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❑ADD ❑DELETE ❑REVIS� 2000 PAGE.(2) I OF(3) L <br /> BUSINESS NAME (4) � t1h� IA�1 <br /> CHEMICAL LOCATION(S)(5) APR 15 2013 <br /> My <br /> MAP# (6)/ GRID#(7) _ — — — � r r� ( RGF�9GY EI910E <br /> CHEMICAL NAME (8) t% y _ I G�s TRADE SECRET(1 1) ❑Y Q N <br /> //\I e� *EHS (12) F0 [DN <br /> COMMON NAME (9) <br /> IF EHS BOX IS "Y" <br /> CAS # (10) /f(� 77� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)l OFURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) FE-]y--g-7N (16) <br /> PHYSICAL STATE(17) ❑SOLID JDLIQUID GAS CURIES <br /> FED HAZARD F7RE f PRESSURE RELEASE ❑ ACUTE HEALTH ❑`CHRONIC HEALTH <br /> CATEGORIES (18) _ O <br /> STATE WASTE (19) UNITS* (22) []GAL ❑CU FT MAX DAILY AMT(23) Zg <br /> CODELBS ®TOON-SITE <br /> NS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 3 *If EHS, am unts must be in lbs ONSITE `FO <br /> LARGEST (21 Zg C) C' ANNUAL WASTE AMT(25) c <br /> INTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY XCYLINDFR '7kAlL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑——••---•••--••---- <br /> ❑STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ ANSIENT ®ABOVEAMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ©AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑ Y ❑N <br /> Y <br /> N11 <br /> YE]NII <br /> ADDITIONAL LOCALLY COLLECTEP ORMATION: (33)UNITED NATIONS ID#(DOT) h ?� <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> Fo fflclal Use Only: ❑ C ❑ R ❑7S SJC 12/99 <br />