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California Hazardous Materials Inventory Form - Chemical Description <br /> OF(3) I Q <br /> (1) ADD DELETE aREVISE 2001 <br /> BUSINESS NAME (4) I P I C Wel A Gl e rs S✓c 91 RECEIVE <br /> CHEMICAL LOCATIONS)(5) <br /> E PEMERGENCYSER ICES <br /> CHEMICAL NAME (8) - -�1) NTRADE SECRET(1 l) ❑Y <br /> L ! I�rJ= Cil <br /> *EHS(12) ❑I <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 2 _ 3 _ ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> RADIOACTIVE(15) (16) <br /> TYPE (14) PURE ❑MIXTURE ❑ <br /> CURIES <br /> PHYSICAL STATE(17)1E]SOLID OLIQUID []GAS <br /> FED HAZARD ❑FIRE ❑REAMVE PRESSURE RELEASE ❑ ACUTE H ALTH [:] CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19)�� UNITS*(22) ❑GAL EfCU FT DAILYOMAX N-SITE <br /> AMT(23) <br /> CODE [:]LBS ❑ TONS <br /> DAYS ON SITE (20) / AVG DAILY AMT(24) ��w U <br /> b *If EHS, amounts must be in Ibs ON-SITE ----77 <br /> LARGEST (21 ANNUAL WASTE AMT(25) I <br /> CONTAINER 3 ULJ u <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY b�:CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE❑-------------------- <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <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 /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 7 7 <br /> (34)WHAT ISMATERIALJ1 e CVS v,C! S <br /> USED FOR? <br /> For Official Use <br /> SIC l2/00 <br /> Only: El C R E] S <br />