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California HazardoO Materials Inventory Form - Chedlecal Description <br /> 1) OADD =DELETE REVISE 2001 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) <br /> `. CITY OF RIPON <br /> CHEMICAL LOCATION(S)(5) 9 e A e r« <br /> ' 4 ti '")i�a "^TF WELLI)10 <br /> MAP#(6)/ GRID#(7) = <br /> CHEMICAL NAME (8) V e TRADE SECRET(11) ❑Y ®N <br /> ❑Y ❑X N <br /> COMMON NAME (9) DIESEL *EHS(12) <br /> *IF EHS BOX IS"Y" <br /> CAS # (I0) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) aPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ©N (16)� <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID [:]GASCURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACn VE [:]PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22)F]LBS <br /> GAL [:]CU FT MAX DAILY AMT(23)� <br /> CODE ON-SITE 540 <br /> [:]TONS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> 365 *If EHS, amounts must be in lbs ON-SITE 500 <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER 540 0- <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 El-------------------- <br /> El 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)%WT (30) HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y QN <br /> `,ADDITIONAL LOCALLY COLLECTED INFORMATION: -(33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL LAQ <br /> USED FOR? <br /> For Official Use Only: L] C R S SIC 12100 <br />