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California Haz.** Materials Inventory Form <br />(I) ®�DDELETE ❑REVISE 2001 <br />BUSINESS NAME (4) <br />11WEIVED <br />1 ription <br />/ ±2- . _ � OF (3) 3 <br />SjwiM UINCooNTY <br />Sierra Chemical Co., Stockton <br />CHEMICAL LOCATION(S) (5) <br /> � <br />MAP # (6) / GRID # (7)-� <br />CHEMICAL NAME (8)FLt.5u ch lie t w w an Gag TRADE SECRET (l I) =YE]N <br />COMMON NAME (9) 7r0 ane *EHS (12) ❑ YEN <br />*IF EHS BOX IS `Y" <br />CAS # (1 0) ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) LL <br />AVE BLANK <br />HAZARD CLASS <br />TYPE (14) 9 PURE []MIXTURE ❑WAST'El RADIOACTIVE (15) [[:]y <br />Y 0 N (16) <br />PHYSICAL STATE (17) ❑SOLID [:]LIQUID PSGAS CURIES <br />FED HAZARD <br />CATEGORIES <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />(18) <br />FIRE ❑ REACTIVE R] PRESSURE RELEASE �(j ACUTE HEALTH <br />STORAGE (26) <br />CONTAINER <br />❑ CHRONIC HEALTH <br />UNI i s- (22) ®GAL ❑ CU FT' ON-SITE MAX DAILY AMT (23) <br />©O <br />[_]LBS❑TONS <br />AVG DAILY AMT (24) <br />*If EHS, amounts must be in lbs ON SITE ago <br />ANNUAL WASTE AMT (25) <br />EjABOVE GROUND TANK CAN ❑ BOX TANK WAGON <br />[:1❑ <br />UNDER GROUND TANK❑CARBOY ❑ CYLINDER L DER ❑RAIL CAR <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE 0 --------------------- <br />El STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br />STORAGE (27)[ ❑ AMBIENI' M ABOVE AMBIENT [_]BELOWAMBIENT <br />PRESSURE <br />STORAGE (28) AMBIENT ❑ ABOVE AMBIENT [:]BELOW AMBIENT ❑ CRYOGENIC <br />TEMPERATURE <br />(30) HAZARDOUS COMPONENT (31) EHS <br />❑Y ❑N <br />❑ YE] N <br />❑Y ❑N <br />❑Y ❑N <br />- ❑7Y[:] N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) <br />(34) WHAT IS MATERIAL X-� 4erA4r, vS e - <br />USED FOR'? <br />For Official Use Only: C � RE] S SJC 12/00 <br />