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California Haz )us Materials Inventory Form vhemical Description Page <br /> (1) ❑ADD❑DELETE❑REVISE 2004 PAGE(z) 1 OF (3) 1 <br /> BUSINESS NAME (4) Jack In The Box#534 <br /> CHEMICAL LOCATION(5) <br /> <br /> CHEMICAL NAME (s) CARBON DIOXIDE TRADESECRET 00 ❑Y ON <br /> COMMON NAME (9) CARBON DIOXIDE 'EHS(1z) ❑y xON <br /> IF EHS BOX IS"Y" <br /> CAS# (to) 124-38-9 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE LEAVE BLANK <br /> HAZARD CLASSES' (13) <br /> -COMPLETE BLOCK(13)IF REQUESTED BY THE LOCAL FIRE CHIEF-REFER TO BYSTRUCTIONS. <br /> TYPE (14) OPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ON (16) <br /> PHYSICAL STATE (17) ❑ SOLID ❑LIQUID OGAS CURIES <br /> FED HAZARD ❑ FIRE ❑ REACTIVE OPRESSURE RELEASE ❑ACUTE HEALTH ❑CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) ❑ GAL 0 CU FT MAX DAILY AMT(23) <br /> UNITS(zz) 3496 <br /> CODE ❑ LBS ❑TONS ON-SITE <br /> AVG DAILY AMT(24) <br /> DAYS ON SITE (zo) 365 If EHS,amounts must be in Ib. 3000 <br /> ON-SITE <br /> LARGEST (21) 400 ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑CAN ❑BOX ❑TANK WAGON <br /> CONTAINER []UNDER GROUND TANK ❑CARBOY []CYLINDER ORAE.CAR <br /> OTANK INSIDE BUILDING ❑SQA ❑GLASS BOTTLE ❑BATTERY CELL <br /> ❑STEEL DRUM ❑FIBERDRUM ❑PLASTIC BOTTLE ❑Other... <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑TOTE BBV <br /> PRESSURE (27) ❑AMBIENT OO ABOVE AMBIENT ❑ BELOW AMBIENT <br /> STORAGE <br /> STORAGE (28> O AMBIENT ❑ ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (3o)HAZARDOUS COMPONENTS (n)EHS (32)CAS# <br /> 100% CARBON DIOXIDE ❑Y ON 124-38-9 <br /> ❑Y ON <br /> ❑Y ON <br /> ❑Y ON <br /> ❑Y ON <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION 33 UNITED NATIONS ID# DO 1013 <br /> (34WEDFORE MATERIAL Soft Dr nk Dispenser <br /> For Official Use Only: ❑C ❑ R ❑S SJC 12/0 <br />