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California Hazardous terials Inventory Form - Chemical -we cription <br />s. <br />PAGE (2) =OF(3)� <br />BUSINESS NAME <br />CHEMICAL LOCATTON(S) <br />MAP #(6)/ GRID #(7) <br />CHEMICAL NAME (8) <br />COMMON NAME (9) <br />CAS # (10) <br />FIRE CODE (13) <br />HAZARD <br />CATEGORIES <br />PROPANE <br />PROPANE <br />74-98-6 <br />VE BLANK <br />BEACH RV PARK <br />TRADE SECRET (11) ❑yES ®NO <br />*EHS (12) ❑YES ®NO <br />*IF EHS BOX IS "Y" <br />ALL AMOUNTS MUST BE IN LBS <br />TYPE (14) ® PURE ❑ MIXTURE ❑WASTE RADIOACTIVE (15) ❑yES ®NO (16) <br />PHYSICAL STATE (17) ❑ SOLID ❑ LIQUID ®GAS CURIES <br />FED HAZARD <br />CATEGORIES (18) ® FIRE ❑ REACTIVE ® PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHRONIC HEALTH <br />STATE WASTE <br />CODE <br />DAYS ON SITE <br />LARGEST <br />CONTAINER <br />STORAGE <br />CONTAINER <br />STORAGE <br />PRESSURE <br />STORAGE <br />TEMPERATURE <br />29) %WT <br />UNITS* (22) ® GAL ❑ LBS <br />I0 CU FT ❑TONS ONSITE YAMT (23)500 <br />ON SITE <br />*If EHS, amounts must be in lbs AVG DAILY AMT (24) 200 <br />ON SITE <br />ANNUAL WASTE AMT (25) <br />(26) <br />® ABOVE GROUND TANK <br />❑ CAN <br />❑ BOX <br />❑ <br />❑YES ❑N <br />❑ UNDER GROUND TANK <br />❑ CARBOY <br />❑ CYLINDER <br />❑ <br />❑ TANK INSIDE BUILDING <br />❑ SILO <br />❑ GLASS BOTTLE <br />❑ <br />❑ STEEL DRUM <br />❑ FIBER DRUM <br />❑ PLASTIC BOTTLE <br />❑ <br />❑ PLASTIC/NONMETALLIC DRUM <br />❑ BAG <br />❑ TOTE BIN <br />(27) J❑ AMBIENT ® ABOVE AMBIENT ❑ BELOW AMBIENT <br />(28) ® AMBIENT []ABOVE AMBIENT ❑ BELOW AMBIENT ❑ CRYOGENIC <br />(30) HAZARDOUS COMPONENT (31) EHS r17� CAcu <br />T <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNTIED NATIONS ID# (DOT) 1978 <br />(34) WHAT IS MATERIAL Resale <br />USED FOR? <br />DATE REC'D: 2/16/05 For Official Use Only: IN C 0 R ❑ S SIC 12/99 <br />Tra <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />❑YES ❑N <br />ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNTIED NATIONS ID# (DOT) 1978 <br />(34) WHAT IS MATERIAL Resale <br />USED FOR? <br />DATE REC'D: 2/16/05 For Official Use Only: IN C 0 R ❑ S SIC 12/99 <br />Tra <br />