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Home My WebLink AboutBUSINESS PLAN 11/19/2004~ ALCORN AIItE, INC.. '. ~ 325 ROBINSON ~/ - - - _ ~! I ~I - UNI~I~.D;,~R.OGRAIVI INSPECTION CHECKLIST -- = SECTION 1: Business-Plan-and Inventory Program • i~ Prevention Services H A F R s ~ ,_ . D 900 Truxtun Ave:; Suite 210 - FiRE Bakersfield, CA 93301 ARTM Tel.: (661) 326-3979 Fax: (661) 872-2171 FACILITY NAME - - ~ L d r~ ~ n ~~..._ .~, t c_.. INSPECTION DATE 2) o ~ INSPECTION TIME ~~ t~ r~ ADDRESS ~,Z S ~ a 6 i `~I S O N ; art, -' PHONE NO. 3- I ~ Z NO OF EMPLOYEES / S FACILITY CONTACT BUSINESS ID NUMBER 021-C~~g7~ 15 (L..~- 1.C~4Zn~ - ..Section 1: Business Plan and Inventory Program ~~'l ROUTINE . ~^ COMBINED ^ JOINT AGENCY ^ .MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION' .~ C V ~ C=Compliance OPERATION V=Violation COMMENTS r ~f ^ APPROPRIATE PERMIT ON HAND /~ v ^ BUSIIIeSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS i~ ^ CORRECT OCCUPANCY i>~ ^ VERIFICATION OF INVENTORY MATERIALS ., ld ^ VERIFICATION OF QUANTITIES i~ ^ VERIFICATION OF LOCATION - CC1Y ^ PROPER SEGREGATION OF MATERIAL ~ ^ VERIFICATION OF MSDS AVAILABILITY , d" ^ 7 VERIFICATION OF HAZ MAT TRAINING ~ / NJ ^ VERIFICATION'OFRBATEMENT SUPPLIES AND PROCEDURES , ,/ L~J ^ EMERGENCY PROCEDURESADEQUATE ^ i~ CONTAINERS PROPERLY LABELED 5 ~ Ct~ Sit;. l C. L / ~.f l~ rz_ ^ HOUSEKEEPING ^ FIRE PROTECTION ^ ~ SITE DIAGRAM ADEQUATE & ON HAND -ANY HAZARDOUS WASTE ON SITE? EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 Inspector (Please Print) Fire Prevention / 1s` In /Shift of Site/Station # Busin s Si a onsible Party (Please Print) White_ Prevention Services Yellow -Station Copy ~ Pink -Business Copy ~ FD 2155 (Rev. 09/05 ^ YES ~O Looz/~z/zo -z- Based on my inquiry of those individuals responsible for obtaining the information, I Certify under penalty of law that I have personally examined and am familiar with the informatlo~ submitted and believe the information Is true, accur te, and co plete. `QQZ 9 f ' ~ ~h~ gnatur Date - ~ " v~~ R f N~ s~z~zH - ~ ooxa sa~z~oa.zzQ ~ouab.zau~~ : oNTao.z~d oN ~sS2i ~P~~z~~aO TAO = = sySgT~~o,y : aa.z~da.zd TAO = ~sSS6'T~~os o~ - pozaad 98£E6 = diZ Q'~I~I3S2iS?iFIt3 ~ ~~zO rdO ~ a~~~S 95£09 XOS Od = ssa.zpp~ xZ 6 6I - E Z £ (Z 9 9) : auoLtd 1~12iO0ZK ~2i2i'dH za~O 98E£6 r dzZ Q'I~I3S2i~?i'dS ~ 1L~tO ' KO ~a~~~S 95E09 XOS Od ~~PpFfTT~L~i xZ66T-£Z£ (Z99) :auoLld N2iOOrl~' ~2i2~H ~o~~uoO u~THuttul ssa.zd a.zi3 : sp.z~z~H ~~tuz~H x - (. ) auoud .zab~d x - (~~-al) auoud .zab~d x - ( ) auoud .znoH - ~ Z ~yb ~ - QZ~ () ~1 ~1) = auoud znoH - ~ Z ) :auoud ssauzsng x - ( g hb >r ( ud s / 2r I~~ ~~n l' ~~~ ~ v J 07~~ h ~ ~ aT~Ts / ~o~~uoO ~~uab.zatus T~YZ / ~a~~uoO ~ouab.zau~~ ~ - p~.zguunQ :apo~ OIS :L1OFI T ~ s~zunap3 Q6Z :pz.zO tyoZ z~HtumoO £ 0 T = d'sW Z66Z-EZE (T99) :auoudsng EL8Z00-TZO-5I0 ~QIa~iS : QwnN Fz'd S zo FtsS Q3g ~ apoOmwoO Q'~ISI~3S2is?i`'dg t~~tO ZS NOSNI O2i SZ£ :uoi~>?ooZ U') 071 t~.l ~i~ ~N .zab~u~W ONI ~2~I~d l~I2I0~'Trd c ~ ;~ ` 4 F ALCORN AIRE INC SiteID: 015-021-002873 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP CHLORODIFLOUROMETHANE F P IH G 123000.00 FT3 Low CHLORODIFLOUROMETHANE F P IH G 9840.00 FT3 Low ARGON/C02 MIX G 228.00 FT3 UnR -2- 01/24/2007 -3- 01/24/2007 r '' F ALCORN AIRE INC SiteID: 015-021-002873 ~ ~ Inventory Item 0003 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE Days On Site 365 Location within this Facility Unit Map: Grid: OUTSIDE S SIDE OF SHOP BLDG CAS# 75-45-6 ~GasATE TPureE ~-AboveSAmbEent AmbientT~E PORTCOPRESSERCYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 123000.00 FT3 123000.00 FT3 123000.00 FT3 r1E1GEiKLVU.7 I.VP'lYV1VtS1V 1.7 $Wt. RS CAS# 100.00 Chlorodifluoromethane No 75456 t1HG1~tCL H.7.7r,.7J1~1JJ1V 1 ~J TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F P IH / / / Low ~ Inventory Item 0002 COMMON NAME / CHEMICAL NAME CHLORODIFLOUROMETHANE Location within this Facility Unit INSIDE W WALL OF SHOP STATE T TYPE Gas I Pure CAS# 75-45-6 CONTAINER TYPE _ PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Co123100rFT3 Daily9840100m FT3 I Daily9840r00e FT3 nr~~r~ru~VUa ~v1nrV1v~1V1~ oWt. RS CAS# 100.00 Chlorodifluoromethane No 75456 - ISHGHtCL L-~J JL" .7w71~1L' 1V 15 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ ~ Curies F P IH / / / Low Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: = PRESSURE TEMPERATURE Above Ambient Ambient -4- 01/24/2007 F ALCORN AIRE INC ~ Inventory Item 0001 COMMON NAME / CHEMICAL NAME ARGON/CO2 MIX Location within this Facility Unit SE CRNR OF SHOP SiteID: 015-021-002873 ~ Facility Unit: Fixed Containers at Site ~ Days On Site 365 Map: Grid: CAS# STATE TYPE PRESSURE TEMPERATURE CONTAINER TYPE _ Gas TPure -Above Ambient Ambient PORT. PRESS. CYLINDER AMOUNTS AT THIS LOCATION Largest Container Daily Maximum ( Daily Average 128.00 FT3 228.00 FT3 228.00 FT3 ~Wt. RSA CAS# tLHGHtCL 1~~~~551~1L' 1V 1 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies / / / UnR HAZARDOUS COMPONENTS -5- 01/24/2007 F ALCORN AIRE INC SiteID: 015-021-002873 ~ Fast Format ~ ~ Notif./Evacuati /Medical Overall Site ~ Agency Notif' ation Employee N tif./Evacuation __~'L ,~ t U1J 1 11. J~V V l~ 1 1~ L~ V CL l.: UCL l~ 1 V l l /JJ/ ~ LdLLCLt~. C11Uy 1.1CU1(:d1 t'1d11 ~,t1 all -6- 01/24/2007 F ALCORN AIRE INC SitelD: 015-021-002873 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ Release Prevention C~~~~ MGR ~ w o~\ Release Cont inment ~.yea.~ uY ~,_ v~.11ci nc~vui~..c t~l.l~lVGil.1V11 -7- 01/24/2007 /~ r., `' .~ . . F ALCORN~AIRE INC SiteID: 015-021-002873 ~ Fast Format ~ ~ Site Emergency Factors Overall' Site ~ Special Hazards Utility Shut-Offs ~c~~ ~ti u~ - o~ - ,_ . bu.~ td~~ n~-- . - C~a:o~c, a- Ca.~-bo~r~ ~ ~ o ~ ~~~. ~ ~e,I a~o~ 1'llc rlvt.c~../ravall. vvcLl.Ci l~ ~ ~ ~ ~ °~ ~' r~ ~~ Building Occupancy Level 12/11/2006 = 15 EMPLOYEES ~~ -8- 01/24•/2007 G /~ i ~. - ~ F ALCORN,P;IRE INC SiteID: 015-021-002873 ~ Fast Format ~ ~ Training Overall Site ~ ~~r+lll~Jl Vy CC 1LCL 111111y (~ ~ -~~~ '~ ~~ s . rayc c. raclu 1_VL rULULC ~~c -- Held for Future Use -9- 01/24'/2007 ~ y .. '~' + ALCORN AIRE INC _____________________________________ SiteID: 015-021-002873 + Manager Location: 325 ROBINSON ST City BAKERSFIELD BusPhone: (661) 323-1992 Map 103 CommHaz Low Grid: 29D FacUnits: 1 AOV: CommCode: BFD STA 02 SIC Code: EPA Numb: DunnBrad: Emergency Contact / Title Emergency Contact / Title / ~ Business Phone: ( ) - x Business Phone: ( ) - x 24-Hour Phone ( ) - x 24-Hour Phone ( ) - x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire Press ImmHlth Contact HARRY ALCORN Phone: (661) 323-1992x MailAddr: PO BOX 60356 State: CA City BAKERSFIELD Zip 93386 Owner HARRY ALCORN Phone: (661) 323-1992x Address PO BOX 60356 State: CA City BAKERSFIELD Zip 93386 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: ~ Emergency Directives: ~ PROG A - HAZMAT ac~T) ~ ~~ `~' ~~~~ ~~~~ 14 ~Op6 55~ Based on my inquiry of those individuals responsible for obtaining the information, I certify under penalty of law that I have personally examined and a familiar with the information sub fitted and b lieve the information is true, ac rate, an plete. ~/~ d~o ignat a Date r- -1- "` 06/06/2006 ~-t~~ Bakersfield Fire Dept. l1NIFIED PROGRAM INSPECTION CHECKLIST Enironmental Services _ _~ - .:, 1715 Chester Ave SECTION 1 Business Plan and Inventory Program ~ Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME INSPE ION ATE INSPECTION TIME Z,Gu~N ~,rr.i; Lt~~ v~. ADDRESS PHO E No. No. of Employees Tj2j ~jgr~.lsvJ 323-(~9Z tZ FACILITYCONTACT Business ID Number ~z.(z~ ~,xz..J 15-021- ~`~L~-.~ Secfion 1: Business Plan and Inventory Program outine ^ Combined O Joint Agency ^hulti-Agency ^ Complaint ^ Re-inspection C V nce l OPERATION ~ P J V=Vio a on ^ ^ PERMIT ON HAND APPROPRIATE ^ ^ BUSINESS PLAN CONTACT INFORMATION ACCURATE ^ ^ VISIBLE ADDRESS ^ ^ CORRECT OCCUPANCY ^ ^ VERIFICATION OF INVENTORY MATERIALS ^ ^ VERIFICATION OF QUANTITIES ^ ^ VERIFICATION OF LOCATION ^ ^ PROPER SEGREGATION OF MATERIAL ^fy„^ VERIFICATION OF MSDS AVAILABILITYE ^~ ^ VERIFICATION OF HAT MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ^ ^ EMERGENCY PROCEDURES ADEQUATE ^ ^ CONTAINERS PROPERLY LABELED ^ ^ HOUSEKEEPING ^ ^ FIRE PROTECTION ^ ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE: ^ YES 1t~'IVO EXPLAIN: V` COMMENTS C ~' \ - - 4- r~ ~- Fp-5~' (661) 323-1992 SE` R~~ FAX (661) 323-5160 ~ , ' i ALCORN AIRE, INC. COMMERCIAL & RESIDENTIAL HEATING & COOLING i HARRY ALCORN P.O. BOX 60356 Sales & Service BAKERSFIELD, CA 93386 QUESTIONS REGARDING THIS INSPECTIONS PLEASE CALL US AT (661) 326-3979 [n~ r ~ 3 Inspector (Please Print) Fire Prevention 1st-InlShift of Site Business S' Responsible Party (Please Print) rn B N White -Environmental Services Yellow -Station Copy Pink -Business Copy _:'':~ ~-..~~ ..- ---_ -- ._. _. CTT'~ OI'-- f~AI<E_RSFIELD ,w-~-gin, B EF~RF ` D OFFICE OF ENVIRONMENTAL SERVICES ~~: ARTM r 1715 Chester Ave., CA 93301 (661) 326-3979 • - _ _ - - ~~~ ~~' HAZARDOUS MATERIALS INVENTORY oR CHEMICAL DESCRIPTION (one form per material per building or area) NEW ^ ADD ^ DELETE ^ REVISE 200 Page _ of y -__...-___,_. _..__ ..__ ._... .~___._-___----- - --- - - - _ __ - - -- -------.~_.. -_... --- _ - -- --- - ._ : _ I- FACILITYINFORMATION : _ _ _____ __ BUSINESS NAME (Same as FACILITY NAME ~or~DBA -Doing Business As) ~~~~~ ~~ >~~-wren) ~ 2 CHEMICAL LOCATION ~ 201 CHEfAICAL LOCATION ~. ~:Z-i~J/~ ~~ S~C~r CONFIDENTIAL(EPCRA) ' FACILITY 10 # ~ '---~' -i_ r -' - - 1" MAP # (optionap - -- - - - 203 - GRID # (optrona~ - - - i I i ~_. -i I ~ _ -_-1.._~___.;-_..._-. _...____-__-_._ .____..._._-.- ._- _......___.._.. __ il. C~iEMiCAL INFORMATION 3 ^ Yes ^ No 202 CHEMICAL NAME ~/~~.[~~,~^) /9 //~/'~ - 205 TRADE SECRET ^ y~ ^ No O6 /~(-V `-"'~ / W Z - l~ t X I' Subject to EPCRA. refer to iristructions 2 --- - --FF//-- -...__ -- -- _ - 207... - ---- ----------- COMMON NAME - - EHS' ^ Yes ^ No 208 i CAS # - ~ ~ ~ - ~ - _ ~ 209 ~ -'If EHS ii'Yes,'~all amoutits below must be-iti lbs. ~ ' FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief) 210 - - -_-._ . . TYPE ~ .-._ - - --- --- ----.----- CURIES 213 ^ p PURE ~ MIXTURE ^ WAS-4 ~ R-,DIOACTIVE ^ Yes ^ No 212 - PHYSICAL STATE ^ s SOLID ^ I LIQUID ~ GAS 214 LARGEST CONTAINER ] '7 ~/ 215 j FED HAZARD CATEGORIES ^ 1 FIRE ^ 2 REACTIVE PRESSURE ^ELEr.SE ~ ~ 4 .4i U-E HEALTH ^ 5 CHRONIC HEALTH 216 (Check all that apply) ! '~ ' I ANNUAL WASTE 217 ;d4XIMUM 218 AVERAGE 219 I STATE WASTE CODE 220 AMOUNT DAILY AMOUNT Z 2 ~ DAILY AMOUNT ' UNITS' ^ ga GAL ~cf CU FT ^ Ib LBS L7 to TONS 221 ! DAYS ON SITE ~ ' If EHS, amount must be in lbs. I 222 STORAGE CONTAINER ^ a ABOVEGROUND TANK ^ e PLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 j (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.-T.OTE BIN _... ___ .. _.-.... __ ..__. _ _. _ ___,_._ ^ d STEEL DRUM ^ h SILO ~Y~CYLINDER ^ p TANK WAGON i ~ STORAGE PRESSURE ^ a AMBIENT ~aa ABOVE AMBIENT ^ ba BELOW AMBIENT STORAGE TEMPERATURE ~ gMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 224 225 UPCF (7/99) ._ .. __ _ _ _ - _ . ._ -. S:\CUPAFORMS10ES2731.TV4.wpd - r `~ ~- -- - - -- - B E R S F 1 D F/RB ~RrM r _ - -- C1TY_Ol~:_ I~c'~~E. RSF~ I_ELD -- -~ .. _ . __ ~- ~.a. OhFICE OF ENVIRONMENTAL SERVICES ~ c' 1715 Chester Ave., CA 93301 (661) 326-3979 OR , ~. HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION NEW ^ ADD ^ DELETE ^ REVISE 200 v.__~, _.,...... ,_ ._.._, . .._ _ --1. FACILITYINFARMATION - ~~ BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) ' ~~Cs~a-~rJ P~ 2 CHEMICAL LOCATION ~Sln~ ~ ~ ~(,~ C~ 5 1-~il r' i FACILITY ID # i i i ~ . ' :' ' 1i MAP # (opiiona~ _ __. i , t x ~.._,.__ ._...._ .. _ _. _.~_ .____. .. ... .. ..~. ____ _. _. -.. -_... __ .. Ii. CiiEMICAL LVf'ORMATION CHEMICAL NAME - - Cf-FJ~l~jj+~~ F~v~2~n~1>`-j COMMON NAME - - - - - - _ ~ -Z`Z 20t CHEMICAL LOCATION ^ y~ ^ No 202 CONFIDENTIAL (EPCRA) - - 203 - ~ GRID # (optional) - - - -~------- - - ~ 204 - 205 TRADE SECRET ^ y~ ^ No -206 I° Subject to EPCRA, refer to instructions . ' _ zo7 - --- --- --- . EHS' ^ Yes ^ No 208 ', CAS # j 209 *If EHS is"Yes,' all amomts below must be io lbs. i FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief) 210 TYPE E~p..PURE ^ m MIXTURE ^ w WAS-_ ~ ~ R-,t?IOACTIVE ^ Yes ^ No 212 CURIES 213 i' PHYSICAL STATE I „~% ^ s SOLID ^ I LIQUID ~ g GAS 2t4 LARGEST CONTAINER ~ ~ ^') J 215 j FED HAZARD CATEGORIES ^ t FIRE ^ 2 REACTIVE ~ PRESSIRE RELE l,SE ^ 4 .gCUTE HEALTH ^ 5 CHRONIC HEALTH 216 (Check all that apply) - -- - _.. _.. -- - -- A N NUNTWASTE c ~ ,.l 217 YtJ X18 ~ A LY^ ~'~~ 2t9 STATE WASTE CODE ~ 220 n ~ AMOUNT p D DA LY AMOUN7 '; UNITS' ^ ga GAL ~ CU FT ^ Ib LBS ^ to TONS 221 DAYS ON SITE 222 ~ ' If EHS, amount must be in lbs. ~~ I 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 u j BAG ^ n PLASTIC BOTTLE ^ r OTHER - ~ -. - -- _-..__ . .^ c-TANK INSIDE BUILDING-~ --.^ g CARBOY _.: -_: _, -_..-_~..~ -.. ^ k BOX..- ... - _.. ^ o_TOTE BIN _. ^ d STEEL DRUM ^ h SILO I I .CYLINDER ^ p TANK WAGON ~ STORAGE PRESSURE I ^ a AMBIENT ~aa ABOVE AMBIENT ^ ba BELOW AMBIENT 224 STORAGE TEMPERATURE I ~ AMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 225 %V11T L ..~_~~- _~ _'. ...... HAZARDOUS COMPONENT =-==__ _._....-_...--------- ------- ..---- ,.. EHS _ ; ': CA$,# , --- j I 1 226 ~ i 227 i ^ Yes ^ No 228 _ _.. 229 _ I 2 230 ~' I I ; 231 ~i ^ Yes ^ No 232 233 I----- - 3 i 234 i - ------ _- .-....--- - - - - -- . -------------- 235 , ^ Yes ^ No 236 237 - - 4---i _ ` - ---238= i - =_--_~~ ___ _~ _~ __~_---=== _ --- : ~ __ 239 ,- -Yes ~- No 240 - -- - -- - - . _. -_ . _ _.__ ~ ..: 241 ~ .:..- 5 242 243 I ^ Yes ^ No 24a 245 UPCF (7/99) . - _.. -_. _ - __ __ _.._ _ _. _ S:ICUPAFORMS10ES2731.TV4.wpd. (one form per material per building or area) Page _ of _ _- - . _- - -- ;,~.~ _- _ _ __ __. ITY. nh_t3~1KERSFIELD __ .~ B EF~rR~ 1 o OFFICE OF ENV1RO~fNIIENTAL SERVICES ~ ~ • -= ~ a Ali<TM r 1715 Chester Ave., CA 93301 (661) 326-3979 q~~,~~ -.i:-.:..c~..fis.....- pR ;. HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION (one form per material per building or area) ^ ADD ^ DELETE ^ REVISE 200 Page _ of - -------° -:•-- = .. _ - - 1. FACILITY hFARMATION- _ - - - -- - - -- BUSINESS NAME (Same as FACILITY NAME or DBA -Doing Business As) 3 ----,A'l~CU2r~1 ~4t 2 - - - --- - - CHEMICAL LOCATION /q, ~-{ 201 CHEtdICAL LOCATION vv ` 't J~~ S S t ~C~-- v~ S{.(~.~ ~~G, CONFIDENTIAL (EPCRA) ^ Yes ^ No 202 - r. FACILITY ID # T-~~ -~~-_ ~- ~ _ ~ ~~ ~-~ t, MAP ~# (optionan- - - --- ~ ~ - 203 ~ -GRID # (optional)- ~ - ~ --- - - --_-- 204- IL CiiEMiCAL INFORMATION CHEMICAL NAME ~~C~~MC~ 205 TRADE SECRET ^ y~ ^ No 206 G , 1 ~M~ ~ t ~L~~~ ~~~~K If Subject to EPCRA, refer to instructions --------° __ - - fi' - - ~- - - 207..._..- .._ --- - -- COMMON NAME ~ ~ ~- - - ~ EHS' ^ Yes ^ No 208 . ... CAS # 209 'If EHS is'Yes,' all amounts below must Ix in lbs. FIRE CODE HAZARD CLASSES (Complete if requested by local fre chief) 210 i i TYPE --------- ------- ------- c c - ---- _-- - --- --..-------- --- CURIES 213 ^ p PURE ^ m MIXTURE WA.,-_ < R-,UIOACTIVc ^ Yes ^ No 212 PHYSICAL STATE ^ s SOLID ^ I LIQUID ~g GAS 21a LARGEST CONTAINER ~ .~ ~ ~ 215 _ / FED HAZARD CATEGORIES ~^ 1 FIRE ^ 2 REACTIVE ~ PRESSURE RELEASE iJ 4 A;;U-E HEALTH ^ 5 CHRONIC HEALTH 216 (Chedt all that apply) ANNUAL WASTE 217 ;v14XIMUM 218 AVERAGE ? i~v~ 219 STATE WASTE CODE 220 AMOUNT ~ DAILY AMOUNT ~ t~~f((~(J DAILY AMOUNT IZ Jr c~~CJ UNITS' ^ ga GAL ~cf CU FT ^ Ib LBS L~ to TONS 221 DAYS ON SITE 222 ' If EHS, amount must be in lbs. i STORAGE CONTAINER ^ a ABOVEGROUND TANK ^ e PLASTIC/NONMETALLIC DRUM ^ i FIBER DRUM ^ m GLASS BOTTLE ^ q RAIL CAR 223 j (Check aN that apply) ^ b UNDERGROUND TANK ^ f CAN t.: j BAG ^ n PLASTIC BOTTLE ^ r OTHER --- -^ c TANK INSIDE BUILDING .. ^ g CARBOY - _ - ^ k. BOX .. _ . _-. _ ^.o TOPE BIN_ .... .- _ _ ^ d STEEL DRUM C h SILO ~ CYLINDER ^ p TANK WAGON j STORAGE PRESSURE ^ a AMBIENT ~.aa ABOVE AMBIENT ^ ba BELOW AMBIENT 224 STORAGE TEMPERATURE (~gMBIENT ^ as ABOVE AMBIENT ^ ba BELOW AMBIENT ^ c CRYOGENIC 225 i %VYt . .. °...HAZARDOUS:COMPONENI' .: __ : _... - ; ._:. .EHS . _ .. ~ GAS #, ' ~ ' 1 226 i 227 ' - - 229 j ^ Yes ^ No 228 _ _ - .- . i ~- - - - 2 230 231.1 ' 233 ~ I ^ Yes ^ No 232 '. i -- - I 3 ! ' 234 i 235 ~ 237 i ^ Yes ^ No 236 ' 4--! -'-- °=--`23&_~_.-._ ~ :._: ._~-~ _._ _-__ -_=-~_:.__=-`----~ --==~9_,- _I _ _ -`--- - ..~..~.__.-X241.'---- ~ i 0 Y-es ^"No -740__ i-' _ _. - i I i --- - - - -_ .. - - _ _. _- -- ---------- - 5 j 242 243 i 245 ^ Yes ^ No 244 i - ( ,_.._-__- _ --. _ ,.:. `"III. SIGNATURE - - .. , ~ ._ .., . - . - - i , PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTATIVE __ _ SIGNATURE _ _ _ DATE 246 _- -_ _ - ._ - - -_. - - .- -r. _~~- ...- - - UPCF(7/99) .... . _ -. _ _.. ___. _. __-- - __ _ _ ___S:ICUPAFORMS\OES2731.TV4.wpd