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California Hazardou■ Alaterials Inventory Form - Chen..cal Description <br /> (D ADD DDELETE REVISE 2002 <br /> PAGE(2) E-1 OF(3)F7 <br /> BUSINESS NAME (4) <br /> Co iN%p I e Ic we e/ S� I <br /> CHEMICAL LOCATIONS) (5) <br /> n : UUNTY <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) PCO e TRADE SECRET(11) ❑Y N <br /> COMMON NAME (9) *EHS (12) ❑Y N <br /> CPG �in�e �� I Me}�ane L; �;6t� Pe����1� (� s <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) " 1 — �/_ ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (16) <br /> PHYSICAL STATE(17) []SOLID LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18)10 FIRE [] REACTIVE gPRESSURERELEASE WACurFHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19)D UNITS*(22) OC GAL ❑CU FT MAX DAILY AMT(23) LI <br /> CODE [:]LBS ❑ TONS ON-SITE <br /> DAYS ON SITE (20) AVG DAILY AMT(24) �O <br /> 3 6 *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 G ANNUAL WASTE AMT(25) <br /> CONTAINER l <br /> STORAGE (26) ArABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑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 [:]BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> E]Y ❑N <br /> ❑Y ❑N <br /> QY N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)EI-3= <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: n C ❑ R [] S SJC 12/01 <br />