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California Hazardous <br /> 1CPaterials Inventory Form - Chemie Descrt�3Liha <br /> (1) ADD DELETE DREVISE 2002 PAGE(2j <br /> 1,, J ALJ <br /> BUSINESS NAME (4) V � ;S '�+ G W "fCE OF- %L'!�fr' '!SERVIC_ t7,9 <br /> y�; <br /> CHEMICAL LOCATION(S)(5) D E�� O n S - Spu ' Q - W-t4 <br /> W-t S I eAv n a y FNCySFR� <br /> (Within facility,not street address F.- 1 'Y'�" "� g <br /> MAP#(6)/ GRID#(7) _3 E::= E= E <br /> CHEMICAL NAME (8)F6 l y 0 1 - �R ( Ar S TRADE SECRET(I1) ❑Y N <br /> �O 1� *EHS(12) ❑Y N]N] <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) r� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ®N (16) <br /> PHYSICAL STATE(17)1 ❑SOLIDSLIQUID [-]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACTIVE [:] PRESSURE RELEASE ❑ ACUTEHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19)� /y UNITS*(22) GAL [-]CU FT ON-S1T'E MAX DAILY AMT(23)� <br /> CODE rI f` w� �S <br /> ❑LBS [:]TONS <br /> DAYS ON SITE (20)� AVG DAILY AMT(24) S <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER �1�� <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO GLASS BOTTLE 1:1-------------------- <br /> MSTEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) FUIAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE Ipj <br /> 29 %WT 30 HAZARDOUS COMPONENT ❑31YEHS N �32�AS# <br /> ❑Y ❑N �_� <br /> 1 F- <br /> ❑Y ❑N <br /> ❑Y ❑N F- <br /> ❑Y ❑N _� <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) j9 <br /> (34)WHAT IS MATERIAL / L6 _ o sig L L <br /> USED FOR? <br /> For Official Use Only: ❑ C El R ❑ S SIC 12/01 <br />