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California Hazardous Materials Inventory For»b��l�e�i Description <br /> (1) OADD ❑DELETE [::]REVISE 2001 r 1 b L�i PAGE(2) = OF(3)al <br /> BUSINESS NAME (4) ( RECEI'JE <br /> a .�. e -� e liveid res hi � I <br /> CHEMICAL LOCATIONS)(5) <br /> <br /> <br /> = <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y <br /> U' <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) A r C/ <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 7 L( l _ 7_� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) URE ❑MIXTURE [:]WASTE RADIOACTIVE(15) <br /> F[:]Y (16) <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID U AS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) TITE❑FIRE ❑REACTIVE PRESSURE RELEASE ❑ ACUHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) [-]GAL [KCU FT MAX DAILY AMT(23) 7 V dV <br /> CODE ON-SITE <br /> [:]LBS ❑TONS AVG DAILY AMT(24) <br /> DAYS ON SITE (20) *If EHS, amounts must be in lbs ON-SITE 6 <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <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 ❑-------------------- <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENT XABOVEAMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)0AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> FE-1Y ❑N <br /> ❑Y E]NJ <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) � <br /> (34)WHAT IS MATERIAL t,kt I G� ✓ $ I G'Nl P t S <br /> USED FOR? <br /> For Official Use Only: C El R ❑ S SJC 12100 <br />