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Nt=U1=1VED <br /> California Hazardo Materials Inventory Form whe{ * description <br /> (I) ADD ❑DELETE DREVISE 2005 -,AN (2) Elf] OF(3) n <br /> -"�)?iIN COON C <br /> „_+GENCY SERVICES <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) . <br /> <br /> <br /> = <br /> CHEMICAL NAME (8) /I r ' / TRADE SECRET(11) ❑Y ❑N <br /> COMMON NAME (9) �tHn v 7_%1_,r ,0 *EHS(12) F-0-Y-0 N <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) 74 - 8(o - 2 Q A ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) k <br /> HAZARD CLASS <br /> TYPE (14) PURE [:]MIXTURE [:]WASTE RADIOACTIVE(15) ❑1 N (16) N <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID F]GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE REACTIVE ffPRESSURF RELEASE ACUTEHEALTH ❑ CHROMCHEALTH <br /> STATE WASTE (19) ` �a UNITS*(22) [:]GAL CU FT MAX DAILY AMT(23) <br /> CODE � <br /> 'K []LBS ❑TONS ON-SITE 21U t GtI_ <br /> DAYS ON SITE (20) AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-BYTE ��- <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER �T N A <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY13 <br /> 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) ❑ AIy1BIENT ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)[Eg AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %aWT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> �7 Col 14af_7-J14&_1 I ❑Y N <br /> YON <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) ((�Q <br /> (34)WHAT IS MATERIAL wE LD I t�C G/T rLI.I M <br /> USED FOR? C T<t L <br /> For Official Use Only: ❑ C E] R F-1 s SIC 12/03 <br />