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I <br /> California Hazardous Materials Inventory Form - Chemical Description <br /> (1) ADD ❑ ELETE ❑REVISE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) COV', Cto I iV <br /> kA/e1 C' I REOEIVE <br /> CHEMICAL LOCATIONS)(5) <br /> <br /> <br /> �TJRADE SECRET(11) F[:]Y ErN <br /> ✓� �t/� I OK C <br /> *EHS(12) Y ❑N <br /> COMMON NAME (9) S Q <br /> V U r K I *IF EHS BOX IS"Y" <br /> CAS # (10) _Q — ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13j LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) []MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (16) <br /> URE �E <br /> CURIES—J <br /> PHYSICAL STATE(17) ❑SOLID IQUID ❑GAS <br /> FED HAZARD FIRE REACTTVE ❑PRESSURE RELEASE ACUIEk�e1I-'IH CHRONIC <br /> CATEGORIES <br /> CATEGORIES (18) ❑ ❑ <br /> STATE WASTE (19)�� UNITS* (22) ❑GAL ❑CU FT MAX DAILY AMT(23) lS0 <br /> CODEON-SITE l <br /> ❑LBS ❑ TONS <br /> AMT(24) <br /> DAYS ON SITE (20) f AVG DAILY �OO <br /> 6 *If EHS, amounts must be in IDs ON-SITE ----II <br /> LARGEST (21 , ANNUAL WASTE AMT(25) I <br /> CONTAINER V J <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY �YLINDER ❑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 Pj AMBIENT ❑ABOVE AMBIENT [-]BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVEAMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (31 EHS (32 CAS# <br /> ❑Y [:]NJ I <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N =�_��77] <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)1 <br /> (34)WHAT IS MATERIAL e Sc;t c vi CU S c/ S <br /> USED FOR? <br /> For Official Use Only: ❑ C R S SIC 12/00 <br />