Laserfiche WebLink
California Hazardous Materials Inventory Form - Ch ftQaj IkWption <br /> PAGE(2) OF(3) <br /> (1) OADD ❑DELETE ❑REVISE 2001 ID <br /> BUSINESS NAME (4) C o w\ e e I a e r RECEI'JED <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> NCYSERVIC <br /> CHEMICAL NAME (8) 1,e I ✓ � TRADE SECRET(11) ❑Y aN <br /> rl *EHS(12) ❑Y N <br /> COMMON NAME (9) N e I ✓ <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) - 4 y 0 _ 59 — � ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y (16)� <br /> PHYSICAL STATE(17) E]SOLID ❑LIQUID t37AS CURIES <br /> FED HAZARD ❑FIRE ❑REACTIVE PRESSURE RELEASE ❑ ACUTEHEALTH ❑ CHRONICHEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS*(22) ❑GALCU FT MAX DAILY AMT(23) L 1 V <br /> CODE ON-SITE L <br /> ❑LBS ❑ TONS <br /> DAYS ON SITE (20) r AVG DAILY AMT(24) <br /> b *If EHS, amounts must be in Ibs ON-SITE (J <br /> LARGEST (21 Z I ANNUAL WASTE AMT(25)D <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY WYLINDER ❑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 [:]ABOVEAMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT 31 EHS (32)CAS# <br /> ❑Y [—]NJ F <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 / e f / �S <br /> USED FOR? Ili ` �Yl � <br /> For Official Use Only: V C ❑ R S SJC 12/00 <br />