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California Hazardous Materials Inventory Form - Chemical Description �F O <br /> T, <br /> (1) (x'ADD ❑DELETE 2001 PAGE(2)REVISE Ic <br /> BUSINESS NAME (4) M I Q I e VQ(? ('; j J )I <br /> r v + <br /> CHEMICAL LOCATION(S)(5) <br /> ES <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) 1 O X( <br /> TRADE SECRET(11) ❑Y N <br /> � aror, � e <br /> ( � 11 *EHS(12) ❑Y N <br /> COMMON NAME (9) C A l UV� (�n 1 O X I G e <br /> *B=EHS BOX IS"Y" <br /> CAS # (10) I Z q _ �8 — q ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) URE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16)� <br /> CURIESS <br /> PHYSICAL STATE(17)1 ❑SOLID IQUID ❑GAS <br /> FED HAZARDREACTTVE PRESSURE RELEASE ❑ ACUIEHEALTH ❑ CHRONICHEALT[l <br /> CATEGORIES (18) ❑FIRE ❑ <br /> STATE WASTE (19)�� UNITS*(22) ❑GAL ❑CU FT MAX DAILY AMT(23) �U U <br /> CODE ON-SITE <br /> LBS ❑TONS <br /> BAYS ON SITE (20) r AVG DAILY AMT(24) SO U <br /> J *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER = <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY L45MINDER [:]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 AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ABOVE AMBIENT BELOW BELOW AMBIENT ❑ CRYO <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT 31 EHS (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> DYE]N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) O <br /> (34)WHAT IS MATERIAL Mescile <br /> 4�0_ <br /> USED FOR? <br /> For Official Use Only: ❑ C ❑ R ❑ S SIC 12/00 <br />