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California Hazardous Materials Inventory Form - hgg�I Ical Description <br /> ADD DELETE REVI2001 <br /> DE� ltS 2001PAGE(2) OF(3) <br /> (1) SE <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) f V� <br /> 9A42M <br /> MAP#(6)/ GRID#(7) FJOAWIINCUU S <br /> CHEMICAL NAME (8) /� c L` ( e`, e 1 N e TRADE SECRET(11) ❑Y ON] <br /> /1 �- <br /> COMMON NAME (9) � C C � I �„� *EHS(12) ❑Y N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) EE Z ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑1 (16) <br /> PHYSICAL STATE(17) [-]SOLID ❑ CURIES <br /> LIQUID G <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REA ❑ URE REI FACE ❑ ACUIE HEALTH [jCHRONIC HEALTH <br /> STATE WASTE (19) UNIT GAL CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE 3 U v 0 <br /> [-]LBS ❑TONS AVG DAILY AMT(24) <br /> DAYS ON SITE (20) -3 ! 5 *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 (<' '1 ANNUAL WASTE AMT(25) <br /> CONTAINER 7 V <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑CAN �❑"BOX [:]TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO GLASS BOTTLE 11-------------------- <br /> El STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAG _.._{27} AMBIENT kqABOVEAMBIENT ❑BELOWAMBIENT <br /> ESS. <br /> STORAGE (28)MAMBIENT ❑ABOVEAMBBENT ❑BELOWAMBIENT E]CRYOGENIC <br /> TEMPERATURE <br /> (30)HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> ❑Y❑Y UN <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N �- <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? e so I e ('r C ✓- ,,,,e' } <br /> For Official Use Only: C R S SJC 12/00 <br />