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California Hazardous Materials Inventory Form - Chemical Description <br />(1)❑ADD ❑DELETE DRE <br />VISE PAGE (2) =OF(3)� <br />VISE <br />BUSINESS NAME (4) 1 EL � � � (( 0 rOO 1J6 I fVC RECEIVED <br />CHEMICAL LOCATION(S) (5)1NOV b 20Ul <br />MAP # (6) / GRID # (7) <br />CHEMICAL NAME (8) yQP<,Twbb Get-r!�6-rn"qf TRADESECRET(II) ❑Y ❑N <br />*EHS (12) ❑Y ❑N <br />COMMON NAME (9) <br />*IF EHS BOX IS "Y" <br />CAS # (10) ALL AMOUNTS MUST BE IN LBS <br />FIRE CODE <br />HAZARD CLASS <br />TYPE <br />(l3) <br />(14) ❑ PURE ❑MIXTURE [:]WASTE RADIOACTIVE (15) ❑ Y ❑ N (1b)1 I <br />L rr�tarFc� <br />PHYSICAL STATE (17) <br />FED HAZARD <br />CATEGORIES (18) <br />STATE WASTE (19) <br />CODE <br />DAYS ON SITE (20 <br />LARGEST (21 <br />CONTAINER <br />STORAGE (26 <br />CONTAINER <br />STORAGE (2i <br />PRESSURE <br />STORAGE (2I <br />TEMPERATURE <br />❑SOLID ❑LIQUID❑SOLID ❑LIQUID ❑GAS <br />❑ FIRE []REACTIVE ❑ PRESSURE RELEASE ❑ ACUTE HEALTH [:]CHRONIC HEALTH <br />UNITS* (22) ❑GAL ❑ CU FT MAX DAILY AMT (23)� <br />ON-SITE <br />❑LBS ❑TONS <br />AVG DAILY AMT (24)� <br />*If EHS, amounts must be in lbs ON-SITE <br />ANNUAL WASTE AMT (25) <br />❑ ABOVEGROUNDTANK ❑ CAN ❑ BOX ❑TANK WAGON <br />❑ UNDER GROUND TANK ❑ CARBOY ❑ CYLINDER ER1LCAR <br />E................ <br />❑ TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE <br />STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br />❑ PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br />❑AMBIENT ]ABOVE AMBIENT ❑BELOW AMBIENT <br />❑ AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: <br />(34) WHAT IS MATERIAL <br />NT (3 1) EHS <br />❑Y ❑N <br />❑Y ❑N C <br />❑Y ❑N C <br />❑Y ❑N <br />F0 ❑N C <br />(33) UNITED NATIONS ID # (DOT) <br />USED FOR? SIC 12/011 <br />For Official Use Only: ❑ C ❑ R [:]S <br />