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0 RFEIVED <br /> California Hazardous Materials Inventory Form - Chell ISE `�salio <br /> (1) ADD DELETE REV2001 <br /> o�M NCCYS <br /> BUSINESS NAME (4) SMJOAl1UINC0UNTY <br /> cS <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> =-!!! <br /> CHEMICAL NAME (8) /]aj, TRADE SECRET(1 1) ❑Y N <br /> COMMON NAME (9) �/ *EHS(12) ❑Y N <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)1 FPURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y N (I6)� <br /> PHYSICAL STATE(17)10 SOLID IQUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) COFIRE REACTIVE ❑PRESSURE RELEASE ACUTE HEALTH CHRONIC HEALTH❑ ❑ ❑ <br /> STATE WASTE (19) UNITS*.(22) GAL [:]CU FT MAXDAILY AMT(23)� <br /> CODE ❑LBS [:] TONS ON-SITE �d <br /> DAYS ON SITE (20)® AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21) 0 d0� ANNUAL WASTE AMT(25) <br /> CONTAINER <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 /> 1 11 E]YE]NII <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> IF[:]Y ON <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT)E7`-'-� <br /> (34)WHAT IS MATERIAL <br /> USED FOR? Gam/ <br /> For Official Use Only: ❑ C [] R ❑ S SIC 12/00 <br />