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COMMON NAML LY) CAS 0 110 PIR1 G CODE 4 01 HAZARD CLASS YPG 1 (I4; PHYSICAL SPATE (171 FED HAZARD CATEGORIES (IN STATE WASTE (19 CODE DAYS ON SITE (20 LARGEST (21 CONTAINER STORAGE (26 CONTAINER STORAGE (27 PRESSURE STORAGE (2a TEMPERATURE 1701 2Yir AC�-ry ler��. - -1 Li- - ?)U, - Z TRADE SECRET (I I) ❑Y ® N *EHS(12) ❑Y ©N *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS ,V BLANK ❑Y ©N ❑Y❑N California Hazardouslaterials Inventory Form - Chem% Description r❑SOLID [:]LIQUID GAS ❑ADD ❑DELETE ®REVISE CHRONIC HEALTH 2001 PAGE (2) OF (3) BUSINESS NAME (4) 1RonS K �o `G� �(,.(V 1 C C. U AMIIIFNT ® ABOVE AINBILNr []BELOW AMBIENT CHEMICAL LOCATIUN(S) (51 CHEMICAL NAMIi 00 Ace C COMMON NAML LY) CAS 0 110 PIR1 G CODE 4 01 HAZARD CLASS YPG 1 (I4; PHYSICAL SPATE (171 FED HAZARD CATEGORIES (IN STATE WASTE (19 CODE DAYS ON SITE (20 LARGEST (21 CONTAINER STORAGE (26 CONTAINER STORAGE (27 PRESSURE STORAGE (2a TEMPERATURE 1701 2Yir AC�-ry ler��. - -1 Li- - ?)U, - Z TRADE SECRET (I I) ❑Y ® N *EHS(12) ❑Y ©N *IF EHS BOX IS "Y" ALL AMOUNTS MUST BE IN LBS ,V BLANK ❑Y ©N ❑Y❑N RADIOACTIVE 1151 ❑Y ❑N (16)� CURIES I ®PURts MIK7IIR[i ❑N'A51'E r❑SOLID [:]LIQUID GAS ❑ FIRE ❑ KEA(TIVE E]I%SSURE RIAA AS[: ❑ ACLr1E HEALTH ❑ CHRONIC HEALTH UNITS* (22) [:]GAL 0 CU FT MAX DAILY AMT (23) Z J ON-SITE ❑LBS ❑TONS AVG DAILY AMT (24)�� *If EHS, amounts muni be in lbs ON-SITE �S ANNUAL WASTE AMT (25)� ❑ ABOVEGROUNDTANK ❑ CAN ❑ UNDER GROUND TANK ❑ CARBOY ❑ TANK INSIDE BUILDING ❑ SILO 0 Siva. DRUM ❑ FIBER DRUM ❑ PLASTIC'/NONMI:TALI W DRUM BAG ❑ BOX ❑TANK WAGON ❑ CYLINDER ❑ RAIL CAR ❑ GLASS BOTTLE 1:1 -------------------- ❑ PLASTIC BOTTLE ❑ TOTE BIN U AMIIIFNT ® ABOVE AINBILNr []BELOW AMBIENT I AMBIENT ❑Af[OV'Ei AAlBI1N1' [-]BELOW AMBIENT []CRYOGENIC CIA It 14 7411h(NIN COM W)NENT (31)EHS (32) CAS# - _ ❑Y ©N ❑Y❑N ❑Y ❑N Y N ❑Y ❑N ADDITIONAL LOCALLY COLLECTED INFORMATION: (33) UNITED NATIONS ID # (DOT) I (34) WHAT IS MATERIAL W �� d I n USED FOR? -t For Official Use Only: I1C I I R I I S I SJC 12/00