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RECEIVEP <br /> California Hazardou Materials Inventory Form - Description <br /> (I) DADD ODELETE W 2EViSE 2(inl DEC PAGE(2) �()F(3)= <br /> S�t/'IU�w�tCNGfAnres L�J <br /> BUSINESS NAME (4) t°° <br /> CHEMICAL LOCATIONS)(5) - Rr.�ECDC"I <br /> r"It,:.v�..�, ErD <br /> MAP#(6)/ GRID#(7) <br /> SAN JUA GE Qp <br /> CHEMICAL NAME (R) TRADE SQ�tllt .�. F�RGE' J N <br /> COMMON NAME (9) 'EHS(12; ❑Y N <br /> '-- C 2 V R6Q <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LDS <br /> FIRE CODE (13) <br /> HAZARD CLASS <br /> TYPE (14)1 rXPURE ❑ vIIXTURE []WASTE RADIOACTIVE(15) ❑1 N (16) <br /> PHYSICAL STATE(17) ❑SOLID Q LIQUID QGAS CURIES <br /> FED HAZARD FIRE ]REACTIVE ❑PRESSURE RELEASE ❑ ACUTEHEALTH [:] CHRONIC HEALTH <br /> CATEGORIES (18) <br /> I STATE WASTE (t9) UNITS*(22)IwAL [3CUFTJMAXDAILYAMT(23) <br /> CODE ON-SITE[:]LBS ❑TGP.S <br /> DAYS ON SITE (20) 5 AVG DAILY AMT(24) <br /> *If EHS, amounts must be in Ibs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ABOVEGROUriTANK F] CAN ❑ BOX TA7AR <br /> CONTAINER UNDER C ROUND TANK CARBOY CYLINDER ❑RALC <br /> TANK IM !DE BUILDING (,L{t . �j SILO ❑Ct.ASS BOTTLE ❑•I- <br /> STEEL DI:UM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> []PLASTIC,NONMETALLIC DRUM BAG ❑ TOTE BIN <br /> STORAGE (27) AMBIEN-. ABOVE AMBIENT BELOW AMBIENT <br /> 7 PRESSURE <br /> STORAGE (28) AMBIEM ❑ABOVE AMBIENT BELOW AMBIENT CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT 30)HA ZARDOUS COMPONENT (31)EHS 32)CAS# <br /> ❑Y ON <br /> []Y ❑N <br /> []Y QN <br /> Y r] <br /> 0Y ❑N <br /> ADDITIONAL LOCALLY COLLECTEC INFORMATION: (33)UNITED NATIONS ID#(DOT) (2 O <br /> (34)WHAT IS MATERIALr n �a <br /> USED FOR? tL 1SaLLp-MAT2 -.0 2 <br /> C,r Official Use Only: C R S SIC 12/00 <br />