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' California Hazardous .4aterials Inventory Form - Chemt*A Description <br /> (1) aADD DELETE REVISE 2002 PAGE(2) OF(3) <br /> BUSINESS NAME (4) fo� RECEIVED <br /> CHEMICAL LOCATION(S)(5) `- � / <br /> <br /> <br /> CHEMICAL NAME (8) /w rOLi E TRADE SECRET(11) —1:1Y EJ N <br /> (SLJJ'tJ *EHS(12) ❑Y ❑IN <br /> COMMON NAME (9) oL / �/� <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) g a o 6 - 6/ ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y ©N (16) <br /> PHYSICAL STATE(17) ❑SOLID LIQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTTVE [-]PRESSURE RELEASE ® ACUTEHEALTH O CHROMCHFALTH <br /> STATE WASTE (19) __ UNITS* (22) ®GAL ❑CuFT MAX DAILY AMT(23) <br /> CODE O ON-SITE <br /> DAYS ON SITE (20)�/ [:]LBS TONS AVG DAILY AMT(24)� <br /> *If EHS, amounts mus[ be in lbs8 O O O <br /> ON-SITE i <br /> LARGEST (21 /O O� ANNUAL WASTE AMT(25)� <br /> CONTAINER J <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑CAN ❑ BOX [-]TANK WAGON <br /> CONTAINER 'RI UNDER GROUND TANK ❑CARBOY ❑ CYLINDER ❑RAIL CAR <br /> ❑TANK INSIDE BUILDING ❑ SILO GLASS BOTTLE 1:1-------------------- <br /> El STEEL DRUM ❑FIBER DRUM ❑ PLASTIC BOTTLE <br /> ❑PLASTIC/NONMETALLIC DRUM ❑BAG ❑ TOTE BIN <br /> STORAGE (27) M AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT []ABOVEAMBIENT [:]BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT30 HAZARDOUS COMPONENT 3 32 CAS# <br /> ❑Y NJ F <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 CaoG <br /> USED FOR? <br /> For Official Use Only: ® C ❑ R ❑ S SIC 12/01 <br />