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California Hazardous Materials Inventory Form - Chemicaf Description <br /> PAGE(2) OF(3) <br /> (1) ADD ❑DELETE ❑REVISE 2001 M <br /> BUSINESS NAME (4) / <br /> x covet le4c V,lelders S✓ <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> CHEMICAL NAME (8) �1^ C e hI Lam`% e e 1 T N if TRADE SECRET(11) ❑Y Z N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) / 1 c t .1 <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) -7 ^ Z ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) i.FAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE [:]WASTE RADIOACTIVE(15) ❑Y (16)�� <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID GAS CURIES <br /> FED HAZARD N [] CHRONIC❑REACTIVE ❑PRESSURE RELEASE ❑ ACLnEHEAL7CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19)�� UNITS*(22) GAL CU FT MAX DAILY AMT(23) <br /> CODE F]LBS <br /> ❑ ON-SITE <br /> TONS <br /> DAYS ON SITE (20) � AVG DAILY 3 AMT(24)G 5 *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21C� ANNUAL WASTE AMT(25)E=CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY LaCYLINDER [:]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) ® AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBB?NT <br /> PRESSURE <br /> STORAGE (28) AMBIENT [:]ABOVEAMBIENT [:]BELOWAMBIENT [:]CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> E]YON11 <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)UJ() <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: 0 C R ❑ S SIC 12/00 <br />