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California Hazardous Materials Inventory Form - Chemic Description <br /> OF(3) I <br /> (1) ADD DELETE REVISE 2001 <br /> BUSINESS NAME (4) C o I e RECEWED <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> E ERGENCYSEMAGE <br /> CHEMICAL NAME (8) QXco TRADE SECRET(11) ❑1 N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) <br /> G k e ✓1 *IF EHS BOX IS"Y" <br /> CAS # (10) , b Z - — ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) URE ❑MIXTURE [:]WASTEI RADIOACTIVE(15) ❑Y (16) � <br /> CURIES <br /> PHYSICAL STATE(17) ❑SOLID QLIQUIDGAS <br /> FED HAZARDFIRE REACTIVE [:1 PRESSURE <br /> ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> CATEGORIES (18)1 N <br /> STATE WASTE (19) UNITS*(22) ❑GAL �U FT MAX DAILY AMT(23) ! �� <br /> CODE ON-SITE 6 <br /> ]LBS ❑ TONS <br /> DAYS ON SITE (20) r AVG DAILY AMT(24) /) <br /> V *If EHS, amounts must be in lbs ON-SITE �QU V <br /> LARGEST (21 (/ ANNUAL WASTE AMT(25)� <br /> CONTAINER Z b U <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK [:]CARBOY WYLINDER []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)1 aAMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT [:]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) ] Z <br /> (34)WHAT IS MATERIAL e e �Ur CL/ S+CV,,Cff <br /> USED FOR? <br /> For Official Use Only: El C SIC 12/00 <br />