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/ California Hazardous materials Inventory Form - Chemift( Description 9� <br /> (1) ADD DELETE DREVISE 2002 _ PAGE(2� OF(3) <br /> BUSINESS NAME (4) - n 9C Aq✓�, Q9 <br /> �VI tv 'S +0 utV- i 2 �oFF.,`oui <br /> $, <br /> CHEMICAL LOCATIONS)(5) S } r0 i r :C_ CySF9�/ }; <br /> (Within facility,not street address r, <br /> MAP#{6)/ GRID#(7) I J E== E:= E= E= <br /> pSl <br /> CHEMICAL NAME (8) M 1= N TRADE SECRET(11) ❑Y N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> 7 <br /> FIRE CODE (13) LEAVEBLANK w` <br /> HAZARD CLASS <br /> TYPE (14) ®PURE ❑MIXTURE [:]WASTE RADIOACTIVE(15) ❑Y N (16) <br /> Ytlbl!' <br /> PHYSICAL STATE(17) [:]SOLID ❑LIQUID JZ GAS CURIES J c_ <br /> CATEGORIES (18)HAZARD FIRE [4REACTIVE 0 PRESSURE RELEASE ® ACUI•EHEALTH [] CHRONIC HFA TH � <br /> STATE WASTE (19) UNITS*(22) ❑GAL N CUINS <br /> MAX DAILY AMT(23)� <br /> CODE <br /> []LBS ❑TOAMT(24)ON-SITE <br /> AVG DAILY <br /> DAYS ON SITE (20) 3 *If EHS, amounts must be in lbs 6S ON-SITE <br /> LARGEST (21 1 s C ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ER CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO GLASS BOTTLE❑------------- r <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLES <br /> Jp <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG TOTE BIN r?' <br /> :.,. <br /> STORAGE (27) ❑ AMBIENT ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT OVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC v <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 3I)EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N ` < <br /> ❑Y ❑N re.^ <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) Q '_ <br /> (34)WHAT IS MATERIAL L <br /> USED FOR? <br /> For Official Use Only: C R S SJC 12/01 <br />