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California Hazardous Inventory Form - Cheml,cal Description , <br /> 2009 PAGE(2) [--p <br /> �iOF(3)® <br /> (I)��ADD �DELE'I'E REVISE I <br /> BUSINESS NAME (4) <br /> REMN <br /> (50 ren , <br /> <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) /_ 7� / 1 TRADE SECRET(11) ❑Y N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) ' <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) l u ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ❑MIXTURE WASTE RADIOACTIVE(15) ❑Y N (16)�� <br /> p CURIES <br /> PHYSICALSTATE(17) ❑SOLID LIQUID ❑GAS <br /> FED HAZARD pIREREACTIVE ❑PRESSURE RELEASE ACUTEHEALTH ❑ CHRONICHEALTH <br /> CATEGORIES (IR) <br /> STATE WASTE (19) UNITS*(22) C,pI ❑CU FI MAX DAILY AMT(23) <br /> CODE Z2/ ON-SITE <br /> 1E]LBS ❑TONS <br /> AVG DAILY AMT(24) <br /> DAYS ON SITE (20) � <br /> �6 fj *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) OCA <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [:]RAILCAR <br /> TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE❑-------------------- <br /> STEEL DRUM [:]FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM BAG ❑ TOTE BIN <br /> STORAGE (27) 2JAMBIENT ❑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 /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> Y N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) '70 <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> FOffiFor <br /> cial Use Only: C ❑ R S SJC 12/00 <br />