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�I�I -QADD ODELETE OREVISE 2000 PAGE(2) <br /> A <br /> yg1' <br /> BUSINESS NAME (4) <br /> ^HEMICAL LOCATION(S) (5) <br /> 5 200 <br /> MAP p (6) / GRID#(7) 77, <br /> CHEMICAL NAME (8) C 2k 1 TRADE SECRET(11) ❑Y Q N <br /> *EHS (12) ❑Y QN <br /> . COMMON NAME (9) �'�h h4. A C t� (4hZ <br /> *IF EHS BOX IS "Y" <br /> CAS M (10) ALL AMOUNTS MUST HE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE []WASTE RADIOACTIVE(15) ❑Y ®N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID OCAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑ REACTIVE OPRESSURE RELEASE ❑ ACUTE HEALTH ❑`CHRONIC HEALTH <br /> . STATE WASTE (19) UNTTS (22) ❑GAL RCU FT MAX DAILY AMT(23)r—, <br /> CODE LBS ❑ TONS ON-SITE L 100th <br /> DAYS ON SITE (20) AVG DAILY AMT(24)�—� <br /> 0 *If EHS, amounts must be in lbs ON-SITE �C7 <br /> LARGEST <br /> I( 21 ANNUAL WASTE AMT(25) <br /> )NTANER D <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY NCYLINDER FRAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO GLASS BOTTLE ❑------------------- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NOINMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT ©ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE. <br /> STORAGE (28) ® —]ABOVE❑ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> 29 %aWT 30 HAZARDOUS COMPONENT3� 32 CAS# <br /> ❑ Y N <br /> ❑ Y ❑E N <br /> E]Y QN — <br /> Y E N <br /> ❑Y QN <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) Oh 1001 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? ! <br /> For Offlclal Use Only: C ❑ R S SJC 12/99 <br />