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California Hazardous Materials Inventory Form -'fie.1je e0etscription <br /> (1) ADD ❑DELETE ❑REVIS <br /> RAGE(2) OF(3) <br /> E 2001 ELI <br /> BUSINESS NAME (4) <br /> C� �, l of 1�elde , s S� l <br /> CHEMICAL LOCATIONS)(5) <br /> <br /> <br /> ` TRADE SECRET(11) ❑1' N <br /> N -hfo ei z-) <br /> *EHS(12) ❑Y <br /> COMMON NAME (9) o i e <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) F-7-7z 7 — 3 7-1 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)1 PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (16)�� <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE ❑REACTIVE PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) ❑GAL (Q CU FT MAX DAILY AMT(23) 30a D <br /> CODE 7� ON-SITE <br /> 1[:]LBS ❑ TONS AVG DAILY AMT(24) <br /> DAYS ON SITE (20) 5 ,, *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25)E=CONTAINER Z <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 /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27)NAMBIENT ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVEAMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%aWT 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) D <br /> (34)WHAT IS MATERIAL - P G o /�� v✓� S <br /> USED FOR? C <br /> For Official Use Only: ® C R S SJC 12/00 <br />