New CUPA Clients

• Company Name

Property Owner

• Name

• Phone Number

• Mailing Address

• Site Address
  Address

• Email Address

Company Information

• EPA ID

• SIC CODE

• Assessor Parcel Number

• Number of Employees at this Site

Emergency Contact #1

• Name

• Title

• Business Phone

• 24 Hour Phone

Emergency Contact # 2

• Name

• Title

• Business Phone

• 24 Hour Phone

Hazardous Material Inventory

Chemical Description 1

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 2

• Photo

  Media

• Add media

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 3

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 4

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 5

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 6

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 7

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 8

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 9

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 10

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 11

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 12

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 13

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 14

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Chemical Description 15

• Photo

  Media

• Name

• Location

• Avg. Daily Amount

• Max. Daily Amount

• Days on Site

• Annual Waste Amount

• Largest Container

• Type of Container

• Is SDS Available ?

  Yes

  No

  N/A

• Hazardous Material Description

• Manufacture

• Phone

• Web/Email Address

• Notes

Site Map Sketch

• Hazmat/Waste Location

• Fire Extinguisher

• Aerial View

• Entrance/Exits

• BP/SDS Location

• Surroundings (in site map)

• Electrical Main

• First Aid Kit

• Spill Kit

• Water Main

• Staging Area?

• Evacuation Route

For preparing Visio map, also make sure to include:

• Key for Symbols

• Note: Map not to scale

• Key # items

• Cross Roads

• Updated as of:

• North Symbol