 MATERIAL SAFETY I)ATA SHEETS ON FILE: Yes BRIEF SUMMARY OF TRAINING PROGRAM: The HVAC technicians and mechanics are trained through Local 409 Plumbers, Steamfitters and Air Conditioning Local in regard to the materials they are / handling. They are certified in the.purchase and application of the hazardous materials used at Air Control'Services. A mandatory first aid and CPR class is given at Local 409. ~hen purchasing the hazardous materials a MSDS information bulletin is issued each time a purchase is made. These bulletins are kept on file in the office. CERTIFICATION I, Ben Wagoner CERTIFY THAT THE ABOVE INFORMATION IS ACCURATE. IJJ~RSTAND THAT THIS INFORMATION WILL BE USED TO FULFI,,LL MY F/J4(M?M{DBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE ON~t~AZA~d~5OUS MATERIALS (DIV. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT ~Z//(CC~TE INFORMATION CONSTITUTES PERJURY. t~l, ~ Owner 11-20200 ATURE TITLE DATE 4 MATERIALS SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: Cart Racks are used for all small bottles containing gases. Refrigeration containers are stored on the ground, under a rack to prevent objects from striking them. Products are segregated. Informational bulletins are posted. Fire Extinguishers are in both the office ;? and warehouse, l_,sc~ pe rolfle is posted. B. RELEASE CONTAINMENT AND/OR MITIGATIONi . Weekly review of hazardous materials for quantity and use. C. CLEAN-UP AND RECOVERY PROCEDURES: Ifa spill is detected, the container would be isolated and pumped down to contain the gas. The defective container wonld be properly disposed. Notification of the spill would be documented in a daily report. United Refrigeration. This is the only waste that we would have for disposal UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: I',t [ P~ Electrical -- NW comer of West building in the complex Gas ............ NE side of West building in the complex Water NE side of West building in the complex LOCK BOX: YES/~__~ IF YES, LOCATION: PRIVATE FIRE PROTECTION/WATER AVAILABILITY A. PRIVATE FIRE PROTECTION: Fire extinguishers in warehouse and office B. WATER AVAILABILITY ffIRE HYDRANT): Fire Hydrant is located at the NW corner of the East Building 3 AIR CONTROL SERVICES = SiteID: 015-021-002163 Fast Format += Traininq - Overall Site +== Employee Training 12/13/2000 WE HAVE 7 EMPLOYEES AT THIS FACILITY. WE DO HAVE MSDS SHEETS ON FILE. BRIEF SUMMARY OF TRAINING PROGRAM: THE HVAC TECHNICIANS AND MECHANICS ARE TRAINED THROUGH LOCAL 409 PLUMBERS, STEAMFITTERS AND AIR CONDITIONING LOCAL IN REGARD TO THE MATERIALS THEY ARE HANDLING. THEY ARE CERTIFIED IN THE PURCHASE AND APPLICATION OF THE HAZARDOUS MATERIALS USED AT AIR CONTROL SERVICES. A MANDATORY FIRST AID AND CPR CLASS IS GIVEN AT LOCAL 409. WHEN PURCHASING THE HAZA/~DOUS MATERIALS A MSDS INFORMATION BULLETING IS ISSUED EACH TIME A PURCHASE IS MADE. THESE BULLETINS ARE KEPT ON FILE IN THE +=== Page 2 ................ .... Held for Future Use Held for Future Use 9 03/21/2002 CITY OF BAKERSFIELD~c~'- \ (c~ ~ ~ OF~',E OF ENVIRONMENTAL SEqgVICES B D 1715 Chester Ave., CA 93301 (661) 326-3979 .... ~2~'"~' ~ OWNER I OPE~TOR IDENTIFICATI~ I~ - ] FACILI~ INFORMATION ~-. / ~ ' FAC~L[~ · ~ ~ . Year Beginning ~oo Year Ending BUSINESS NAME (Same as FACILI~ NAME or DBA- Doing Business ~) 3 BUSINESS PHONE 102 AIR CONTROL SERVICES 661-327-8755 SITE ADDRESS lO3 3101 16th Street, ~ #107 Cl~ Bakersfield ~ ~ CA ZIP 93301 DUN & ~o$ SIC CODE aoz B~DSYREET 91-1891274 (4 Digit ~) 5183 ~o8 COUNW Kern OWNERNAME Ben Wagoner ~' I OWNERPHONE 66]-~27-8755 OWNER ~ILING ADDRESS P.O. Box 10595 ~3 CONTACT NAME S~ AS OI~ER 117 [ CONTACT PHONE CONTACT MAILING a a9 ADDRESS CI~ ~20 STATE 121 ZIP 122 NAME O~ER 123 NAME Roger Noble 129 TITLE ~25 TITLE General Fore~n ~30 BUSINESS PHONE 126 BUSINESS PHONE 661-327-8755 131 24-HOUR PHONE 661-327-8755 ~ 24-HOUR PHONE 661-327-8755 132 PAGER ~ 394- ~28 PAGER ~ 394-3076 133 Certification:/ on my , ( ~ individuals responsible for obtaining the info~ation, I ~i~ under penal~ of law that I have personally examined and am familiar with the submiffed in this invento~ and believe the info~ation is tree, a~umte, and ~mplete. SIGNATURE DATE 134 NAME OF DOCUMENT PREPARER ~35 (print) ~3s TITLE OF OWNE~OPE~TOR 137 Ben ~agoner ~er UPCF (7/99) S:\CU PAFORMS\OES2730.TV4.wpd CITY OF BAKERSFIELI OF CE OF ENVIRONMENTAL S IRVICES ' 1715 Chester Ave., CA 93301 (661) 3.26-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fon~ per matedal per building or area) I'-[ NEW [] ADD [] DELETE [] REVISE 200 Page ~ of __ ?;~.;;~J'5:,.:,; :~:i~::.:i.i!;?', ~?I~'FACIL~INFORMATION i';',~ ~.!:~!::.;~!:~.:':~.~ BUSINESS NAME (Same as FACILITY NAME o~ DBA - Doing Business As) 3 AIR CONTROL SERVICES CHEMICAL LOCATION 201 CHEMICAL LOCATION [] Yes [] No 202 WAREHOUSE CONFIDENTIAL (EPCRA) FACIUTY ID # ~ ~ ~'~-~ T'-~--~- MAP # (optional) · 203 [ GRID # (optional). · 204 , .,: :..: .' .:, ~: ::~ mx..w :,, '? ... ~;' :;:'-, ':~ ::: ,,.-.IL CHEMICAL INFORMATION :):.':c.:~.,:,,,;:'.,=..~ 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME Oxygen If Subject to EPCRA. refer' to instructions 207 COMMON NAME EHS' [] Yes ~] No 208 Oxygen :~':~if ERS is'Y~,' all amo~t~ b~low must b~ in lbs; 209 ~;,.;":~:~,~.~)2~!'~¥, ..!. ',h:3':. '-*:: ; '- '.~.".!:,~ CAS# 7782--44--7 FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE '1~ p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE []Yes ~i~ No 212 CURIES 213 LARGEST CONTAINER 215 PHYSICAL STATE [] s sOLID E:]l LIQUID ~1 g GAS 214 FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE Bi 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT DAILYAMOUNT :[25~ DAILY AMOUNT :[25~ DAYS ON SITE 222 UNITS* [] ga GAL' [] cf CU FT [] lb LBS [] tn' TONS 221 · If EHS, amount must be in lbs. 3 6 5 STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] I FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check ail that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BOTTLE [] r OTHER [] C TANK INSIDE BUILDING [] g CARBOY [] k BOX [] 0 TOTE BIN [] d STEEL DRUM [] h SILO i~ I CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] be BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOWAMBIENT [] c CRYOGENIC' 225 '"1 227 [] yes r~ No 228 229 100 226 Oxygen 7782-44-7 234 235 237 238 ~ 241 242 : es [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE - 24~ UPCF (7/99) S:\CUPAFORMS\~ES2731 .TV4.wp, OF~E CITY OF BAKERSFIE OF ENVIRONMENTAL VICES 1715 Chester Ave., CA 93301 (661) 3.26-3979 '~"'"~~'""' ~"" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fomt per material per building or area) [] NEW [] ADD r-i DELETE [] REVISE 200 Page __ of __ BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business AS) 3 AIR CONTROL SERVICES CHEMICAL LOCATION 201 CHEMICAL LOCATION r'-] yes [] No 202 WAREHOUSE *CONFIDENTIAL (EPCRA) ~ ~ , MAP#(optional) . * 203 GRID#(~optional) FACILITY ID # 204 . :'~': *.:': ~' ? :":~::~ ',':? '~!~:,!~ ~:?~:.'~:? :,~!.~. ~';!' II:'CHEMICAL INFORMATION ~;~:'~::~ ~;":??i~!?:.~:!::?:~:~ 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME N i t r 0 g em If Subject to EPCRA, refer to instructions 207 COMMON NAME EHS* [] Yes rl~ No 208 Nitrogen CAS# 7727-37-9 ~' '~'~'~'~'"~ ~?';"~" ' =:~ ....... "" .......... '~" FIRE CODE HAZARD CLASSES (Complete if requested by local fire ohief) 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 2tl RADIOACTIVE []Yes [~No 212 CURIES 213 LARGEST CONTAINER 215 PHYSICAL STATE [] s SOLID I'-I1 LIQUID [] g CAS 214 FED HAZARD CATEGORIES [] I FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 ~t'CX~MUM 2~e AVERAGE 219 STATE WASTE CODE 220 AMOUNT DAILY AMOUNT 3 3 O, DAILY AMOUNT 0 DAYS ON SITE 22z UNITS' [] ga GAL [] cf CU FT ~ lb LBS [] tn TONS 221 · If EHS, amount must be in lbs. STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] I FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] 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 STORAGE PRESSURE ~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [~ a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 226 227 [] Yes [] No 228 229 100 Nitrogen 233 230 231 [] Yes [] No 232 234 235 [] No 236 237 238 'es [] No 240 241 242 []Yes []No 244 -245 MPANY Sl~ DATE 24~ ~ S:\CUPAFORMS\~ES2731.TV4.wp UPCF (7199) t~At~r.,~l~'l' 1715 Chester Ave., CA 93301 326-3979 "~"~--~'-*' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per material per building or ama) ~ NEW ~ ADD ~ DELETE ~ REVISE 200 Page of ~us~.~'s ~e (sa% ~ ~c~U~ ~A; 0"~: 6;'.'~'".~,% A~~ ""*" .... * ......... ""~"~' ' ~ :?~''''''' '"'"' ' ....... :~ ~''~ ~' ........... "~ .......... ' '''~ ' '"" .............. A~A CO~TAO~ SgA~ZCgS CHEMICAL LO~TION ~1 CHEMICAL LOCATION 205 T~DE SECRET CHEMICAL NAME ~ Y~ ~ NO 206 AC e ~ 7 ~ e~ e if Subj~ lo EPC~, ref~ to insignias 207 co~ ~A~E EHS' Acetylene ~Y" ~N° 2o~ FIRE ~OE ~RO C~ES (~plete if r~u~t~ by I~1 fire 210 ~PE ~ p PURE ~ m MIX.RE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 CURIES 213 PHYSICAL STA~ ~ s SOLID ~1 UOUID ~ g ~S 214 ~RGEST ~AINER ~ ~¢~ 215 FED H~RD ~TE~RIES ~ 1 FIRE ~ 2 R~CT~ ~ 3 PRESSURE REL~SE ~ 4 AC~E H~LTH ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) ANNUAL WASTE 217 ~ ~I~M 218 AVENGE 219 ~ STATE WASTE ~DE UNITS*I ~ ga GAL ~ d CU ~ ~ lb LBS ~ tn TONS 221~ DAYS ON SITE 222 ' If EHS, am~nt must be in lbs. 3 ~ STOOGE CO~AINER ~ a ABOVEGROUND TANK ~ e P~STI~ONM~ALLIC DRUM ~ I FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (Check all ~at apply) * ~ b UNDERGROUND TANK ~ f CAN ~ ~ 6AG ~ n P~STtC 80~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g CARBOY ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM , ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a A~IE~ ~ aa ABOVE A~IE~ ~ ba BELOW AMBIENT 224 STO~GETEMPE~TURE ~ a A~IE~ ~ aa A~VEA~IE~ ~ ba BELOWAMBIE~ ~ c CRYOGENIC 225 229 [00 226 Acetylene =7 ~Y~ ~ 22e 94-86-2 ~0 231 ~ Y~ ~ No 232 233 2~ 235 ~ No 236 237 238 Y~ ~ No 240 241 242 ~ y~ ~ ~ 244 245 PRINT NAME & TITLE OF AU~ORIZED ~MPA~ REPRESENTAT~E DATE 2~ UPCF (7/99) S:\CUPAFORMS\~)ES2731.TV4.wp' CITY OF BAKERSFIELI~ ;~ FtRg ~ OF~E OF ENVIRONMENTAL SI~RVICES t~nRrm,~rr 1715 Chester'Ave., CA 93301 (661) 3.26-3979 "~~"~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ pe~ material per building or ama, ~ NEW ~ ADD ~ DELETE ~ REVISE 2~ Page of BUSINESS ~ME (Same es FACILI~ ~ME ~ DBA - D~ng Busin~ ~ ' "' .... -'" ' ~"" ~" ' "' ' 3 A[R CONTROL SERV[CES CHEMICAL LOCATION 201 CHEMICAL LOCATION ~ Y~ ~ No 202 WAREHOU S E ~NFIOENTIAL CHEUICAL ~E 205 T~OE SECRET ~O~ ~O~ If Subj~ to EPC~, refer to inst~i~s ~7 co~. NA~ co 2 ~ ~" ~ No ~0~ c~s. 124-38-9 ~ FIRE CODE H~RD C~SSES (~plete if ~u~t~ by I~1 fire ~ie~ 210 ~PE ~ p PURE ~ m MIX.RE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 CURIES 213 PHYSICALSTA~ ~ s SOLID ~1 LIQUID i g ~S 214 ~RGESTCO~AINER ~0~/ 215 FED H~RD ~TEGORIES ~ 1 FIRE ~ 2 REACTI~ ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~LTH ~ 5 CHRONIC HEALTH 216 (Ch~ all that apply) ANNU~WASTE 217 } ~I~M 218 ] AVENGE _. 21g I STATE WASTE COOE ~u~ D~C~U~ ~0~/ O~V~U~ *-~-~ --0- UNITS* ~ ga GAL ~ d CU ~ ~ lb LBS ~ ~ TONS 221 DAYS ON SITE 222 ' if EHS, amount must be in Ihs. STOOGE CONTAINER ~ a ABOVEGROUND TANK ~ e P~STI~NONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL CAR 223 (Check afl that apply) · ~ b UNDERGROUND TANK ~ f ~N D J BAG ~ n P~STIC BO~LE ~ r OTHER ~ c T~K INSIDE BUILDING ~ g ~RBOY ~ k BOX ~ o TOTE ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ p TANK WA~N STOOGE PRESSURE ~ a A~IE~ ~ ~ ASOVE~IE~ ~ ba B~OWA~IE~ 224 STO~GETEMPE~RE ~ aA~IE~ ~ ~ A~VEA~IE~ ~ ba BELOWAMBIE~ ~ c CRYOGENIC 225 100 226 Carbon Dioxide 22? []Yes []No 226 124--38--9 229 230 231 233 234 235 ; [] No 236 237 238 ] Yes O No 240 241 242 · [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2n6 "~ex,~ 'VXl R c~c~ ~,. O~A~ II'LO UPCF (7/99) S:\CUPAFORMS\~ES2731 .TV4.wp, CITY OF BAKERSFIELi~i~ OF~E OF ENVIRONMENTAL ~VICES 1715 Chester Ave., CA 93301 (661) 3.26-3979 "~"~~""~-" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per mate#al per building or area? [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of BUSINESS NAME (Same as FACILITY NAME or DBA ~ Doing Business As) 3 AIR CONTROL SERVICES CHEMICAL LOCATION 201 CHEMICAL LOCATION [] Yes [] No 202 WAREHOUS E 'CONFIDENTIAL (EPCRA) FAC,L,TY,D # ~ ~ , ,,~P # (op~.a~ - 203 GR,D # Iop~na~ 20. 205 TRADE SECRET [] Yes [ii No CHEMICAL NAME C-6ne t rom ~ 3 9 If Subject to EPCRA, re[er Io instructions 207 COMMON NAME EHS* lV~3¢/401A I-I¥~. I~No ~0. CAS# 209 i,*ii EHS ls'Ye~,' all ~s below must be i~ ~' FIRE CODE HAZARD CLASSES (Complete if requested by local fire cflie0 210 TYPE [] p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 PHYSICAL STATE [] s SOLID r'il LIQUID [] g ~S :214 LARGEST CONTAINER 30¢f 215 FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] $ CHRONIC HEALTH 210 (Check all thai apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT OA~LYAMOUNT 30~'/ DA~LYAMOUNT 15% UNITS* [] ga GAL [] d CU FT ~ lb LBS [] tn TONS 221 DAYS ON SITE 222 · If EHS, amount must be in lbs. 3 65 STORAGE CONTAINER [] a ABOVEGROUND TANK [] · PLASTIC/NONMETALLIC DRUM [] i FIBER DRUM [] m GLASS BOTTLE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG []. 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 STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE [] a AMBIENT [] aa ABOVE AMBIENT [] be BELOW AMBIENT [] c CRYOGENIC 225 226 227 [] Yes [] NO 228 229 5 3 Chloradif luo romethane 13 .230 Difluor~oethane 23~ []Yes ~No 232 75--37-6 234 235 237 34 Chlorotetrafluoroethane 238 23 ~s [] No 240 241 242 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REP, RESENTATIVE SIGNATURE DATE 246 ~-~6.~ \/xl~om~, OUO,,q~,. \\- 2..o -oo UPCF (7~99) S:\CUPAFORMS\~)ES2731.TV4.wp, CITY OF BAKERSFIEL ll OF I CE OF ENVIRONMENTAL SI VICES 1715 Chester Ave., CA 93301 (661) 3.26-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one fon'n per matedal per building or area [] NEW [] ADD [] DELETE [] REVISE 200 Page __ of __ BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 AIR CONTROL SERVICES CHEMICAL LOCATION 201 CHEMICAL LOCATION [] Yes [] No 202 WAREHOUSE 'CONFIDENTIAL (EPCRA) FACILITYID# ~ ~ , ?P # (optional) ' 203 GRID # (optional) · 204 205 TRADE SECRET [] Yes [] No 206 CHEMICAL NAME Genet r on 134A If Subject to EPCRA. refer to instructions 2O7 COMMON NAME EHS° [] Yes [] No 208 R-134A i * If, EHS ia,Ycd;, ail amounts t~low must be fn lbs. 811-97-2 FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) 210 TYPE I~ p PURE [] m MIXTURE [] w WASTE 211 RADIOACTIVE [] Yes [] No 212 CURIES 213 LARGEST CONTAINER 215 PHYSICAL STATE [] s SOLID []1 LIQUID [] g GAS 214 30.~/~ L FED HAZARD CATEGORIES [] 1 FIRE [] 2 REACTIVE [] 3 PRESSURE RELEASE [] 4 ACUTE HEALTH [] 5 CHRONIC HEALTH 216 (Check all that apply) ANNUAL WASTE 217 MAXIMUM 218 AVERAGE 219 STATE WASTE CODE 220 AMOUNT DAILY AMOUNT 30,~ DAILY AMOUNT 15 DAYS ON SITE 222 UNITS* [] ga GAL [] cf CU FT ~] lb LBS [] tn TONS 221 · If EHS. amount must be in lbs. 3 STORAGE CONTAINER [] a ABOVEGROUND TANK [] e PLASTIC/NONMETALLIC DRUM [] I FIBER DRUM [] m GLASS BOTI'LE [] q RAIL CAR 223 (Check all that apply) [] b UNDERGROUND TANK [] f CAN [] j BAG [] n PLASTIC BO'I-FLE [] r OTHER [] c TANK INSIDE BUILDING [] g CARBOY [] k BOX [] o TOTE BIN [] d STEEL DRUM [] h SILO I~11 CYLINDER [] p TANK WAGON STORAGE PRESSURE [] a AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT 224 STORAGE TEMPERATURE t · AMBIENT [] aa ABOVE AMBIENT [] ba BELOW AMBIENT [] c CRYOGENIC 225 1 ' 227 [] Yes [] No 228/ 8 1 1 97 2 229 100 226 1,1,1,2-Tetrafluorethane - - 234 235 [] Yes [] No 236 237 238 Yes [] No 240 241 242 [] Yes [] No 244 245 ~AME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE S DATE 24~ UPCF (7199) S:\CUPAFORMS\~)ES2731.TV4.wp, ~l t~tttm I OF~E CITY OF BAKERSFIEL OF ENVIRONMENTAL SVIS, ES ~nnr~,~r 1715 Chester Ave., CA 93301 (661) 3.26-3979 "~'~~'~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per matedal per building or ama, ~ NEW ~ ADD ~ DELETE ~ REVISE 200 Page ~ of BUSINESS NAME (Same as FACILI~ NAME ~ DBA - O~ng Busings ~) 3 AIR CO~T[O~ S~[V[C[S CHEMI~L LO~TION 201 CHEMI~L LOCATION ~EHOUSE 'CONFIDE~IAL(EPC~) ~Y~ ~No 202 205 T~DE SECRET CHEMICAL NAME C erie cr on 2 2 if subl~ to EPC~. ref~ to tnstmml~s 207 COM~N ~ME EHS* ~ Y~ ~ No 208 ~-~1 FIRE ~DE H~RD C~SSES (~plete if r~u~t~ by I~1 fire 210 ~PE ~ p PURE ~ m MIX. RE ~ w WASTE 211 ~DIOACTNE ~ Y~ ~ No 212 CURIES 213 PHYSICALSTA~ ~ s SOLID ~1 LIQUID i g ~S 214 ~RGESTCO~AINER 30~ 215 FED H~RD ~TE~RIES ~ I FIRE ~ 2 REACTIVE ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~L~ D 5 CHRONIC H~LTH 216 (Ch~ all Ihat apply) ANNUAL WASTE 217 ] ~I~M 218 AVENGE 219 STATE WASTE ~DE ~0 A~U~ ~ OAILY~U~ 360~ OA~CYA~Um 60~ UN~TS' ~ g~ GAL ' If EHS, am~nt must be in lbs. 3 6 STOOGE CONTAINER ~ a A~VEGROUND TANK ~ o P~STI~ONMETALLIC DRUM ~ I FIBER DRUM ~ m G~SS BO~LE ~ q ~lL ~R 223 (Check all ~at apply) ~ b UNDERGROUND TANK ~ f CAN ~ j BAO ~ n P~ST~C BO~LE ~ r OTHER ~ c TANK INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER ~ 9 TANK WAGON STOOGE PRESSURE ~ a A~lE~ ~ aa ABOVEA~IE~ ~ ba BELOW AMBIE~ 224 STOOGE TEMPE~TURE ~ a A~lE~ ~ aa ABOVE A~lE~ ~ ba BELOWAMBIENT ~ c CRYOGENIC 225 100 226 Chlorodifluoromethane 227 '[]Y. []No 22S 75--45--6 2m 230 231 [] No 232 233 234 235 [] No 236 237 238 t'es [] No 240 241 242 [] Yes [] No 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE 2a6 UPCF (7~99) S:\CUPAFORMS\~)ES2731.TV4.wp' CITY OF BAKERSFIELI OI I CE OF ENVIRONMENTAL VICES 1715 Chester Ave., CA 93301 (661) 3.26-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per matedal per building or areal [] NEW [] ADD r-] OELETE [] REVISE 200 Page __ of __ · ,.. ,,:'/,,~ ?~: ::~ :~:~:!.i?~!~/~i;:!!:~?!,i!:~?!:!!~:ii!,!,'?!,!:!i~!i.i.'~i::!,,,~i, ~,i.~ :=.::~.~'"i~:'i:i ,,,, ~1~ FACIU~* i~FORM~IbN~??5.~;~?~?~:~':?=.~:?:': ??~,~ '~*~','~: ?'.L:: ,. ~', '.' '*.. , "'~ BUSINESS ~ME (Same es FACILI~ ~ME ~ DBA - Doing Busings ~) 3 AIR CONTROL SERVICES 201 CHEMICAL LOCATION CHEMI~L LOCATION ~ Y~ ~ No 202 WA~HOUS E ·CONFIDENTIAL (EPC~) 205 T~DE SECRET ~ Y~ ~ No CHEMICAL ~ME Genetron 12 If Subj~ to EPC~, ref~ to instm~i~s 201 COM~N NAME EHS' ~ Y~ ~ NO 2~ R-12 CAS ~ 209 ~i~h~ i~'?~;~ ~ ~ ~ioW a~t~ a ~. FIRE CODE H~RD C~SSES (~plete if r~u~t~ by I~1 fire ~ie0 210 ~PE ~ p PURE ~ m MIX.RE ~ w WASTE 211 ~DIOACTIVE ~ Y~ ~ No 212 CURIES ~RGEST CO~AINER 215 PHYSICAL STA~ ~ s SOLID ~I LIQUID ~ g ~S 214 125~ FED H~RD ~TE~RIES ~ 1 FIRE ~ 2 REACT~E ~ 3 PRESSURE REL~SE ~ 4 ACUTE H~LTH ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) ANNUAL WASTE 217 ~I~M 218 ~ AVENGE 219 STATE WAS~ CODE A~U~ DAILY A~U~ [25~ I DAILY A~UNT DAYS ON SITE 22z UNITS* ~ ga GAL ~ d CU ~ ~ ~b LBS D tn TONS 221 * If EHS, am~nt must be in lbs. ~ ~ ~ STOOGE CONTAINER ~ a ABOVEGROUND TANK ~ e P~STI~NONMETALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R 223 (Check all that apply] ~ b UNDERGROUND TANK ~ f CAN ~ J BAG ~ n P~STIC BO~LE ~ r OTHER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ k BOX ~ o TOTE BIN ~ d S~EL DRUM ~ h SILO ~ I CYLINDER D p TANK WA~N STOOGE PRESSURE ~ a A~IE~ ~ aa ABOVE A~IE~ ~ be BELOWAMBIE~ 224 STO~GETEMPE~TURE ~ a A~IE~ ~ aa ABOVE A~IE~ ~ be BELOWA~IE~ ~ c CRYOGENIC 225 227 [] Yes ~ No 228 229 [00 226 Dichlorodifluoromethane 75-71-8 253 230 231 [] Yes [] No 232 237 234 235 No 236 241 238 Yes [] No 240 242 [] Yes [] NO 244 245 PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE SIGNATURE DATE UPCF (7/99) S:\CUPAFORMS\~)ES2731.TV4.wp,