Laserfiche WebLink
California Hazardous Materials Inventory Form - Chemical Description <br /> (I) ADD ❑DELETE ❑REVISE 2001 PAGE(2) F / IOF(3)54-1-1 <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATIONS)(5) <br /> ^ YY <br /> MAP#(6)/ GRID#(7) 11L�J <br /> CHEMICAL NAME (8) L TRADE SECRET(11) ❑1" N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) Z)/6 $erL L L <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) rV /AS ALI, AMOUNTS.MUST,BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK [ <br /> HAZARD CLASS <br /> TYPE (14) [—]PURE IXTURE ❑WASTE RADIOACTIVE(15) ❑�, N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID MfIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE [:]REACTIVE [:]PRESSURE RELEASE ❑ ACUTEHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19)D UNITS*(22) GAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE (,b <br /> 1E]LBS ❑TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE SV <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER l ,� <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) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> 'ES� G EL 0 N (o 4, <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> _— ❑Y ❑N <br /> II <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? wF47 �' 4 ' <br /> For Official Use Only: M C [] R [] S SIC 12/00 <br />