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California Hazardous Materials Inventory Form - Chemical Description <br /> M tgADD ❑DELETE [—]REVISE 2001 PAGE (2) = OF(3) <br /> BUSINESS NAME (4) (f r! L r r� € ��! - <br /> C4Ipp��� W N(S)( <br /> <br /> OMUMMEHUCRUT SERVICES <br /> CHEMICAL NAME (8) /a17 1/ 5 j j��- TRADE SECRET(1 1) FO-1 Y A_N <br /> COMMON NAME (9) � 5� 4 /A/ *EHS (12) ❑Y �N <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) PURE ❑MIXTURE [_]WASTE RADIOACTIVE(15) ❑Y ®N (16) <br /> PHYSICAL STATE(17)1 ❑SOLIDAQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18)10 ❑ ❑FIRE REACTIVE PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH ldlly <br /> STATE WASTE (19) UNITS* (22) 4GAL ❑CU FT MAX DAILY AMT(23) <br /> CODE ON-SITE <br /> ❑LBS ❑TONS <br /> DAYS ON SITE (20)� AVG DAILY AMT(24) <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21) ANNUAL o � WASTE AMT(25)� <br /> CONTAINER avv /0_Zy-G� <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)191 AMBIENT ElABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE � <br /> STORAGE (28) gI AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 1)EHS x / (32 CAS# C� <br /> CT GINS ❑1' ®N g � — h/ - / <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N �� <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL )Cop, A(j 70IP07� s <br /> USED FOR? <br /> For Official Use Only: 14 C R S SIC 12/00 <br />