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California Hazardous�terials Inventory Form OF(blehtica4,Description <br /> „ OF <br /> (3) <br /> (1) ADD ❑DELETE ❑REVISE 2001 PAGE(2) IO lO <br /> BUSINESS NAME (4) C e REGEWE <br /> D 11 <br /> CHEMICAL LOCATIONS)(5) <br /> ® <br /> F <br /> CHEMICAL NAME (8) TRADE SECRET 01) ❑Y ffN <br /> COMMON NAME (9) 5v\ ICU ICI Q *EHS(12) Y ❑N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) l/ _Q – ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBILANK <br /> HAZARD CLASS <br /> TYPE (14) URE ❑MIXTURE [:]WASTE RADIOACTIVE(15) ❑Y (16)�� <br /> PHYSICAL STATE(17) ❑SOLID CSfIQUID [:]GAS CURIES <br /> FED HAZARD ] IREACTIVE PRESSURERELEASE ACUMHEALTH ❑ CHRONICHEALTH <br /> CATEGORIES (18)FE- <br /> 18) ❑ ❑ <br /> STATE WASTE (19)�� UNITS*(22) ❑G MAX DAILY AMT(23) U �O <br /> CODE ON-SITE lJ <br /> BAYS ON SITE (20) TS ,TONS�( AVG DAILY AMT(24) �OO <br /> 3 b � *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 Sv ANNUAL WASTE AMT(25) <br /> IN <br /> CONTAER V <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK []CARBOY La-61,INDER ❑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)I AMBIENT ABOVE AMBIENT [:]BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT ❑31)EHS[–] <br /> H❑S N (32)CAS# <br /> yJ <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)1 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? eSu C <br /> yr CUS �C/S <br /> For Official Use Only: X C ❑ R ❑ S SIC 12/00 <br />