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California Hazardous 0terials Inventory Form - Chemical Wription DEC —0 2004, <br /> PAGE(2) = OF(3) <br /> BUSINESS NAME (4)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) USED ANTIFREEZE *EHS(12) ❑YES ®NO <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) 107-21-1 ALL AMOUNTS MUST BE 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 ®LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE []REACTIVE ❑PRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) I GAL ❑LBS MAX DAILY AMT(23)110 <br /> CODE ' ❑CU FT []TONS 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) ❑ABOVE GROUND TANK ❑CAN ❑BOX ❑TAN <br /> CONTAINER []UNDER GROUND TANK []CARBOY [ICYLINDER ElRAIL <br /> El TANK INSIDE BUILDING [I SILO [I GLASS BOTTLE ElOTH <br /> [I STEEL DRUM [I FIBER DRUM [I PLASTIC BOTTLE El Other <br /> ®PLASTIC/NONMETALLIC DRUM []BAG ❑TOTBIN <br /> STORAGE (27) ®AMBIENT []ABOVE AMBIENT [I BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT []ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %aWT 30 HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> OYES ®N <br /> :::]P-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 REMOVED FROM VEHICLE DURING RADIATOR FLUSH&FILL SERVICE. <br /> USED FOR? <br /> DATE REC'D: 12/6/04 For Official Use Only: ❑C ❑R ❑S SJC 12/99 <br />