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California Mazar( viaterials Inventory Form - C -,,,cal Description <br /> (I) ❑ADD ❑DELETE REVISE 2001 PAGE(2) OF(3) 3� <br /> BUSINESS NAME (4) '-- '— ---- <br /> Sier <br /> <br /> <br /> L ,(Y <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) v m t f1 v rYl Sv �t✓, TRADE SECRET(1 1) ❑Y 0 N <br /> COMMON NAi\IE (9) *EHS (12) Ely X❑ N <br /> Lt �►cQ � lvN► <br /> IF EHS BOX IS "Y" <br /> CAS # (10) _ 3 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) [:]PURE ®MIXTURE ❑WAS'[E RADIOACTIVE(15) 1❑1, ❑N (16) <br /> PHYSICAL STATE(17) 10 SOLID COLIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (l 8) ❑ FIRE ® REACTIVE ❑ PRESSURE RELEASE [SACU C HEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) ®GAL ❑CU FT MAX DAILY AMT(23) <br /> CODEON-S ITE p�S 9O <br /> [:]LBS [:] TONS AVG DAILY AMT24 <br /> 3 6 5 (- ) <br /> DAYS ON SITE (20) <br /> If EHS, amounts must be in lbs ON-SITE I 1 OOO <br /> LARGEST (21) ANNUAL WASTE AMT(25) <br /> CONTAINER 515 1�v <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 /> 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 /> F F I I ❑Y ❑N <br /> ❑ Y ❑N <br /> E 11 ❑ Y ❑ N <br /> ❑Y ❑ N <br /> ❑ Y o-1 F 7777�__il <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) 7(oQ <br /> (34)WVHAT IS MATERIAL <br /> USED FOR.? <br /> For Official Use Only: 4 C ❑ R ❑ S SIC 12/00 <br />