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/ California Hazardous4Haterials Inventory Form - Chemitgtl Description <br /> —��–,� h <br /> (1) [:]ADD ❑DELETE ❑REVISE 2002 PAGE(2) F fl�TF} <br /> t-------- <br /> BUSINESS NAME T J _ <br /> (4) �I� A-t..��5 4.v1V' 'N�9 •1_•_ <br /> CHEMICAL LOCATION(S)(5) r <br /> (Within facility, " f"� , ; .; OFFICE 0.-_1^:EHGENCY SE VfEEc>: <br /> not street address <br /> MAP#(6)/ GRID#(7) E:::� E== E= <br /> esu <br /> CHEMICAL NAME (8) /�++ TRADE SECRET I1 Y N <br /> tcj �sOt^/ U� ( ) ❑:]Y N <br /> COMMON NAME (9) *EHS(12) ❑Y 93 <br /> : J <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) � _ (o/ _ ALL AMOUNTS MUST BE'IN:Las <br /> FIRE CODE (13) ' <br /> LEAVE BLANK <br /> HAZARD CLASS <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)191 FIRE ❑REACTTVE ❑PREssuRERELEASE ❑ ACUTEHEALTH ❑ CHRONICHEAI-TH ? <br /> STATE WASTE (19) UNITS*(22)'SGAL ❑CU FT MAX DAILY AMT(23) <br /> []LBS <br /> ALS <br /> ❑LBS ❑TONS ON-SITE <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 3�pS *If EHS, amounts must be in lbs ON-SITE S G Q Lg E <br /> rj <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK CAN ❑ BOX [:]TANK WAGON – ti <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑RAIL CAR <br /> p❑p�1 TANK INSIDE BUILDING ❑SILO E] GLASS BOTTLE ❑-------–---— <br /> EKSTEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE <br /> (27) AMBIENT ❑ABOVE AMBIENT ❑BII,OW AMBTENT <br /> PRESSURE <br /> STORAGE (28)191AMBIENT ❑ABOVEAMBIENT ❑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 ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT 1S MATERIAL <br /> USED FOR? <br /> For OMcial Use Only: C R ❑ S SJC 12101 <br />