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California Hazardous rials Inventory Form - Chei> & ),,r I <br /> (I) OADD ❑DELETE REVISE JAI` .'PACA�Z OF(3) <br /> BUSINESS NAME (4) C,'xw -C FVi <br /> CHEMICAL LOCATION(S)(5) CfS <br /> (Within facility,not street address So o �� 0� v 1 L D I sl Q — 6 v 7 $ D E S —V) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) li..l A STC to I L TRADE SECRET(11) ❑Y CON <br /> COMMON NAME (9) <br /> *EHS(12) ❑Y ®N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14)1 (15)❑MIXTURE ®WASTE RADIOACTIVE(15) ❑Y ®N (16) <br /> PHYSICAL STATE(17) ❑SOLID ULIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACTIVE []PRESSURE REL EA SE C&ACUTE HEALTH M CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22)['I <br /> GAL E]CU FT MAX DAILY AMT(23)� <br /> CODE 22/ t ON-SITE �� <br /> DAYS ONSITE (J0)� LBS ❑ TONS AVG DAILY AMT(24)Q <br /> 3�oS *If EHS, amounts must be in lbs ON-SITELAR ;LOO <br /> CONTG�AINER (21 µOD ANNUAL WASTE AMT(25) �O�c y SLS <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 El-------------------- <br /> El STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENTE]ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)INAMBIENT ❑ABOVE AMBIENT ❑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 E]NII <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL WMT� <br /> USED FOR? O) (- F12.0 M G ff/-eacs <br /> For Official Use Only: ❑ C R S SJC 12/03 <br />