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California Hazardous Materials Inventory Form - Chemical Description <br /> (1) EJADD ❑DELETE ❑REVISE2002 FEB 2P5� 0 = OF(3)� <br /> BUSINESS NAME (4) Z 1FfiCEOFEMERGENCYSERVICE; <br /> HEMICAL LOCATION(S)(5) <br /> Within facility,not street address <br /> <br /> VICEI <br /> CHEMICAL NAME (8) w�Z E AIE TRADE SECRET(11) ❑Y QN <br /> COMMON NAME (9) <br /> *EHS(12) ❑Y ®N <br /> w✓AJ� ,q.�lTt FREE�a= <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 g N (16) <br /> PHYSICAL STATE(17)1 ❑SOLID LIQUID ❑GAS <br /> CURIES <br /> FED HAZARD <br /> CATEGORIES (18) N FIRE ❑REACn W [:]PRESSURE RELEASE ❑ ACUTE HEALTH ❑ CHROIQIC IIEAI.TH <br /> STATE WASTE (19) UNITS*(22) NGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE 1[-]LBS [-]T ON-SITE (Ov <br /> DAYS ON SITE (20)� AVG DAILY AMT(24)� <br /> 3ls� *If EHS, amounts must be in lbs ON-STYELARGEST <br /> SC7 <br /> CONTAINER (2I .u� ANNUAL WASTE AMT(25) X00 <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) NJ AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ©AMBIENT []ABOVEAMBIENT []BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 '%WT 30 HAZARDOUS COMPONENT 31 EHS (32 CAS# <br /> ❑Y ❑N _L <br /> F77 ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N I —� <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (N)WHAT IS MATERIAL W✓1 STt- <br /> USED FOR? <br /> For Official Use Only: C [] RE] S I SIC 12/01 <br />