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RELIED <br /> +° California Hazardousta(crials Inventory Form O (!t callM� scriptiuu <br /> (1) I ADD [::]DELETE ❑REVISE 2001 �")'41GE(2) MOF(3)� <br /> SANJUAUUII�' JAFRAU <br /> BUSINESS NAME (4) CEIVED <br /> I �vuekly <br /> CHEMICAL LOCATIONS)(5) FEB 12001 <br /> <br /> <br /> <br /> MAP#(6)/ GRID#(7) FHCEOFEMERGEN ERV]CEb <br /> CHEMICAL NAME (8) ']'RADE SECRET(1 1) ❑Y ©N <br /> COMMON NAME (9) j� *EHS(12) ❑—Y —Q N <br /> aJfeSe�� <br /> *IP EITS BOX Is "Y" <br /> CAS # (10) Ou 8 y7 t _ ALL AMOUNTS MUSTBE IN LBS <br /> FIRE CODE (I3) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURENMIXTURE ❑WASTE RADIOACTIVE(15) ❑Y �N (16)� <br /> PHYSICALSTATE(17) [:]SOLID [2g]-IOUID ❑GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) FIRE ❑REACTIVE ❑PRFSSURERELEASE ❑ ACU'I ,iimu 1 ❑ CHRONIC HF.A1, if <br /> STATE WAS'T'E (19)� UNITS* (22) ®CAL ❑CU FT MAX DAILY AMT(23) <br /> CODE � <br /> ON-SITE /U v <br /> ❑LBS ❑"TONS <br /> DAYS ON SITE (20) AVG DAILY AMT'(24) <br /> *If EHS, amounts must be in lbs ON-SI'Z'E 5 ©0 <br /> LARGEST (21) ANNUAL WASTE AMT(25) <br /> CONTAINER �D <br /> STORAGE (26) ABOVEGROUNDTANK ❑ 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)1—Fit AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)[[AAMBIEN"1' ❑ABOVE AMBIENT [:]BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> (29)%WT (30) HAZARDOUS COMPONENT (31 EHS (32)CAS# <br /> ❑Y ❑ N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> _ ❑Y ❑N <br /> C—A ❑Y ❑N <br /> ADDITIONAL LOCALLY COLLECTED INFORMA'T'ION: (33)UNITED NA'T'IONS ID#(DOT)[T I q q Jj <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: R C R L-_� S SJC 12/00 <br />