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Home My WebLink AboutBUSINESS PLAN / \ ../ - ,.,;ft? 1 ,RACERS HAVEN I 7401 WHITE LANE #12 {~]g ~~ .. ti RACERS HAVEN ' 1301 SiteID: 015-021-002351 Manager : KENT BEAL Location: 7401 WHITE LN 12 City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: BusPhone: Map : 123 Grid: 16A (661) 835-0441 CommHaz : Moderate FacUnits: 1 AOV: SIC Code:3644 DunnBrad: Emergency Contact FRANK AMESTOY IV Business Phone: 24-Hour Phone Pager Phone / Title / OWNER (661) 835-0441x (661) 619-5222x (661) 619-5223x Hazmat Hazards: Contact : FRANK AMES TOY IV - MailAddr: . 740.1 WH-ITE LN 12/ City BAKERSFIELD Owner Address City FRANK & KERI AMESTOY IV 7401 WHITE LN 12 BAKERSFIELD Period Preparer: Certif'd: ParcelNo: to Emergency Directives: PROG A - HAZMAT Emergency Contact KERI AMES TOY Business Phone: 24-Hour Phone Pager Phone / Title / OWNER (661) 322-5687x (661) 619-5222x (661) 588-8990x Fire ImmHlth DelHlth Phone: (661) 835-0441x State: CA Zip '93309 Phone: (661) 835-0441x State: CA Zip 93309 TotalASTs: = TotalUSTs: = RSs: No Gal Gal WV'OD 5 ENT'D MAY 25} 2007 Basl'Jd .Oft rrty inquiry of those individuals responsible tor obtaining the information, I certify unde~ penQ./ty ()f law that I have personally examl.ned and am familiar with the information submitted and believe the information is true, ac uratet a comptet, S' ~Vl ,V _. - . Ignature 6, ;J;)-Q) Date -1- 05/16/2007 t' 'i SiteID: 015-021-002351 9 By Facility Unit 9 Fixed Containers at site 9 \speCHaz\EPA Hazards I Frm I DailyMax IUnitlMCP F RACERS HAVEN p= Hazmat Inventory p== MCP+DailyMax Order Hazmat Common Name... MODEL ENGINE FUEL F IH DH L 100.00 GAL UnR -2- 05/16/2007 r, 'j -3- 05/16/2007 F RACERS HAVEN f= Inventory Item 0001 F=== COMMON NAME / CHEMICAL NAME MODEL ENGINE FUEL SiteID: 015-021-002351 1 Facility Unit: Fixed Containers at Site 9 Days On Site 365 Location within this Facility Unit INSIDE SW CRNR OF SHOP Map: Grid: CAS # STATE - TYPE Liquid Mixture PRESSURE Ambient TEMPERATURE Ambient CONTAINER TYPE PLASTIC CONTAINER Largest Container 1. 00 GAL AMOUNTS AT THIS LOCATION Daily Maximum 100.00 GAL Daily Average 55.00 GAL N %Wt. RS CAS # 30.00 Nitromethane No 75525 .- .- HAZARDOUS COMPO ENTS HAZARD ASSESSMENTS TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ CUries F IH DH / / / UnR -4- 05/16/2007 r' ~ SiteID: 015-021-002351 1 Fast Format 1 Overall Site 9 F RACERS HAVEN I p= Notif./Evacuation/Medical Agency Notification Employee Notif./Evacuation ~'___~~ ~-_~_-O"" ~~- -"'.- ~-~ -. Public Notif./Evacuation Emergency Medical Plan -5- 05/16/2007 " .€ F RACERS HAVEN I f= Mitigation/Prevent/Abatemt Release Prevention SiteID: 015-021-002351 1 Fast Format "I Overall Site 1 Release Containment -~..-,-.-...- ~ -.-....,.....-;-:-~-- . . -~--- - -',,-~---- :...--~- -=---~-... -..-" ~--~ Clean Up Other Resource Activation -6- 05/16/2007 ... " ; SiteID: 015-021-002351 1 Fast Format 1 Overall Site 1 F RACERS HAVEN I f= Site Emergency Factors Special Hazards Utility Shut-Offs -~--,~--,,",,"--::-- ---=---...---~- --~~~.-~- ---,... -- ~.-..,--~=--. --~-~~ FireProtec.j-Avail. Water BUilding Occupancy Level -7- 05/16/2007 ~. ~ , I F RACERS HAVEN I f= Training Employee Training SiteID: 015-021-002351 , Fast Format 1 Overall Site 9 Page 2 --, -- ~~; ;..~.,..,.-""'" Held for Future Use Held for Future Use -8- 05/16/2007 UNIFIED PROGRAM INSPECTION CHECKLIST Prevention Services D 900 Truxtun Ave., Suite 210 ,." Bakersfield, CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-2171 SECTION 1: Business Plan and Inventory Program L ;J.. IN/~OUE :A,CILlTY NAME f\- A-v~ "^ lZ ~ *<..Q....> ADDRESS 401 NO OF ~LOYEES z;S-1 Section 1: Business Plan and Inventory Program o COMBINED 0 JOINT AGENCY 0 MULTI-AGENCY 0 COMPLAINT ~~07 ORE-INSPECTION C V (C-COmplianCe) V=Violalion ~O ApPROPRIATE PERMIT ON HAND ~ 0 Business PLAN CONTACT INFORMATION ACCURATE ~D VISIBLE ADDRESS OPERA TION COMMENTS )3"" 0 CORRECT OCCUPANCY Z 0 VERIFICATION OF INVENTORY MATERIALS C 11 ZOQ5 ~ 0 VERIFICATION OF QUANTITIES o VERIFICATION OF LOCATION ff" 0 PROPER SEGREGATION OF MATERIAL ~D VERIFICATION OF MSDS AVAILABILITY z- 0 VERIFICATION OF HAl MAT TRAINING ~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ 0 EMERGENCY PROCEDURES ADEQUATE ;a--'D CONTAINERS PROPERLy'LABELED o HOUSEKEEPING ~'D FIRE PROTECTION ff"D SITE DIAGRAM ADEQUATE & ON HAND KBF.6013 EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 (J hAN k. A~~~TO\J -rrt. Business Sile I Responsible party'(Please Prinl) White - Prevention Services Yellow. Station Copy Pink - Business Copy FD 2155 (Rev. 09/05 ~ ", ~ -'J + RACERS HAVEN ======================================== SiteID: 015-021-002351 + Manager : I~ ~ Location: 7401 WHITE LN 12 City BAKERSFIELD BusPhone: Map : 123 Grid: 16A (661) 835-0441 CommHaz : Moderate FacUnits: 1 AOV: CommCode: BFD STA 09 SIC Code:3644 EPA Numb: DunnBrad: +==============================================================================+ +=======================================+======================================+ Emergency Contact / Title ~ Emergency Contact / Title €:Ri:C 0El8FER / 6'~ A-rne.-~tI J..Y / 0l.0 ~ , Business Phone: (661) 835-0441X! n Business Phone: (/;M )69a -'fX.p~7x.l&2.v1 24-Hour Phone : ((rCeI )vl4 -~~x CQ..X 24-Hour Phone : (~ltl )[,Iq -5Boo.x CJL)? Pager Phone : (v<tl )Ctlq -Sge~xW Pager Phone : (L,ul )8''1; -'1'iCfDx h.rmItp +---------------------------------------+--------------------------------------+ I Hazmat Hazards: Fire ImmHlth DelHlth I +-----------------------~--------~-A-------~-------------------------------+ Contact: Sli....'" __~....l!!lR rrc....vlK, .teVI rTYYIE-'7:sIoy-Jr Phone: (661) 835-0441x MailAddr: 7401 WHITE LN 12 State: CA City : BAKERSFIELD Zip : 93309 + - - - - - - - - - - - - - - - - - - - - 7,- - - - - - - -~- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - + Owner fvC<YI1< Y'eYf trJlYl~.:Ji>r~ YlLLO OW~ Phone: (661) 835-0441x Address : 7401 WHITE LN 12 State: CA City : BAKERSFIELD Zip : 93309 +------------------------------------------------------------------------------+ Period : to ~ 3D ) ,!)jOLP TotalASTs: = 100 . () Gal Preparer: ., TotalUSTs: = jtJO Gal Certif'd: (:)/5 -"6RI cx:x~3>~J RSs: No ParcelNo: +------------------------------------------------------------------------------+ Emergency Directives: PROG A - HAZMAT Based on my inquiry of those individuals responsible for obtaining the Information, I certify unde~ penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, ace ate, a complete. [NT'D J U N 26 (006 . &-7-~ Date +==============================================================================+ -1- 06/01/2006 UNIFIED PROGRAM INSPECTiON CHECKLIST BAKERSFIELD FIRE DBPI' Prevention Services 900 Truxtun Ave., Suite 210 Bakersfield. CA 93301 Tel.: (661) 326-3979 Fax: (661) 872-:2171 . SECTION 1: Business Plan and Inventory Program LM. INSPECTION TIME IPJO FACILITY NAME s I-4AVr...,wt.. to lA-lTec o OF EMPLOYEES $I ADDRESS FACILITY CONTACT G lZ,<"'Co C~c(At\: It- "' IIY'"ROUTINE Section 1: Business Plan and Inventory Program o COMBINED 0 JOINT AGENCY 0 MULTI-AGENCY 0 COMPLAINT ORE-INSPECTION . C V ( c=Compliance) OPERATION COMMENTS V=Violalion 1---. - ~O ApPROPRIATE PERMIT ON HAND rn/"o Business PLAN CONTACT INFORMATION ACCURATE lB"'o VISIBLE ADDRESS rv/o CORRECT OCCUPANCY iiY"o VERIFICATION OF INVENTORY MATERIALS ~o VERIFICATION OF QUANTITIES lW"'o VERIFICATION OF LOCATION li?"'o PROPER SEGREGATION OF MATERIAL .. ~o VERIFICATION OF MSDS AVAILABILITY [!('O VERIFICATION OF HAl MAT TRAINING ~ 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES riY"o EMERGENCY PROCEDURES ADEQUATE [iii""" 0 CONTAINERS PROPERLY LABELED - VO HOUSEKEEPING lR"'o FIRE PROTECTION / uV'O SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? EXPLAIN: o YES ~~ _QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 S .'0 Itfr-7 ClG Fire Prevenlion 11'1 In 1 Shift of Site/Stalion # Inspector (Please Prinll White - Prevenlion Services Yellow - Slalion Copy Pink - BU9ine9s Copy FD2049 (Rev. 02/05) UNIFIED PROGRAM INSPECTION CHECKLIST SECTION 1 Business Plan and Inventory Program Bakersfield Fire Dept. Enironmental Services 1715 Chester Ave Bakersfield, CA 93301 Tel: (661)326-3979 FACILITY NAME '!~s~<~..-H.o..v~u.v._----_.-it-....._-.._.. ....____._..._._..u__._~~u\~~\u... . --.o..... '71-1 ~l__W l~._l&.__.__i1...__._____.____.__~C~_..._.___._.. FACILITYCONTACT G. r INSPECTION DATE i INSPECTION TIME i IQ_~~~C:>3.L._J_.s=_._....... PHONE No, \ No. of Employees ~?:'5- ou ! 5 ,.__1~t-l_...__.. ....--. Business 10 Number 15-02l- OCrd3 Section 1: Business Plan and Inventory Program ~Routine o Combined o Joint Agency o Multi-Agency o Complaint CJ Re-inspection ( C=Compliance ) V=Violalion OPERATION COMMENTS c V , D ~ D (J 0 ApPROPRIATE PERMIT ON HAND BUSINESS PLAN CONTACT INFORMATION ACCURATE VISIBLE ADDRESS ~ 0 CORRECT OCCUPANCY ~ 0 VERIFICATION OF INVENTORY MATERIALS ( ~ D VERIFICATION OF QUANTITIES ----. ~ 0 VERIFICATION OF LOCATION -- ~ LJ PROPER SEGREGATION OF MATERIAL ~ CJ VERIFICATION OF MSDS AVAILABILlTYE -----~ ~ 0 VERIFICATION OF HAT MAT TRAINING f:;J 0 VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES ~ 0 EMERGENCY PROCEDURES ADEQUATE ~ 0 CONTAINERS PROPERLY LABELED ~ 0 HOUSEKEEPING ~ 0 FIRE PROTECTION 113 a SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE?: DYES ANO / - // EXPLAIN: QUESTIONS REGARDING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 (;~_ Q vC t~_________....._~ I (j~ ______. Inspeclor Badge No. White. Environmental Services Yellow . Slalion Copy Pink . Business Copy L\ C.) ð3tJ7 . ES f3Ó 7 . CITY OF üAKE.R§JFJiIEl,J1) FiRE DEJP ARTMIENT OIFFJiICE OF ENVTIRONMIENT AL SiERVICES UNlrHlE1UJ PROGIRAM llN§!?ECTION CHECKLIST i iR§ CJ¡)(~$~~I!" A. V~09 yd rr~'ll~JI({)rr9 JaækenfiehB9 CA 93301 (~outine o Joint Agency ¡ /) 'I ~¡(\ \ ~ l-r ~~ \ :¿3S7 JrNSPECnON DATE 3/î /61.- PHONE NO. 'b 3Ç-oL/4/ BUSINESS no NO. 15-210- NUMBER Of EMPLOYEES /2~.'/ /I ".VrøH ,-3&9'1 o Complaint fACILITY NAME ~([LS I~~ ADDRESS 74ö , W;'¡·I1"(~.. uJ.o;;# 17.-- FACIUTY CONTACT h('ej c.~o~r- INSPECTION TiME Sedülf])U1J R: [ffi!ill§nU1Jæ§@ !Pll$!U1J $!!J1l«il nIJ1JV~U1Ja([DIT1' JP'IT'If])~IJ'Æ1IJ1J1J 1G 01 Combined OJ Multi-Agency ORe-inspection OPERA nON c v COMMENTS Appropriate pennit on hand Business plan contact infonnation accurate Visible address Correct occupancy Veri fication of inventory materials leV v~'if:-£t V ,*[)A~ Verification of quantities L. çÇ" GA.<- ç:;;0- - Ö/<- Verification of location Proper segregation of material Verification of MSDS availability Verification of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection Site Diagram Adequate &. On Hand C=Compliance V=Violation A.U1Jy 1h1Æ171Æ1IJ'«fiIf])!illi:\J 'WÆ1i:\JQœ ([DU1J i:\JôQœ?~ Explain: OVœ~ ~([D QuestiOR1lS regMding this i!!lspec~ãon? 1?1ease emR! lRS a~ ~ 66 R) 326-3979 White - Env, Svcs, Yellow - Station Copy Pink - Business Copy ¡ \1 vC.~~ Inspector: VJ - .,:" !3tJ 1 . . CiTY (Q)]F JEJAlihJEJRì.SIFUIEll..jJ)) IFUJRì.JE jJ))IEIP AjRr]flWIE~1r (Q)JFlFICE (Q)JF JE~VllJRì.O~lWJE~1f AIL SIELºlVllCJES lUNllIFll!Ej}) IPJRì.(Q)GJl<S.A!\>~ ll~S!J!'IEC1rll(Q)~ <ClliIIEClihll..llS1r llI'll§ <C1Jn~¡¡)~~U' AV~'9 3\rd TI<'~Œ}Œ}rr9 Iffi~lkelJ"$ffn~~irl19 cCA ~3\3\([])n 123/~¡B¡ '1 Jtø1i fACKUTYNAME ~ Mwc~ ~f&l~ ADDRESS 74ð1 Wá-!tf€ ùJ --#- ¡'"L fACKUTY CONTACT C¡Jß..i~ vJl(..(.r~5 JrNSJP>ECTKON TiME ~. JrNSIPECnON DATE (g Irs fø 1 PHONE NO. Õ3S" - 644, :BUSiNESS [D NO. 15-210- ¡JC-t-J NUMBER Of !EMPLOYEES .3 J:?3lhA 9 S~~~ñi!J)U!l n: JEJilll¡¡)D!I1l~~\:ì IPn~¡¡¡¡ æJIID«!J nU!lV~U!lQi!J)IT1' IPIT'i!J)¡ÆI1'$11J1Jll ~outine OJ Combined! OJ Jloint Agency OJ Multi-Agency OJ Complaint OJ IRe-inspection OJP>EIRA nON C v COMMENTS Appropriate pennit on hand ¡JGY.J fEeM. .¡- s, 'TE" Business plan contact infonnation accurate Visible address Correct occupancy Verification of inventory materials ðß'f"A-, oJf:D (j¡....) ¡N~P£c'ïforJ Verification of quantities Verification of location Proper segregation of material Verification of MSDS availability Veri fication of Haz Mat training Verification of abatement supplies and procedures Emergency procedures adequate Containers properly labeled Housekeeping Fire Protection II ?LC...d).~ ~¡,),,,fÏ ¡JéML ~ oF <:;~ Site Diagram Adequate &. On Hand C=Compliance V=Violation AU!l~ Du$llZÆJrr«ilaDilll¡¡) w$l\:ìQœ i!J)ITi) mMœ'P: bplain: O)f~~ ~~i!J) CL~ Questñolffis regwdñng iliñs ãlffisJPie~tñŒ}lffi? Pßems® ~mllll M!iì m~ (iõ>lð)ll) 321ð)-3979 White - Env, Svcs. Yellow - Sial ion Copy Pin/¡ - Business Copy !8\1JJ§ñIIM~SS §ñ~e Responsible lParty WINGs rr1I1lspec~o!!': ~EW I' I I I I CHEMICAL LOCATION DADO D DELETE CITY OF BAKERSFIJEWi\ .ICE OF ENVIRONMENT ALWRVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION D REVISE 200 (one form per material per building or area) Page of "-~--~-_._-_._..._---- -~_. ~_. -. - ,..- ---. .,.--..-- ---.~ "---'-"-~--" -.- ~------- :;1 3 I I I o Yes 0 No 202 I '"I o Yes 0 No 206 I ¡ I. FACILITY INFORMATION " BUSINESS NAME (Same as FACILITY NAMEorOBA:'OOfrig'BusiiïëšŠ-ÃŠj--'- - --- ~.Il.-5 ~VC-o...J -.. ~~--_.__. ~- . .. ...·_·,__·_·___~w__· - -- --- .... --- INS I D~ SW cf?tJfJ.. ~ s-ktR ]I~~Ir'-ì-MAP#-(ÕPi¡Onã7)-, f'JL.....' 201, CHEMICAL LOCATION ~ I.J\:>- ' CONFIDENTIAL (EPCRA) ---- - -- - . ---20jTGRID '# (Opiionai)-' ~-_._----_._--~-_._---¡-------_._. CHEMICAL NAME fViOO1:=tL. ~i^oJé COMMON NAME CAS # II. CHEMICAL INFORMATION -.-.--.-.---....-.---.---.----.--..-.-.-------.-..... 205 : TRADE SECRET Ç'Ù~L If Subject to EPCRA, refer to instructions ___-Ì- 207 ! ----- -- -- - -- --~----- - . ----- -- - -- - EHS· o Yes 0 No 208 ' -- .. ------------------- - . - . 209 ·If EHS is ~Yes.~ aD amoun!S beIowlllllSt be in Ibs. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) -,----------- _,um_ -.-.----- ------,----.-- .. -- ._-~--~~------ - ------------ 210 I 213 ! 215 I TYPE --------- ---~- -------- --- D P PURE PHYSICAL STATE· FED HAZARD CATEGORIES (Check all that apply) ANNUAL WASTE AMOUNT STORAGE CONTAINER (Check all that apply) STORAGE PRESSURE STORAGE TEMPERATURE o s SOLID ~FIRE Dyes oNo 212 I CURIES ~ MIXTURE D w WASTE , , RADIOACTIVE ----_.__._----~~----- þlLLlQUID o g GAS 214 LARGEST CONTAINER t. _ __.~_______L_.____ __.__~_._________~_ o 2 REACTIVE D 3 PRESSURE RELEASE D 4 ACUTE HEALTH D 5 CHRONIC HEALTH 216 .-----.-.-------------- ---.---- --_.__._.~-- - _.~---+--------,_.,-~--_. , , 220 UNITS· o a ABOVEGROUND TANK o b UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM ~ a AMBIENT 217 MAXIMUM t I DAILY AMOUNT 60 __L_.__ ___ ~GAL DdCUFT . If EHS. amount must be in Ibs, 218 ¡ AVERAGE t""~ L DAILY AMOUNT ~ .) --- ~--- -- ------. --.--- ---.--- ~.. --------. D Ib LBS 0 tn TONS 221 219 STATE WASTE CODE DAYS ON SITE 222 ------- o e PLASTIC/NONMETALLIC DRUM ~CAN D g CARBOY o h SILO o i FIBER DRUM OJ BAG D k BOX o I CYLINDER D m GLASS BOTTLE D n PLASTIC BOTTLE D 0 TOTE BIN D P TANK WAGON o q RAIL CAR o r OTHER 223 .~._--- ---.-.--.--- --. -. .. - -~~--- .. .------------ o aa ABOVE AMBIENT o ba BELOW AMBIENT 224 ø-a AMBIENT ._._-_.__.._----------~-- ~-- 22~ :30 226 2 230 3 234 4 238 5 242 --_.._--,--- o aa ABOVE AMBIENT o ba BELOW AMBIENT o c CRYOGENIC HAZARDOUS COMPONENT EHS ._----_._.__._--~ -.--..- 227 229 -.---- ..---.------.-.----- -.. --- --.--- .------------ o Yes 0 No 228 Dyes 0 No 232 I _,______h_,_ -L o Yes D No 236 I 237 vJ t"'{ìitOj\.Q c. ~rE: 231 233 -------- ... - -----,_._-- --_._-_._----~------_.- ._,,-----.- .--- - ---------...- PRINT NAME & TITLE OF AUTHORIZED COMPANY REPRESENTÃTIVE UPCF (7/99) 235 '.'-"- ..----_._---. 239 241 o Yes 0 No 240 --+----------+---.----..--. . -.- ---.--------- -.-- .-.---------- 243 245 o Yes D No 244 III. SIGNATURE 246 -SïGN'ÃTÜRE--- - , ._~.._-_._-_.__.._--_._--_._-------- DATE /1/r5/ot .--,.---- - --- --. -..- -.--.----.------. -- --- ~---- ----..------.. -- -------- S:\CUPAFORMS\OES2731.TV4.wpd , CITY OF BAKERSFIE~ .ICE OF ENVIRONMENTA~RVICES 1715 Chester Ave., CA 93301 (661) 326-3979 HAZARDOUS MATERIALS INVENTORY CHEMICAL DESCRIPTION ,iNEW DADO D REVISE 200 D DELETE _._._--_.._--~.__...._-----_. . . __ 0.....______. . n ___. __.._.____ .:,.\~~·:~.IÚ;~t~W· " I. FACILITY INFORMATION BUSINESS NAME (Same as FACILITY NAME orëiBA:ÕÖingB¡¡siñëšSÃŠj-··· .... ... ~~ .. .." . --.-.---.-"- t..J.&¡Gf-J ".----." CHEMICAL LOCATION (tV<;\\)f ¡VE C.f2.vR..... ð S'~ FACILI1Y 1011 ~-~.- -i-·-¡--'--1["1.1AP lI(opWnal) ., ~I¡:_LL I :,"':;·::2J~Kf)j~-:·,,: ," - . _ _nu__~ . __.. 201 CHEMICAL LOCATION CONFIDENTIAL (EPCRA) -'-2õj',-GRID"# (opiionai¡--' (one form per mal8tial per building or area) Page of ,~<·~~·~i:~:,' ~';~'.~,.. . .' . ~'. ' "1 ., . . \-.~. " , " > ~'", ' ", :~(~:~~~";'~::" , -" >- 3 o Yes 0 No 202 204 205 . .".d."..;:-.:.,·;.,.. ,.'.'. . ~,'. ';-".'. . ."'-.'/ --" .'" ",.. '~\~'::'~.-, :~';;-._; .;;···t·o~,:~~):· ":\:~~'.:.',','.;:., ~."~ TRADE SECRET 0 Yes 0 No 206 . If Subject to EPCRA. refer to instructions ---.--------.--..-----.--.-. II. CHEMICAL II~FORMATION ---.---.-.----..-----.-.-.. CHEMICAL NAME Mooé-L. ~oc..«er bvG-'N~5 COMMON NAME EHS· o Yes 0 No 20B - -. _.. -.---.- -.-- 207 ....- .------------..- .--.. CAS II 209 ·Ii EHi~ì~~¿,~:~~~ -------.----.--------------------. FIRE CODE HAZARD CLASSES (Complete if requested by local fire chief) TYPE o p PURE ¢. MIXTURE PHYSICAL STATE ¢s SOLID o I LIQUID FED HAZARD CATEGORIES ~ FIRE o 2 REACTIVE (Check all that apply) ANNUAL WASTE 217 MAXIMUM AMOUNT DAILY AMOUNT -'- 210 o w WAS,: L , R"OIOACTIVE DYes oNo 212 CURIES 213 ..--- -.------,_._-- -.-.------- 215 .-.-- - .....- --.-. -.- ogGAS 214 LARGEST CONTAINER --....-----.----- --.._----- o 3 PRESSURE RELEASE 05 CHRONIC HEALTH 216 04 ACUTE HEALTH ..-- .- - -..--- ------.-..-.- .-----..--------- 218 i AVERAGE (0 L DAILY AMOUNT o ga GAL 0 d CU FT . --~b L;;--O-;;;-~~~S --- -----.-. . If EHS. amount must be in 105, (ð UNITS· 219 STATE WASTE CODE 220 221 DAYS ON SITE 222 STORAGE CONTAINER (Check all that apply) o a ABOVEGROUND TANK Db UNDERGROUND TANK DC TANK INSIDE BUILDING o d STEEL DRUM De PLASTlCINONMETALLlC DRUM Or CAN o 9 CARBOY o h SILO o i FIBER DRUM ~BAG Ok BOX o I CYLINDER o m GLASS BOTTLE o n PLASTIC BOTTLE o 0 TOTE BIN o p TANK WAGON ....._----,- STORAGE PRESSURE ~ AMBIENT o ba BELOW AMBIENT o aa ABOVE AMBIENT -~-- --.-- ,--_. .--- -- . --- .~-_. STORAGE TEMPERATURE ~ AMBIENT 0 aa ABOVE AMBIENT ,. -'", \"~':", '.' ·~J...'....·~~.~.,.~{~¡...,~(:.};~';f~:."..,' . " ";~~tIÅZARÓOÚS.CÖMPONENT . ,."... ..." .'$,. "..··,~i' .> , .:.;,;)'",.., "."".~ ... . 'j, . :EI;!S o c CRYOGENIC 22~ o ba BELOW AMBIENT , '.' ~J~~,~.::~:~>~:<, . 226 I 2 I 230 I I I 3 I 234 4 238 5 242 227 DYes 0 No 228 .n __ _._._____.._.__.____ 231 0 Yes 0 No 232 . -.---..-----,-.---------.. ...------.- .. -..-----.- - ----¡--._-----_.._--~ m - -- ---- - - - _".'10'"[]-"-~i -=~==-==___~==-_~:~t~:~~: -:J . ',' . ",' ,,- , .~.!~: ~;'~ X~ìj' .~.'~' >l::·'·':,;'~~(·'ìli. 'SIGNATURE '. ";' -'. >~::/:>:. ..... o q RAIL CAR o r OTHER 223 224 229 233 237 241 245 --siGÑA TÜRE----· .,_........,~_.._._--~._--~..:.....--_.- .--...--- -- -. ...- -.----.---. -,~-_.. .,~ _... .-- ..---.... -- .--.--.----.- 246 It UPCF (7/99) S:\CUPAFORMS\OES2731.TV4.wpd