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California Hazardous Materials Inventory Form - Chetm,"_'M Description <br /> (1) DADD DDELETE OREVISJE 2001 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) _ <br /> CHEMICAL LOCATION(S)( <br /> <br /> <br /> <br /> <br /> <br /> CHEMICAL NAME (R) TRADE SECRET(11) ❑Y ON <br /> COMMON NAME (9) 0i W <br /> *EHS (12) ❑Y N <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) f/) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) [—]PURE [:]MIX WASTE RADIOACfIVE(15) ❑Y _k N] (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID ZLIQUID [—]GASCURIES <br /> FED HAZARD <br /> CATEGORIES (I8) FIRE [] REACTIVE [—]PRESSURE RELEASE ® ACUTEHEALTH [_] CHRONIC HEALTH <br /> STATE WAST (19) UNITS* (22) RGAL ❑CU FT MAX DAILY AMT(23) <br /> CODE B t ZZ ON -SITE <br /> ❑LBS ❑T <br /> DAYS ON SITE (20) 'AMT(24)�*If EHS, amounts must be in lbs ON-SITE �OV <br /> LARGEST (21 ANNUAL WASTE AMT(25) S� <br /> CONTAINER <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 El-------------------- <br /> El STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) X AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE t� <br /> STORAGE (28) ®AMBIENT ❑ABOVEAMBIENT ❑BELOW AMBIENT E]CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 1)EHS (32)CAS# <br /> ❑Y N 2 <br /> ❑ Y ❑N <br /> ❑ Y ❑ N <br /> ❑Y ❑ N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL / <br /> USED FOR? L 6,16 <br /> For Official Use Only: [_] R S S3C 12/00 <br />