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alifornia Hazardous Materials Inventory Form - Chemical Description <br /> (1) ADD DELETE REVISE <br /> 2001 PAGE(2) E-1 OF(3)� <br /> BUSINESS NAME (4) � <br /> CHEMICAL LOCATION(S)( ) SAN JOAOUIN004T`/ <br /> FS <br /> MAP#(6)/ GRID#(7) <br /> CHEMICAL NAME (8) � w TRADE SECRET(11) ❑Y <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) � �jSQ�� <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) URE ❑MIXTURE ❑WASTE RADIOACPIVE(15) ❑Y N (16) lJ " <br /> PHYSICAL STATE(17) ❑SOLID LIQUID []GAS CURIES <br /> FED HAZARD FIRE REACi7VE PRESSURE RELEASE ACUTE HEALTH ❑ CHRO <br /> CATEGORIES (I8) NIC HEAL'PH <br /> ❑ ❑ <br /> STATE WASTE (19) UNITS* (22) GAL ❑CU FT MAX DAILY AMT(23) L�y� <br /> CODE LJ /j.� ON-SITE �1=J <br /> BS ❑ TONS <br /> DAYS ON SITE (20) 2/ AVG DAILY AMT(24)�� <br /> �lJs *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER OO <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑RAIL CAR <br /> TANK INSIDE BUILDING ❑ SILO ❑ GLASS BOTTLE ❑-------------------- <br /> STEEL DRUM ❑ FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ IE <br /> AMBNT EABOVEAMBIENT []BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT E]ABOVE AMBIENT BELOW AMBIENT ❑CRYOGENIC <br /> ❑ <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3_1 E) HS 32 CAS# <br /> ❑�Y ❑�N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> El El-' I <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) 1 b[5 <br /> (34)WHAT IS MATERIALP ��–r <br /> USED FOR? <br /> For Official Use Only: ❑ C ❑ R ❑ S SIC 12/00 <br />