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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) ❑ADD ❑DELETE IN REVISE PAGE(2) 4 4 OF(3) 5 S <br /> BUSINESS NAME (4) BULK TRANSPORTATION <br /> CHEMICAL LOCATION(S)(5) OUTSIDE SE CORNER OF SHOP <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) PETROLEUM OIL PRODUCT, WASTE TRADE SECRET(11) ❑YES ®NO <br /> COMMON NAME (9) <br /> WASTE OIL *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) N/A ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ❑MIXTURE ®WASTE RADIOACTIVE(IS) ❑yES ®NO (16) N/A <br /> CURIES <br /> PHYSICAL STATE(17) ❑SOLID ®LIQUID ❑GAS <br /> FED HAZARD ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ®ACUTE HEALTH ❑CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) 221 UNITS*(22) ®GAL ❑LBS MAX DAILY AMT(23 5 0 <br /> CODE ❑CU FT ❑TONS ON SITE <br /> DAYS ON SITE (20)9 0 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 2 0 <br /> ON SITE <br /> LARGEST (21400 ANNUAL WASTE AMT(25) 200 <br /> CONTAINER <br /> STORAGE (26) ®ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑CYLINDER ❑RAII <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑Othe <br /> ❑STEEL DRUM ❑FIBER DRUM ❑PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BIN <br /> STORAGE (27) ®AMBIENT [:]A OVE AMBIENT ❑BELOW AMBI <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT OYES EHS N F <br /> OYES ON <br /> ❑ E- <br /> YES ON <br /> OYES ON <br /> OYES ON <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL maintenance <br /> USED FOR? <br /> DATE RECD: 1/2/?y For Official Use Only: ®C 0 R ❑S SJC 12/99 <br />