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California gazardous....,aterials Inventory Form - Chemica' -scription YAW 1 Q 9�0? <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4) TRACY VW <br /> CHEMICAL LOCATION(S)(5)IOIL ROOM <br /> MAP#(6)/ GRID#(7) 4/H3 a f N/A N/A N/A <br /> CHEMICAL NAME (8) ANTIFREEZE WASTE TRADE SECRET(11) ❑YES ®NO Tra <br /> *EHS(12) ❑YES ®NO <br /> COMMON NAME (9) ANTIFREEZE WASTE <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) N/A ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ❑MIXTURE ®WASTE RADIOACTIVE(15) ❑yES ®NO (16) <br /> CURIES <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS <br /> FED HAZARD ❑FIRE ❑REACTIVE [I PRESSURE RELEASE ®ACUTE HEALTH [I CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS MAX DAILY AMT(23 100 <br /> CODE 221 ❑CU FT ❑TONS ON SITE <br /> DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 25 <br /> ON SITE <br /> LARGEST (21 12 0 ANNUAL WASTE AMT(25) 2 5 <br /> CONTAINER <br /> STORAGE (26)❑ABOVE GROUND TANK []CAN ❑BOX ❑TAN <br /> CONTAINER []UNDER GROUND TANK []CARBOY ❑CYLINDER ❑RAIL <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑OTH <br /> ❑STEEL DRUM ❑FIBER DRUM ❑PLASTIC BOTTLE ❑Other <br /> ®PLASTIC/NONMETALLIC DRUM []BAG ❑TOTE BIN <br /> STORAGE (27)IN AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT []ABOVE AMBIENT []BELOW AMBIENT []CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> ❑YES E]Nql <br /> ❑YES ❑N <br /> ❑YES ON <br /> ❑YES ❑N <br /> ❑YES ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N/A <br /> (34)WHAT IS MATERIAL COOLANT SERVICES <br /> USED FOR? <br /> DATE REC'D: 1/14/05 For Official Use Only: ® C ❑ R ❑S SJC 12199 <br />