Laserfiche WebLink
• 11 1--Or n <br /> California Hazardous Materials Inventory Form - Ch- escription <br /> (1) ❑ADD ❑DELETE [:]REVISE 2002 <br /> FES 5 ZD��pAGE(2) = OF(3) <br /> gAlv3unuuw uuw��Y <br /> BUSINESS NAME (4) <br /> lropv T2�c L C��v t-E X- <br /> CHEMICAL LOCATION(S)(5) to t 0 Cu <br /> (Within facility,not street address <br /> <br /> ;"'r <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y JRN <br /> C>k <br /> waombdlL <br /> COMMON NAME (9) t 'A5-c-E *E HS(12) ❑Y ®N <br /> *IF EHS BOX IS"Y' <br /> CAS # (10) ��, kYA- ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) [:]PURE IMMIXTURE MWASTEI RADIOACTIVE(15) ❑Y SILL3�11N (16)� <br /> PHYSICALSTATE(17) [:]SOLID EgLIQUID [:)GAS CURIES <br /> FED HAZARD N FIRE ❑REACTIVE [:]PRESSURE RELEASE ❑ ACUrE HEALTH [_ CHROMC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19) UNITS*(22) MGAL ❑CU FT MAX DAILY AMT(23)� <br /> CODE ZZ( ON-SITE IOC <br /> ❑ <br /> DAYS ON SITE (20) [:]LBS TONS <br /> � AVG DAILY AMT(24)� <br /> *If EHS,amounts must be in lbs ON-SITE SO <br /> LARGEST (21 ANNUAL WASTE AMT(25) <br /> CONTAINER 1-03 22V X100 <br /> STORAGE (26) ABOVE GROUND TANK ❑CAN C] 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) 55 AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) ©AMBffiVT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT3( 1)EHS32 CAS# <br /> 1 -1 ❑Y ❑N❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N �_ <br /> ❑Y ❑N � _� <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: tJMTED NATIONS ID#(DOT) t Z 1 C> <br /> WHAT IS MATERIAL Vd <br /> USED FOR? <br /> For Official Use Only: C 0 R El S SJC 12/01 <br />