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California Hazardous Oerials Inventory Form - Chemical Aption <br />PAGE (2) = OF (3) <br />BUSINESS NAME (4) <br />t-HEMICAL LOCATION(S) (5) <br />SIERRA CHEMICAL CO (STKN) <br /> <br /> <br />CHEMICAL NAME (8) NITROGEN, REFRIGERATED LIQUID TRADE SECRET (11) ❑ YES IN Tra <br />COMMON NAME (9) NITROGEN *EHS (12) ❑ YES ® NO <br />*IF EHS BOX IS "Y" <br />CAS # (10) 17727-37-9 ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />LEAVE BLANK <br />TYPE (14) ® PURE ❑ MIXTURE ❑ WASTE RADIOACTIVE (15) ❑ YES ®NO (16) <br />PHYSICAL STATE (17) ❑ SOLID ®LIQUID ❑ GAS CURIES <br />FED HAZARD ❑ FIRE [IREACTIVE [:1PRESSURE RELEASE ® ACUTE HEALTH ElCHRONIC HEALTH <br />CATEGORIES (18) <br />STATE WASTE (19) UNITS* (22) ❑ GAL ® L B S <br />"'IDE NA 1E] CU FT ❑TONS MAX DAILY AMT (23) 250 <br />ON SITE <br />—,YS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT (24) 150 <br />ON SITE <br />LARGEST (21) 250 ANNUAL WASTE AMT (25) NA <br />CONTAINER <br />STORAGE (26) <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />❑ ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ TANIS <br />❑ UNDER GROUND TANK <br />[]CARBOY <br />® CYLINDER <br />❑ RAIL <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ OTHI <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ Other <br />❑ PLASTIC/NONMETALLIC <br />DRUM ❑ BAG <br />❑ TOTE BIN <br />(27) ❑ AMBIENT ® ABOVE AMBIENT ❑ BELOW AMBIENT <br />(28) ® AMBIENT [:]ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br />29 %WT (10) NA7.ARDOiIS COMPONENT (3 1) EHS (32) CAS# <br />99.995 <br />7:1 <br />NITROGEN <br />❑YES ®N <br />7727-37-9 <br />❑YES ❑ N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES Ell <br />DITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID# (DOT) JUN 1977 <br />4) WHAT IS MATERIAL PURGE LINES ON DELIVERY <br />USED FOR? <br />DATE REC'D: 8/4/05 For Official Use Only: ❑ C ❑ R ❑ S <br />SJC 12/99 <br />