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California Hazardou aterials Inventory Form - Chen# Description <br /> (l) E]ADD DELETE REVISE 2002 PAGE(2) = OF(3)� <br /> BUSINESS NAME (4) <br /> C .t/ Af <br /> CHEMICAL LOCATION(S)(5) <br /> <br /> MAP#(6) / GRID#(7) <br /> CHEMICAL NAME (8) { E SECT(11) I ❑Y <br /> ❑Y N <br /> COMMON NAME (9) *EHS (12)� <br /> *IF EHS BOX IS"Y" <br /> CAS # (10) l �jS y>7 ALL AMOUNTS MUST BE IN LBS <br /> FIRE CODE (13) LEAVE BLANK <br /> HAZARD CLASS <br /> TYPE (14) PURE ❑MIXTURE [-]WASTERADIOACTIVE(15) ❑Y (16) <br /> PHYSICAL STATE(17) ❑SOLID ❑LIQUID GAS CURIES <br /> FED HAZARD ❑FIRE ❑REACTIVE ❑PRESSURE RELEASE A HEALTH [-] CHRONIC HEALTH <br /> CATEGORIES (18) <br /> STATE WASTE (19)D UNITS*(22)ELBS <br /> GAL CU FT MAX DAILY AMT(23) 1 <br /> CODE ON-SITE <br /> TON <br /> ❑ S <br /> DAYS ON SITE (20) AVG DAILY AMT(24) <br /> E <br /> *If EHS, amounts must be in lbs ON-SITE <br /> LARGEST (21 ANNUAL WASTE AMT(25)D <br /> CONTAINER <br /> STORAGE (26) ❑ABOVE GROUND TANK AN ❑ 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) ❑ AMBIENT VE AMBIENT ❑BELOW AMBIENT <br /> PRESSURE <br /> STORAGE (28) AMBIENT ❑ABOVEAMBIENT ❑BELOWAMBIENT ❑CRYOGENIC <br /> TEMPERATURE <br /> 29 %WT 30 HAZARDOUS COMPONENT 31 EHS 32 CAS# <br /> —� ❑Y ❑N <br /> ❑Y ❑N <br /> ❑Y ❑N I — <br /> ❑Y ❑N <br /> ❑Y ❑N <br /> ADDITIONAL LOCALLY C TED INFORMATION: (33)UNTIED NATIONS ID#(DOT) <br /> (34)WHAT IS MATERI <br /> USED FOR? <br /> For Official Use Only: ❑ C R S SJC 12/01 <br />