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California Hazardous N,-. --,als Inventory Form - Chemical Des.,al,,.Ion <br /> (1) ❑ADD ❑DELETE ®REVISE PAGE(3) = OF(3)� <br /> BUSINESS NAME <br /> (4)1AUTOFIX OF STOCKTON <br /> CHEMICAL LOCATION(S)(5)SHOP <br /> MAP#(6)/ GRID#(7) I-1 H-3 E <br /> CHEMICAL NAME (8) ANTI-FREEZE WASTE TRADE SECRET(11) ❑YES ®NO <br /> COMMON NAME (9) ANIT-FREEZE WASTE *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 ®WA—S—TE7 RADIOACTIVE(15) ❑yES ®NO (16) <br /> PHYSICAL STATE(17) ❑SOLID H LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ®FIRE ❑REACTIVE ❑PRESSURE RELEASE ®ACUTE HEALTH ❑CHRONIC HEALTH <br /> STATE WASTE (19) UNITS*(22) ®GAL ❑LBS <br /> CODE 3 4 3 MAX DAILY AMT(23 14 0 <br /> ❑CU FT ❑TONS ON SITE <br /> DAYS ON SITE (20)3 6_ *If EHS, amounts must be in Ibs AVG DAILY AMT(24) 7 0 <br /> ON SITE <br /> LARGEST (21)140 ANNUAL WASTE AMT(25) 900 <br /> CONTAINER <br /> STORAGE (26) ®ABOVE GROUND TANK []CAN ❑BOX []TAN <br /> CONTAINER ❑UNDER GROUND TANK []CARBOY ❑CYLINDER ❑ RAI <br /> ❑TANK INSIDE BUILDING ❑SILO ❑GLASS BOTTLE ❑Othc <br /> []STEEL DRUM ❑FIBER DRUM ❑PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM []BAG ❑TOTE BIN <br /> STORAGE (27) ®AMBIENT []ABOVE AMBIENT []BELOW AMBI <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT []CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT (3 1)EHS 32 CAS# <br /> 11 ❑YES ❑N <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. Waste Product <br /> USED FOR? <br /> DATE REC'D: 9/11/01 For Official Use Only: H C ❑R ❑S SJC 12/99 <br />