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RL, :EIVED <br /> California Hazardous Materials Inventory Form - Chemical Description <br /> (U ❑ADD ❑DELETE REVISE 2001 DEC 19 PAM(2) OF(3) <br /> QPA <br /> BUSINESS NAME (4) EOFEMER N Y btHVJUtb <br /> Gee r�r``� <br /> JOAQEGOUNTYQFRCEOfES <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) r eS / 1/, TRADE SECRET(I 1) ❑Y N <br /> COMMON NAME (9) �S C/ *EHS(12) ❑Y ZIN <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) f � ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14)INPURE ❑MIXTURE [:]WASTE RADIOACTIVE(15) ❑Y N (16)� <br /> PHYSICAL STATE(17)1 ❑SOLIDMLIQUID ❑GAS <br /> CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRE,SSURERELEASE ACLfIEHEALTH CHRONIC HEALTH <br /> STATE WASTE (19) A , UNITS*(22) NOAL ❑CU FT MAX DAILY AMT(23) <br /> CODE `V 11:1LBS ❑TONS ON-SITE <br /> DAYS ON SITE (20) / AVG DAILY AMT(24) <br /> / *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER ��L3 <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 %wr 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <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 L f�1 R ❑ S SIC 12/00 <br />