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California Hazardous lhlterials Inventory Form - ChemicVIDescription <br /> (l) ADD DELETE DREVISE 2002 <br /> BUSINESS`NAME (4) ,8 9708 `. <br /> \T1/ tS / 4t✓ i <br /> CHEMICAL LOCATION(S)(5) fNCOS <br /> (Within facility,not street address J 1 1 V <br /> MAP#(6)1 GRID#(7) F: <br /> CHEMICAL NAME (8) ADE SECRET(11)E ❑❑YY �NN <br /> *EHCOMMON NAME (9) S(12) {" <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) q l{ -7 ALL AMOUNTS MUST BE IN IA y <br /> xn <br /> FIRE CODE (13) <br /> LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ®PURE ❑MIXTURE []WASTE RADIOACTIVE(15) ❑ Y ONI <br /> PHYSICAL STATE(17)1 ❑SOLID ❑nLIQUID EGAS CURIES <br /> D HAZARD <br /> CATEGORIES (18) FIRE REACTIVE® K11 [:1 ~ <br /> PRESSURE RELEASE ACUIEHFALTH CNROMCHEALTH <br /> STATE WASTE (19) UNITS* (22) ❑GAL [4CU FT MAX DAILY AMT(23)� , <br /> CODE ON-SITE Z 7� <br /> ❑LBS ❑TONS ' <br /> DAYS ON SITE (20)® AVG DAILY AMT(24)© <br /> *If EHS, amounts must be in lbs ON-SITE O!J <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <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 ❑------------- <br /> ar. <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑ TOTE BIN <br /> 43 � <br /> STORAGE (27) ❑ AMBIENT MABOVEAMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) .aAMBIENT IENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> FE!Y ❑N <br /> ❑Y ❑N <br /> Fay--E-IN <br /> --- ❑Y ❑N <br /> 11 <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL L <br /> USED FOR? LJ E <br /> For Official Use Only: ❑ C R S SIC 11101 <br />