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REQEJVED <br /> California Hazardousitalerials Inventory Form - CI e c'}(n I D7�j�•I tion <br /> ()) ADD ❑DELET'E ❑REVISE 2001 �� 15P (2) I:i:l � <br /> MJUAUUIN JUUhIIy S <br /> BUSINESS NAME (4) t-� <br /> RECEIVED <br /> CHEMICAL LOCATION(S)(5) FEB .21 'ZU <br /> MAP#(6)/ GRID#(7) ' OFFICOFEME G NCYSE&ICES <br /> CHEMICAL NAME (8) i I r h ]'RADE SECRET'(I 1) Fl-:1Y ®N <br /> Mjo-COMMON NAME (9) �Y *EHS (12) ❑Y N <br /> *IF EHS BOX IS "Y" <br /> CAS # (Ill) ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) ❑PURE MIXTURE ❑WAS"PE RADIOACTIVE 05) ❑Y �N (16)l <br /> PHYSICAL STATE(17) ❑SOLIDLIQUID []GAS CURIES <br /> FED HAZARD <br /> CATEGORIES (,tt) TIRE [:]REACTIVE ❑PRESSURERELEASE F] ACLlIEHEAI:I'll [JOIRONICHE.A1,111 <br /> STATE WASTE (19) UNPI'S* (22) ®CAL ❑CUF"1' MAXDAILYAMT(23)� <br /> CODE ON-SITE <br /> DAYS <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> loS *If EHS, amounts must be in Ibs ON-SITE v <br /> LARGEST - ANNUALWAST'EAMT(25) <br /> CONTAINER � <br /> � "l� I J <br /> STORAGE (26) ❑ABOVF GROUND TANK ❑ CAN ❑ BOX ❑T'ANK 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) PAAMBIENT [:]ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28)r®AMBIENT ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑CRYOGENIC <br /> TEMPERATURE L <br /> (29)%WT (30)HAZARDOUS COMPONENT 31 HS N �AS#_ <br /> ❑Y ❑N t <br /> [:] Y [:]NJ <br /> ❑Y ❑N <br /> ❑Y ❑ N <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (**)?UNITED NATIONS ID#(DOT) g� 1a1Als <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: C El SIC 12100 <br />