Loading...
HomeMy WebLinkAboutHAZ-BUSINESS PLAN 1/14/2003 HAZARDOUS MATERIAL INVENTORY PACKET Date: 1/14/03 Business Name: SCP Distributors, LLC Business Address: 4601 Grissom Street Bakersfield, CA 93313 New Inventory: [] Annual Update: X BUSINESS EMERGENCY PLAN: EMERGENCY PROCEDURES Emergency response, plans and procedures are an integral part of the Business Emergency Plan. By taking the time to develop plans and procedures for your business, you will avoid complications resulting from inaction or misguided action during an emergency. Once the plans and procedures are developed, your employees will have an informative guide to follow in the event of an emergency. You must address each of the following items, however, the amount, of detail you provide will depend upon the size and nature of the business, the damage potential of the hazardous materials handled, and the location of the business with respect to residential or other populated areas. 1. EMERGENCY RESPONSE PLANS AND PROCEDURES A. Your business is required by State Law to provide immediate notification of any release or threatened release of a hazardous material to: 1. Local fire emergency response personnel; 2. The.Office of Emergency Services (OES); 3. The Hazardous Materials Management Division. If you have a release or threatened release of hazardous materials, immediately call: FIRE/PARAMEDICS/POLICE/SHERIFF PHONE: 911 STATE OFFICE OF EMERGENCY SERVICES: (800) 852-7550 OR (916) 262-1621 THE COUNTY OF KERN HAZARDOUS MATERIALS MANAGEMENT DIVISION: (661) 391-7000 INDIVIDUAL RESPONSIBLE FOR CALLING THE HAZARDOUS MATERIALS MANAGEMENT DIVISION AND THE OFFICE OF EMERGENCY SERVICES: -Val Estrada IDENTIFICATION OF THE CLOSEST APPROPRIATE EMERGENCY MEDICAL FACILITY AVAILABLE TO YOUR BUSINESS: NAME: Bakersfield Memorial ADDRESS: 420 34th Street CITY: Bakersfield, CA 93312 PHONE: (661) 327-4647 2. PREVENTION Describe the kinds of hazards associated with the materials present at your business. Provide information of the steps taken at your facility, or the policies or procedures now in place, to help PREVENT an accidental release of hazardous material. Issues for discussion may include safety, storage, and containment procedures. Please be specific for each type of Hazardous Material at your business. NEW HIRE ORIENTATION, ONGOING'DOCUMENTED SAFETY MEETING, ANNUAL HAZ COM REFRESHER TRAINING COURSE. TRAINING GIVEN IN PROPER SEGREGATION AND STACKING OF CHEMICALS. 3. MITIGATION Describe the procedures to be followed to REDUCE THE SEVERITY of a release or threatened release of a hazardous material at your business. The procedures should detail the actions to be taken by employees to stop a release, contain a release, or to reduce the problems associated with a release. What is your immediate response to a spill, fn'e explosion or airborne release at your business? Do not write procedures that exceed the capabilities of employees or equipment at your business or that violate any workers safety laws. DOCUMENTED MONTHLY SAFETY MEETINGS AND FACILITY INSPECTIONS ARE DESIGNED TO IDENTIFY POTENTIAL HAZARDS. IN CASES OF A RELEASE, ALL EMPLOYEES ARE TRAINED TO IMMEDIATELY NOTIFY THE MANAGER. IN OUR WAREHOUSE, A HAZARDOUS SPILL WOULD PROBABLY BE A SMALL LIQUID SPILL. ALL EMPLOYEES HAVE BEEN TRAINED IN USING ABSORBANT TO CONTROL A SPILL. A SMALL HAZARDOUS CHEMICAL SPILL CLEAN UP KIT IS PROVIDED AT THE BRANCH. THE CHEMICAL SPILL KIT CONSISTS OF A NONPOROUS CONTAINER, PLASTIC SHOVEL, GOGGLES, RUBBER BOOTS, CHEMICAL RESISTANT GLOVES, AND AN APRON. THE BRANCH MANAGER IS TRAINED TO IDENTIFY THE SPILL AND IN CASES.OF A LARGE SPILL TO CALL THE FIRE DEPT. "911". 4. ABATEMENT Describe what you would do to STOP and REMOVE each hazard. How do you handle the complete process of stopping a release, cleaning up, and disPosing of released materials at your business? What aspects of the response are beyond your ability and need to be handled by others? Who would you call to handle the release? ALL EMPLOYEES HAVE BEEN TRAINED IN USING ABSORBANT TO CONTROL A SPILL. A SMALL HAZARDOUS CHEMICAL SPILL CLEAN UP KIT IS PROVIDED AT THE BRANCH. THE CHEMICAL SPILL KIT CONSISTS OF A NON-POROUS CONTAINER, PLASTIC SHOVEL, GOGGLES, RUBBER BOOTS, CHEMICAL RESIST)kNT GLOVES, AND AN APRON. THE BRANCH MANAGER IS TRAINED TO IDENTIFY THE SPILL AND IN CASES OF A LARGE SPILL TO CALL THE FIRE DEPT. "911". 5. EARTHQUAKES Identify the areas and equipment in your business which would require immediate attention following an earthquake. Check for equipment such as gas cylinders, piping, drams, etc., that may need to be secured or spillage that may require mitigation. THE AREAS IN THE WAREHOUSE THAT WOULD BE OF CONCERN WOULD BE THE LIQUID CHEMICALS BREAKING IF THEY WERE TO FALL. ALL CHEMICALS ARE IN PLASTIC BOTTLES THAT RESIST SHATTERING UPON IMPACT. 6. HAZARDous WASTE coNTINGENCY Specific procedure for prevention, mitigation and abatement of a release of hazardous waste generated at your business. This section only applies to hazardous waste generators. 7. UNAUTHORIZED RELEASE RESPONSE PLAN SPecific procedures for mitigation,· abatement and reporting of an unauthorized release from an underground storage tank (UST). The plan must address a release from a single wall or a double · wall tank system as applicable. This plan should cover the entire UST system. This section only applies to UST owner/operators. BUSINESS EMERGENCY TRAINING Employers are required by State law to have a program which provides employees with initial and refresher training in the following areas: A. Methods for the safe handling of hazardous materials stored at your business, including familiarity with the characteristics and hazards of each material (MSDS's) and measures employees can take to protect themselves from chemical hazards; B. The CAL OSHA Hazardous Communication Standards; C. Correct use of emergency response equipment and supplies available at your facility; D. The prevention, abatement and mitigation procedures you have developed for.your business and explained on the business plan forms; E. The emergency evacuation plans you have developed, the notification procedure used to alert people to evacuate, and the closest location to obtain appropriate emergency medical care; F. Procedures to coordinate with and assist the local emergency personnel that may respond to your business; G. Who and how to call for immediate assistance in the event of an accident involving hazardous materials. ALL EMPLOYEE TRAINING SHALL BE DOCUMENTED AND UPDATED ANNUALLY 1. Personnel · A. Are there any specially mined hazardous materials emergency response personnel at your bus~ness? ~ NO If yes, how many personnel and what are their levels of training or capabilities? EACH PERSON IS TRAINED TO USE HAZ MAT SPILL KITS IF A SMALL SPILL, LARGE SPILLS REQUIRE A CALL TO THE FIRE DEPARTMENT.. B. Do you have decontamination capabilities for victims of exposure to hazardous materials at your business? ~-~ NO If yes, what type of decontamination can be performed at you business? SHOWER AND EYE WASH STATION C. Do you have personnel that will provide site security at your business during and after a hazardous materials incident? ~ NO 2. Equipment A. List the type and location of equipment that can or will be used for response to hazardous materials incidents at your facility. (Examples of equipment types: personal protective equipment, fire extinguishers, spill containment material, etc.) TYPE OF EQUIPMENT LOCATION PPE HAZ MAT DRUM FIRE EXTINGUISHERS THROUGHOUT WAREHOUSE HAZMAT CONTAINMENT KIT IN CHEMICAL STORAGE WAREHOUSE POST FOR EMPLOYEES BUSINESS EMERGENCY PLAN: EMERGENCY NOTIFICATION During an emergency involving a release or a threatened release of a hazardous material you MUST notify appropriate agencies. Information you should be prepared to supply includes: 1. Name and telephone number of reporter; 2. Name and address of business; 3. Time and typeofrelease (e.g., damaged containers, malfunctioning equipment, etc.); 4. Name and quantity of material(s) involved; 5. Extent and number of injuries; 6. Actions taken or being taken to mitigate or reduce emergency; 7. Potential hazards to human health or the environment surrounding the business. TELEPHONE ROSTER AGENCY TELEPHONE NUMBER FIRE DEPARTMENT 911 AMBULANCE/PARAMEDIC 911 POLICE/SHERIFF 911 HOSPITAL Mercy Southwest (661) 666-6000 PRIMARY FACILITY EMERGENCY CONTACT PERSON: Val Estrada, Branch Manager (661) 837-8344 HAZARDOUS MATERIALS MANAGEMENT DIVISION Kern County (661) 391-7000 CALIFORNIA OFFICE OF EMERGENCY SERVICES (800) 852-7550 NATIONAL RESPONSE CENTER (800) 424-8802 POISON CONTROL CENTER (800) 876-4766 HAZARDOUS MATERIALS CLEAN UP CONTRACTOR ChemTrec .. ' (800) 424-9300 Other Contacts · Thomas Flake (985) 801-5128 OR 1-877-821-9166 UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS ACTIVITIES I. FACILITY IDENTIFICATION BUSINESS NAME (Same as Facility Name of DBA-Doing Business As) H. ACTIVITIES DECLARATION NOTE: If you check YES to any part of this list, please submit the Business Owner/Operator Identification page (OES Form 2730).. Does your facility... If Yes~ please complete these pal~es of the UPCF .... A. HAZARDOUS MATERIALS Have on site (for any purpose) hazardous materials at or above 55 gallons for liquids, 500 pounds for solids, or 200 cubic feet for compressed gases HAZARDOUS INVENTORY (includ~ liquids in ASTs and USTs); or the applicable Federal thresholdV']YES [] NO 4 CHEMICAL DE$CRIFTION (OES 2731) quantity for an extremely hazardous substance specified in 40 CFR Part 355, Appendix A or B; or handle radiological materials in quantities for which an emergency plan is required pursuant to 10 CFR Pa~s 30, 40 or 70? B. UNDERGROUND STORAGE TANKS (LISTs) UST FACILITY (Form,~ SWRCB Fo~ ^) 1. Own or opcrate underground storage tanka? []YES [~O $ USTTANK(o~,~e~r~)(~orm~riyl:ormB) 2. Intend to upgrade existing or install new USTs? [] YES [~ 6 UST FACILITY UST TANK (or~ v~r ~) UST INSTALLATION - CERTIFICATE OF COMPLIANCE (on~ pas* p~ ta~k) (l'orm~ Fo=a C) 3. Need to report closing a UST? [-]YES [~/NO 7 USTTANK(~oa~r~ort~n-on~.~.rt~,) C. ABOVE GROUND PETROLEUM STORAGE TANKS (ASTs) Own or operate ASTs above these thresholds: ---any tank capacity is greater than 660 gallons, or [] YES' [~NO 8 NO FORM REQUIiZED TO CUPA's --the total capacity for the facility is greater than 1,320 gallons? D. HAZARDOUS WASTF, EPA ID NUMBER - provide at the top of this 1. Generate hazardous waste? [] YES ~/NO 9 page. Complete tho Hazardous Waste Generator, County of Riverside form. 2. Recycle more than 100 kg/month'of excluded or exempted REcYCLABLE MATERIALS REPORT (or~ recyclable materials (per HSC 25143.2)? [] YES [{~/NO 10 3. Treat hazardous waste on site? [] YES ~]/NO 11 ON$1TE HAZARDOUS WASTE TREATMENT - FACILITY (~om~y o?sc ~orm ON$1TE HAZARDOUS WASTE TREATMENT - UNIT (oazp~*pzruni0(Forr~rlyDTSCForma 17T2 A, B, C, D ~ndL) 4. Treatment subject to f'mancial assurance requirements (for CERTIFICATION OF FINANCIAL ASSURANCE Permit by Rule and Conditional Authorization)? [] YES [~O 12 (Fo~m~ re'SC ~o,, REMOTE WASTE / CONSOLIDATION SITE 5. Consolidate hazardous waste generated at a remote site? [] YES [~]~O 13 ANNUAL NOTIFICATION (~or,,~y rrrsc ~om l~) O HAZARDOUS WASTE TANK CLOSURE 6. Need to report the closure/removal of a tank that was classified as [] YES 14 hazardous waste and cleaned onsite? CERTIFICATION (l~on~-ly lyrsc l:orm E. LOCAL REQUIREMENTS Note: If you have answered "NO" to question A listed above, complete and submit the Statement of Exemption page. UNIFIED PROGRAM CONSOLIDATED FORM FACILITY INFORMATION BUSINESS OWNER/OPE~TOR IDENTIFICATION I. IDENTIFICATION BUSINESS NAME (s=,. ~ r^aLrrY ~,~ o~ rrnA- V~ins ~= ~) ~ BUSINESS PHONE ~o2 BUSINESS .~I'I'E ADDRESS . ~ 104 I [ ZIP CODE DUN & BRADSTR.~T Jo6 I SIC CODE (4 digit f0 lO? ~'7-07 ?0- 8 S03 · [ 5'o q l COUNTY BUSINESS OPERATOR NAME lo~ [ BUSINESS OPERATOR PHO~ ~ BUS--SS O~R O~N~ m [ O~PHO~ ~ ) u4 STA~ ns [ ~ CODE 116 m. ~o~~ CO~tACT . 117 [ CO~A~PHO~ lis ~A~ ~G ~D~SS !~q ~4k9~.. ~ ~1~. ~..,'~ C~ I STA~ 111 I~CODE -PR~Y- iv. EM~ENCY CO.ACTS -SECONDARY- N~ i~ [ N~ ~ ~ BU~S PHO~ ~zo ~HO~ PHO~ 126 24-HO~ PHO~ 131 ~D~ION~ LOgY CO~C~ ~O~ON: Certification: Based on my inquiry of thos~ individuals r~ponsibl~ for obtaining tho information, I certify under penalty of law that I have personally examined and am SIG~O~~EKATOR OR DESIGNATED REPRESENTATIVE DATE 1~4 NAM~ OF DOC~ PREPARER NAME OF SIGNER. (prira) 136 TITLE OF SIGNER 137 UNIFIED PROGRAM CONSOLIDATED FORM ttAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - C}IEMtCAL DEscRn'TtON [-]ADD [-]DELETE [~EVISE 200I Page~ °fo~': I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) 3 CHY_2MICAL LOCATION '/ 2Ol I CHEMICAL LgCATION CONFIDENTIAL EPCRA 202 I II. CB]gMICAL INFORMATION CHZMICAL NAME 20~ TRADE SECRET [] Yes ~o 2o6 COMMON NAME ,z ..g ,,) ~ 208 CAS# 2o9 FIRE CODE HAZARD CLASSES (Comp~t~ ifr~qui~a ~ CUBA) 2~o I 213 HAZARDOUS MATERIAL TYPE (Check om ~m only) rIG. PURE ~.MI~ [-]~.WASTE 211 RJ~DIOA(~KIV~ [-]Yi~ [~1o 212 CIJRIES 215 PHYSICAL STATE 2~4 LARGEST CONTAINER FED HAZARD CATEGORIES 216 AVERAGE DAILY AMOUNT 21 ? MAXIMUM DAILY AMOUNT 218 I mzJ~ WASTE AMOUNT 219 I STATE WASTE CODE 2~ ,960JJ ~21 I DAYS ON SITE: (Check on~ item onl~t) * If EH.q, mount must b~ in pound~ STORAGE CONTAINER I-la. ABOVE GROUNDTANK I-]~.?LASTIC/NONM~TALLICDRUM [] i. FIBERDRUM I-]m. GLA£S'BOTrLE [] q. RAILCAR [] b. UNDI~GROUND TANK [] fi CAN [] j. BAG [~ PLASTIC BOTTLE [] r. OTHER [] ¢. TANK INSIDE BUILDING I--Ig. CARBOY [-] k. BOX []o. TOTEBIN [] d. STEEL DRUM [] h. SILO [] L CYLINDER [] p. TANK WAGON 223 STORAGE PRESSURE ~ AMBIENT [] b.. ABOVEAMBIEN'r [] ¢. BELOW AMBIENT STORA~ Tm~V,~TUm~ ~ ~vmmawr [] ~. ~ov~'mm'm [] e. ~ELow tdm3m~rr [] a. cx¥c~a, nc %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 2 ~30 2n []Yes [] No m 3 z~4 2~ [] Yes [] No 2~ 4 2~8 2~9 [] Yes [] No 240 5 242 24, [] Yes [] No 244 NFPA HAZARD IDENTIFICATION: HEALTH ~ FLAMMABmrrY l REACTIVITY / SPECIAL HAZAKD ~ UNIFI~D PROGRAM CONSOLIDATED FORM HAZARDOUS MATER/ALS HAZARDOUS MATERIALS INVENTORY - CHEM~CAL'DESCRIPTION I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA - Doing Business As) 3 CHEMICAL LOCATION 201 I CHEMICAL L~CATION CONFIDENTIAL EPCRA FA~ ID # II. CHEMICAL INFORMATION CHEMICAL NAME :a~ TRADE SECRET [] Yes [~40 COMMON NAME ao7 Cc, l¢,:l,,o.x Tt'xC.o't't~.b~,t' EHS* [] Y~ [~o CAS// :o~ FIRE CODE HAZARD CLASSES (c,~vt,,~ ir r,.,tua.~d by cu~^) 2]0 TYPE (Check one item only) D~a. PLIR.E [~.MIXTURE I-~c. WASTE 2II RADIOACTIVE [-}Yea [~o 2EZ[ CURIES PffYSICAL STATE 2]5 (Checkone itemonly) ~a. SOLID l-lb. LIQUID [] c. GAS 214 LARGEST COmAINER FED HAZARD CAT~GOI~I~S 216 (Check all tim apply) [] a. FIRE [] b. REACTIVE [] c. ?RESS2JRE n~).~ASE [] cl. ACUTE HEALTH UI ~. CHRONIC HEALTH AVERAGE DAILY AMOUNT 217 I MAX]MUMDAILY AMOLINT 218 ANNUAL WASTE AMOUNT 219 ~ STATE WASTE CODE 220 90.50I ,5oo [ Ayg (Check one item only) * IfEHS, mount must be in pounds. STORAGE CONTAINER r-la. ABOVE GP, OLrNDTANK rIe. PLASTIC/NONMETALLICDRLrM [] i. FIBERDRUM~rlm. GLASS BOTTLE [] q. RAILCAR [] b. UNDERGROUND TANK [] £ CAN [] j. BAG [~n. PLASTIC BOTTLE [] r. OTHER I-lc. TANK INSIDE BUII~ING []g. CARBOY [] k. BOX r'lo. TOTEBIN []cl. STEELDRUM r'ltt silo [] L CYLINDER. []p. TANKWAGON 2.13 STORAGE PRESSURE [~ AMBIENT [] b.- ABOVE AMBIENT [] c. BELOW AMBIENT 224 STORAGE TEIVI~ERATURE ~ AMBIENT [] b. ABOVE AMBIENT [] ¢. BELOW AMBIENT [] d. CRYOOD, tlC %WT . HAZARDOUS COMPONENT (For mix•re or Waste only) EHS CAS # 1 ~^ HAZARD ~ENTa:ZCATION: ~:.~L~_O_ FLnMM~Lrr¥_~ ~.EACTrVTrY i SeEC~nL I¢~z~D ~ ' UNIFIED PROGRAM CONSOLIDATED FORM ItAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION n~D nDm~Vz ~ mI I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) CHEMICAL LOCATION 201 I CHEMICAL LgCATION CONFIDENTIAL EPCRA IL CltlgMICAL INFORMATION CHEMICAL NAME 2m TRADE SECRET [] Yes [~Io COMMON NAME 'J' ' 20~ E~S* [] ¥~ Et~o CAS# ,,ol '~o 209 ? -2 "] ~' '- U ~'l" 5 *IfEHS is"Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (com~t~if~,q~¢a ~ CtmA} ilO I 213 rVPS(Ch~ko,,it,mo~v) [],.~ma r~.Hrrrtam D,.w^sr~ 2,1 axv]D^crr~ D¥~ ill'rio PHYSICAL STATE - ~ FED HAZARD CATEGORIES AVEIt~GE DAILY AMOUNT 217 I MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOUNT 219 I STATE WASTE CODE 220 ~l DAYS ON SITE: 222 STORAGE CONTA.INER [] ~ ABOVE GROUND TANK ~ PLASTICJNONMETALLIC DRUM []i. FrBER DRUMEr~ [] m. GLASS BOTTLE [] q. RAIL CAR [-I b. UNDERGROUND TANK r'If. cAN [] j. BAG PLASTIC BOTTLE [] r. OTHER [] c. TANK INS]DE BUILDING [] g. CARBOY [] k. BOX [] o. TOTE BIN I-Id. STEELDRUM []ES[LO [] [ CYLn,]DER []p. T~'aCWXGON STO1L~GE PRESSURE [~ AMBIENT [] b.' ABOVE AMBIENT [] c. BELOW AMBIENT 224 STORAGE TEM~PERATURE [~ AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or wast~ only) EHS CAS # 1 4 238 239 [] Yes [] No 240 241 5 ~42 2a~ [] Yes [] No 244 NFPA HAZARD IDENTIFICATION: HF_..~TH ~ FLAMMABILITY ('~ REACTIVITY q~ SPECIAL ItAZARD/kJ/~ 246 UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS ' HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRrPT~ON nA~D E]DmaT~ ~E ~oo I Pag~ IL or~t~ I. FACILITY INFORMATION . . BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 · SC{) ¢);s¥c:b~)r~s CCC CHEMICAL LOCATION / zo~ ] CtIEMICAL LOCATION CONFIDENTIAL EPCRA II. CIIEMICAL INFORMATION CHEMICAL NAME · :os TRADE SECRET [] Yes ~qo 2as COMMONI I'IAME · 2o~ 2o~ CAS# ~' ~O~ (~C~ -~ -,5 ~ - (.0 *IfEHS is "Y~", all mounts below must I~ in lbs. FIRE CODE HAZARD CLASSES (c~np~t~ ifteqair~d by. CUPA) 210 HAZARDOUS MATER~A,L 2~3 TYPE (Check or~ item only) [] a. PUILE ~]'~. MIXTURE [] c. WASTE 231 RADIOACTIVE [] Yes [~o PHYSICAL STATE (Check one item only) [] a. SOLID [~. LIQUID [] c. GAS 214 LARGEST CONTAINER i FED HAZARD CATEGORIES (Clzck all that appty) [] a. FIRE [] b. REACTIVE [] c. PRESSURE R~-~ASE [~ ACUTE HEALTH [] e. CI~ZOI~ffC HEALTH AVERAGE DAILY AMOUNT 217 I M~$'X]]VfI'J~DA-I~¥AMOUlqT 218 ANNUAL WASTE AMOUNT 219 UNITS* ~a. GALLONS [] b. CUBIC FEET [] ¢. POUNDS [] cl. TONS '~ DAYS,~ON SITE: ~-~ item only) * IfEHS. amount must be in pounds. STORAGE CONTAINER I--la. ABOVE GROUNDTANK I-le. PLASTICJNONMETALLICDRIJI~ [] LFIBERDRI~ []m. GLASS BOTTLE [] q. RAILCAR [] b. UNDERGROLFND TANK [] E CAN ·~. j. BAG ~ n. PLASTIC BOTTLE [] r. OTI~R IZI¢.TANKn~sIDEBUnX)n~o I-Ig. CAmSO¥ [] k.~OX []o. TOTEiSI~ [] cL STEEL DRUM [] t~ SiLO [] k CYLINDER [] p. TANK WAGON STORA(m i'i~SStm,~ ~ ~a~mm~rr [] ~.. ABov~ ~vmm:,rr [] ~. ~ow ~i~,rr STORAGE TEMPERATURE [~ AMBIENT [] b. ABOVE AMBII~Nrr [] c. BELOW AMBIENT [] d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 · 228 229 3 ~4 zss []Yes [] No =s 4 238 239 [] Yes [] No 240 ,41 5 242 143 [] Yes [] No 244 ,45 NFPA HAZARD IDENTIFICATION: HEALTH ~ FLAMMABILITY J REACTIVITY (-,) SPECIAL HAZARD ~,}/.~ ~46 UN # £2(~' maam c_~s.s oa DnnS~O~ # UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS 'HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION I. FACILITY 131FORMATION BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) CHEMICAL LOCATION / 20~ J CHEMICAL L~CATION CONFIDENTIAL EPCRA 2o2 II. CBEMICAL INFORMATION CHEMICAL NAME ~o~ TRADE SECRET [] Yes [~qo ~0~ COMMON NAME 2o~ 2o8 CAS# 2o9 FIRE CODE HAZARD CLASSES (comva,t, ifrequ~d by CUP.n.) 210 I-IAZARDOU$ MATERIAL 213 PHYSICAL STATE 215 (Ch~ck one item only) ~a. SOLID ["] b. LIQUID nc. GAS 214 LARGEST CONTAINER 50lbs FED HAZARD CATEGORIES (C~ck all that apply) [] tu FIRE [] b. REACTIVE [] ¢. PRESSURE RRI,gA, SE [] d. ACUTE HEALTH [] e. CHRONIC HEAL'ITI 221 DAYS ON SITE: UNrrS* [] a. ans.~oss [] b. CtmIC UT ~ ?om,iDs [] & TONS (Check one item only) * If Eib, mount must be in pounds. STORAGE CONTAINER. []a. ABOVE GROUNDTANK [-] e. PLASTIC/NONMETALLICDR.IYM/ [] ~.FIBERDR. UM ["]m. GLA$SBoTrLE [] q. RAILCAR. [-Ib, UNDERGROUND TANK [] I~CAN [~ j. BAG []n. PLASTIC BOTTLE [] r. OTHER [] c. TANK INSIDE BUILDING [] g. CARBOY [] k. BOX [] o. TOTE BIN [] cl. STEEL DR.UM [] h. SILO [] L CYLINDER. [] p. TANK WAGON 223 STORAGE PRESSURE [~ AMBIENT [] b.'ABOVEAMBIENT [] c. BELOWAMBII~NT STOILAGE TEMPERATURE [~ AIVlBIENT [] b. ABOVE AMBIENT [] e. BELOW AMBIENT [] d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 [] Yes [] No 22S 229 2 ~o 2~ []Yes [] No m 3 234 235 [] Yes [] No 236 237 4 2~ 23~ [] Yes [] No 240 5 2n~ 24~ [] Yes [] No ~44 245 NFPA HAZARD IDENTIFICATION: HEALTH C~ FLAMMABILITY O REACTIVITY C) SPECIAL HAZARD k/[/~b 2,~6 I£EPCRA, Please Sign Here r~ . UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMiCaL ~ESCRn'TIO~ I. FACILITY INFO~TION BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) CHEMICAL LOCATION zm [ CHEMICAL LgCATION CONFIDEIVrlAL EPCRA 202 II. CItEMICAL INFORMATION CHEMICAL NAME 2~ TRADE SECRET [] Ye~ [~No COMMON NAME 2or 2os CAS# FIRE CODE HAZARD CLASSES (Com~t~ irr~u~,d ~ CmA) I TYPE (Check one item only) [~"'~URE I-Ih. MIXTURE r'[¢.WASTE 211 RADIOACTIVE ]'-]Yes [~o 212 CURIES PHYSICAL STATE 215 FED HAZARD CATEGORIES ~ 2~6 (Check all that apply)~-- IRE [] b. REACTIVE [] ¢. PRESSIJRE RELEASE [] d. ACUTE HEALTH [~e. CHRONIG HEALTH AVERAGE DAILY AMOUNT 217 ] MAX]MUM DAILY AMOUNT 218 [ ANNUAL WASTE AMOUNT 219 ] STATE WASTE CODE 220 / UNITS* item I-Ia. GALLONS. []b. CUBICFEET F'M'~c. POUNDS I-Id. TONS 221[DAYS ON $1TE:t'~ ~ ~ 222 {Check one only) * IfEHS, amount must be in pounds.I V O STORAGE CONTAINER r'ia. ABOVE GROUNDTANK [~.PLASTICdNONMETALLICDRUM [] L FIBER DRUM, [-l m. GLASSBOTrLE [] q. RAILCAR [-Ib. UNDERGROUND TANK ["I~CAN [] j. BAG [~/n. PLASTIC BOTTLE [] r. OTHER [-Ic. TANK INSIDE BUILDING []g. CARBOY [] k. BOX I-lo. TOTEBIN I-Id. STEI~DRUM []h. SILO [] I. CYLINDER []p. TANKWAGON 223 STORAGE PRESSUR~ ~'/~' AMBIENT [] b.' ABOVE AMBIENT [] c. BELOW AMBIENT 224 STORAGE TEMPERATURE ~ AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] d. CRYOGENIC 22~ %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 22s n7 [] Yes [] No ns 2 2~0 m []Y~s[]No m 3 ~4 z~ [] Yes [] No ~as 4 m m []Yes [] No :40 ~41 5 242 ~s [] Yes [] No ~ NFPA HAZARD IDENTIFICATION: I-IEALTH,~) FLAMMABILITY J REACTIVITY ~ SPECIALHAZARD~/~ UN # ~/a HAZARD C.J~AS_S OR DIVISION # UNIFIED PROGRAM CONSOLII)ATED FORM ~OUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION EI~DD FIDm~W~ ~E ~oo [ L FAClI.ITY I/VFORMATION BUSINESS NAME (Same as FACIL1T~ NAME or DBA- Doing Business Aa) CHEMICAL LOCATION / 2ol [ CHEMICAL LgCATION CONFIDENTIAL EPCR. A ~ :az FACILITY ID # H. CltEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET [] Yes [~qo COMMON' NAME ~ v ~ ffhu'r:o,~c. ' c~c:& ms* [] ¥= CAS# 209 7 "17 - ct 0 FIRE CODE HAZARD CI~SSES (Coml~t~ ifrq~, by CUI'A) ~10 HAZARDOUS MATERIAL 213 TY'~F-,,(Cheokori~itelllOllly) O~.~Ul~ ~.M~"TUR~ r~c.I~VASTE ill I~.DIOACTIV~. OY~ [i~To ll2 CU'R~-q 215 PHYSICAL STATE 114 LARGEST CONTAINER. F~D ~ CATSGORIES 216 (Check all lhat apply) [] a. FIRE ~. REACTIVE [] c. PRJ~SSURE. RRT.~.ASE [~/d. ACT. JT~ ~TI"I [] e. CI-IRONIC HE. ALTH AVERAGE DAILY A~I OLIN'r 217 [ MAXIMUM DAVY AMOUIN-r 218 I ANNUAL WASTF. AMOUiWr 219 [ STATE WASTE CODE /-79 ,lryo UNITS* ~a. GALLONS Flb. CUBICFEET I-I'c. POUNDS [-]&TONS 221~l DAYS ON SITE:,r~ G 5 222 (Clmck on~ item only) *'IfEH$, mount mu~t be in potmda. STORAGE CONTAINER F'Ia. ABOVE GROUNDTANK Fl ~.PLASTIG'NONlvfETALLICDRUM '17] i. FIBERDRUM [-Im. GLASS BOTTLE [] q. RAILCAR [] b. UNDER.GROUND TANK [] £ CAN [] j. BAG [~m PLASTiC BOTTLE [] n OTHER [] c. TANK INSIDE BUILDING [] g. CARBOY [] k. BOX [] o. TOTE I-Id. STEELDRLrM rib. SILO [] L CYLINDER lip. TANKWAGON 213 STORAGE PRESSURE [~ AMBIENT [-[ b.. ABOVE AMBIENT [] c. BELOW AMBIENT 224 STORAGE TEMPERATURE [~ AMBIENT [] b. ABOVE AMBIENT [] c. BELOW AMBIENT [] & CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS ' CAS # 1 4 238 239 [] Y~s [] No 240 241 5 :4~ ~4~ [] Yes [] No :~4 If more ham~rdous components are present at grealer thma 1%. by weight If non-marduogcnlc~ or 0.1% by weight If carel~ogenlc~ attach ~utdlUonal sheets ut'paper rapturing the reRulred luformattom NFPA HAZARD IDENTIFICATION: HEALTH.~_~ ~MABIL1TY/,~r REACTIVITY ~/q SPECIAL HAZARD/0/.~. UNIFIED PROGRAM CONSOLIDATED FORM ItAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CI-mYnCAL D~SCRn'TION I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Bmin~ A~) 3 $C,¢ 0;s+,-:h,,+oc~ L.~C, CHEMICAL LOCATION / 20i I CHEMICAL lOCATION CONFIDENTIAL EPCRA ..., .. I"/" m,¼ou~ Ckco,,.o,iI [] ~s Et'so . · I 204 · t~1 · · II. CI]I, MICAL INFORMATION CHEMICAL NAME ~o~ TRADE SECRET [] ¥~ [~qo COMMON NAME <.J ' ~ 2O~ FIRE CODE HAZARD CLASSES (Com~t~ i~,q~,d M'CUPA) HAZARDOUS MATERIAL . PHYSICAL STATE FED HAZARD CATEGOILIES 216 (Ch~ka~matappiy) [3/~ FIRE ~ REACTIVE [] ¢.PP. ESSU~.~SE [3~ActrrE~LTH [] ~. CH~OmCltEALTH 221 DAYS ON SITE: 222 UNITS* [~a. GALLONS l-lb. CUBICFEET [] c. POUNDS II&TONS (Check one item only) * IfEHS, amount mu~t be in pounds. STORAGE CONTAINER [] a. ABOVE GROUND TANK [] e. PLASTIC/NONMETALLIC DRUA4 [] L FIBER DRUM [] m. GLASS BOTTLE [] q. RAIL CAR [] b. UNDERGROUND TANK [i~/'CAN [] j. BAG [] n. PLASTIC BOTrLE [] r. [-] ¢. TANK INSIDE BUlLDING [-]g. CARBOY [] k. BOX 1']o. TOTEBIN [] d. STEEL DRUM [] b. SILO [] L CYLINDI~. [] p. TANK WAGON STORAGE PRESSURE [~ AMBIENI [] b.. ABOVE AM:BlENT [] c. BELOW AMBI][~rr 224 STORAGE TEMPERATURE ~a~ AMBIENT [] b. ABOVE AMBIENT [] c. BELOW .A_M~I]~qT [] & CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 5-0¢ ei- al 2,, ra4o -27- 73-. 4 n8 239 [] Yes [] No 240 241 5 242 243 [] Y~$ [] No 244 245 NFPA HAZARD IDENTIFICATION: H~.ALTH X~ FLAM~ILrrY .~ REACTIVITY t SPECIAL HAZARD k}/~ UN # I!q,q' ~ c,~s_s o~ Drm~ox # IfEPCRA, Please Sign H~r¢ f~ UNIF~D PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION I. FACILITY INFORMATION BUSI~SS NAME (Samc aa FACILITY NAME or DBA-Doing Business Aa) 3 CKEMICAL LOCATION / 201 [ Cllt~IICAL LgCATION CONFIDENTIAL EPCRA 2~2 II. CItEMICAL INFORMATION CKEMICALNAME 2m T1L&DESECRET. [] Yes [~qo 20~ IfSabjeet to F2CRA, refer to inamaetiona COMMONNAME--('~X,~ - ,--'~.4~/)t~%r EHS* [] Yes Ergo CAS# '3 FIRE CODE HAZARD CLASSES (come, re ifr,qu~a ~ cu~^) 2~o HAZARDOUS MAIERIAL [ PHYSICAL STATE (Check one item only) [2~a. SOLID [""lb. LIQUID [] {:.OAS 214 LAR.GEST CONT~ '5(~ lbs FED HAZARD CATEGORIES 216 (C~k ,U ma,~¢y) [] ~ Faro [i~. P,,sAcrrv~ [] ~. pRESSU~)~;.~s~ [~ ACUra m_~TH [] ~. c~momc AVERAGE DAILY AMOUNT 2,7 i m~xmm DAmY A~OUNT 211t ANNUA.L WASTE AMOUNT 21' [ STATE WASTE CODE 220 UNITS* [] a. GALLONS [] b. CUBIC FEET ~c. POUNDS [] & TONS 22! [ DAYS~ON(~SITE:~ (aneck one itom only) * ifEHS, mount must be in pounds., V 'J STORAGE CONTAINER I-la. ABOVE GR. OUNDTANK []~.PLASTICJNONMETALLICDRUM [] LFIBERDRUM r'Im. GLASSBOTYLE [] q. RAILCAR [] b. Ln, rvF_xoaotrm) TaW< [] ~ CaN [] j. BAG ~ PLaSTiC BOT'E~ [] ~. or-mR [] ¢. TANK INSIDE BUILDING [] g. CARBOY [] k. BOX [] o. TOTE BIN [] d. STEEL DRUM [] h. SILO [] L CYLINDER. [] p. TANK WAGON STORAGE PRESSI. JR~ ~ AIM~BIENT [] b.' ABOVE AzM]31l~q'r [] c. BI~;LOW AM]31~NT 224 STORAGE TEMPERATURE [~1/~ AMBIENT [] b. ABOVE AMBILqqI [] ¢. BELOW AMBIENI [] d. CRYOGEI, rlC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 1 NFPA HAZARD IDENTIFICATION: HEALTH '..~ FLAMMABmlTY o REACTIVITY I SPECIAL ~/k,//.~ If EPCRA. Please Sign Here r.~'~ ~ UNIFIED PROGRAM CONSOLIDATED FORM ItAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRn'T~ON [~]ADD ~ID]~h~T~ [~R~VI~E 200[ Pa§e~of~ I. FACILITY INFORMATION BusnqESS NAME (Same as FACILITY NAME or DBA-Doing B~iness As) 3 CHEMICAL LOCATION 2or [ CI-IEVIICAL LQCATION CONFIDENTIAL EPCRA 2o2 II. CHEMICAL INFORMATION CHEMICAL NAME 2~ TRADE SECRET [] Y~ [~'~,1o 206 COMMON NAME 2}n Iq ~" 09- ~/,.~-- ? ' *IfEHS is "Ycs", all amounts below mttst b~ in lbs. FIRE CODE HAZARD CLASSES (Complet, ffrequked by CUPA) 210 HAZARDOUS MATERIAL ' I 213 TYPE (Ctmck one item only) ~PURE [-lb. MIXTURE I-lc. WASTE 211 RADIOACTIVE I-lYes [~o 212 CUR~S PHYSICAL STATE (Check one item only) ~a. SOLID [] b. LIQUID [] c. GAS 214 LARGEST CONTAINER ~ ~ CATEGOI~IES 216 (Check all that apply) [] a. FIRE [] b. REACTIVE [] ¢. PRESSURE g~.~4SE F1 d. ACUTE HEALTH [~e. CHRONIC HEALTH AVERAGE DAILY AMOUNTj~,, (%,"'~O__ 217 I MAXIMUM DAILY aMlOUNTqff~, [.~ I~ O 2ts ANNUAL WASTE AMouNT~/.f~ 2'9 I STATE WASTE CODE]~]/,f4 220 I ~' 221 UNITs* ["Ia. GALLONS I-lb. CUBICFEET [~c. POUNDS I-Id. TONS I DAYS ON SITE: 222 Check one item only) * IfEHS, mount must be in pounds.I STORAGE CONTAINER I-la. ABOVE GROUNDTANK I-le. PLASTICdNONMETALLICDRUM ~] i. FIBERDRUM I-Im. GLASSBOI-rLE [] q. RAILCAR [] b. UNDERGROUND TANK [] £ CAN ~j. BAG [] m PLASTIC BOTTLE [] r. OTHER []c. TANK INSIDE BUILDING I--Ig. CARBOY [] k. BOX I-lo. TOTEBIN [] d. ~ DRUM [] h. SILO [] L CYI,IIqDER [] p. TANK WAGON 223 STORAGE PRESSURE [~ AMBIENT 'Fl b.- ABOVE AMBIENT [] c. BELOW .AMBIENT 224 STORAGE TEMPERATURE [~ AMBIENT [] b. ABOVE AMBIENT [] ¢. BELOW AMBIENT [] d. CRYOGENIC %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # 226 227 []Y~ [] No 22g 2 2~0 2~ []Yes [] No 2n 3 2~4 235 [] Yes [] No 2~6 237 4 m ~ []Yes [] No 2~o 5 242 243 [] Yes [] No 244 245 NFPA HAZARD 1DEN lib]CATION: HEdkLTH __OFLAMMABILrrY ~ REACTIVITY C) SPECIAL ~ ]k)//~ 246 UNIFIED PROGRAM CONSOLIDATED FORM ItAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL ~)ESCRn'TIO~ F[ADD ['-[DELETE [~-W'ISE ~oo I Page ~ of~" I. FACILITY I1NFORMATION BUSINESS NAME (Same as FACILITY NAME or DBA- Doing Business As) 3 CI-IEMI,CAL LOCATION z 2oi I CHEMICAL lOCATION CONFIDENTIAL EPCRA 2o2 II. Cl~EMICAL 12NFORMATION CHEMICAL NAME 2c~ TRADE SECRET [] Y~s [~]"~o 2o~ COMMON NAME 20~ 208 mis* [] ~'~3- "7 ~" ~ *If EHS is "Yes", all amounts b~low must I~ in lbs. FIRE CODE HAZARD CLASSES (Com~,t~ifr~lu~d byCUPA) ' 210 HAZARDOUS MATERJAL 213 PIT~SICAL STATE (c~ekon~it~on~y) E~.SOL~ []~. LIQUID [] ~.e~ 2i4 ~GESTCOm.~ FED ~ GA'i'EGOI),JE S 216 AVEt~GE DAdLY AMOLrN'f~¥'~'. q(3~,--~ 217 I M~XIMUIvI DA'ILY '~2~IO!'Ti'~VI' ' ~) OO 2~' ~'a'~,~ W~TE^MOUmk,//& 2~ I STATE W^S~ CODE 22~ DAYS ON SITE: 222 Lrb,VITS* [] a. GALLONS [] b. CUBIC FEET [~OUNDS [] d. TONS (Cheek om item only) * IfEHS, mount must be in ~ounds. ~ G 5 STORAGE CONTAINER I-la. ABOVE GROUNDTANK ~e. PLASTICdNONMETALLICDRUM [] i. FIBERDRUM~I-lm. GLASS BOTTLE [] q. RAILCAR [] b. UNDERGROUND TANK [] t' CAN [] j. BAG [~n. PLASTIC BOTTLE [] r. OTHER [] c. TANK INSIDE BUILDING [] g. CARBOY [] k. BOX [] o. TOTE BIN [] d. STEEL DRUM [] h. SILO [] L CYLINDER [] p. TANK WAGON 223 STORAGE PRESSURE [~ AMBIENT [] b..ABOVEAMBIE2qT [] ¢. BELOW AMBIENT 224 STORAGE TEMI~ERATURE [~ A.M]BIENT I'-I b. ABOVE AMBIENT [] c. BELOW AMBIENT [] ct. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or wasto only) EHS CAS # I ' ~ 227 [] Y~s [] No 22s 2 2a0 221 [] Yes [] No 222 3 22n 22s [] Yes [] No ~ ,~7 4 2~s 2~ [] Y~s [] No 2,,0 $ 242 243 [] Yes [] No 244 245 NFFA HAZARD IDENTIFICATION: HEALTH ~ FLAMMABILITY __L_ REACTIVITY [ SPECIAL HAZARD ]LJ/.~ 246 u~ ~ o<%/t¢5 HC.Z¢~ c_~s_s o~ DrV~S,ON # 6. I IfEPCRA, Please Sign Here .~" ~ UNIFIED PROGRAM CONSOLIDATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION [-']ADD [-]DELETE ~]'REVISE 200[ Page~ of~l~' I. ' FACILITY INFO~TION BUSINESS NAME (S~_amc as FACILITY NAME or DBA-Doing Business As) CHEMICAL LOCATION 101 } CHEMICAL I.~CATION CONFIDENTIAL F~CRA II. CHEMICAL INFORMATION CHEMICAL NAME 10s TILADESE~T [] Yes [~'~1o ' 106 COMMON NAME ' 2~ 7071 - ~...-5o-q .~ms is "Ye~", all amounts b~low must bo in lbs. FIRE CODE HAZARD CLASSES (comlt*t~ irrq,ma ~, Ct~A) TYPE (Check one item only) r[~.PURE ~.MIXTURE r']c. WASTE 211 RADIOACTIVE I'-lYes [~o 212 PHYSICAL STATE 115 (Cl~ckun~ it~monly) [] mSOLID ~. LIQUID [] c. GA-q 214 LARGF_~T CONTAINER / FF_.D HAZARD CATEC_~O~.]]~S 216 (Check all thal apply) [] a. FIRE I-lb. REACTIVE [] c, PRF~,qURE~RI.I~ASE [~& AC'U'i~I-ffiALTH [] e. CHRONIC HEALTH AVtiRAGE DAILY AMOUNT 217 ~ MAXIMUM DAILY AMOUNT 218 ANNUAL WASTE AMOLTNT 21~ ~ $'rA'rE WASTE CODE; 220 JJ uNrr$* [~a. OALLON$ ["lb. CUBICFEET [] c. POUND$ [-] d. TONS 121![ DAYS ON $1TE:r.~ (~)5 222 (Clzck om item only) * IfEHS, mount mus~ be in pounds. STORAGE CONTAINER [-]a. ABOVE GROUNDTANK []e. PLASTIC/NONMETALLICDRUM [] i. FIBF_.I~DRUM rlm. GLAS.qBOTTLE [] q. RAILCAR ' r'Jb. UNDERGROUND TANK [-] £CAN [] j.B^G J~ ?LAST~CBOTTLE [] r. OTHER J-]c. TANK IN$IDE BUILDING rig. CARBOY [] k. BOX J-lo. TOTEBIN [] d. STEEL DRUM [] h. SILO [] L CYLINDER [] p. TANK WAGON 123 STORAGE PRESSURE ~ AMBIENT [] b..ABOVEAMB[ENT [] c. BELOW AMBI]~rl' 224 STORAGE TEMPERATURE' [5~/~ AMBIENT [] b. ABOVE AMBIENT [-I ¢. BELOW AMBIENT [] d. CRYOGENIC 2~ %WT HAZARDOUS COMPONENT (For mixture or ~vast¢ only) EHS CAS # 3 234 235 [] Yes [] No z~ =37 4 l~S 239 [] Yes [] NO 240 241 5 24l 24~ [] Y~s [] No 244 ~s NFPA HAZARD IDENTIFICATION: HEALTH ~ FLAMMABILrrY O REACTIVrrY (~;' SPECIAL HAT_.7~.D ~ ~46 UN # / '~ q I HAZARD C~_~S_S OR DIVISION # If EPCRA, Please Siam Here ~'~ ~ UNIFIED PROGRAM CONSOLH)ATED FORM HAZARDOUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION I. FACII,ITY INFORMATION BUSD,IESS NAME (Same as FACILITY NAME or DBA-DOing Business As) CHEMICAL I.~CATION 2ol I CHEMICAL L~)CATION CONFIDENTIAL EPCRA IL CItEMICAL INFORMATION CHEMICAL NAME 205 TRADE SECRET [] Yes [~/~Io 2o6 [] y~ ] UN"- ~,5~--~- ~ *IfEHs is "Yes", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (CoroNet. irr~ulr~d ~ etnA) 210 FduZARDOUS MATERIAL 213 TYPE (Ct~ck one item only) [~?URE I--Ih. MIXTURE nc. WASTE ~.n RADIOACTIVE OY= [1~o =,2 CURIES /~/.~ ?ttYSlCAL STATE 21.5 (Check om item only) [~a. SOLID [] b. LIQIJID [] c. GAS 214 LARGEST CONTAINER IED [4.AZAI~D cA'rlRGOI~IES 216 (CN~k all that apply) [] n. FIRE nb. REACTIVE [] e. PRESSURERRI.I~&SE nd. ACLrl"EREALTH [] e. CHRONIC HEALTH ~' 221 DAYS ON SrlE: 2?.2 UNITS* [] a. GALLON'S [] b. CUBIC FEET ~c. POUNDS [] d. TONS .tO STORAGE CONTAINER. [] a. ABovE GROUND T.~IqK [] e. PLASTIC_.~ONMET~IC DR.UM [] 1. FIBER. DR.UM [] m. GLASS BOTTLE [] q. ~ CAR. I-Ic. ra>,m~sm~um~G n,.cam~o¥ [] k.~ox Fl0. [-~d. STEELDRUM []b. SILO [] L CYLINDER []p. TANKWAGON 223 STORAGE PRESSURE ~ AMBIENT [] b., ABOVE AMBIENT [] c. BELOW AMBIENT 224 STORAGE TEMPERATURE [~ AMBIENT [] b. ABOVE AMBIENT [] e. BELOW AMBIENT [] d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I 226 227 [] Yes [] No 228 229 2 2~0 2~1 [] Yea [] No ~2 3 234 235 [] Yes [] No 236 2~7 4 2~a 2~9 [] Yea [] No 24o 241 5 242 243 [] Yea [] No 244 245 NFPA HAZARD g)ENTn=ICATION: HEALTH ~ FLAMMABILITY O REACTIVITY ~ SPECIAL HAZARD ~)/.q UN # ~'~77~ HAZARD CJ.AS_S OR DIVISION # ~,'~ 'fEPCRA, Please Sign Here ,~ UNIFIED PROGRAM cONSOLIDATED FORM HAZAR1) OUS MATERIALS HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION ['-]ADD [-'[DELETE ~ 2oo I ?ag~ l_~ 'I. FACILITY INFORMATION BUSINESS NAME (Same ae FACILITY NAME or DBA-Doing Business As) 3 CHEMICAL LOCATION / aol ~ CHEMICAL LgCATION CONFIDENTIAL EPCRA o?- ~c¢ .¢~ [] YES tit I 1I. CItEMICAL INFORMATION C~O ,AL NAME 2~ TRADE SECRET [] Yes [~ho ~06 , c. ¼ )of' o-...s--kc ;o.-z b r-,c' COMMON NAME :~ CAS# 2o9 ~"]~ ~ ["~'~ I *IfEHS is "Y~", all amounts below must be in lbs. FIRE CODE HAZARD CLASSES (ComiC.t, ifr,qdr, d t, CU~^) HAZARDOUS MATERIAL PHYSICAL STATE 2 t5 (c~eo,,o~mo~y) I~.sotm []h. uquiD [] ~.~AS n4 ZAR~STCOm~ ~©O lbs FED HAZARD CATEGORIES (Check all that apply) [~ FIRE ~f. REACTIVE [] c. PKESSURERRL~E [])~ ACUTE HEALTH [] e. CHRONIC HEALTH AVERAGE DA]LY AMOUNT 217 MAXIM-UM DAILY AMOUNT 2IS I A]qNUALWAS~AMO~ :119 ] STATE WASTE CODE 220 UNITS* I-la. GALLONS E'[b. CUBICFEET ~c. POUNDS I-Id. TONS 221 DAYS ON SITE: 222 (Check one item only) * IfEHS, amount must be in pour~!.s. · '~ ~5 STORAGE CONTAINER [-] a. ABOVE GROUND TANK ~e. PLASTIC.'NONMETALLIC DRUM [] L FIBER DRUM .ri m. GLASS BOTTLE [] q. RAIL CAR r'l~.'tnVOm~OROtm~TAN~ I-1~ C~ [] j. RAO ~ PLAszIcsornm [] r. or~me [], e. TANK INSIDE BUK~IlqG [] g. CARBOY [] lc. BOX [] o. TOTE BIN []ct S~DRUM []~.SmO [] L cYLE, IDm~ []p. TANKWA~ON 2~3 STORAGE PRESSURE [~ AMBIENT [] b.' ABOVE AMBIENT [] e. BELOW AMBIENT 224 STORAGE TEMPERATURE ~ AMBIENT [] b. ABOVE AMBIENT [] e. BELOW AMBIENT [] d. CRYOGENIC 225 %WT HAZARDOUS COMPONENT (For mixture or waste only) EHS CAS # I '::lc:/ : (' , ¼1o r' o - -kr ; z : c : or, . " ?.7-?0-1 3 234 ~35 [] Yes [] No 236 237 4 2ia a3~ [] Yes [] No 24o 5 242 243 [] Yes [] No 244 If more hamardous components are pre~emt a~ grea~er thaa 1% by weight if aon-carcluogenl~, or. 0.1 ¥. by weight If carcinogenic, altach addlttonal sheets of paper eaptuHn~ the required NFPA HAZARD IDENflFICATION: HF-~LTH ~ FLAMMABILITY ~ REACTIVITY ~ SPECIAL ~ Ae///e'~ ~6 n'E?CRA, Pba~ Si~n H~r: ~'~C---~ SCP DISTRIBUTORS, LLC. / SUPERIOR POOL PRODUCTS, LLC. Street Address: City: State: Zip: Branch #: A B C D E F G .L L ~ i .. ~ ~ i t ~, ................. ~ . ~.~.....~ ............. .......................... ~ ........ , ................................... ...................................................... ................. .................... .............................. . ...................................................... ~ ........................... : .......................... ~....~ ...................... ...........~ ......... ,......~.~..~ ...... ~ ......... ~ ........ ~ ............................. ,....; .............. ~ ............................ ~ ....................... ~ ~ ~ I ~} ................................... ? ................ ~.~..~ ..................................................... .~ ~ ....... ~ ............. ~:,....: ......... ................. ~ ...... ........................... ~ .................................. .... '~ ............................. ~ ......... ~'"i ............... ~ ............ ~ ................... ~ .............................................. ~ .................................................. ~ .................. '~ ........................... B .................... .q. ................ 'NI ce~i¢ that this ~s accurate anO up to date to the best of my knowleO~e. Signature: SCP DISTRIBUTORS, LLC. I SUPERIOR POOL PRODUCTS, LLC. " Street Address: ..i/&~?/ d .~_//'5~.~,~'~/~../~' _~ "~' I ~OT certify that this map is accurate and up to date to the best of my knowledge. Signature: HAZARDOUS MATERIAL LEGEND Legend Common Symbol Other Equipment/Non-Hazardous Items Trade Chemical Name for use Name on Site Legend Map Trichlor Tablets Trichloroisocyanuric acid, dry (D sewer floor drains Dy-chlor Dichloroisocyanudc acid, dry . (~) Storm drains Litho Lithium hypochlorite, dry (~) Electrical shut-off Shock Bromine 1-bromo-3-chloro-5,5-dimethyl- Tablets hydantion (~ Gas shut-off Cai-hypo Calcium hypochlodte, hydrated (~) Emergency assembly, area .shock 02 Shock Potassium peroxymonosulfate ~ Personal Protection Equipment Metal Out 1-Hydroxyethylidene-1, diphosphonic (~) Medical & First Aid Equipment PVC Methyl ethYl ketone, Cement Tetrahydrofuran (J~) Safety Showers & Eyewashes Epoxy Epoxy resin, Xylene (~ Spill Containment & Mitigation Materials/Equipment Solvents, Aromatic naphtha light, Palmers Propoxy propanol (~J) MSDS & Emergency Response Plan Colorseal, Propolene glycol, Butoxy Palmers dipropanol Z Fire Extinguishers Bleach Sodium hypochlodte y Fire Hydrants & Connections Calcium Increaser Calcium, chloride S Sprinkler System Valves Stabilizer CyanUri¢ acid R Emergency shut-off(i.e, gas pump etc. Alkalinity Sodium hydrogren Carbonate p Air Conditioning Shut-~)ff .. Plus pH Decreaser Sodium bisulfate N water Shut-off Algae Plus Copper-Triethanolamine complex Sand Silicon dioxide Si02 H D.E. Diatomaceous earth B Muriatic Acid Hydrochloric acid K Aqua Ammonia Ammonia L vermiculite vermiculite A Freeze Propylene Glycol