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California Hazardo- slaterials Inventory Form - Ch( cal Description <br /> (1) ©ADD ❑DELETEREVISE 2002 PAGE(2) OF(3)� <br /> SWS (4) <br /> CHEMIC41,I OCA�'ION(S) (5) <br /> <br /> CHEMICAL NAME (S) TRADE SECRET 11 Y N <br /> c0pri 0L)nc�'i. CIectnInc, � Sv(14 t405 ( ) ❑ <br /> COMMON NAME (9) w�e 2 i n Co n n a U n� *EHS (12) ❑Y ®N <br /> 1 <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) 5,J+vU Sand (y$c)3-tk).-7 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) [LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑ Y I N (16) <br /> PHYSICAL STATE(17) ©SOLID ❑LIQUID []GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (1 S) ❑ FIRE ❑REACTIVE ❑PRESSURE RELEASE ACUTE HEALTH ❑ CHRONIC HEALTH <br /> STATE <br /> CODE WASTE (19) UNITS* (22) ❑GAL E]CU FT MAX DAILY AMT(23) I <br /> ON-SITE 'zSD I h 5 <br /> ©LBS ❑ TONS <br /> DAYS ON SITE (20) AVG DAILY ANIT(24) <br /> ?j� *If EHS, amounts must be in lbs ON-SITE I too S. <br /> LARGEST (21) ANNUAL WASTE AMT(25) �/� <br /> CONTAINER Sv I G3] I <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) M AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) [K AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29) %WT 30) HAZARDOUS COMPONENT 31 EHS 32) CAS# <br /> —11 RE1YE]NII <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> 11 ❑Y ❑N <br /> ❑Y=[:]N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID#(DOT) N /a <br /> (34)WHAT IS MATERIAL �e 5Q`e r� hc��se U se <br /> USED FOR? <br /> For Official Use Only: El C ❑ R ❑ S SJC 12/01 <br />