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California HazardoL .Materials Inventory Form - Chei..,,;al Description <br /> (1) ©AD�Fo__JDELETE ❑ 2002 PAGE(2) OF(3)� <br /> BUSINESS.NAM11 (4) <br /> V -. .r�, ii .= 5ieryo. C�eMIC�n� Com . <br /> CHEMICAL LOCATIONS)(5) <br /> <br /> <br /> CHEMICAL NAME (8) /405 TRADE SECRET(11) ❑Y N <br /> Cv,� dt�,1d', Clean�nc� Sv( 'd1 <br /> COMMON NAME (9) sweep kr%cl. Co m n o U ncl *EHS (12) ❑Y N <br /> rn'koefr'A10o goqji2- cfl-j-/ *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) ❑Y N (16) <br /> PHYSICAL STATE(17) ©SOLID ❑LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE [] REACTIVE ❑PRESSURE RELEASE ACUTE HEALTH [:] CHRONICHEALTH <br /> STATE WASTE (19) UNITS* (22) ❑GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE � �ra ON-SITE <br /> DAYS ON SITE (20) ©LBS ❑ TONS <br /> AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE too 5. <br /> LARGEST (21) <br /> CONTAINER �(� ��� ANNUAL WASTE AMT(25) �/A <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) AMB1ENT [:]ABOVE AMBIENT [:]BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29) %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> ❑Y ❑N <br /> F_ ] I ❑Y ❑N <br /> ❑Y EINIE <br /> ❑Y ❑N <br /> ny:❑N <br /> DITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL ` Sn hc>vs U S� <br /> USED FOR? <br /> For Official Use Only: ® C ❑ R ❑ S SJC 12/01 <br />