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Home My WebLink AboutBUSINESS PLAN Per PERMIT ID # 015-021-002205 'H ' OCHOAS AUTO REPAIj(:\: .tt\, /::: }r:"./;il/ ,""t,~",^ LOCATION 2323 ¡~:S} 't"""llNION"I\;",> _ t, "-, . ":f t' J: ~",j~,~, ~., j' t~~ {, '. I f"~1 !t:1 1;." " :.~. ..:~ '\,,~.. \", ... ~ '" Issued by: it Operil.te to Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON ,REVERSE SIDE This oermit is issued for the following: It! Hazardous Materials Plari o Underground Storage of Hazardous Materials o Risk Management Program o Hazardous Waste On-Site Treatment CA 93307 Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES' 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (661) 326-3979 FAX (661) 326-0576 MAY 3 2001 Approved by: Issue Date Expiration Date: 'June 3j), 2003 ~'--....-.....~.. {i'" ~ - /'" r- N /' ,/ - ~ 6£ IJ)-#- 2::Lð~ ,/1!!f't SITE DIAGRAM I_J FACILITY DIAGRAM I_J Business Name: (JG40A~S Avro RtJ'pAI2.. Business Address: Z323 ,5. {/;...,.hoA.Ì, f S'. . ~ . \7... ~ \::7 D'¡ \ -...p.""- ~ ~ ~\ ~, ^ C <;? 1J~( ol'Y\.prc:Só r 'b~ ~~ \:;>~ - <::> ~~ ~,~ ~:.J. "'" , º D "'\l -:::;::::; ~ fa 'h'\-t G:> ~~ Wa.w ~ ~ ~*' <.J" 3 hù\'~ c C?~ ~ ~ ~ Z3Z3 (/Jo~/ - A'- A-J- ',~~~ ~ 9>.., ^' S:\PROCEDURE MANUALldiagraminst,wpd GS 3{,; oc( ( C!J . - /Nul * ( ¿~I) , 1;)/-/077 (1ii£¿ þ ::tf:: ¿'II éµ4j.æ. CITY OF BAKERSFIEI..D FIRE DEPARTMENT OFFICE OF ENVIRONMENT AI... SERVICES UNIFIED PROGRAM INSPECTION CHECKLIST 171S Chester Ave., 3rd 1;'loor, Bakersfield, CA 93301 (It-Pftl «... FACILITY NAME a C-tto fì-- ç: 1+ ll~ INSPECTION DATE 6 -2.7 -02- ADDRESS rz-:32':S S. Ltf'J«yH PHONE NO. \ FACILITY CONTACT_ BUSINESS ID NO. 15-21O-ðé) "z"2-0S- INSPECTION TIME NUMBER OF EMPLOYEES Section I: Business Plan and Inventory Program tf-ð c.. 0 t-L6-~ ~ o Routine 0 Combined 0 Joint Agency 0 Multi-AgencyR bCO~l.e/J:' 0 RelJ!:,~.!J OPERA TION C V COMMENTS Appropriate pennit on hand Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials Verification of quantities Verification of locatiqn Proper segregation of material Verification of MSDS availability Veri fication of Haz Mat training 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 hazardous waste on site?: Explain: DYes DNo Q~estions regarding this inspection? Please call us at (661) 326-3979 Business Site Responsible Party White - Env, Svcs. Yellow· Station Copy Pink - Business Copy Inspector: M/wtf; 5G- Y'.. I FIRE CHIEF RON FRAZE ADMINISTRATIVE SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAX (661) 395-1349 SUPPRESSION SERVICES 2101 "H" Street Bakersfield. CA 93301 VOICE (661) 326-3941 FAJ«661) 395-1349 PREVENTION SERVICES 1715 Chester Ave, Bakersfield. CA 93301 VOICE (661) 326·3951 FAJ< (661) 326-0576 ENVIRONMENTAL SERVICES 1715 Chester Ave. Bakersfield. CA 93301 VOICE (661) 326-3979 FAJ< (661) 326-0576 TRAINING DIVISION 5642 Victor Ave, Bakersfield, CA 93308 VOICE (661) 399-4697 FAX (661) 399-5763 - - May 3,2001 Ochoas Auto Repair 2323 South Union Avenue, #4 Bakersfield, CA 93307 Dear Business Owner: Enclosed, please find your "Permit to Operate," which is a consolidated permit authorizing as many as four separate hazardous materials or hazardous waste programs. Thee programs have now been consolidated as part of the State's efforts to coordinate the regulated activities into one Unified Program at the local level. You mayor may not participate in all of these programs and your permit will indicate which programs or activities are authorized at your facility, These activities include: ~ Hazardous Materials Business Plan and Inventory (which also includes hazardous waste generation and management requirements) ~ Underground Storage of Hazardous Materials ~ Risk Management Program ~ Hazardous Waste On-Site Treatment We value your feedback. If you have any questions or comments regarding either your permit or your responsibilities as a regulated facility, please call us at 661 326-3979 or visit our environmental Services web site at Sincerely, RALPH E. HUEY, DIRECTOR OFFICE OF ENVIRONMENT AL SERVICES ?) Esther Duran, Accounting Clerk II Office of Environmental Services RH\ED\db "" C;P -I ß (£' . r)7." 44 ('jfiJ ./) (/', _ /_ .,., Jýq~ uw (:JtJ-'n//u//lL{~ J,PtJp '/P0tJpe J/I,Q/þ ../(:J U~'.Ft-U//,'r' ~. '" L" ( ( - - CITY OF BAKERSFIELD OFFICE OF ENVIRONMENTAL SERVICES 1715 Chester Ave., Bakersfield, CA (661) 326-3979 HAZARDOUS MATE É S MANAG,El\1ENT,;LAN ~ ' b \?\À~'\l~ .t~,~ INSTRUCTIONS: (\,'¡-Y\5 \~O rTh \,' ~ 4,ollryl0'r> '( 'V "&þ. ~ 0 ~-ð 1. To avoid further action, r this fonn within 30 days of receipt. .,<>00/ 2. TYPEIPRINT 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 1 Operator Fonn and Chemical Description Fonn(s) to the front of this plan instead of completing SECTION 1. below for initial submission. SECTION I: BUSINESS IDENTIFICATION DATA Moo\, A~ 2efct\ r :::I?::f)-5 S, U(\\OC\ ,^\fe #~ MAILING ADDRESS: ~E? CITY: ~(iies~~ f> ~d STATE: r...:À-zIP:ffiPHONE: ~'SI-IÇI~ PRIMARY ACT!VITY: ~~~~ ~(ÙÍ' OWNER: (Yl¡y~j e,-¿D k ..j05~ ~OO\... PHONE: ð~ì-lt;; l~ ~~ BUSINESS NAME: ( '- LOCATION: MAILING ADDRESS: EMERGENCY NOTIFICATION TITLE 24 HR. PHONE CONTACT 1. (Yl5ùv\ e\~'O 2. ~O"?C OG~,^, (, BUS. PHONE ~~f\-.e.Y ('0 - Dw(\ef l5 (d4- ()s<6~ 36b~ ~(DL\ <is?::> {,- \S \ ~ ~~ (-\~ \ d..- 1 ;. ~ .. ) ( ( e - HAZARDOUS MATEIDALS MANAGEMENT PLAN SECTION II.I: DISCOVERY AND NOTIFICATIONS A. LEAK DETECTION AND MONITORING PROCEDURES: Vr<sv~ B. EMPLOYEE AND AGENCY NOTIFICATION: Vel bcJ C. ENVIRONMENTAL RESPONSE MANAGEMENT: w~<i\- Co Oc"S-I- 0', \ P; \ -\-If eE'~d \. R'J - D. EMERGENCY MEDICAL PLAN: U e.oJ <"-S~ r<\ ed.,'cal 'Fò..d \ ~ \-\./ 2 (. (i' . ( ( ( e e HAZARDOUS MATERIALS MANAGEMENT PLAN SECTION II.2: RELEASE RESPONSE PLAN A. HAZARD ASSESSMENT AND PREVENTION MEASURES: stc{e,cl où~ð~, '01\. CCf\c-rd-~( keep \,des ö<\ -\-'5k+" B. RELEASE CONTAINMENT AND/OR MITIGATION: àbor'b-a..\ \ +D\" eOf\+~\(\ M€...f\+ C. CLEAN-UP AND RECOVERY PROCEDURES: Lù~ Cz'({ c,.t 0'" h \ ~( Qec,"\c\" f\~ UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY) NATURAL GAS/PROPANE: kJt~ ELECfRICAL: . O::\d.~ _pH'if b~ WATER:' Ð~<s\ d. fe.o....r "b\ SPECIAL: ~~ LOCK BOX: YES 0, IF YES, LOCATION: \0n PRIVATE FIRE PROTECTIONIW A TER AVAILABILITY A. PRN ATE FIRE PROTECTION: .;;:2 R K:... e,d--(' f1(JV í'Sh e r S , B. WATER A V AILABILITY (FIRE HtfDRANT): ()Jf-sjd€- /-. t'n front-;J-, ne'(jh.hoff:J bùs.\\\c~s. 3 .. e e , ;: ~ HAZARDOUS MATEIDALSMANAGEMENT PLAN ( SECTION III: TRAINING NUMBER OF EMPLOYEES: , +,-U \\ + \ f\1 e a..1\d l fCt rt ti ()'\ e. , MATERIAL SAFETY DATA SHEETS ON FILE: BRIEF SUMMARY OF TRAINING PROGRAM: .:5v1\oo \ l (\~ 'l C\ T ~, 0-ACl Se.À1L ~ùJ~-\- h.eQr . ( CERTIFICATION I, ,41~r"/ II/? -Ø CERTIFY THAT THE ABOVE INFORMATION _ IS AC TE. Í UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FIRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFETY CODE" ON HAZARDOUS MATERIALS (DIY. 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THAT INACCURATE INFORMATION CONSTITUTES PERJURY. ~~ SÍGN URE ~·Co &lJ/J1er TITLE CY-;23" &/ DATE ( HAZ MAT MNGMNT PLAN & INSTRUC 4 II ~' HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION . CITY OF BAKERSFIELIIa OF~CE OF ENVIRONMENTAL Slf{VICES 1715 Chester Ave., CA 93301 (661) 326-3979 DNEW DADD 200 D DELETE D REVISE .....--.... . I. FACILITY INFORMATION . '""'''S"'='t0~WOÕ'":j&.:~~ .~..~~~.~..~.~:~.....~.~..- CHEMICALLOCATIONUu-\- 4,ð.e ~,~ð S~C> () ~~~~IL:~IÕ #:"-1' '" J=,ì~~ -I~.'-T_'J'n ----=__~J'~p#{opï~nan-"....-'--:h="'-'·- (one form per material per bUIlding 0' area) Page of _·__·_H___·_.._____,____ _ ...____ _... ..._ _. ._____._ _..___ __'____h 201, CHEMICAL LOCATION CONFIDENTIAL (EPCRA) 203';' -GRiÖ¡¡ (opìiOnar; ,h__ , ..__._~' ,-...-- -"-' .--. o Yes 0 No 202 ,---- --- h_' -, ----'--'204-' II. CHEMICAL INFORMATION --..----,.,--.--------.---- ,..-. ..-,--.---. _ __._._._H___~ .....__..__._, hh_ 20s--l'RÄöesEcf¡ET CHEMICAL NAME o Yes 0 No 206 If Subject to EPCRA, refer to instructions COMMON NAME EHS' '-------'---------'-------'n2or----_--'-' __ '_hn_,_, ,_h____, o Yes 0 No 208 ---.-----.-.------,---- ---------------- 209 : ·If EHS is' Yes. . all amounts below musl be in Ibs. CAS # -- FIRE roDe HAZARÒ-ëLASSES(ëCiñpÎele if requested by loCal fire ChÛJf) -~ ..-...-,.------- 210 TÝPE-'----' ----------, ·-Ö~..~~~;-· 0 -~--;;;~~~~-J_:-;¡~~ 211: RADIOACTIVE -'O~--O-~-----'-;;;-' CURIES"'- n_-~13' '----'-.-"'--'-..----,h,n.--'-----.------'-f-~--'--~--'- ',..-, ,_ ----------..:.------'-----'-. _.:~~~'CA~~TATE __~__=, SOLl~__~~LlQUID_ 0 9 GAS 214 LARG,EST CONTAIN~~__~ 5____,__,___ .__n__'_ _,_,__~~ FED HAZARD CATEGORIES (f"ock alllhal apply) AL WASTE A".vUNT o 4 ACUTE HEALTH 01 FIRE o 2 REACTIVE o 3 PRESSURE RELEASE o 5 CHRONIC HEALTH ~--,--_._-------------------- 220 .-.---.--.--.-------.--.--- 216 lJO OgaGAL OdCUFT . If EHS, amount must be in Ibs, o Ib LBS o tn TONS ~:?_ ____:..~~~_E WASTE CODE 221 DAYS ON SITE 222 217 i MAXIMUM , DAILY AMOUNT 218 ¡AVERAGE ! DAILY AMOUNT -- ________1 UNITS' ---,_··___0·_____-------- -----,------_._-~-_.._-----, '------------,-- o a ABOVEGROUND TANK 0 e PLASTIC/NONMETALLIC DRUM 0 i FIBER DRUM 0 m GLASS BOTTLE Db UNDERGROUND TANK 0 f CAN 0 j BAG 0 n PLASTIC BOTTLE ~c TANK INSIDE BUILDING 0 9 CARBOY 0 k BOX 00 TOTE BIN . d STEEL DRUM 0 h SILO 0 I CYLINDER 0 P TANK WAGON .-.------------. --,..--..:...--- -------------.--------------------------,---.-.-----.----_._--------~_._.-._----------------------- STORAGE PRESSURE 0 a AMBIENT 0 aa ABOVE AMBIENT 0 ba BELOW AMBIENT 224 STORAGE TEMPERATURE 0 a AMBIENT 0 aa ABOVE AMBIENT 0 ba BELOW AMBIENT 0 c CRYOGENIC : __..%W! __'__-,-_ ______,_,______~~~~~~~.~?M:.~~~~!______ __,_._.._,_____L___:!:~,____1__ ._n_'_' CAS # ,--;~:-,_ __'_' ,_~2~CiSj~--Œ'-\_---------------., ____,_~~-~-~~~-~o 228 J .u_________,_ 2 230 : 231 : 0 Yes 0 No 232 ¡ ..', m..,L.., _ _.. '..,.... ,___..,.._ ______,____.. , .., _,... .._,_,_._ ,_,_" ,___ __....,_,__,______,......, ,_..,.._____L__...__ '_,.._'____'+ _,_ __._.... ,,_.._______.n_'.. 3 234 i 235 I 0 Yes 0 No 236 I 237 4, n 23~__r'----' _'_'n_..'___,_, ..,......--,-------",-,..,--,-,- ,,- .. ------..------;~~-'i'~-~~-~-~:·~4~·~..' -..---- --'-'-..---~; ,.¡~_~.;;,j==:-~~~..~~-~..~~=_~..=~.=~. ..~~=m ..==-'~J~~~~o..'":;;.l..~~~~. == ~-=- ,,,. III. SIGNATURE STORAGE CONTAINER (Check all that apply) :...,..--.---.--. ---------.-----------. ------- 'po'';'YNAMÈ & Tïií.eõF Am:H'õR-lzeÕcoMPA'NY-REPRESENTArive-'--·---------------'sIGNATURE -..,- -,- n_ .------.---.------'-' . .- ,..-.. _.-. "-......- ...'''- -.., ...__.·h...., __.., ""._n..'__"__." ..n o q RAIL CAR o r OTHER 223 225 229 233 ..'....n ----- _Un DATE-246", ..-. ----- - - .- .-.----_. UPCF (7/99) S:\CUPAFORMS\OES2731,TV4.wpd - e """"" Hazardous Materials Inventory. Chemical Description .. You must complete a -;eparate Hazardous Matenals Inventory· Chemical Descnption page for each hazardous matenal (hazardous substances and hazardous waste) that you handle at your facIlity In aggregate quantIties equal 10 or 9,eater than 500 pounds, 55 gal/ons, 200 cubic feet of gas (calculated at standard temperature and pressure) or the federatthreshold plann,ng quantity for Extremely Hazardous Substances, whichever is less, Also complete a page for each radioactive material handled over quantities lor which an emer<Jency plan 's reqUired to be adopted pursuant to 10 CFR Parts 30, 40, or 70, The completed inventory should renect aI/ reportable quantities of hazardous matenals at your facIlity, reported separately for each building or outside adjacent area, with separate pages for unique occurrences of physical state. storage temperature and storage pressure, (Note: the numbering 01 the instructions follows the data element numbers that are on the UPCF pages. These data elåment numbers are used for electronIC submiSSion and are the same as the numbering used in 27 CCR, Appendix C, the Business Section of the Unified Program Data Dictionary,) Please number all pages of your subm,ttal. This helps your CUPA or AA identify whether the submittal is complete and if any pages are separated, 1, FACILITY 10 NUMBER· This number is assigned by the CUPA or AA, This is the unique number which identifies your facility, 3, BUSINESS NAME, Enter the ful/legal name of the business, 200, ADD/DELETEI REVISE· Indicate if the material is being added to the inventory, deleted from the inventory, or if the information previously submitted is being revised, NOTE: You may choose to leave this blank if you resubmit your entire inventory annually, 201, CHEMICAL LOCA nON· Enter the building 0' ou/sidel ad;acent area where the hazardous material is handled, A chemical that is stored at the same pressure and temperature, in mulliple locations within a building, can be reported on a single page, NOTE: This information is not subject to public disclosure pursuant to HSC §25506, 202, CHEMICAL LOCATION CONFIDENTIAL· EPCRA . All businesses which are subject to the Emergency Planning and Community Right to Know Act (EPCRA) must check "Yes' to keep chemical location information confidential, If the business does not wish to keep chemical location information confidential check "No·, 203, MAP NUMBER· If a map is included, enter the number of the map on which the location of the hazardous material is shown, 204, GRID NUMBER· If grid coordinates are used, enter the grid coordinates of the map that correspond to the location of the hazardous material. If applicable, multiple grid coordinates can be listed, 205, CHEMICAL NAME· Enter the proper chemical name associated with the Chemical Abstract Service (CAS) number of the hazardous material. This should be the Intemational Union of Pure and Applied Chemistry (IUPAC) name found on the Material Safety Data Sheet (MSDS). NOTE: If the chemical is a mixture. do not complete this field; complete the "COMMON NAME· field instead. 206, TRADE SECRET - Check "Yes" if the information in this section is declared a trade secret. or "No· if il is nol. State requirement: 1/ yes. and business is not subject to EPCRA, disclosure of the designated trade secret information is bound by HSC §25511, Federal requirement: If yes. and business is ~ubject to EPCRA. disclosure of the designated Trade Secret information is bound by 40 CFR and the business must submit a "Substantiation to Accompany Claims of Trade Secrecy" form (40 CFR 350,27) to USEPA. 207. COMMON NAME - Enler the common name or trade name of the hazardous malerial or mixture containing a hazardous material. 208, EHS - Check "Yes· if the hazardous material is an Extremely Hazardous Substance (EHS). as defined in 40 CFR, Part 355. Appendix A. 1/ the material is a mixture containing an EHS, leave this section blank and complete the section on hazardous components below, 209, CAS # . Enter the Chemical Abstract Service (CAS) number for the hazardous maleriaL For mixtures. enter the CAS number of Ihe mixture if it has been assigned a number distinct from its components, 1/ the mixture has no CAS number. leave this column blank and report the CAS numbers of the individual hazardous components in the appropriate section below, 210, FIRE CODE HAZARD CLASSES - Fire Code Hazard Classes describe to first responders the type and level of hazardous materials which a business handles. This information shall only be provided if the local fire chief deems it necessary and requests the CUPA or AA to collect it. A list of the hazard classes and instructions on how to determine which class a material falls under are included in the appendices of Article 80 of the Uniform Fire Code, If a material has more than one , applicable hazard class. include all, Contact CUPA or AA for guidance. 21" HAZARDOUS MATERIAL TYPE - Check the one box that best describes the type of hazardous material: pure. mixture or waste, If waste material. check only that' box. If mixture or waste. complete hazardous components section. 212, RADIOACTIVE· Check ·Yes" jf the hazardous material is radioactive or "No· if it is not. 213, CURIES -1/ the hazardous material is radioactive. use this area to report the activity in curies, You may use up to nine digits with a noating decimal point to report activity in curies, 214. PHYSICAL STATE - Check the one box that best describes the state in which the hazardous material is handled: solid, liquid or gas, 215. LARGEST CONTAINER· Enter the total capacity of the largest container in which the material is stored, 216, FEDERAL HAZARD CATEGORIES - Check all categories that describe the physical and health hazards associated with the hazardous material. PHYSICAL HAZARDS HEALTH HAZARDS Fire: Flammable liquids and Solids, Combustible liQuids, Pyrophorics. Oxidizers Acute Health (Immediate): Highly Toxic. Toxic. Irritants. Sensitizers. Corrosives. Reactive: Unstable Reactive. Oraanic Peroxides, Water Reactive. Radioactive other hazardous chemicals with an adverse effect with short term exposure Pressure Release: Explosives, Compressed Gases, Blasting Agents Chronic Health (Delayed): Carcinogens. other hazardous chemicals with an adverse effect with lono term exoosure , , 217, AVERAGE DAILY AMOUNT· Calculate the average dady amount of the hazardous matenal or mIXture containing a hazardous matenal. In each budding or adacent/ outside area, Calculations shall be based on the previous year's inventory of material reported on this page. Total all daily amounts and divide by the number of days the chemical will be on site, If this is a material that has not previously been present at this location. the amount shall be the average daily amount you project to be on hand during the course of the year. This amount should be consistent with the units reported in box 221 and should not exceed that of maximum daily amount. 218, MAXIMUM DAIL Y AMOUNT - Enter the maximum amount of each hazardous material or mixture containing a hazardous material. which is handled in a building or adjacent/outside area at anyone time over the course of the year. This amount must contain at a minimum last year's inventory of the material reported on this , page. with the renection of additions. deletions. or revisions projected for the current year, This amount should be consistent with the units reported in box 221. 219, ANNUAL WASTE AMOUNT· If the hazardous material being inventoried is a waste. provide an estimate of the annual amount handled. 220, STATE WASTE CODE - If the hazardous material is a waste. enter the appropriate Califomia 3-digit hazardous waste code as listed on the back of the Uniform Hazardous Waste Manifest. 221, UNITS· Check the unit of measure that is most appropriate for the material being reported on this page: gallons, pounds, cubic feet or tons, NOTE: If the material is a federally defined Extremely Hazardous Substance (EHS). all amounts must be reported in pounds, 1/ material is a mixture containing an EHS. report the units that the material is stored in (gallons, pounds. cubic feet. or tons), 222. DAYS ON SITE· List the total number of days during the year that the material is on site, 223, STORAGE CONTAINER - Check all boxes that describe the type of storage containers in which the hazardous material is stored, NOTE: If appropriate. you may choose more Ihan one, 224, STORAGE PRESSURE· Check the one box that best describes the pressure at which the hazardous material is stored, 225. STORAGE TEMPERATURE· Check the one box that best describes the temperature at which the hazardous material is stored, 226, HAZARDOUS COMPONENTS 1-5 (% BY WEIGHT) . Enter the percentage weight of the hazardous component in a mixture. If a range of percentages is available. report the highest percentage in that range, (Report for components 2 through 5 in 230. 234. 238. and 242,) 227, HAZARDOUS COMPONENTS 1-5 NAME - When reporting a hazardous material that is a mixture. list up to five chemical names of hazardous components in that mixture by percent weight (refer to MSDS or. in the case of trade secrets. refer to manufacturer). All hazardous components in the mixture present at greater than 1 % by weight if non-<:arcinogenic. or 0,1% by weight if carcinogenic. should be reported, If more than five hazardous components are present above these percentages. you may attach an additional sheet of paper to capture the required information, When reporting waste mixtures. mineral and chemical composition should be listed, (Report for components 2 through 5 in 231,235.239, and 243,) 228, HAZARDOUS COMPONENTS 1·5 EHS . Check 'Yes" if the component of the mixture is considered an Extremely Hazardous Substance as defined in 40 CFR. Part 355. or "No" i~jt is not. (Report for components 2 through 5 in 232, 236, 240, and 244,) 229, HAZARDOUS COMPONENTS 1·5 CAS· List the Chemical Abstract Service (CAS) numbers as related to the hazardous components in the mixture, (Repeat for 2-5,) 246, LOCALLY COLLECTED INFORMATION· This space may be used by the CUPA or AA to collect any additional information necessary to meet the requirements of their individual programs, Contact the CUPA or AA (or guidance, UPCF (1/99) 7 OES Form 2731