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California Haza_ <br />, Materials <br />Inventory Form <br />- Ctk,,nic� D <br />(1)EDADD <br />❑DELETE <br />❑REVISE <br />2001 <br />P(��E{2�q� <br />OF (3) <br />3� <br />BUSINESS NAME (4) <br />M'JUAUUIN NTY <br />Sierra Chemical Co. , StocktonOR�GEOHMERG 0C -ES <br />L"hM1C:AL LOCATION(S) (5) <br /> <br /> <br /> <br />CHEMICAL NAME (8) �� n`�m 11 D �r for -`lam TRADESECRET(II) FE-1—YE] N <br />COMMON NAME (9) � I *EHS (12) =YE] <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) ❑ ❑ N (16) <br />PHYSICAL STATE (17) ❑SOLID nLIQUID ❑GAS CURIES <br />FED HAZARD <br />CATEGORIES <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />(18) ( ❑ FIRE N REACTIVE ❑ PRESSURE RELEASE FX] ACUIT HEALTH <br />STORAGE (26) <br />CONTAINER <br />❑ CHRONIC HEALTH <br />UiN113- (<-') DgGAL ❑ CU F1' MAX DAILY AMT (23) <br />ON-SITE <br />❑LBS [–]TONS <br />AVG DAILY AMT (24) <br />*If EHS, amounts must be in It's ON-SITE <br />ANNUAL WASTE AMT (25) <br />® ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br />❑ UNDER GROUND TANK CARBOY ❑ CYLINDER ❑ RAIL CAR <br />fig TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE El --------------------- <br />El STEEL DRUM ❑ FIBER DRUM ® PLASTIC BOTTLE <br />N PLASTIC/NONMETALLIC DRUM ❑ BAG TOTE BIN <br />STORAGE (27) R] AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT <br />PRESSURE <br />STORAGE (28) 12 AMBIENT ❑ ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(29) "/0W I' <br />F ra•s <br />7.j <br />(30) HAZARDOUS COMPONENT (3 1) EHS <br />jocpiv^n <br />Y ❑N <br />(,(�Qf e / <br />❑ Y ❑ N <br />❑Y ❑N <br />❑Y ❑N <br />❑Y ❑N <br />C:AN# <br />176ir / -s a - '9 1 <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) 1 17,9/ 71 <br />(34) WHAT IS MATERIAL �-®� set leUSED FOR'? <br />For Official Use Only: 1/j C I I R I I S <br />SJC 12/00 <br />