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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) 2001 PAGE(2) F OF(3) to <br /> ADD DELETE QREVISE <br /> BUSINESS NAME (4) 0 W+ RECEIVE <br /> CHEMICAL LOCATION(S)(5) I <br /> �� 0 EMER6ENCVSER ES <br /> CHEMICAL NAME (8) A r U TRADE SECRET(11) ❑Y <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) A r o <br /> FJ <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) �- _ 7'� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) URE MIXTURE [—]WASTE RADIOACTIVE(15) ❑Y (16) <br /> CURIES <br /> PHYSICAL STATE(17) SOLID ❑LIQUID GAS <br /> FED HAZARDPRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> CATEGORIES (18) ❑FIRE ❑REACTIVE <br /> STATE WASTE (19) UNITS*(22) ❑GAL CU FT 1 MAX DAILY AMT(23) <br /> CODEON-SITE I (� <br /> ❑LBS [:] TONS <br /> DAYS ON SITE (20) r AVG DAILY AMT(24) <br /> j *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21� ANNUAL WASTE AMT(25) <br /> CONTAINER C� <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 1:1---------- ---------- <br /> STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) INAMBIENT E]ABOVE AMBIENT BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT E]ABOVE AMBIENT OBELOW AMBIENT CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (31 EHS (32) CAS# <br /> ❑Y ❑N <br /> FE-1Y ❑N <br /> ❑Y ❑N <br /> YON <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL rkeSCllr G r C / S iv Aq C! j <br /> USED FOR? <br /> For Official Use Only: ❑ C R 0 S SJC 12/00 <br />