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�.. <br /> California Hazardous Materials Inventory Form - Chemical Description <br /> 0)1 ADD ODELETE 0 REVISE 2001 DEC 18 % <br /> <br /> <br /> <br /> w!E RY` <br /> CHEMICAL NAME (8) TRADE SECRET(l I) ❑1 <br /> COMMON NAME (9) L) <br /> *EHS(12) ❑Y N <br /> G d �/C �✓1 <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) V 3 ,_7 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14)12 PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (16) <br /> PHYSICAL STATE(17)1 ❑SOLID JgLIQUID [:]GA=S CURIES <br /> FED HAZARD <br /> CATEGORIES (18) [jFIRE ❑REAcnvE PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) <br /> []GAL CU FT MAX DAILY AMT(23) <br /> CODE DON-SITE <br /> ❑TONS <br /> DAYS ON SITE (20)� AVG DAILY AMT(24) <br /> 3 6 S *If EHS, amounts must be in Ibs ON-SITE O <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 ABOVE:AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) BIENT ❑ABOVEAMBIENT [—]BELOW AMBIENT CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT (30)HAZARDOUS COMPONENT (31)EHS 32 CAS# <br /> ❑Y ❑N <br /> 110YON11 <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNTIED NATIONS ID#(DOT) S <br /> (34)WHAT IS MATERIAL <br /> USED FOR? r SCA(f <br /> For Official Use Only: g C ❑ R ❑ S SIC 12/00 <br />