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California Hazardous Materials Inventory Form - Chemical Description OF(3) `0 <br /> (1) ADD DELETE REVISE <br /> 2001 PAGE(2) El <br /> BUSINESS NAME (4) C O Vh 9 C r ) ✓n ( / , <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> TRADE SECRET(11) <br /> CHEMICAL NAME (8) ❑Y <br /> /C 6 V1 <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) L "4 i✓1 *IF EHS BOX IS"Y" <br /> CAS # (10) L G) j _7 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16)E <br /> CURIES <br /> PHYSICAL STATE(17)1E]SOLID RfLIQUID ❑GAS <br /> FED HAZARD ❑ RELEASE ❑ ACUIEHEALTH El CHRONIC HEALTH <br /> CATEGORIES (18) FIRE �qVg PRESSURE❑ <br /> STATE WASTE (19)�� UNITS*(22) ❑GAL CU FT MAX DAILY AMT(23) I C�`yc7 <br /> CODE ON-SITE <br /> ❑LBS ❑TONS AVG DAILY AMT(24) <br /> DAYS ON SITE (20) ! S *If EHS, amounts must be in lbs <br /> b ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER UQd <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX [-]TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY gCYLINDER ❑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 [:]BELOWAMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT CRYOGENIC <br /> TEMPERATURE as <br /> 29 %WT (30)HAZARDOUS COMPONENT 31 EHS (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ON <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) S <br /> (34)WHAT IS MATERIAL <br /> USED FOR? S GI 1 u/ ✓ " ti c.' <br /> SJC 12/00 <br /> For Official Use Only: ❑ C El F-1S <br />