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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) EJADD ODELETE OREVISE 2001 PAGE(2 <br /> <br /> <br /> <br /> == <br /> CHEMICAL NAME (8) � j\/D`nt 1 ��TRADE SECRET(11) ❑Y ®N <br /> COMMON NAME (9) V1 � �2( <br /> ES * F ❑Y �N <br /> E (I2) <br /> V— *IF EHS BOX IS"Y" <br /> CAS # (10) ' D8,00� ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) `PURE ❑MIXTURE ❑WASTE RADIOACTIVE(IS) ❑Y (16) <br /> PHYSICAL STATE(17)1 ❑SOLID }❑LIQUID []GAS CURIES <br /> FED HAZARDCATEGORIES (IS)i FIRE [:]REACTIVE ❑PRESSURE RELEASE ❑ ACUTE HEALTH ® CHRONIC HEALTH <br /> STATE WASTE (19)r—� * ❑CU FC MAX DAILY AMT(23) <br /> u UNITS (22GAL) <br /> CODE ON-SITE <br /> JE]LBS ❑TONS I AVG <br /> DAYS ON SITE (20) � ON-SITE DIY AM"f(24) <br /> *[f EHS, amounts must be in lbs <br /> LARGEST (21 ANNUAL WASTE AMT(25)E=CONTAINER �' CC <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 ❑-------------------- <br /> ❑STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ® AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> p0,�o ❑Y N yOk <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) N <br /> (34)WHAT IS MATERIAL <br /> USED FOR? !7 <br /> For Official Use Only: ❑ C R S SIC 12/00 <br />