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S <br /> w <br /> California Hazardous Materials Inventory Form - Chemical Description <br /> (1) ADD ❑DELETE ❑REVISE 2001 PAGE(2) M OF(3) 'a <br /> BUSINESS NAME (4) RECEIVE <br /> CHEMICAL LOCATION(S)(5) AUG 2 3 2001� • <br /> ` EEMER6ENCYSER CES <br /> CHEMICAL NAME (8) 0 xC' Lvl TRADE SECRET(11) ❑y <br /> COMMON NAME (9) 0 X �,� L (� *EHS(12) ❑y <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) L l f ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) WPURE ❑MIXTURE [-]WASTE RADIOACTIVE(15) IM Y DrN 1 (16) <br /> PHYSICAL STATE(17)1 ❑SOLID aIQUID F]GAS=] CURIES <br /> FED CATEGORIES <br /> FIRE ❑REACnVE ❑PRESSURE RELEASE ❑ ACUTEHEALTH ❑ CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS* (22) ❑GAL CU FT MAX DAILY AMT(23) O G Q D <br /> CODE ON-SITE <br /> ❑LBS ❑TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) Q �y <br /> *If EHS, amounts must be in lbs ON-SITE V----11 <br /> LARGEST (21 LI U U ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK [:]CARBOY b56LINDER ❑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)13AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)WWBIENT [:]ABOVE AMBIENT ❑BELOW AMBIENT CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30 HAZARDOUS COMPONENT (3l EHS (32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N —� <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITEDNATIONSID#(DOT)=F= <br /> I t F= <br /> (34)WHAT IS MATERIAL L I <br /> USED FOR? <br /> For Official Use Only: [] C R S SIC 12/00 <br />