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Home My WebLink AboutBUSINESS PLAN JIM ROBERTS __LOBA_L £LAS~rOM£R~C Rubber Molded Products 5551 District Blvd. IndustriaI-Agricuiture-Oilfield Bakersfield, CA 93313 "Mold Design" - "Product Design" Tel: (661) 831-5380 Engineering "CAD-CAM" Design Fax: (661) 831-6562 ' Enironmental Services 1715 Chester Ave SECTION i Business Plan and InVentory Program Bakersfield, CA 93301 · - Tel: (661)326-3979 FACILITY NAME I INSPECTION DATE INSPECTION TIME ADDRESS ' PHONE No. NO. of Employees FACILITYCONTACT Business ID Number ~ Combined ~ Joint Agency ~ Multi-Agency ~ Complaint ~ Re-inspection ~ C~ / C=Compliance ~ OPE~TION COMMENTS ~ V=Violation APPROPRIATE PERMIT ON HAND ~ VERIFICATION OF INVENTORY UATERIALS _'_._ v~.,~,c~,o, o~ o~.~..,~s ................ ~~~_;_~.~_~_~ ......................... VERIFICATION OF LOCATION .............................. ~_~_L.~ ......... ~ PROPER SEGREGATION OF MATERIAL ~ ~ / VERIFICATION OF MSDS AVAILABILI~E ~ VERIFICATION OF HAT MAT T~INING ~ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ EMERGENCY PROCEDURES ADEQUATE HOUSEKEEPING ANY H~ARDOUS WASTE ON SITE?: ES GLOBAL ELASTOMERIC UCT SiteID: 015-021-r002263 Man'ag.er : %%%% BusPhone: (661) 831-5380 Location: 5551 DISTRICT BLVD . % Map : 123 CommHaz : Moderate City : BAKERSFIELD ~%9~ Grid: 15D FacUnits: 1 AOV: CommCode: BAKERSFIELD STATION 13 SIC Code: 1382 EPA Numb: DunnBrad: Emergency 'Contact / Title Emergency Contact> / Title~ GUIELLERMO MARIACAL / ~7 ~0~~ ~// ~-~7~ Business Phone: (661) 831-5380x Business Phone: ( )~ 24-Hour Phone : ( ) x 24-Hour Phone : (~/)~9~-- Pager Phone : ( ) - x Pager Phone : ( ) - x Hazmat Hazards: Fire Press ImmHlth DelHlth Contact : GUIELLERMO MARiSCAL Phone: (661) 831-5380x MailAddr: 5551 DISTRICT BLVD State: CA City : BAKERSFIELD Zip : 93313 Owner ~/_~ ~F.~~~ ~V~d~ 4_ Phone: (661) 831-5380x Address : 5551 DISTRICT BLVD State: CA City : BAKERSFIELD Zip : 93313 Period : to TotalASTs: = Gal Preparer: TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: I, -__~,~;-Z::~;.~: Do hereby csr~i;~ ~ha~ ! have reviewed ~h~ ~ched h~rdous ~n~ plan for~~. ~~d ~h~ ~ along ~i~h =ny ~ions ~ns~i~u~s a ~mpl~s ~ ~rr~ m=n- ~msn~ plan for ~y -1- 08/13/2003 GLOBAL ELASTOMERIC SiteID: 015-021-002263 ~ Inventory Item 0002 Facility Unit: Fixed Containers at Site 365 Location within this Facility Unit Map: Grid: INSIDE ~~. ~.~r~ ROOM S END OF BLDG CAS# _Z--,~, /c~.S5 ~m~/n 74 - 98 - 6 Gas /Pure Above Ambient Ambient PORT. PRESS. CYLINDER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 175.00 FT3 700.00 FT3 700.00 FT3 I HAZARDOUS COMPONENTS I %Wt. RS CAS# 100.00 Propane Yes 74986 HAZARD ASSESSMENTS TSecretNo N~SIBioHazNo Radi°active/Amount I EPA HazardsNo/ Curies F P IH NFPA/// I USDOT# IMCPHi -3- 08/13/2003 :~GLOBAL E~STOMERIC PRODUCT SiteID: 015-021-002263 = Inventory Item 0003 Facility Unit: Fixed Containers at Site ~U~ ~vl~ / ~£~ ~vl~ WASTE OIL Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE NE C~R OF BLDG CAS# 221 Liquid Waste A~ient A~ient DR~/B~REL-METALLIC [ ~O~TS AT THIS LOCATION Largest Container Daily Maximum Daily Average 55.00 GAL 55.00 GAL 55.00 GAL 100.00 Waste Oil, Petroleum Based N 0 [TSecret RS Bi°Hazl ~ZARD ASSESSMENTS I I Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F DH / / / Low Treated On Site CA Code US Code GAL Generated/Mo. GAL Generated/Yr. No Treatment UnitID: Unit T~e: Agency-Defined Text Label -6- 08/13/2003 -' Jll~' 'nOBERTS E. E. EMBUR¥, INC. MAIqUF^CTUR. ERS REPRESEi~^TIVE O/I.FIELD SPECIAL'r/ES ,5551 D/STRICT BLVD. BAKERSFIELD, CA 93313 TEL: (661) 831-5380 Fnx: (661) 831-6562 CITY OF BA ~KERSFIELD · OFFICE O~' ENVIRONMENTAL SERVICES 1715, Chester Ave;; Bakersfield, CA (805) 326-3979 ~ 'INSTRUCTIONS:" : . ' " ; '~ 1. ': To avoid <further action, return this form within 30days °freceiPt. 2. TYPE/PRINT ANSWERS IN ENGLISH. · /., . · An~er th~ .que~iom I~loW,for th~busine.~ ~'a whole. ~onci a~'possibl ,-~4.~ Be as brigand se e. ! """ i;::i" SECTION '1: BUSINESS'IDENTIFICATI N DATA ? ~:' : .:<.="BAI~RSFIm,~ / · :C_~ :ZIP 1=3 PHONE: 661-$2J-.4051 ?' ':' -,., DuN (~::BRADS'I~.~TNUMBER:, 95-3061638:: ~'" ,. ' SIC CODE: .~ :' " "' ':' ~d indus~ial use ,,~ · ~. ~O~R:; ,Phil~ ~d~ S~a'. ~ ~ O ~D~SS~ 1337' ~lle ~s~a .. S~ D~s,- ~.--91773 s c oN .., ~ .' ~O~ACT . . ~ BUS. ~HO~ 24 ~:'P~O~ 1.~ Phil ~ ProsSd~ 5622634-5710 626-339-1278 {- ! :,~H.~ZIRDOUS MATERIALS MANAGEMENT PLAN SE~T{ON3:. ~G OF .tOYEES: ..·," 1~~, SAFETY DATA SHEETS ON FII · SECTION 4: EXEMPTION REOUEST I. CERTIFY UNDER PENALTY OF PER/URY THAT MY BUSINESS IS EXEMPT FROM ' TI-ffi,:~R~G REQ~S OF C'HAPTER 6.95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR ~ FOI.! OWING RF..,A~ON$: WE DO NOT HANDLE HAZARDOUS MATERIALS. xx WE DO HANDLE HAZARDOUS MATERIALS, BUT THE QUANTITIES AT NO TIME EXC~.~.r) THE MINIMUM REPORTING QUANTITIES. OTHE (SP .CIFY R ASO SECTION 5: CERTIFICATIO~ I, Phil ~mbur~ CERTIFY THAT THE ABOVE iNFORMATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WrLr. BE USED TO FULFK,L MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIV. 20 CHAPTER ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PER/URY. '~~~/'- '" Pr~sideht ~' '. _i.' ~/25/00 SIGNATURE ~,-' ~TITLE DATE ,, 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACiLITY NAME ~.~-t-o~xu- ~t.a,-ST. ~RO~ INSPECTION DATE FACILITY CONTACT~,~~ ~~ BUSINESS IDNO. 15-210- INSPECTION TIME NUMBER OF EMPLOYEES Section 1: Business Plan and lnvento~ Program / 3 ~ ~ Routine ~ Combined ~ Joint Agency ~ Multi-Agency ' ~ Complaint ~ Re-inspection OPERATION C V COMMENTS Appropriate pe~it on hand '~ ~c~ ~C~ Business plan contact info~ation accurate ~ ~ t~ ~ Visible address Co~ect occupancy Verification of invento~ materials ~~ ~o~ Verification ofquantities ~~ (4 -~c~ Verification of location Proper segregation of material Verification ~ ,,, Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate & On Hand C=Compliance V=Violation Any hazardou~ waste on ~ite?: ~Ye~ ~ No Explain: ~~ ¢~ ~~ ~O~ Questions reg~ding ~is inspe~fion? Please ~ali us at (661) 326-3979 ~ess ~sible 'White- Env. Svcs. Yellow- Station Co~y Pink- Business Copy Inspector: UNIFIED PROGraM INSPECTION cHECKLIST. ' · 1715 Chester .A;e., 3~a Floor, BakerSfield, CA 93301 FACILIT~AME¢~u ee-sT, e~ ' 'm.SpEeTIOND~ ~' ADD,SS" ~ O{Sr~c~' ~L~P "PHONE NO:: . ~,'~,~ '. FACILIty CONTACT~,~~ ~~ BUSINESS IDNO. 15-210- ~SPECTION TIME : : NUMBER OF EMPLOYEES ' ~'. .. SeCtion 1': Business Plan and Invento~ Program . j~[~ :' ' . lC V . COMMENTS OPERATION Appropriate pe~it on hand ~~ ~C~· Business plan contact info~ati'on acc6rate .'- ~ ~' t.~ Visible address ...... Co~ect occupancy ~ .... Verification of invento~ materials " ~~'C .~C~ : Verification of quantities' ' '' . ?~(4 , . ~' . . . Verification of location · , Proper segregation of material - . ' Verification o labilit ": :' Verification ~~;~ai;(~b ,, '~ : : .. Verification of abatement supplies and procedures. ... . ~} ' Emergency procedures adequate ': : ~: iai P lylbld ..... ' ' " .': Co~ ~ers roper a e e · - '. · .,,ouse~eep, ns ' . · · . Fire Protection Site Diagram Adequate & On Hand /:~ , C=Compliance V=Violation Any hazardous waste on site?: ~yes ~ No ..... Explain: ~ &~ ~~O~ ) . . Questions reg~ding ~is inspection? Please call us at (661) 326,3979 Bu~~s~ble White 2 Env. Svcs, Yellow: StatiOn Copy Pink- Business Copy Inspector:. CITY OF BAKERSFIELD FIRE DEPARTMENT OFFICE OF ENVIRONMENTAL SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 1715 Chester Ave., 3rd Floor, Bakersfield, CA 93301 FACILITY NAME ~'LOf~d~.c. ~-'CO'gT,- 3~'c~/)- INSPECTION DATE.. 7A~/t Section 4: Hazardous Waste Generator Program EPA ID # <2~C'~ C>~ ~ ~3fc>~ [ [] Routine I~-. Combined [] Joint Agency [] Multi-Agency [] Complaint [] Re-inspection OPERATION C V COMMENTS Hazardous waste determination has been made EPA ID Number (Phone: 916-324-1781 to obtain EPA ID #) Authorized for waste treatment and/or storage A.~ Reported release, fire, or explosion within 15 days of occurrence A.~ Established or maintains a contingency plan and training Hazardous waste accumulation time frames Containers in good condition and not leaking Containers are compatible with the hazardous waste Containers are kepi closed when not in use Weekly inspection of storage area Ignitable/reactive waste located at least 50 feet from property line Secondary containment provided Conducts daily inspection of tanks Used oil not contaminated with other hazardous waste Proper management of lead acid batteries including labels Proper management of used oil filters Transports hazardous waste with completed manifest Sends manifest copies to DTSC Retains manifests for 3 years Retains hazardous waste analysis for 3 years Retains copies of used oil receipts for 3 years Determines if waste is restricted from land disposal C=Compliance V=Violation Office of Environmental Services (661) 326-3979 ible Party White - Env. Svcs. Pink - Bus/ness Copy CITY OF BAKERSHEI~ O/CE OF ENVIRONMENTAL~IgRVICES 1715 Chester Ave., CA 93301 (661) 326-3979 ' ~" ~"'-" HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per ma~al ~ ~ding or ama) ~W ~ ADD ~ OELETE ~ REVISE P~e ~ . ~ ,~ ~:~?~..-* ,~,.~. · ~ BUSINESS ~E (~e ~ FACILI~ ~ ~ D~ - ~ng B~n~) 3 ~1] ~EMI~L LO~TION ~ Y~ ~ No ~2 ~ ~ T~E SEC~ CHEMI~L ~E ~N ~ / EHS FI~ ~DE ~ ~8~E8 (~pl~e ~ ~u~ ~ I~ [m ~ 210 ~ CURIE~ 2~3 ~PE ~ ~ PU~ ~ m ~RE ~w WA~ 211 ~D~A~ ~Y~ ~No 212 I PHYSI~L STA~ · ~uo ~,ou.o ~ ~ ~s 2.. ~.~ST~,.E. /~ 215 ~D~RD~TE~ES ~ 1 FIRE ~2 ~ ~3 ~U~E ~4 A~ H~L~ ~ ~RONIC H~ 216 (~ ~1 ~at ~p~) ~NU~WAS~ 217 ~I~M ~ 218 A~ 219 ~ STA~W~DE ~u~ DA~Y ~U~ ~ DA~LY I UN~S' ~ ~L D ~ CU ~ D ~ LSS D ~ TONS =~ I DAYS ON · ~ ~S, ~nt m~ ~ in ]~. STOOGE CO~AINER ~ A~VE~UND T~K ~ · ~S~N~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~E ~ q ~IL ~ 2~ (Check all ~at app.) ~ b UNDER~OUND T~K ~ f ~N ~ j ~G ~ n P~C SO~ ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~Y ~ k SOX ~ o TO~ BIN ~ d S~ DRUM ~ h SILO ~ 1 CYLIND~ ~ p T~K WA~N STOOGE P~SSU~ ~a A~IE~ ~ ~ A~VEA~IE~ ~ ~ BELOW~IE~ ~4 S~GE ~~ ~ a A~IE~ ~ ~ ~ ~1~ ~ ~ BELOW A~I~ ~ c CRYOGENIC 226 227 [] Yes [] No 228 229 230 23~ 233 [] Yes [] NO 232 234 235 [] Yes [] No 236 237 238 239 [] Yes J-~ No 240 241 242 243 [] Yes [] No 244 245 IGNATURE UPCF (7/99) S:\CUPAFORMS\OES2731 .TV4.wpd o ~ CITY OF BAKERSFIEI~ O~[CE OF ENVIRONMENTAL~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 *~ ~' ~" ~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ ~r maMhal per building or ama) ~ .~IEW ~ ADO ~ OEL~E ~ REVISE ~ P~e i of i BUSINESS ~ (~e ~ FACILt~ ~ ~ D~ - ~ng B~ ~) 3 ~1i CHE~LLO~TION ~ Y~ ~ ~ ~2 CHEMI~LLO~TiON (~S(bE ~OF~ ~~- ~ ~ %~ O~ ~ ~ ~NFIDENTIAL(EPC~) FACILI~ID, ~ / ~ ~ l~,(op,naO ~3ORIO,(op~naO CHEMI~L ~E '~~ ,~ E Subj. to E~ ~. to ins.~s ~7 ~M~N ~ FI~ ~DE H~D C~ES (~pl~e ~ ~ ~ ~ tim ~ 210 P~SI~STA~ ~, ~LID ~1 LIQUID ~S 214 ~GEST~NER /~ ~ 215 FED ~D ~TE~RIES ~1~ ~ 2 ~ ~P~ ~E ~ 4 AC~ H~L~ ~ S ~RONIC H~ 216 (~ al ~al apply) ~U~ DAILY ~U~ ~ DAILY ~U~ * ~ ~S, ~mnt m~ N in lbs. STOOGE ~AINER ~ a A~UND T~K ~ e ~N~LIC DRUM ~ i FIBER DRUM (Chec~ ali ~at apply] ~ b U~E~OUND TANK ~ f ~N ~ j ~G ~ n P~S~C ~ ~ r O~ER ~ c T~K INSIDE BUILDING ~ g ~Y ~ k BOX ~ o TO~ BIN ~ d S~ ~UM D h SILO ~ CYUNDER ~ p TANK WA~N STOOGE P~SSU~ ~ a ~IE~ ~a A~VE ~1~ ~ ~ BELOW A~IE~ ~4 S~GE ~RE ~ a ~1~ ~ ~ ~1~ ~ ~ 8ELOW~IE~ 1 ~ ~7 2" ~0 ~1 3 ~ ~5 5 242 ~, 243 ~Y~ ~ 2~ :¥..' ~'~'.t ~.:.:,.::,:,~:~: ~:~., ,~?~:~?~'~ ~:~.~,:~~~:::~.~:.: :~',?;:, ~ ,.:~:::::::::::::::::::::: :~.¥:;; ~. ,., ;.~ ~:.:. ::,,,.¥ ::.. .~. PRINT ~ & T~E OF AU~OR~EO ~A~ REP~SE~A~E 81G~TURE UPCF (7199) S:\CUPAFORMS\OES2731.TV4.wpd OICE OF ENVIRONMENTAL RVICES tl /imratt 'r 1715 Chester Ave., CA (661)326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per ma~al per budding or ama) W ADD DELVE ~ REVISE ~ Page BUSINESS ~E (~e ~ FACILI~ ~E ~ - ~ng B~n~ ~) ....... 3 CHEMI~L LO~TIO" ~'~C ~' C~ ~ ~ ~lj CHEMI~L LO~TION ~ ~NFIDE~IAL (EPC~) ~5 ~ T~E SECR~ CO~N ~ EHS' FIRE ~DE ~ ~ES (~plme ~ ~u~t~ ~y I~ tim m~ 210 ~PE D p ~ a m ~ ~w WA~E 211 ~D~A~ D Y. a No 212 i CURIES 213 PHYSI~STA~ ~ s ~UD ~L~UID ~ g ~S 214 ~GEST~AINER ~ 215 FED~D~TE~RIES ~'FIRE D2 ~ ~3 P~U~E D4 A~ H~L~ ~5 ~RONIC H~ 216 (~ all ~at ~p~) - ~U~WAS~ 217 ~ ~M 2~e A~ 219 STA~W~DE ~U~ DAILY ~U~ ~ ~ DAILY ~U~ I UN.S* ~ ~L ~ ~ CU ~ ~ lb ~S ~ m TONS ~1 DAYS ON S~E * ~ EHS, ~mnt m~ ~ in lbs. STOOGE ~AINER ~ a A~VE~UND T~K ~ e ~S~NM~LIC DRUM ~ i FIBER DRUM ~ m G~SS BO~ ~ q ~IL (C~k al~ ~at ap~y) ~ b UNDER~OUND T~K D f ~N ~ j ~G ~ n P~C BO~ ~ r O~ER ~ c T~ INSIDE BUI~ING ~ g ~Y ~ k ~X ~ o TO~ BIN .~ ~EL DRUM D h SILO ~ I ~LINDER ~ p T~K WA~N STOOGE P~SSU~ ~a ~IE~ ~ ~ A~VEA~I~ D ~ BELOWA~IE~ ~4 S~GE ~RE ~a A~IE~ ~ ~ ~VE ~IE~ ~ ba BELOWA~I~ ~ c C~OGENIC 226 227 [] Yes [] No 228 229 2 230 231 [] Yes [] NO 232 233 234 235 [] Yes [] NO 236 237 238 239 [] Yes [] NO 240 241 242 243 [] Yes [] NO 244 245 [ P~INT NAME SIGNATURE DATE /. 7 UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd s~n ~ CITY OF BAKERSFIEI~ ~ ~ tqt~m ~ O~IICE OF ENVIRONMENTAL~RVICES ~~~r 1715 Chester Ave., CA 93301 (661) 326-3979 "~'~~'~' H~RDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ ~r maMnal per budging or ama) ~EW ~ ADO ~ DELETE ~ REVISE ~ Page ~ of BUSINESS ~E (~e ~ FACILI~ ~ ~ D~ - ~ng B~n~ ~) 3 CHE~I~LL~T{O" [~gtO~ ~ C~ ~ ~ ~1i CHE~LLO~TION ~Y. UNO ~2 ~ ~NFIDENT~L (EPC~) FACIL'~ ID ~ ~ ~" 1 ~ ' (~n.0 ~ GRID ~ (op~naO 2~ ~5 { T~DE SEC~ ~ y~ ~ ~ ~ CHEMI~L ~E ~. ', g Subj~ ~o E~ ~ to ins~s ~7 = ~M~N~ ' EHS* ~y~ ~'~ ~ FIRE ~DE H~ C~ES (~pl~e ~ ~u~t~ ~ I~ fire ~ 210 ~PE '~PU~ ~ m ~RE ~ w WA~E 211 ~DIOA~ ~ Y~ ~ No 212 ~ ~RIES 213 PHYSI~L STA~ ~ s SOLID ~LIQUID ~ g ~S 214 ~GEST ~AINER ~ ~.~ 215 FED ~RD ~TE~R/ES ~. FI~ ~ 2 ~ ~ 3 P~SSU~ ~E ~ 4 A~ H~L~ ~ 5 ~RONIC H~ 216 (~ all ~at apply) UNffS' ~ ~L ~ ~ CU ~ ~ lb ~S ~ ~ TONS ml DAYS ON SffE ~ * ff ~S. ~nt m~ ~ in lbs. ~ STOOGE CO~AINER ~ A~VEG~UND T~K ~ · ~NM~IC DRUM ~ i FIBER DRUM ~ m G~SS BO~E ~ q ~IL ~R ~ (Che~ afl ~at apply) ~ b UNDER~OUND T~K ~ f ~N ~ j ~G ~ n P~C BO~LE ~ r O~ER ~ ~ c T~K INSIDE BUI~ING ~ g ~R~Y ~ k ~X D o TO~ BIN ~ ~ d S~ DRUM ~ h SILO ~ I ~UNDER ~ p T~K WA~N ~a A~IE~ ~ ~ A~VE~IE~ ~ ba 8ELOWA~IENT ~4 ~ STOOGE PRESSU~ S~GE ~RE ~ ~IE~ ~ ~ ~VE~IE~ ~ ba 8ELOWA~IE~ ~ c CRY~IC ~ 226 227 [] Yes [] NO 22a 229 233 230 23"1 [] Yes [] No 232 234 235 [] Yes [] No 236 237 238 239 [] Yes [] No 240 241 242 243 [] Yes [] No 244 245 PRINT NAME & TITLE REPRESENTATIVE SIGNATURE DATE UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd I rt~l ~ ~]ICE OF ENVIRONMENTA~RVICES t~.nttr~r [5 Chester Ave., CA. 93301 (661) 326-3979 "'"""~~~' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one ~ per mate~al ~er building or ama) W ~ ADD ~ DELETE ~ REVISE Page ~ BUSINESS ~ME (~me as FACILI~ ~ME ~ D~ - ~ng Busin~ ~) 3 ~ CONFIDENTIAL (EPC~) FAC,L,~ lO. ~ J ~ ,~P.(op~naO 203iORlO.(op~naO ~~/ 205 ~ T~DESECRET DY~ CHEMISE ~ME ~ ~ I~ ~ ~ If Subj~ tO EPC~. ref~ to instm~i~s ~ 207 {, FiRE CODE H~RD C~SSES (Complete if r~u~t~ by I~1 fire ~i~ 210 ~PE p PURE ~. MITRE ~ w WASTE 211 ~DIOACT~ ~ Y~ ~ No 212 ~ CURIES 213 PHYSICAL STATE ~s SOLID ~1 LIQUID ~ ~S 214 ~RGEST CO~AINER ~ ~ 215 FED H~RD ~TE~RIES ~ 1 FiRE ~ 2 R~IVE ~RESSURE ~L~SE ~ 4 AC~ H~L~ ~ 5 CHRONIC H~LTH 216 (Ch~ all that apply) ANNUALWAS~ 217 --I.M ~ 218 ~ AVENGE 219 ~ STA~WAS~DE A~U~ DAILY A~U~ DALLY A~U~ UNffS' ~ ga ~L ~d CU~ ~ lb LBS ~ ~ TONS 221 ] DAYSONSITE ' ~ EHS. am~nt must be in lbs. STO~GE CO~AINER (Check all ~at apply) ~ a A~VEGROUND T~K ~ e P~STI~ONM~ALLIC DRUM ~ i FIBER DRUM ~ m G~SS BO~LE ~ q ~IL ~R ~ b UNDERGROUND TANK ~ f ~N ~ j BAG ~ n P~STIC BO~LE ~ r OTHER ~ c T~K INSIDE BUILDING ~ g ~R~Y ~ BOX ~ o TOTE BIN ~ d STEEL ORUM ~ h SILO ~CYLINDER~ ~ p TANK WA~N ~ a A~IE~ ~ A~VE A~IE~ ~ ba BELOW AMBIENT ~4 STOOGE PRESSURE STO~GE TEMPE~TURE ~A~IE~ ~ ~ ~VE A~IE~ ~ ba BELOW AMBIE~ ~ c CRYOGENIC , 2 I lO 230 ~ 01~,0¢ 231 ~Y~ ~No232 233 3 2~ 235 ~ Y~ ~ No 236 ~7 4 238 239 ~ Y~ ~ No 240 241 5 242 243 ~ Y~ ~ NO 244 245 PRINT NAME & TITLE OF AU~ORIZED COMPA~ REPRESE~ATIVE SIGNATURE ~ ~ ~ DATE 2~ UPCF (7~99) S:\CUPAFORMS\OES2731 .'l'V4.wpd