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California Hazardous A:ials Inventory Reporting Form-Whemical Description Page <br /> (1) ❑ADD ❑DELETE REVISE 1998 PAGE(2) OF(3) <br /> NOV 2 4 <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) <br /> MAP# (6)/ GRID#(7) = <br /> CHEMICAL NAME (8) C� <br /> TRADE SECRET(11) ]Y N <br /> COMMON NAME (9) Ql7�Uc`C�� *EHS 02) <br /> CAS # (10) / *IF EHS BOX IS "Y" <br /> 3 —% ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) <br /> HAZARD CLASS LEAVE BLANK <br /> TYPE (14) ®PURE ❑MIXTURE []WASTE RADIOACTIVE(15) � (16) <br /> PHYSICAL STATE(17) ]SOLIDLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (IS) ]FIRE ❑REACTIVE ]PRESSURE RELEASE TE HEALTH CHRONICHEALTH <br /> STATE CODE WASTE (19) UNITS*(22) ]GAL CU FT MAX DAILY AMT(23) � <br /> ®LBS TONS ON-SITE <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> *If EHS, amounts must be in,lbs ON-SITE <br /> /bs <br /> CONTAINER �Od `6J <br /> LARGEST (21 / ANNUAL WASTE AMT(25) <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 /> STORGE PRESSURE (27) ] AMBIENT EIABOVEAMBIFNT ]BELOW AMBIENT <br /> STORAGE (28) ]AMBIENT ]ABOVE AMBIENT BELOW AMBIENT CRYOGENIC <br /> TEMPERATURE <br /> (29) %WT (30)HAZARDOUS COMPONENT (3 1)EHS 32) CAS# <br /> �Y QN <br /> �Y QN <br /> ]Y ]N <br /> �Y ]N <br /> ]Y QN <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) — <br /> (34) WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: [ ] C R 0 S SJC 12/97 <br />