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California Haza► <br />s Materials <br />Inventory Form - <br />0,,.nical Description <br />(1) <br />ED: ❑DELETE <br />©REVISE <br />2001 <br />PAGE (2) <br />[�K] <br />OF (3)[3K] <br />BUSINESS NAME (4 <br />CHEMICAL LOCATION(S) ( <br /> <br /> <br /> <br /> <br /> , <br />.:,;v 5E€ VICES <br />CHEMICAL NAME <br />(R) SocQ�c� rnoke ��> �p �•� <br />TRADE SECRET (1 1) ❑Y E] N] <br />COMMON NAME <br />(9) S {-� C ©�� Q S <br />*EHS (12) =YE] <br />CAS # <br />(10) I I 1 O -73- -Z <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />HAZARD CLASS <br />(13) <br />LEAVE BLANK <br />TYPE <br />(14) <br />NPURE❑MIXTURE []WASTE <br />RADIOACTIVE(15) 10 aN (16) <br />PHYSICAL STATE <br />(17) <br />SOLID ❑LIQUID ❑GAS <br />CURIES <br />FED HAZARD <br />CATEGORIES <br />(1 K) <br />❑FIRE ®REACTIVE []PRESSURE RELEASE ACUTE HEALTH ❑CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />(19) <br />UNITS* (22) ❑GAL ❑CU FT MAX DAILY AMT (23) <br />ON-SITE S� <br />:1 <br />® LBS ❑TONS- <br />___—]365 <br />DAYS ON SITE <br />(20) <br />AVG DAILY AM't (24) <br />*If EHS, amounts must be in lbs ON-SITEo <br />LARGEST <br />CONTAINER <br />(21) <br />7 ANNUAL WASTE AMT (25) <br />SOQ <br />STORAGE (26) <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />❑ ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br />❑ 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 />(27)1 91AMBIENT ❑ ABOVE AMBIENT []BELOW AMBIENT <br />(28) j ® AMBIENT [:]ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT (31) EHS <br />D ❑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 �p �e <br />USED FOR'? <br />For Official Use Only: C Lj R S SJC 12/00 <br />