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California Hazardous :aterials Inventory Form - CNLt� -q"glption <br /> (I) DADD DELETE REVISE 2002DEC 1 AW) = OF(3)= <br /> BUSINESS NAME (4) Cn SANJ0AQi i GCSNIY <br /> o S Ja s /v �� /v�o� %�-0 OFRCEOFEMERGENCYSERVICES <br /> CHEMICAL LOCATION(S)(5) <br /> N- .Lk 4 .A1tP/L,o�l <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) 'I ' TRADE SECRET(11) ❑Y <br /> VV�it L <br /> COMMON NAME (9) ( � 6 + *EHS (12) Fl---]Y ❑N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE _ (14) []PURE ❑MIXTURE DV�ASTE RADIOACTIVE{-15)- 1, jff_7„ (16) <br /> PHYSICAL STATE(17)1 [:]SOLID ❑'LIQUID []GASLam" CURIES <br /> FED HAZARD1-y ❑ ❑ ❑ E] CHRONIC HEALTH <br /> CATEGORIES (18) FIRE REACTIVE PRESSURE RELEASE ACU'['E HEALTH <br /> STATE WASTE (19) UNITS* (22) [;ItAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE YON-SITE Sa �4l <br /> ONS <br /> DAYS ON SITE (20) [[:]LBS ❑T <br /> � AVG DAILY AMT(24)� <br /> *If EHS, amounts mus[be in lbs ON-SITELARGEST <br /> CONTAINER (21 ANNUAL WASTE AMT(25) oo <br /> n <br /> STORAGE (26) ErABOVE 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) AMB¢NT []ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) [''AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> Pe. G.l AStt oil ❑Y ❑N <br /> ❑Y 0 <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? <br /> For Official Use Only: ❑ C E] R ❑ S SIC 12/01 <br />