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UNIDOCS <br /> HAZARDOUS MATERIALS <br /> HAZARDOUS MATERIALS INVENTORY - CHEMICAL DESCRIPTION <br /> (One page per material per building or area) <br /> ❑ ADD ❑ DELETE ❑ REVISE 2m. <br /> I. FACILITY INFORMATION <br /> BUSINESS NAME(Same as Facility Name or DBA-Doing Business As) 3. <br /> S-Mart#209 <br /> CHEMICAL LOCATION 201 1 CHEMICAL LOCATION CONFIDENTIAL EPCRA 202. <br /> Backroom ❑ YES ® NO <br /> FACILITY ID# _ I MAP#(Optional) 20A GRID#(opt tnnal) 204. <br /> (Agency Ure(holy) <br /> II. CHEMICAL INFORMATION <br /> CHEMICAL NAME 205. TRADE SECRET 206. <br /> Helium Com ressedP-4602-G [I Yes ®No <br /> If subject to EPCRA,refer to innructions <br /> COMMON NAME 207 EHS* 209_ <br /> Helium ❑Yes ®No <br /> CAS# 20, *If EHS is"Yes,"all amounts below must be in lbs. <br /> 7440-59-7 <br /> FIRE CODE HAZARD CLASSES(Complete ifrequtred by CUPA) 210_ <br /> HAZARDOUS MATERIAL zn. RADIOACTIVE 212. CURIES 213. <br /> TYPE (Check one item only) ❑a.PURE ❑b.MIXTURE ❑c.WASTE El Yes ON, <br /> N/A <br /> PHYSICAL STATE 214. LARGEST CONTAINER 215. <br /> ([heck one than only) ❑a.SOLID ❑b.LIQUID ®c.GAS 218 <br /> FED HAZARD CATEGORIES 216. <br /> (Check all that apply) ❑a.FIRE ❑b.REACTIVE ®c.PRESSURE RELEASE ❑d.ACUTE HEALTH ❑e.CHRONIC HEALTH <br /> AVERAGE DAILY AMOUNT 217. 1 MAXIMUM DAILY AMOUNT ne. ANNUAL WASTE AMOUNT 219. STATE WASTE CODE 220. <br /> 327 654 N/A N/A <br /> UNITS* ❑a.GALLONS ®b.CUBIC FEET ❑c.POUNDS ❑d.TONS 221. DAYS ON SITE 222. <br /> (('heck one Item only) o If EHS,amount roust be in pounds. 365 <br /> STORAGE ❑a. ABOVEGROUND TANK ❑f. CAN ❑It. BOX ❑p. TANK WAGON 223_ <br /> CONTAINER ❑It. UNDERGROUND TANK ❑g. CARBOY ®1. CYLINDER ❑q. RAILCAR <br /> ❑c. TANK INSIDE BUILDING ❑h. SILO ❑m. GLASS BOTTLE ❑r. OTHER <br /> ❑d. STEEL DRUM ❑i. FIBER DRUM ❑n. PLASTIC BOTTLE <br /> ❑e. PLASTIC/NONMETALLIC DRUM ❑j. BAG ❑o. TOTE BIN <br /> STORAGE PRESSURE ❑a. AMBIENT ®It. ABOVE AMBIENT ❑c. BELOW AMBIENT 224. <br /> STORAGE TEMPERATURE ®a. AMBIENT ❑b. ABOVE AMBIENT ❑c. BELOW AMBIENT ❑d. CRYOGENIC 225. <br /> %WT HAZARDOUS COMPONENT(For mixture or waste only) EHS CAS# <br /> 226. 227 228. 229. <br /> 1. ❑Yes ❑ No <br /> 230. 231. 232, 233. <br /> 2. ❑Yes ❑ No <br /> 234. 235. 236. 237. <br /> 3. ❑Yes ❑ No <br /> 238. 239. 240. mi. <br /> 4. ❑Yes [INo <br /> 242. 243. 244. 245. <br /> 5. ❑Yes ❑ No <br /> If more havrdouacomgoaentaaupreuntit greater than1%by weight if non<ercinogenic,or 0.1%by weight if cominopnic,attach additional sheets of papereapturing the required information. <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 246. <br /> DOT Hazard Class: <br /> If EPCRA,Please Sign Here. <br /> If this facility is subject to Federal Emergency Planning and Community Right to Know Act(EPCRA)reporting requirements,a signature is required at the <br /> bottom of the form if the page lists an Extremely Hazardous Substance(EHS) handled at or above its Federal Threshold Planning Quantity (TPQ)or 500 <br /> pounds,whichever is less. <br /> 5-Mart#209 Page 3 of 20 July 2012 <br />