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�-California Hazardous *2(terials Inventory Form - Chemichv/Description <br /> (1)I OADD DELETE OREVISE 2002 r P J <br /> BUSINESS NAME (a) ' t7g <br /> CHEMICAL LOCATION(S)(5) - Ccti'CY <br /> (Within facility,not street address SfR <br /> MAP#(6)/ GRID#(7) 6 _ 4 E= E= i <br /> CHEMICAL NAME (8) �V A _ 1 i n l_ee e Z L TRADE SECRET(11) ❑Y N <br /> COMMON NAME (9) �� *EHS(12) ❑Y N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) l ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS LEAVE BLANK <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17) []SOLID LIQUID []GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑RFAC"17VE []PRESSURE RELEASE ❑ ACUTEHFAI.TH ❑ CHIROMCHEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑CUFT MAX DAILY AMT(23) <br /> CODENS I I ON-SITE S S <br /> 1[]LBS <br /> DAYS ON SITE (20) E] <br /> �/ � ON-SITE <br /> Y AMT(24)0 b� *If EHS, amounts must be in lbs ON-SITE 3 <br /> LARGEST (21 ANNUAL WASTE AMT(25) f ( _ <br /> CONTAINER <br /> r�� L'e' <br /> STORAGE (26) E]ABOVE GROUND TANK ❑ CAN E] 1_ <br /> BOX 11 ANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [—]RAIL 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) <br /> AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT [:]BELOWAMBIENT ❑CRYOGENIC fir. <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> v_ <br /> ❑Y ❑N <br /> ❑y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)EE= <br /> (34)WHAT IS MATERIAL �S7-R i / CQ / N <br /> USED FOR? <br /> For Official Use Only: [] C D R S SIC 12101 <br />