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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) HADD ❑DELETE [_—]REVISE 2001 PAGE(2) E� OF(3)rj�� <br /> BUSINESS NAME (4) <br /> -i\:,yy) " T <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> <br /> <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y ©N <br /> COMMONNAME (9) *EHS(12) ❑Y [37N�4 "T>✓ G l <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) (J) Or ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE ❑MIXTURE ®WASTE RADIOACTIVE(15) ❑Y [DN (16)� <br /> PHYSICAL STATE(17)1 ❑SOLID LIQUID <br /> _]CAS CURIES <br /> FED HAZARD ® <br /> CATEGORIES (IS) FIRE [:]REACTIVE ❑PRESSURE RELEASE ® ACUTE HEALTH ® CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22) QGAL ❑CU FTMAX DAILY AMT(23) <br /> CODE ON-SITE ]rC <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 WASTE AMT(25) I L�`� <br /> CONTAINER _ Cj� J <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) ®AMBIENT ❑ABOVE AMBIENT []BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30)HAZARDOUS COMPONENT (3 (32)CAS# <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> F0 ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)E:5= <br /> (34)WHAT IS MATERIAL �� <br /> USED FOR? <br /> For Official Use Only: T C E1R ❑ S SJC 12/00 <br />