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0�ssss- <br /> California Hazardous Oterials Inventory Form - Chemical 9cription DEC — 6 2004 <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4) <br /> JIFFY LUBE #598 <br /> CHEMICAL LOCATION(S)(5) <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) ANTIFREEZE (ETHYLENE GLYCOL) TRADE SECRET(11) ❑yES ®NO Tra <br /> COMMON NAME (9) RECYCLE ANTIFREEZE *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 107-21-1 ALL AMOUNTS MUST BE <br /> IN LBS <br /> FIRE CODE (13) <br /> HAZARD LEAVE BLANK <br /> CATEGORIES <br /> TYPE (14) ❑PURE ®MIXTURE ❑WASTE RADIOACTIVE(15) ❑yES ®NO (16) <br /> PHYSICAL STATE(17) ❑SOLID H LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18)IN FIRE ❑REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS <br /> CODE N/A ❑CU FT [I TON MAX DAILY AMT(23)110 <br /> ON SITE <br /> DAYS ON SITE (20) 365 *If EHS, amounts must be in lbs AVG DAILY AMT(24) 110 <br /> ON SITE <br /> LARGEST (21)60 GL. ANNUAL WASTE AMT(25) N/A <br /> CONTAINER <br /> STORAGE (26) El ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER ❑UNDER GROUND TANK ®CARBOY ❑CYLINDER ❑RAIL <br /> [I TANK INSIDE BUILDING [I SILO ❑GLASS BOTTLE ❑OTH <br /> El STEEL DRUM [I FIBER DRUM [I PLASTIC BOTTLE ElOther <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 /> ❑YES ON <br /> ❑YES ❑N <br /> ❑YES ❑N <br /> ❑YES ❑ N <br /> ❑YES ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1142 <br /> (34)WHAT IS MATERIAL RADIATOR FLUSH&FILL SERVICE <br /> USED FOR? <br /> DATE REC'D: 12/6/04 For Official Use Only: ®C 0 R ❑S SIC 12/99 <br />