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California Hazardouslaterials Inventory Form - Chemical Description <br /> (1) E]ADD DELETE DREVISd <br /> 2001 PAGE(2) = OF(3)= <br /> BUSINESS NAME (4) 1�ht lL �N CK� Pw?c # S(OS' <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> CHEMICAL NAME (8) CPrR160N Z)10%( 1DF, TRADESECRET(11) ❑Y ON <br /> COMMON NAME (9) CO-2, *EHS(12) ❑Y ®N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 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 /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID ®GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (l8) ❑FIRE ❑REACTIVE ®PRESSURE RELEASE ❑ ACUTE HEALTH [:]CHRONIC HEALTH <br /> STATE WASTE (19)Q UNITS*(22) [—]GAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE Q �5 <br /> J�LBS ❑TONS <br /> DAYS ON SITE (20) * AVG DAILY AMT(24) <br /> If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21db ANNUAL WASTE AMT(25)Q <br /> CONTAINER <br /> STORAGE (26) ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER [:]RAIL CAR <br /> 0—TANK INSIDE BUILDING [:] SILO , ❑GLASS BOTTLE El--------------------- <br /> [:1 STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT ❑ABOVE AMBIENT BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)IWAMBIENT ❑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 /> FI: Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) Q <br /> (34)WHAT IS MATERIAL PQ>✓Peel N CL z=0 2 SO-F-rt 70 R 1 N K , <br /> USED FOR? <br /> For Official Use Only: 0 C ❑ R ❑ S SIC 12/00 <br />