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California Hazardous�Materials Inventory Form - Chemi al Description <br /> (1) r7ADD DELETE aREV iSE 2001 PAGE(2) OF(3) <br /> BUSINESS NAME (4) <br /> S=r <br /> CHEMICAL LOCATION(S)(5) <br /> MAP # (6)/ GRID#(7) <br /> CHEMICAL NAME (8), TRADE SECRET(1 1) ❑Y ON <br /> COMMON NAME (9) D r' *EHS (12) ❑Y N <br /> zdAC <br /> *IF EHS BOX IS "Y-' <br /> CAS # (I d7 <br /> 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 <br /> PHYSICAL STATE(17) ❑SOLID , UIDMGRS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ®REACTIVE Z PRESSURE RELEASE ,&ACUTEHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) ❑GALCU FT MAX DAILY AMT(23) <br /> CODE x i ON-SITE C <br /> DAYS ON SITE (20) []LBS ❑ TONS AVG DAILY AMT(24) <br /> *If EHS, amounts must be in Ibs ON-SITE 7Oo <br /> LARGEST (21)�CY ANNUAL WASTE AMT(25) oN� <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER I❑I ,UNDER GROUND TANK ❑CARBOY CYLINDER ❑RAIL CAR <br /> J TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE 1:1-------------------- <br /> El STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIENTABOVE AMBIENT [:]BELOW AMBIENT <br /> PRESSURC->Nry(3"1„ <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> ❑ Y N <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? <br /> For Official Use Only: L J R S SIC 12/00 <br />