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California Hazardous Materials Inventory Form - Chemical Description <br /> (q ADD DELETE OREVISE <br /> 2001 PAGE(2) OF(3) <br /> BUSINESS NAME 4) C o � <br /> CHEMICAL LOCATION( (5) NJ <br /> MAP#(6)/ GRIPI It(7) NERORWYWRVI <br /> "ES <br /> CHEMICAL NAME (8) x TRADE SECRET(11) ❑Y ®N <br /> o � �� <br /> *EHS(12) ❑Y 21N <br /> COMMON NAME (9) <br /> *IF EHS BOX IS "Y" <br /> CAS # (10) _ ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVEBLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE ❑WASTE RADIOACTIVE(15) ❑Y 1 N (16) <br /> PHYSICAL STATE(17)[E]SOLID [:]LIQUID ®LAS r� CURIES <br /> FED HAZARD <br /> CATEGORIES (18) ❑FIRE ❑REACTIVE [:PRESSURE RELEASE ACUTE HEALTH [:] CHRONIC HEALTH <br /> STATE WASTE (19) UNITS* (22)F]LBS <br /> GAL CRCU FT MAX DAILY AMT(23) g 2 <br /> CODE ON-SITE <br /> [:] TONS <br /> DAYS ON SITE (20) AVG 'AMT(24) <br /> *If EHS, amounts must be in Ibs ON-SITE <br /> LARGEST (21 c ANNUAL WASTE AMT(25) <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK ❑ CAN ❑ BOX ❑TANK WAGON <br /> CONTAINER ❑UNDER GROUND TANK ❑CARBOY Dq 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 1)EHS (32)CAS# <br /> ❑Y ❑N <br /> i ❑Y ❑N <br /> I ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y E]N] <br /> ADDITIONAL LOCALLY COLLECTED INFORMATION: (33)UNITED NATIONS ID#(DOT) d 7 Z <br /> (34)WHAT IS MATERIAL <br /> USED FOR? <br /> For Official Use Only: C [] R EJ S SJC 12/00 <br />