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,%W ..i <br /> California Hazardous Materials Inventory Form - Chemical Description <br /> (I) ADD DELETE OREV[SE 2001 PAGE(2) ®OF(3)� <br /> BUSINESS NAME (4) 1 RECEIVED <br /> Zwvc <br /> CHEMICAL LOCATION(S)(5) © n5itq�—, // D E C - 8 2000 <br /> MAP#(6)/ GRID#(7) .� -1. E:= (>FjE RGENCYSEW(:i <br /> CHEMICAL NAME (11) TRADE SECRET(11) 1 ❑Y N <br /> COMMON NAME (9) <br /> 'EHS 02) ❑1' <br /> *IF EHS BOX IS`Y" <br /> CAS# (ICI) Z 7 S y/3 , ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE IXTURE []WASTE RADIOACTIVE(15) y, N (16)� <br /> PHYSICAL STATE(17)1 ffSOLID []LIQUID []GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (I8) FIRE []REACTIVE E]PRFSSURERM-LASE [] AC117THFA1.'11I []C(IRONICLIEAL-m <br /> STATE WASTE (19) UNITS'(22) AL C L-1' MAX DAILY AMT(23)� <br /> CODE ON-SITE <br /> DAYS ONSITE (20) []LBS ONS� AN-SITE YAMT(2A)� <br /> J�� /��L 'If ENS. amountsxnts must be in Ibs ON-SITE / <br /> LARGEST (21 Lam..J ANNUAI.WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) IJ ABOVts GROUND TANK ❑CAN ❑ BOX TANK WAGON <br /> CONTAINER []UNDER GROUND TANK CARBOY [:] CYLINDER [:]RAIL CAR <br /> ❑TANK INSLDG BUILDING SILO E]GLASS DOTTLE CI---------------_--- <br /> ❑STEEL DRUM []FIBER DRUM [] PLASTIC BOTTLE <br /> []PLASTIC/NONMETALLIC DRUM 1 BAG [] TOTE BIN <br /> STORAGE (27) AMBIENT E]ABOVE []BELOWAMBIENT <br /> PRESSURE 1111- <br /> STORAGE (28) [EAMRIF.NT OAROVF.AMRIFN'r []RFLOW AMRIFNT E]CRVOC.F.NIC <br /> TEMPERATURE <br /> 29 %WT 30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> Ely N <br /> c ❑Y <br /> []Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATTONS TD#(DOT) <br /> (34)WHAT IS MATERIAL <br /> USED FOR? �-��/47; r <br /> For Official Use Only: K C R r 5 SIC 12/00 <br />