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California Hazardous Materials Inventory Form Chemical Description <br /> (1) 2001 PAGE(2) OF(3) <br /> ❑ADD ❑DELETE ❑REVISE <br /> BUSINESS NAME (4) <br /> CHEMICAL LOCATION(S)(5) `� /'� / <br /> MAP#(6)/ GRID#(7) � JUAUUINGUUNIY CES <br /> CHEMICAL NAME (8) TRADE SECRET(11) ❑Y DR N <br /> *EHS(12) ❑Y N <br /> COMMON NAME (9) <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) I / � p vZ— ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y I�N (16)F <br /> PHYSICAL STATE(17)1 ❑SOLID ❑LIQUID ROAS CURIES <br /> FED HAZARD <br /> CATEGORIES (18) N FIRE ❑REACTIVE JK PRESSURE RELEASE KACLrFEHEALTH ❑ CHRONIC HEALTH <br /> STATE WASTE (19)= UNITS*(22) []GAL MCUFT MAX DAILY AMT(23) <br /> CODEON-SITE � <br /> ❑LBS ❑ TONS <br /> DAYS ON SITE (20) �/ AVG DAILY AMT(24)� <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25)= <br /> CONTAINER D <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 /> ❑PLASTICINONMETALLIC DRUM ❑ BAG ❑ TOTE BIN <br /> STORAGE (27) ❑ AMBIENT ABOVE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) NAMBIENf ❑ABOVE AMBIENT ❑BELOW AMBIENT ❑ CRYOGENIC <br /> TEMPERATURE <br /> 29)%WT (30)HAZARDOUS COMPONENT (31)EHS (32)CAS# <br /> 11 ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y NIF <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERIAL ✓G — d <br /> USED FOR? <br /> For ficial Use Only: C RE] S SIC 12/1111 <br />